Emergency medical services priority dispatch

Curka, Peter A.; Pepe, Paul E.; Ginger, Victoria F.; Sherrard, Robert C; Ivy, Michael V; Zachariah, Brian S.

doi:10.1016/s0196-0644(05)81307-1

Cited by 83 publications

(80 citation statements)

References 20 publications

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“…Hence, not asking all questions within a protocol is consistent with this dispatch center policy. This dispatch center practice is similar to that reported by Curka and colleagues 10 in their evaluation of computer-aided dispatch triage algorithm.…”

Section: Methodssupporting

confidence: 87%

“…8,18 Dispatch data from Cleveland, Ohio, reveal 15.7% of all 1995 EMS dispatches were assigned the lowest severity level. Palumbo et al 14 report 27% of callers were assigned to the lowest of four severity levels, and Curka et al 10 report 40% were assigned to this level.…”

Section: Discussionmentioning

confidence: 99%

“…Our center and at least one other large urban center 10 emphasize NC/SC assignment over thorough caller questioning. This is done in our community because of high call volume, because of community expectations for a rapid response after calling 911, and because there is little variation in EMS response based on NC/SC assignment.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Associated triage guidelines may be adaptations of existing risk-stratifying dispatch protocols or newly developed instruments specifically crafted to this purpose. Most current dispatch 10,11 However, no data have shown that such triage protocols can identify callers who safely may be triaged to non-EMS resources without an accompanying EMS response. One characteristic of an ideal triage protocol would be its ability to classify accurately both patient condition and severity based on an external standard, such as paramedic field findings.…”

mentioning

confidence: 99%

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Do Emergency Medical Services Dispatch Nature and Severity Codes Agree with Paramedic Field Findings?

Neely

Eldurkar

Drake³

2000

Academic Emergency Medicine

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Abstract. Emergency medical services (EMS) systems increasingly seek to triage patients to alternative EMS resources. Emergency medical services dispatchers may be asked to perform this triage. New protocols may be necessary. Alternatively, existing protocols may be sufficient for this task. For an existing dispatch protocol to be sufficient, it at least must accurately categorize patient condition and severity based on an external standard. Objective: To examine the extent to which nature codes (NCs), or patient condition codes, and severity codes (SCs) currently assigned in one urban 911 center agree with paramedic field findings. The null hypothesis was that there is no routine agreement (75%) between dispatcher-assigned NC or SC and paramedic-assigned NC or SC for the same patient using the same protocol. Methods: Emergency medical services dispatch nature and severity code data and matching out-ofhospital data were prospectively gathered over six months. Dispatch data included the NC: caller-identified problem, and the SC: dispatcher-assessed severity. Each NC is modified by one of three SCs (1, 3, or 9): 1 is emergent, 3 is urgent, and 9 is neither. Paramedics verified and/or corrected dispatcher-assigned NCs and SCs using the same dispatch protocol. Results: One thousand forty usable cases fell into 33 unique NC/SC combinations. The designation of SC 1 was assigned 275 times, SC 3 was assigned 736 times, and SC 9 was assigned 24 times. The SC was missing five times. The overall NC agreement was 0.70 (95% CI = 0.697 to 0.703). The overall SC agreement was 0.65 (95% CI = 0.645 to 0.655). The NC agreement exceeded 75% for ten (59%) NC/SC combinations. The SC agreement exceeded 75% for five (29%) NC/SC combinations. There was both NC and SC agreement for four (24%) combinations: urgent breathing problems, urgent diabetic problems, urgent falls, and urgent overdoses. The greatest NC/SC disagreement occurred within emergent and urgent traffic crashes. Paramedics adjusted SC toward lower severity 29% of the time and toward higher severity 5.4% of the time. There was no upward SC adjustment for eight (47%) combinations. Conclusions: Certain dispatcher-assigned NC and SC codes and NC/ SC combinations achieved the study threshold. Overall agreement failed to achieve the threshold. The lowest SC level was rarely assigned, preventing a meaningful analysis of all severity levels.

