Top

European Journal of Trauma and Emergency Surgery

Published in:

01-02-2011 | Original Article

Prehospital triage, discrepancy in priority-setting between emergency medical dispatch centre and ambulance crews

Authors: A. Khorram-Manesh, K. Lennquist Montán, A. Hedelin, M. Kihlgren, P. Örtenwall

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2011

Abstract

Background

The timely provision of emergency medical services might be influenced by discrepancies in triage-setting between emergency medical dispatch centre and ambulance crews (ACR) on the scene resulting in overloaded emergency departments (ED) and ambulance activities. The aim of this study was to identify such discrepancies by reviewing ambulance transports within a metropolitan city in the western region of Sweden.

Methods

All data regarding ambulance transports in Gothenburg, Sweden, during a 6-month period were obtained and analyzed by reviewing the available registry.

Results

There was a discrepancy between emergency medical dispatch centre and ACR in priority setting, which may result in a number of unnecessary transports to the hospital with consequent overloading of ED and a negative impact on ambulance availability.

Conclusion

Appropriate ambulance use is one important part of emergency preparedness. Overuse results in decreased emergency medical services (EMS) availability and ED-overcrowding. Several factors, such as an imprecise triage system and increased public demands, may influence such overutilization. Improving the triage system and comprehensive public education on appropriate use of ambulances are two important steps toward a better use of national EMS resources.

Khorram-Manesh A, Hedelin A, Örtenwall P. Hospital-related incidents; causes and its impact on disaster preparedness and prehospital organizations. Scand J Trauma Resusc Emerg Med. 2009;17:26.CrossRefPubMed

Cherry RA, Trainer M. The current crisis in emergency care and the impact on disaster preparedness. BMC Emerg Med. 2008;8:1–7.CrossRef

Marinovich A, Afilao J, Afilalo M, Colacone A, Unger B, Giguére C, Léger R, Xue X, Boivin JF, McNamara E. Impact of ambulance transportation on resource use in the emergency department. Acad Emerg Med. 2004;11:312–5.CrossRefPubMed

Brokaw J, Olson L, Fullerton L, et al. Repeated ambulance use by patients with acute alcohol intoxication, seizure disorder, and respiratory illness. Am J Emerg Med. 1998;16:141–4.CrossRefPubMed

Camasso-Richardson K, Wilde JA, Petrack EM. Medically unnecessary pediatric ambulance transport: a medical taxi service? Acad Emerg Med. 1997;4:1137–41.CrossRefPubMed

Billittier AJ, Moscati R, Janicke D, et al. A multisite survey of factors contributing to medically unnecessary ambulance transport. Acad Emerg Med. 1996;3:1046–52.CrossRefPubMed

Strange GR, Chen EH, Sanders AB. Use of emergency departments by elderly patients: projections from a multicenter data base. Ann Emerg Med. 1992;21:819–24.CrossRefPubMed

Ruger JP, Richter CJ, Lewis LM. Clinical and economic factors associated with ambulance use to the emergency department. Acad Emerg Med. 2006;13:879–85.CrossRefPubMed

Richards JR, Ferrall SJ. Inappropriate use of emergency medical services transport: comparison of provider and patient perspectives. Acad Emerg Med. 1999;6:14–20.CrossRefPubMed

10.

Hjälte L, Suserud BO, Herlitz J, Karlberg I. Initial emergency medical dispatching and prehospital needs assessment: a prospective study of the Swedish ambulance service. Eur J Emerg Med. 2007;14:134–41.CrossRefPubMed

11.

Hjälte L, Suserud BO, Herlitz J, Karlberg I. Why are people without medical needs transported by ambulance? A study of indications for prehospital care. Eur J Emerg Med. 2007;14:151–6.CrossRefPubMed

12.

Ambulink. http://www.zait.se.

13.

Cooke MW, Morrell R, Wilson S, Bridge P, Edwards S, Allan TF, Holder RL. Does criteria based dispatch of 999 calls adequately detects the critically ill and injured? Prehosp Immed Care. 1999;3:191–5.CrossRef

14.

