A study of police operated dispatch to acute coronary syndrome cases arising from 112 emergency calls in Aarhus county, Denmark

Abstract

Background: The accuracy of the Danish police operated "112" emergency call system was studied. Dispatch of the anaesthesiologist staffed mobile emergency care unit (MECU) to acute coronary syndrome (ACS) cases was used as an indicator of accuracy of dispatch to life threatening emergencies. Methods: This was an observational cohort study of patients given a 112 system report of heart attack and patients with a provisional diagnosis of ACS made on scene by the MECU. Sensitivity, specificity, and positive predictive value with 95% confidence intervals (CI) were calculated. Results: There were 341 reports of ''heart attack'' and 205 patients with ACS. Sensitivity was 75% (95% CI 68% to 80%) specificity 90% (89% to 92%) and positive predictive value 45% (40% to 50%). Conclusion: The accuracy of 112 dispatch of the MECU was found to be moderate. We suggest more training of dispatch staff and medical supervision.T he common emergency phone number in Denmark is "112".1 The police operate the 112 alert, except in Copenhagen; this is unique among European countries. 2Studies on dispatch of emergency medical services (EMS) are few, and a systematic review found only 20 studies containing original data. 3In Aarhus, an anaesthesiologist staffed mobile emergency care unit (MECU) is called in addition to an ambulance to life threatening cases, including acute coronary syndrome (ACS). 4 The MECU enables us to achieve an early provisional diagnosis.We wanted to study the accuracy of dispatch of the MECU to acute coronary syndrome (ACS) cases. ACS was used as an example of a life threatening emergency. METHODSFollowing consultation with the ethics committee, permission was not required for the project to proceed. The study was designed as an observational cohort study based on consecutive data collected in Aarhus (330 000 inhabitants) during a 6 month period in 2002. Inclusion criteria were: (a) patients with a chief complaint of ''heart attack'' on calling 112, and (b) patients with an on scene provisional diagnosis of ACS.The report of ''heart attack'' as the main complaint from the emergency 112 call was compared with the provisional diagnosis of ACS made by the MECU physician. A 12 lead electrocardiogram was performed on scene. Sensitivity, specificity, and positive predictive value were calculated with 95% confidence intervals (CI). RESULTSThere were 341 reports from 112 of ''heart attack'', and 2154 MECU responses during the study period, with ACS diagnosed in 205 patients (9.5%) (table 1). Sensitivity was 75% (95% CI 68% to 80%) specificity 90% (89% to 92%) and positive predictive value 45% (40% to 50%).There were 188 false positive cases with provisional diagnoses (table 2) and 52 false negative cases with the 112 reports (table 3). DISCUSSIONThis is the first study to present data from police operated 112 alarm centres in a country with 112 as the single unique number for all emergencies. The MECU enabled us to retrieve a provisional diagnosis made by a physician on scene, giving us an early evaluation and provisional ...

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