title: 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.
abstract: 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.
authors.affiliation: Regional Centre for Emergency Medical Research and Development, Rogaland Central and University Hospital, 4068 Stavanger, Norway. birger.vaardal@hesbynett.no <birger.vaardal@hesbynett.no>
authors.forename: B
authors.initials: B
authors.lastname: Vaardal
authors.forename: H M
authors.initials: HM
authors.lastname: Lossius
authors.forename: P A
authors.initials: PA
authors.lastname: Steen
authors.forename: R
authors.initials: R
authors.lastname: Johnsen
mesh_terms: 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
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