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EBHPME 2023, 7(1): 51-58 |
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Pakdaman M, Askari R, Dehghan A, Pahlavanpoor S, Nikafshan A. Evaluation of the Consequences and Costs of the Anglo-American System in the Pre-Hospital Emergency Department of Yazd in 2018. EBHPME 2023; 7 (1) :51-58
URL: http://jebhpme.ssu.ac.ir/article-1-415-en.html
URL: http://jebhpme.ssu.ac.ir/article-1-415-en.html
Health Policy and Management Research Center, Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran , Nikanjan115@gmail.com
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A B S T R A C T
Background: One of the most important tasks of health care managers is allocateing resources, controling them and ensuring their effective use when available. This study examines the consequences and costs of emergency services in Yazd in 2018.
Methods: This was a descriptive-analytical study performed on patients of 11 centers in Yazd in 2018. The population of the city was approximately 750,000 in 2018 (1). Direct and indirect costs were extracted, and the consequences and costs of Yazd emergency in 2018 were calculated in riyal and Dollars.
Results: This study showed that in 2018, out of 173154 contacts, 37988 cases led to the dispatch of an ambulance, and the response rate was 18 %. The rate of hospitalization was 52 %. The average time of dispatch in Yazd pre-hospital emergency department was (10:48) in 2018. Of the 59 high-risk patients who were transported to Yazd's pre-hospital emergency in 2018, 5 patients had successful cardiopulmonary resuscitation(discharge from the hospital). In other words, effectiveness and saving people from death was 8.4 %. Depreciation costs in the pre-hospital emergency department of Yazd in 2018 amounted to 65,061 Dollars (9,759,264,923 Rial). The cost of personnel salaries and benefits was 39669829 Dollars ( 59504743663 Rial). This amount was about 40 % of the total cost of the year for pre-hospital emergency in Yazd city. The average cost of each mission-dispatch was 25 Dollars (3775967 Rial).
Conclusion: This study examines the consequences and costs of per hospital emergency department in Yazd in 2018. The high number of unnecessary calls to Yazd emergency department calls for the need to raise public awareness. Moreover, the lack of need to transfer half of these people to hospital requires training and retraining of telephone triage nurses.
Key words: Ambulance, Pre-hospital, Medical emergencies, Anglo-American , Cost
Discussion
By reviewing patients' files in Yazd Emergency department, data from at least 51 patients were recorded. This is more in line with the Angelo-American system and can provide more accurate and comprehensive information than the Franco-German system. The research receives 28 information elements (34).
Byrne et al. (35) examined the relationship between response time and mortality rate in vehicle accidents. They found that the effect of time on mortality rate was significant (35).
In the study by Altintaş et al. (36), the average response time was 9 minutes (36). However, in Yazd emergency department, it was 7:59. The average time obtained in this study was more than 59 seconds for pre -hospital emergencies compared to the prioritization of effective components of dr.bahadori.
In another study (37) regarding Shiraz’s emergency room, 49.9 % of the calls were answered between 8 to 10 minutes, which is more than the standard time (37). Bahadori et al. (38) concluded that the required time to reach the emergency location in urban areas of the country, except Tehran, was 7 minutes and in suburban areas it was 14 minutes. The ambulance per 100,000 population was 3.1, which in this study was less than 2 for the city of Yazd (38). Nichol et al. (39) showed that a 1-minute decrease in the average response time results in an absolute increase in survival rate between 0.4 % to 0.7 % (39).
the average time of dispatch(10:48), which is the same as the time spent to take the patient to a suitable medical center, was also in the pre-hospital emergency department of Yazd in 2018. Peralta LMP examined the Mexico City Emergency Department. They found that the minimum time was 6:7 minutes, and the maximum time was 61 minutes. This could cover weaknesses and give the researchers incorrect information (40).
Dadashzadeh et al. (41) found that the averagetime of activation, response, and presence on the scene and transfer of patients to the hospital were 2.3, 10.0, 8.1 and 9.1, respectively (41).
Although the emergency response time was used to measure performance in the world, it seems that the patient recovery index should be considered for emergency performance (42).
Studies have shown that the rate of survival and discharge from the hospital increases threefold with the presence of a physician (43).
