scholarly journals ‘Primary care sensitive’ situations that result in an ambulance attendance: a conversation analytic study of UK emergency ‘999’ call recordings

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e023727 ◽  
Author(s):  
Matthew James Booker ◽  
Ali R G Shaw ◽  
Sarah Purdy ◽  
Rebecca Barnes
Keyword(s):  
Primary Care ◽  
Ambulance Dispatch ◽  
Emergency Ambulance ◽  
Life Threatening ◽  
Medical Emergencies ◽  
Telephone Calls ◽  
Alternative Question ◽  
Personal Accounts ◽  
Access To Knowledge ◽  
Question Formats

ObjectivesTo explore common features of conversations occurring in a sample of emergency calls that result in an ambulance dispatch for a ‘primary care sensitive’ situation, and better understand the challenges of triaging this cohort.DesignA qualitative study, applying conversation analytic methods to routinely recorded telephone calls made through the ‘999’ system for an emergency ambulance. Cases were identified by a primary care clinician, observing front-line UK ambulance service shifts. A sample of 48 ‘999’ recordings were analysed, corresponding to situations potentially amenable to primary care management.ResultsThe analysis focuses on four recurring ways that speakers use talk in these calls. Progress can be impeded when call-taker’s questions appear to require callers to have access to knowledge that is not available to them. Accordingly, callers often provide personal accounts of observed events, which may be troublesome for call-takers to ‘code’ and triage. Certain question formats—notably ‘alternative question’ formats—appear particularly problematic. Callers deploy specific lexical, grammatical and prosodic resources to legitimise the contact as ‘urgent’, and ensure that their perception of risk is conveyed. Difficulties encountered in the triage exchange may be evidence of misalignment between organisational and caller perceptions of the ‘purpose’ of the questions.ConclusionsPrevious work has focused on exploring the presentation and triage of life-threatening medical emergencies. Meaningful insights into the challenges of EMS triage can also be gained by exploring calls for ‘primary care sensitive’ situations. The highly scripted triage process requires precise, ‘codeable’ responses to questions, which can create challenges when the exact urgency of the problem is unclear to both caller and call-taker. Calling on behalf of someone else may compound this complexity. The aetiology of some common interactional challenges may offer a useful frame for future comparison between calls for ‘primary care sensitive’ situations and life-threatening emergencies.

scholarly journals Ambulance dispatch of older patients following primary and secondary telephone triage in metropolitan Melbourne, Australia: a retrospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e042351
Author(s):  
Kathryn Eastwood ◽  
Dhanya Nambiar ◽  
Rosamond Dwyer ◽  
Judy A Lowthian ◽  
Peter Cameron ◽  
...  
Keyword(s):  
Cohort Study ◽  
Older Adult ◽  
Retrospective Cohort Study ◽  
Older Patients ◽  
Retrospective Cohort ◽  
Vital Signs ◽  
Telephone Triage ◽  
Ambulance Dispatch ◽  
Emergency Ambulance ◽  
Primary Triage

BackgroundMost calls to ambulance result in emergency ambulance dispatch (direct dispatch) following primary telephone triage. Ambulance Victoria uses clinician-led secondary telephone triage for patients identified as low-acuity during primary triage to refer them to alternative care pathways; however, some are returned for ambulance dispatch (secondary dispatch). Older adult patients are frequent users of ambulance services; however, little is known about the appropriateness of subsequent secondary dispatches.ObjectivesTo examine the appropriateness of secondary dispatch through a comparison of the characteristics and ambulance outcomes of older patients dispatched an emergency ambulance via direct or secondary dispatch.DesignA retrospective cohort study of ambulance patient data between September 2009 and June 2012 was conducted.SettingThe secondary telephone triage service operated in metropolitan Melbourne, Victoria, Australia during the study period.ParticipantsThere were 90 086 patients included aged 65 years and over who had an emergency ambulance dispatch via direct or secondary dispatch with one of the five most common secondary dispatch paramedic diagnoses.Main outcome measuresDescriptive analyses compared characteristics, treatment and transportation rates between direct and secondary dispatch patients.ResultsThe dispatch groups were similar in demographics, vital signs and hospital transportation rates. However, secondary dispatch patients were half as likely to be treated by paramedics (OR 0.51; CI 0.48 to 0.55; p<0.001). Increasing age was associated with decreasing treatment (p<0.005) and increasing transportation rates (p<0.005).ConclusionSecondary triage could identify patients who would ultimately be transported to an emergency department. However, the lower paramedic treatment rates suggest many secondary dispatch patients may have been suitable for referral to alternative low-acuity transport or referral options.

