Why and when citizens call for emergency help: an observational study of 211,193 medical emergency calls.

Background: A medical emergency call is citizens' access to pre-hospital emergency care and ambulance services. Emergency medical dispatchers are gatekeepers to provision of pre-hospital resources and possibly hospital admissions. We explored causes for access, emergency priority levels, and temporal variation within seasons, weekdays, and time of day for emergency calls to the emergency medical dispatch center in Copenhagen in a two-year study period (December 1(st), 2011 to November 30(th), 2013).

Dynamic ambulance reallocation for the reduction of ambulance response times using system status management.

Objectives: Dynamically reassigning ambulance deployment locations throughout a day to balance ambulance availability and demands can be effective in reducing response times. The objectives of this study were to model dynamic ambulance allocation plans in Singapore based on the system status management (SSM) strategy and to evaluate the dynamic deployment plans using a discrete event simulation (DES) model.

Methods: The geographical information system-based analysis and mathematical programming were used to develop the dynamic ambulance deployment plans for SSM based on ambulance calls data from January 1, 2011, to June 30, 2011.

Can emergency medical services use turnaround time as a proxy for measuring ambulance offload time?

Background: "Offload delay" occurs when the transfer of care from paramedics to the emergency department (ED) is prolonged. Accurately measuring the delivery interval or "offload" is important, because it represents the time patients are waiting for definitive care. Because recording this interval presents a significant challenge, most emergency medical services systems only measure the complete at-hospital time or "turnaround interval," and most offload delay research and policy is based on this proxy.

Comparing emergency medical service systems--a project of the European Emergency Data (EED) Project.

Aim: The aim of this prospective study was the comparison of four emergency medical service (EMS) systems-emergency physician (EP) and paramedic (PM) based-and the impact of advanced live support (ALS) on patients status in preclinical care.

Methods: The EMS systems of Bonn (GER, EP), Cantabria (ESP, EP), Coventry (UK, PM) and Richmond (US, PM) were analysed in relation to quality of structure, process and performance when first diagnosis on scene was cardiac arrest (OHCA), chest pain or dyspnoea. Data were collected prospectively between 01.

Geographic-time distribution of ambulance calls in Singapore: utility of geographic information system in ambulance deployment (CARE 3).

Introduction: Pre-hospital ambulance calls are not random events, but occur in patterns and trends that are related to movement patterns of people, as well as the geographical epidemiology of the population. This study describes the geographic-time epidemiology of ambulance calls in a large urban city and conducts a time demand analysis. This will facilitate a Systems Status Plan for the deployment of ambulances based on the most cost effective deployment strategy.

Using demand analysis and system status management for predicting ED attendances and rostering.

Introduction: It has been observed that emergency department (ED) attendances are not random events but rather have definite time patterns and trends that can be observed historically.

Objectives: To describe the time demand patterns at the ED and apply systems status management to tailor ED manpower demand.

Methods: Observational study of all patients presenting to the ED at the Singapore General Hospital during a 3-year period was conducted.

An observational, prospective study exploring the use of heart rate variability as a predictor of clinical outcomes in pre-hospital ambulance patients.

Objective: To explore the use of pre-hospital heart rate variability (HRV) as a predictor of clinical outcomes such as hospital admission, intensive care unit (ICU) admission and mortality. We also implemented an automated pre-analysis signal processing algorithm and multiple principal component analysis (PCA) for outcomes.

Materials And Methods: We conducted a prospective observational clinical study at an emergency medical services (EMS) system in a medium sized urban setting in the United States.

An observational study describing the geographic-time distribution of cardiac arrests in Singapore: what is the utility of geographic information systems for planning public access defibrillation? (PADS Phase I).

Introduction: Public access defibrillation (PAD) has shown potential to increase cardiac arrest survival rates.

Objectives: To describe the geographic epidemiology of prehospital cardiac arrest in Singapore using geographic information systems (GIS) technology and assess the potential for deployment of a PAD program.

Methods: We conducted an observational prospective study looking at the geographic location of pre-hospital cardiac arrests in Singapore.

Use of an automated, load-distributing band chest compression device for out-of-hospital cardiac arrest resuscitation.

Context: Only 1% to 8% of adults with out-of-hospital cardiac arrest survive to hospital discharge.

Objective: To compare resuscitation outcomes before and after an urban emergency medical services (EMS) system switched from manual cardiopulmonary resuscitation (CPR) to load-distributing band (LDB) CPR.

Design, Setting, And Patients: A phased, observational cohort evaluation with intention-to-treat analysis of 783 adults with out-of-hospital, nontraumatic cardiac arrest.

European Emergency Data Project (EED Project): EMS data-based health surveillance system.

Emergency Medical Services (EMS) constitute a unique component of health care at the interface between primary and hospital care. EMS data within the pre-hospital setting represents an unparalleled source of epidemiological and health care information that have so far been neglected for public health monitoring. The European Emergency Data Project (EED Project) thus intends to identify common indicators for European EMS systems and to evaluate their suitability for integration into a comprehensive public health monitoring strategy.

Current issues in cardiopulmonary resuscitation.

Current Advanced Cardiac Life Support (ACLS) guidelines and emergency medical services (EMS) clinical protocols usually recommend immediate defibrillation for victims of out-of-hospital cardiac arrest who have ventricular fibrillation (VF). However, animal studies and results from a small number of clinical investigations now suggest that a short period of chest compressions or ACLS procedures delivered before defibrillation may improve the outcome of patients with prolonged VF. Although the basic science and clinical data supporting a chest-compression-first procedure are compelling, large, multicenter randomized trials are still necessary to determine whether such protocols do indeed improve outcome.

Performance measurements in emergency medical services.

With the strong encouragement of leading health care agencies, business principles are being implemented throughout health care, including emergency medical services (EMS). The reason is simple--quality of care can be enhanced by incorporating the management concepts of continuous quality improvement (CQI). The CQI process couples carefully identified, measurable performance indicators with information systems to monitor, analyze, and trend data.

Reimbursement in emergency medical services: how to adapt in a changing environment.

The proposed Medicare fee schedule for medically necessary ambulance transportation will have a profound impact on emergency medical services (EMS) systems throughout the country. When the new Medicare rules are implemented, reimbursement for Medicare patients will be largely based on national relative value units that vary depending on the level of service provided, from basic life support to advanced life support emergency. Under the new fee schedule, nearly all EMS systems will lose money when compared with the actual cost of providing the service, particularly advanced life support services, rural services, efficient systems, and those that bill for services.

Synchronization of Timepieces to the Atomic Clock in an Urban Emergency Medical Services System.

Study Objective: Erroneous time documentation of emergency treatment caused by the variation in the accuracy of timepieces has profound medical, medicolegal, and research consequences. The purpose of this study was to confirm the variation of critical timepiece settings in an urban emergency care system noted in previous studies and to implement and monitor the results of a prospective program to improve time synchronization.

Methods: Timepieces (n=393) used by firefighters, paramedics, and emergency physicians and nurses were randomly sampled immediately before and at two time intervals (1 and 4 months) after attempted synchronization to the US atomic clock standard.