Effect and accuracy of emergency dispatch telephone guidance to bystanders in trauma: post-hoc analysis of a prospective observational study

Håkon Kvåle Bakke,Torben Wisborg,Håkon Ruud,Tine Steinvik

doi:10.1186/s13049-016-0343-z

Abstract

BackgroundEmergency medical communication centres (EMCCs) dispatch and allocate ambulance resources, and provide first-aid guidance to on-scene bystanders. We aimed to 1) evaluate whether dispatcher guidance improved bystander first aid in trauma, and 2) to evaluate whether dispatchers and on-scene emergency medical services (EMS) crews identified the same first aid measures as indicated.MethodsFor 18 months, the crew on the first EMS crew responding to trauma calls used a standard form to assess bystander first aid. Audio recordings of the corresponding telephone calls from bystanders to the EMCC were reviewed.ResultsA total of 311 trauma calls were included. The on-scene EMS crew identified needs for the following first-aid measures: free airway in 26 patients, CPR in 6 patients, and hypothermia prevention in 179 patients. EMCC dispatchers advised these measures, respectively, in 16 (62%), 5 (83%), and 54 (30%) of these cases. Dispatcher guidance was not correlated with correctly performed bystander first aid. For potentially life saving first aid measures, all (20/20) callers who received dispatcher guidance attempted first aid, while only some few (4/22) of the callers who did not receive dispatcher guidance did not attempt first aid.DiscussionOverall, the EMCC dispatchers had low sensitivity and specificity for correctly identifying trauma patients requiring first-aid measures. Dispatcher guidance did not significantly influence whether on-scene bystander first aid was performed correctly or attempted in this study setting, with a remarkably high willingness to perform first-aid. However, the findings for potentially lifesaving measures suggests that there may be differences that this study was unable to detect.ConclusionThis study found a high rate of first-aid willingness and performance, even without dispatcher prompting, and a low precision in dispatcher advice. This underlines the need for further knowledge about how to increase EMCC dispatchers’ possibility to identify trauma patients in need of first aid. The correlation between EMCC-guidance and bystander first aid should be investigated in study settings with lower spontaneous first-aid rates.

Highlights

Emergency medical communication centres (EMCCs) dispatch and allocate ambulance resources, and provide first-aid guidance to on-scene bystanders
In that study we found a high rate of first aid intervention from bystanders, securing airway and recovery position were done in 76% of patients where those measures were indicated, bleeding control was done in 81%, hypothermia prevention for 62% of patients where needed [5]
Among 408 eligible cases, 355 EMCC audio recordings were retrieved, 73 of which were shared by multiple patients

Summary

Introduction

Emergency medical communication centres (EMCCs) dispatch and allocate ambulance resources, and provide first-aid guidance to on-scene bystanders. We aimed to 1) evaluate whether dispatcher guidance improved bystander first aid in trauma, and 2) to evaluate whether dispatchers and on-scene emergency medical services (EMS) crews identified the same first aid measures as indicated. Bystander first aid can improve survival [1]. Emergency medical communication centres (EMCCs) dispatch ambulances and provide guidance to bystanders. Dispatcher guidance reportedly increases the bystander CPR rate following out-of-hospital cardiac arrest (OHCA) [2, 3]. Dispatchers may have difficulty correctly assessing situations, [3, 4] and no studies have described bystander first-aid guidance in trauma cases. We have previously published a study assessing which first aid measures bystanders performed in trauma. As the study was a follow-up on already prospectively collected first aid assessments no sample size calculation was performed

Objectives

Methods

Results

Conclusion