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Cancellations of (helicopter-transported) mobile medical team dispatches in the Netherlands.

Giannakopoulos GF, Lubbers WD, Christiaans HM, van Exter P, Bet P, Hugen PJ, Innemee G, Schubert E, de Lange-Klerk ES, Goslings JC, Jukema GN - Langenbecks Arch Surg (2010)

Bottom Line: Statistically significant differences between assists and cancellations were found for overall mortality, mean RTS, GCS and ISS, mean hospitalization, length and amount of ICU admissions (p < 0.001).We found an undertriage rate of 4%, which we think is acceptable.According to this study, it seems to be possible to reduce the overtriage rate of the MMT dispatches, without increasing the undertriage rate to non-acceptable levels.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma Surgery, VU University Medical Centre, 7F-018, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. gf.giannakopoulos@vumc.nl

ABSTRACT

Background: The trauma centre of the Trauma Center Region North-West Netherlands (TRNWN) has consensus criteria for Mobile Medical Team (MMT) scene dispatch. The MMT can be dispatched by the EMS-dispatch centre or by the on-scene ambulance crew and is transported by helicopter or ground transport. Although much attention has been paid to improve the dispatch criteria, the MMT is often cancelled after being dispatched. The aim of this study was to assess the cancellation rate and the noncompliant dispatches of our MMT and to identify factors associated with this form of primary overtriage.

Methods: By retrospective analysis of all MMT dispatches in the period from 1 July 2006 till 31 December 2006 using chart review, we conducted a consecutive case review of 605 dispatches. Four hundred and sixty seven of these were included for our study, collecting data related to prehospital triage, patient's condition on-scene and hospital course.

Results: Average age was 35.9 years; the majority of the patients were male (65.3%). Four hundred and thirty patients were victims of trauma, sustaining injuries in most cases from blunt trauma (89.3%). After being dispatched, the MMT was cancelled 203 times (43.5%). Statistically significant differences between assists and cancellations were found for overall mortality, mean RTS, GCS and ISS, mean hospitalization, length and amount of ICU admissions (p < 0.001). All dispatches were evaluated by using the MMT-dispatch criteria and mission appropriateness criteria. Almost 26% of all dispatches were neither appropriate, nor met the dispatch criteria. Fourteen missions were appropriate, but did not meet the dispatch criteria. The remaining 318 dispatches had met the dispatch criteria, of which 135 (30.3%) were also appropriate. The calculated additional costs of the cancelled dispatches summed up to a total of 34,448 euro, amounting to 2.2% of the total MMT costs during the study period.

Conclusion: In our trauma system, the MMT dispatches are involved with high rates of overtriage. After being dispatched, the MMT is cancelled in almost 50% of all cases. We found an undertriage rate of 4%, which we think is acceptable. All cancellations were justified. The additional costs of the cancelled missions were within an acceptable range. According to this study, it seems to be possible to reduce the overtriage rate of the MMT dispatches, without increasing the undertriage rate to non-acceptable levels.

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Related in: MedlinePlus

Mobile Medical Teams in the Netherlands
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Related In: Results  -  Collection


getmorefigures.php?uid=PMC2908760&req=5

Fig1: Mobile Medical Teams in the Netherlands

Mentions: During daylight hours, almost 80% of the Dutch population can be reached within 15 min by the (totally four) H-MMTs in the Netherlands (Fig. 1). After sunset and until midnight, the MMT is transported by a specially equipped vehicle. Table 1 shows the difference of the dispatch, assist and cancellation rate between the four MMT's in the Netherlands.Fig. 1


Cancellations of (helicopter-transported) mobile medical team dispatches in the Netherlands.

Giannakopoulos GF, Lubbers WD, Christiaans HM, van Exter P, Bet P, Hugen PJ, Innemee G, Schubert E, de Lange-Klerk ES, Goslings JC, Jukema GN - Langenbecks Arch Surg (2010)

Mobile Medical Teams in the Netherlands
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2908760&req=5

Fig1: Mobile Medical Teams in the Netherlands
Mentions: During daylight hours, almost 80% of the Dutch population can be reached within 15 min by the (totally four) H-MMTs in the Netherlands (Fig. 1). After sunset and until midnight, the MMT is transported by a specially equipped vehicle. Table 1 shows the difference of the dispatch, assist and cancellation rate between the four MMT's in the Netherlands.Fig. 1

Bottom Line: Statistically significant differences between assists and cancellations were found for overall mortality, mean RTS, GCS and ISS, mean hospitalization, length and amount of ICU admissions (p < 0.001).We found an undertriage rate of 4%, which we think is acceptable.According to this study, it seems to be possible to reduce the overtriage rate of the MMT dispatches, without increasing the undertriage rate to non-acceptable levels.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma Surgery, VU University Medical Centre, 7F-018, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. gf.giannakopoulos@vumc.nl

ABSTRACT

Background: The trauma centre of the Trauma Center Region North-West Netherlands (TRNWN) has consensus criteria for Mobile Medical Team (MMT) scene dispatch. The MMT can be dispatched by the EMS-dispatch centre or by the on-scene ambulance crew and is transported by helicopter or ground transport. Although much attention has been paid to improve the dispatch criteria, the MMT is often cancelled after being dispatched. The aim of this study was to assess the cancellation rate and the noncompliant dispatches of our MMT and to identify factors associated with this form of primary overtriage.

Methods: By retrospective analysis of all MMT dispatches in the period from 1 July 2006 till 31 December 2006 using chart review, we conducted a consecutive case review of 605 dispatches. Four hundred and sixty seven of these were included for our study, collecting data related to prehospital triage, patient's condition on-scene and hospital course.

Results: Average age was 35.9 years; the majority of the patients were male (65.3%). Four hundred and thirty patients were victims of trauma, sustaining injuries in most cases from blunt trauma (89.3%). After being dispatched, the MMT was cancelled 203 times (43.5%). Statistically significant differences between assists and cancellations were found for overall mortality, mean RTS, GCS and ISS, mean hospitalization, length and amount of ICU admissions (p < 0.001). All dispatches were evaluated by using the MMT-dispatch criteria and mission appropriateness criteria. Almost 26% of all dispatches were neither appropriate, nor met the dispatch criteria. Fourteen missions were appropriate, but did not meet the dispatch criteria. The remaining 318 dispatches had met the dispatch criteria, of which 135 (30.3%) were also appropriate. The calculated additional costs of the cancelled dispatches summed up to a total of 34,448 euro, amounting to 2.2% of the total MMT costs during the study period.

Conclusion: In our trauma system, the MMT dispatches are involved with high rates of overtriage. After being dispatched, the MMT is cancelled in almost 50% of all cases. We found an undertriage rate of 4%, which we think is acceptable. All cancellations were justified. The additional costs of the cancelled missions were within an acceptable range. According to this study, it seems to be possible to reduce the overtriage rate of the MMT dispatches, without increasing the undertriage rate to non-acceptable levels.

Show MeSH
Related in: MedlinePlus