Research Profile – Traffic Control

Dalhousie University researchers are tracking ambulances to improve overall emergency services in Nova Scotia.

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A new project will track the locations of all of Nova Scotia's ambulances by use of global positioning systems (GPS). The goal? To find out what happens to overall ambulance services when there is overcrowding in hospital emergency departments. Researchers hope to use findings from the project to improve emergency services across the province.

When emergency departments are over-crowded, it can affect ambulance services in a number of ways, especially in urban centres such as Halifax, according to Dr. Mikiko Terashima, a postdoctoral fellow in Community Health and Epidemiology at Dalhousie University.

For example, when emergency departments are especially busy and crowded, it takes longer to move patients out of the ambulance and onto a bed. If beds aren't available, patients must remain on the ambulance for a longer period, meaning the crew can't be freed-up to respond to another call, says Dr. Terashima.

This delay in transfer time forces ambulances to stay parked in front of an emergency department for far longer than the 20 to 30 minutes it should normally take – sometimes for hours.

At any given time, there are about 100 ambulances on call for emergency duty throughout the province. But if ambulances are stuck waiting at hospitals, fewer vehicles can respond to emergency calls. Ambulances from the outskirts of the Halifax area may be called in to make up for the shortfall, according to Dr. Terashima. This creates a domino effect, leading to shortages of ambulances in more rural areas

"Patient offload delay problems can lead to some areas not having adequate ambulance access, not just in the cities," says Dr. Terashima.

But before the problem can be fixed, the issue needs to be better understood. At this point, it's not known exactly which areas in the province have the greatest risk of losing ambulance access when offload delay problems are at their peak. Another question is whether there are particular times when shortages are more of an issue, and is it in any way predictable?

To study the problem, researchers will use GPS devices that are built into all of Nova Scotia's ambulances.

"Nova Scotia is unique in that all ambulance services in the province are managed by one company, and the vehicles each have their own GPS. We'll be able to track all the active ambulances throughout the day," says Dr. Terashima.

With support from the Canadian Institutes of Health Research, Dr. Terashima and her colleagues will begin collecting data from the GPS devices in the fall of 2012, and continue for one year. The researchers will be able to see where ambulances are and when. Data will help show whether there are seasonal or monthly variations in ambulance availability in different regions, and what happens to rural availability when ambulances are called in to cover shortages in cities. The data will also provide a better idea of just how long it actually takes to do patient transfers at hospitals.

"Data from the study will be used to determine cost-effectiveness and efficiency of ambulance services in Nova Scotia, as well as issues relating to access and inequalities in the population, and what sort of differences may exist between urban and rural areas," says Dr. Terashima.

"Nova Scotia is unique in that all ambulance services in the province are managed by one company, and the vehicles each have their own GPS."
– Dr. Mikiko Terashima, Dalhousie University