Nine golden codes: Improving the accuracy of Helicopter Emergency Medical Services (HEMS) dispatch - a retrospective, multi-organisational study in the East of England

Author:

Edmunds Christopher1ORCID,Lachowycz Kate1,McLachlan Sarah2,Downes Andrew1,Smith Andrew3,Major Rob1,Barnard Edward1

Affiliation:

1. EAAA: East Anglian Air Ambulance

2. Anglia Ruskin University

3. MAGPAS: Magpas Air Ambulance

Abstract

Abstract Background Helicopter Emergency Medical Services (HEMS) are a limited and expensive resource, and should be intelligently tasked. HEMS dispatch was identified as a key research priority in 2011and 2022, with a call to identify a ‘general set of criteria with the highest discriminating potential’. However, there have been no published data analyses in the subsequent decade that specifically address this priority, and this priority has been reaffirmed in 2022. The objective of this study was to define the dispatch criteria available at the time of the initial emergency call with the greatest HEMS utility using a large, regional, multi-organizational dataset in the UK. Methods This retrospective observational study utilized dispatch data from a regional emergency medical service (EMS) and three HEMS organisations in the East of England, 2016-2019. In a logistic regression model, Advanced Medical Priority Dispatch System (AMPDS) codes with ≥50 HEMS dispatches in the study period were compared with the remainder to identify codes with high-levels of HEMS patient contact and HEMS-level intervention/drug/diagnostic (HLIDD). The primary outcome was to identify AMPDS codes with a >10% HEMS dispatch rate of all EMS taskings that would result in 10-20 high-utility HEMS dispatches per 24-hour period in the East of England. Data were analysed in R, and are reported as number (percentage); significance was p<0.05. Results There were n=25,491 HEMS dispatches (6.4k per year), of which n=23,030 (90.3%) had an associated AMPDS code. n=13,778 (59.8%) of HEMS dispatches resulted in patient contact, and n=8437 (36.6%) had an HLIDD. 43 AMPDS codes had significantly greater rates of patient contact and/or HLIDD compared to the reference group. In an exploratory analysis, a cut-off of ≥70% patient contact rate and/or ≥70% HLIDD (with a >10% HEMS dispatch of all EMS taskings) resulted in 17 taskings per 24-hour period. This definition derived nine AMPDS codes with high HEMS utility. Conclusion We have identified nine ‘golden’ AMPDS codes, available at the time of initial emergency call, that are associated with high-levels of whole-system and HEMS utility in the East of England. We propose that UK EMS should consider immediate HEMS dispatch to these codes.

Publisher

Research Square Platform LLC

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