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Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
The evolving prehospital care: a 12-year retrospective analysis.
Helena Johansson1,2,3, Daniel Wilhelms4,5, Jens Wretborn4,5
1Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. helena.a.johansson@liu.se.
Summary
Emergency medical services (EMS) patients are increasingly presenting with higher acuity, leading to a greater proportion of hospital admissions. This shift indicates a changing role for EMS in prehospital clinical assessment and disposition.
Area of Science:
- Prehospital Care
- Emergency Medicine
- Health Services Research
Background:
- Limited longitudinal, population-level studies exist on Emergency Medical Services (EMS) patient populations.
- EMS serves as a critical interface between prehospital care and hospital-based services.
- Understanding trends in EMS demand, triage, and outcomes is vital for healthcare planning.
Purpose of the Study:
- To characterize temporal trends in EMS demand, triage acuity, hospital admission, and short-term mortality.
- To analyze changes in EMS patient populations transported to emergency departments (EDs) in a Swedish healthcare system.
- To assess the evolving role of EMS in prehospital patient management from 2011 to 2022.
Main Methods:
- Retrospective, population-based study of primary EMS assignments in Region Östergötland, Sweden (2011-2022).
- Utilized linked electronic health records for EMS, ED, and inpatient care data.
- Triage acuity assessed using the Rapid Emergency Triage and Treatment System (RETTS); temporal trends analyzed with regression models.
Main Results:
- Triage acuity significantly shifted towards higher severity categories (acuity 1 & 2 increased from 32% to 57%).
- Non-transport dispositions increased fivefold (5% to 25%), while hospital admission rates for transported patients remained stable (~50%).
- EMS patients' share of ED-originating hospital admissions rose from 42% to 57%; short-term mortality was stable.
Conclusions:
- EMS patients exhibit progressively higher triage acuity and represent an increasing proportion of hospital admissions.
- A significant rise in non-transport dispositions suggests a shift towards field-based clinical assessment by EMS.
- Findings impact EMS resource planning, triage system evaluation, and hospital capacity management.
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