Emergency Medical Communication Centre Research Articles

A comparison of two emergency medical dispatch protocols with respect to accuracy

BackgroundEmergency medical dispatching should be as accurate as possible in order to ensure patient safety and optimize the use of ambulance resources. This study aimed to compare the accuracy, measured as priority level, between two Swedish dispatch protocols – the three-graded priority protocol Medical Index and a newly developed prototype, the four-graded priority protocol, RETTS-A.MethodsA simulation study was carried out at the Emergency Medical Communication Centre (EMCC) in Stockholm, Sweden, between October and March 2016. Fifty-three voluntary telecommunicators working at SOS Alarm were recruited nationally. Each telecommunicator handled 26 emergency medical calls, simulated by experienced standard patients. Manuscripts for the scenarios were based on recorded real-life calls, representing the six most common complaints. A cross-over design with 13 + 13 calls was used. Priority level and medical condition for each scenario was set through expert consensus and used as gold standard in the study.ResultsA total of 1293 calls were included in the analysis. For priority level, n = 349 (54.0%) of the calls were assessed correctly with Medical Index and n = 309 (48.0%) with RETTS-A (p = 0.012). Sensitivity for the highest priority level was 82.6% (95% confidence interval: 76.6–87.3%) in the Medical Index and 54.0% (44.3–63.4%) in RETTS-A. Overtriage was 37.9% (34.2–41.7%) in the Medical Index and 28.6% (25.2–32.2%) in RETTS-A. The corresponding proportion of undertriage was 6.3% (4.7–8.5%) and 23.4% (20.3–26.9%) respectively.ConclusionIn this simulation study we demonstrate that Medical Index had a higher accuracy for priority level and less undertriage than the new prototype RETTS-A. The overall accuracy of both protocols is to be considered as low. Overtriage challenges resource utilization while undertriage threatens patient safety. The results suggest that in order to improve patient safety both protocols need revisions in order to guarantee safe emergency medical dispatching.

Local emergency medical communication centres - staffing and populations.

There are several examples of inadequate staffing at local emergency medical communication centres (LEMCs) resulting in limited availability and long waits on the telephone. There are no guidelines for population size or the staffing of a LEMC. In the following, we present models of catchment areas and staffing. Traffic intensity on Saturdays and Sundays was based on data on figures for patient contacts at seven LEMCs in 2014 and 2015. We defined the minimum optimal population base as at least 50 % probability of ≥ 10 contacts in the course of a night duty. The Erlang-C formula was used to estimate service level and hence staffing requirements on the basis of population and response-time requirements. We have surveyed the combined staffing requirements of all the LEMCs in Norway. The minimum optimal population base was 29 134. In 2016, 48 of 103 LEMCs were smaller than this. In order to be able to satisfy the response-time requirements in the Norwegian Emergency Medicine Regulations, 112 LEMC night operators and 158 day operators would be necessary for the whole of Norway. A reduction of the response-time requirement from 120 to ten seconds would require 9.8 % more operators at night and 17 % more operators during the day. The models we have presented provide a basis for planning the population base and staffing of LEMCs. Significantly stricter response-time requirements will result in limited need for more personnel.

Stroke identification by criteria based dispatch - a register based study.

BackgroundRapid and precise dispatch of resources is a key element in pre‐hospital emergency medicine. Emergency medical communication centres (EMCCs) dispatch resources based on protocols and guidelines, balancing the acute need of the individual and the resource allocation of the pre‐hospital emergency medical system. The aim of this study was to determine the validity of stroke identification by the Norwegian dispatch guidelines.Method and materialThis was a register‐based study where patients suspected for stroke were compared to those with the final diagnosis of stroke as an indicator group for the guideline validation. One EMCC and its three associated hospitals participated with 13 months of data. Four subcodes of the stroke dispatch code were defined as suspicious of stroke and further analysed. Factors associated with stroke identification were explored.ResultsThe sensitivity for identifying a stroke patient at initial EMCC contact was 57.9% (51.5, 64.1), specificity was 99.1% (98.9, 99.2), positive predictive value was 45.7% (40.1, 51.4) and negative predictive value was 99.4% (99.3, 99.5). The emergency medical access telephone (113) was initial EMCC contact line in only 48% of the cases. Paralyses and admittance to a smaller hospital were associated with increased probability for stroke (OR 2.6, P = 0.001 and OR 2.7, P = 0.01), respectively.ConclusionThe sensitivity for identification of stroke patients by the dispatch guidelines is modest, while the specificity is high. The 113 telephone line was initial EMCC access point for less than half of the stroke patients.

