Response time is an important factor in determining the prognosis of a victim. There are well-documented increases in response time in urban areas. In 63% of cases, MEM arrived before other emergency vehicles.
Response time is an important factor in determining the prognosis of a victim. There are well-documented increases in response time in urban areas. In 63% of cases, MEM arrived before other emergency vehicles.
Response time is an important factor in determining the prognosis of a victim. There are well-documented increases in response time in urban areas. In 63% of cases, MEM arrived before other emergency vehicles.
medical emergency system? Miguel Soares-Oliveira MD * , Paula Egipto MD, Isabel Costa RN, Luis Manuel Cunha-Ribeiro MD Instituto Nacional de Emergencia Medica (INEM) R Dr Alfredo Magalhaes, 62, 4000-063 Porto, Portugal Received 7 September 2006; revised 3 November 2006; accepted 12 November 2006 Abstract Introduction/Aim: In an emergency medical service system, response time is an important factor in determining the prognosis of a victim. There are well-documented increases in response time in urban areas, mainly during rush hour. Because prehospital emergency care is required to be efficient and swift, alternative measures to achieve this goal should be addressed. We report our experience with a medical emergency motorcycle (MEM) and propose major criteria for dispatching it. Material and Methods: This work presents a prospective analysis of the data relating to MEM calls from July 2004 to December 2005. The analyzed parameters were age, sex, reason for call, action, and need for subsequent transport. A comparison was made of the need to activate more means and, if so, whether the MEM was the first to arrive. Results: There were 1972 calls. The average time of arrival at destination was 4.4 F 2.5 minutes. The main action consisted of administration of oxygen (n = 626), immobilization (n = 118), and control of hemorrhage (n = 101). In 63% of cases, MEM arrived before other emergency vehicles. In 355 cases (18%), there was no need for transport. Conclusion: The MEM can intervene in a wide variety of clinical situations and a quick response is guaranteed. Moreover, in specific situations, MEM safely and efficiently permits better management of emergency vehicles. We propose that it should be dispatched mainly in the following situations: true life-threatening cases and uncertain need for an ambulance. D 2007 Elsevier Inc. All rights reserved. 1. Introduction Survival from cardiac arrest is dependent on response time. Benefits have been demonstrated with lower response times [1,2]. Thus, prehospital emergency care should be efficient and swift. The usual traffic congestion in larger cities means that achieving these objectives is somewhat affected when traditional medical emergency vehicles are used [3,4]. Medical emergency motorcycles (MEM) are used in several countries, although few results have been published to date, and they may provide advantages in the provision of prehospital emergency medical care, by reducing response times, as described by various authors [3-7]. The authors present the results of their analysis based on their experience with this type of vehicle within a 0735-6757/$ see front matter D 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.ajem.2006.11.030 * Corresponding author. Instituto Nacional de Emergencia Medica (INEM)Delegacao Norte, 4000-063 Porto, Portugal. Tel.: +351 222065029; fax: +351 222065010. E-mail address: miguel.oliveira@inem.pt (M. Soares-Oliveira). American Journal of Emergency Medicine (2007) 25, 620622 www.elsevier.com/locate/ajem medical emergency system, and report the main criteria for its dispatch. 2. Material and methods The emergency medical service system in Portugal was previously described by Gomes et al [8]. It is run by a nonprofit governmental organization, which has 4 regional centers. Each center has it own dispatch center, Basic Life Support (BLS) units, and Advanced Life Support (ALS) units. Each emergency call that enters the dispatch center is received by a technician, who has undergone specific training (a 210-hour course), and supervised by a medical doctor, whobesides hearing each callcan intervene in it. A telephonic triage is performed to classify 3 main categories: very urgent situation (requiring an ALS and a BLS unit); urgent (requiring BLS unit); nonurgent situations (neither an ALS nor a BLS is dispatched). The MEMs were assigned to 