Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

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Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
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Best regards,
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Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
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It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2009 | Month : June | Volume : 3 | Issue : 3 | Page : 1519 - 1522

Emergency (108) Calls To The Ambulance Service In The State Of Gujarat (India) That Do Not Result In The Patient Being Transported To Hospital: An Epidemiological Study

PANDEY A *, RANJAN R **

*Senior Partner,**Associate Partner,Emergency Medicine Learning& Care, EMRI, Ahemadabad, Gujarat,(India)

Correspondence Address :
Dr Ashendu Pandey,Senior Partner,
Emergency Medicine Learning &Care,
EMRI, Ahemadabad, Gujarat, (India).
E.mail:ashendu_pandey@emri.in

Abstract

Objective: To describe the demographical and clinical characteristics of the patients who are not transported to the hospital after an emergency (108) call to the Gujarat EMRI emergency response center, the reason for non-transportation, and the priority assigned when the ambulance is dispatched.
Methods: All non-transported patients from 1st December 2008 to 28th February 2009 were identified from the ambulance service command and control data. Epidemiological and clinical data were then obtained from the patient care record which was completed by the attending emergency medical technician (EMT) and were compared with the initial critical code that determined the urgency of the ambulance response.
Results: Data were obtained for 22186 patients who were not shifted during the study period. Less than one per cent of these calls were labeled critical (the most urgent category) at the time when the call was received. Trauma (vehicular) accounted for 30.3% and pregnancy related emergency cases accounted for 16.1% of all non-transported calls. These group of patients were predominantly young adults (between 20 to 30 yrs old) and the majority (more than 99%) were identified as less urgent (non critical) at telephone triage. The mean time that an ambulance was committed to each non-transported call was 2hrs 67 minutes per day.
Conclusions: This study shows that trauma (vehicular) accounted for a significant proportion of non-transported 108 calls inspite of assigning a high priority status when the call is first received. There could be major gains if some of these patients could be triaged to an alternative response, both in terms of increasing the ability of the ambulance service to respond faster to clinically more urgent calls and improving the cost effectiveness of the health service. Classifying calls into critical and non critical for the dispatch system has been shown to be sensitive, but this study suggests that its specificity may be poor, resulting in rapid responses to relatively minor problems. More research is required to determine whether such prioritisation can reliably and safely identify 108 calls where an alternative to an emergency ambulance would be a more appropriate response.

Keywords

emergency 108 calls; ambulance services; priority dispatch systems; telephone triage

How to cite this article :

PANDEY A , RANJAN R . EMERGENCY (108) CALLS TO THE AMBULANCE SERVICE IN THE STATE OF GUJARAT (INDIA) THAT DO NOT RESULT IN THE PATIENT BEING TRANSPORTED TO HOSPITAL: AN EPIDEMIOLOGICAL STUDY. Journal of Clinical and Diagnostic Research [serial online] 2009 June [cited: 2019 Sep 22 ]; 3:1519-1522. Available from
http://jcdr.net/back_issues.asp?issn=0973-709x&year=2009&month=June&volume=3&issue=3&page=1519-1522&id=518

Each year, in the state of Gujarat (India), a large number of emergency (108) calls received by ambulance services do not result in a patient being transported to hospital. These calls have implications both in terms of how rapidly an ambulance can respond to other emergencies and the efficiency of service delivery (1). To date, little has been published on this group of 108 calls.

Chen et al(2) reported from Taiwan that 32% of all ambulances dispatched, led to no patient being transported. In the United States, Hipskind et al (3) found 30% of ambulance responses resulted in the patient refusing transportation. These patients were commonly asymptomatic, were in the 11–40 year old age group and were involved in motor vehicle accidents. However, this study did not investigate calls where the ambulance crew decided not to transport the patient and differences in the organisation and delivery of emergency health care may limit the relevance of such findings in the UK.

