Contents lists available at ScienceDirect International Emergency Nursing journal homepage: www.elsevier.com/locate/aaen Mobile emergency care service: A time-course assessment and characterization of demand Geiza Costa a , Olavo Cabral a , Eduardo Santana a , Glaucia Lima b , Israel Figueiredo Jr a,b, ⁎ a Mobile Emergency Care Service – SAMU Metropolitana2, Rio de Janeiro, Brazil b Maternal and Child Department, School of Medicine, Federal Fluminense University, Rio de Janeiro, Brazil ARTICLE INFO Keywords: Emergency Health Emergency Medical Service Medical Dispatcher Mobile Health Units Prehospital Prehospital Emergency Care ABSTRACT Introduction: Prehospital care is defined as any medical attention provided outside the hospital environment. This study aims to study the operation of a regional SAMU by assessing electronic records of cases managed and to evaluate demand patterns over time. Methods: A retrospective, cross-sectional study was conducted through an analysis of emergency calls handled between the years of 2009 and 2013 by the SAMU Metropolitan 2 Region mobile emergency care service, located in Niterói, Brazil. Nonparametric tests were used to evaluate differences in the variables of interest between the two halves of the 5-year period of analysis and annually. Results: The total call volume during the period of analysis was 590,902 (monthly mean [SD], 9848 [3764]; 95%CI = 8875 to 10,820). Analysis of calls over time revealed a significant decline in call volume (p = 0.008), mainly between the year 2009 and subsequent years (p < 0.001). The vast majority of patients were adults with clinical conditions (average = 2311). Predominantly, calls were made to request prehospital assistance at the patient’s home, and the most prevalent age range was 41–50 years. Conclusion: The SAMU Metropolitan 2 regional emergency medical service predominantly attended to middle- aged women at their homes. Total call volume has been decreasing, perhaps reflecting a multifactorial phe- nomenon and improvements in the primary health care network. 1. Introduction In Brazil, prehospital care is defined as any medical attention pro- vided outside the hospital environment in order to best respond to the demands of the care-seeking population. Prehospital emergency care in the country has the specific mandate of reaching the victim as early as possible to provide care and/or adequate transportation to a health facility, maintaining a coherent continuum of care that is hierarchically integrated within the national Unified Health System (Sistema Único de Saúde, SUS) [1]. The Brazilian National Policy for Urgent Care has been implemented since 2003 [2], with the purpose of integrating a health sector-wide effort to address risks in the national epidemiological scenario. The mobile prehospital component of the Policy, known as the Mobile Emergency Care Service (Serviço de Atendimento Médico de Urgência, SAMU), was expanded through technological innovations to in- corporate physician-led gatekeeping mechanisms known as medical regulation [3], which include the coordination of out-of-hospital emer- gency care in private and public settings, telemedicine, management of patient flow between outpatient clinics and hospitals, and support for mass casualty incidents with the support of military emergency care services, among other activities. Interventions in the prehospital environment are performed by basic life support (BLS) and advanced life support (ALS) teams, which are dispatched at the discretion of the physician regulator (analogous to a medical director in other EMS systems) [4]. BLS teams, each staffed by a driver and a nursing aide or nursing technician, are prepared to provide non-invasive life support, which includes the initial approach to the victim, basic support of breathing and circulation, immobiliza- tion, and transport to medical facilities. ALS teams, each staffed by a driver, nurse, and physician, can perform invasive procedures and provide advanced ventilatory and circulatory support, as well as in- terfacility transfers (known in Brazil as medicalized transport), using specific protocols [5,6]. The state of Rio de Janeiro is unique among Brazilian subnational divisions in that it pioneered the regionalization of prehospital care ser- vices, starting with the Metropolitan2 Region (SAMU Metropolitana2). Since the second half of 2004, this system has been providing https://doi.org/10.1016/j.ienj.2018.06.006 Received 4 February 2018; Received in revised form 24 May 2018; Accepted 30 June 2018 ⁎ Corresponding author at: Rua Desembargador Athayde Parreiras 266, Bairro de Fátima, Niterói, RJ 24020-210, Brazil. E-mail address: ifigueiredo@id.uff.br (I. Figueiredo). International Emergency Nursing xxx (xxxx) xxx–xxx 1755-599X/ © 2018 Published by Elsevier Ltd. Please cite this article as: Costa, G., International Emergency Nursing (2018), https://doi.org/10.1016/j.ienj.2018.06.006