The Ambulance Location Can Influence Emergency Medical Service Response Time:
A Literature Review
I Wayan Edi Sanjana, Titin Andri Wihastuti and Nurul Muslihah Faculty of Health Sciences, University of Brawijaya, Indonesia Email Address : [email protected]
Abstract Factor of the accident was the highest cause of mortality. The mortality or death caused by accident could be avoided through a fast and appropriate first aid.
The ambulance was a component of EMS that must reach the incident location in a quick time. This research was aimed to identify the effects of ambulance station location and ambulance response time. In the literature review, four databases were used as EBSCOhost, Proquest, Science Direct, and SpringerLink and through access help from Brawijaya University library. PRISMA method was exerted in this research to select the articles and choose as many as 15 research articles that fulfill inclusion criteria. The response time of EMS was very influential for patient care and safety. The standby ambulance location can affect the officer's response time.
The determination of the ambulance location for the EMS service provider was very significant to offer an optimal service.
Introduction
A traffic accident is the leading cause of mortality in the United States of America at the range of 1-54 years old. The accident is also the most cause of abnormal mortality type on the traveler people. There are about 3,700 mortality cases that daily occur all over the world because of bus, car, and motor accidents (Centers of Disease Control and Prevention (CDC), 2019).
The traffic accident in Indonesia is also regarded as a severe problem. The Indonesian police in the last 2014 have reported approximately 28,000 mortality cases because of the accident, and the Indonesian mortality rate has reached 12 per 100,000 population (Jusuf et al., 2017).
A right pre-hospital intervention can prevent mortality in case of a traffic accident. In this context, the ambulance is one of EMS (Emergency Medical Service) components that will always be available for 24 hours in the hospital and public health center with an inpatient facility. It is used to serve pre-hospital
patients. According to the Regulation of Health Ministry of Republic Indonesia 47th 2018 about the emergency service, the ambulance is used for medical evacuation from incident location/patient location to get health service facility or referral among health facilities by maintaining the resuscitation stabilization efforts (Minister of Health Regulation of 47, 2018).
The first intervention of ambulance service on accident victim is expected to be optimally performed. The intervention on accident victim in the incident location exerts a principle of
"getting a right patient to the right place at the right time" (Golden Hour), which significantly enables the traumatic patients to have a better survival chance when they can acquire any medical service or surgery in less than 60 minutes after the incident is occurred (Anand et al., 2013). The more extended response from ESM will increase the probability of death caused by a motor accident. The significant KEYWORDS
Ambulance;
location;
emergency medical service;
response time.
proportion of accident victim death is indicated by the EMS officer's length of aid (Byrne et al., 2019). Thus, it needs the right way to improve ambulance service response time or EMS, aiming to prevent disability and death on the accident victim.
Material and Method
This research exerted a literature review method. The literature search was done by searching several relevant research articles about the attempts to improve ambulance service response time or EMS related to the EMS service location. The databases were Science Direct, Proquest, SpringerLink, and EBSCOhost through library access of University of Brawijaya. The research articles' search was according to inclusion criteria as the research articles should be published from 2016 to 2021.
The research was concerning response time and standby ambulance location. The articles have consisted of article review and original research.
The search process exerted these keywords:
ambulance, emergency medical service (EMS), location, place, and response time. The use of those keywords was then combined with the Boolean of AND & OR. The article selection employed the PRISMA analysis method to find out the articles that were in accordance with the aim of the literature review.
Result and Discussion
The total articles acquired in this research were about 1502 research articles from 1114 articles from the Science Direct database, 27 articles from the EBSCOhost database, 201 articles from the Proquest database, and 160 articles from SpringerLink. The researcher identified 32 articles that would be filtered in the full text. The researcher selected 15 research articles to be included in this research discussion. The article selection was through PRISMA and would be explained in figure 1.
Table 1 would refer to the summary of selected
research articles. To conclude, the researcher read the article content comprehensively and addressed the article summary in the researcher's language.
The researcher finally concluded the research result analyzed that ambulance officer response time or emergency medical service was related significantly to patient safety prognosis. The quicker the officer could reach the incident location and perform an intervention for the patient, the higher the patient safety. There were a lot of factors that could influence the ambulance officer response time. In this context, the researcher found that the factors of standby ambulance location and ambulance amount were interrelated. The ambulance station must be available in the accident-prone area. The location, which might be occurred many accidents were like a busy roadway with a high average of vehicle speed.
Each area or territorial should have at least two units of standby ambulance to offer first aid.
This strategy was aimed to anticipate when the first ambulance was unable to give help, and then it could be backed up by the second ambulance.
