Accuracy of Stroke Recognition by Emergency Medical Dispatchers andParamedics—San Diego Experience

Ramanujam, Prasanthi; Guluma, Kama Z.; Castillo, Edward M.; Chacon, Marcus; Jensen, Matthew B.; Patel, Ekta; Linnick, William; Dunford, James V.

doi:10.1080/10903120802099526

Cited by 129 publications

(95 citation statements)

References 19 publications

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“…4 However, delays in presentation and specialist assessment frequently prevent patients from receiving rtPA. Emergency medical dispatch sensitivity and positive predictive value (PPV) for identifying stroke is < 50%, [7][8][9] and this is compounded by long delays in patients accessing emergency medical services (EMSs). 10 Studies have shown that activation of the EMSs is the single most important factor in the rapid triage and treatment of acute stroke patients.…”

Section: Fundingmentioning

confidence: 99%

Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) – a programme of research to facilitate recognition of stroke by emergency medical dispatchers

Watkins

Jones

Leathley

et al. 2014

Programme Grants for Applied Research

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BackgroundRapid access to emergency stroke care can reduce death and disability by enabling immediate provision of interventions such as thrombolysis, physiological monitoring and stabilisation. One of the ways that access to services can be facilitated is through emergency medical service (EMS) dispatchers. The sensitivity of EMS dispatchers for identifying stroke is < 50%. Studies have shown that activation of the EMSs is the single most important factor in the rapid triage and treatment of acute stroke patients.ObjectivesTo facilitate recognition of stroke by emergency medical dispatchers (EMDs).DesignAn eight-phase mixed-methods study. Phase 1: a retrospective cohort study exploring stroke diagnosis. Phase 2: semi-structured interviews exploring public and EMS interactions. Phases 3 and 4: a content analysis of 999 calls exploring the interaction between the public and EMDs. Phases 5–7: development and implementation of stroke-specific online training (based on phases 1–4). Phase 8: an interrupted time series exploring the impact of the online training.SettingOne ambulance service and four hospitals.ParticipantsPatients arriving at hospital by ambulance with stroke suspected somewhere on the stroke pathway (phases 1 and 8). Patients arriving at hospital by ambulance with a final diagnosis of stroke (phase 2). Calls to the EMSs relating to phase 1 patients (phases 3 and 4). EMDs (phase 7).InterventionsStroke-specific online training package, designed to improve recognition of stroke for EMDs.Main outcome measuresPhase 1: symptoms indicative of a final and dispatch diagnosis of stroke. Phase 2: factors involved in the decision to call the EMSs when stroke is suspected. Phases 3 and 4: keywords used by the public when describing stroke and non-stroke symptoms to EMDs. Phase 8: proportion of patients with a final diagnosis of stroke correctly dispatched as stroke by EMDs.ResultsPhase 1: for patients with a final diagnosis of stroke, facial weakness and speech problems were significantly associated with an EMD code of stroke. Phase 2: four factors were identified – perceived seriousness; seeking and receiving lay or professional advice; caller’s description of symptoms and emotional response to symptoms. Phases 3 and 4: mention of ‘stroke’ or one or more Face Arm Speech Test (FAST) items is much more common in stroke compared with non-stroke calls. Consciousness level was often difficult for callers to determine and/or communicate. Phase 8: there was a significant difference (p = 0.003) in proportions correctly dispatched as stroke – before the training was implemented 58 out of 92 (63%); during implementation of training 42 out of 48 (88%); and after training implemented 47 out of 59 (80%).ConclusionsEMDs should be aware that callers are likely to describe loss of function (e.g. unable to grip) rather than symptoms (e.g. weakness) and that callers using the word ‘stroke’ or describing facial weakness, limb weakness or speech problems are likely to be calling about a stroke. Ambiguities and contradictions in dialogue about consciousness level arise during ambulance calls for suspected and confirmed stroke. The online training package improved recognition of stroke by EMDs. Recommendations for future research include testing the effectiveness of the Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) training package on the recognition of stroke across other EMSs in England; and exploring the impact of the early identification of stroke by call handlers on patient and process outcomes.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Fundingmentioning

confidence: 99%

Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) – a programme of research to facilitate recognition of stroke by emergency medical dispatchers

Watkins

Jones

Leathley

et al. 2014

Programme Grants for Applied Research

View full text Add to dashboard Cite

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“…9,[15][16][17][18][19][20] Most research has demonstrated that MPDS and other EMD systems identify most but not all urgent calls with a considerable degree of overtriage. [7][8][9]11,16,18,[21][22][23] One intriguing study that linked dispatch, prehospital, and emergency department records of over 28,000 patients noted that a small subset of MPDS codes were associated with a greater than 90% predictive ability for ED discharge.…”

Section: Introductionmentioning

confidence: 99%

Which Emergency Medical Dispatch Codes Predict High Prehospital Nontransport Rates in an Urban Community?

