Red response. Studies on the role of primary care doctors in out-of-hospital emergency medicine

The aim of this thesis was to explore the role of the doctor in the emergency primary health care service in red response situations in Norway, including the doctors’ experiences with a variety of emergency situations. The Norwegian municipalities are responsible for medical support and treatment to every person in the municipality. This is managed through the primary health care services, also encompassing home nurses, regular general practitioners (rGPs), health visitors, midwives, nursing homes, out-of-hours services, casualty clinics, doctors oncall and a local emergency communication centre. The main resources in the emergency primary care services are the rGPs during office hours and the out-ofhours services, casualty clinics and doctors on-call out-of-hours. The secondary health care services manage the ambulance services (vehicles, boats, airplanes and helicopters) and the emergency medical communication centres (EMCCs). When someone calls the national emergency number 113, a nurse at the EMCC does a triage of the patient’s/patients’ problem based on the Norwegian Index of Medical Emergency Assistance (Index). The triage shall result in one of three possible levels of urgency; red response, which concerns potentially or manifestly life-threatening situations and therefore has the highest priority; yellow response, which is urgent but where the condition in question is not considered life-threatening at the moment; and the green response, which has the lowest priority with no urgency. If in need of medical attention during daytime (not life-threatening, but urgent), patients are supposed to contact their own rGP or call the local emergency communication centre (LEMC). Doctors on-call in the emergency primary care service in the municipalities shall be in a state of readiness 24 hours a day, with the out-of-hours services as an included part. The rGPs are equipped with radios. In potentially life-threatening situations patients are expected to call 113 to an EMCC. If the EMCC defines the problem as life-threatening the ambulance and doctor on-call shall be alerted by a radio alarm from the EMCC, and attend the patients at site. In some cities casualty clinics are open during office hours and some have open access 24/7. Inter-municipal co-operations, where one doctor is on-call out-of-hours covering all municipalities in the co-operation, are common. The main objectives of the thesis were: - To explore the emergency primary care services and the most urgent emergency patients, defined as red responses, in general. - To explore the role of the doctors on-call and their experiences with red response patients. Main findings in the thesis; - There was an insufficient radio use among doctors on-call in about half of the emergency primary care districts. - There were large differences in numbers of doctors receiving alarms between the three areas. The most important factor with respect to doctors on- call being alerted or not was the individual EMCC. - The rGPs took part in emergency care with an overall high self-confidence in performing emergency procedures. - The emergency primary health care services constitute an important part of the out-of-hospital emergency system in Norway