Telephone counselling by nurses in Norwegian primary care out-of-hours services: a cross-sectional study

BackgroundThe primary care out-of-hours (OOH) services in Norway are characterized by high contact rates by telephone. The telephone contacts are handled by local emergency medical communication centres (LEMCs), mainly staffed by registered nurses. When assessment by a medical doctor is not required, the nurse often handles the contact solely by nurse telephone counselling. Little is known about this group of contacts. Thus, the aim of this study was to investigate characteristics of encounters with the OOH services that are handled solely by nurse telephone counselling.MethodsNurses recorded ICPC-2 reason for encounter (RFE) codes and patient characteristics of all patients who contacted six primary care OOH services in Norway during 2014. Descriptive statistics and frequency analyses were applied.ResultsOf all telephone contacts (n = 61,441), 23% were handled solely by nurse counselling. Fever was the RFE most frequently handled (7.3% of all nurse advice), followed by abdominal pain, cough, ear pain and general symptoms. Among the youngest patients, 32% of the total telephone contacts were resolved by nurse advice compared with 17% in the oldest age group. At night, 31% of the total telephone contacts were resolved solely by nurse advice compared with 21% during the day shift and 23% in the evening. The share of nurse advice was higher on weekdays compared to weekends (mean share 25% versus 20% respectively).ConclusionThis study shows that nurses make a significant contribution to patient management in the Norwegian OOH services. The findings indicate which conditions nurses should be able to handle by telephone, which has implications for training and routines in the LEMCs. There is the potential for more nurse involvement in several of the RFEs with a currently low share of nurse counselling.

Targeted simulation and education to improve cardiac arrest recognition and telephone assisted CPR in an emergency medical communication centre

AimRecognition of cardiac arrest and prompt activation time by emergency medical dispatch are key process measures that have been associated with improved survival after out-of-hospital cardiac arrest (OHCA). The aim of this study is to improve recognition of OHCA and time to initiation of telephone assisted chest compressions in an emergency medical communication centre (EMCC). MethodsA prospective, interventional study implementing targeted interventions in an EMCC. Interventions included: (1) lectures focusing on agonal breathing and interrogation strategy (2) simulation training (3) structured dispatcher feedback (4) web-based telephone assisted CPR training program. All ambulance-confirmed OHCA calls in the study period were assessed and relevant process and result measures were recorded pre- and post-intervention. Cardiac arrest was reported as (1) recognised, (2) not recognised or (3) delayed recognition. ResultsWe included 331 and 230 calls pre- and post-intervention, respectively. Recognition of cardiac arrest improved significantly after intervention (89 vs. 95%, p=0.024). Delayed recognition was significantly reduced (21 vs. 6%, p>0.001), as was misinterpretation of agonal breathing (25 vs. 10%, p<0.001). Telephone assisted compressions increased (71% vs. 83%, p=0.002) whereas bystander performed ventilations decreased after intervention (23% vs. 15%, p=0.016). Time intervals for initiation of chest compression instructions (2.6 vs. 2.3min, p=0.042) and delivery of telephone assisted chest compressions (3.3 vs. 2.8min, p=0.015) were significantly shortened after intervention. ConclusionTargeted simulation, education and feedback significantly improved recognition of OHCA and reduced time to first chest compression. Continuous measurement of key quality metrics can facilitate development of targeted education and training.

QUALITY ASSESSMENT ON EMERGENCY MEDICAL SERVICES DOCUMENTATIONS IN TRAUMA CASES.

