Improving the Appropriateness of Advanced Life Support Teams' Dispatch: A Before-After Study.

Abstract

The dispatch of Advanced Life Support (ALS) teams in Emergency Medical Services (EMS) is still a hardly studied aspect of prehospital emergency logistics. In 2015, the dispatch algorithm of Emilia Est Emergency Operation Centre (EE-EOC) was implemented and the dispatch of ALS teams was changed from primary to secondary based on triage of dispatched vehicles for high-priority interventions when teams with Immediate Life Support (ILS) skills were dispatched. This study aimed to evaluate the effects on the appropriateness of ALS teams' intervention and their employment time, and to compare sensitivity and specificity of the algorithm implementation. This was a retrospective before-after observational study. Primary dispatches managed by EE-EOC involving ambulances and/or ALS teams were included. Two groups were created on the basis of the years of intervention (2013-2014 versus 2017-2018). A switch from primary to secondary dispatch of ALS teams in case of high-priority dispatches managed by ILS teams was implemented. Appropriateness of ALS team intervention, total task time of ALS vehicles, and sensitivity and specificity of the algorithm were reviewed. The study included 242,501 emergency calls that generated 56,567 red code dispatches. The new algorithm significantly increased global sensitivity and specificity of the system in terms of recognition of potential need of ALS intervention and the specificity of primary ALS dispatch. The appropriateness of ALS intervention was significantly increased; total tasking time per day for ALS and the number of critical dispatches without ALS available were reduced. The revision of the dispatch criteria and the extension of the two-tiered dispatch for ALS teams significantly increased the appropriateness of ALS intervention and reduced both the global tasking time and the number of high-priority dispatches without ALS teams available.