The accessibility, distribution and utilisation of emergency medical services are important components of health care delivery. The impact of these services on well-being is heightened by the fact that ambulance resources must respond in a reliable and timely manner to emergency calls from demand areas. However, many factors, such as the unavailability of an ambulance at a center closest to a call, can adversely influence response time. This paper discusses the design and implementation of a framework developed in a Geographic Information System for assessing ambulance response performance. A case study of ambulance response in three communities in Southern Ontario, Canada is presented that allows easy and rapid identification of anomalous calls that may adversely affect overall operating performance evaluation. Extensions of the framework into a fully fledged service deployment and planning decision support system are discussed.
During Saskatchewan's healthcare reform of the 1990s, the number of acute hospital beds in Saskatoon District Health was cut in half. The emergency room and outpatient facilities were not able to accommodate an increasing number of patients needing urgent assessments and medical procedures. In this article, we describe the development, implementation and utilization of a day medicine program. This description may be useful to others planning healthcare delivery to medical patients, especially in a setting of resource constraint.
3-year experience of dispensary-diagnostic department (DDD) working at the Center of emergency surgical care is analyzed. DDD activity consists of 2 types: dispensary-diagnostic and curative-prophylactic. Department has 5 beds where patients with indeterminate diagnosis are hospitalized (2737 patients over 3 years). Diagnostic beds permit to make diagnosis and select patients with parallel therapeutic procedures. 503 patients were discharged from DDD over 3 years. 534 patients were transferred to surgery department, 97 patients--in internal medicine department. 2% patients required 1-3 hours for final diagnosis, 17%--3-6 hours, 29%--12-24 hours, and only 4%--over twenty-four hours. In 1998--30% patients didn't require hospital treatment, in 1999--38.5%, in 2000--48.5%. A significant cost-effect was achieved.
Providing better and more cost-efficient health services is a goal for health policy. It is seen as desirable to provide health services close to the patient's home. From 2016, all municipalities must provide emergency hospitalisation (EH). The objective of this study was to develop experience-based knowledge from medium-sized municipalities that operate such services without any inter-municipal collaboration.
Focus-group interviews with 25 health workers who are responsible for this service in six small and medium-sized municipalities in Western Norway were conducted in the autumn of 2013 and the spring of 2014. Additional information on bed utilisation was also collected.
The informants reported that their municipalities had chosen emergency hospitalisation as a measure to reinforce the professional communities in the nursing homes. They described this as a patient-centred and flexible treatment option. In their opinion, the programme would help ensure competence enhancement in the municipalities. Bed utilisation increased from the introduction of EH until 31 August 2014.
The health workers reported that emergency hospitalisation in the municipality fulfilled key intentions of the Interaction Reform, in terms of providing treatment to patients locally and close to their homes.
Comment In: Tidsskr Nor Laegeforen. 2015 Oct 20;135(19):171326486660
Comment In: Tidsskr Nor Laegeforen. 2015 Sep 22;135(17):152826394562
Comment In: Tidsskr Nor Laegeforen. 2015 Oct 20;135(19):1713-426486661
In summary, there are important differences among patients admitted via the ED versus those admitted via other means in terms of both utilization and patient characteristics. When compared with patients admitted via other means, patients admitted via the ED are more likely to fall into the medical patient group, to be older and to have more complex and more diseases or health conditions. Medical patients admitted via the ED are more likely to become ALC patients than are other types of patients. As hospitals, health regions and policy makers focus on improving patient flow through Canada's EDs, it is important to consider the volume and characteristics of the patient population admitted via the ED.
OBJECTIVES: To assess whether easy access to medical information of the emergency department's (ED) frequent users would be useful to patient care in the ED and at primary healthcare centres (PHCs), and if resource utilization in the following year would be affected. METHODS: During a 6-month period, frequent users presenting to the ED of Karolinska University Hospital Huddinge, Sweden, were randomized by the electronic database system into an intervention (n=834) or control group (n=965), the definition being three or more visits in 12 months before the index visit. Printout case notes, from the intervention patients' last three visits, were made accessible to the ED physicians and optionally forwarded to the patient's PHC physician. Usefulness of this enhanced information was measured by questionnaires, whereas healthcare utilization was compiled from the electronic database. RESULTS: The case notes of 59 (7.1%) intervention patients were forwarded to the respective PHCs. Of these, access to the enhanced patient information was deemed useful in 82% cases in the ED, versus 76% in PHCs. The mean number of ED visits in the following year did not differ significantly in the total intervention group as compared with the controls: 4.0 and 3.9, respectively (P=0.49). Nor were there any differences in utilization of other care resources. CONCLUSION: Although only a small subgroup's information was shared, yielding no decrease in overall healthcare utilization, the study indicated benefits of the enhanced information at the respective care level and also had important clinical and organizational implications.
