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75 VALIDATION OF EMS DISPATCH CODES ASSOCIATED WITH LOW- ACUITY PATIENTS Manish N. Shah, Paul Bishop, E. Brooke Lerner, Eric A. Davis, University of Rochester School of Medicine and Dentistry Objective: To prospectively validate the ability of EMS dispatch codes to identify patients with low-acuity illnesses, using patient need for only basic life support (BLS) care as a proxy for low illness acuity. Methods: This prospective cohort study was conducted in an urban city with a single advanced life support (ALS) level EMS provider. The 911 center was certified in using EMS dispatch protocols from Priority Medical Dispatch. Patients were included if they requested emergency assistance between July 2002 and June 2003 and they were assigned one of 28 previously derived low acuity EMS dispatch codes. Dispatch data, level of care actually provided, and disposition were obtained for each patient. For each low-acuity dispatch code, we used de- scriptive statistics to calculate the fraction of patients who received 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: EMS cared for 30,806 patients during the study period. 11,334 (36.5%) met inclusion criteria and 10,782 (95.1%) received BLS care. 22 of the 28 codes resulted in low-acuity care at least 90% of the time. The performance of selected low-acuity diagnoses include: 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/suicide attempt (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 confirms that most of the previously derived EMS dispatch codes do accurately identify patients who primarily require BLS level prehospital care, a proxy for low-acuity patients. These low- acuity codes can be used to triage EMS responses and EMS patients based upon dispatch information when using the Priority Medical Dispatch protocols and a certified 911 call center. 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 used by paramedics to assist them in deciding which patients need transport to an emergency department (ED) and which patients could be safely transported to an alternative health care facility. Unfortunately, the criteria to determine which patients need ambulance transport to the hospital, and which patients can safely receive care in some other fashion, has not been determined. It is thus imperative to determine these criteria and, once established, use these criteria to propose acceptable levels of undertriage rates for patients. Objective: To undertake a feasibility study to determine if prehospital criteria, including the Canadian Triage and Acuity Scale (CTAS) score, can predict patient disposition and/or neces- sity of transport to an emergency department. Methods: One hundred twenty-one (121) consecutive charts of patients arriving at the QEII Health Sciences Center Emergency Department by ambulance during March 2003 were re- viewed. Charts were excluded if they were completely blank, or were direct consults to other hospital services, thus bypassing ED care, or inter-facility transfers. The ambulance patient care reports (PCRs) were obtained for each cor- responding patient chart, and reviewed for the demographic, health, management and disposition criteria. Results: Using criteria agreed to prior to the study as to which patients needed to be seen in the emergency department, the percentages of CTAS 1, 2, 3, 4, and 5 patients requiring transport to the ED were 100%, 85.7%, 57.7%, 46%, and 20%, respectively. We did not look at the influence of age or sex. There was only one CTAS 1 patient and 5 CTAS 5 patients. Also, the CTAS score was the most frequent criterion not documented on the PCR. Conclusions: There was direct correlation between the CTAS score and the need for ED attendance. A larger study is planned after communication with the paramedics on the importance of CTAS documentation. 77 PATTERN OF EMS CALLS FOR ASSAULTS IN AN URBAN ENVIRONMENT Ronald Low, Yu-Feng Chan, Trevor Talbert, Keith McCabe, John Erickson, Karen Onufer, Tiffany Murano, Tamika Hibodeaux, UMDNJ Objective: To the extent that we can predict usage, we can plan for it. We studied whether EMS calls for assaults (other than rape) were related to external factors. Methods: Our service used the Clausen Priority Dispatch system. Retrospective review of computerized records was made to count the number of calls of assault, stabbing, and gunshot wound calls (04 and 06 series of patient conditions). Weather data were obtained from the National Weather Service. SAS9 was used for statistical analysis. Results: Over 1,342 days beginning on 1/1/2000, our service replied to 6,826 calls for assaults other than rape. The median number of calls/day was 5; the maximum was 19 and the minimum 0. ARIMA modeling showed a clear seasonal effect, with peaks in the summer (p = 0.0023). There is a clear day of the week effect with a higher volume on weekends (p = 0.0118). There is an independent increase of 0.125 calls for each 10-degree Celsius increase in temperature. Interestingly, we did not find a stat- istically significant effect of precipitation. Conclusion: EMS dispatches relatively more ambulances to respond to assaults on 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 patients suffering from allergic reactions. BLS and first responders are 106 PREHOSPITAL EMERGENCY CARE JANUARY /MARCH 2004 VOLUME 8/NUMBER 1

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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