Mechem C Crawford, Yates Crystal A, Rush Maureen S, Alleyne Arturo, Singleton H Jay, Boyle Tabitha L
Prehosp Emerg Care. 2020 May-Jun;24(3):378-384. doi: 10.1080/10903127.2019.1657212. Epub 2019 Sep 16.
Faced with increasing demand for their services, Emergency Medical Services (EMS) agencies must find more efficient ways to use their limited resources. This includes moving beyond the traditional response and transport model. Alternative Response Units (ARUs) are one way to meet the prehospital medical needs of some members of the public while reducing ambulance transports. They are non-transport vehicles tasked with very specific medical missions. These can include acute management of low-acuity complaints, ongoing home care for chronic medical conditions, preventive medicine, and post-hospital discharge follow-up visits. Their focus can be tailored to the individual needs of the agency. The Philadelphia Fire Department (PFD) operates one of the busiest EMS systems in the country. It has added additional staff and ambulances in recent years yet continues to face an increasing call volume. In an effort to reduce ambulance transports, the PFD recently introduced two ARUs. The first unit, AR-1, is deployed on a university campus and responds to students with low acuity medical complaints or mild alcohol intoxication. It provides many of these a courtesy ride to one of two university emergency departments for further evaluation, eliminating the need for ambulance transport. The second unit, AR-2, works in an area heavily impacted by the opioid crisis. It responds to individuals who have overdosed, been revived with naloxone, and refuse ambulance transport but are interested in long-term treatment for their opioid use disorder. The staff of AR-2 has successfully placed some of these individuals in treatment programs the same day. The AR-1 program is financially supported by the university while AR-2 is funded by the PFD and a federal grant. Both have the potential to decrease ambulance transports or reduce 9-1-1 calls. Whether these or other ARU programs can be financially sustained long-term is unclear. It is also unknown if ARUs represent a better investment than using the money to purchase additional transport vehicles. However, as health care evolves, EMS must innovate and adapt so it can continue to meet the prehospital needs of the public in a timely and cost-effective manner.
面对对其服务日益增长的需求，紧急医疗服务（EMS）机构必须找到更有效的方法来利用其有限的资源。这包括超越传统的响应和运输模式。替代响应单位（ARU）是满足部分公众院前医疗需求同时减少救护车运输的一种方式。它们是承担非常特定医疗任务的非运输车辆。这些任务可以包括对低急症投诉的急性处理、对慢性疾病的持续家庭护理、预防医学以及出院后随访。其重点可以根据机构的个体需求进行调整。费城消防局（PFD）运营着美国最繁忙的EMS系统之一。近年来它增加了额外的工作人员和救护车，但仍面临不断增加的呼叫量。为了减少救护车运输，PFD最近引入了两个ARU。第一个单位，AR - 1，部署在大学校园，应对有低急症医疗投诉或轻度酒精中毒的学生。它为其中许多人提供免费乘车服务，将他们送到两个大学急诊科之一进行进一步评估，从而无需救护车运输。第二个单位，AR - 2，在受阿片类药物危机严重影响的地区工作。它响应过量用药、已用纳洛酮复苏、拒绝救护车运输但对其阿片类药物使用障碍进行长期治疗感兴趣的个人。AR - 2的工作人员已成功在同一天将其中一些人安置到治疗项目中。AR - 1项目由大学提供资金支持，而AR - 2由PFD和一项联邦拨款资助。两者都有可能减少救护车运输或减少911呼叫。这些或其他ARU项目能否长期在经济上维持尚不清楚。也不清楚ARU是否比用这笔钱购买额外的运输车辆是更好的投资。然而，随着医疗保健的发展，EMS必须进行创新和适应，以便能够继续及时且经济高效地满足公众的院前需求。
