Paramedic intercepts with basic life support ambulance services in rural Minnesota.

INTRODUCTION: In rural Minnesota, it is common for paramedics providing advanced life support (ALS) to rendezvous with ambulances providing only basic life support (BLS). These "intercepts" presumably allow for a higher level of care when patients have certain problems or need ALS interventions. The aim of this study was to review and understand the frequency of paramedic intercepts with regard to the actual care rendered and transport urgency (lights and sirens vs. none).

METHODS: All paramedic intercepts occurring between January 2003 and December 2007 for one multi-site emergency medical services (EMS) provider were reviewed for ALS interventions and treatments provided. In addition, the urgency of responses to the dispatch call or "intercept" and transport to a receiving facility were analyzed.

RESULTS: During the study period, 1,675 paramedic intercepts occurred and were reviewed. The ALS ambulances responded to the dispatch emergently (lights and sirens) in 97.5% of intercepts (1,633), but emergently transported only 24.2% of the patients (405). Paramedics performed no interventions above BLS levels in 11.6% (194) of the cases. Of the remaining 1,481 patients who received ALS interventions, 955 (64.4%) received no treatment or diagnostic testing other than electrocardiographic monitoring, intravenous access, or both.

CONCLUSIONS: A significant discrepancy between emergent responses and actual ALS care rendered during intercept calls was demonstrated. Given the significant rate of EMS worker fatalities and transferable patient care costs, further study is needed to determine whether costs and safety are potentially improved by decreasing emergent responses. Future directions include developing or emulating Medical Priority Dispatch System triage protocols for advanced services providing intercepts. In addition, further study of patient outcomes between intercept and non-intercept cases is necessary.