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Emergency Medical Service Information System: the ARES 118 Experience

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Ann Ig 2017; 29: 504-514 doi:10.7416/ai.2017.2181 Emergency Medical Service Information System: the ARES 118 experience D.A. Ientile1, M.A. Cardinale1, S. Cataldi1, M. Parafati1, A. Pasquarella1, N. Trani1, M.P. Corradi1 Key words: Emergency Medical Service, Information system, Data Warehouse, Business Intelligence, Cube Parole chiave: Servizio Sanitario Emergenza, Sistema Informativo, Data Warehouse, Business Intelligence, Cubo Abstract Background. In this paper we describe ARES 118, the prehospital Emergency Medical Service of the Region Lazio, Italy, focusing on its data system used to populate a data warehouse and to create ad hoc reports. ARES 118 is a regional public mono-specialized health company, established in 2004, that manages the emergency care throughout the Region Lazio. Methods. Being a peculiar company in its kind, and being the first experience of this kind in Italy, ARES 118 has begun to equip itself, in an autonomous way, with a corporate information system, starting from what already existed as data collection from the individual provincial operating Centers and then by activating a unique information system at a regional and company level by deploying a data warehouse. All operations were carried out using open source software. Results. Currently, ARES 118 is equipped with a business information system that enables data collection with its storage, management and processing of the same in fairly and easy way. The system allows the pro- duction of specific reports and measures modulated on the user requests in order to highlight the different aspects of the activity. Conclusions. The production of ad hoc reports, with the possibility of developing specific indicators, allows the identification and analysis of critical areas/processes in order to implement any corrective actions and monitor the effectiveness of the same. Introduction hospital network, in order to guarantee citizen the continuity of care. In Italy the prehospital Emergency The Regional Service for Health Medical Service is organized in specific Emergency 118 (ARES 118), established in regional models, despite the same national 2004 in Latium Region, was the first national reference laws. The common objective to be experience of a single regional service, pursued is the realization of a medical aid versus other regional realities where the system, in emergency-urgency, effective, service was entrusted to multiple healthcare efficient and closely integrated with the local organizations, sometimes employing 1 Azienda Regionale Emergenza Sanitaria 118 Lazio (ARES 118), Rome, Italy Emergency Medical Service Information System 505 hospital staff. ARES means “Regional The Latium Region has circa 5,880,000 Company for Emergency Service” and 118 is inhabitants. To this value, people moving the free phone number to call the service. across the Region, tourists visiting Rome, ARES 118’ aims are to ensure the students of the six universities in Rome, following performances throughout the government employees, central state organs region: and diplomatic representatives determine - management and coordination of the a daily additional transitory population of prehospital emergency: alarm phase and circa 155,000 persons. local treatment phase, including secondary ARES 118 operates with four Operation transport related to first management (the Centres: Rome Metropolitan City (RM), patient, according to his critical medical Rieti (RI) along with Viterbo (VT), Latina conditions, is first transported to the closest (LT) and Frosinone (FR). It has a helicopter emergency room for the clinical stabilization, rescue service and a specific Service for and then to the most appropriate hospital); the management of maxi-emergencies, - management of health-related catastrophes and of the planned major events transportation activity for transplants; (National and Vatican celebrations). - management of planned inter-hospital The emergency phone number in transfers. the majority of the Italian territory is 118. Only in Rome’s district, as of 19 The Context November 2015, the phone number 112 (“Unique European Emergency Number”) Ares 118 operates in the Latium Region, became effective. ARES 118, counting divided in the five provinces of Rome 1,815 employees of various professional (RM), Frosinone (FR), Latina (LT), Rieti qualifications, coordinates 154 rescue (RI) and Viterbo (VT). The Region counts stations located throughout the region, 223 378 municipalities, an area of about 17,232 emergency vehicles: ambulances, cars for sqkm, 54% of which are hilly areas, 26% EMS (Emergency Medical Service, non mountainous and the remaining 20% plains transporting patients), off-road vehicles and (1). The municipality of Rome is the largest, helicopters, all with sanitary staff, nurse or counting 1,287.4 sqkm, and equalling the nurse + physician). 