To send content items to your account,
please 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 account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
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.
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.
Matthias Fischer, Department of Anaesthesiology and Intensive Care Medicine, Klinik am Eichert, Göppingen, Germany,
Thomas Krafft, Ludwig-Maximilians-Universität München, Germany,
Luis García-Castrillo Riesgo, Universidad de Cantabria, Hospital Universitario Marqués de Valdecilla, Santander, Spain,
Freddy Lippert, Copenhagen Hospital Corporation, Copenhagen University Hospital, Denmark,
Jerry Overton, Richmond Ambulance Authority, Richmond, Virginia, USA,
Iain Robertson-Steel, West Midlands Ambulance Service NHS Trust, Dudley, W. Midlands, UK
Emergency Medical Services (EMS) constitute a unique component of health care in the prehospital setting. Prehospital EMS systems are commonly understood as the resources used for planning and providing medical care for patients who experience an unpredicted need for emergency or urgent medical care outside a hospital. The EMS system 's primary role is to provide care for patients whose lives are at immediate or imminent risk. In the beginning of organized prehospital care, most emergencies were of traumatic origin but in the last decades this has changed to include medical problems. In 2002 at the conference of the European Resuscitation Council in Florence the First Hour Quintet (FHQ) was defined, a set of five major medical problems of prehospital care on which EMS can have a significant impact on the outcome; these are:
out-of-hospital cardiac arrest (OHCA)
severe respiratory difficulties
chest pain, including acute coronary syndrome
Together these conditions areamongthe four leading causes of death in the European Union (EU). Cardiovascular problems, cancer, externalcauses,andrespiratorydiseases represent the top four leading causes of death and morbidity: 80% of all deaths are attributable to these common causes. Cardiovascular disease (CVD) is the number one cause of death in all EU countries, resulting in 4 million deaths per year inEuropeor 1.5 million in theEU,respectively.CVDalso accounts for the largest amount of years of life lost by early death in Europe and in the European Union, contributing significantly to the escalating costs of health care. Coronary HeartDisease (CHD) is the most important cause of death in the adult population, comprising 55% of all CVD deaths.
In a single-tier, advanced-life-support (ALS) emergency medical service (EMS) system, ALS-trained staff in ALS-equipped vehicles respond to all ambulance calls. In some two-tier systems, basic life support (BLS) vehicles respond to calls which are determined initially to be non-emergency based on dispatcher triage. I emergency requiring ALS is discovered (or recognized) by BLS personnel, then a subsequent ALS response can be requested.
The purpose of this study was to determine the frequency of ALS care provided on ambulance calls initially dispatched as non-emergency.
A single-tier, all-ALS provider, EMS system, serving an urban population of 475,000 with an annual response volume of 45,000 calls.
A retrospective review of all prehospital transports initially dispatched as non-emergency from 1 January 1989 to 1 January 1990 that resulted in an ALS intervention being performed was conducted. An ALS intervention was defined as, “administration of a medication, endotracheal intubation, attempted IV insertion, and/or ECG monitoring.”
A total of 6,362 non-emergency calls were identified; of these 309 (5%) were upgraded to emergency while the responding unit was in route. Of 6,053 non-emergency calls remaining, 710 (11.7%) involved the provision of one or more ALS interventions. Of these, 296 (42%) received an IV, 24 (3%) a medication, and three (0.4%) were intubated. Calls that were upgraded by dispatchers required one or more interventions in 144/309 calls (46.6%). This was statistically significantly different than for the non-upgraded calls.
Despite the use of strict dispatching protocols, 11.7% of patients prioritized as non-emergent unexpectedly received ALS care after evaluation by ALS personnel. These results add support for the use of a single-tier, ALS ambulance system.
Email your librarian or administrator to recommend adding this to your organisation's collection.