Does the Implementation of an Advanced Life Support Quick Response Vehicle (QRV) in an Integrated Fire/EMS System Improve Patient Contact Response Time?

2015 ◽  
Vol 30 (4) ◽  
pp. 382-384 ◽  
Author(s):  
Dustin W. Anderson ◽  
Harinder S. Dhindsa ◽  
Wen Wan ◽  
David Salot
Keyword(s):  
Response Time ◽  
Life Support ◽  
Response Times ◽  
Advanced Life Support ◽  
Quick Response ◽  
Average Response Time ◽  
Patient Response ◽  
Contact Response ◽  
Improve Patient ◽  
Call Volume

AbstractBackgroundThe current Fire/Emergency Medical Services (EMS) model throughout the United States involves emergency vehicles which respond from a primary location (ie, firehouse or municipal facility) to emergency calls. Quick response vehicles (QRVs) have been used in various Fire/EMS systems; however, their effectiveness has never been studied.ObjectivesThe goal of this study was to determine if patient response times would decrease by placing an Advanced Life Support (ALS) QRV in an integrated Fire/EMS system.MethodsResponse times from an integrated Fire/EMS system with an annual EMS call volume of 3,261 were evaluated over the three years prior to the implementation of this study. For a 2-month period, an ALS QRV staffed by a firefighter/paramedic responded to emergency calls during peak call volume hours of 8:00 am to 5:00 pm. The staging of this vehicle was based on historical call volume percentages using respective geocodes as well as system requirements during multiple emergency dispatches.ResultsPrior to the study, the citywide average response time for the twelve months preceding was 5.44 minutes. During the study, the citywide average response time decreased to 4.09 minutes, resulting in a 27.62% reduction in patient response time.ConclusionThe implementation of an ALS QRV in an integrated Fire/EMS system reduces patient response time. Having a QRV that is not staged continuously in a traditional fire station or municipal location reduces the time needed to reach patients. Also, using predictive models of historic call volume can aid Fire and EMS administrators in reduction of call response times.AndersonDW, DhindsaHS, WanW, SalotD. Does the implementation of an Advanced Life Support quick response vehicle (QRV) in an integrated Fire/EMS system improve patient contact response time?Prehosp Disaster Med. 2015;30(4):1 – 3.

Abstract TP245: Variance in Ems Run Times by Receiving Hospital for Stroke Patients in San Diego County

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Amelia Kenner-brininger ◽  
Lindsay Olson-Mack ◽  
Lorraine Calzone ◽  
Kristi L Koenig ◽  
Thomas M Hemmen
Keyword(s):  
Response Time ◽  
San Diego ◽  
Life Support ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
San Diego County ◽  
Stroke Patients ◽  
Transport Time ◽  
Stroke Registry ◽  
Few Data

Background: Emergency Medical Services (EMS) play an important role as initial providers after stroke. Few data are available that capture Stroke Receiving System and EMS response and transport data. We used a stroke registry from a community of 3.3 million residents, 18 stroke receiving centers, and 19 ground transporting advanced life support EMS agencies to evaluate EMS response time, scene time, and transport times. Our aim was to inform the stroke community about duration of EMS care and guide future prehospital interventions. Methods: We included all cases from the San Diego County Stroke Registry arriving by EMS with associated computer automated dispatch (CAD) record and base hospital record (BHR) from July 2017 through December 2018. Records were linked on the EMS incident number, reviewed for accuracy. We analyzed EMS response, scene, transport and total run times (enroute to arrival) by receiving hospital. Results: Between July 2017 and December 2018 2,376 EMS patients were transported to 18 hospitals. Volume per hospital ranged from 11 to 483 patients over the study period. Mean (±SD) response time was 7.0 (±3.7) minutes, range: 5.3 to 9.3 minutes between hospitals. Mean (±SD) scene time was 13.1 (±5.2) minutes, range: 10.5 to 15.0 minutes between hospitals. Transport time averaged 13.8 (±7.7) minutes, range: 8.3 to 23.8 minutes between hospitals (IQR=8.5-17.9). The mean (±SD) total EMS run time was 33.8 (±10.8) minutes, range: 26.4 to 44.9 minutes between hospitals (IQR=26.4-39.9). Conclusion: Only minor variations in EMS response and scene times were observed across the Stroke Receiving Centers. However, transport time showed greater variation and contributed to the differences in total EMS run times. Many systems had short transport times, limiting prehospital interventions. Next steps include studying factors contributing to transport time variation to inform prehospital care and triage decisions of possible stroke patients to optimize transport times.

scholarly journals The influence of advanced life support response time on patient outcomes after out-of-hospital cardiac arrest in Taipei

