The Canadian National EMS Research Agenda: a mixed methods consensus study.

Introduction: Research is essential for the development of evidence-based emergency medical services (EMS) systems of care. When resources are scarce and gaps in evidence are large, a national agenda may inform the growth of EMS research in Canada. This mixed methods consensus study explores current barriers and existing strengths within Canadian EMS research, provides recommendations, and suggests EMS topics for future study.

Clinical events and treatment in prehospital patients with ST-segment elevation myocardial infarction.

Background: Little is known about clinically important events and advanced care treatment that patients with ST-segment elevation myocardial infarction (STEMI) encounter in the prehospital setting.

Objectives: We sought to determine the proportion of community patients with STEMI who experienced a clinically important event or received advanced care treatment prior to arrival at a designated percutaneous coronary intervention (PCI) laboratory or emergency department (ED).

Methods: We reviewed 487 consecutive community patients with STEMI between May 2008 and June 2009.

The impact of distance on triage to trauma center care in an urban trauma system.

Background: Urban trauma systems are characterized by high population density, availability of trauma centers, and acceptable road transport times (within 30 minutes). In such systems, patients meeting field trauma triage (FTT) criteria should be transported directly to a trauma center, bypassing closer non-trauma centers.

Objective: We evaluated emergency medical services (EMS) triage practices to identify opportunities for improving care delivery.

Methodology for the development of a Canadian national EMS research agenda.

Background: Many health care disciplines use evidence-based decision making to improve patient care and system performance. While the amount and quality of emergency medical services (EMS) research in Canada has increased over the past two decades, there has not been a unified national plan to enable research, ensure efficient use of research resources, guide funding decisions and build capacity in EMS research. Other countries have used research agendas to identify barriers and opportunities in EMS research and define national research priorities.

Serial prehospital 12-lead electrocardiograms increase identification of ST-segment elevation myocardial infarction.

Background: Many prehospital protocols require acquisition of a single 12-lead electrocardiogram (ECG) when assessing a patient for ST-segment elevation myocardial infarction (STEMI). However, it is known that ECG evidence of STEMI can evolve over time.

Objectives: To determine how often the first and, if necessary, second or third prehospital ECGs identified STEMI, and the time intervals associated with acquiring these ECGs and arrival at the emergency department (ED).

The relationship between temperature and ambulance response calls for heat-related illness in Toronto, Ontario, 2005.

Background: Concern over the adverse effects of heat on human health has led to numerous studies assessing the relationship between heat and mortality. Few studies have quantified the impact of heat on morbidity, including ambulance response calls. This study describes the association between temperature and ambulance response calls for heat-related illness (HRI) in Toronto, Ontario, Canada during the summer of 2005.

Does emergency medical dispatch priority predict delphi process-derived levels of prehospital intervention?

Objective: The Medical Priority Dispatch System (MPDS) is an emergency medical dispatch system widely used to prioritize 9-1-1 calls and optimize resource allocation. This study evaluates whether the assigned priority predicts a Delphi process-derived level of prehospital intervention in each emergency medical dispatch category.

Methods: All patients given a MPDS priority in a suburban California county from 2004-2006 were included.

Evidence-based optimization of urban firefighter first response to emergency medical services 9-1-1 incidents.

Introduction: Many emergency medical services (EMS) systems dispatch nonparamedic firefighter first responders (FFRs) to selected EMS 9-1-1 calls, intending to deliver time-sensitive interventions such as defibrillation, cardiopulmonary resuscitation (CPR), and bag-mask ventilation prior to arrival of paramedics. Deciding when to send FFRs is complicated because critical cases are rare, paramedics often arrive before FFRs, and lights-and-siren responses by emergency vehicles are associated with the risk of en-route traffic collisions.

Objective: To describe a methodology allowing EMS systems to optimize their own FFR programs using local data, and reflecting local medical oversight policy and local risk-benefit opinion.

Temporal and spatial variation of heat-related illness using 911 medical dispatch data.

Background: The adverse effect of hot weather on health in urban communities is of increasing public health concern, particularly given trends in climate change.

Objectives: To demonstrate the potential public health applications of monitoring 911 medical dispatch data for heat-related illness (HRI), using historical data for the summer periods (June 1-August 31) during 2002-2005 in Toronto, Ontario, Canada.

Methods: The temporal distribution of the medical dispatch calls was described in relation to a current early warning system and emergency department data from the National Ambulatory Care Reporting System (NACRS).

Development of a surveillance case definition for heat-related illness using 911 medical dispatch data.

Objectives: The adverse effects of hot weather on public health are of increasing concern. A surveillance system using 911 medical dispatch data for the detection of heat-related illness (HRI) could provide new information on the impact of excessive heat on the population. This paper describes how we identified medical dispatch call codes, called "determinants", that could represent HRI events.

Comparison of the medical priority dispatch system to an out-of-hospital patient acuity score.

Background: Although the Medical Priority Dispatch System (MPDS) is widely used by emergency medical services (EMS) dispatchers to determine dispatch priority, there is little evidence that it reflects patient acuity. The Canadian Triage and Acuity Scale (CTAS) is a standard patient acuity scale widely used by Canadian emergency departments and EMS systems to prioritize patient care requirements.

Objectives: To determine the relationship between MPDS dispatch priority and out-of-hospital CTAS.