Requests for Prehospital Emergency Medical Services Increases

A 40% increase in requests for prehospital emergency medical services was observed over a 10-year period (2001-2010), according to results from a recent study [BMC Health Serv Res. 2014;14:380].

There has been a trend of increased requests for prehospital emergency medical services in Europe over the past 20 years, much of which can be explained by the growth and aging of the population, limited access to primary care physicians, and wider public awareness of specific health problems. However, little is known about the epidemiology and evolution of prehospital emergency medical services. Valérie Pittet, PhD, Lausanne University Hospital, Switzerland, and colleagues conducted a study to describe the time trends of all requests to prehospital emergency medical services in Switzerland.

Data were collected routinely and prospectively for each prehospital emergency medical services request in the Canton of Vaud, Switzerland, from January 2001 to December 2010. Primary interventions included onsite and at-home emergencies, and secondary interventions included urgent interhospital transfers. Primary interventions were further classified according to priority (P1, life-threatening; P2, health-threatening; and P3, nonemergency situations). Every emergency call created a record in the electronic decision-support system database. Identification numbers were assigned for actual interventions and regulation data were collected, including caller characteristics, chronological data, type of situation, prehospital emergency medical services resources engaged, and patient’s name, age, and gender.

The study’s results showed an increased number of calls to the emergency call center from 2001 to 2010, up from 21,160 calls in 2001 to 29,593 in 2010, which amounts to an almost 40% increase. Prehospital emergency medical services interventions also increased, with a rate per 1000 individuals increasing from 34 to 39, particularly among those 80 to 89 years of age (171 per 1000 in 2001 vs 214 in 2010) and those ≥90 years of age (259 per 1000 in 2001 vs 391 in 2010). Almost 40% of those requesting an intervention were <50 years of age, which decreased slightly over time (40.1% in 2001 vs 36.5% in 2010).

The intervention rate of prehospital emergency physicians ranged between 9 and 11 per 1000 individuals, with the highest rates occurring among those 80 to 89 years of age (38 per 1000 in 2001 vs 43 in 2010) and those ≥90 years of age (52 per 1000 in 2001 vs 59 in 2010).

Interventions were requested most for medical issues (66%), including unconsciousness, chest pain, or respiratory distress; 28% involved trauma. Interventions for medical diseases increased over time, particularly those requesting prehospital emergency physicians (71.1% in 2001 and 77.6% in 2010). More than half of prehospital emergency physician interventions involved cardiovascular pathologies and 25% were related to respiratory or thromboembolic pathologies.

The proportion of patients alive and out of the hospital after 48 hours remained stable over the study period, around 37%; this percentage was higher for patients with psychiatric issues. Overall survival after 48 hours also remained consistent, from 87.6% in 2001 to 89.2% in 2010, with the exception of cardiac arrests and myocardial infarction, which increased 10.6% and 6.9%, respectively.

The researchers acknowledged limitations, chiefly an inability to properly link all 3 databases used in the study. Better data matching would have enabled the researchers to determine appropriateness of use of ambulances and prehospital emergency physician interventions.—Mary Mihalovic