In the present study, based on the Anglo-American system, no doctor is sent to the patient's bedside in other parts of the world. In order to estimate the survival of high-risk patients in this study, 59 patients at the red triage level in 2018 were selected, 5 of whom had successful resuscitation (discharge from the hospital). These data showed that, in the pre-hospital emergency department of Yazd city based on the Anglo-American system, the effectiveness rate was 8.4 %.
In the study by Stiell IG et al. )14(,the survival rate for out-of-hospital cardiac arrest was 2.5 %, which showed a 5.2 % improvement after the provision of a defibrillation set (14).
In Amsterdam, Joey Depp et al. (44) revealed that 40 % of the annual calls (165,000) received at the dispatch center were rejected under national protocols, and 30 % of the patients were treated on-site; therefore, there was no need for them to be transferred by an ambulance to a medical center or hospital (44).
82 % of the calls ( 115 calls) did not require the dispatch of an ambulance. Moreover, 48 % of the dispatches did not lead to a transfer to hospital. The frameworks specified in previous studies for costs were used.
A study published by Lerner et al. (33) developed a general framework for measuring emergency components (33).
Another important point obtained from both similar articles and the findings of this study is that the cost of labour for society is more than the cost of maintaining and establishing a unit.
In the study by Ebrahimi et al. (45), the average cost of each dispatch was 2114337 ± 217786 Rial, 51.7 % of which (1660129 ± 1578445 Rial) related to staff salaries, 24.1 % (406824 ± 375083 Rial) related to the current expenses of each base, 02.2 % (42761 ± 42822 Rial ) concerned medical supplies, and 23.0 % (4476 ± 4796 Rial) related to depreciation in each pre-hospital emergency dispatch (45).
It also seems that the most cost-effective approach to field triage entirely related to triage characteristics and adherence to shipping methods of triage-based emergency medical services (46).
In Patterson's study, the overall mean weight of annual rate regarding turnover was 10.7 %. The annual turnover rate in different types of emergencies is very different (32). The cost of staff salaries and benefits for Yazd emergency in 2018 was 59504743663 Rial (396698.2 Dollars).
A study by Valenzuela et al. (47), examined cardiac arrest patients for whom the emergency system was established, and the cost was $ 8,886.0 per year of life saved. Outpatient treatment by paramedics was more cost-effective than a transplant of heart, liver, bone marrow, or chemotherapy for acute leukaemia (47).
The use of telehealth in pre-hospital emergency medical services found a potential reduction of 6.7 % in potential non-essential medical visits, and a total reduction of 44 minutes in total ambulance service return times.
The average cost of remote treatment was 167 Dollars, which was statistically 103 Dollars less than the control group, generating 928,000 Dollars in annual cost savings, or 2,468 Dollars in cost savings per face-to-face visit (48). In a study by Lee Michael et al. (49), it was shown that 5 to 10 percent of a country's health expenditures are allocated to pre-hospital emergencies (49).
Conclusion
The high number of calls and lack of the need for an ambulance or even the need for special treatment in nearly 80 % of the cases, which is very different from the standards, necessitates the urgent need to raise public awareness.
Unnecessity of transfering half of the cases indicates the need for training or retraining of telephone triage nurses. Statistics also show that the presence of a physician in the emergency team reduces the number of deaths and injuries. This requires improvements in the structure of emergency procedures by the Anglo-American method.
The availability of rescue equipment and facilities, such as the automatic defibrillator in crowded centers and public education, can lead to the rescue of more people in the golden tiem. The appropriate arrangement of the centers and the provision of ambulances at the standard level can be useful in reducing the arrival time, and of course saving more and more human beings.
Acknowledgments
This article was extracted from the thesis prepared by Alireza Nik Afshan to meet the requirements for obtaining master's degree in health management. The authors would like to thank the staff in Shahid Sadoughi University of Medical Sciences, Faculty of Health and Yazd Pre-Hospital Emergency Department for their support.
Conflict of interests
The authors declared no conflict of interests©.
Authors' contributions
Pakdaman M designed research; Nikafshan AR conducted research; Askari R, Dehghan A, and Pahlavanpoor SR analyzed data; and Nikafshan AR wrote the paper. Nikafshan AR had the primary responsibility for final content. Authors read and approved the final manuscript.
Funding
Non applicable.
Background: One of the most important tasks of health care managers is allocateing resources, controling them and ensuring their effective use when available. This study examines the consequences and costs of emergency services in Yazd in 2018.
