Search

Background: National guidelines recommend that high-performing systems process 9-1-1 calls within 60 s and deliver the first telecommunicator cardiopulmonary resuscitation compression within 90 s. The inability of systems employing secondary public safety answering points (PSAPs) to capture the call arrival timestamp at the primary PSAP is a challenge in out-of-hospital cardiac arrest response time research. Objective: We sought to measure the interval from call receipt at primary PSAPs to call answer at secondary PSAPs in metropolitan areas. Methods: This was a retrospective observational study evaluating 9-1-1 call transfers between PSAPs serving large urban populations. Call transfer records were extracted from the 9-1-1 telephony systems at the primary and secondary PSAPs covering seven metropolitan EMS systems. For each transferred call, we obtained the call arrival timestamp at both the primary and secondary PSAPs. The primary outcome was the interval between these two times. Results were compared to a national standard of 90% of calls forwarded within 30 s of receipt. Results: Data collected at seven metropolitan EMS agencies from January 1, 2021, through June 30, 2021, yielded 299,679 records for evaluation. The median interval required to transfer a 9-1-1 caller from primary to secondary PSAPs was 41 s (IQR 31, 59), and 86 s at the 90th percentile. The 90th percentile performance level at individual agencies ranged from 63 s to 117 s. Conclusions: The primary to secondary PSAP transfer interval lengths observed in this study preclude these EMS agencies from meeting out-of-hospital cardiac arrest performance recommendations at the 90% percentile performance level. [ABSTRACT FROM AUTHOR]

Emergency medical services (EMS) often serve as the first medical contact for ill or injured patients, representing a critical access point to the health care delivery continuum. While a growing body of literature suggests inequities in care within hospitals and emergency departments, limited research has comprehensively explored disparities related to patient demographic characteristics in prehospital care. We aimed to summarize the existing literature on disparities in prehospital care delivery for patients identifying as members of an underrepresented race, ethnicity, sex, gender, or sexual orientation group. We conducted a scoping review of peer-reviewed and non-peer-reviewed (gray) literature. We searched PubMed, CINAHL, Web of Science, Proquest Dissertations, Scopus, Google, and professional websites for studies set in the U.S. between 1960 and 2021. Each abstract and full-text article was screened by two reviewers. Studies written in English that addressed the underrepresented groups of interest and investigated EMS-related encounters were included. Studies were excluded if a disparity was noted incidentally but was not a stated objective or discussed. Data extraction was conducted using a standardized electronic form. Results were summarized qualitatively using an inductive approach. One hundred forty-five full-text articles from the peer-reviewed literature and two articles from the gray literature met inclusion criteria: 25 studies investigated sex/gender, 61 studies investigated race/ethnicity, and 58 studies investigated both. One study investigated sexual orientation. The most common health conditions evaluated were out-of-hospital cardiac arrest (n = 50), acute coronary syndrome (n = 36), and stroke (n = 31). The phases of EMS care investigated included access (n = 55), pre-arrival care (n = 46), diagnosis/treatment (n = 42), and response/transport (n = 40), with several studies covering multiple phases. Disparities were identified related to all phases of EMS care for underrepresented groups, including symptom recognition, pain management, and stroke identification. The gray literature identified public perceptions of EMS clinicians' cultural competency and the ability to appropriately care for transgender patients in the prehospital setting. Existing research highlights health disparities in EMS care delivery throughout multiple health outcomes and phases of EMS care. Future research is needed to identify structured mechanisms to eliminate disparities, address clinician bias, and provide high-quality equitable care for all patient populations. [ABSTRACT FROM AUTHOR]