The “Vertical Response Time”: Barriers to Ambulance Response in an Urban Area
Article first published online: 28 JUN 2008
© 2007 Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 14, Issue 9, pages 772–778, September 2007
How to Cite
Silverman, R. A., Galea, S., Blaney, S., Freese, J., Prezant, D. J., Park, R., Pahk, R., Caron, D., Yoon, S., Epstein, J. and Richmond, N. J. (2007), The “Vertical Response Time”: Barriers to Ambulance Response in an Urban Area. Academic Emergency Medicine, 14: 772–778. doi: 10.1111/j.1553-2712.2007.tb02350.x
- Issue published online: 28 JUN 2008
- Article first published online: 28 JUN 2008
- Received June 29, 2006; revision received March 2, 2007; revision received April 24, 2007; accepted April 29, 2007
- emergency medical services;
- time factors
Background: Ambulance response time is typically reported as the time interval from call dispatch to arrival on-scene. However, the often unmeasured “vertical response time” from arrival on-scene to arrival at the patient's side may be substantial, particularly in urban areas with high-rise buildings or other barriers to access.
Objectives: To measure the time interval from arrival on-scene to the patient in a large metropolitan area and to identify barriers to emergency medical services arrival.
Methods: This was a prospective observational study of response times for high-priority call types in the New York City 9-1-1 emergency medical services system. Research assistants riding with paramedics enrolled a convenience sample of calls between 2001 and 2003.
Results: A total of 449 paramedic calls were included, with a median time from call dispatch to arrival on-scene of 5.2 minutes. The median on-scene to patient arrival interval was 2.1 minutes, leading to an actual response interval (dispatch to patient) of 7.6 minutes. The median on-scene to patient interval was 2.8 minutes for residential buildings, 2.7 minutes for office complexes, 1.3 minutes for private homes (less than four stories), and 0.5 minutes for outdoor calls. Overall, for all calls, the on-scene to patient interval accounted for 28% of the actual response interval. When an on-scene escort provided assistance in locating and reaching the patient, the on-scene to patient interval decreased from 2.3 to 1.9 minutes. The total dispatch to patient arrival interval was less than 4 minutes in 8.7%, less than 6 minutes in 28.5%, and less than 8 minutes in 55.7% of calls.
Conclusions: The time from arrival on-scene to the patient's side is an important component of overall response time in large urban areas, particularly in multistory buildings.