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At least 19 recordsLinked to original sources
PubMed1979

Implications of alternative sampling strategies for emergency medical service evaluation.

Evaluations of emergency medical service (EMS) programs have been ambiguous, due in part, to problems of sample definition. Four different sampling strategies were studied: 1) all patients in cardiac arrest; 2) patients with a final diagnosis of myocardial infarction (MI); 3) patients with an emergency room diagnosis of "rule out MI"; and 4) patients identified by the ambulance team as a possible MI. Using a regional data base of all ambulance runs, we created study samples based on each of these strategies and measured the error that may be introduced as a result of sample selection. Bias was measured along three parameters of EMS system performance: 1) observed incidence of MI in the ambulance system; 2) condition recognition--the ability of the ambulance team to correctly identify acute cardiac patients; and 3) emergency room and hospital mortality rates. The emergency room diagnosis strategy systematically excludes all false-positives, while samples based on the ambulance team's assessment omit all false-negatives. The final diagnosis strategy yields significant underestimates of cardiac mortality. Samples restricted to cardiac arrests result in biased estimates of both the incidence of MI and the number of deaths.

Ambulances↗
PubMed1979

Emergency medical service: delays, response time and survival.

A major concern in emergency medical services (EMS) planning has been the need to minimize ambulance response time, only one of several delays in reaching definitive care. Other important delays include patient delay in seeking medical care and dispatch delay. In this study, the importance of response time in light of other delays is discussed, and response time as one determinant of patient survival is analyzed, using Seattle's EMS system as a case study. The major conclusion is that paramedic response times influence short-term patient survival.

Ambulances↗
PubMed1978

A quality of care evaluation measure for emergency medical service systems.

This paper presents the development and validation of an emergency medical service (EMS) systems quality of care evaluation measure. The System Input Severity Measure consists of a set of single and multiple injury survival rates that would be expected to occur in an EMS system classified as providing "baseline" advanced life support services. These expected survival rates were developed by a nationwide panel of emergency medicine experts through the use of the Delphi group opinion surveying technique. Validation of the System Input Severity Measure was a twofold process. First, reliability of the results of the Delphi surveying process was validated by comparing the resultant expected survival rates with Illinois Trauma Registry data. Second, the applicability of the measure was validated using data collected in EMS systems generally recognized to be providing exceptional (either superior or inferior) emergency patient care. It was recognized that the development of a comprehensive, large-scale System Input Severity Measure through the use of the Delphi technique alone is impractical. Consequently, a functional relationship between single and multiple injury survival rates was also developed. It appeared that when employed in conjunction with data developed from the Delphi technique, such an approach would make practicable the development of a comprehensive System Input Severity Measure.

Delphi Technique↗
PubMed1979

Statistical models of the demand for emergency medical services in an urban area.

First- and second-order statistical regression models are presented for the Emergency Medical Services (EMS) demand in an urban area as it relates to various socioeconomic, demographic, and other characteristics of the area. Individual models are formulated for different types of medical emergencies with the city of Atlanta, GA, serving as the data base. These models are generally shown to provide excellent fits to the empirical data.

Emergency Medical Services↗