Hodell

Sporer

2013

Prehospital Emergency Care

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“…413-422, 2013 Copyright Author's personal copy (6), with the dispatch priority of Delta (D), and the modifier of a known history of asthma (1A). Several studies have examined the predictive accuracy of MPDS and other EMD systems for a variety of outcomes, including paramedic-assigned acuity score, physician diagnosis of an acute illness, cardiac arrest, ''Code 3'' or ''lights and sirens'' return, and the need for Advanced Life Support (ALS) intervention (9,(15)(16)(17)(18)(19)(20). Most research has demonstrated that MPDS and other EMD systems identify most, but not all, urgent calls with a considerable degree of overtriage (7)(8)(9)11,16,18,21,22).…”

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How Well Do Emergency Medical Dispatch Codes Predict Prehospital Medication Administration in a Diverse Urban Community?

Sporer

Wilson

2013

The Journal of Emergency Medicine

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, Abstract-Background: The Medical Priority Dispatch System (MPDS) is an emergency medical dispatch (EMD) system that is widely used to prioritize 9-1-1 calls and optimize resource allocation. MPDS is a computer-based EMD system that uses callers' responses to scripted questions to categorize cases into groups and subgroups, based on complaint and perceived acuity. Objective: This study evaluates the ability of MPDS codes to predict prehospital use of medications. Methods: All transported prehospital patients assigned a subgroup by MPDS from January 1, 2009 to December 31, 2009 in a diverse urban community were matched with their prehospital electronic patient care records. The records of transported patients dispatched through EMD were queried for prehospital interventions and matched to their MPDS classifications. Only MPDS subgroups with 10 or more calls were included in the analysis. Results: A total of 38,005 patients met inclusion criteria. Patients with chest pain, breathing problems, heart problems, and diabetic problems received the most medications. Medications were administered in 19% of all calls. The individual MPDS subgroup with the highest rate of medication administration was 6E1A (breathing problems, 76%). Higher rates of Advanced Life Support (ALS) interventions in higher-acuity categories (e.g., Alpha, Bravo, Charlie) were seen in several EMD categories, including unconscious/fainting, breathing problems, and abdominal pain; but this was not observed in many other categories, including seizure, sick person, traumatic injury, and hemorrhage/lacerations. Conclusions: Medications were administered in 19% of all calls. There were higher rates of ALS interventions in higher-acuity categories that were not observed in many other categories. Ó 2013 Elsevier Inc., Keywords-ambulances/utilization; emergencies/classification; Emergency Medical Dispatch; Emergency Medical Service communication systems/standards; risk assessment; triage INTRODUCTIONEmergency Medical Dispatch (EMD) is an internationally utilized system of categorizing and prioritizing emergency calls to send an appropriate and timely prehospital response. A variety of studies in differing systems with both health and non-health trained dispatchers have been published using a variety of different clinical measures to gauge success (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).The Medical Priority Dispatch System (MPDS; Medical Priority Consultants, Salt Lake City, UT) is a computer-based or card-based emergency medical dispatch system that uses callers' responses to scripted questions to categorize cases into numerical complaint-based categories, which are then assigned a priority (Omega, Alpha, Bravo, Charlie, Delta, or Echo) based on their perceived acuity. These priority categories also can be subdivided by various clinical modifiers. An example would be 6D1A, composed of a category of breathing problems RECEIVED: 11 April 2011; FINAL SUBMISSION RECEIVED: 9 August 2011; ACCEPTED: 26 February 2012 413The Journal of Emergency Medicine, V...

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Accuracy of Stroke Recognition by Emergency Medical Dispatchers andParamedics—San Diego Experience

Abstract: In our EMS system, EMD using MPDS Stroke protocol with a high compliance has a higher sensitivity than paramedics using CSS.

Cited by 129 publications

References 19 publications

Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) – a programme of research to facilitate recognition of stroke by emergency medical dispatchers

Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) – a programme of research to facilitate recognition of stroke by emergency medical dispatchers

Which Emergency Medical Dispatch Codes Predict High Prehospital Nontransport Rates in an Urban Community?

How Well Do Emergency Medical Dispatch Codes Predict Prehospital Medication Administration in a Diverse Urban Community?

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