References

Agresti A. Categorical data analysis, 3rd edn. Hoboken (NJ): John Wiley & Sons, Inc; 2013

Donabedian A. The quality of care. How can it be assessed?. JAMA. 1988; 260:(12)1743-1748 https://doi.org/10.1001/jama.260.12.1743

Donabedian A, Bashshur R. An introduction to quality assurance in health care.Oxford: Oxford University Press; 2003

El Sayed MJ. Measuring quality in emergency medical services: a review of clinical performance indicators. Emerg Med Int. 2012; 2012 https://doi.org/10.1155/2012/161630

Kim HY. Statistical notes for clinical researchers: chi-squared test and Fisher's exact test. Restor Dent Endod. 2017; 42:(2)152-155 https://doi.org/10.5395/rde.2017.42.2.152

Lights and siren use by emergency medical services (EMS): above all do no harm. 2017. https//tinyurl.com/3a9fwnnf (accessed 23 November 2021)

Musgrove LM. Swiss cheese model.Amenia (NY): Salem Press Encyclopedia; 2021

National EMS Information System. Data dictionary. 2020. https//tinyurl.com/axuw6aup (accessed 27 November 2021)

National Highway Traffic Safety Administration. EMS system demographics. 2014. https//tinyurl.com/spwzmak9 (accessed 23 November 2021)

NEMSIS Technical Assistance Center. NEMSIS 2019 user manual. 2020. https//tinyurl.com/4mu3w3jc (accessed 23 November 2021)

Newgard CD, Schmicker RH, Hedges JR Emergency medical services intervals and survival in trauma: assessment of the ‘golden hour’ in a North American prospective cohort. Ann Emerg Med. 2010; 55:(3)235-246.e4 https://doi.org/10.1016/j.annemergmed.2009.07.024

Office of EMS. What is EMS?. 2021. https//www.ems.gov/whatisems.html (accessed 12 November 2021)

Reichard AA, Marsh SM, Tonozzi TR, Konda S, Gormley MA. Occupational injuries and exposures among emergency medical services workers. Prehosp Emerg Care. 2017; 21:(4)420-431 https://doi.org/10.1080/10903127.2016.1274350

Rogers FB, Rittenhouse KJ, Gross BW. The golden hour in trauma: dogma or medical folklore?. Injury. 2015; 46:(4)525-527 https://doi.org/10.1016/j.injury.2014.08.043

Stein JE, Heiss K. The Swiss cheese model of adverse event occurrence—closing the holes. Semin Pediatr Surg. 2015; 24:(6)278-282 https://doi.org/10.1053/j.sempedsurg.2015.08.003

Watanabe BL, Patterson GS, Kempema JM, Magallanes O, Brown LH. Is use of warning lights and sirens associated with increased risk of ambulance crashes? A contemporary analysis using National EMS Information System (NEMSIS) data. Ann Emerg Med. 2019; 74:(1)101-109 https://doi.org/10.1016/j.annemergmed.2018.09.032

Weaver MD, Patterson PD, Fabio A, Moore CG, Freiberg MS, Songer TJ. An observational study of shift length, crew familiarity, and occupational injury and illness in emergency medical services workers. Occup Environ Med. 2015; 72:(11)798-804 https://doi.org/10.1136/oemed-2015-102966

service evaluation
patient care
injury
evidence
practice

Organisational structural predictors of ambulance crashes: an analysis

02 December 2021
Features
02 December 2021
Volume 13 · Issue 12

Abstract

Objective: This study investigated the association between three organisational structural factors—organisational type, organisation status (staffing model), and level of service—and ambulance crash rates. The null hypothesis was that there would be no difference in ambulance crash rates during response or transport between any of the three factors. Methods: A cross-sectional design with a sample drawn from the 2019 National Emergency Medical Services Information System dataset was used to examine the relationship between these systems-level factors and ambulance crashes. After applying inclusion criteria, a sample of 2207 cases was drawn and analysed using the χ2 test of association and multiple logistic regression. Results: There was a statistically significant but small association between level of service and ambulance crashes during transport, using the χ2 test of association (P<0.05). Emergency medical technician (EMT)-level services had lower crash rates and paramedic-level services had higher rates than expected. There was no statistically significant association between organisational type or organisational status and ambulance crashes during either the response or transport phase of an emergency medical service (EMS) call, using the χ2 test of association (P>0.05). Of the two logistic regression models performed, only EMT-level services had a statistically significant association with ambulance crashes during transport (P<0.05; OR 0.208 [0.050, 0.866]). Conclusion: The organisational structural factors examined in this study failed to explain most of the variance in ambulance crash rates. However, EMT-level services were associated with lower rates of ambulance crashes than paramedic level services. EMS healthcare administrators and researchers should continue to explore potentially modifiable factors to reduce the incidence of these events and promote positive social change by reducing the risk of injury to patients, EMS workers and the public at large.

Emergency medical services (EMS) is a healthcare specialty concerned with delivering prehospital emergency medical care and transporting patients to the hospital for further care (Office of EMS, 2021). In the United States, EMS workers include emergency medical technicians (EMTs), paramedics and others who work in fire departments, hospitals, non-fire-based governmental agencies, private companies and tribal departments. The EMS workforce of any of these organisations may be paid, volunteer or a mix of the two.

When responding to a scene of injury or illness and when transporting patients to the hospital, EMS workers often use lights and sirens (L&S) to signal traffic to yield to them to expedite their transit. Industry practice prioritises the rapid transport of patients to the hospital, based on the golden hour concept, attributed to R Adams Cowley, the founder of Baltimore's Shock Trauma Institute (Rogers et al, 2015). Cowley asserted that a trauma patient has the best chance of survival if they receive definitive care within 60 minutes of injury. This concept has led to an emphasis on rapid response and transport of trauma patients by EMS agencies, despite a lack of evidence supporting this (Newgard et al, 2010).

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Emergency medical service
Ambulance
Crash
Donabedian model
Organisational factors