Degree of implementation of structured answering of emergency calls in German emergency dispatch centers and effects of the introduction in daily practice

Abstract

The emergency call-taking process is crucial for the adequate disposition of emergency vehicles and the provision of first aid instructions. Moreover, it has adirect impact on the quality of out-of-hospital emergency care. Organizations such as the European Resuscitation Council, the German Federal Association of Emergency Medical Directors and the German Association of Emergency Dispatch Centers call for the nationwide implementation of aformal call-taking process in emergency dispatching. This is required for the provision of telephone-assisted cardiopulmonary resuscitation (T-CPR). This article presents the results of an online survey among members of the German Association of Emergency Dispatch Centers on the implementation of structured call-taking programs. The survey comprised data on the implementation of astructured call-taking process, its effects on important quality indicators such as the frequency of T‑CPR and employee satisfaction. Of the 100 participants who completed the survey, 49 already used formal call-taking systems and 24 (47%) of the remaining 51emergency dispatch centers intended to implement such asystem. Formal call-taking systems were mainly used in the dispatch of emergency medical services (98% of emergency dispatch centers using aformal call-taking system) and fire brigades (83.7% of emergency dispatch centers using aformal call-taking system). In 42 (85.7%) of the 49emergency dispatch centers using aformal call-taking process, this process is mandatory; however, only 27 (64.3%) reported compliance rates of more than 95% in medical emergencies. Comparing the pre-post results after the introduction of astructured approach, the quality of the inquiries improved for almost all emergency dispatch centers. On the other hand, important quality indicators, e.g. mean dispatch initiation time or the necessity of subsequently alerting an advanced life support unit to the scene, were not recorded in 42.9% and 49.0% of the dispatch centers, respectively. Of the emergency dispatch centers that analyzed the frequency of T‑CPR, 94.3% could show an increase in T‑CPR. Moreover, 79.5% of the respondents reported improved employee satisfaction. Whereas the demand for dispatchers remained nearly static, 24 out of the 49dispatch centers that used aformal call-taking system set up new posts for quality management (maximum: 3posts in dispatch centers handling more than 250,000 missions annually). Structured emergency call-taking has not yet been comprehensively implemented in German emergency dispatch centers. Wherever it is used consistently, important quality parameters are improved. Further investigations should aim to identify crucial factors for its implementation and to analyze additional quality parameters.