A comparison of two emergency medical dispatch protocols with respect to accuracy

Abstract

BackgroundEmergency medical dispatching should be as accurate as possible in order to ensure patient safety and optimize the use of ambulance resources. This study aimed to compare the accuracy, measured as priority level, between two Swedish dispatch protocols – the three-graded priority protocol Medical Index and a newly developed prototype, the four-graded priority protocol, RETTS-A.MethodsA simulation study was carried out at the Emergency Medical Communication Centre (EMCC) in Stockholm, Sweden, between October and March 2016. Fifty-three voluntary telecommunicators working at SOS Alarm were recruited nationally. Each telecommunicator handled 26 emergency medical calls, simulated by experienced standard patients. Manuscripts for the scenarios were based on recorded real-life calls, representing the six most common complaints. A cross-over design with 13 + 13 calls was used. Priority level and medical condition for each scenario was set through expert consensus and used as gold standard in the study.ResultsA total of 1293 calls were included in the analysis. For priority level, n = 349 (54.0%) of the calls were assessed correctly with Medical Index and n = 309 (48.0%) with RETTS-A (p = 0.012). Sensitivity for the highest priority level was 82.6% (95% confidence interval: 76.6–87.3%) in the Medical Index and 54.0% (44.3–63.4%) in RETTS-A. Overtriage was 37.9% (34.2–41.7%) in the Medical Index and 28.6% (25.2–32.2%) in RETTS-A. The corresponding proportion of undertriage was 6.3% (4.7–8.5%) and 23.4% (20.3–26.9%) respectively.ConclusionIn this simulation study we demonstrate that Medical Index had a higher accuracy for priority level and less undertriage than the new prototype RETTS-A. The overall accuracy of both protocols is to be considered as low. Overtriage challenges resource utilization while undertriage threatens patient safety. The results suggest that in order to improve patient safety both protocols need revisions in order to guarantee safe emergency medical dispatching.

Priority accuracy by dispatch centers and Emergency Medical Services professionals in trauma patients: a cohort study

“…Our findings are in line with two studies that demonstrated a dispatch priority sensitivity of 82.6% [22] and 86% [23]. However, these studies also included patients Table 3 Outcomes per priority subgroup Data are median (IQR) or n (%), unless otherwise stated.…”

Outpatient care in acute and prehospital emergency medicine by emergency medical and patient transport service over a 10-year period: a retrospective study based on dispatch data from a German emergency medical dispatch centre (OFF-RESCUE)

“…Assistant services are not officially recorded by statistics. In order to reduce these non-life-threatening operations in favour of efficient patient management, various solution approaches have been applied in the past; processes of the emergency medical dispatch centre (EMDC) were improved in respect of emergency call handling, which, however, led to an over-prioritization (false positive assignment of a higher priority level) of many patients [ 21 – 23 ]. In addition, protocols for handling low-priority patients have been successfully implemented, which lead either to the outpatient usage of a nurse or to telephone consultation [ 24 , 25 ].…”

Mobilisation of emergency services for chemical incidents in Sweden - a multi-agency focus group study

“…mining incidents [11], common training for major chemical incidents is to our knowledge very rare in Sweden. Previously, the general performance of Swedish emergency medical dispatch protocols have been evaluated from various perspectives [12,13]. In the neighbouring country of Finland, the preparedness of the emergency medical services for chemical emergencies has been surveyed, finding unsufficient antidote and decontamination capacity [14].…”