Methods: This was a descriptive-analytical study performed on patients of 11 centers in Yazd in 2018. The population of the city was approximately 750,000 in 2018 (1). Direct and indirect costs were extracted, and the consequences and costs of Yazd emergency in 2018 were calculated in riyal and Dollars.
Results: This study showed that in 2018, out of 173154 contacts, 37988 cases led to the dispatch of an ambulance, and the response rate was 18 %. The rate of hospitalization was 52 %. The average time of dispatch in Yazd pre-hospital emergency department was (10:48) in 2018. Of the 59 high-risk patients who were transported to Yazd's pre-hospital emergency in 2018, 5 patients had successful cardiopulmonary resuscitation(discharge from the hospital). In other words, effectiveness and saving people from death was 8.4 %. Depreciation costs in the pre-hospital emergency department of Yazd in 2018 amounted to 65,061 Dollars (9,759,264,923 Rial). The cost of personnel salaries and benefits was 39669829 Dollars ( 59504743663 Rial). This amount was about 40 % of the total cost of the year for pre-hospital emergency in Yazd city. The average cost of each mission-dispatch was 25 Dollars (3775967 Rial).
Conclusion: This study examines the consequences and costs of per hospital emergency department in Yazd in 2018. The high number of unnecessary calls to Yazd emergency department calls for the need to raise public awareness. Moreover, the lack of need to transfer half of these people to hospital requires training and retraining of telephone triage nurses.
Key words: Ambulance, Pre-hospital, Medical emergencies, Anglo-American , Cost
Introduction
The greatest role considered for pre-hospital emergencies at the beginning of its existence was transporting the people wounded and killed in wars. Until World War II, it was not organized and coherent in structure (2). Nowadays, by organizing and writing a description of pre-hospital emergency duties, the necessary measures to be taken have become more specific, and the duties are clearer and more precise than before (3). One of the most important tasks is the management of this department in health system, with regard to the allocation of resources, and efficiency (4, 5). The Emergency Medical Services System (EMS) is an ongoing care system that which begins with initial contact ,and is accompanied by patient care and transfer of patients to an appropriate medical facility. It also covers mass casualties and injury prevention (2, 6). Pre-hospital emergency, which is responsible for the rapid and comprehensive relief and treatment of all emergency patients injured in accidents, is one of the essential and invincible pillars of public hospitals (7, 8). An ambulance is a vehicle equipped with medical equipment that transports patients to medical centers (9). Emergency services can significantly reduce the mortality of patients (10). The first recorded use of the ambulance dates back to a thousand years before Christ, which was used in wars (11). Iran Emergency Medical Center was established in 1975. The pre-hospital emergency provides effective, coordinated and timely health care and safety services to victims of accidents or illnesses using special personnel and facilities. In a study by Stiell et al. (11-13), the survival rate for out-of-hospital cardiac arrest was 2.5 %, This showed an improvement of 5.2 % after the provision of defibrillators, which was US $ 2,400 per person per year, had economic efficiency (14).
Emergency services around the world are divided into two main models: The Franco-German system, in which pre-hospital care is provided by physicians, and the Anglo-American system, in which pre-hospital care is provided by trained technicians at the basic, intermediate, and advanced levels. In both models, there is an attempt to use modern techniques, tools and technologies to reduce medical errors and increase the quality of pre-hospital emergency services (15-22). Most systems around the world today have a variety of combinations of both models (3, 15, 17). Franco-German,s system is based on the philosophy of "Stay and Stabilization". The philosophy of this model is to transfer hospital to patient, s bed (3, 12, 16). In this method, the work is usually done by physicians with extensive expertise and highly advanced technology.
In this model, more than other methods of patient transfer, ambulances and other kinds of equipment such as helicopters and coastal ambulances are used. This model usually includes a set of extensive healthcare systems and is widely implemented in Europe, where the team is led by emergency medicine. Therefore, in Europe, pre-hospital emergency care is almost always provided by an emergency physician (10, 17, 23-30).
Emergency physicians working in this area, have the authority to judge patients in complex clinical and medical settings at home or on the scene . In doing so, many clients were treated on-site, and were not transported to hospitals.
Countries such as Germany, French, Greece, Malta and Austria have fully developed the Franco–German system (3, 12, 13, 16, 18, 27). In contrast to the Franco- German system is the Angelo-American system, which is based on the philosophy of "Picking and Taking". The goal of this system is to quickly transport patients to the hospital to reduce pre-hospital interventions.