Background: The quality assessment would enhance accountability in emergency medical services (EMS) and provide EMS agencies with data to measure their system’s overall performance and to develop sound strategic quality improvement planning. The aim of this study was to determine the quality assessment of emergency medical service documentation for trauma cases. Methods: The quality assessment of emergency medical services (EMS) documentation for trauma cases was conducted in the Emergency Medical Communication Centre, Hospital TengkuAmpuanAfzan (HTAA), Kuantan Pahang. A stratified convenience sampling was used as sampling method and the EMS documentation checklist was adopted by Monash University, Centre for Ambulance and Paramedic Studies. The score of the documentation will be reflected with the health care personnel background. The data were analysed by using (SPSS) version 19.0 for windows. Results: 235(100%) of EMS healthcare personnel had fulfilled the requirement for date, patient details, caller details, police notification and also hospital destination. However, for the medications given, only 15 out of 235 documents were documented and 235 (100%) were excluded the adverse effect and allergic reaction of medication to the patient. The overall mean of the quality assessment documentation was 75.013 while the standard deviation was 11.780. Based on the result shown, there was a significant association between years of employment with the quality assessment (t=-4.01, p<0.001). Conclusion: Only 40% of the documentation were categorised as quality documentations. And only years of employment had significant association with the quality of emergency medical service documentation. Meanwhile, there was no significant association of races and gender with the quality emergency medical service documentation

Prehospital path in acute stroke.

Too few patients with acute stroke receive thrombolytic therapy owing to the limited time window for treatment and prehospital delay. The purpose of this study is to describe the prehospital path for patients with acute stroke and, in particular, what distinguishes patients who contact the Emergency Medical Communication Centre (EMCC) from those who contact their general practitioner (GP) or Out-of-hours (OOH) services. Patients with acute cerebral infarction and intracerebral haemorrhage admitted to the Stroke Unit, Department of Neurology, Akershus University Hospital, were included. Data on the prehospital path (prehospital delay, medical contacts) were collected over the period 15 April 2009 – 1 April 2010. A total of 299 patients were included in the study. The median age was 75 years and 48.5 % were women. In all, 63.9 % of patients with acute stroke called the EMCC, and 93.7 % of these were taken directly to hospital by ambulance. Of those who called the GP’s office or OOH services, 60.7 % were asked to go to the GP’s office or OOH services in person. Patients who called and attended the GP’s office or OOH services had milder neurological deficits (p < 0.001) and longer patient delay (p = 0.018) than those who called the EMCC. Six out of ten patients who contacted the primary health care services were asked to go to the GP’s office/OOH services in person, which resulted in unnecessary delay. The findings from this study may indicate a need for specific training of this group of health care professionals in the prompt handling of patients with possible stroke.

Time delays to reach dispatch centres in different regions in Europe. Are we losing the window of opportunity? — The EUROCALL study

AimIn out of hospital cardiac arrest (OHCA) the start of Cardiopulmonary Resuscitation (CPR) by a single rescuer may be delayed considerably if the total time (TT) to connect the telephone call to the Emergency Medical Communication Centre (EMCC) is prolonged. EUROCALL investigated the TT-EMCC and its components using different calling procedures. MethodsThis prospective, multicentre, randomised study was performed in April 2013. Telephone calls were randomly allocated to time of call, and to those connecting directly to the EMCC (1-step procedure) and those diverted before connecting to the EMCC (2-step procedure). ResultsTwenty-one EMCCs from 11 countries participated in the study. Time to first ringtone was similar between 1-step 3.7s (IQR 1.0–5.2) and 2-step calls 4.0s (IQR 2.4–5.2). For the 1878 1-step calls, the median TT-EMCC was 11.7s (IQR 8.7–18.5). For the 1550 2-step calls, the median time from first ringtone to first call-taker was 7s (IQR 4.6–11.9) and from first call-taker to EMCC was 18.7s (IQR 13.4–29.9). Median TT-EMCC was 33.2 s (IQR 24.7–46.1) and was significantly longer than the TT-EMCC observed with the 1-step procedure (P<0.0001). Significant differences existed among participating regions between and within different countries both for 1-step and 2-step procedures. ConclusionTT-EMCC was significantly shorter in a 1-step procedure compared to a 2-step procedure. Regional differences existed between countries but also within countries. This may be relevant in cases of OHCA and other situations where patient outcome is critically time-dependent.