scholarly journals Knowledge discovery from emergency ambulance dispatch during COVID-19: A case study of Nagoya City, Japan

2021 ◽  
pp. 103743
Author(s):  
Essam A. Rashed ◽  
Sachiko Kodera ◽  
Hidenobu Shirakami ◽  
Ryotetsu Kawaguchi ◽  
Kazuhiro Watanabe ◽  
...  
Keyword(s):  
Knowledge Discovery ◽  
Ambulance Dispatch ◽  
Emergency Ambulance

scholarly journals IMPACT OF GERIATRIC INTERPROFESSIONAL TRAINING ON ADVANCE CARE PLANNING IN GERIATRIC PRIMARY CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S151-S152
Author(s):  
Maureen E Barrientos ◽  
Anna Chodos ◽  
Alicia Neumann ◽  
Yvonne Troya ◽  
Pei Chen
Keyword(s):  
Primary Care ◽  
Social Work ◽  
Advance Care Planning ◽  
Health Resources ◽  
The United States ◽  
Care Practice ◽  
Care Planning ◽  
Office Visits ◽  
Advance Care ◽  
Telephone Calls

Abstract Currently, an important measure of Advance Care Planning (ACP), Advance Health Care Directives (AHCD) documentation rate, is at 33% for older adults in the United States. To address this disparity, geriatric faculty in an academic geriatric primary care practice aimed to train geriatrics fellows and other interprofessional (IP) learners to engage patients in ACP. As part of a Geriatric Workforce Enhancement Program funded by the Health Resources and Services Administration, geriatrics faculty and the Medical Legal Partnership for Seniors based at University of California Hastings College of Law provided ACP training to fellows and IP learners, including social work interns. In practice, the fellows and social work interns collaborated to incorporate ACP into patient visits and follow-up telephone calls. To monitor ACP progress, research staff reviewed patients’ electronic health records and performed descriptive analysis of the data. In 21 months, 4 geriatrics fellows built a panel of 59 patients who on average had 3 office visits and 7 telephone calls per person. Prior to clinic enrollment, 12 (20.3%) patients had preexisting AHCD, and 47 lacked AHCD documentation. After ACP intervention, 42 of 47 patients without AHCD documentation engaged in ACP discussion. Of those who engaged in ACP discussion, 24 completed AHCD, raising AHCD completion rate to 61%, or 36 patients in the panel of 59. ACP is a complex process that benefits from skilled communication among interprofessional providers and patients. Findings underscore the potential advantages of IP training and engaging patients in ACP discussion in an academic primary care setting.

scholarly journals Tragic and Heroic Moments in the Lives of Forced Migrants: Memories of Political Asylum-Seekers in Post-Apartheid South Africa

Refuge ◽  
2016 ◽  
Vol 32 (3) ◽  
pp. 63-72 ◽  
Author(s):  
Ernest A. Pineteh ◽  
Thecla N. Mulu
Keyword(s):  
South Africa ◽  
Autobiographical Memory ◽  
Asylum Seekers ◽  
Forced Migration ◽  
Political Asylum ◽  
Discursive Space ◽  
Life Threatening ◽  
Forced Migrants ◽  
Personal Accounts ◽  
At Home

This article examines the memories of a group of Cameroonian asylum-seekers in South Africa, analyzing personal accounts of memories of fear, suffering, and pain as well as resilience and heroism during their forced migration. The article argues that the legitimacy of applications for asylum often depends on accurate and consistent memories of specific life-threatening episodes at home and during migration. Drawing on theoretical conceptions such as construction of memory, autobiographical memory, and politics of storytelling, this article teases out how personal memories of asylum-seekers provide a discursive space to access and understand the asymmetries of seeking political asylum in post-apartheid South Africa.