Resuscitation ◽  
2019 ◽  
Vol 142 ◽  
pp. e101
Author(s):  
Ying-Chih Ko ◽  
Jen-Tang Sun ◽  
Wen-Chu Chiang ◽  
Yu-Chun Chien ◽  
Yao-Cheng Wang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Response Time ◽  
Patient Outcomes ◽  
Life Support ◽  
Advanced Life Support ◽  
Hospital Cardiac Arrest

scholarly journals Effect of the Floor Level on the Probability of a Neurologically Favorable Discharge after Cardiac Arrest according to the Event Location

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Han Joo Choi ◽  
Hyung Jun Moon ◽  
Won Jung Jeong ◽  
Gi Woon Kim ◽  
Jae Hyug Woo ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Response Times ◽  
Advanced Life Support ◽  
Public Place ◽  
Public Places ◽  
Floor Level ◽  
High Rise ◽  
Event Location ◽  
At Home

As the number of people living in high-rise buildings increases, so does the incidence of cardiac arrest in these locations. Changes in cardiac arrest location affect the recognition of patients and emergency medical service (EMS) activation and response. This study aimed to compare the EMS response times and probability of a neurologically favorable discharge among patients who suffered an out-of-hospital cardiac arrest (OHCA) event while on a high or low floor at home or in a public place. This retrospective analysis was based on Smart Advanced Life Support registry data from January 2016 to December 2017. We included patients older than 18 years who suffered an OHCA due to medical causes. A high floor was defined as ≥3rd floor above ground. We compared the probability of a neurologically favorable discharge according to floor level and location (home vs. public place) of the OHCA event. Of the 6,335 included OHCA cases, 4,154 (65.6%) events occurred in homes. Rapid call-to-scene times were reported for high-floor events in both homes and public places. A longer call-to-patient time was observed for home events. The probability of a neurologically favorable discharge after a high-floor OHCA was significantly lower than that after a low-floor OHCA if the event occurred in a public place (adjusted odds ratio (aOR), 0.58; 95% confidence intervals (CI), 0.37–0.89) but was higher if the event occurred at home (aOR, 1.40; 95% CI, 0.96–2.03). Both the EMS response times to OHCA events in high-rise buildings and the probability of a neurologically favorable discharge differed between homes and public places. The results suggest that the prognosis of an OHCA patient is more likely to be affected by the building structure and use rather than the floor height.

The Efficacy of Combined Physical and Mental Practice in the Learning of a Foot-Sequence Task after Stroke: A Case Report

2004 ◽  
Vol 18 (2) ◽  
pp. 106-111 ◽  
Author(s):  
Philip L. Jackson ◽  
Julien Doyon ◽  
Carol L. Richards ◽  
Francine Malouin
Keyword(s):  
Response Time ◽  
Lower Limb ◽  
Response Times ◽  
Single Case ◽  
Mental Practice ◽  
Physical Practice ◽  
Average Response Time ◽  
Additional Improvement ◽  
Study Setting

Objective. To investigate the effect of mental practice on the learning of a sequential task for the lower limb in a patient with a hemiparesis resulting from a stroke. Design. A single-case study. Setting. Research laboratory of a university-affiliated rehabilitation center. Patient. A right-handed 38-year-old man who had suffered a left hemorrhagic subcortical stroke 4 months prior. Intervention. The patient practiced a serial response time task with the lower limb in 3 distinct training phases over a period of 5 weeks: 2 weeks of physical practice, 1 week of combined physical and mental practice, and then 2 weeks of mental practice alone. Main Outcome Measures. Performance on the task measured through errors and response times. Imagery abilities measured through questionnaires. Results . The patient’s average response time improved significantly during the 1st 5 days of physical practice (26%) but then failed to show further improvement during the following week of physical practice. The combination of mental and physical practice during the 3rd week yielded additional improvement (10.3%), whereas the following 2 weeks of mental practice resulted in a marginal increase in performance (2.2%). Conclusion. The findings show that mental practice, when combined with physical practice, can improve the performance of a sequential motor skill in people who had a stroke, and suggest that mental practice could play a role in the retention of newly acquired abilities.

