Safety of Tiered-Dispatch for 911 Calls for Abdominal Pain.

Tiffany Abramson,Stephen Sanko,Marc Eckstein,Saman Kashani

doi:10.5811/westjem.2019.9.44100

Abstract

IntroductionMany dispatch systems send Advanced Life Support (ALS) resources to patients complaining of abdominal pain even though the majority of these incidents require only Basic Life Support (BLS). With increasing 911-call volume, resource utilization has become more important to ensure that ALS resources are available for time-critical emergencies. In 2015, a large, urban fire department implemented an internally developed, tiered-dispatch system. Under this system, patients reporting a chief complaint of abdominal pain received the closest BLS ambulance dispatched alone emergency if located within three miles of the incident. The objective of this study was to determine the safety of BLS-only dispatch to abdominal pain by determining the frequency of time-sensitive events.MethodsThis was a retrospective review of electronic health records of one emergency medical service provider agency from May 2015–2018. Inclusion criteria were a chief complaint of abdominal pain from a first- or second-party caller, age over 15, and the patient was reported to be alert and breathing normally. The primary outcome was the prevalence of time-sensitive events, including cardiopulmonary resuscitation (CPR), defibrillation, or airway management. Secondary outcomes were hypotension (systolic blood pressure < 90 mmHg); or a prehospital 12 lead-electrocardiogram (ECG) demonstrating ST-elevation myocardial infarction (STEMI) criteria or a wide complex arrhythmia. Descriptive statistics were used.ResultsDuring the study period, there were 1,220,820 EMS incidents, of which 33,267 (2.72%) met inclusion criteria. The mean age was 49.9 years (range 16–111, standard deviation [SD] 19.6); 14,556 patients (56.2%) were female. Time-sensitive events occurred in seven cases (0.021%), mean age was 75.3 years (range 30–86, SD18.7); 85.7% were female. Airway management was required in seven cases (0.021%), CPR in six cases (0.018%), and defibrillation in one case (0.003%). Two of the seven (28.6%) cases involved dispatch protocol deviations. Hypotension was present in 240 (0.72%) cases; six (0.018%) cases had 12-lead ECGs meeting STEMI criteria; and no cases demonstrated wide complex arrhythmia.ConclusionAmong adult 911 patients with a dispatch chief complaint of abdominal pain, time-sensitive events were exceedingly rare. Dispatching a BLS ambulance alone appears to be safe.

Highlights

Many dispatch systems send Advanced Life Support (ALS) resources to patients complaining of abdominal pain even though the majority of these incidents require only Basic Life Support (BLS)
Time-sensitive events occurred in seven cases (0.021%), mean age was 75.3 years; 85.7% were female
Under Los Angeles Fire Department (LAFD)-TDS, patients reporting a chief complaint of abdominal pain receive the closest BLS ambulance dispatched alone emergency if located within three miles of the incident

Summary

Introduction

Many dispatch systems send Advanced Life Support (ALS) resources to patients complaining of abdominal pain even though the majority of these incidents require only Basic Life Support (BLS). In 2015, a large, urban fire department implemented an internally developed, tiered-dispatch system Under this system, patients reporting a chief complaint of abdominal pain received the closest BLS ambulance dispatched alone emergency if located within three miles of the incident. Of low-acuity calls requiring ALS resources.[1,2,3,4,5,6] For this reason, multiple large cities with accelerating EMS call volumes are re-evaluating their current dispatch systems. The few studies that have been published suggest overtriage and overutilization of ALS resources for abdominal pain with a range from 10-51%.8,9 Other retrospective reviews found that 84-98% of abdominal pain calls are low acuity and that less than 6-8% were considered true emergencies.[4,9,10] Of note, most ALS care was pulse oximetry and/or an intravenous (IV) placement, and when the analysis was restricted to IV fluid bolus, medication, intubation or defibrillation, the majority (19/28) received ALS

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