Evaluation of the Appropriateness of Prehospital Emergency Care by 119 Rescue Services in Seoul Metropolitan Area

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the appropriateness of prehospital emergency care by 119 rescue services in Seoul. METHODS: We enrolled all patients who used 119 rescue services in Seoul between January and Sepember 2006 and analyzed the 119 ambulance patient care record databases. Major emergencies were defined and categorized into four groups cardiopulmonary complaint (CP), neurologic complaint (NR), cardiorespiratory arrest (CA) and major trauma (MT). Interventions provided by emergency medical technicians were scored as 2essential, 1optional and 0unnecessary in each category of major emergency. We summed scores of provided interventions per patient and graded them into four levels for conducting the appropriateness review. Multivariate logistic regression analysis was performed to determine the relationship of risk factors to the appropriateness of intervention. RESULTS: Total number of cases was 171,112 of which 36,065 were major emergencies. The proportion of "very low" level appropriate was 40.1% for CP (N=11,522). 49.3% for NR (N=15,239), 14.5% for CA (N=1,591), and 32.7% for MT (N=7,713). The proportion of "high" level was less than 3% except for CA(11.3%). Variables affecting the "moderate" or "high" level of appropriateness of prehospital emergency care, as determined by multivariate logistic regression analysis, were age > or =65(OR 1.425, 95% CI 1.337-1.520), female gender (OR 0.880, 95% CI 0.828-0.935), and type of complaint in the order CP (OR 0.181, 95% CI 0.161-0.204), NR (OR 0.184, 95% CI 0.164-0.207), and MT (OR 0.202, 95% CI 0.178-0.229). CONCLUSION: The prehospital emergency care of 119 rescue services in Seoul was frequently inappropriate and was influenced by patient's age, gender and chief complaints.