The significance of Emergency Medical Service (EMS) was very vital (Leknes et al., 2017). The faster the EMS officer could give first aid, the higher the patient safety (Badi et al., 2017). The EMS provider must organize an ambulance unit in certain territorial points to get an optimal service (Mohri & Haghshenas, 2020). This idea was in line with the statement that the receiver of an emergency call must synergize with the officer to quicken response time in the incident location (Colla et al., 2019).
The other items that should also be a significant consideration for EMS providers in the service performance were standby ambulance and ambulance station location (Nogueira et al., 2016). The standby ambulance station should be located at the locations in which accidents frequently happened. The
other researches have defined further that high speed roadway and road with heavy traffic must be a consideration to locate the standby ambulance (Amorim et al., 2017). The organization of the ambulance unit location would be very helpful to fasten EMS service (Navazi & Sazvar, 2018).
The EMS service provider could exert mathematical formula or other methods to decide the allocation of the standby ambulance station. The accident probability formula by considering the area's geographical location, area, and traffic activity could examine the ambulance placement (Nickel et al., 2016). The weather factor could also be influential to the call of EMS service, so the consideration of area with extreme hot weather could be a consideration point for EMS service provider to decide the ambulance station position (Devine et al., 2017).
Furthermore, the determination of the ambulance location could be done by utilizing technology. Sudtachat et al. have further explained that EMS location arrangement could be done using computer-aided dispatch and Global Positioning System (GPS) (Sudtachat et al., 2016). According to the previous idea
(Sarkisian et al., 2020) have also stated that the response time in determining patient location was faster found by using GPS. The GPS utilization was also easily benefitted by volunteers trained to give first aid (Sarkisian et al., 2020). Moreover, GPS use in the patient location determination could develop future clinical aid (Fukushima & Moriya, 2020).
To decide the development model, the provider of EMS service should consider the relocation (Carvalho et al., 2020). The ambulance relocation would provide better overall coverage for EMS provider with limited resources (Trujillo et al., 2020). Next, the EMS service provider must consider the resource aspect to decide the wide range of services. The incompatibility between resource and service- wide range would hamper the delivery of EMS service. At least, there should be two ambulance units and officers in an area or territory. If the first ambulance could not give medical aid, the second ambulance could take over the duty to provide EMS with service (Leknes et al., 2017).
The results of the article selection study can be illustrated in the Flow Diagram using PRISMA in Figure 1.
Figure 1. Reporting Items for Flow Diagram Study
Table 1 Summary of selected articles (n=15)
No Study Reference Result
1. Nogueira et al. (2016) The standby ambulance amount and ambulance location are related to the performance of Emergency Medical Service (EMS).
2. Badi et al. (2017) The emergency Medical Service (EMS) can affect significantly to the health service. The regulation of ambulance location is required to be able to give a quick response time.
3. Liu et al. (2017) The regulation of ambulance model through Double Standard Model (DSM) is aimed to improve officer response time during the service.
4. Nickel et al. (2016) The use of accident probability formula to locate standby ambulance is quite significant in the determination of ambulance location.
5. Navazi & Sazvar (2018) The management of ambulance and helicopter unit placement is very useful to speed up the ambulance arrival and lessen the expense.
6. Mohri & Haghshenas (2020) The placement of ambulance amount is adjusted to ambulance need in each location.
7. Sudtachat et al. (2016) The regulation of Emergency Medical Service (EMS) location can be performed through computer aid dispatch and Global Positioning System (GPS).
8. Trujillo et al. (2020) The ambulance relocation can provide better overall coverage for Emergency Medical Service (EMS) provider with limited resource.
9. Sarkisian et al. (2020) The response time of patient location determination is performed quicker by utilizing Global Positioning System (GPS) 10. Carvalho et al. (2020) To determine the development model, the relocation should be
considered.
11. Fukushima & Moriya (2020) The utilization of Global Positioning System (GPS) can improve the quality of future clinical aid.
12. Dibene et al. (2017) The accurate decision of standby ambulance location can reduce service response time.
13. Amorim et al. (2017) The locations near to roadway with a heavy traffic and high speed will increase the number of accident, so the ambulance location should be placed near to the area of high speed road.
No Study Reference Result
14. Yang et al. (2019) The Emergency Medical Service (EMS) system can be simplified using an adjustable method, and allocation cost can be saved up to 41%.
15. Leknes et al. (2017) An area or territory should be managed by two ambulance stations. If the first ambulance cannot give first aid, it will be backed up by the second ambulance.
Conclusions and Suggestion
The quickness of EMS service response time was related to patient safety. The ambulance station location or standby ambulance's decision would impact the officer response time to give emergency service. The EMS service provider was expected to consider the resource or ambulance amount and the officer to determine the ambulance location.
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