Factors impacting upon timely and adequate allocation of prehospital medical assistance and resources to cardiac arrest patients

AimExplore, understand and address issues that impact upon timely and adequate allocation of prehospital medical assistance and resources to out-of-hospital cardiac arrest (OHCA) patients. MethodsMixed-methods design obtaining data for one year in three emergency medical communication centres (EMCC); Oslo-Akershus (OA), Vestfold-Telemark (VT) and Østfold (Ø). Data collection included quantitative data from analysis of dispatch logs, ambulance records and audio files. Qualitative data were collected through in-depth interviews and non-participant observations. ResultsOA-, VT- and Ø-EMCC responded to 1095 OHCAs and 579 of these calls were included for further analysis (333, 143 and 103, respectively). There were significant site differences in their recognition of OHCA (89, 94 and 78%, respectively, p<0.001), provision of CPR instructions (83, 83 and 61%, respectively, p<0.001), time from call answered to initial CPR instructions (1.4min (1.2, 1.6), 1.1min (0,9, 1.2) and 1.3 (1.2, 1.7) respectively, p=0.002). The most frequent reason for delayed or failed recognition of OHCA was misinterpretation of agonal breathing. Interviews and observations revealed individual differences in protocol use, interrogation strategy and assessment of breathing. Use of protocol was only part of decision making, dispatchers trusted their own clinical experience and intuition, and used assumptions about the patient and the situation as part of decision making. ConclusionAgonal breathing continues to be the main barrier to recognition of cardiac arrest. Individual differences among dispatchers’ strategies can directly impact on performance, mainly due to the wide definition of cardiac arrest and lack of uniform tools for assessment of breathing.

Dispatch guideline adherence and response interval-a study of emergency medical calls in Norway.

BackgroundThe Emergency Medical Communication Centre (EMCC) operators in Norway report using the Norwegian Index for Medical Emergency Assistance (Index), a criteria-based dispatch guideline, in about 75 % of medical emergency calls. The main purpose of a dispatch guideline is to assist the operator in securing a correct response as quickly as possible. The effect of using the guideline on EMCC response interval is as yet unknown. We wanted to ascertain an objective measure of guideline adherence, and explore a possible effect on emergency medical dispatch (EMD) response interval.MethodsObservational cross-sectional study based on digital telephone recordings and EMCC records; 299 random calls ending in acute and urgent responses from seven strategically selected EMCCs were included. Ability to confirm location and patient consciousness within an acceptable time interval and structural use of criteria cards were indicators used to create an overall guideline adherence variable. We then explored the relationship between different levels of guideline adherence and EMD response interval.ResultsThe overall guideline adherence was 80 %. Location and patient consciousness were confirmed within 1 min in 83 % of the calls. The criteria cards were used systematically as intended in 64 % of the cases. Total median response interval was 2:28, with 2:01 for acute calls and 4:10 for urgent calls (p < 0.0005). Lower guideline adherence was associated with higher EMD response interval (p < 0.0005).ConclusionThe measured guideline adherence was higher than previously reported by the operators themselves. Patient consciousness was rapidly confirmed in the majority of cases. Failure to use Index criteria as intended result in delayed ambulance dispatch and a potential risk of undertriage.Electronic supplementary materialThe online version of this article (doi:10.1186/s12873-016-0105-2) contains supplementary material, which is available to authorized users.

