Emergency medical services (EMS) administrators consistently attempt to improve system performance through innovative methods and technologies. The emergency medical response system is a complex network consisting of multiple elements, each with unique structures that can be examined, analyzed, and improved if deficiencies are discovered. A commonly scrutinized factor by involved stakeholders such as administrators, politicians, and the public is the response time it takes for medical care to arrive from the time that a call was received. EMS systems depending on their characteristics and elements, have varying response intervals and times. The time it takes for EMS to arrive in the hospital is known as the pre-hospital stage, which consists of multiple time periods. Studies usually split the pre-hospital stage of response into four unique time periods, which include activation, response, on-scene, and transport intervals (Khorasani-Zavareh, Mohammadi & Bohm 2018).
The activation interval describes the time when the emergency call is placed to the dispatch of the ambulance vehicle. The response interval encompasses the travel time from ambulance dispatch to arrival at the scene. The on-scene arrival interval covers the time spent at the location, beginning with arrival until the ambulance departs for the hospital. The transport interval is the time spent en route, departing from the scene to arrival at the medical facility. The four separate time intervals combined produce the total pre-hospital period, which begins with the emergency call and ends with arrival at the hospital.
The importance of quick response time is due to the need for care for patients with urgent conditions such as a stroke or heart attack, where early treatment can be potentially lifesaving. While the international cardiovascular health organizations do not establish a specific time for response, it is recommended that EMS systems attempt to reach a shocking time of 8 to 10 minutes from collapse, with defibrillation performed within 5 minutes. This provides the maximum potential for successful cardiac and cerebral resuscitation, with increased response times associated with decreased odds of 1-month neurological intact survival, with statistical chances falling with each 1-minute passing without aid (Goto, Funada & Goto, 2018). In order to decrease the time from the onset of illness or injury to the arrival of medical care, significant EMS resources need to be expended, including but not limited to communication systems, ambulances, equipment, and healthcare personnel.
According to the World Health Organization (WHO) guidelines, an ideal EMS response time should be less than 8 minutes (Noguiera, Pinto & Silva 2016). Response time can depend on secondary outcomes outside the primary ambulance pre-hospital time metrics. These can include average ambulance response interval and out-of-service interval, which is the period an ambulance cannot respond to another incident (Lawner et al., 2016). Furthermore, Vile et al. (2016) notes that ambulance response times are an essential element of WEST’s Key Performance Indicators (KPIs) which provide a competent indication of the quality and timeliness of care offered by the emergency health provider.
The modern ambulance management process benefits from the guidance of advanced information technologies. The technologies encompass road network surveillance, vehicle positioning systems, geographical information systems (GIS), and artificial intelligence systems screening and directing calls (Becknell & Simon 2016). In a well-structured EMS operation, the technology systems should be fully integrated and incorporated within the ambulance relocation module for greater efficiency. However, technology is often viewed as a non-reimbursable expense that must be paid for with limited funds. Despite incentives from governments, technology is being implemented slowly into EMS. The primary strategy for EMS providers is to engage in meaningful use of information technology and its promotion in the EMS continuum of care. In the future, telecommunications and digital technology can serve a role in service delivery to non-urgent patients, greatly reducing the load on existing infrastructure and networks and leading to improved response times. However, to achieve this, digital architecture and services must be developed with consideration of mobile technology and appropriate level of response which could support multiple EMS service delivery models and facilitate real-time data-based decision-making (Schooley & Horan 2015).
From a health and economics perspective, urban emergency medical services should operate a variety of vehicle types on a consistent basis. This approach has been shown to improve global system performance when dealing with trauma and cardiac cases. Emergency medical services commonly work with distinct providers, each offering various options and capabilities, the most basic of which are basic life support (BLS) units and advanced life support (ALS) units, which may be dispatched to a scene of an incident at different time standards. For example, some jurisdictions in the United States maintain BLS services through firemen trained as paramedics as fire engines are usually first to arrive at the scene. In turn, ALS is ensured by ambulances that arrive based on need, with the majority of calls served by one vehicle unless more is necessary. There are distinct differences between EMS operations of ambulances and those of fire and police departments. Unlike other services, ambulances are not always based in a facility or permanent location, positioned in rudimentary locations such as a parking lot, and constantly relocated to ensure competent coverage. Although ambulances do not engage in patrol, they may be redirected to other calls based on the seriousness and emergency of the situation.
A variety of research has been conducted on the importance of time in EMS. Examining the relationship between hospital proximity and road traffic accident mortality rates, it was found that incidents without an emergency department or trauma center within a reasonable boundary demonstrated higher fatalities after controlling for other factors. Response time is an accurate parameter to evaluate the accessibility of EMS care as it is a critical factor in determining victim survivability and a chance of recovery (El Sayed et al., 2017). Globally, this indicator is quantified and tracked due to its relevance in evaluating the quality of care and service. There are certain guidelines in English cities with more than one million residents. In 75% of cases under the critical Category A Red 1 calls for patients without a pulse or not breathing, 8 minutes are allotted for a response. An additional 60 seconds is given for Category A Red 2, which is the code for strokes or fits. As a secondary performance target that is applied, 95% of all life-threatening cases must be responded to within 19 minutes, while countries like the Netherlands establish a standard response time of 30 minutes for patient transport and 15 minutes for emergencies (Reuter-Oppermann, van den Berg & Vile 2017).
Some countries, such as Australia, regulate emergency medical services through state governments, and there are no official national standards. Incidents are categorized by level of urgency, and ambulances respond according to codes such as code 1 emergency, code 2 urgent, and the non-emergency codes 3 and 4 (Productivity Commission 2018). There is no federal tracking or standards of ambulance response times in Australia, with average times ranging from 14.3 to 31.4 minutes depending on the incident. In some areas such as New South Wales, the median response time was as low as 7.47 minutes in 2016-2017. However, such figures only apply to approximately 50% of ambulances, implying that response times can be much higher, particularly for urgent calls. Federal standards such as the USA EMS Act establish a response time for 95% of emergency calls of 10 minutes in urban areas and 30 minutes in rural areas (Hsia et al., 2018).
Meanwhile, the United Arab Emirates (UAE) has an interesting social and legal dynamic in regard to emergency aid. There is no stand-alone ‘Good Samaritan’ law, but a Fatwa issued in 2010 by the General Authority of Islamic Affairs & Endowments allows to provide first aid in accordance with Sharia law without criminal liability when providing help to someone in need (Batt, Al-Hajeri & Cummins 2016). Saudi Arabia has two primary ambulance services â ALS and BLS. The ALS units are staffed with paramedics who have the qualifications for invasive procedures to be conducted in an ambulance to preserve a patient’s life until arrival at a hospital (Mutairi et al., 2016). Saudi Arabia also has no national standards or guidelines for local agencies. While international standards are commonly applied in research and practice, the average response time in the capital of Riyadh is 13 minutes (Alnemer et al., 2016).
In practice, this suggests that rural areas may have much higher response times, particularly in regions with little resident concentration outside the urban areas due to lower ambulance availability and fewer medical facilities. In more densely populated areas such as Seoul, South Korea, the average response time are 7.3 minutes and a median of 7 minutes, with a travel time of 5.5 and 5 minutes, respectively. Travel time encompasses 75% of the total response time. Cumulative distribution demonstrates that 62% of emergency calls met the 5-minute travel time standard established by the Ministry of Security and Public Administration (Cho, You & Yoon 2015).
In conclusion, official standards for response times for emergency care and EMS operations are only present in some jurisdictions such as the United States, South Korea, and the UK. The literature demonstrates that the countries with formal standards generally have lower response times in comparison to Saudi Arabia and Australia, which lack them, suggesting a correlation between the existence of standards and EMS system performance. At the same time, the better performance indicators of these EMS systems may also depend on factors such as better capacity and technology. Furthermore, factors such as the density of the residential population should also be considered. Nevertheless, research demonstrates that there is potential for improvement in Saudi Araba and Australia to meet international standards (Alnemer et al., 2016). There are significant and numerous benefits to improving response times at a national level in terms of health promotion, reducing geographical health disparities, and lowering fatality rates while improving a chance at recovery for urgent care patients. To achieve these objectives, it is vital to adopt comprehensive and formal standards of EMS operations and ambulance response time while providing a modern and robust network of support, vehicles, and technology for the improvement of emergency management capabilities.
Reference List
Alnemer, K, Al-Qumaizi, KI, Almener, A, Alsayegh, A, Alqahtani, A, Alrefaie, Y, Alkhalifa, M & Alhariri, A 2016, âAmbulance response time to cardiac emergencies in Riyadhâ, Imam Journal of Applied Sciences, vol. 1, no. 1, pp. 33-38.
Batt, AM, Al-Hajeri, AS & Cummins, FH 2016, âA profile of out-of-hospital cardiac arrests in Northern Emirates, United Arab Emiratesâ, Saudi Medical Journal, vol. 37, no. 11, pp. 1206-1213.
Becknell J & Simon L 2016, Beyond EMS data collection: envisioning an information-driven future for emergency medical services, Web.
Cho, J, You, M & Yoon, Y 2017, âCharacterizing the influence of transportation infrastructure on emergency medical services (EMS) in urban areaâa case study of Seoul, South Koreaâ, PloS One, vol. 12, no. 8, pp. 1-12.
El Sayed M, Al Assad R, Abi Aad Y, Gharios N, Refaat MM & Tamim H 2017. âMeasuring the impact of emergency medical services (EMS) on out-of-hospital cardiac arrest survival in a developing country: A key metric for EMS systems’ performanceâ, Medicine (Baltimore), vol. 96, no. 29, pp. 1-7
Goto, Y, Funada, A & Goto, Y 2018, âRelationship between emergency medical services response time and bystander intervention in patients with outâofâhospital cardiac arrestâ, Journal of the American Heart Association, vol. 7, no. 9, pp. 1-19.
Hsia, RY, Huang, D, Mann, NC, Colwell, C, Mercer, MP, Dai, M & Niedzwiecki, MJ, 2018, âA US national study of the association between income and ambulance response time in cardiac arrestâ, JAMA Network Open, vol. 1, no. 7, pp. 1-13.
Khorasani-Zavareh, D, Mohammadi, R & Bohm, K 2018, âFactors influencing pre-hospital care time intervals in Iran: a qualitative studyâ, Journal of Injury and Violence Research, vol. 10, no. 2, pp. 83-90.
Lawner, BJ, Hirshon, JM, Comer, AC, Nable, JV, Kelly, J, Alcorta, RL, Pimentel, L, Tupe, CL, Vanhoy, MA & Browne, BJ 2016, âThe impact of a freestanding ED on a regional emergency medical services systemâ, The American Journal of Emergency Medicine, vol. 34, no. 8, pp. 1342-1346.
Mutairi, MA, Jawadi, A, Harthy, NA, Enezi, FA, Jerian, NA, Qahtani, AA, Harbi, AA & Anazi, AA 2016, âEmergency medical service system in the Kingdom of Saudi Arabiaâ, Journal of Medical Science and Medical Research, vol. 4, no. 10, pp. 13084-13092.
Noguiera, LC, Pinto, LR & Silva, PMS 2016, âReducing emergency medical service response time via the reallocation of ambulance basesâ, Health Care Management Science, vol. 19, no. 1, pp. 31-42.
Productivity Commission 2018, Chapter 11 ambulance services, Web.
Reuter-Opperman, M, van den Berg, PL & Vile, JL 2017, âLogistics for emergency medical service systemsâ, Health Systems, pp. 1-22.
Schooley B & Horan TA 2015, Emerging digital technologies in emergency medical services: considerations and strategies to strengthen the continuum of care, Web.
Vile, JL, Gillard, JW, Harper, PR & Knight, VA 2016, âTime-dependent stochastic methods for managing and scheduling emergency medical servicesâ, Operations Research for Health Care, vol. 8, pp. 42-52.