The system is usually connected to public safety services such as police or fire departments, instead of health systems and trained emergency technicians managing the pre-hospital emergency system. This system depends on ground ambulances. Almost all patients in the Angelo-American model are transferred to the emergency department of hospitals for emergency care.
Countries useing this delivery model include the United States, Canada, New Zealand, Oman and Australia (3, 12, 13, 31).
In a study by Patterson, P.D, the total emergency costs were calculated. The average annual turnover was 10.7 % (32). Considering that the Anglo-American method is being implemented in pre-hospital emergencies in Iran and there is no documentation on the consequences and costs of this method, we examined the consequences and costs of this method in order to provide better this way so that the cost is more effective, we have provided solutions and these solutions are available to policymakers in this field.
Materials and Methods
1) This was a descriptive-analytical study on patients in Yazd in 2018. Pre-hospital emergency services were performed using the Angelo-American system; Yazd has 11 emergency stations and the same number of active ambulances. The population included approximately 750,000 people. This study consists of 3 phases. In the first phase, articles in domestic and foreign journals, and published articles, dissertations, and conferences in the database of review studies were studied. Then, follow-up groups of the Anglo-American system in the pre-hospital emergency department were identified, and a checklist of the desired outcomes for data collection was prepared.
After conducting a review study and using the searched articles, the cost groups related to the Angelo-American system was identified according to the objectives of the study. After that, a checklist for the cost groups was prepared.
Accordingly, direct and indirect costs were extracted. In the third phase, using the checklist of cost groups and outcomes prepared in the previous phases, data of the consequence groups were collected by referring to the patients' files, who referred to Asayar emergency system. Then, the researchers went to the accounting sector of Yazd Emergency Medical Center, and then analyzed the data with EXCEL and SPSS16 software.
Regarding the validity, first, for face validity , the checklist was provided to 10 experts and professors to insert corrective comments. For sampling in the present study with a variance of (1.2) (taken from previous studies) and error rate of 5 % the sample size of 2000 patients who used the Yazd pre-hospital emergency in 2018, we considered that to collect data on the consequences of We referred to their case file. Yazd’s emergency expenses were calculated in Rial in 2018, and total expenses were converted into Dollar. This study
by obtaining the code of ethics by (IR.SSU.SPH.REC.1398.133) Registered.
Results
In 2018, out of a total of 173154 contacts with to Yazd medical emergency center, 37988 calls led to the dispatch of an ambulance and the response rate was 18 %. Also, the rate of dispatch, 52 % was and the average time of dispatch in Yazd emergency department in 2018 (10:48). The number and percentage of successful resuscitation regarding high-risk people are among the indicators of pre-hospital emergency. According to the data, 59 high-risk people were registered, from whom 5 people (8.4 %) had successful resuscitation (discharge from the hospital).
Costs were calculated separately or in combination, based on the checklist and framework obtained from previous studies (33). 150,000$ was considered to calculate the costs.
One of the main expenses for emergency is the cost of staff salaries and benefits, which for Yazd emergency in 2018 was 59504743663 Rial (396698.29 Dollars). This was about 40 % of the total cost of the year. The average cost of each dispatch was 3775967 Rial, or in other words, the cost of each dispatch was $ 25.
Expenses of depreciation and wear regarding equipment and facilities used in the pre-hospital emergency department of Yazd was approximately 7 %, which in 2018 amounted to 9,759,264,923 Rial or 65,061 Dollars.
The greatest role considered for pre-hospital emergencies at the beginning of its existence was transporting the people wounded and killed in wars. Until World War II, it was not organized and coherent in structure (2). Nowadays, by organizing and writing a description of pre-hospital emergency duties, the necessary measures to be taken have become more specific, and the duties are clearer and more precise than before (3). One of the most important tasks is the management of this department in health system, with regard to the allocation of resources, and efficiency (4, 5). The Emergency Medical Services System (EMS) is an ongoing care system that which begins with initial contact ,and is accompanied by patient care and transfer of patients to an appropriate medical facility. It also covers mass casualties and injury prevention (2, 6). Pre-hospital emergency, which is responsible for the rapid and comprehensive relief and treatment of all emergency patients injured in accidents, is one of the essential and invincible pillars of public hospitals (7, 8). An ambulance is a vehicle equipped with medical equipment that transports patients to medical centers (9). Emergency services can significantly reduce the mortality of patients (10). The first recorded use of the ambulance dates back to a thousand years before Christ, which was used in wars (11). Iran Emergency Medical Center was established in 1975. The pre-hospital emergency provides effective, coordinated and timely health care and safety services to victims of accidents or illnesses using special personnel and facilities. In a study by Stiell et al. (11-13), the survival rate for out-of-hospital cardiac arrest was 2.5 %, This showed an improvement of 5.2 % after the provision of defibrillators, which was US $ 2,400 per person per year, had economic efficiency (14).