Non-urgent Emergency Callers: Characteristics and Prognosis

ABSTRACTObjective: In Denmark, calls to the Danish emergency number 1-1-2 concerning medical emergencies are received by an emergency medical communication center (EMCC). At the EMCC, health care professionals (nurses, paramedics, and physicians) decide the necessary response, depending on the level of emergency as indicated by the Danish Index for Emergency Care. The index states 37 main criteria (symptoms) and five levels of emergency, descending from A (life threatening) to E (not serious). An ambulance is not sent to emergency level-E patients (level-E patients), but they are given other kinds of help/advice. No prior studies focusing on Danish level-E patients exist, hence the sparse knowledge about them. This study aimed to characterize level-E patients in the Central Denmark Region and to investigate their progress in the health care system after the 1-1-2 call, regarding contacting 1-1-2 again, general practitioner and Emergency Department (ED) visits, hospital admission, and death. Methods: This is a retrospective follow-up study of callers who contacted the EMCC of the Central Denmark Region and were assessed as level-E patients from August 2013 to July 2014. The study population was identified in the EMCC dispatch software, whose data were supplemented with health care data from three national registries. Results: Of the 53,414 patients who called 1-1-2 over the study period, 4,962 level-E patients were included in the study. The median age was 47 years (IQR: 24.3–67.7), and 53.4% were men. The most common main criteria were extremity pain - minor wounds. Within 1 day after their 1-1-2 call, 42.1% had a subsequent contact with the health care system. Of those, 5.9% called 1-1-2 again, 24.3% contacted an ED, and 8.6% were admitted. The fatality rate was 0.1%. Conclusions: Level-E patients who contacted the EMCC of the Central Denmark Region were most frequently young adults. Almost 60% of level E-patients, who could be tracked, had no further contact with the health care system within a day after their 1-1-2 call. Of those who did, a quarter contacted an ED, indicating that level-E patients needed medical attention. The low fatality rates suggest limited undertriage, that is, level-E patients do not seem to need emergency medical service transportation. Further studies on undertriage among other things are needed.

Potential cardiac arrest – an observational study of pre-hospital medical response

Objectives: A previous study showed that Norwegian GPs on call attended around 40% of out-of-hospital medical emergencies. We wanted to investigate the alarms of prehospital medical resources and the doctors' responses in situations of potential cardiac arrests. Design and setting: A three-month prospective data collection was undertaken from three emergency medical communication centres, covering a population of 816,000 residents. From all emergency medical events, a sub-group of patients who received resuscitation, or who were later pronounced dead at site, was selected for further analysis. Results: 5,105 medical emergencies involving 5,180 patients were included, of which 193 met the inclusion criteria. The GP on call was alarmed in 59 %, and an anaesthesiologist in 43 % of the cases. When alarmed, a GP attended in 84 % and an anaesthesiologist in 87 % of the cases. Among the patients who died, the GP on call was alarmed most frequently. Conclusion: Events involving patients in need of resuscitation are rare, but medical response in the form of the attendance of prehospital personnel is significant. Norwegian GPs have a higher call-out rate for patients in severe situations where resuscitation was an option of treatment, compared with other “red-response” situations.Key PointsThis study investigates alarms of and call-outs among GPs and anaesthesiologists on call, in the most acute clinical situations:Medical emergencies involving patients in need of resuscitation were rare.The health care contribution by pre-hospital personnel being called out was significant.Compared with other acute situations, the GP had a higher attendance rate to patients in life-threatening situations.

Recognition of out of hospital cardiac arrest in the emergency medical communication center improves survival

s / Resuscitation 96S (2015) 5–42 25 had been allocated as control group (CG)with a standard ILS course and 12 courses as intervention group (IG)with an interactive, video supported and directed targeted–training in NTS, according to the ILS course regulation. Self-assessment was conducted by an aftercourse-questionnaire for all participants with statements around the elements of the Anaesthetists Non-Technical Skills (ANTS) as behavioural marker.3,4,5 Results: 330 surveys had been validated positively (IG n=139 andCGn=191). The distribution of the overall resultwith reference to ANTS behavioural in IG and CG shows a statistically significant difference (p=0.001) between responder trends (IG median 1.0, IQR 1.0–2.0; CGmedian 1.50, IQR 1.0–2.0). In detail we determined differences in the skill category “Decision making” (p=0.024) and “Situational awareness” (p<0.001). The skill category “Teamwork” (p=0.566) and “Taskmanagement” (p=0.143) are statistically similar in both groups. Conclusions: Out of our results we recommend the use of NTS specific targeted–training in ILS provider courses, especially to improve “Decision making” and “Situational awareness” performances.

