Skip to main content Accessibility help
×
Home

20. Circadian Variation in Paramedic-Initiated Turndowns to Basic Life Support

  • Jonathan M. Rubin (a1) and Ronald G. Pirrallo (a1)

Extract

Objectives: Paramedic-initiated turndowns-to-BLS are a high-risk area for EMS. One non-clinical factor that might affect paramedics’ decision-making is a 24-hour work schedule. We attempted to determine the presence of circadian variation in the turndown rate from ALS to BLS when paramedics work 24-hour shifts.

Methods: Retrospective analysis of all 1994 ALS patient evaluations. Encounters were classified as: ALS transport; turndown-to-BLS; patient-initiated refusal of transport; other transport; field death. Analysis of variation in turndown rate by hour of ALS dispatch was performed using logistic regression to make paired comparisons for each hour.

Results: 17,877 patients were evaluated by ALS. Of these, 10,956 (61%) were ALS transports, 6,200 (35%) were not transported by ALS, and 721 (4%) were dead. Of the 6,200 alive non-ALS transports, 4,291 (69%) were turned down to BLS, 1,748 (28%) refused transport, and 161 (3%) were transported by others. One turndown-to-BLS was excluded due to missing dispatch time; for the remaining 4,290 the overall turndown rate was 25%. The turndown rates for 15 of 24 hours did not differ significantly (p >0.01) from any other hour. The rates at the following hours differed significantly: hour 3 < 13; hour 5 < 8,9,10,13,16,22; hour 9 > 20,22; hour 10 > 22; hour 13 > 20,22; hour 16 > 20,22.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      20. Circadian Variation in Paramedic-Initiated Turndowns to Basic Life Support
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      20. Circadian Variation in Paramedic-Initiated Turndowns to Basic Life Support
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      20. Circadian Variation in Paramedic-Initiated Turndowns to Basic Life Support
      Available formats
      ×

Copyright

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed