196 Comparing Response Times, Intensity of Care and Outcomes between Private versus Municipal Emergency Medical Services Systems

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Conference Proceeding

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Annals of emergency medicine


Study Objectives: The financial and oversight complexities associated with providing emergency medical services (EMS) in the United States ultimately led to the creation of both private and municipal-based EMS systems providing out-of-hospital medical care to our communities. For over four decades an emotional debate has spurned regarding which system can provide better coverage and quality of care to patients. Although there are many heated editorials and commentary papers on this topic, there is very little scientific research to support one method of delivery over the other. The primary objective of this study was to identify any quantitative differences in care between private and municipal EMS systems related to response times, intensity of services and patient outcomes.

Methods: This IRB approved retrospective chart review included all patients presenting to a 60 bed community Emergency Department (ED) via advanced life support (ALS) ambulance between Jan 1, 2017 and March 31, 2017. Our ED receives ambulance traffic from 9 EMS agencies (7 municipal, 2 private)who provide 911 coverage for approximately 20 square miles of suburban communities. Data were collected using the hospital’s electronic records and included patient age, emergency severity index score (ESI), out-of-hospital response and transport times, IVs started, fluids and medications given, airway interventions (oxygen delivery, CPAP, Intubation), cardiac monitoring, 12 lead EKGs, ED intubations, ED mortality, hospital mortality and ICU admission. Categorical data were summarized as counts and percentages, and continuous data as means with corresponding standard deviations. Between-group mean differences were compared by calculating t-tests for independent measures. Categorical data were compared using the chi-square test for association or Fisher’s exact test.

Results: A total of 769 patients were included into the study sample with 483 in the private EMS cohort and 286 in the municipal EMS cohort. A detailed breakdown of cohort demographics, out-of-hospital response times, intensity of services, outcomes and comparisons between these groups are displayed in Table 1. A p-value≥0.05 (two-tail) was considered statistically significant.

Conclusion: The current operating structure of providing EMS to our communities is based around the premise that there are no significant quality and safety differences between municipal and private EMS systems. It is therefore surprising to see so many statistically and potentially clinically significant differences between these two modes of EMS delivery. Municipal EMS agencies in our community were identified to provider faster care with more intense services in nearly every out-of-hospital time and intensity of care metric. Despite these differences, no outcome disparities were identified in regards to ED and hospital mortality, ICU admissions or ED intubations. Recognizing strengths and potential weakness related to these two systems is essential as we continue to minimize any disparities in care to our communities and maximize the benefits of mutual aid within our national EMS system.





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