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System Implications of the Ambulance Arrival-to-Patient Contact Interval on Response Interval Compliance

Published online by Cambridge University Press:  28 June 2012

Jack P. Campbell ,
Matthew C. Gratton ,
Joseph A. Salomone III ,
Daniel J. Lindholm  and
William A. Watson
Jack P. Campbell*
Affiliation:
Department of Emergency Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Mo. Emergency Medical Services, Health Department, Kansas City, Mo.
Matthew C. Gratton
Affiliation:
Department of Emergency Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Mo.
Joseph A. Salomone III
Affiliation:
Department of Emergency Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Mo.
Daniel J. Lindholm
Affiliation:
Emergency Medical Services, Health Department, Kansas City, Mo.
William A. Watson
Affiliation:
Department of Emergency Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Mo. Department of Pharmacy Practice, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Mo.
*
Department of Emergency Medicine, Truman Medical Center, 2301 Holmes Street, Kansas City, MO 64108, USA
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Abstract

Background:

Background: In some emergency medical services (EMS) system designs, response time intervals are mandated with monetary penalties for noncompliance. These times are set with the goal of providing rapid, definitive patient care. The time interval of vehicle at scene-to-patient access (VSPA) has been measured, but its effect on response time interval compliance has not been determined.

Purpose:

To determine the effect of the VSPA interval on the mandated code 1 (<9 min) and code 2 (<13 min) response time interval compliance in an urban, public-utility model system.

Methods:

A prospective, observational study used independent third-party riders to collect the VSPA interval for emergency life-threatening (code 1) and emergency nonlife-threatening (code 2) calls. The VSPA interval was added to the 9-1-1 call-to-dispatch and vehicle dispatch-to-scene intervals to determine the total time interval from call received until paramedic access to the patient (9-1-1 call-to-patient access). Compliance with the man dated response time intervals was determined using the traditional time intervals (9-1-1 call-to-scene) plus the VSPA time intervals (9-1-1 call-to-patient access). Chi-square was used to determine statistical significance.

Results:

Of the 216 observed calls, 198 were matched to the traditional time intervals. Sixty three were code 1, and 135 were code 2. Of the code 1 calls, 90.5% were compliant using 9-1-1 call-to-scene intervals dropping to 63.5% using 9-1-1 call-to-patient access intervals (p<0.0005). Of the code 2 calls, 94.1% were compliant using 9-1-1 call-to-scene intervals. Compliance decreased to 83.7% using 9-1-1 call-to-patient access intervals (p = 0.012).

Conclusion:

The addition of the VSPA interval to the traditional time intervals impacts system response time compliance. Using 9-1-1 call-to-scene compliance as a basis for measuring system performance underestimates the time for the delivery of definitive care. This must be considered when response time interval compliances are defined.

Keywords

definitive careemergency medical servicesHawthorne effect9-1-1 call-to-dispatch intervalresponse time interval compliancesystem performance parameterthird-party observersUtstein modelvehicle at scene-to-patient access intervalvehicle dispatch-to-scene interval
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 9 , Issue 4 , December 1994 , pp. 230 - 232
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1994

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