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Transport outcomes and dispatch determinants in a paramedic long-term care program: a pilot study

Published online by Cambridge University Press:  04 March 2015

Jan L. Jensen ,
Andrew H. Travers ,
Darrell J. Bardua ,
Thomas Dobson ,
Bruce Cox ,
Jennifer McVey ,
Ed Cain ,
Robert Merchant  and
Alix J.E. Carter
Jan L. Jensen*
Affiliation:
Emergency Health Services and Division of Emergency Medical Services, Dalhousie University, Halifax, NS Division of Emergency Medical Services, Department of Emergency Medicine, Dalhousie University, Halifax, NS
Andrew H. Travers
Affiliation:
Emergency Health Services and Division of Emergency Medical Services, Dalhousie University, Halifax, NS Division of Emergency Medical Services, Department of Emergency Medicine, Dalhousie University, Halifax, NS Capital District Health Authority, Halifax, NS
Darrell J. Bardua
Affiliation:
Emergency Health Services and Division of Emergency Medical Services, Dalhousie University, Halifax, NS
Thomas Dobson
Affiliation:
Emergency Health Services and Division of Emergency Medical Services, Dalhousie University, Halifax, NS
Bruce Cox
Affiliation:
Emergency Health Services and Division of Emergency Medical Services, Dalhousie University, Halifax, NS
Jennifer McVey
Affiliation:
Emergency Health Services and Division of Emergency Medical Services, Dalhousie University, Halifax, NS Division of Emergency Medical Services, Department of Emergency Medicine, Dalhousie University, Halifax, NS Capital District Health Authority, Halifax, NS
Ed Cain
Affiliation:
Division of Emergency Medical Services, Department of Emergency Medicine, Dalhousie University, Halifax, NS Capital District Health Authority, Halifax, NS
Robert Merchant
Affiliation:
Emergency Health Services and Division of Emergency Medical Services, Dalhousie University, Halifax, NS
Alix J.E. Carter
Affiliation:
Emergency Health Services and Division of Emergency Medical Services, Dalhousie University, Halifax, NS Division of Emergency Medical Services, Department of Emergency Medicine, Dalhousie University, Halifax, NS Capital District Health Authority, Halifax, NS
*
Emergency Health Services and Division of Emergency Medical Services, Dalhousie University, 239 Brownlow Avenue, #300, Dartmouth, NS B3B 2B2; jan.jensen@emci.ca

Abstract

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Objectives:

Long-term care (LTC) patients are often sent to emergency departments (EDs) by ambulance. In this novel extended care paramedic (ECP) program, specially trained paramedics manage LTC patients on site. The objective of this pilot study was to describe the dispatch and disposition of LTC patients treated by ECPs and emergency paramedics.

Methods:

Data were collected from consecutive calls to 15 participating LTC facilities for 3 months. Dispatch determinants, transport rates, and relapse rates were described for LTC patients attended by ECPs or emergency paramedics. ECP involvement in end-of-life care was identified.

Results:

Of 238 eligible calls, 140 (59%) were attended by an ECP and 98 (41%) by emergency paramedics. Although the top three determinants were the same in each group, the overall distribution of dispatch determinants and acuity differed. In the ECP cohort, 98 of 140 (70%) were treated and released, 33 of 140 (24%) had “facilitated transfer” arranged by an ECP, and 9 of 140 (6%) were immediately transported to the ED by ambulance. In the emergency paramedic cohort, 77 of 98 (79%) were immediately transported to the ED and 21 of 98 (21%) were not transported. In the ECP group, 6 of 98 (6%) patients not transported triggered a 911 call within 48 hours for a related clinical reason, although none of the patients not transported by emergency paramedics relapsed.

Conclusion:

ECP involvement in LTC calls was found to reduce transports to the ED with a low rate of relapse. These pilot data generated hypotheses for future study, including determination of appropriate populations for ECP care and analysis of appropriate and safe nontransport.

Keywords

long-term carehealth servicesparamedics
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 4 , July 2013 , pp. 206 - 213
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

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