title: The impact of an emergency motorcycle response vehicle on prehospital care in an urban area.
abstract: BACKGROUND
  Faster emergency response times are generally considered to have a positive effect on life expectancy of patients with a life-threatening event, leading many communities to determine response time intervals. However, worldwide, increasing urbanization and traffic congestion threatens ambulance response times. An emergency motorcycle response vehicle (MRV) can overcome these hurdles more easily than a larger ambulance. It also offers dispatch flexibility in responding to calls estimated to have a low likelihood of a patient who needs transport. The first aim of this study was to determine whether an MRV can shorten response times and impact on resuscitation outcomes in a heavily urbanized and densely populated region in the Netherlands. The second aim was to evaluate differences in dispatch and transport between MRV and ambulance.
  
  
  METHODS
  This was a nonrandomized, prospective cohort study comparing an MRV unit with regular ambulances in a Dutch city of 265 000 people. Included were all 'urgent patient' cases within operating time of the MRV between January 2003 and August 2003.
  
  
  RESULTS
  A total of 1664 patients was evaluated, including 468 motorcycle and 1196 ambulance responses. Use of MRVs led to a decrease in response time of 54 s (P≤0.01). We could not show a decrease in mortality risk in cases of resuscitation [relative risk (RR): 2.50, confidence interval (CI): 0.17-36.21]. There was a slightly improved 1-year survival in other life-threatening cases (RR: 1.13, CI: 1.03-1.24). However, this is most likely because of differences in dispatch decisions (the MRV is sent to 'lighter' cases) and not because of faster assistance. The MRV paramedic was more likely to treat and release the patient (RR: 2.21, CI: 1.80-2.73) or refer them to a general practitioner (RR: 2.11, CI: 1.73-2.58) and much less likely to refer them to the hospital emergency department (41.2 vs. 72.6%). Referrals to the hospital by the MRV were mostly by the patient's own means of transportation (RR: 13.14, CI: 5.89-29.32) rather than by ambulance.
  
  
  CONCLUSIONS
  Using motorcycles in a Dutch setting lead to better emergency medical service response times. The MRV serves a different population. Resulting in a higher treat and release rate and less transportation to hospital.
authors: Research and Development, The Orange Cross, The Hague, The Netherlands. hansvanderpols@hetnet.nl
authors: Hans
authors: H
authors: van der Pols
authors: Francis
authors: F
authors: Mencl
authors: Rien
authors: R
authors: de Vos
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000552:Ambulances; D016001:Confidence Intervals; D004632:Emergency Medical Services / Q000379:methods*; D004635:Emergency Medicine / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009049:Motorcycles; D009426:Netherlands; D011446:Prospective Studies; D012306:Risk; D013223:Statistics as Topic; D014505:Urban Population