Currently, in England and Wales, 17% of the patients are not conveyed to the hospital after an emergency ambulance has attended a 999 call (4). Ambulance services are not required to transport all patients to an accident and emergency department (5) and the Department of Health has now permitted careful piloting and evaluation of alternative ways of responding to the least serious (category C) emergency calls (6) . While this has resulted in considerable interest in implementing service developments, till date, no ambulance operator in India has carried out an audit of non-transported calls.

Several studies have investigated the inappropriate use of the emergency ambulance service in the UK and have provided estimates ranging from 16% to 52% (8),(9),(10),(11). Victor et al (8) recently studied one week's calls to the London Ambulance Service and reported that while the majority of calls required a 999 response, 40% could have been dealt with by primary care, psychiatric services or social services. Non-transported calls (20%) were not identified as a separate category in this research, but it might be anticipated that a significant proportion did not need an emergency ambulance response.

Priority based dispatch systems have been introduced by nearly all ambulance services in the UK and are designed to match the urgency of the ambulance response to the clinical needs of the patient. The Advanced Medical Priority Dispatch System (AMPDS) (12) uses structured protocols and systematic questioning of the 999 caller to assign a series of alpha-numeric codes and it is currently being used by over 75% of ambulance services.

In this study, we describe for the first time in India, the epidemiology of the group of patients who were not transported to the hospital after an emergency (108) call, the priority assigned at that time, and the reasons for non-transportation.

Material and Methods

Non-transported cases were defined as those cases where a 108 call was made and an ambulance from any one of the 400 ambulance stations of the Gujarat EMRI attended the scene, but the patient was not conveyed to the hospital. Cases where the patient was dead before the arrival of the ambulance and those where the call was malicious were excluded. The computer databases that hold both the Command and Control data and information scanned routinely from patient care records completed by the ambulance EMTs (14) , were searched to find the first 500 non-transported cases starting from 1st December 2008. The sample size was determined to provide the 95% confidence limits of ±5% for each variable with an allowance made for missing data. The patient report forms for these cases were further examined by manual inspection. Clinical categories were attributed to each case after examination of the free text description of the incident which was recorded on the patient care record. Each case was categorised by two researchers (AP and RR) using a system devised by the authors. Where there was disagreement about categorization, the case was discussed and a consensus was reached (Table/Fig 2).

The data collected, comprised of age, sex, type of residence, critical / non critical case assigned by the emergency response center, clinical category, whether patient had been drinking alcohol and the reason for which the patient was not transported to the hospital. The time for which each ambulance was committed, was also calculated. This was taken as the interval between the time when the call was being passed on to the ambulance crew and the time when they became available to respond to another call.

Proportions, means, medians, and 95% confidence intervals were calculated using SPSS for Windows version 9.0.

Results

In 22186 cases where data were extracted from the patient report forms, the age distribution (Table/Fig 1) showed a distinct peak in young adults in the age group 21 to 30 yrs. Men accounted for 63.8% of the cases studied.

(Table/Fig 3) shows the reasons for non-transportation. In almost half of the cases, the reason was recorded as no emergency / first aid, in a quarter of the cases, it was recorded as the refusal to travel, and in the rest, the patient was already shifted before the arrival of the 108 ambulance. Trauma (vehicular) was the commonest clinical category for both the refusal to travel (56%) and the no injuries (51%) groups, whilst general assistance (13%) was the largest category where the reason for non-conveyance was that a GP visit had been arranged.

Criticality codes were available for 16196 (73%) of the cases. Of those with codes available, 213 (0.8%) were critical cases (the most urgent code) and the rest 15983 were non critical cases. The mean time for which the ambulance was committed was 2hrs and 67 minutes per day and a median of 2hrs and 33 minutes (standard deviation 17 minutes, interquartile range 24–43 minutes).

Trauma (Vehicular)
Trauma (vehicular) accounted for 6733 (30%) of the non-transported calls. The mean age of non-transported cases presenting with falls was 19 years (median 18 years, SD 20, interquartile range 68–86 years).10592 (31.78%) cases were males and 6% were linked to alcoholism.