Dispatch of the Mobile Emergency Care Unit to children with febrile seizures. Reliability of diagnoses made by the Emergency Medical Communication Center

s / Resuscitation 96S (2015) 43–157 131 andnurses), therewas no association betweenhaving children, and willingness towithdraw care for their child. Responder genderwas also not associated with willingness to withdraw care. Conclusions:Professionalperspectivesovershadowedtheemotional influence of parenthood when workers of healthcare institutionsmade theoretical decisions regardingwithdrawal of life support for their own child against a religious edict. Non-medical professionals weremorewilling towithdraw care if theywere parents. http://dx.doi.org/10.1016/j.resuscitation.2015.09.310

Descriptions and presentations of sepsis – A qualitative content analysis of emergency calls

BackgroundSepsis is a serious condition which requires early treatment. We often fail to recognize sepsis patients in the chain of prehospital care. Knowledge of how sepsis is expressed in calls to the emergency medical communication centre (EMCC) is limited. An increased understanding could lead to earlier identification of patients with sepsis. ObjectiveThe aim of this study was to describe the descriptions of sepsis used during communication between the caller and the emergency medical dispatcher (EMD). MethodsTo achieve the aim of the study, an inductive approach of qualitative content analysis was used. In total, 29 consecutive patients, who arrived at the emergency department by ambulance and received a diagnosis of sepsis according to the International Classification of Diseases (ICD)-10, were included in the study. For each case, the corresponding emergency call recording from the EMCC was transcribed verbatim. Main categories and subcategories from the text were abstracted. ResultsFrom fifteen subcategories, three main categories were abstracted: “Deterioration”, “Physical signs and symptoms” and “Difficulties establishing satisfactory contact with the patient.” The way laymen and professionals expressed themselves seemed to differ. ConclusionsSepsis was described in terms of the physical symptoms, changes of condition and communication abilities of the patient. This knowledge could lead to the identification of keywords which could be incorporated in the decision tool used by the EMD to increase sepsis identification, but further research is required.

Non-specific complaints in the ambulance; predisposing structural factors

BackgroundThe pre-hospital assessment non-specific complaint (NSC) often applies to patients whose diagnosis does not match any other specific assessment correlating to particular symptoms or diseases, though some previous studies have found them to be related to serious underlying conditions. The aim was to identify whether the structural factors such as urgency according to the dispatch priority of the Emergency Medical Communication Centre (EMCC) or work load in the Emergency Medical Services (EMS) are predisposing factors for the assessment of NSC instead of a specific assessment.MethodsAll patients with assessed condition NSCs by the EMS to Södersjukhuset during 2011 (n = 493) were compared with gender- and age-matched controls (n = 493), which were randomly drawn from all patients with specific conditions in the EMS, regarding day of week, time of day and priority set by EMCC with chi-squared tests and multivariate logistic regression models.ResultsAmong patients with NSCs, more were females (58 %) and the median age was 82. Almost all patients were categorized with NSCs during the daytime (8 a.m. to 9 p.m.), i.e. 450 (91 %) as compared to 373 (75 %) of those with specific conditions (p < 0.01). The risk of having an EMS dispatched as low priority by the EMCC was almost doubled among patients with NSCs compared to controls (OR 1.97, 95 % CI 1.38–2.79).ConclusionsSince patients with NSCs appear most frequently during the hours with most transportations for the EMS, i.e. 10 a.m. to 2 p.m., and the risk of having the assessment NSC was doubled if the EMCC dispatched EMS as low priority, structural factors might be predisposing factors for the assessment.

Identification of stroke during the emergency call: a descriptive study of callers’ presentation of stroke

ObjectivesTo evaluate symptoms presented by the caller during emergency calls regarding stroke, and to assess if symptoms in the Face-Arm-Speech-Time Test (FAST) are related to identification of stroke.SettingEmergency calls to...

Preventable deaths following emergency medical dispatch--an audit study.

