Besteht ein Zusammenhang zwischen der Einschätzung der Vitalgefährdung und der notfallmedizinischen Erfahrung des Notarztes?

Knapp, Jürgen; Bernhard, Michaël; Hainer, C.; Sikinger, M.; Brenner, T.; Schlechtriemen, T.; Gries, A.

doi:10.1007/s00101-008-1454-3

Cited by 22 publications

(12 citation statements)

References 19 publications

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“…It is an observational, retrospective study in a specific local setting and, as stated above, not applicable to other dispatch systems or two-tier EMS. The NACA score is known to be described as subjective [24] and not always reproducible [25], and the patient’s condition may change for better or worse while the EMS is on its way, inducing incoherence between the dispatch and EMS findings on scene. Therefore it may not always describe the patient’s clinical state on EMS arrival on site, as a minority of patient worsen during EMS care or transport, wich may overestimate under-traige.…”

Section: Discussionmentioning

confidence: 99%

Merger of two dispatch centres: does it improve quality and patient safety?

Moser¹,

Mettler²,

Fuchs³

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundDispatch centres (DCs) are considered an essential but expensive component of many highly developed healthcare systems. The number of DCs in a country, region, or state is usually based on local history and often related to highly decentralised healthcare systems. Today, current technology (Global Positioning System or Internet access) abolishes the need for closeness between DCs and the population. Switzerland went from 22 DCs in 2006 to 17 today. This study describes from a quality and patient safety point of view the merger of two DCs.MethodsThe study analysed the performance (over and under-triage) of two medical DCs for 12 months prior to merging and for 12 months again after the merger in 2015. Performance was measured comparing the priority level chosen by dispatcher and the severity of cases assessed by paramedics on site using the National Advisory Committee for Aeronautics (NACA) score. We ruled that NACA score > 3 (injuries/diseases which can possibly lead to deterioration of vital signs) to 7 (lethal injuries/diseases) should require a priority dispatch with lights and siren (L&S). While NACA score < 4 should require a priority dispatch without L&S. Over-triage was defined as the proportion of L&S dispatches with a NACA score < 4, and under-triage as the proportion of dispatches without L&S with a NACA > 3.ResultsPrior to merging, Dispatch A had a sensitivity/specificity regarding the use of lights and sirens and severity of cases of 86%/48% with over- and under-triage rates of 78% and 5%, respectively. Dispatch B had sensitivity and specificity of 92%/20% and over- and under-triage rates of 84% and 7%, respectively. After they merged, global sensitivity/specificity reached 87%/67%, and over- and under-triage rates were 71% and 3%, respectivelyConclusionsA part the potential cost advantage achieved by the merger of two DCs, it can improve the quality of services to the population, reducing over- and under-triage and the use of lights and sirens and therefore, the risk of accidents. This is especially the case when a DC with poor triage performance merges with a high-performing DC.

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Section: Discussionmentioning

confidence: 99%

Merger of two dispatch centres: does it improve quality and patient safety?

Moser¹,

Mettler²,

Fuchs³

et al. 2017

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

show abstract

“…We used the NACA score to evaluate the patient’s severity status, as this score has been significantly correlated with short-term survival, transfer to the intensive care unit and hospital length of stay [ 17 – 19 ] although it has been described as partly subjective [ 30 ] and not always reproducible [ 31 ]. The NACA score defines the most serious clinical state experienced at any given time during the mission.…”

