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Barriers to EMS System Evaluation: Problems Associated with Field Data Collection

Published online by Cambridge University Press:  17 February 2017

Daniel W. Spaite ,
Terence D. Valenzuela  and
Harvey W. Meislin
Daniel W. Spaite*
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, Ariz.
Terence D. Valenzuela
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, Ariz.
Harvey W. Meislin
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, Ariz.
*
Emergency Medicine, University of Arizona, 1501 N. Campbell, Tucson, AZ 85724, USA
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Extract

For more than two decades, emergency medical services (EMS) systems have proliferated primarily based upon governmental impetus and funding at the federal, state, and local levels. Although many of the foundations of patient care rendered in these systems have been based upon intuitive logic, the understanding of the impact on patient outcome is poor, at best. The reasons for the current status are varied, but five issues are preeminent:

1) The authority for the development of these medical systems has been based primarily in political and bureaucratic institutions which have little or no medical expertise;

2) Little attention has been paid to system evaluation, particularly in the area of cost-effectiveness;

3) Few academic medical institutions have become involved in EMS research;

4) Traditional approaches to medical research primarily are disease-specific and are not multidisciplinary. Thus these are not useful for evaluating and understanding the highly complex and uncontrolled environmental interactions that typify EMS systems; and

5) The process of efficiently and reliably collecting accurate data in the prehospital setting is extremely difficult.

Keywords

Emergency Medical ServicesEMSEvaluationEMS SystemsData CollectionDatabasesEfficacyCost-EffectivenessPerceptionsEstimatesData SourcesValidityCollaborationResourcesSystems Research
Type
Research Article
Information
Prehospital and Disaster Medicine , Volume 8 , supplement S1: Research in Prehospital Care Systems , March 1993 , pp. S35 - S40
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1993

