title: Transport outcomes and dispatch determinants in a paramedic long-term care program: a pilot study.
abstract: OBJECTIVE
  Long-term care (LTC) patients are often sent to emergency departments (EDs) by ambulance. In this novel extended care paramedic (ECP) program, specially trained paramedics manage LTC patients on site. The objective of this pilot study was to describe the dispatch and disposition of LTC patients treated by ECPs and emergency paramedics.
  
  
  METHODS
  Data were collected from consecutive calls to 15 participating LTC facilities for 3 months. Dispatch determinants, transport rates, and relapse rates were described for LTC patients attended by ECPs or emergency paramedics. ECP involvement in end-of-life care was identified.
  
  
  RESULTS
  Of 238 eligible calls, 140 (59%) were attended by an ECP and 98 (41%) by emergency paramedics. Although the top three determinants were the same in each group, the overall distribution of dispatch determinants and acuity differed. In the ECP cohort, 98 of 140 (70%) were treated and released, 33 of 140 (24%) had "facilitated transfer" arranged by an ECP, and 9 of 140 (6%) were immediately transported to the ED by ambulance. In the emergency paramedic cohort, 77 of 98 (79%) were immediately transported to the ED and 21 of 98 (21%) were not transported. In the ECP group, 6 of 98 (6%) patients not transported triggered a 911 call within 48 hours for a related clinical reason, although none of the patients not transported by emergency paramedics relapsed.
  
  
  CONCLUSIONS
  ECP involvement in LTC calls was found to reduce transports to the ED with a low rate of relapse. These pilot data generated hypotheses for future study, including determination of appropriate populations for ECP care and analysis of appropriate and safe nontransport.
authors.forename: Jan L
authors.initials: JL
authors.lastname: Jensen
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Travers
authors.forename: Darrell J
authors.initials: DJ
authors.lastname: Bardua
authors.forename: Thomas
authors.initials: T
authors.lastname: Dobson
authors.forename: Bruce
authors.initials: B
authors.lastname: Cox
authors.forename: Jennifer
authors.initials: J
authors.lastname: McVey
authors.forename: Ed
authors.initials: E
authors.lastname: Cain
authors.forename: Robert
authors.initials: R
authors.lastname: Merchant
authors.forename: Alix J E
authors.initials: AJ
authors.lastname: Carter
mesh_terms: D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care; D009674:Nova Scotia; D010865:Pilot Projects; D014187:Transportation of Patients / Q000706:statistics & numerical data