title: A model for the association of the call volume and the unavailable-for-response interval on the delayed ambulance response for out-of-hospital cardiac arrest using a geographic information system.
abstract: BACKGROUND
  An optimal ambulance response interval is desirable for emergency medical services (EMS) operations. Arriving on scene within a treatment time window is often delayed for many reasons, including overwhelming call volume.
  
  
  OBJECTIVE
  To determine whether an association exists between the ambulance call volume (ACV), the unavailable-for-response (UFR) interval, and the delayed ambulance response for out-of-hospital cardiac arrest (OHCA) patients.
  
  
  METHODS
  This was a retrospective observational study conducted in Seoul, Republic of Korea. The EMS ambulance logs from the metropolitan city's 22 EMS agencies, from January 1, 2006, to June 30, 2007, were obtained from the National Emergency Management Agency. These data included patient demographics and call location addresses. The addresses of the call locations and ambulance stations were geocoded and configured with a polygon expressing the optimal coverage areas in which an ambulance could travel within 4 minutes from their base station. The median ACV and mean UFR interval of each EMS agency were calculated. An actual response time interval greater than 4 minutes compared with the optimal coverage area was defined as a suboptimal response. Potential influencing factors on suboptimal response were analyzed using a multivariate logistic regression model to calculated the odds ratio (OR) and 95% confidence interval (95% CI).
  
  
  RESULTS
  Geocoding was successful for 255,961 calls, and 3,644 cardiac arrests occurred within the configured optimal response coverage areas. The response rate intervals for cardiac arrest patients, however, were optimal in only 22.6% of calls. Influencing factors for suboptimal response (occurring in 77.4% of the cases) were the median ACV and the mean UFR interval of each EMS agency. When the median ACV was seven or more, the OR of suboptimal response was 1.407 (1.142-1.734). If the mean UFR interval was 55 minutes or more, the OR for suboptimal response was 1.770 (1.345-2.329).
  
  
  CONCLUSIONS
  The ambulance response time intervals in this study setting were associated with EMS agencies with higher ACVs and longer UFR intervals.
authors.affiliation: The Center for Education and Training of EMS and Rescue (KOA), Seoul Fire Academy, Seoul, Republic of Korea.
authors.forename: Ki Ok
authors.initials: KO
authors.lastname: Ahn
authors.forename: Sang Do
authors.initials: SD
authors.lastname: Shin
authors.forename: Won Chul
authors.initials: WC
authors.lastname: Cha
authors.forename: Chulmin
authors.initials: C
authors.lastname: Jun
authors.forename: Tae Sik
authors.initials: TS
authors.lastname: Lee
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Pirrallo
mesh_terms: D000552:Ambulances / Q000458:organization & administration*; D017598:Efficiency, Organizational; D040362:Geographic Information Systems; D006801:Humans; D017146:Models, Organizational; D058687:Out-of-Hospital Cardiac Arrest; D056910:Republic of Korea; D012189:Retrospective Studies; D013997:Time Factors