Abstract 19131: The Advanced Life Support Termination of Resuscitation Rule: A Local Evaluation of the Impact on Termination Rates

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Joris Nas ◽  
Judith L Bonnes ◽  
Dominique V Verhaert ◽  
Wessel Keuper ◽  
Pierre van Grunsven ◽  
...  
Keyword(s):  
Life Support ◽  
Response Times ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Shock Delivery ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
The Impact ◽  
Termination Decisions

Introduction: Termination of Resuscitation (TOR) rules have been designed to guide in-field termination decisions and reduce futile hospital transportations. The impact of such a rule may depend on regional infrastructure, arrest characteristics and pre-existent termination rates. Our region is characterized by high rates of bystander cardiopulmonary resuscitation (CPR), and Advanced Life Support (ALS) trained rescuers authorized to make termination decisions. We aim to investigate the actual in-field termination rates and the termination rates as recommended by the ALS-TOR rule. Furthermore, we studied factors associated with the actual termination decisions. Methods: Cohort of out-of-hospital cardiac arrest patients who were resuscitated in the Nijmegen area, the Netherlands (2008-2011). The ALS-TOR rule recommends termination in case all following criteria are met: unwitnessed arrest, no bystander CPR, no shock delivery, no return of spontaneous circulation (ROSC). Results: The observed percentage of in-field termination was 46% (275/598), while the ALS-TOR rule recommended termination in only 6% (35/588), owing to high percentages of witnessed arrests (73%) and bystander CPR (54%) in our region. Factors independently associated with the actual decisions to terminate resuscitation were absence of ROSC [aOR 35.6 (95% CI 18.3-69.3)], non-shockable initial rhythm [aOR 6.0 (95% CI 3.2-11.0)], unwitnessed arrest [aOR 2.7 (95% CI 1.4-5.2)], non-public arrest [aOR 2.5 (95% CI 1.2-5.0)] and longer EMS-response times [aOR 1.1 per minute increase (95% CI 1.0-1.2)]. Conclusions: Contrary to previous studies, implementation of the ALS-TOR rule in our region would have decreased termination rates from almost half to less than 10% due to the favourable arrest characteristics. In light of the prognosis after OHCA, this finding suggests that adherence to this set of criteria does not contribute to efficient triage in our population. Therefore it seems prudent to locally evaluate the utility of the ALS-TOR rule prior to implementation.

scholarly journals Emergency Medical Service in Rural Mountain Areas in Taiwan: A Nantou Mountain Areas Based Study

2014 ◽  
Vol 21 (6) ◽  
pp. 373-381 ◽  
Author(s):  
Sc Hung ◽  
Yh Li ◽  
Mc Chen ◽  
Sw Lai ◽  
Fc Sung ◽  
...  
Keyword(s):  
Response Time ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Life Support ◽  
Advanced Life Support ◽  
Patient Characteristics ◽  
Emergency Medical Technician ◽  
Mountain Areas ◽  
Emergency Medical ◽  
The Mean

Background This study explored the emergency medical service (EMS) in rural mountain areas in Taiwan to establish the public health policies in rural mountain areas. Methods This was a retrospective study. Based on mission records available at 3 EMS branches in Ren-Ai and Sinyi townships of Nantou County, we evaluated dispatched status, patient characteristics, and pre-hospital emergency managements. Results From January to June 2011, a total of 765 EMS were dispatched from these 3 mountain branches. Each dispatched EMS team was consisted of one official emergency medical technician (EMT) with EMT II certificate (100%), and one (88.0%) or two (11.2%) volunteers as EMT I personnel. Most of missions were conducted in the daytime and peaked during 10am to 12pm. Patients were characterised with more men and elderly and predominant with non-traumatic medical complains (55.0%). Approximately 38.7% EMS patients required the advanced life support. Of these 3 mountain EMS branches, the mean response time was 15.3±16.9 minutes, the mean management time on site was 6.1±6.9 minutes and the mean transport time was 38.0±15.9 minutes. The response time and transportation time of EMS in rural mountain areas were relatively longer than that in urban towns in Taiwan. Conclusions The rural EMS is under the challenges of providing appropriate and adequate medical care. Each EMS team should be equipped with adequate emergency care facilities and well trained personnel. (Hong Kong j.emerg.med. 2014;21:373-381)

scholarly journals A Conversation History-Based Q&A Cache Mechanism for Multi-Layered Chatbot Services

2021 ◽  
Vol 11 (21) ◽  
pp. 9981
Author(s):  
Ozoda Makhkamova ◽  
Doohyun Kim
Keyword(s):  
Response Time ◽  
Binary Code ◽  
Quick Response ◽  
Average Response ◽  
Average Response Time ◽  
Knowledge Processing ◽  
High Intelligence ◽  
Amount Of Knowledge ◽  
Cache Mechanism ◽  
Cache Miss

