Challenges with index protocols in EMS Belgrade of the city of Belgrade

Abstract

Introduction: EMS Belgrade uses INDEX protocols in its everyday operations, according to which all calls are divided into 2 types of emergency calls: code red response calls (immediate response call) and code yellow response calls (prompt response call). Refused calls are marked as green in the system. If an operator receives a call where a person is unconscious, that call is by default marked as a red response call. Objective: To evaluate the degree of successful functioning of INDEX protocols in the operations of the EMS of the City of Belgrade (EMS Belgrade). To evaluate, based on the calls received where patients have been declared unconscious, to what degree has the operator been adhering to the INDEX protocols and marked these calls as 'code red response calls'. Also, to evaluate to what degree of urgency have the operators managed to adhere to INDEX protocols when giving code red response calls to teams for execution as opposed to code yellow response calls. Finally, to establish if there is a significant time difference when distributing code red and code yellow response calls for execution. Method: The study has been conducted by examining retrospectively all accepted calls at the EMS Belgrade in the period from 01.06.2010 to 01.09.2010. Out of 24777 calls the following calls have been excluded: patients in which level of consciousness was unknown, patients suffering from malignant neoplasm as losing consciousness could be part of their primary illness, patients who have regained consciousness prior or during the call and calls that have waited on execution for over 30 minutes at the dispatch centre. Remained 520 calls referring to unconscious patients that were then graded as code red or code yellow response calls by the operators. Basic statistical data was obtained in the Statistical Package for Social Sciences and statistical testing was done according to Mann-Whitney U test. Results: Out of 520 analyzed calls 54% of them were not graded as code red response. Before the operator submits a call to a team for execution the average time for red response calls is 2.13 min. whereas for yellow response calls it is 5.47 min. In the first 5 minutes after receiving the call 90% of red response calls and 62% of yellow calls are submitted for execution. Statistically, there is a big difference in pre-execution times when the calls are still kept with operators, Mann- Whitney U, Z=-8.200 p<0.01. Discussion: It is extremely difficult to evaluate a state of emergency of a patient only based on information obtained in a telephone call. Operators at the EMS call centre do not always fully adhere to the protocols for responding to calls. Conclusion: In over 50% of the calls with unconscious patients these have not been graded as code red response calls. Operators usually adhere to emergency codes and red response calls are given to teams for execution sooner. Statistically, there is a significant difference in pre-execution times of red response and yellow response calls, i.e. red response calls were given to teams for execution significantly sooner.