title: Measuring the EMS patient access time interval and the impact of responding to high-rise buildings.
abstract: OBJECTIVE
  To measure the patient access time interval and characterize its contribution to the total emergency medical services (EMS) response time interval; to compare the patient access time intervals for patients located three or more floors above ground with those less than three floors above or below ground, and specifically in the apartment subgroup; and to identify barriers that significantly impede EMS access to patients in high-rise apartments.
  
  
  METHODS
  An observational study of all patients treated by an emergency medical technician paramedics (EMT-P) crew was conducted using a trained independent observer to collect time intervals and identify potential barriers to access.
  
  
  RESULTS
  Of 118 observed calls, 25 (21%) originated from patients three or more floors above ground. The overall median and 90th percentile (95% confidence interval) patient access time intervals were 1.61 (1.27, 1.91) and 3.47 (3.08, 4.05) minutes, respectively. The median interval was 2.73 (2.22, 3.03) minutes among calls from patients located three or more stories above ground compared with 1.25 (1.07, 1.55) minutes among those at lower levels. The patient access time interval represented 23.5% of the total EMS response time interval among calls originating less than three floors above or below ground and 32.2% of those located three or more stories above ground. The most frequently encountered barriers to access included security code entry requirements, lack of directional signs, and inability to fit the stretcher into the elevator.
  
  
  CONCLUSIONS
  The patient access time interval is significantly long and represents a substantial component of the total EMS response time interval, especially among ambulance calls originating three or more floors above ground. A number of barriers appear to contribute to delayed paramedic access.
authors.affiliation: Prehospital and Transport Medicine Research Program, Sunnybrook and Women's College Health Sciences Center, Toronto, Ontario, Canada. laurie.morrison@sw.ca
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Morrison
authors.forename: Mark P
authors.initials: MP
authors.lastname: Angelini
authors.forename: Marian J
authors.initials: MJ
authors.lastname: Vermeulen
authors.forename: Brian
authors.initials: B
authors.lastname: Schwartz
mesh_terms: D000552:Ambulances / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004607:Elevators and Escalators; D004632:Emergency Medical Services / Q000379:methods*; D004779:Environment Design; D005160:Facility Design and Construction; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D009864:Ontario; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D013996:Time and Motion Studies; D019037:Urban Health Services / Q000592:standards / Q000639:trends