Chatbot technologies have made our lives easier. To create a chatbot with high intelligence, a significant amount of knowledge processing is required. However, this can slow down the reaction time; hence, a mechanism to enable a quick response is needed. This paper proposes a cache mechanism to improve the response time of the chatbot service; while the cache in CPU utilizes the locality of references within binary code executions, our cache mechanism for chatbots uses the frequency and relevance information which potentially exists within the set of Q&A pairs. The proposed idea is to enable the broker in a multi-layered structure to analyze and store the keyword-wise relevance of the set of Q&A pairs from chatbots. In addition, the cache mechanism accumulates the frequency of the input questions by monitoring the conversation history. When a cache miss occurs, the broker selects a chatbot according to the frequency and relevance, and then delivers the query to the selected chatbot to obtain a response for answer. This mechanism showed a significant increase in the cache hit ratio as well as an improvement in the average response time.

scholarly journals Response Times of Motorcycle Ambulances during the COVID-19 Pandemic

2020 ◽  
Vol 8 (T1) ◽  
pp. 526-529
Author(s):  
Korakot Apiratwarakul ◽  
Kamonwon Ienghong ◽  
Vajarabhongsa Bhudhisawasdi ◽  
Dhanu Gaysonsiri ◽  
Somsak Tiamkao
Keyword(s):  
Response Time ◽  
Response Times ◽  
Operation Time ◽  
Cross Sectional Study ◽  
Average Response Time ◽  
Transport Time ◽  
Cross Sectional ◽  
Normal Period ◽  
System Data ◽  
Information Database

BACKGROUND: Motorcycles (motorlance) are often deployed as ambulances to the scene of an emergency to reduce response time. The COVID-19 pandemic has affected emergency medical services (EMS) in Thailand in many respects, and this study was conducted to examine its effect on motorlance operation time. AIM: The aim of the study was to examine motorlance operation time during the COVID-19 pandemic in comparison to normal periods. METHODS: This cross-sectional study examined all EMS motorlance operations dispatched from Srinagarind Hospital (Thailand). Data were collected from the Srinagarind Hospital EMS operation database and hospital information database system. Data from June 1, 2018, to December 31, 2019 (normal period) were compared with those from January 13 to April 21, 2020 (COVID-19). RESULTS: Eight hundred seventy-one EMS operations were examined over two periods. Mean patient age during the COVID-19 pandemic was 41.5 ± 6.2 years, and 54.6% (n = 59) were male. Average response time was 6.20 ± 1.35 min during the normal period and 3.48 ± 1.01 min during the pandemic (p = 0.021). Transport time was also significantly shorter during the latter period (2.35 vs. 5.20 min). CONCLUSIONS: Motorlance response and transport time during the COVID-19 pandemic were significantly shorter than usual.

Paramedic Skills And Medications: Practice Options Utilized By Local Advanced Life Support Medical Directors

1991 ◽  
Vol 6 (1) ◽  
pp. 29-33 ◽  
Author(s):  
Herbert G. Garrison ◽  
Nicholas H. Benson ◽  
Theodore W. Whitley ◽  
Bob W. Bailey
Keyword(s):  
Urban Areas ◽  
Life Support ◽  
Advanced Life Support ◽  
Medical Director ◽  
The State ◽  
Positive Pressure ◽  
Primary Specialty ◽  
Medical Directors ◽  
Local Advanced ◽  
Call Volume

AbstractLocal advanced life support (ALS) medical directors in North Carolina choose the skills and medications they want utilized in their jurisdiction from a list of options authorized by the State Board of Medical Examiners. We surveyed all 35 medical directors of paramedic providers in the state to determine which optional skills and medications local medical directors allow to be used and, therefore, how they tailor their prehospital practices. Information concerning the urban or rural status of the paramedic service area, annual call volume, and the specialty classification of the medical director also were obtained.All of the medical directors surveyed responded. Twenty-one (60%) of the paramedic service areas were rural and 14 (40%) urban. Twenty-three physicians (66%) listed emergency medicine as their primary specialty. Annual call volumes ranged from 580 to 33,500. Skills allowed by >80% of the medical directors include: drawing blood, insertion of esophageal and endotracheal airways, defibrillation, cardioversion, and initiation of intravenous fluids prior to hospital contact. The majority permit the administration of bretylium, dopamine, NaCl injection, sodium bicarbonate, furosemide, sublingual nitroglycerin, diazepam, diphenhydramine, and morphine. The majority do not allow the use of positive-pressure ventilators and do not allow administration of dobutamine, nifedipine, procainamide, propranolol, local procaine, isoetharine, metaproterenol, nitroglycerin paste, 10% dextrose solution, methylprednisolone, mannitol, phenytoin, meperidine, or nitrous oxide. Nitroglycerin paste and dexamethasone were significantly (p<.05) more likely to be allowed in rural than in urban areas. No differences in utilization by medical director specialty classification or call volume were detected. The results suggest that, when given a choice, local ALS medical directors select a limited prehospital practice. Further study is warranted to determine why available skill and medication options are not utilized.

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