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References

1. Braun, O, Turns, J, McCallion, R, et al: Necessity for objective evaluation of EMS system performance. Ann Emerg Med 1988; 17: 415. Abstract.Google Scholar
2. Braun, O, McCallion, R, Fazackerley, J: Characteristics of mid-sized urban EMS systems. Ann Emerg Med 1990; 19: 536–546.CrossRefGoogle Scholar
3. Spaite, DW, Joseph, M: Prehospital cricothyrotomy: An investigation of indications, technique, complications, and patient outcome. Ann Emerg Med 1990;19:279–285.CrossRefGoogle ScholarPubMed
4. Pointer, JE, Osur, M, Campbell, C, et al: The impact of standing orders on medication and skill selection, paramedic assessment, and hospital outcome: A follow-up report. Prehospital and Disaster Mediane 1991;6:303–308.CrossRefGoogle Scholar
5. Valenzuela, TD, Criss, EA, Spaite, DW, et al: Cost-effectiveness analysis of paramedic emergency medical services in the treatment of prehospital cardiopulmonary arrest. Ann Emerg Med 1990;19: 1407–1411.CrossRefGoogle ScholarPubMed
6. Shuster, M, Chong, J: Pharmacologic intervention in prehospital care: A critical appraisal. Ann Emerg Med 1989;18: 192–196.CrossRefGoogle ScholarPubMed
7. Dean, NC, Haug, PJ, Hawker, PJ: Effect of mobile paramedic units on outcome in patients with myocardial infarction. Ann Emerg Med 1988; 17:1034–1041.CrossRefGoogle ScholarPubMed
8. Pressley, JC, Severance, HW, Rancy, MP, et al: A comparison of paramedic versus basic emergency medical care of patients at high and low risk during acute myocardial infarction. J Am Coll Cardio 1988;12:1555–1561.CrossRefGoogle ScholarPubMed
9. Cohen, HC: Assessment of EMT-P medications used by Baltimore County Fire Department EMS supervisors/EMT,Ps. Prehospilal and Disaster Medicine 1990;5:19–24.CrossRefGoogle Scholar
10. Valenzuela, T, Criss, EA, Facter, K, et al: Medical versus regulatory necessity: Regulation of ambulance service in Arizona. J Emerg Med 1989;7:253–256.CrossRefGoogle ScholarPubMed
11. Spaite, DW, Valenzuela, TD, Meislin, HW, et al: Prospective validation of a new model for evaluating EMS systems by in-field observation of specific time intervals in prehospital care. Ann Emerg Med 1992;21:643. Abstract.Google Scholar
12. Saunders, CE: A computer simulation study of the effects of priority dispatch and lights and sirens operation on ambulance response time. Prehospital and Disaster Medicine 1992;7:S22. Abstract.Google Scholar
13. Saunders, CK, Amick, P, Applegarth, J: Analysis ol ambulance “response time” and Component intervals: Suggestions for standard definitions. Prehospital and Disaster Medicine 1991;6:382. Abstract.Google Scholar
14. Valenznela, TD, Criss, EA, et al: Computer modeling of EMS system performance. Ann Emerg Med 1990;19:898–901.CrossRefGoogle Scholar
15. Maio, RF, Burney, RK: Improving reliability of abstracted prehospital care data: Use of decision rules. Prehospital and Disaster Medicine 1991;6:15–20.CrossRefGoogle Scholar
16. Spaite, DW, Criss, EA, Valenzuela, TD, et al: A prospective evaluation of prehospital patient assessment by direct in-field observation: Failure of ALS personnel to measure vital signs. Prehospital Disaster Medicine 1990;5:325–334.CrossRefGoogle Scholar
17. Spaite, DW, Valenzuela, TD, Meislin, HW, Criss, VA, Ross, J: A prospective evaluation of the impact of initial Glasgow Coma Scale on prehospital treatment and transport of seizure patients. Prehospital and Disaster Medicine 1992;7: 19–24.CrossRefGoogle Scholar
18. Valenzuela, TD, Keelcy, KT, Criss, KA, et al: Implementation of a computerized prehospital management information system in an urban fire department. Ann Emerg Med 1989;18:573–578.CrossRefGoogle Scholar
19. Spaite, DW, Hanlon, T, Criss, EA, et al: Prehospital data entry compliance by paramedics after institution of a comprehensive EMS data collection tool. Ann Emerg Med 1990;19:1270–1278.CrossRefGoogle ScholarPubMed
20. Valenzuela, TD, Spaite, DW, Meislin, HW, et al: Emergency response intervals versus collapse to CPR and defibrillation intervals: Monitoring EMS system performance in sudden cardiac death. Ann Emerg Med 1992;21:648. Abstract.Google Scholar
21. Spaite, DW, Hanlon, T, Criss, EA, et al: Prehospital cardiac arrest: The impact of witnessed collapse and bystander CPR in a metropolitan EMS system with short response times. Ann Emerg Med 1990; 19: 1264–1269.CrossRefGoogle Scholar
22. Valenuela, TD, Spaite, DW, Meislin, HW, et al: Case and survival definitions in out-of-hospital cardiac arrest. JAMA 1992;267:272–274.CrossRefGoogle Scholar
23. Joyce, SM, Brown, DE: An optically scanned EMS reporting form and analysis system for statewide use: Development and five years, experience. Ann Emerg Med 1991;20:1325–1330.CrossRefGoogle ScholarPubMed
24. Joyce, SM, Criss, E: Guidelines for development of EMS reporting forms: Nationwide survey. Ann Emerg Med 1987;16: 508. Abstract.Google Scholar
25. Hedges, JR, Joyce, SM: Minimum data set for EMS report form: Historical development and future implications. Prehospital and Disaster Medicine 1990;5:383–388.CrossRefGoogle Scholar
26. Stewart, RD, Burgman, J, Cannon, GM, et al: A computerassisted quality assurance system for an emergency medical service. Ann Emerg Med 1985;14:25–29.CrossRefGoogle ScholarPubMed
27. Wiederhold, R: Integrated information management system. Prehospital and Disaster Medicine 1992;7:161–166.CrossRefGoogle ScholarPubMed
28. Valenzuela, TD, Criss, EA: Data collection and ambulance call report design. In Kuehl, AE (ed): EMS Medical Directors, Handbook. St. Louis, CV Mosby, 1989.Google Scholar
