Monitoring of quality assurance of Emergency Medical Technicians (EMTs) in the emergency department

Objective: To understand the characteristics of Emergency Medical Services (EMS) and the performance of prehospital care by Emergency Medical Technicians (EMTs) in Hualien. Patients and Methods: A prospective study was conducted from Jan. 1, 2000 through Dec. 31, 2000. Patients sent to the Emergency Department (ED) of Tzu Chi General Hospital-Hualien by Hualien EMTs during this period were studied. The performance of EMTs was evaluated via prehospital records and evaluation of the patients by triage nurses or research assistants. The sex and age of the patients; the time the call was received; the time of arrival and leaving the scene; the time of arrival in the ED; the reason for the call; which prehospital skills should have been used theoretically; which skills were actually used; and vital signs were evaluated and keyed into the computer. Results: Altogether or 1,541 cases were collected during these 12 months. The patients' average age was 44.7 ± 11.9 years. The male to female ratio was 1.6:1.0. The response time on average was 5.3 ± 5.5 minutes. Time spent on the scene averaged 4.6 ± 2.6 minutes. Transportation time on average was 21.1 ± 14.7 minutes. The most common reason for calling the EMS was motorcycle accidents (30.3%, 466/1541), followed by car accidents (9.3%, 143/1541) and dizziness or headaches (6.0%, 92/1541). The three leading prehospital skills which should have been used theoretically on the scene were bleeding control and packing (42.6%, 655/1541), maintaining airway (35.4%, 544/1541), and oxygenation through a nasal cannula (23.3%, 359/1541). The three top prehospital skills EMTs actually used on the scene were maintaining airway (35.4%, 133/376), bleeding control and packing (34.6%, 130/376), and splinting (17.6%, 66/376). The percentage of prehospital skills actually done among the same skills theorectically needed were as follows: Heimlich maneuver (66.7%, 4/6), short board (50.0%, 5/10), and removal of helmet (45.5%, 5/11). The percentage of prehospital skills that should have been done but were not done by EMTs was 64.1 ± 25.3%. In about 29.6 ± 25.4% of prehospital records the time were not recorded completely. In 9.7 ± 15.0% of prehospital recoreds, no reason for calling was recorded. In about 23.7 ± 24.1% of cases, the reasons for calling were not correctly recorded. Almost all EMTs (98.0%) did not record the vital signs at the scene. In comparing the performance of EMTs between the first three months and the last three months of the study, there was improvement in prehospital skills on the scene (25.5 ± 25.5% Vs 33.8 ± 25.5%), no time spot recorded (32.6 ± 28.0% Vs 24.7 ± 26.5%), no reason for calling recorded (13.9 ± 25.2% Vs 6.8 ± 7.6%). The reasons for calling which were incorrectly recorded increased (13.1 ± 8.9% Vs 24.0 ± 24.8%) during this time, and the recordings of vital signs (0% Vs 6.7%) increased as well. Conclusions: We conclude that the performance of the EMS in Hualien is poor. Evaluating the characteristics of patients and checking the prehospital records upon arriving at ED by triage nurses are good methods of improving quality assurance in the EMS.