Improving the Appropriateness of Advanced Life Support Teams’ Dispatch: A Before-After Study

Abstract Background and Importance: The dispatch of Advanced Life Support (ALS) teams in Emergency Medical Services (EMS) is still a hardly studied aspect of prehospital emergency logistics. In 2015, the dispatch algorithm of Emilia Est Emergency Operation Centre (EE-EOC) was implemented and the dispatch of ALS teams was changed from primary to secondary based on triage of dispatched vehicles for high-priority interventions when teams with Immediate Life Support (ILS) skills were dispatched. Objectives: This study aimed to evaluate the effects on the appropriateness of ALS teams’ intervention and their employment time, and to compare sensitivity and specificity of the algorithm implementation. Design: This was a retrospective before-after observational study. Settings and Participants: Primary dispatches managed by EE-EOC involving ambulances and/or ALS teams were included. Two groups were created on the basis of the years of intervention (2013-2014 versus 2017-2018). Intervention: A switch from primary to secondary dispatch of ALS teams in case of high-priority dispatches managed by ILS teams was implemented. Outcomes: Appropriateness of ALS team intervention, total task time of ALS vehicles, and sensitivity and specificity of the algorithm were reviewed. Results: The study included 242,501 emergency calls that generated 56,567 red code dispatches. The new algorithm significantly increased global sensitivity and specificity of the system in terms of recognition of potential need of ALS intervention and the specificity of primary ALS dispatch. The appropriateness of ALS intervention was significantly increased; total tasking time per day for ALS and the number of critical dispatches without ALS available were reduced. Conclusion: The revision of the dispatch criteria and the extension of the two-tiered dispatch for ALS teams significantly increased the appropriateness of ALS intervention and reduced both the global tasking time and the number of high-priority dispatches without ALS teams available.

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Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

10.20944/preprints202107.0447.v1 ◽

2021 ◽

Author(s):

Charles Payot ◽

Christophe A Fehlmann ◽

Laurent Suppan ◽

Marc Niquille ◽

Christelle Lardi ◽

...

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Advanced Life Support ◽

Multivariable Logistic Regression Model ◽

Physician Decision Making ◽

Factors Influencing ◽

Cardio Pulmonary Resuscitation ◽

Prehospital Emergency ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 01.01.2009 to 01.01.2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of "obvious death" or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardio-pulmonary resuscitation (CPR). Prognostic factors known at the time of EP's decision were included in a multivariable logistic regression model. 784 patients were included. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR=2.14, 95%CI1.43–3.20) and bystander CPR (OR=4.10, 95%CI2.28–7.39). Traumatic aetiology (OR=0.04, 95%CI0.02–0.08), age >80 years (OR=0.14, 95%CI0.09–0.24) and a Charlson comorbidity index greater than 5 (OR=0.12, 95%CI0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.

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Current Controversies in Prehospital Resuscitation of the Terminally Ill Patient

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00026522 ◽

1990 ◽

Vol 5 (1) ◽

pp. 49-57 ◽

Cited By ~ 11

Author(s):

R. Jack Ayres

Keyword(s):

Health Care ◽

Nursing Homes ◽

Health Care Providers ◽

Care Provider ◽

Life Support ◽

Terminally Ill ◽

Advanced Life Support ◽

Care Providers ◽

Emergency Health Care ◽

Prehospital Emergency

Prehospital health-care providers regularly are called upon to assist terminally ill patients in residential or institutional, non-hospital settings such as nursing homes or hospices. Among the most crucial issues regarding such patients is whether they should be resuscitated. With alarming frequency, EMS providers are encountering vigorous and sometimes violent refusals of examination, treatment, and/or transportation from the terminally ill patient, members of the patient's family, or third persons ostensibly acting on the patient's behalf. Today, the prehospital emergency health-care provider repeatedly is faced with the legal and ethical questions that surround the issue of resuscitation and advanced life support.

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Maximizing resource efficiency in rural prehospital emergency medical services through call frequency analysis

UNED Research Journal ◽

10.22458/urj.v5i2.267 ◽

2013 ◽

Vol 5 (2) ◽

pp. 297-301

Author(s):

Andrew Flynn

Keyword(s):

Emergency Medical Services ◽

Traffic Accident ◽

Life Support ◽

Advanced Life Support ◽

Time Of Day ◽

Medical Services ◽

Red Cross ◽

Emergency Medical ◽

Accident Data ◽

Prehospital Emergency

Rural prehospital emergency medical services are often lacking when compared with their urban counterparts in terms of resources and coordinated resource use: can only employ important resources, such as paramedics, during limited shifts. This project demonstrates a method for determining the most effective use of these limited resources in a rural Red Cross ambulance service in Guápiles, Costa Rica. In this community, paramedic services are only available six days a week for twelve hours. Emergency call frequency was mapped using 20 months of traffic accident data and after establishing that traffic accident frequency was statistically dependent on the time of day, polynomial models of the data were generated. The model functions were integrated and the results were tested for accuracy. Integrals were calculated, and the results were reported to the Guápiles Red Cross committee to achieve an improved service. Methods such as this can be applied to any emergency response service.KEY WORDSWorld Health Organization (WHO), Prehospital Emergency Medical Service(s) (PEMS), Traffic Accident (TA), Téchnico de Emergencias Medicas (Paramedic), Advanced Life Support (ALS)

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Moving towards the next level...