29. Polsky, SS: Medical record keeping. In Roush, RR (ed): Principles of KMS Systems. Dallas, American College of Emergency Physicians, 1989.Google Scholar
30. Herrman, N, Cayten, CG, Senior, J, et al: Interobserver and intraobserver reliability in the collection of emergency medical services data. Health Services Research 1980;15:127–143.Google Scholar
31. Cummins, RO, Chamberlain, DA, Abramson, NS, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: The Utstein style. Ann Emerg Mcd 1991;20:861–874.Google ScholarPubMed
32. Bell, JM, Moody, M, Wiles, CE, et al: Computer management of prehospital information. JEMS 1982;7:33–38.Google ScholarPubMed
33. Eisenberg, MS, Bergner, L, Hearne, T: Out-of-hospital cardiac arrest: A review of major studies and a proposed uniform reporting system. Am J Public Health 1980;70:236–240.CrossRefGoogle Scholar
34. Heller, MB, Melton, JB, Kaplan, RM, et al: Data collection by paramedics for prehospital research. Ann Emerg Med 1988;17:414–415. Abstract.Google Scholar
35. Steele, R: Development of a minimum data set for emergency medical services patient record keeping. July 1974; National Technical Information Service, PB243822.Google Scholar
36. Spaite, DW, Criss, EA, Valenzuela, TD, et al: Analysis of prehospital scene time and survival from out-of-hospital, non-traumatic cardiac arrest. Prehospital and Disaster Medicine 1991;6:21–28.CrossRefGoogle Scholar
37. Weaver, WD, Hill, D, Fahrenbruch, CE, et al: Use of the automatic external defibrillator in the management of out-of-hospital cardiac arrest. N Engl J Med 1988;319:661–666.CrossRefGoogle ScholarPubMed
38. Roth, R, Stewart, RD, Rogers, K, et al: Out-of-hospital cardiac arrest: Factors associated with survival. Ann Emerg Med 1984;13:237–243.CrossRefGoogle ScholarPubMed
39. Weaver, WD, Cobb, LA, Hallstrom, AP, et al: Considerations for improving survival from out-of-hospital cardiac arrest. Ann Emerg Med 1986;15:1181–1186.CrossRefGoogle ScholarPubMed
40. Eitel, DR, Walton, SL, Guerci, AD, et al: Out-of-hospital cardiac arrest: A six-year experience in a suburban-rural system. Ann Emerg Med 1988;17:808–812.CrossRefGoogle Scholar
41. Eisenberg, M, Hallstrom, A, Bergner, L: The ACLS score: Predicting survival from out-of-hospital cardiac arrest. JAMA 1981;246:50–52.CrossRefGoogle ScholarPubMed
42. Eisenberg, MS, Cummins, RO, Damon, S, et al: Survival rates from out-of-hospital cardiac arrest: Recommendations for uniform definitions and data to report. Ann Emerg Med 1990;19:1249–1259.CrossRefGoogle ScholarPubMed
43. Thompson, BM, Stueven, HA, Mateer, RJ, et al: Comparison of clinical CPR studies in Milwaukee and elsewhere in the United States. Ann Emerg Med 1985;14;750–754.CrossRefGoogle ScholarPubMed
44. Eisenberg, M, Bergner, L, Hallstrom, A: Paramedic programs out-of-hospital cardiac arrest: I. Factors associated with successful resuscitation. Am J Public Health 1979;69:30–38.CrossRefGoogle ScholarPubMed
45. Becker, LB, Ostrander, MP, Battett, J, et al: Outcome of CPR in a large metropolitan area- where are the survivors? Ann Emerg Med 1991;20:355–361.CrossRefGoogle Scholar
46. Campbell, JC, Gratton, MC, Robinson, WA: Meaningful response time interval: Is it an elusive dream? Ann Emerg Med 1991;20:433. Editorial.CrossRefGoogle ScholarPubMed
47. Campbell, JP, Gratton, MC, Salomone, JA, et al: Time-to patient interval: The hidden component of response time. Ann Emerg Med 1992;21:643. Abstract.Google Scholar
48. Jones, SE, Nesper, TP, Alcouloumre, E: Prehospital intravenous line placement: A prospective study. Ann Emerg Med 1989;18:244–246.CrossRefGoogle ScholarPubMed
49. Pons, PT, Moore, EE, Cusick, JM, et al: Prehospital venous access in an urban paramedic system - A prospective on-scene analysis. J Trauma 1988;28:1460–1463.CrossRefGoogle Scholar
50. Jurkovich, GJ, Campbell, LD, Padrta, J, et al: Paramedic perception of elapsed field time. J Trauma 1987;27:892–897.CrossRefGoogle ScholarPubMed
51. Valenzuela, TD, Wright, AL, Venkatraman, ES, et al: Collapse of CPR and defibrillation intervals in out-of-hospital sudden cardiac death: Ethical thresholds for prospective, randomized trials. Prehospital and Disaster Medicine 1992;7:S15. Abstract.Google Scholar
52. Spaite, DW, Criss, EA, Valenzuela, TD, et al: A prospective evaluation of prehospital patient assessment by direct in-field observation: Failure of ALS personnel to measure vital signs. Prehospital and Disaster Medicine 1990;5:325–334.CrossRefGoogle Scholar
53. U.S. Congress, Office of Technology Assessment, Rural Emergency Medical Services - Special Report, OTA-H-445. Washington, D.C.: U.S. Government Printing Office, 11, 1989.Google Scholar
54. Donovan, PJ, Cline, DM, Whitley, TW, et al: Prehospital care by EMTs and EMT-Is in a rural setting: Is the advancement of service justified? Ann Emerg Med 1988;17:415. Abstract.Google Scholar
55. Bowman, WD: The development and current status of wilderness prehospital emergency care in the United States. J Wilderness Med 1990;1:93–102.CrossRefGoogle Scholar
56. Mueller, BA, Rivara, FP, Bergman, AB: Urban-rural location and the risk of dying in a pedestrian-vehicle collision. J Trauma 1988;18:91–94.CrossRefGoogle Scholar
57. Valenzuela, TD, Spaite, DW, Meislin, HW, et al: Case and survival definitions in out-ofhospital cardiac arrest: Effect on survival rate calculation. JAMA 1992;267:272–275.CrossRefGoogle Scholar
58. Warnke, WJ, Bonnin, MJ: Direction and motivation of prehospital personnel to do research: How to do it better. Prehospital and Disaster Medicine 1992;7:79–83.CrossRefGoogle Scholar
59. Witte, MH, Kerwin, A, Witte, CL, et al: A curriculum on medical ignorance. Medical Educ 1989;23:24–29.CrossRefGoogle ScholarPubMed