References
The new Red 1 ambulance response time definition: evaluating clinical impact
Abstract
Rapid identification of patients with life-threatening conditions is the main priority for any ambulance telephone triage system. Historically there has been a focus on the identification of patients in cardiac arrest; however, the clinical benefits of early recognition of patients in peri-arrest could be considered equally important. An expanded definition of the highest priority response, Red 1, was introduced to identify patients who are critically unwell, at high risk of cardiac arrest, and who would benefit clinically from the fastest level of response from the ambulance service.
An evaluation of the impact of the new Red 1 definition was completed in South Western Ambulance Service NHS Foundation Trust during 2013. It demonstrated that the new Red 1 definition was more sensitive than the previous Red 1 definition in identifying patients in cardiac arrest and those at high risk of out-of-hospital cardiac arrest. The total number of patients who required resuscitation decreased by 11.7% under the new Red 1 definition, supporting the hypothesis that more patients are captured by the new Red 1 definition and a more rapid response diminishes their likelihood of experiencing a cardiac arrest.
The rapid identification of patients with life-threatening conditions is the primary function of any emergency medical service (EMS) dispatch system. The most time critical condition is cardiac arrest, and the relationship between a delay in commencing resuscitation and subsequent survival from out of hospital cardiac arrest (OHCA) is well documented (Perkins at al, 2012). Accurate identification of patients with life threatening conditions during the call triage process can facilitate a range of interventions shown to benefit survival rates. In addition to facilitating the provision of the fastest possible ambulance response, benefits include telephone instructions on cardiopulmonary resuscitation (CPR) and the promotion of community defibrillator use (O'Keeffe et al, 2011).
Peri-arrest is the recognised period occurring either just before, or just after, a full cardiac arrest. In a period of peri-arrest the patient's condition is very unstable and care must be taken to prevent progression or regression into a full cardiac arrest. Whilst appropriate ambulance dispatch to patients already in cardiac arrest is important, the clinical benefits of early recognition of patients in peri-arrest could be considered equally important. O'Keeffe et al (2011) conclude that this is at least as beneficial as a rapid response to patients who are already in cardiac arrest.
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