Several factors are important for the number and severity of medical emergencies during mass-gatherings. The risk of violence, the size and mobility of the crowd, the type of event, weather, and duration of the event all influence the outcome. During the European Union (EU) Summit, from 15-16 June 2001 in Gothenburg, Sweden, approximately 50,000 people participated in 43 protest marches, some which included 15,000 participants. Clashes between police and the protesters occurred.
The objective of this study was to analyze the amount and character of injuries as well as the medical complaints in relation to the EU Summit. In addition, the aim of this study was to describe the organization and function of the healthcare services provided during the meeting.
This study is based on the medical records of patients presenting with injuries and other types of medical emergencies at the healthcare stations during the Summit.
In total, 143 patients sought medical care. Fifty-three (37.1%) were police officers. Most patients had minor complaints, but a few were seriously injured. The Patient Presentation Rate (PPR) was 2.7. Nine victims were hospitalized as high priority.
The PPR for the EU Summit was 2.7, which is in the same range as previously reported from other mass-gatherings.
Heat-related illness is reported to be a significant cause of morbidity at outdoor mass gatherings during warm weather. Paramedics are traditionally present at mass gatherings to provide prehospital care for people in need.
To describe a paramedic-staffed medical rehydration unit and a new role for paramedics at a mass gathering attended by more than 450,000 people.
A 48-bed medical rehydration unit was deployed adjacent to the main field hospital. Paramedics admitted patients to the unit if they met predetermined criteria for mild to moderate heat-related illness. Each paramedic was responsible for four beds. Paramedics initiated oral and intravenous rehydration therapy by following medical directives. Emergency medical services (EMS) physicians reviewed patients before discharge.
The medical rehydration unit managed 143 patients (3/10,000 attendees). The mean number of patients admitted per hour was nine. The average age was 24 years; 103 (72%) were female. The main presenting complaint was syncope, presyncope, or dizziness in 43 (30%). Forty-four (31%) patients received parenteral and oral fluids; the remainder received oral fluids alone. The average length of stay was 94 minutes (95% CI 82-106). One hundred seven (75%) patients were discharged, 17 (12%) were transferred to the main field hospital, four (3%) left against medical advice, and two (1%) required transfer to a hospital off site. In 13 (9%) cases, records of patient disposition were incomplete.
This article defines a new role for paramedics and describes the operation of a medical rehydration unit at a large, single-day mass gathering in summer.
International mass gatherings can cause great challenges to local healthcare system and emergency medical services (EMS). Traditionally, planning has been based on retrospective reports of previous events, but there still is a need for prospective studies in order to make the process more evidence-based. The aim of this study was to analyze the success of medical preparedness, ambulance patient characteristics, emergency care, and the use of pre-hospital resources during the 2005 World Championship Games in Athletics in Helsinki, Finland.
The study was a prospective, observational study conducted within the Helsinki EMS. Data from all emergency calls at the sport venues and Games village between 05 and 14 August 2005 were collected. Data from the organizations responsible for the health care and first aid of spectators and accredited persons (e.g., athletes, coaches, the press, very important persons and personnel working in the Games area) also were collected. The Institutional Review Board of Helsinki University Central Hospital approved the study plan.
A total of 479,000 persons visited the Games. The ambulance call incidence at the Olympic Stadium was 0.50 per 10,000 people and 0.7 per 10,000 when the Games Village was included. The overall need for ambulance transportation to the emergency department was 0.52 per 10,000. No patients needed cardiopulmonary resuscitation or other immediate, life-saving procedures on-site. First aid was provided to 554 spectators (0.17 per 10,000 people). The three medical organizations cared for 1,586 patients of which 25 (1.6%) were transported to a hospital by an ambulance. The number of patients needing transportation and the overall patient load for the healthcare system was well-anticipated. Accredited persons sought health care a total of 1,009 times. The number of patients treated was associated closely with the number of spectators (p = 0.05). The number of ambulance calls in the city increased 5.9 % as compared to the corresponding time period in the five previous years.
The medical preparedness and resources for the Games proved to be sufficient. The EMS personnel were able to provide quality emergency care. This prospective study provided new, detailed data for the medical aspects of mass gatherings and confirmed many previous observations.