In cases of Emergency… Emergency events involving unconscious patients. Are they dealt with differently when they may be associated with use of alcohol, or illicit or prescribed drugs?

NAKOS (Norwegian Competence Centre for Emergency Medicine) carried out a study, on behalf of the Norwegian Board of Health, of the chain of events from when emergency service headquarters (AMK) are informed that an unconscious person has been found until the ambulance service has completed dealing with the event.

The aim of the study was to obtain information about routines, procedures and assessments made after emergency service headquarters have been informed about an event involving an unconscious person and to establish whether events involving alcohol or drugs are dealt with differently from other emergency events.

The study was carried out over a three-month period during the autumn of 2005, and was based on an analysis of data from three sources:

• A questionnaire to staff in emergency service headquarters
• Interviews of leaders in a sample of emergency service headquarters
• Log recordings 1  and associated print-outs from AMIS 2  for a sample of events dealt with by the emergency services, and ambulance records for the same events.

The report is in two parts:

I. Assessment by the Norwegian Board of Health of the results of the study, and the implications for supervision

II. The NAKOS report “Survey of Health Services for Substance Abusers. The chain of events from when the emergency service headquarters (AMK) is informed that an unconscious person has been found until the pre-hospital service has completed dealing with the event” (Wik, 2005). (This report is only available in Norwegian).

The results of the NAKOS report indicate that emergency service headquarters have established good routines and procedures. When asked in the questionnaire and interviews, both staff and managers replied that they put these into practice when an emergency event is reported. However, a sample of the records shows that emergency service headquarters did not always do as they said. For several emergency events, emergency service headquarters did not collect adequate information about the patient’s vital functions (level of consciousness, respiration and circulation) before making a decision about the appropriate response. The results also indicate that better routines for cooperation between emergency service headquarters and the police are needed in cases of emergency.

The NAKOS report also indicates that emergency service headquarters do not always use their experience to improve services. The findings show that the system for registering emergency calls and response is not designed in a way which facilitates correcting incorrect information. Consequently the system is not adequate as an instrument for learning and continuous improvement.

The study does not provide a conclusive answer to the question about whether or not events involving alcohol and drugs are dealt with differently from other events.

According to the assessment made by the Norwegian Board of Health, there is considerable potential for improving emergency services and learning from experience. Those responsible for running emergency service headquarters should examine current routines and practices and improve them as necessary.

1  Log recordings are recordings of all telephone calls and radio communication lines at the emergency service headquarters, including conversations between the emergency service operator and telephone calls to the emergency telephone number (113).

2  The database AMIS, which is an abbreviation for Acute Medicine Information System, is the emergency service headquarters’ system for registering events that the emergency services are informed about through telephone calls to the emergency telephone number (113).