Discussion

This is the first Indian study to describe the epidemiology of non-transported 108 calls and to link these data to the criticality code used to determine the priority of the ambulance service response. However, there are a number of limitations in the study design.

There was no independent validation of the clinical assessment made by the ambulance crew nor did this study follow up non-transported patients to establish the clinical outcome after the ambulance left the scene. In addition, only few criticality criteria were recorded by the crew after they had attended to the patient and so no comparison could be made with the initial code assigned by the call taker. Therefore, it was not possible to confirm from our data whether the decision of not transferring the patient to the hospital was appropriate or to analyse whether the urgency assigned to the call by the emergency response center was justified by the clinical need.

Clinical data on the nature of the incident could not be easily extracted from the routine computer database. Therefore, the authors had to develop their own coding system to categorise the free text description of the incident on the patient report form and this limited the comparison between our survey and other published research. Manual inspection also introduced possible observer error into the study findings, but this was minimised by two of the authors by independently categorising each call.

References

1.
. Audit Commission. A life in the fast lane; value for money in emergency ambulance services. London: Audit Commission, 1998.
2.
. Chen JC, Bullard MJ, Liaw SJ. Ambulance use, misuse, and unmet needs in a developing emergency medical services system. European Journal of Emergency Medicine 1996; 3:73–8.[Medline]
3.
. Hipskind JE, Gren JM, Barr DJ. Patients who refuse transportation by ambulance: a case series. Prehospital Disaster Medicine 1997; 12:278–83.
4.
. Department of Health Statistical Bulletin. Ambulance Services 1998–9. Bulletin 1999/16. London: Department of Health, 1999.
5.
. Chapman R. Transporting patients. London: NHS Executive, 1997.
6.
. Department of Health. Modernisation of ambulance services. Health service circular (1999/091). London: Department of Health, 1999.
7.
. Snooks H, Kearsley N, Dale J, et al. New models of care for 999 callers with conditions that are neither life threatening nor serious: results of a national survey. Pre-hospital Immediate Care 2000; 4:180–2.
8.
. Victor CR, Peacock JL, Chazot C, et al. Who calls 999 and why? A survey of the emergency workload of the London Ambulance Service. J Accid Emerg Med 1999; 16:174–8.[Abstract/Free Full Text]
9.
. Gardner GJ. The use and abuse of the emergency ambulance service: some of the factors affecting the decision whether to call an emergency ambulance. Arch Emerg Med 1990; 7:81–9.[Medline]
10.
. Morris DL, Cross AB. Is the emergency ambulance service abused? BMJ 1980; iii:121–3.
11.
. Palazzo FF, Warner OJ, Harron M, et al. Misuse of the London Ambulance Service: how much and why? J Accid Emerg Med 1998; 15:368–70.[Abstract/Free Full Text]
12.
. Clawson JJ, Martin RL, Havert SA. Protocols vs guidelines. Choosing a medical-dispatch program. Emergency Medical Services 1994; 23:52–60.[Medline]
13.
. NHS Executive Steering Group. Review of ambulance performance standards. London: Department of Health, 1996.
14.
. Tobin MD, Nguyen-Van-Tam JS, Bailey RC, et al. Completeness of recording clinical information and diagnostic accuracy of ambulance crews using scanned patient report forms. Pre-hospital Immediate Care 2000; 4:143–7.
15.
. Schmidt T, Atcheson R, Federiuk C, et al. Evaluation of protocols allowing emergency technicians to determine need for treatment and transport. Am J Emerg Med 2000; 7:663–9.
16.
. Burstein JL, Henry MC, Alicandro J, et al. Outcome of patients who refused out-of-hospital medical assistance. Am J Emerg Med 1996; 14:23–6.[Medline]
17.
. Nicholl J, Coleman P, Parry G, et al. Emergency priority dispatch systems - a new era in the provision of ambulance services in the UK. Pre-hospital Immediate Care 1999; 3:71–5.

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