title: Intentional drug poisoning care in a physician-manned emergency medical service.
abstract: OBJECTIVE
  Severely poisoned patients can benefit from intensive and specific treatments. Emergency medical services (EMS) may therefore play a crucial role by matching prehospital care and hospital referral to the severity of poisoned patients. Our aim was to investigate EMS accuracy in this condition.
  
  
  METHODS
  A 3-year retrospective study was conducted in a university hospital. Emergency telephone calls about adult patients with intentional drug poisoning (IDP) were included. In daily practice, an emergency physician answers such telephone calls and dispatches either first responders or a mobile intensive care unit (MICU). According to on-scene evaluation, patients are referred to the emergency department (ED) or to an intensive care unit (ICU). We therefore calculated global EMS accuracy according to patients' actual medical needs. We further evaluated the performance of dispatch and hospital referral decision. We also performed a regression analysis to identify factors of inappropriate dispatch.
  
  
  RESULTS
  A total of 2,227 patients were studied. Median age was 41 years old (range 30-49) and 63% were women. Dispatch was appropriate for 1,937 (87%) patients. Sensitivity and specificity of dispatch decision were 0.43 and 0.93, respectively. Decision of patients' referral to an appropriate hospital facility had a sensitivity of 0.67 and a specificity of 0.98. Toxicological data, age, and Glasgow coma scale were significantly associated with inappropriate EMS decisions.
  
  
  CONCLUSIONS
  A physician-operated EMS is an accurate system to provide prehospital care to IDP patients. However, dispatch physicians should pay attention, especially to toxicological anamnesis, to anticipate proper patient care.
authors.forename: Maxime
authors.initials: M
authors.lastname: Maignan
authors.forename: Anais
authors.initials: A
authors.lastname: Richard
authors.forename: Guillaume
authors.initials: G
authors.lastname: Debaty
authors.forename: Philippe
authors.initials: P
authors.lastname: Pommier
authors.forename: Damien
authors.initials: D
authors.lastname: Viglino
authors.forename: François
authors.initials: F
authors.lastname: Loizzo
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Jérome
authors.initials: J
authors.lastname: Hanna
authors.forename: Françoise
authors.initials: F
authors.lastname: Carpentier
authors.forename: Vincent
authors.initials: V
authors.lastname: Danel
mesh_terms: D000328:Adult; D003657:Decision Making; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D011041:Poisoning / Q000628:therapy*; D012017:Referral and Consultation; D012044:Regression Analysis; D012189:Retrospective Studies; D014218:Triage
keywords: dispatch; emergency medical service; poisoning; process assessment