Have the implementation of a new specialised emergency medical service influenced the pattern of general practitioners involvement in pre-hospital medical emergencies? A study of geographic variations in alerting, dispatch, and response.
OBJECTIVE
Emergency medical service systems in Norway are based on equity and equality. A toll free number (113) and criteria based dispatch are crucial components. The establishment of an emergency medical system (EMS) manned by an air and ground emergency physician (EP) has challenged the role of the general practitioner (GP) in emergency medical care. We investigated whether there were any geographical differences in the use of 113, alerts to GPs by the emergency medical dispatch centres (EMDCs), and of the presence of GPs on scene in medical emergencies leading to a turnout of the EP manned EMS.


METHODS
This was a prospective, observational cohort study of 385,000 inhabitants covered by the two EMDCs of Rogaland county, Norway, including 1035 on scene missions of the EP manned EMS during the period 1998-99.


RESULTS
The proportion of emergency calls routed through 113 was significantly lower, the proportion of alerts to GPs significantly higher, and the proportions of GPs on scene significantly higher in rural than urban areas.


CONCLUSIONS
We found geographical differences in the involvement of GPs in pre-hospital emergency medical situations, probably caused by a specialised emergency medical service system including an EMDC and an air and ground EP manned EMS. There were geographical differences in public use of the toll free 113, and alerts to GPs by the EMDCs, which is likely to result from geographical conditions and proximity to medical resources. Future organisation of the EMS has to reflect this to prevent unplanned and unwanted autonomously emerging EMS systems.
Vaardal
B
B
Regional Centre for Emergency Medical Research and Development, Rogaland Central and University Hospital, 4068 Stavanger, Norway. birger.vaardal@hesbynett.no <birger.vaardal@hesbynett.no>
Lossius
H M
HM
Steen
P A
PA
Johnsen
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000458:organization & administration*; D004635:Emergency Medicine / Q000458:organization & administration* / Q000706:statistics & numerical data; D005194:Family Practice / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009664:Norway; D011446:Prospective Studies; D019035:Rural Health Services / Q000458:organization & administration; D012720:Severity of Illness Index; D013997:Time Factors; D015599:Trauma Severity Indices; D019037:Urban Health Services / Q000458:organization & administration
Aust J Rural Health. 1999 May;7(2):104-8
10646371
JAMA. 2000 Jul 5;284(1):60-7
10872014
Acta Anaesthesiol Scand. 2002 Aug;46(7):771-8
12139529
Aust Fam Physician. 1997 Dec;26(12):1406-9
9470295
Eur J Emerg Med. 1995 Sep;2(3):160-71
9422202
Eur J Emerg Med. 1995 Sep;2(3):109-12
9422194
Eur J Emerg Med. 1994 Jun;1(2):62-8
9422140
Eur J Emerg Med. 1994 Mar;1(1):27-30
9422133
Lancet. 1996 May 18;347(9012):1362-6
8637341
Ann Emerg Med. 1994 Nov;24(5):867-72
7978559
Acta Anaesthesiol Scand. 2003 Feb;47(2):146-52
12631042