Irish Journal of Paramedicine ◽

10.32378/ijp.v3i1.93 ◽

2018 ◽

Vol 3 (1) ◽

Author(s):

Chris O'Connor

Keyword(s):

Life Support ◽

Advanced Life Support ◽

Support Service ◽

Turn Of The Century ◽

Prehospital Emergency Care ◽

Bachelor Of Science ◽

Body Of Knowledge ◽

Science Degree ◽

Prehospital Emergency ◽

Bona Fide

<p>Since the turn of the century, significant progressive changes have taken place in the provision of prehospital emergency care in Ireland. Few would have dared to imagine the scale of advancement both in terms of education and scope of practice that has taken place since the bells tolled to herald the arrival of the new millennium. Academically, paramedics in Ireland who for over 20 years have been qualified at diploma level now have the opportunity to qualify with an honours bachelor of science degree, and the possibility of progression to masters and doctoral degrees should they feel so inclined. From a clinical perspective, the Advanced Life Support service that is available nationwide today has evolved from an emergency service provided by EMTs just a few short years ago.</p><p>In order to make the step up to the next level in our development as a bona fide recognised profession, it is essential that we embark on the journey of the development of our own body of knowledge in relation to our education, our practice and our profession as a whole. This editorial will explore some issues related to this.</p>

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The need to adapt the rescue chain for out-of-hospital cardiac arrest during the COVID-19 pandemic: Experience from the Paris Fire Brigade Basic Life Support and Advanced Life Support teams

Resuscitation ◽

10.1016/j.resuscitation.2020.06.005 ◽

2020 ◽

Vol 153 ◽

pp. 56-57 ◽

Cited By ~ 3

Author(s):

Daniel Jost ◽

Clément Derkenne ◽

Romain Kedzierewicz ◽

Frédérique Briche ◽

Benoit Frattini ◽

...

Keyword(s):

Cardiac Arrest ◽

Basic Life Support ◽

Life Support ◽

Advanced Life Support ◽

Support Teams ◽

Fire Brigade ◽

Rescue Chain ◽

Hospital Cardiac Arrest

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Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18168323 ◽

2021 ◽

Vol 18 (16) ◽

pp. 8323

Author(s):

Charles Payot ◽

Christophe A. Fehlmann ◽

Laurent Suppan ◽

Marc Niquille ◽

Christelle Lardi ◽

...

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Advanced Life Support ◽

Multivariable Logistic Regression Model ◽

Physician Decision Making ◽

Factors Influencing ◽

Prehospital Emergency ◽

Bystander Cpr ◽

Comorbidity Index ◽

Hospital Cardiac Arrest

The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 1 January 2009 to 1 January 2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of “obvious death” or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardiopulmonary resuscitation (CPR). Prognostic factors known at the time of EP’s decision were included in a multivariable logistic regression model. Included were 784 patients. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR = 2.14, 95% CI: 1.43–3.20) and bystander CPR (OR = 4.10, 95% CI: 2.28–7.39). Traumatic aetiology (OR = 0.04, 95% CI: 0.02–0.08), age > 80 years (OR = 0.14, 95% CI: 0.09–0.24) and a Charlson comorbidity index greater than 5 (OR = 0.12, 95% CI: 0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.

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Vehicle Crash Rescue Skills and Residency Training in Emergency Medicine

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00043983 ◽

1985 ◽

Vol 1 (S1) ◽

pp. 103-104

Author(s):

Robert R. Harrison ◽

Kimball I. Maull ◽

C. Paul Boyan

Keyword(s):

Life Support ◽

Prehospital Care ◽

Advanced Life Support ◽

Hospital Environment ◽

Prehospital Emergency Care ◽

Care Providers ◽

Accident Victim ◽

Prehospital Emergency ◽

Time Required ◽

Injured Patients

Recent advances in the resuscitation and stabilization skills of prehospital emergency care providers have done much to improve the quality of immediate care provided to suddenly ill or injured patients. Although much of the innovation and leadership in this area has been provided by emergency department physicians, most of them still lack an adequate appreciation of the circumstances under which these skills are executed. While many physicians participate in prehospital care teaching and evaluation of the system, most have not gained personal experience in those aspects of care foreign to hospital environment. They are particularly unacquainted with the intricacies of rescuing patients from automobile accidents and similar entrapments. It is not unusual, however, for an accident victim to spend half of the time required for the prehospital phase of emergency medical care undergoing extrication, and in many cases this must be done before full advanced life support measures may be initiated.

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