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Nationwide emergency department (ED) crowding is a multifactor problem that has previously been well described in the literature. Crowding impacts ED bed capacity by limiting the number of available stretchers to place patients who arrive via the emergency medical services (EMS) system. Reduced ED bed capacity also leads to hospital diversion, a mechanism whereby EMS personnel are left caring for patients in their ambulances until another facility can be identified.An ED paramedic-staffing model focused on receiving EMS-arrived patients at times when the ED is at full bed capacity significantly reduced the offload time for EMS units.
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