Emergency services around the world are divided into two main models: The Franco-German system, in which pre-hospital care is provided by physicians, and the Anglo-American system, in which pre-hospital care is provided by trained technicians at the basic, intermediate, and advanced levels. In both models, there is an attempt to use modern techniques, tools and technologies to reduce medical errors and increase the quality of pre-hospital emergency services (15-22). Most systems around the world today have a variety of combinations of both models (3, 15, 17). Franco-German,s system is based on the philosophy of "Stay and Stabilization". The philosophy of this model is to transfer hospital to patient, s bed (3, 12, 16). In this method, the work is usually done by physicians with extensive expertise and highly advanced technology.
In this model, more than other methods of patient transfer, ambulances and other kinds of equipment such as helicopters and coastal ambulances are used. This model usually includes a set of extensive healthcare systems and is widely implemented in Europe, where the team is led by emergency medicine. Therefore, in Europe, pre-hospital emergency care is almost always provided by an emergency physician (10, 17, 23-30).
Emergency physicians working in this area, have the authority to judge patients in complex clinical and medical settings at home or on the scene . In doing so, many clients were treated on-site, and were not transported to hospitals.
Countries such as Germany, French, Greece, Malta and Austria have fully developed the Franco–German system (3, 12, 13, 16, 18, 27). In contrast to the Franco- German system is the Angelo-American system, which is based on the philosophy of "Picking and Taking". The goal of this system is to quickly transport patients to the hospital to reduce pre-hospital interventions.
The system is usually connected to public safety services such as police or fire departments, instead of health systems and trained emergency technicians managing the pre-hospital emergency system. This system depends on ground ambulances. Almost all patients in the Angelo-American model are transferred to the emergency department of hospitals for emergency care.
Countries useing this delivery model include the United States, Canada, New Zealand, Oman and Australia (3, 12, 13, 31).
In a study by Patterson, P.D, the total emergency costs were calculated. The average annual turnover was 10.7 % (32). Considering that the Anglo-American method is being implemented in pre-hospital emergencies in Iran and there is no documentation on the consequences and costs of this method, we examined the consequences and costs of this method in order to provide better this way so that the cost is more effective, we have provided solutions and these solutions are available to policymakers in this field.
Materials and Methods
1) This was a descriptive-analytical study on patients in Yazd in 2018. Pre-hospital emergency services were performed using the Angelo-American system; Yazd has 11 emergency stations and the same number of active ambulances. The population included approximately 750,000 people. This study consists of 3 phases. In the first phase, articles in domestic and foreign journals, and published articles, dissertations, and conferences in the database of review studies were studied. Then, follow-up groups of the Anglo-American system in the pre-hospital emergency department were identified, and a checklist of the desired outcomes for data collection was prepared.
After conducting a review study and using the searched articles, the cost groups related to the Angelo-American system was identified according to the objectives of the study. After that, a checklist for the cost groups was prepared.
Accordingly, direct and indirect costs were extracted. In the third phase, using the checklist of cost groups and outcomes prepared in the previous phases, data of the consequence groups were collected by referring to the patients' files, who referred to Asayar emergency system. Then, the researchers went to the accounting sector of Yazd Emergency Medical Center, and then analyzed the data with EXCEL and SPSS16 software.
Regarding the validity, first, for face validity , the checklist was provided to 10 experts and professors to insert corrective comments. For sampling in the present study with a variance of (1.2) (taken from previous studies) and error rate of 5 % the sample size of 2000 patients who used the Yazd pre-hospital emergency in 2018, we considered that to collect data on the consequences of We referred to their case file. Yazd’s emergency expenses were calculated in Rial in 2018, and total expenses were converted into Dollar. This study
by obtaining the code of ethics by (IR.SSU.SPH.REC.1398.133) Registered.