scholarly journals Benefits of venom immunotherapy: How soon can they be expected

2017 ◽  
Vol 145 (3-4) ◽  
pp. 173-177
Author(s):  
Sasa Kadivec ◽  
Mitja Kosnik
Keyword(s):  
First Year ◽  
Severe Reaction ◽  
Allergic Reactions ◽  
Venom Immunotherapy ◽  
Emergency Situations ◽  
Sting Reaction ◽  
Life Threatening ◽  
Medical Emergencies ◽  
The Cost ◽  
Patients Experience

Introduction/Objective. Allergic reactions to insect stings are medical emergencies that could be prevented by venom immunotherapy (VIT). The main purpose of VIT is to prevent fatal or life-threatening reactions. We aimed to show the rapidity with which patients experience the benefits of VIT and estimate the number of emergency treatments that are prevented. Methods. We reviewed the medical files of patients who started VIT between 2010 and 2014. We calculated the costs of treatment of the sting reactions, the costs of immunotherapy, and estimated the costs of prevented allergic reactions. Results. In a cohort of 514 patients (40.9% female, age 47.2 ? 14.4 years), the cost of treatment of the index sting reaction was 180.4 ? 166.8 euros. During VIT, 195 patients experienced 446 field stings. In 86.3% of patients, stings were well tolerated, and only one patient experienced a severe reaction (grade III, according to Mueller). A total of 20.4% of VIT treated patients were stung during the first year of VIT and 57% during five years of VIT. The expenditure for five years of VIT was 2,886 euros per patient, which corresponded to an average of 16 emergency treatments for systemic reactions. Conclusion. Emergency situations are prevented in a substantial number of venom-allergic patients and a beneficial effect was already observed during the first year of VIT.

Anaphylaxis: how to recognise and manage in primary care

2021 ◽  
Vol 32 (6) ◽  
pp. 232-236
Author(s):  
Hannah Kramer ◽  
Rebecca Batt
Keyword(s):  
Primary Care ◽  
Practice Nurse ◽  
Correct Diagnosis ◽  
Insect Sting ◽  
Vulnerable Patients ◽  
Immune Mediated ◽  
Emergency Medication ◽  
Life Threatening ◽  
Systemic Hypersensitivity

Anaphylaxis is a life-threatening emergency. Hannah Kramer and Rebecca Batt explain how correct diagnosis, avoidance and patient education are fundamental in reducing risk Anaphylaxis is a serious systemic hypersensitivity reaction that is usually rapid in onset and can cause death. It is an immune-mediated reaction, which typically occurs when a person is exposed to a trigger, for example a food, drug, or insect sting. This article aims to assist with the recognition of symptoms and to guide management of anaphylaxis in primary care. Beyond the acute, the practice nurse can play a key role in helping patients to manage their allergies in the long-term, particularly for those who are most vulnerable. Patients should be supported in understanding how best to avoid their triggers, in managing their emergency medication, and in the importance of good asthma control.

scholarly journals Ambulance use for ‘primary care’ problems: an ethnographic study of seeking and providing help in a UK ambulance service

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e033037 ◽  
Author(s):  
Matthew James Booker ◽  
Sarah Purdy ◽  
Rebecca Barnes ◽  
Ali R G Shaw
Keyword(s):  
Primary Care ◽  
Emergency Situation ◽  
Sociodemographic Factors ◽  
Ethnographic Study ◽  
Ambulance Service ◽  
Service Users ◽  
Care Seeking ◽  
Emergency Ambulance ◽  
Care Problems ◽  
Public Health Strategies

