Lack of association between prehospital response times and patient outcomes

Thomas H. Blackwell, Jeffrey Kline, J. Jeffrey Willis, G. Monroe Hicks

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background. Limited data exist that examine the relationship between prehospital response times (RTs) and improved patient outcomes. Objective. We tested the hypothesis that patient outcomes do not differ substantially based on an explicitly chosen advanced life support (ALS) RT upper limit of 10 minutes 59 seconds (10:59 minutes). Methods. This case-control retrospective study was conducted in a metropolitan county with a population of 750,000 for the calendar year 2004. The emergency medical services (EMS) system is a single-tiered, ALS paramedic service that includes basic life support (BLS) first responders. The 90% fractile RT specification required by contractual agreement is 10:59 minutes or less for emergency, life-threatening (Priority 1) calls. Cases (study patients), defined as Priority 1 transports with RTs exceeding 10:59 minutes, were compared with controls, which comprised a random sample of Priority 1 calls with RTs of 10:59 minutes or less. Prehospital run reports and hospital outcomes were evaluated using explicit criteria by one observer for the primary outcome of in-hospital death and secondary outcomes of critical interventions performed in the field. We tested the hypothesis of equivalence using the 95% confidence intervals (CIs) for difference in proportions with α = 0.05 and β = 0.2 to show Δ = ±5%. Results. Of the 3,270 emergency transports in 2004, we identified 373 study patients (RT > 10:59 min) and a random sample of 373 controls (RT ≤ 10:59 min). Survival to hospital discharge was 80% (76% to 84%) for study patients vs. 82% (77% to 85%) for controls, yielding a 95% CI for the difference of -6 to +4%. ALS procedures were performed in 47.7% (95% CI: 43% to 53%) of study patients vs. 45.4% (40% to 51%) of controls (95% difference in proportions -10 to +5%). The most frequently performed procedures were administration of nitroglycerine and endotracheal intubation. Conclusions. Compared with patients who wait 10:59 minutes or less for ALS response, Priority 1 patients who wait longer than 10:59 minutes could experience between a 6% increase and a 4% decrease in mortality, and do not have an increase in critical procedures performed in the field. Our data are most consistent with the inference that neither the mortality nor the frequency of critical procedural interventions varies substantially based on this prespecified ALS RT.

Original languageEnglish (US)
Pages (from-to)444-450
Number of pages7
JournalPrehospital Emergency Care
Volume13
Issue number4
DOIs
StatePublished - 2009
Externally publishedYes

Fingerprint

Reaction Time
Confidence Intervals
Emergencies
Allied Health Personnel
Intratracheal Intubation
Mortality
Nitroglycerin
Emergency Medical Services
Case-Control Studies
Retrospective Studies
Survival
Population

Keywords

  • Ambulances
  • Eaction time
  • Emergency medical services
  • Outcome assessment (health care)
  • Prehospital

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Lack of association between prehospital response times and patient outcomes. / Blackwell, Thomas H.; Kline, Jeffrey; Willis, J. Jeffrey; Hicks, G. Monroe.

In: Prehospital Emergency Care, Vol. 13, No. 4, 2009, p. 444-450.

Research output: Contribution to journalArticle

Blackwell, Thomas H. ; Kline, Jeffrey ; Willis, J. Jeffrey ; Hicks, G. Monroe. / Lack of association between prehospital response times and patient outcomes. In: Prehospital Emergency Care. 2009 ; Vol. 13, No. 4. pp. 444-450.
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