An International Comparison of Emergency Medical Services Delivery \nSystems: Which Produces The Optimum Outcome For The Patient?
Why this work is in the frame
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Bibliographic record
Abstract
This thesis was written to address a problem with ambulance service delivery \ntimes in Victoria, Australia. For a number of years, ambulance response times have \nbeen increasing to unacceptable levels. As a result of the ever-increasing problem it was \nappropriate to see if the are other alternative solutions producing better results. There \nare a number of different service delivery models for Emergency Medical Services \n(EMS) around the world. The main two are the Anglo/American model (also known as \nscoop and run) and the Franco/German model (also known a stay and play). There are \nalso two major delivery agencies; the British model of a separate third party public \nsector service as used in UK, Australia and New Zealand or the fire service model \nwhere the fire service is the main delivery agency such as most of Asia, Europe and \nNorth America. Which model provides the best outcome for the patient? Such research \nhas not been done in the past. The research will also examine if the Metropolitan Fire \nbrigade has capacity to undertake possible EMS roles. \nA number of case studies were undertaken and explored with key issues of \nresponse times, patient outcomes, skills and new technologies compared. The results, \nparticularly of response time show that in Victoria the response time for fire EMS (8.3 \nminutes) to medical emergencies is similar to that provided by fire services delivering \nEMS in North America. The MFB in Victoria is providing the equivalent of first \nresponder; the American and Canadian fire services are delivering Advanced Life \nSupport (ALS). The response times for Basic Life Support (BLS) in Victoria provided \nby ambulance service are over twice as long (8.3 minutes for fire compared to 18.2 \nminutes for Victorian Ambulance at the 90%). The US and Canadian Fire Services \nprovide EMS response time considerably lower than Ambulance Victoria, some as low \nas 7.43 minutes. UK Ambulance (on which the Victorian model is based) also provides \nresponse time considerably less than Ambulance Victoria. The issue of whether the fire \nservice in Victoria has capacity to undertake further EMS delivery was explored and \nwhilst it has the capacity it is doubtful it could be delivered in the current industrial \nenvironment with the union having the capability of vetoing managerial decisions. \nThe research raised fundamental questions regarding the effective use of scarce \npublic sector resources and agencies working across organisational boundaries in the \ninterests of serving the public. Data analysis involved pattern matching, explanation \nbuilding and time series analysis to identify trends and commonalities across the cases. \nA number of themes emerged including continued increases in call volumes, challenges \nmeeting response times and the development of proactive programs to reduce the \nimpact of these trends.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.005 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it