Results
In 2018, out of a total of 173154 contacts with to Yazd medical emergency center, 37988 calls led to the dispatch of an ambulance and the response rate was 18 %. Also, the rate of dispatch, 52 % was and the average time of dispatch in Yazd emergency department in 2018 (10:48). The number and percentage of successful resuscitation regarding high-risk people are among the indicators of pre-hospital emergency. According to the data, 59 high-risk people were registered, from whom 5 people (8.4 %) had successful resuscitation (discharge from the hospital).
Costs were calculated separately or in combination, based on the checklist and framework obtained from previous studies (33). 150,000$ was considered to calculate the costs.
One of the main expenses for emergency is the cost of staff salaries and benefits, which for Yazd emergency in 2018 was 59504743663 Rial (396698.29 Dollars). This was about 40 % of the total cost of the year. The average cost of each dispatch was 3775967 Rial, or in other words, the cost of each dispatch was $ 25.
Expenses of depreciation and wear regarding equipment and facilities used in the pre-hospital emergency department of Yazd was approximately 7 %, which in 2018 amounted to 9,759,264,923 Rial or 65,061 Dollars.
Table 1. Total expenses of Yazd emergency department in 2018
| Total expenses of Yazd emergency in 2018 | Cost in Rial | Cost in Dollars |
| Cost of employees compensation service | 59504743663 | 39669.82 |
| Cost of using goods and services | 56717720184 | 378118.13 |
| Financial costs and rent | 121746667 | 811.64 |
| Social welfare costs | 11382761861 | 75885.07 |
| Other expenses (fines, insurance, compensation service, years and employees leave) | 5955220278 | 39701.46 |
| Depreciation fee (indirect) | 9759264923 | 65061.76 |
| Total | 143441457576 | 599274.88 |
Table 2. Indirect costs in Yazd pre-hospital emergency in 2018 (Rial)
| Depreciation cost of assets | Amount |
| Depreciation cost of innovations | 59675000 |
| Building depreciation cost | 2015520948 |
| Facility depreciation cost | 90193835 |
| Depreciation of machinery and equipment | 937562266 |
| Depreciation of technical tools and equipment | 807606 |
| Depreciation cost of vehicles | 5112873259 |
| Cost of furniture depreciation and appointments | 1527560342 |
| Depreciation cost of other assets | 15071667 |
| Total depreciation cost | 9759264923 |
By reviewing patients' files in Yazd Emergency department, data from at least 51 patients were recorded. This is more in line with the Angelo-American system and can provide more accurate and comprehensive information than the Franco-German system. The research receives 28 information elements (34).
Byrne et al. (35) examined the relationship between response time and mortality rate in vehicle accidents. They found that the effect of time on mortality rate was significant (35).
In the study by Altintaş et al. (36), the average response time was 9 minutes (36). However, in Yazd emergency department, it was 7:59. The average time obtained in this study was more than 59 seconds for pre -hospital emergencies compared to the prioritization of effective components of dr.bahadori.
In another study (37) regarding Shiraz’s emergency room, 49.9 % of the calls were answered between 8 to 10 minutes, which is more than the standard time (37). Bahadori et al. (38) concluded that the required time to reach the emergency location in urban areas of the country, except Tehran, was 7 minutes and in suburban areas it was 14 minutes. The ambulance per 100,000 population was 3.1, which in this study was less than 2 for the city of Yazd (38). Nichol et al. (39) showed that a 1-minute decrease in the average response time results in an absolute increase in survival rate between 0.4 % to 0.7 % (39).
the average time of dispatch(10:48), which is the same as the time spent to take the patient to a suitable medical center, was also in the pre-hospital emergency department of Yazd in 2018. Peralta LMP examined the Mexico City Emergency Department. They found that the minimum time was 6:7 minutes, and the maximum time was 61 minutes. This could cover weaknesses and give the researchers incorrect information (40).
Dadashzadeh et al. (41) found that the averagetime of activation, response, and presence on the scene and transfer of patients to the hospital were 2.3, 10.0, 8.1 and 9.1, respectively (41).
Although the emergency response time was used to measure performance in the world, it seems that the patient recovery index should be considered for emergency performance (42).
Studies have shown that the rate of survival and discharge from the hospital increases threefold with the presence of a physician (43).
