JACEP
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For Health Systems Agencies to fulfill their needs assessment and facility regulation functions under the National Health Planning and Resources Development Act of 1974 (PL 93-641), process measures are needed to evaluate the overall efficiency of an emergency ambulance system. In Erie County, New York, unmet ambulance need, defined as the proportion of emergency patients who clinically need ambulance transportation but do not receive it, was found to be 55%. Inappropriate ambulance use, defined as the proportion of emergency patients receiving ambulance care who did not clinically need it, was found to be 30%. These two measures were cross-tabulated with patient and visit characteristics to identify the determinants of unmet need and inappropriate use and to generate recommendations for system changes to reduce both types of ambulance ineffectiveness.
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A disproportionately high percentage of trauma fatalities occur in rural areas. Almost half of these fatalities occur after arrival at a community hospital. A review of the initial evaluation and management of major trauma victims in rural community hospitals in the intermountain West revealed a surprisingly high incidence of departure from well defined standards. Reducing the magnitude of this rural hospital component of trauma facilities will require application of the same standards of initial evaluation and management which have proved effective in major medical center emergency department settings.
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In a review by questionnaire of the emergency visits to 185 Florida hospitals, the number of annual estimated visits appears to exceed national estimates. In addition, the concept that in excess of 75% of patients are not true emergencies is not borne out. In spite of changes in the emergency medical services system, only 10% of patients came by ambulance or rescue vehicle. ⋯ Some 40% of Florida's emergency departments have full-time emergency physicians. Although nearly 70% of the emergency patients were seen by these physicians, 2.4% were seen by interns only, and a total of 10% were seen by house officers only. There was a great variety of referral patterns among the Health Service Agencies.