The primary aim of theresearch was to determinewhether a motorcycle responsevehicle (MRV) could reduceresponse times and improveresuscitation outcomes inurban areas. The secondaryaim was to evaluate differencesin dispatch and transportbetween MRV and ambulances.
A non-randomised, prospective, cohort study wascarried out over seven monthsin the Dutch city of Utrechtwhich has a population of265 000. All calls classifed asurgent were included in thestudy if they occurred duringthe operating hours of the MRV(Monday–Friday 7:30–23:00and Saturday and Sunday10:00–18:00). There were someexclusion criteria including, for example, if the call camefrom outside the city limits;incomplete documentation ofresponse times etc.
Data pertaining todemographic information, presenting complaint, treatmentand transportation decisionswere collected throughinterrogation of the patients’Ambulance RegistrationRecords. Patient outcomeswere determined by examininghospital databases, and anysurvivors were followed for12 months after hospitaladmission.
There were 1842 emergencydispatches in the study period, but only 1664 were consideredprimary dispatches: MRVn=468, ambulance n=1196.
The demographics of thepatient groups were notidentical as there was a setof dispatch criteria for MRVswhich resulted in signifcantdifferences between the twogroups, which the authorsrecognize as a limitation of thestudy.
The MRV response timeswere signifcantly less thanambulance response times, showing a mean differenceof 54 seconds (CI: 76–33 sseconds). As a result, theMRVs were 30 % more likelythan ambulances to reach theircalls within 8 minutes (RiskRatio 1.29, CI: 1.16–1.43); butthere was almost no differencebetween MRVs and ambulancesin achieving the mandated15 minutes response timerequired by Dutch governmentguidelines.
In relation to resuscitationcases, the MRV arrived onscene more quickly (averagetime 5 min 11 s, with a rangeof 3 min 54 seconds–6 minutes29 s) than an ambulance(average 7 minutes 26 seconds, with a range of 5 minutes58 s–8 min 54 s), but this wasnot statistically signifcant(P=0.068). This decrease inresponse time is unlikelyto have a positive effect onpatient outcome except incases such as airway occlusion and cardiac arrest.
An examination of dataconcerning survival at oneyear for patients who requiredadvanced life support (ALS)interventions revealed that 89 %of MRV patients and 79 % ofambulance patients survived, which demonstrates a slightlyimproved outcome for the MRVgroup. Of patients resuscitatedsurvival in both groups waspoor and not signifcantlydifferent.
With regard to the secondaim of the study, the resultsindicate higher rates of treatand release or referral to ageneral practitioner withinthe MRV group, with only41.2 % of their patientsbeing referred to emergencydepartments (ED) comparedto 72.6 % of ambulance cases.One explanation for thisis that the dispatch criteriafor MRVs seemed to favourpatients presenting withcomplaints that may be lesslikely to need transportation, such as hyperventilation orhypoglycaemia.
However, even incomparable cases, patientsattended by MRVs were lessfrequently referred to EDthan patients attended byambulances. Van der Pols etal speculate that when anambulance attends, transportis available and therefore usedeven if the patient’s conditiondoes not require it, but theauthors recognize that thishypothesis would require further investigation.
The researchers identifyseveral limitations of thestudy including the absenceof randomization; restrictedoperating hours of the MRV;differences in the dispatchcriteria for the MRV; lownumbers of resuscitation events(MRV n=10; ambulance n= 25)which limits the conclusionsthat can be drawn aboutdifferences in patient outcomebetween the two responses.
Overall, the researchersidentify that MRVs havesignifcantly shorter responsetimes in congested urbansettings but, in this study, therewas limited impact on patientoutcome. The real beneftof these units seems to liein their increased fexibilityof response, possible costsavings when compared toproviding an ambulance, andthe potential for managing adifferent category of patientwhich may then releaseambulances to attend moresevere cases.