ObjectivesTo explore what factors shape a service user’s decision to call an emergency ambulance for a ‘primary care sensitive’ condition (PCSC), including contextual factors. Additionally, to understand the function and purpose of ambulance care from the perspective of service users, and the role health professionals may play in influencing demand for ambulances in PCSCs.DesignAn ethnographic study set in one UK ambulance service. Patient cases were recruited upon receipt of ambulance treatment for a situation potentially manageable in primary care, as determined by a primary care clinician accompanying emergency medical services (EMS) crews. Methods used included: structured observations of treatment episodes; in-depth interviews with patients, relatives and carers and their GPs; purposeful conversations with ambulance clinicians; analysis of routine healthcare records; analysis of the original EMS ‘emergency’ telephone call recording.ResultsWe analysed 170 qualitative data items across 50 cases. Three cross-cutting concepts emerged as central to EMS use for a PCSC: (1) There exists a typology of nine ‘triggers’, which we categorise as either ‘internal’ or ‘external’, depending on how much control the caller feels they have of the situation; (2) Calling an ambulance on behalf of someone else creates a specific anxiety about urgency; (3) Healthcare professionals experience conflict around fuelling demand for ambulances.ConclusionsPrevious work suggests a range of sociodemographic factors that may be associated with choosing ambulance care in preference to alternatives. Building on established sociological models, this work helps understand how candidacy is displayed during the negotiation of eligibility for ambulance care. Seeking urgent assistance on behalf of another often requires specific support and different strategies. Use of EMS for such problems—although inefficient—is often conceptualised as ‘rational’ by service users. Public health strategies that seek to advise the public about appropriate use of EMS need to consider how individuals conceptualise an ‘emergency’ situation.

Comment on ‘Ambulance dispatch versus GP home visit for highly urgent out-of-hours primary care’ by Plat et al.

2018 ◽  
Vol 36 (2) ◽  
pp. 102-102
Author(s):  
Marre M M de Koning ◽  
Nathalie Reurink ◽  
Marianne F Mol ◽  
Bart Koes
Keyword(s):  
Primary Care ◽  
Home Visit ◽  
Out Of Hours ◽  
Ambulance Dispatch

scholarly journals Emergency Ambulance Dispatch and Drive Times: An Analysis of Prehospital Vehicular Response in the Kingdom of Bhutan

2019 ◽  
Vol 34 (s1) ◽  
pp. s125-s125
Author(s):  
Jenevieve Kincaid ◽  
Charles Mize ◽  
Mila Dorji
Keyword(s):  
Emergency Response ◽  
Complete Data ◽  
Emergency Vehicle ◽  
Response Data ◽  
Medical Response ◽  
Ambulance Dispatch ◽  
Significant Difference ◽  
Emergency Ambulance ◽  
Activation Times ◽  
National Emergency

Introduction:The Kingdom of Bhutan is a small, mountainous country with limited financial resources. Its population is scattered in hard-to-reach villages with poor road access. Ambulance drivers piloting Toyota Landcruisers provide the majority of the country’s emergency response and are dispatched by the national emergency response center (Health Help Service/112) to calls in the nation’s twenty districts.Aim:By collecting and analyzing prehospital response data, we aimed to describe Bhutanese emergency medical response (EMS) ambulance activities and make system-wide recommendations to improve the speed of emergency vehicle dispatch, reduce the time between ambulance activation and ambulance arrival on scene, and adequately describe emergency vehicle drive time as it relates to distance driven.Methods:The following data was compiled in Excel: Dispatch center phone records, EMS ambulance activation times, drive times, vehicle geospatial data, and written records of ambulance drivers. No identifiable data was collected.Inclusion Criteria: All prehospital calls from 2017 and 2018 where complete data was available.Exclusion Criteria: Complete data unavailable, i.e. geographic data without a matching call or report.Statistical Tools: SPSS Statistics Version 25, NVivo 12-12.2.0.3262.Results:Preliminary analysis of the data shows a significant difference between data collected and data previously reported, the speed of emergency vehicular response and dispatch, drive times, and distance traveled. Facility transfer rather than scene response was found to take more time.Discussion:Due to adverse road conditions, lengthy drive times, and an inadequate number of personnel and satellite ambulance locations, we recommend optimizing ambulance location using an optimization model that will minimize the number of ambulances needed and maximize response time. Future considerations may include adding a ground arm to the Bhutan Emergency Aeromedical Retrieval team, or a second aeromedical team in the eastern part of the country.

Sign in / Sign up

Export Citation Format

Share Document