Hinchey P, Myers B, Zalkin J, Lewis R, Garner D. Low acuity EMS dispatch criteria can reliably identify patients without high-acuity illness or injury. Prehosp Emerg Care. 2007;11:42–8.CrossRefPubMed

15.

Widgren B, Jourak M. Medical emergancy triage and treatment system (METTS): a new protocol in primary triage and secondary priority decision in emergency medicine. J Emerg Med. 2008 [Epub ahead of print].

16.

Clawson J, Olola CHO, Heward A, Scott G, Patterson B. Accuracy of emergency medical dispatchers’ subjective ability to identify when higher dispatch levels re warranted over a medical priority dispatch system automated protocol’s recommended coding based on paramedic outcome data. Emerg Med J. 2007;24:560–3.CrossRefPubMed

17.

O′cathain A, Webber E, Nicholl J, Munro J, Knowles E. NHS direct: consistency of triage outcomes. Emerg Med J. 2003;20:289–92.CrossRefPubMed

18.

Guidelines for Field Triage of Injured Patients. Recommendations of the National Expert Panel on Field Triage. Morbidity and Mortality Weekly Report 2009; 58: RR-1. (http://www.cdc.gov/mmwr).

19.

Squires JP, Mason S. Developing alternative ambulance response schemes: analysis of attitudes, barriers, and change. Emerg Med J. 2004;21:724–7.CrossRefPubMed

20.

Gray JT, Wardrope J. Introduction of non-transport guidelines into an ambulance service: a retrospective review. Emerg Med J. 2007;24:727–9.CrossRefPubMed

21.

Snooks HA, Dale J, Hartley-Sharpe C, Halter M. On-scene alternatives for emergency ambulance crews attending patients who do not need to travel to the accident and emergency department: a review of the literature. Emerg Med J. 2004;21:212–5.CrossRefPubMed

22.

Kawakami C, Ohshige K, Kubota K, Tochikubo O. Influence of socioeconomic factors on medically unnecessary ambulance calls. BMC Health Serv Res. 2007;7:120.CrossRefPubMed

23.

Yarris LM, Moreno R, Schmidt TA, Adams AL, Brooks HS. Reasons why patients choose an ambulance and willingness to consider alternatives. Acad Emerg Med. 2006;13:401–5.CrossRefPubMed

24.

Ohshige K. Reduction in ambulance transports during a public awareness campaign for appropriate ambulance use. Acad Emerg Med. 2008;15:289–93.CrossRefPubMed

25.

Ramanujam P, Guluma KZ, Castillo EM, Chacon M, Jensen MB, Patel E, Linnick W, Dunford JV. Accuracy of stroke recognition by emergency medical dispatchers and paramedics—San Diego experience. Prehosp Emerg Care. 2008;12:307–13.CrossRefPubMed

26.

Kindberg K, Nielsen SL, Møller AM. Physician-based prehospital units in Denmark. Ugeskr Laeger. 2009;171:2553–7.PubMed

27.

Ringburg AN, Frissen IN, Spanjersberg WR, Jel G, Frankema SP, Schipper IB. Physician-staffed HEMS dispatch in the Netherlands: adequate deployment or minimal utilization? Air Med J. 2005;24:248–51.CrossRefPubMed

Title: Prehospital triage, discrepancy in priority-setting between emergency medical dispatch centre and ambulance crews
Authors: A. Khorram-Manesh
K. Lennquist Montán
A. Hedelin
M. Kihlgren
P. Örtenwall
Publication date: 01-02-2011
Publisher: Springer-Verlag
Published in: European Journal of Trauma and Emergency Surgery / Issue 1/2011
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-010-0022-0

At a glance: The STEP trials

Springer Medicine

Prehospital triage, discrepancy in priority-setting between emergency medical dispatch centre and ambulance crews

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2011

Traumatic limb amputations at a level I trauma center

Pattern of civilian gunshot wounds in Durban, South Africa

Radial head arthroplasty with an uncemented modular metallic radial head prosthesis: short- and mid-term results

Evaluation of admissions to the Major Incident Hospital based on a standardized protocol

Functional outcome and quality of life in victims of terrorist explosions as compared to conventional trauma

Introduction to the third “Focus-on” issue specially devoted to papers within the field of the ESTES section for Disaster and Military Surgery