In addition to the direct effect of the 911 system on the productivity of the emergency health care system, the emergency response system also affects the allocation of patients to hospitals. The ambulance personnel are instructed to use a standard protocol for allocating patients to hospitals (see Figure 1 for a representative county protocol).
In Figure 1, patients are allocated to hospitals according to a number of risk criteria, with more severe patients being allocated to the “trauma center” (which provides a certified level of emergency room services and technology) in most cases but to the geographically closest hospital if the nearest trauma center is greater than 30 minutes away from the site of the emergency. While the protocol provides “bright line” rules for most situations, ambulance personnel are given a limited amount of discretion about borderline cases and are also instructed to confirm some discretionary choices with “medical command ” Thus, ambulance personnel, using agreed-upon protocols and their own judgement, resolve a tradeoff between reduced transport time and allocating the patient to the hospital with the highest level of cardiac care facilities. By providing better dispatching, gathering more patient information prior to arrival, and shortening response time, higher levels of 911 service may allow the allocation of patients to hospitals to be more efficient. For example, when response time is shorter and dispatchers have more precise information about the patient’s location, there will be more time to transport a cardiac patient to a hospital with specialized facilities. more