2 major cities of Portugal as part of a pilot project to try to reduce response times. They were placed in preexisting facilities, in the center of areas were there have been many previous emergency calls. We focused this study on the countrys second major city, which has an overall population of about 1 500 000. The principal aim of using MEM is to provide help more quickly, mainly in areas with traffic congestion, taking advantage of its size and versatility. Dispatch criteria for the MEM, before this study, were all emergency situations in an urban setting, where a BLS or an ALS unit is needed. The MEMs are driven by a professional trained in medical emergency techniques (a 210-hour course on medical emer- gency techniques for ambulance crew members), automated external defibrillation (a 10-hour course), and motorcycling. The first aid equipment carried by the MEM comprises an automated external defibrillator (AED), portable oxygen, basic airway management and trauma gear, sphygmoma- nometer, stethoscope, capillary glucose meter, and ther- mometer (Fig. 1). The motorcycles, Honda Jazz 250, Honda Transalp 650 (Honda Portugal S.A., Sintra, Portugal), and BMW 650 GS (BMW Motorrad Portugal, Lisbon, Portugal), are equipped with siren and warning lights, radio, and mobile phone communications. Because safety is a constant concern, the crews of this first- aid vehicle are properly equipped with personal protection suits: summer and winter gloves (Spidi, Meledo Di Sarego, Italy), jackets with elbow and shoulder protection (Dainese, Molvena, Italy), pants with knee protection (Dainese), and appropriate boots (Dainese) (Fig. 2). This new first aid facility has been operating in the countrys 2 biggest cities since July 2004. It operates during hours of greater traffic congestion, that is, from 8 am to 12 pm on working days. Prospective analysis was performed in respect of the MEM call-outs in the countrys second biggest city from July 2004 to December 2005. The analyzed parameters were as follows: age, sex, reason for call, action, need for subsequent transport to a health establishment, and time of arrival at destination. Acomparison was also made, over the same period, of the need to activate more means and, if so, whether the MEMwas the first to arrive. 3. Results During the period there were 1972 calls. The average age of victims was 51 F 21.1 years (median, 48 years); breakdown in terms of sex shows that 51% of calls were for men. The main reasons for the calls were as follows: sudden illness (n = 868, 44%), trauma (n = 419, 21%), intoxication (n = 96, 5%), and support for other first aid teams and vehicles (n = 63, 3%). The main actions consisted of administration of oxygen (n = 626, 48%), immobilization (n = 118, 9%), control of hemorrhage (n = 101, 8%), and use of AED (n = 13, 1%). Fig. 1 Medical emergency motorcycle and its main clinical material (AED, oxygen, etc). Fig. 2 Medical emergency motorcycle rider with personal protective gear. Emergency motorcycle: has it a place in a medical emergency system? 621 The average time of arrival at destination was 4.4 F 2.5 minutes. In 767 of 1217 analyzed cases (63%), in which 2 or more medical emergency vehicles were called out, the MEM was the first to arrive at the destination. With regard to the need for transporting victims to a health care establishment, there was no need for such transport in 355 (18%) cases. The main reasons for no transport being required were as follows: victims refusal of treatment, 63%; false call-out, 11%; death, 6%; medical decision, including decision at the place of the occurrence by the physician of the emergency medical and resuscitation vehicle (mobile advanced life support unit), or by the coordinating physician of the dispatch center, 3% [5]. 4. Discussion Response time is an important factor dictating survival among emergency victims. Time of arrival at the destina- tion, in emergency situations, is often conditioned during peak traffic hours. To overcome this difficulty, many different approaches were proposed, including increasing the number of ambulances, their geographic relocation, defibrillation programs, etc [1-7]. Although there are several medical emergency systems scattered around the world that use emergency motorcycles, few results have been published to date. Lin et al. [4-7] have demonstrated that an emergency motorcycle had a shorter response time than a regular ambulance, in 274 cases studied, during a 3-month period. A