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Section: Methodssupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Do Emergency Medical Services Dispatch Nature and Severity Codes Agree with Paramedic Field Findings?

Neely

Eldurkar

Drake³

2000

Academic Emergency Medicine

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“…[1][2][3][4][5][6] Today, more than 25 million EMS responses are made in the United States each year, including a significant number (5-15%) that may involve the advanced monitoring and invasive interventional skills of paramedics. [6][7][8][9] In retrospect, however, between 30% and 50% of all EMS responses still are made to nonemergency situations, and an equal number of cases require only basic life support (BLS) skills such as splinting and spinal immobilization. 7,10 Recognizing that only a small percentage of calls ever utilize advanced life support (ALS) skills, modern priority dispatch systems have been developed that either triage the need for a rapid, ''lights and siren'' response (which may pose some additional traffic risk) or, in other cases, simply limit paramedic deployment to those emergencies that probably will require advanced skills.…”

mentioning

confidence: 99%

Can First Responders Be Sent to Selected 9-1-1 Emergency Medical Services Calls without an Ambulance?

Key

Pepe²,

Persse

et al. 2003

Acad Emergency Med

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Objectives: To evaluate the feasibility and safety of initially dispatching only first responders (FRs) to selected low-risk 9-1-1 requests for emergency medical services. First responders are rapidly-responding fire crews on apparatus without transport capabilities, with firefighters trained to at least a FR level and in most cases to the basic emergency medical technician (EMT) level. Low-risk 9-1-1 requests include automatic medical alerts (ALERTs), motor vehicle incidents (MVIs) for which the caller was unable to answer any medical dispatch questions designed to prioritize the call, and 9-1-1 call disconnects (D/Cs). Methods: A beforeand-after study of patient dispositions was conducted using historical controls for comparison. During the historical control phase of six months, one year prior to the study phase, basic life support ambulances (staffed with two basic EMTs) were dispatched to selected low-risk 9-1-1 incidents. During the six-month study phase, a fire FR crew equipped with automated external defibrillators (AEDs) was sent initially without an ambulance to these incidents. Results: For ALERTs (n ¼ 290 in historical group vs. 330 in study group), there was no statistical difference in the transport rate (7% vs 10%), but there was a statistically significant increase in the follow-up use of advanced life support (ALS) (1% vs 4%, p ¼ 0.009). No patient in the ALERTs historical group required airway management, while one patient in the study group received endotracheal intubation. No patient required defibrillation in either group. Analysis of the MVIs showed a significant decrease (p \ 0.0001) in the patient transport rate from 39% of controls to 33% of study patients, but no change in the follow-up use of ALS interventions (2% for each group). For both the ALERTs and MVIs, the FR's mean response time was faster than ambulances (p \ 0.0001). Among the 9-1-1 D/Cs with FRs only (n ¼ 1,028), 15% were transported and 43 (4%) received subsequent ALS care. Four of these patients (0.4%) received intubation and two (0.2%) required defibrillation. However, no patient was judged to have had adverse outcomes as a result of the dispatch protocol change. Conclusions: Fire apparatus crews trained in the use of AEDs can safely be used to initially respond alone (without ambulances) to selected, low-risk 9-1-1 calls. This tactic improves response intervals while reducing ambulance responses to these incidents.

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EMS dispatch

Clawson¹

2015

Emergency Medical Services

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Emergency medical services priority dispatch

Cited by 83 publications

References 20 publications

Do Emergency Medical Services Dispatch Nature and Severity Codes Agree with Paramedic Field Findings?

Do Emergency Medical Services Dispatch Nature and Severity Codes Agree with Paramedic Field Findings?

Can First Responders Be Sent to Selected 9-1-1 Emergency Medical Services Calls without an Ambulance?

EMS dispatch

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