title: System implications of the ambulance arrival-to-patient contact interval on response interval compliance.
abstract: BACKGROUND
  In some emergency medical services (EMS) system designs, response time intervals are mandated with monetary penalties for noncompliance. These times are set with the goal of providing rapid, definitive patient care. The time interval of vehicle at scene-to-patient access (VSPA) has been measured, but its effect on response time interval compliance has not been determined.
  
  
  OBJECTIVE
  To determine the effect of the VSPA interval on the mandated code 1 (< 9 min) and code 2 (< 13 min) response time interval compliance in an urban, public-utility model system.
  
  
  METHODS
  A prospective, observational study used independent third-party riders to collect the VSPA interval for emergency life-threatening (code 1) and emergency nonlife-threatening (code 2) calls. The VSPA interval was added to the 9-1-1 call-to-dispatch and vehicle dispatch-to-scene intervals to determine the total time interval from call received until paramedic access to the patient (9-1-1 call-to-patient access). Compliance with the mandated response time intervals was determined using the traditional time intervals (9-1-1 call-to-scene) plus the VSPA time intervals (9-1-1 call-to-patient access). Chi-square was used to determine statistical significance.
  
  
  RESULTS
  Of the 216 observed calls, 198 were matched to the traditional time intervals. Sixty-three were code 1, and 135 were code 2. Of the code 1 calls, 90.5% were compliant using 9-1-1 call-to-scene intervals dropping to 63.5% using 9-1-1 call-to-patient access intervals (p < 0.0005). Of the code 2 calls, 94.1% were compliant using 9-1-1 call-to-scene intervals. Compliance decreased to 83.7% using 9-1-1 call-to-patient access intervals (p = 0.012).
  
  
  CONCLUSIONS
  The addition of the VSPA interval to the traditional time intervals impacts system response time compliance. Using 9-1-1 call-to-scene compliance as a basis for measuring system performance underestimates the time for the delivery of definitive care. This must be considered when response time interval compliances are defined.
authors.affiliation: Department of Emergency Medicine, School of Medicine, University of Missouri-Kansas City, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Campbell
authors.forename: M C
authors.initials: MC
authors.lastname: Gratton
authors.forename: J A
authors.initials: JA
authors.lastname: Salomone
authors.forename: D J
authors.initials: DJ
authors.lastname: Lindholm
authors.forename: W A
authors.initials: WA
authors.lastname: Watson
mesh_terms: D000552:Ambulances; D004630:Emergencies; D004631:Emergency Medical Service Communication Systems; D004632:Emergency Medical Services / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D013597:Systems Analysis; D013997:Time Factors