An Evaluation of Emergency Medical Dispatch System in Taipei

• Main Authors: Ming-Tai Cheng, 鄭銘泰
• Other Authors: Tung-Liang Chiang
• Format: Others
• Language: zh-TW
• Published: 2011
• Online Access: http://ndltd.ncl.edu.tw/handle/11400385166973866872

碩士 === 國立臺灣大學 === 公共衛生碩士學位學程 === 99 === Background: The implementation of the pre-hospital advanced life support (ALS) measures, such as advanced airway management, defibrillation and intravenous drugs administration, has been shown to reduce the mortality and morbidity to the critical causalities. However, the ALS services require more medical and social resources in both training and the equipment. The two-tiered EMS system took place since April 1999 in Taipei. According to the last study of 2000 in Taipei, the appropriateness of our EMS dispatch was suboptimal. Compared with the previous international studies, the last study showed similar under-triage rate but much higher over-triage rate. Over-triage of ALS dispatch may result in resource-wasting and delaying the cases that actually require ALS services. In July 2006, the computerized medical priority dispatch system was conducted to improve the efficiency of the EMS dispatch in Taipei. Objective: The first part of this study is sought to determine that ALS demand and the appropriateness after several years of the two-tiered EMS system implemented in Taipei, whether or not the computerized dispatch system improved the appropriateness of the EMS dispatch. The second part of study is try to use the computer program of the system to access and record the time periods during each stage of dispatch to check the compliance of dispatchers. Method: A retrospective, cross-sectional analysis of the EMS records of Taipei City Fire Department from January 2005 to December 2008 was conducted. Stratified random sampling of all EMS records in the second week of January, April, July and October of 2005 and 2008 were obtained. Retrospective ALS demand criteria, including the chief complaints, mechanisms of injury/illness, initial vital signs and types of care rendered, were developed to estimate the rate of ALS demand. ALS demand is expressed as the percentage of cases fulfilling ALS criteria over the total number of EMS cases. Appropriate ALS dispatches were those ALS dispatches determined as fulfilling the ALS demand criteria. Results: In the first part of study, 7594 and 8279 EMS cases were retrieved from year 2005 and 2008 database according to the sampling method. 664 (8.74%) and 745 (9%) cases were fulfilled the ALS criteria. Among the two groups, ALS demands were all higher in the cold climates and morning/evening rush hours. The characters of ALS demands between year 2005 and 2008 were similar but true ALS level procedures such as tracheal intubation were performed more often in 2008 (P<0.0001). Actually ALS dispatches were 232 (3.06%) and 213 (2.57%) of sampled EMS calls. Deducting ambulance non-transport and incomplete record cases, the proper triage rate (ALS dispatched to ALS cases) was 67.52% and 95%; and the over-triage rate (ALS dispatched to non-ALS cases) were 32.48% and 5%. The proper triage rate and over-triage rate were significant improved in year 2008(P<0.0001). However, the under-triage rate was not improved (around 10% both) and ALS non-transport rate was significant higher in 2008 (32.33% vs. 43.66%, P=0.0146). In the second part of study, 45660 cases were downloaded from the computer system but failure to determine the compliance of dispatchers. Conclusion: No significant change of ALS demands were found before and after computerized medical priority dispatch system conducted but proper triage rate, over-triage rate were significant better. However, the under-triage rate and non-transport rate were not improved. The compliance of dispatchers was also failure to determine. Further studies for accuracy improvement of dispatch codes and the compliance of dispatchers are recommended.