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Prevalence and Distribution of Advanced Life Support (ALS) Interventions by EMS in Pre-Hospital Patients

Author: Caitlin Delaney MS, NRP | Medical Student | University At Buffalo

Associate Authors: Reuter, Mitchel, L. MSEMS, CCEMT-P, NRP | Koontz, Katherine, J. BS, NREMT | Milliman, Joseph, C. MBA, AEMTP | Rosen, Joshua, A. MBA, NREMT | Beckstead, Rylee, E. MStat | Jarvis, Jeffery L. MD, MS, EMT-P

Introduction

Emergency Medical Services (EMS) respond to incidents with a variety of patient acuity. Higher acuity incidents may require interventions by scarce ALS clinicians, while more readily available BLS clinicians may handle lower acuity incidents. Recent work has targeted lights-and-sirens responses based on interventions performed by EMS clinicians. A similar methodology could provide insight into which incidents may be appropriately cared for by BLS units, potentially freeing up ALS units for higher acuity incidents. No work, however, has used clinical interventions as a method to determine the appropriate response level. We sought to describe the proportion of calls handled by an ALS unit and the frequency with which ALS interventions were performed.

Methods

We conducted a retrospective descriptive analysis of the 2023 NEMSIS dataset. Patients treated by a ground EMS unit during a 911 response were identified; incidents without patient contact were excluded. ALS interventions were defined based on the 2019 NHTSA National EMS Scope of Practice. Each call was coded as either receiving an ALS intervention or not. We described the proportion and type of ALS interventions performed, stratified by call nature.

Results

Of 34,909,312 responses, 27,699,200 (79.4%) had ALS responses. The most common call types with ALS responses were: Sick Person (Non-Traumatic) (19.3%), Falls (10.9%), Breathing Problem (10.4%), Chest Pain (Non-Traumatic) (6.9%), and Traffic/Transportation Incident (6.7%). The call types with the highest rate of ALS interventions by an ALS provider were Healthcare Professional/Admission (55.5%), Cardiac Arrest/Death (45.5%), Heart Problems/AICD (40.7%), Stroke/CVA (37.9%), and Chest Pain (Non-Traumatic) (37.8%) while the call types with the lowest ALS intervention rate were Well Person Check (9.5%), Assault (9.8%), Psychiatric Problem/Abnormal Behavior/Suicide Attempt (10.1%), Animal Bite (10.2%), and Eye Problem/Injury (11.1%).

Conclusion

Approximately 75% of ALS responses result in no ALS intervention. 911 call type can be utilized to determine the likelihood of an ALS intervention being performed. Further studies can expand on these findings to tailor response levels to patient needs.