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Hospitalization/Emergency Care

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Some 911 callers may be safely referred to alternative services to save ambulances for true emergencies

About 4,000 emergency dispatch centers in the United States assign 334,000 ambulances to transport 25 million people to emergency departments (EDs) each year. Currently, after the ambulance arrives, as many as 30 percent of patients are not transported, suggesting that it might be safe to triage some patients to other resources.

Terri Schmidt, M.D., M.S., of Oregon Health & Science University, and colleagues worked to develop a decision rule that could allow 911/emergency medical services (EMS) dispatchers to identify callers with an immediate need for an emergency medical technician (EMT)-paramedic response versus those who could receive alternative services.

The researchers, who were supported in part by the Agency for Healthcare Research and Quality (HS09835), listened to recordings of calls to an urban EMS dispatch center that were assigned the lowest severity level according to dispatch criteria. These were callers with complaints of back pain, fall, bleeding or laceration, sickness, or trauma. The researchers reviewed related EMS patient care forms and ED patient care records to determine what factors could help identify which of the 656 EMS callers could potentially be referred to alternative resources, such as non-911 access numbers, non-ambulance transport, and medically appropriate treat-and-release programs.

Overall, 24 percent of 911 callers in this already low-risk group had a problem warranting an EMT response. Nineteen percent of callers had an EMS finding suggesting an emergency when administration of any medication in the ambulance was included, but this number decreased to 7 percent when comfort medications, such as morphine for pain or droperidol for nausea, were excluded. Another 7 percent had an important ED finding suggesting an emergency, such as administration of blood products in the ED or admission to an intensive care unit. Using age less than 12 as a threshold predicted a subset of patients with the five complaints studied who did not need an EMS response. This rule would have allowed 10 percent of patients studied to be safely triaged to an alternative resource. However, this finding is preliminary, and it requires further validation, caution the researchers.

See "Is it possible to safely triage callers to EMS dispatch centers to alternative resources?" by Dr. Schmidt, Keith W. Neely, Ph.D., Annette L. Adams, M.A., M.P.H., and others, in the July 2003 Prehospital Emergency Care 7(3), pp. 368-374.

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