Identification of new demands regarding prehospital care based on 35,188 missions in 2018

Abstract

Background: Population ageing and increased prevalence of chronic diseases result in the emergence of new demands in prehospital care. The prehospital system is facing an increase of cases without acute threat to life (so-called "non-urgent"), which generates tension due to a higher number of admissions to emergency departments and a greater use of prehospital resources. Our aim is to understand this transition in prehospital activities and to delineate the primary missions performed by paramedics in 2018 with a focus on the population concerned, the severity of cases encountered and the typology of health issues.

Method: The study is retrospective, and descriptive, using a statistical description of 35,188 primary missions realized in 2018 in the State of Vaud (Switzerland). The characteristics taken into consideration are the age and gender of patients, as well as the health issue, the severity of cases based on National Advisory Committee for Aeronautics score (NACA score), and the time and place of intervention.

Results: The results describe the primary missions in the State of Vaud in 2018 and show that 87% of missions concern "non-urgent" situations (without acute threat to life). Over half of patients are 65 or older, the highest proportion of health issues, 49%, are medical and only 23% of missions are for traumas. Mission related to mental health issues reach 7% and those for intoxication 6%. Most missions take place between 7:00 am and 6:00 pm (67%), and around 12% of missions lead to the non-transport of the patient.

Conclusion: The prehospital sector is confronted with a major transition in terms of patient care. An increase of non-urgent cases is observed, associated with the care of persons aged 65 or more. Our results question the adequacy between the needs in terms of prehospital care and the paramedic profession as it is currently defined, as well as the place of this profession within the health network. Reflecting upon the role of paramedics with respect to the socio-demographic evolution of populations appears necessary, to analyse the adequacy of the paramedics' skills to respond to the current needs.

Keywords: Emergency medical service; Non-urgent patients; Prehospital; Transport.

Fig. 1

Age distribution as a function of the level of severity determined by the NACA score. Boxplot 1 represents all the missions in 2018 (n = 35,156, 32 data items missing). Boxplots 2 and 3 respectively represent the age distributions for the prehospital missions with NACA scores between 0 and 3 (non-urgent, n = 30,633) and NACA scores between 4 and 7 (vital emergency, n = 4523). The Mann–Whitney U test shows that the two medians are different with high significance. For NACA scores 0–3 and NACA scores 4–7, statistical values are respectively: median: 64–69, SD: 26.06–22.80, IQR: 45–30

Fig. 2

Typology of the health issues encountered in 2018 (n = 35,184–4 missing data)

Fig. 3

Places of intervention in 2018 (n = 35,188)

Fig. 4

Distribution of missions of the year 2018 over the hour of the day (n = 35,188)