Implementing a nationwide criteria-based emergency medical dispatch system: A register-based follow-up study

Andersen, Mikkel S; Johnsen, Søren Paaske; Sørensen, Jan; Jepsen, S; Hansen, Jesper Bjerring; Christensen, Erika Frischknecht

doi:10.1186/1757-7241-21-53

Cited by 138 publications

(161 citation statements)

References 15 publications

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“…A study from the Central Region of Denmark showed a 51.4% prevalence of high-priority missions. The Danish study also demonstrated a significantly lower annual rate of ambulance missions: 32.2 per 1000 inhabitants compared to 229.5 per 1000 inhabitants in the present study [14]. It is difficult to explain these striking differences between the two countries, but they may be due to differences in the dispatch protocols, EMCC personnel education as well as cultural differences related to contacting the EMCC.…”

Section: Discussioncontrasting

confidence: 57%

Medical priority dispatch codes—comparison with National Early Warning Score

Hoikka

Länkimäki

Silfvast

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundIn Finland, calls for emergency medical services are prioritized by educated non-medical personnel into four categories—from A (highest risk) to D (lowest risk)—following a criteria-based national dispatch protocol. Discrepancies in triage may result in risk overestimation, leading to inappropriate use of emergency medical services units and to risk underestimation that can negatively impact patient outcome. To evaluate dispatch protocol accuracy, we assessed association between priority assigned at dispatch and the patient’s condition assessed by emergency medical services on the scene using an early warning risk assessment tool.MethodsUsing medical charts, clinical variables were prospectively recorded and evaluated for all emergency medical services missions in two hospital districts in Northern Finland during 1.1.2014–30.6.2014. Risk assessment was then re-categorized as low, medium, or high by calculating the National Early Warning Score (NEWS) based on the patients’ clinical variables measured at the scene.ResultsA total of 12,729 emergency medical services missions were evaluated, of which 616 (4.8%) were prioritized as A, 3193 (25.1%) as B, 5637 (44.3%) as C, and 3283 (25.8%) as D. Overall, 67.5% of the dispatch missions were correctly estimated according to NEWS. Of the highest dispatch priority missions A and B, 76.9 and 78.3%, respectively, were overestimated. Of the low urgency missions (C and D), 10.7% were underestimated; 32.0% of the patients who were assigned NEWS indicating high risk had initially been classified as low urgency C or D priorities at the dispatch.Discussion and conclusionThe present results show that the current Finnish medical dispatch protocol is suboptimal and needs to be further developed. A substantial proportion of EMS missions assessed as highest priority were categorized as lower risk according to the NEWS determined at the scene, indicating over-triage with the protocol. On the other hand, only a quarter of the high risk NEWS patients were classified as the highest priority at dispatch, indicating considerable under-triage with the protocol.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0336-y) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 57%

Medical priority dispatch codes—comparison with National Early Warning Score

Hoikka

Länkimäki

Silfvast

et al. 2016

Scand J Trauma Resusc Emerg Med

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“…The vast majority of patients with hip fracture gain access to acute medical help by dialing the Danish national emergency number (1-1-2) connecting to healthcare professionals in the Emergency Medical Communication Centre (EMCC) who will dispatch an ambulance when needed. Ambulances are dispatched according to a symptom- and criteria-based dispatch protocol which categorizes patients into different levels of urgencies [20]. Alternatively, a GP is contacted and, based on the information obtained from a telephone consultation or a physical examination, the GP can request ambulance transport through the EMCC.…”

Section: Methodsmentioning

confidence: 99%

Prehospital intravenous fentanyl to patients with hip fracture: an observational cohort study of risk factors for analgesic non-treatment

Friesgaard

Christensen

Kirkegaard

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundPatients with proximal femoral neck fracture have a high short-term mortality, a high risk of postoperative complications, and impaired quality of life. One of the challenges related to the prehospital treatment of these patients is to administer systemic opioids fast and properly. Effective analgesic prehospital treatment ought be initiated rapidly in order to alleviate the stress that follows acute pain, to facilitate transportation, and to improve quality of care. The objectives of this study were to explore the prevalence of prehospital administration of intravenous fentanyl to patients with proximal femoral neck fracture in the ambulances and to assess risk factors for analgesic non-treatment.MethodsThis was a register-based observational cohort study of patients with proximal femoral neck fracture from the North Denmark Region transported by ambulance. The patients were identified via the Danish Interdisciplinary Hip Fracture Registry over a 3-year period from 1 July 2011 to 30 June 2014. This hospital registry contains data on several patient characteristics used for the risk factor analysis. Data on prehospital treatment (intravenous fentanyl) and patient monitoring were registered in an electronic prehospital patient record. A modified Poisson regression with robust standard errors was carried out with intravenous fentanyl as the primary binary outcome and the following explanatory variables: age, sex, Charlson Comorbidity Index score, housing, body mass index, type of fracture, fracture displacement, prior consultation with general practitioner, dispatch triage level, and time with ambulance personnel.ResultsIn total, 2,140 patients with proximal femoral neck fracture were transported by ambulance, of which 584 (27.3%, 95% CI: 25.4-29.2) were treated with intravenous fentanyl. Risk factors for non-treatment were: older age, male sex (RR 0.77, 95% CI: 0.64-0.91), institutional housing (RR 0.72, 95% CI: 0.56-0.92), medial fracture (RR 0.74, 95% CI: 0.60-0.92), short time with ambulance personnel, Charlson Comorbidity Index score > 1, year of fracture (2011), low levels of urgency at dispatch, and if seen by general practitioners prior to transport.DiscussionEducation of ambulance personnel in assessing and treating patients with hip fracture seems to be required. Also, future studies should consider alternative or supportive pain treatment options with suitable analgesic effects and side effects.ConclusionsFew patients with proximal femoral neck fracture were treated with intravenous fentanyl, and several risk factors were associated with prehospital analgesic non-treatment. Future prospective studies should explore covariates of socioeconomic, cultural, and psychological origin to provide further insight into the multifactorial causes of non-treatment of acute pain.

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“…Calls concerning illness and injury are redirected to one of five regional EMCCs, which are staffed with nurses and paramedics as call‐takers, technical staff as dispatchers, and medical doctors as supervisors. The call‐takers use a criteria‐based dispatch protocol, namely the Danish Index for Emergency Care . This protocol divides patients into five emergency levels and into 37 chief complaint groups.…”

Section: Methodsmentioning

confidence: 99%

“…1200/100,000 inhabitants pr. year in the involved regions) . The aim of this study was to investigate whether information about demographic factors and hospitalization history could improve the identification of high‐risk patients in the triage of critically ill and severely injured patients as performed by EMCCs.…”

mentioning

confidence: 99%