0.4% of the entire national territory (2). The helicopter rescue service operates Rome hosts the Fiumicino International from 3 bases, Rome, Latina and Viterbo, Airport “Leonardo da Vinci” (40.2 million with three helicopters. The Latium territory travellers per year), which is classified as the has large mountainous areas that constitute first national and the seventh Europe’s largest a hostile environment for emergency on the airport. Along with Rome’s second airport road équipes. Hence, Ares 118 collaborates “Giovanni Battista Pastine” in Ciampino (5.8 with the National Corps for Mountain million travellers per year) it forms Rome’s Rescue - Delegation of Latium (CNSAS - airport system, counting a total of 46 million SASL), for joined rescue operations with passengers per year (2015 data) (3). helicopters in mountain areas, underground Furthermore, the Latium Region has three or otherwise inaccessible areas. major harbours, Civitavecchia and Fiumicino Each of the five provinces has an in the province of Rome, and Gaeta-Formia Emergency Medical Communications in the province of Latina. In 2014 the Centre (EMCC). It is composed of nurses Civitavecchia harbour was classified as the plus a referring physician for more complex first in Mediterranean cruise activity, counting issues. The EMCC handles territorial almost 2.3 million passengers per year (4). emergencies receiving the help request calls, 506 D.A. Ientile et al. defining levels of urgency, and directing the Rome and province, 8% for the province required emergency vehicles. of Frosinone, 11% for the province of Upon arrival, the healthcare staff evaluates Latina, and 9% for the provinces of Rieti the patient/s conditions and confirms or and Viterbo. modifies the gravity phone code assigned Relieved patients were male in 49.7% by the EMCC, performs first aid treatments and females in 50.3% of cases; 1.9% of on site and, if necessary, transports the cases were children under 10 years of age, patient/s to the nearest emergency hospital and 54.4% of cases were patients over 60 department or, if clinical conditions allow it, years of age, with a significant proportion to the more suitable hospital for the specific of octogenarians, accounting for 27.8% of clinical condition or disease. the total. EMCC interacts via telephone with target In 67.5% of cases the code assigned on hospitals to pre-alert arrivals of patients in the phone by EMCC staff was “yellow”, critical clinical conditions or with specific 18.4% “green”, 13.6% “red”, only <1% diseases (“golden hour disease”). of the cases were “white”. The “house” ARES 118 monitors the availability and “street” were the most frequent event of beds in critical units (intensive care, places, respectively 58.3% and 21.7%. The coronary care, specialist post-operative on site treatments concerned for 24.6% care) in the Region’s hospitals, and the traumas, for 13.5% cardiovascular diseases, connection between the hospitals requiring/ for 9.6% respiratory diseases and for 8.1% accepting the transfer of patients in critical neurological diseases. conditions. It also manages the Continuity In 2015 the helicopter rescue service Care Listening Centre (CCLC) of Rome’s was activated 2,138 times for a total of territory, providing first aid guidance to 1,536 flight hours, with a prevalence of citizens that require care when primary interventions for traumatic pathology. The physicians are not on duty (during the night, severity code on arrival on site was “red” for on weekends, etc.) and activating physicians 54.3% of rescue cases, “yellow” for 22.1%, in charge for the continuity of care in “green” for 2.5%, “white” for < 1%. different Local Public Health Units. Information system The health information systems allow the ARES - Activity data collection of the data necessary to measure and to evaluate the health activities, making In 2015, ARES 118 EMCCs received it a useful tool for health planning and for the 2,555,042 calls; of these, 1,506,979 were improvement of the quality of care (5, 6). made by citizens requiring health aid, While for the hospitals, in Italy, there’s resulting in about 255 calls per 1,000 a national specifically encoded and inhabitants. consolidated information flow, the EMS Emergencies calls were followed by information flow was only very recently 447,472 missions, resulting in 76 missions established (2008) and not yet consolidated, per 1,000 inhabitants and 1 intervention also because of the regional peculiarities and every 3.9 calls. the type of provided service. Emergency calls were managed: 62.8% ARES 118 considered it necessary by the EMCC of Rome, 9.1% by the EMCC to establish a specific data stream that of Frosinone,
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