In the present study, based on the Anglo-American system, no doctor is sent to the patient's bedside in other parts of the world. In order to estimate the survival of high-risk patients in this study, 59 patients at the red triage level in 2018 were selected, 5 of whom had successful resuscitation (discharge from the hospital). These data showed that, in the pre-hospital emergency department of Yazd city based on the Anglo-American system, the effectiveness rate was 8.4 %.
In the study by Stiell IG et al. )14(,the survival rate for out-of-hospital cardiac arrest was 2.5 %, which showed a 5.2 % improvement after the provision of a defibrillation set (14).
In Amsterdam, Joey Depp et al. (44) revealed that 40 % of the annual calls (165,000) received at the dispatch center were rejected under national protocols, and 30 % of the patients were treated on-site; therefore, there was no need for them to be transferred by an ambulance to a medical center or hospital (44).
82 % of the calls ( 115 calls) did not require the dispatch of an ambulance. Moreover, 48 % of the dispatches did not lead to a transfer to hospital. The frameworks specified in previous studies for costs were used.
A study published by Lerner et al. (33) developed a general framework for measuring emergency components (33).
Another important point obtained from both similar articles and the findings of this study is that the cost of labour for society is more than the cost of maintaining and establishing a unit.
In the study by Ebrahimi et al. (45), the average cost of each dispatch was 2114337 ± 217786 Rial, 51.7 % of which (1660129 ± 1578445 Rial) related to staff salaries, 24.1 % (406824 ± 375083 Rial) related to the current expenses of each base, 02.2 % (42761 ± 42822 Rial ) concerned medical supplies, and 23.0 % (4476 ± 4796 Rial) related to depreciation in each pre-hospital emergency dispatch (45).
It also seems that the most cost-effective approach to field triage entirely related to triage characteristics and adherence to shipping methods of triage-based emergency medical services (46).
In Patterson's study, the overall mean weight of annual rate regarding turnover was 10.7 %. The annual turnover rate in different types of emergencies is very different (32). The cost of staff salaries and benefits for Yazd emergency in 2018 was 59504743663 Rial (396698.2 Dollars).
A study by Valenzuela et al. (47), examined cardiac arrest patients for whom the emergency system was established, and the cost was $ 8,886.0 per year of life saved. Outpatient treatment by paramedics was more cost-effective than a transplant of heart, liver, bone marrow, or chemotherapy for acute leukaemia (47).
The use of telehealth in pre-hospital emergency medical services found a potential reduction of 6.7 % in potential non-essential medical visits, and a total reduction of 44 minutes in total ambulance service return times.
The average cost of remote treatment was 167 Dollars, which was statistically 103 Dollars less than the control group, generating 928,000 Dollars in annual cost savings, or 2,468 Dollars in cost savings per face-to-face visit (48). In a study by Lee Michael et al. (49), it was shown that 5 to 10 percent of a country's health expenditures are allocated to pre-hospital emergencies (49).
Conclusion
The high number of calls and lack of the need for an ambulance or even the need for special treatment in nearly 80 % of the cases, which is very different from the standards, necessitates the urgent need to raise public awareness.
Unnecessity of transfering half of the cases indicates the need for training or retraining of telephone triage nurses. Statistics also show that the presence of a physician in the emergency team reduces the number of deaths and injuries. This requires improvements in the structure of emergency procedures by the Anglo-American method.
The availability of rescue equipment and facilities, such as the automatic defibrillator in crowded centers and public education, can lead to the rescue of more people in the golden tiem. The appropriate arrangement of the centers and the provision of ambulances at the standard level can be useful in reducing the arrival time, and of course saving more and more human beings.
Acknowledgments
This article was extracted from the thesis prepared by Alireza Nik Afshan to meet the requirements for obtaining master's degree in health management. The authors would like to thank the staff in Shahid Sadoughi University of Medical Sciences, Faculty of Health and Yazd Pre-Hospital Emergency Department for their support.
Conflict of interests
The authors declared no conflict of interests©.
Authors' contributions
Pakdaman M designed research; Nikafshan AR conducted research; Askari R, Dehghan A, and Pahlavanpoor SR analyzed data; and Nikafshan AR wrote the paper. Nikafshan AR had the primary responsibility for final content. Authors read and approved the final manuscript.
Funding
Non applicable.
Type of Study: Original article |
Subject:
General
Received: 2022/12/25 | Accepted: 2023/03/28 | Published: 2023/03/30
Received: 2022/12/25 | Accepted: 2023/03/28 | Published: 2023/03/30
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