Prehospital risk assessment and patient outcome:a population based study in Northern Finland

• Main Author: Hoikka, M. (Marko)
• Other Authors: Ala-Kokko, T. (Tero), Silfvast, T. (Tom)
• Format: Doctoral or Postdoctoral Thesis
• Language: English
• Published: Oulun yliopisto 2018
• Subjects: Causes of Death; Diagnostic Test; Early Warning Score; Emergency Medical Dispatch; Emergency Medical Services; Hospital Admission; Triage; diagnostinen testi; ensihoitopalvelu; hätäkeskusjärjestelmä; kuolinsyyt; sairaala-admissio; varhaisen varoituksen pisteet; Kainuu; Northern Finland
• Online Access: http://urn.fi/urn:isbn:9789526221366

Abstract Emergency medical services (EMS) are designed to provide prompt response, on-scene treatment and transport for definitive care in patients with acute illness or injury. In recent years, the growing number of missions for non-urgent matters has challenged emergency care to design risk assessment protocols and tools to support decision-making and resource management at both dispatch and on-scene. The present study was designed to examine the efficacy of a criteria based dispatch protocol and National Early Warning Score (NEWS) in the Finnish EMS system. In addition, the aim of the research was to obtain data on patient allocation and mortality in the Northern Finnish population. The study data included 13,354 EMS missions from a six-month cohort (1.1.2014–30.6.2014) of prehospital emergency patients in two hospital districts — Kainuu and Länsi-Pohja — in Northern Finland, using a retrospective, observational design. Prehospital data including patient clinical physiological variables were combined with the national Finnish registries (Care Registry for Health Care, Intensive Care Consortium Database and Cause of Death Registry) in order to examine risk assessment in EMS and prehospital patient outcomes. Based on the result, the risk assessment at the dispatch was correct in 67.5% of the cases and four out of ten EMS missions did not lead to transportation by an ambulance. The use of the Finnish dispatch protocol resulted in an overall rate of 23% of over-triage and a 9% rate of under-triage. The highest NEWS category showed a good sensitivity for 1-day mortality but failed to adequately discriminate patients in need of intensive care or who died within 30-days in a large, unselected, typical EMS population. In conclusion, the criteria based dispatch protocol resulted in over-triage of a quarter of missions and in a significant rate of EMS missions without ambulance transportation. In addition, the predictive value of prehospital NEWS regarding the patient’s risk of death and need for intensive care was ...