Prospective Multicenter Evaluation of Prehospital Care by 119 Rescue Services

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the quality of prehospital care provided by 119 rescue services. METHODS: An evaluation tool for prehospital care provided by 119 rescue services was developed from the consensus opinion of an expert panel consensus. Using the evaluation tool, a prospective survey was performed to 3,578 patients who were transported to three Regional Emergency Medical Centers and six Local Emergency Medical Centers by 119 rescue services between November 2004 and January 2005. A total 515 patients in six disease groups were included. Initial patient assessments (including vital signs and level of consciousness) and communication with medical director were evaluated. The frequency and appropriateness of prehospital care were analyzed for each of the types of emergency medical technicians (EMTs) and medical director. RESULTS:The rates of assessment of vital signs were 26.6%~37.1%. Among the patients who had abnormal vital signs or level of consciousness at arrival, 7.7% were not assessed. Just 3.1% were communicated with medical director providing the prehospital care. The frequency and appropriateness of prehospital care were better when communication occurred between 119 rescue services personnels and medical director, but the differences were not statistically significant. Invasive procedures(e.g., intubation, intravenous line) and prehospital drug therapies(e.g., nitroglycerin) were performed to only 0.0%~10.6% of needed patients and other prehospital care(e.g., cervical fixation, oxygen supply) was provided for 42.3%~89.7%. The rates of appropriateness of prehospital care were 0.0%~37.1%. The performance of EMT-1 type was better than other types, but the differences were not statistically significant. CONCLUSION: The results of this study suggest the performance of 119 rescue services studied was not at high level and needs significant improvement. More communicating with medical direction and increased provision of EMT-1 could be the considerations in improving the quality of prehospital care.