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75 VALIDATION OF EMS DISPATCH CODES ASSOCIATED WITH LOW-
ACUITY PATIENTS Manish N. Shah, Paul Bishop, E. BrookeLerner, Eric A. Davis, University of Rochester School ofMedicine and Dentistry
Objective: To prospectively validate the ability of EMSdispatch codes to identify patients with low-acuity illnesses,using patient need for only basic life support (BLS) care asa proxy for low illness acuity. Methods: This prospectivecohort study was conducted in an urban city with a singleadvanced life support (ALS) level EMS provider. The 911center was certified in using EMS dispatch protocols fromPriority Medical Dispatch. Patients were included if theyrequested emergency assistance between July 2002 and June2003 and they were assigned one of 28 previously derivedlow acuity EMS dispatch codes. Dispatch data, level of careactually provided, and disposition were obtained for eachpatient. For each low-acuity dispatch code, we used de-scriptive statistics to calculate the fraction of patients whoreceived only BLS level care and the 95% confidence interval.We prospectively defined a low-acuity patient as an in-dividual who received only BLS level care. Results: EMScared for 30,806 patients during the study period. 11,334(36.5%) met inclusion criteria and 10,782 (95.1%) received BLScare. 22 of the 28 codes resulted in low-acuity care at least 90%of the time. The performance of selected low-acuity diagnosesinclude: abdominal pain (EMS dispatch code: 1A) 97.5% BLS,95% CI: 96.3%–98.4%; assault (4A) 98.4% BLS, 95% CI: 95.5%–99.7%; back pain (5A) 97.6% BLS, 95% CI: 95.7%–98.8%, falls(17A) 92.6% BLS, 95% CI: 90.6%–94.4%, eye problems (16A)100% BLS, 95% CI: 97.6%–100%; headache (18A) 95%BLS, 95% CI: 90%–98%; traumatic injuries (21A, 30A, 30B1)95.7% BLS, 95% CI: 94.3%–96.8%, abnormal behavior/suicideattempt (25A, 25B) 97.7% BLS, 95% CI: 97.1%–98.2%,pregnancy/miscarriage (24A, B, D) 92.7% BLS, 95% CI:90.8%–92.3%; and general illness (26A) 94.4% BLS, 95% CI:93.4%–95.3%. Conclusions: This validation study confirmsthat most of the previously derived EMS dispatch codes doaccurately identify patients who primarily require BLS levelprehospital care, a proxy for low-acuity patients. These low-acuity codes can be used to triage EMS responses and EMSpatients based upon dispatch information when using thePriority Medical Dispatch protocols and a certified 911 callcenter.
76 CAN PREHOSPITAL CRITERIA BE USED TO TRIAGE PATIENTS WHO
CALL 911 TO ALTERNATIVE HEALTH CARE FACILITIES? Ed J.Cain, Rick Lau, Emergency Health Services Nova Scotia
Background: The increased demand on emergency de-partments and excessive waits by patients are well publi-cized. There is interest in developing triage criteria to be usedby paramedics to assist them in deciding which patients needtransport to an emergency department (ED) and whichpatients could be safely transported to an alternative healthcare facility. Unfortunately, the criteria to determine whichpatients need ambulance transport to the hospital, and whichpatients can safely receive care in some other fashion, has notbeen determined. It is thus imperative to determine thesecriteria and, once established, use these criteria to propose
acceptable levels of undertriage rates for patients. Objective:To undertake a feasibility study to determine if prehospitalcriteria, including the Canadian Triage and Acuity Scale(CTAS) score, can predict patient disposition and/or neces-sity of transport to an emergency department. Methods: Onehundred twenty-one (121) consecutive charts of patientsarriving at the QEII Health Sciences Center EmergencyDepartment by ambulance during March 2003 were re-viewed. Charts were excluded if they were completely blank,or were direct consults to other hospital services, thusbypassing ED care, or inter-facility transfers. The ambulancepatient care reports (PCRs) were obtained for each cor-responding patient chart, and reviewed for the demographic,health, management and disposition criteria. Results: Usingcriteria agreed to prior to the study as to which patientsneeded to be seen in the emergency department, thepercentages of CTAS 1, 2, 3, 4, and 5 patients requiringtransport to the ED were 100%, 85.7%, 57.7%, 46%, and20%, respectively. We did not look at the influence of age orsex. There was only one CTAS 1 patient and 5 CTAS5 patients. Also, the CTAS score was the most frequentcriterion not documented on the PCR. Conclusions: Therewas direct correlation between the CTAS score and theneed for ED attendance. A larger study is planned aftercommunication with the paramedics on the importance ofCTAS documentation.
106 PREHOSPITAL EMERGENCY CARE JANUARY / MARCH 2004 VOLUME 8 / NUMBER 1
77 PATTERN OF EMS CALLS FOR ASSAULTS IN AN URBAN
ENVIRONMENT Ronald Low, Yu-Feng Chan, Trevor Talbert,Keith McCabe, John Erickson, Karen Onufer, TiffanyMurano, Tamika Hibodeaux, UMDNJ
Objective: To the extent that we can predict usage, we canplan for it. We studied whether EMS calls for assaults (otherthan rape) were related to external factors. Methods: Ourservice used the Clausen Priority Dispatch system.Retrospective review of computerized records was made tocount the number of calls of assault, stabbing, and gunshotwound calls (04 and 06 series of patient conditions). Weatherdata were obtained from the National Weather Service. SAS9was used for statistical analysis. Results: Over 1,342 daysbeginning on 1/1/2000, our service replied to 6,826 calls forassaults other than rape. The median number of calls/daywas 5; the maximum was 19 and the minimum 0. ARIMAmodeling showed a clear seasonal effect, with peaks in thesummer (p = 0.0023). There is a clear day of the week effectwith a higher volume on weekends (p = 0.0118). There is anindependent increase of 0.125 calls for each 10-degree Celsiusincrease in temperature. Interestingly, we did not find a stat-istically significant effect of precipitation. Conclusion: EMSdispatches relatively more ambulances to respond to assaultson weekends, during the summer, and on relatively hot days.
78 INCIDENCE OF EMS CALLS REQUIRING BLS ADMINISTRATION
of EPINEPHRINE FOR ACUTE ALLERGIC REACTIONS AND ANAPHY-
LAXIS E. David Bailey, Ross E. Megargel, Michael R.Schnyder, Robert E. O’Connor, Christiana Care Health System
Objective: EMS personnel are called to care for patientssuffering from allergic reactions. BLS and first responders are