title: Emergency Medical Services Utilization in EMS Priority Conditions in Beirut, Lebanon.
abstract: BACKGROUND
  Early activation and use of Emergency Medical Services (EMS) are associated with improved patient outcomes in EMS priority conditions in developed EMS systems. This study describes patterns of EMS use and identifies predictors of EMS utilization in EMS priority conditions in Lebanon METHODS: This was a cross-sectional study of a random sample of adult patients presenting to the emergency department (ED) of a tertiary care center in Beirut with the following EMS priority conditions: chest pain, major trauma, respiratory distress, cardiac arrest, respiratory arrest, and airway obstruction. Patient/proxy survey (20 questions) and chart review were completed. The responses to survey questions were "disagree," "neutral," or "agree" and were scored as one, two, or three with three corresponding to higher likelihood of EMS use. A total scale score ranging from 20 to 60 was created and transformed from 0% to 100%. Data were analyzed based on mode of presentation (EMS vs other).
  
  
  RESULTS
  Among the 481 patients enrolled, only 112 (23.3%) used EMS. Mean age for study population was 63.7 years (SD=18.8 years) with 56.5% males. Mean clinical severity score (Emergency Severity Index [ESI]) was 2.5 (SD=0.7) and mean pain score was 3.1 (SD=3.5) at ED presentation. Over one-half (58.8%) needed admission to hospital with 21.8% to an intensive care unit care level and with a mortality rate of 7.3%. Significant associations were found between EMS use and the following variables: severity of illness, degree of pain, familiarity with EMS activation, previous EMS use, perceived EMS benefit, availability of EMS services, trust in EMS response times and treatment, advice from family, and unavailability of immediate private mode of transport (P≤.05). Functional screening, or requiring full assistance (OR=4.77; 95% CI, 1.85-12.29); acute symptoms onset ≤ one hour (OR=2.14; 95% CI, 1.08-4.26); and higher scale scores (OR=2.99; 95% CI, 2.20-4.07) were significant predictors of EMS use. Patients with lower clinical severity (OR=0.53; 95% CI, 0.35-0.81) and those with chest pain (OR=0.05; 95% CI, 0.02-0.12) or respiratory distress (OR=0.15; 95% CI, 0.07-0.31) using cardiac arrest as a reference were less likely to use EMS.
  
  
  CONCLUSIONS
  Emergency Medical Services use in EMS priority conditions in Lebanon is low. Several predictors of EMS use were identified. Emergency Medical Services initiatives addressing underutilization should result from this proposed assessment of the perspective of the EMS system's end user. El Sayed M , Tamim H , Al-Hajj Chehadeh A , Kazzi AA . Emergency Medical Services utilization in EMS priority conditions in Beirut, Lebanon. Prehosp Disaster Med. 2016;31(6):621-627.
authors.affiliation: 1Department of Emergency Medicine,American University of Beirut Medical Center,Beirut,Lebanon.
authors.forename: Mazen
authors.initials: M
authors.lastname: El Sayed
authors.affiliation: 3Department of Internal Medicine,American University of Beirut Medical Center,Beirut,Lebanon.
authors.forename: Hani
authors.initials: H
authors.lastname: Tamim
authors.affiliation: 1Department of Emergency Medicine,American University of Beirut Medical Center,Beirut,Lebanon.
authors.forename: Ahel Al-Hajj
authors.initials: AA
authors.lastname: Chehadeh
authors.affiliation: 1Department of Emergency Medicine,American University of Beirut Medical Center,Beirut,Lebanon.
authors.forename: Amin A
authors.initials: AA
authors.lastname: Kazzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007861:Lebanon; D008297:Male; D008485:Medical Audit; D008875:Middle Aged
keywords:  AUBMC American University of Beirut Medical Center;  ED emergency department;  EMS Emergency Medical Services;  ESI Emergency Severity Index;  OHCA out-of-hospital cardiac arrest; EMS; Lebanon; predictors; prehospital; priority conditions; utilization