Dean Stephen F
Department of Emergency Health Services, University of Maryland, Baltimore County, Baltimore, Maryland 21250, USA.
Prehosp Disaster Med. 2008 Mar-Apr;23(2):161-5. doi: 10.1017/s1049023x00005793.
Response time performance is related to increased survival for a relatively small group of patients with critical emergencies. Effectively utilizing current resources is a challenge for all emergency medical services (EMS) systems for reasons of cost-effectiveness and safety.
The objective of this study was to identify opportunities for improving ambulance response-time performance in an urban EMS system using fixed deployment.
This was a qualitative and quantitative case study which consisted of structured interviews with policy makers, managers, and workers in a fire department EMS division, as well as analysis of dispatch data and observation of dispatch operations.
The current computer-aided dispatch (CAD) system does not identify the closest ambulance to the emergency, and therefore, dispatchers must guess which unit is closer when units are not within their stations or "first due" areas. There is no means to track how often dispatchers guess correctly or how often the closest ambulance actually is dispatched to the emergency. Temporal and geographic patterns were identified. Opportunities also were identified to improve response time performance through the use of dynamic deployment and peak-load staffing.
The results suggest that there were opportunities for improving ambulance response times by implementing strategies such as peak-load staffing and dynamic deployment. However, the most important improvement would be the implementation of a policy to send the closest ambulance to the emergency. More research is needed to identify how prevalent the failure to send the closest ambulance is within EMS systems that use fixed-deployment response strategies and computer-aided dispatch systems that are incapable of tracking unit locations outside of their stations.
对于一小部分患有严重紧急情况的患者而言，响应时间表现与生存率的提高相关。出于成本效益和安全方面的考虑，有效利用现有资源对所有紧急医疗服务（EMS）系统来说都是一项挑战。
本研究的目的是确定在一个采用固定部署的城市EMS系统中，改善救护车响应时间表现的机会。
这是一项定性和定量的案例研究，包括对消防部门EMS部门的政策制定者、管理人员和工作人员进行结构化访谈，以及分析调度数据和观察调度操作。
当前的计算机辅助调度（CAD）系统无法识别距离紧急情况最近的救护车，因此，当各单位不在其站点或“第一响应”区域内时，调度员必须猜测哪个单位更近。没有办法追踪调度员猜对的频率，或者实际上距离最近的救护车被派往紧急情况的频率。确定了时间和地理模式。还确定了通过使用动态部署和高峰负荷人员配置来改善响应时间表现的机会。
结果表明，通过实施高峰负荷人员配置和动态部署等策略，有机会改善救护车响应时间。然而，最重要的改进将是实施一项政策，即派遣距离紧急情况最近的救护车。需要更多研究来确定在使用固定部署响应策略和无法追踪站点外单位位置的计算机辅助调度系统的EMS系统中，不派遣距离最近的救护车的情况有多普遍。