Section: Discussionmentioning

confidence: 99%

Prehospital triage accuracy in a criteria based dispatch centre

et al. 2015

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BackgroundPriority dispatch accuracy is a key issue in optimizing the match between patients’ medical needs and pre-hospital resources. This study measures the accuracy of a Criteria Based Dispatch (CBD) system, by evaluating discrepancies between dispatch priorities and ambulance crews’ severity evaluations.MethodsThis is a retrospective study conducted from January 2011 to December 2011. We ruled that a National Advisory Committee for Aeronautics (NACA) score > 3 (injuries/diseases which can possibly lead to deterioration of vital signs) to 7 (lethal injuries/ diseases) should require a priority dispatch with lights and siren (L&S), while NACA scores < 4 should require a priority dispatch without L&S. Over triage was defined as the proportion of L&S dispatches with a NACA score < 4, and under triage as the proportion of dispatches without L&S with a NACA score > 3.ResultsThere were 29,008 primary missions in 2011, 1122 were excluded. Of the 15,749 L&S missions, 12,333 patients had a NACA score < 4, leading to an over triage rate of 78 %; 561 missions out of 12,137 missions without L&S had a NACA score > 3, leading to an under triage rate of 4.6 %. Sensitivity was 86 % (95 % confidence interval: 85.6–86.4 %), specificity 48 % (47.4–48.6 %), positive predictive value 21.7 % (21.2–22.2 %), and negative predictive value 95.4 % (95.2–95.6 %).ConclusionThe rates of over triage and under triage in our CBD are 78 and 4.6 % respectively. The lack of consistent or universal metrics is perhaps the most important limitation in dispatch accuracy research. This is mainly due to the large heterogeneity of dispatch systems and prehospital emergency system.

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“…The experience and training level of the doctors that use the scoring system increases scoring quality according to a study by Knapp et al. 12 A study from the German ADAC Luftrettung service described the use of the NACA score as highly subjective and showed that even unequivocal conditions such as resuscitation and death, and clearly life-threatening diseases such as acute myocardial infarction, were all often found to be scored incorrectly. 13 …”

Section: Discussionmentioning

confidence: 99%

Do pre‐hospital anaesthesiologists reliably predict mortality using the NACA severity score? A retrospective cohort study

Raatiniemi

Mikkelsen

Fredriksen

et al. 2013

Acta Anaesthesiol Scand

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IntroductionThe National Advisory Committee on Aeronautics' (NACA) severity score is widely used in pre-hospital emergency medicine to grade the severity of illness or trauma in patient groups but is scarcely validated. The aim of this study was to assess the score's ability to predict mortality and need for advanced in-hospital interventions in a cohort from one anaesthesiologist-manned helicopter service in Northern Norway.MethodsAll missions completed by one helicopter service during January 1999 to December 2009 were reviewed. One thousand eight hundred forty-one patients were assessed by the NACA score. Pre-hospital and in-hospital interventions were collected from patient records. The relationship between NACA score and the outcome measures was assessed using receiver operating characteristic (ROC) curves.ResultsA total of 1533 patients were included in the analysis; uninjured and dead victims were excluded per protocol. Overall mortality rate of the patients with NACA score 1–6 was 5.2%. Trauma patients with NACA score 1–6 had overall mortality rate of 1.9% (12/625) and non-trauma patients 7.4% (67/908). The NACA score's ability to predict mortality was assessed by using ROC area under curve (AUC) and was 0.86 for all, 0.82 for non-trauma and 0.98 for trauma patients. The NACA score's ability to predict a need for respiratory therapy within 24 h revealed an AUC of 0.90 for all patients combined.ConclusionThe NACA score had good discrimination for predicting mortality and need for respiratory therapy. It is thus useful as a tool to measure overall severity of the patient population in this kind of emergency medicine system.

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Besteht ein Zusammenhang zwischen der Einschätzung der Vitalgefährdung und der notfallmedizinischen Erfahrung des Notarztes?

Abstract: The results demonstrate that emergency physicians with less rescue experience rated the severity of illness or injury relatively lower in comparison to colleagues who had worked in the pre-hospital setting for many years.

Cited by 22 publications

References 19 publications

Merger of two dispatch centres: does it improve quality and patient safety?

Merger of two dispatch centres: does it improve quality and patient safety?

Prehospital triage accuracy in a criteria based dispatch centre

Do pre‐hospital anaesthesiologists reliably predict mortality using the NACA severity score? A retrospective cohort study

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