MEM, driven by an individual with training and experience in medical emergencies and provided with adequate clinical materials, allows swift, efficient response to the difficulties posed by city traffic congestion, keeping response times at the desired level. Trained personnel using MEMs can intervene in various clinical situations. The training given to MEM crews and the materials provided allow a large number of fist aid and life-saving measures to be implemented. In addition to this obvious advantage stemming from its speed in traffic, the MEM allows better resource management. In a large number of cases, telephone triage cannot determine, with 100% certainty, if the situation is serious and if transport to a health care unit is not required (eg, a victim found lying in a street, recovery from lipothymy, minor trauma). In our series, in 18% of cases, there was no need to transport the victim to a hospital. Most of these cases are attributable to the victims refusal to be transported. These data stress the importance of using MEM, considering the limitation of a telephonic screening process. It will quickly and efficiently allow prompt assessment of these situations and confirm the need for urgent transport, and, if required, can provide initial clinical stabilization. This will ensure optimization of man- agement of available resources without jeopardizing the level of medical emergency response to patients [9-12]. A limitation of this study is that no control groups were included. In short, and in the wake of the arguments set out in this report [13-15], we propose that the MEM be included in medical emergency systems, mainly in zones of severe traffic congestion during peak hours, based on the following call-out criteria: 1. life-threatening situations in which speed is cru- cial; and 2. situations in which the need for transport to health care units is bdoubtfulQ or bnot very probableQ (eg, recovery from lipothymy, a convulsion crisis in an individual with a history of epilepsy, minor trauma, etc), but the dispatch of emergency medical facilities is bprudent.Q 5. Conclusion The addition of this newmeans of providing care within the medical emergency systems in major urban centers seems to allow fast response, while maintaining the quality of service provided and allowing better management of available resources. Further study is needed to confirm these results. References [1] Pons PT, Haukoos JS, Bludworth W, et al. Paramedic response time: does it affect patient survival? Acad Emerg Med 2005;12:594- 600. [2] Vukmir RB. Survival from prehospital cardiac arrest is critically dependent upon response time. Resuscitation 2006;69:229- 34. [3] Peleg K, Pliskin JS. A geographic information system simulation model of EMS: reducing ambulance response time. Am J Emerg Med 2004;22:164- 70. [4] Lin CS, Chang H, Shyu KG, et al. A method to reduce response times in prehospital care: the motorcycle experience. Am J Emerg Med 1998;16:711- 3. [5] Papaspyrou E, Setzis D, Grosomanidis V, et al. International EMS systems: Greece. Resuscitation 2004;63:255- 9. [6] Riley P. Motorcycle medics. JEMS 2000;25:32- 41. [7] Spivak M. Motorcycle medics. Delivering patient care from the back of a bike. Emerg Med Ser 1999;28:22- 4. [8] Gomes E, Arau jo R, Soares-Oliveira M, et al. International EMS systems: Portugal. Resuscitation 2004;62:257- 60. [9] Dale J, Williams S, Foster T, et al. Safety of telephone consultation for dnon-seriousT emergency ambulance service patients. Qual Saf Health Care 2004;13:363- 73. [10] Marks PJ, Daniel TD, Afolabi O, et al. Emergency (999) calls to the ambulance service that do not result in the patient being transport to hospital: an epidemiological study. Emerg Med J 2002;19:449- 52. [11] Key CB, Pepe PE, Persse DE, et al. Can first responders be sent to selected 9-1-1 Emergency Medical Services calls without an ambulance? Acad Emerg Med 2003;10:339- 46. [12] Woollard M. Emergency calls not requiring an urgent ambulance response: expert consensus. Prehosp Emerg Care 2003;7:384- 91. [13] Peleg K, Plinskin JS. A geographic information system simulation model of EMS: reducing ambulance response time. Am J Emerg Med 2004;22:164- 70. [14] Pons PT, Haukoos JS, Bludworth W, et al. Paramedic response time: does it affect patient survival? Acad Emerg Med 2005;12:594- 600. [15] Vukmir RB. Survival from prehospital cardiac arrest is critically dependent upon response time. Resuscitation 2006;69:229- 34. M. Soares-Oliveira et al. 622