Study objective: We determine the relationship between physician, nursing, and patient factors on emergency department use of ambulance diversion. Methods: Data were collected at 1 ED in Toronto, Ontario, Canada, on t...
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Study objective: We determine the relationship between physician, nursing, and patient factors on emergency department use of ambulance diversion. Methods: Data were collected at 1 ED in Toronto, Ontario, Canada, on the duration of ambulance diversion during consecutive 8-hour intervals from January to December 1999 (intervals=1,095). By using time series methods, the association between ambulance diversion and nurse hours, physician on duty, and boarded patients was determined. Covariates included patient volume, assessment time, and boarding time. Results: A total of 37,999 patients were treated in the ED over the study period (2% major trauma, 16% ambulance arrivals, and 22% admitted). Nurse hours per interval averaged 60. A mean of 3.2 admitted patients were boarded in the ED each interval. For admitted patients, the time from registration to admission order and from admission order to ED departure averaged 5.2 and 3.5 hours, respectively. There was no ambulance diversion during 170 (15.5%) intervals, whereas 17 (1.5%) intervals were continuously on diversion. In time series analyses, ambulance diversion increased with the number of admitted patients boarded in the ED (6.2 minutes per patient;95% confidence interval [Cl] 2.6 to 9.8 minutes), the number admitted per interval (4.6 minutes per patient;95% Cl 0.1 to 9.1 minutes), assessment time (9.9 minutes per hour;95% Cl 3.3 to 16.5 minutes), and boarding time (11.3 minutes per hour;95% Cl 5.6 to 17.0 minutes). Thirteen of 15 emergency physicians were not associated with ambulance diversion, 1 was associated with reduced use (-36.3 minutes;95% Cl -65.2 to -7.5 minutes), and 1 was associated with increased use (47.6 minutes;95% Cl 4.5 to 90.6 minutes). ED nurse hours were not associated with diversion. Ambulance-delivered patient volume was associated with diversion (5.2 minutes per patient;95% Cl 2.7 to 7.8 minutes), but walk-in patients and patients with major trauma were not. Conclusion: Admitted patients in th
Study objective: In March 2000, an estimated 500,000 people attended an annual motorcycle rally in Daytona Beach, FL, where approximately 64,000 residents live year-round. The media reported 15 deaths during this 10-d...
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Study objective: In March 2000, an estimated 500,000 people attended an annual motorcycle rally in Daytona Beach, FL, where approximately 64,000 residents live year-round. The media reported 15 deaths during this 10-day event. To more, comprehensively assess the extent of trauma and need for emergency medical care we, investigated all motorcycle crashes, regardless of outcome. Methods: Motorcycle-related crash data from local medical examiner, hospital, emergency medical services (EMS), and police sources were linked. Frequencies of crashes, injuries, hospitalizations, and deaths were determined, and EMS use data were analyzed. Results: During Bike Week 2000, 570 people were involved in 281 motorcycle-related crashes. Two hundred thirty (40%) people were injured, of which 147 (64%) sought treatment in emergency departments, 72 (31%) were hospitalized, and 11 (5%) died. In crashes between motorcycles and passenger cars, individuals exposed as motorcycle Occupants were 8.7 times more likely to be injured than car occupants (95%, confidence limit 1.7, 15.7). Of 205 EMS dispatches for motorcycle-related crashes, two thirds resulted in transport to an ED. Data needed to assess known risk factors (eg, alcohol use, speed, lack of helmet use) were not routinely ascertained at either the Crash site or ED. Conclusion: Although fatalities first called attention to the problem, nonfatal injuries outnumbered deaths 20:1. The manpower resources of civil service and health resources could become overwhelmed or exhausted in circumstances in which many people are injured or killed throughout a relatively long period. The situation deserves future study. Better risk factor surveillance is needed to help prevent crashes.
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