BackgroundCall taker triage of calls to the 112 emergency number, can be error prone because rapid decisions must be made based on limited information. Here we investigated the preventability and common characteristics of same-day deaths among patients who called 112 and were not assigned an ambulance with lights and sirens by the Emergency Medical Communication Centre (EMCC).MethodsAn audit was performed by an external panel of experienced prehospital consultant anaesthesiologists. The panel focused exclusively on the role of the EMCC, assessing whether same-day deaths among 112 callers could have been prevented if the EMCC had assessed the situations as highly urgent. The panels’ assessments were based on review of patient charts and voice-log recordings of 112 calls. All patient related material was reviewed by the audit panel and all cases where then scored as preventable, potentially preventable or non-preventable during a two day meeting. The study setting was three of five regions in Denmark with a combined population of 4,182,613 inhabitants, which equals 75% of the Danish population. The study period was 18 months, from mid-2011 to the end of 2012.ResultsLinkage of prospectively collected EMCC data with population-based registries resulted in the identification of 94,488 non-high-acuity 112 callers. Among these callers, 152 (0.16% of all) died on the same day as the corresponding 112 call, and were included in this study. The mean age of included patients was 74.4 years (range, 31–100 years) and 45.4% were female. The audit panel found no definitively preventable deaths; however, 18 (11.8%) of the analysed same-day deaths (0.02% of all non-high-acuity callers) were found to be potentially preventable. In 13 of these 18 cases, the dispatch protocol was either not used or not used correctly.ConclusionSame-day death rarely occurred among 112 callers whose situations were assessed as not highly urgent. No same-day deaths were found to be definitively preventable by a different EMCC call assessment, but a minority of same-day deaths could potentially have been prevented with more accurate triage. Better adherence with dispatch protocol could improve the safety of the dispatch process.

Barriers and opportunities in assessing calls to emergency medical communication centre--a qualitative study.

IntroductionPrevious studies have described the difficulties and the complexity of assessing an emergency call, and assessment protocols intended to support the emergency medical dispatcher’s (EMD) assessment have been developed and evaluated in recent years. At present, the EMD identifies about 50-70 % of patients suffering from cardiac arrest, acute myocardial infarction or stroke. The previous research has primarily been focused on specific conditions, and it is still unclear whether there are any overall factors that may influence the assessment of the call to the emergency medical communication centre (EMCC).AimThe aim of the study was to identify overall factors influencing the registered nurses’ (RNs) assessment of calls to the EMCC.MethodA qualitative study design was used; a purposeful selection of calls to the EMCC was analysed by content analysis.ResultsOne hundred calls to the EMCC were analysed. Barriers and opportunities related to the RN or the caller were identified as the main factors influencing the RN’s assessment of calls to the EMCC. The opportunities appeared in the callers’ symptom description and the communication strategies used by the RN. The barriers appeared in callers’ descriptions of unclear symptoms, paradoxes and the RN’s lack of communication strategies during the call.ConclusionBarriers in assessing the call to the EMCC were associated with contradictory information, the absence of a primary problem, or the structure of the call. Opportunities were associated with a clear symptom description that was also repeated, and the RN’s use of different communication strategies such as closed loop communication.

Face Arm Speech Time Test Use in the Prehospital Setting, Better in the Ambulance than in the Emergency Medical Communication Center

Background: Prehospital identification of acute stroke increases the possibility of early treatment and good outcome. To increase identification of stroke, the Face Arm Speech Time (FAST) test was introduced in the Emergency Medical Communication Center (EMCC). This substudy aims to evaluate the implementation of the FAST test in the EMCC and the ambulance service. Methods: The study was conducted in the region of Stockholm, Sweden during 6 months. The study population consisted of all calls to the EMCC concerning patients presenting at least one FAST symptom or a history/finding making the EMCC or ambulance personnel to suspect stroke within 6 h. Positive FAST was compared to diagnosis at discharge. Positive predictive values (PPV) for a stroke diagnosis at discharge were calculated. Results: In all, 900 patients with a median age of 71 years were enrolled, 667 (74%) by the EMCC and 233 (26%) by the ambulances. At discharge, 472 patients (52%) were diagnosed with stroke/transient ischemic attack (TIA), 337 identified by the EMCC (71%) and 135 (29%) by the ambulances. The PPV for a discharge diagnosis of stroke/TIA was 51% (CI 47-54%) in EMCC-enrolled and 58% (CI 52-64%) in ambulance-enrolled patients. With a positive FAST the PPV of a correct stroke/TIA diagnosis increased to 56% (CI 52-61%) and 73% (CI 66-80%) in EMCC- and ambulance-enrolled patients, respectively. Positive FAST from EMCC was also found in 44% of patients with a nonstroke diagnosis at discharge. A stroke/TIA diagnosis at discharge but negative FAST was found in 58 and 27 patients enrolled by the EMCC and ambulances, respectively. Conclusions: The PPV of FAST is higher when used on the scene by ambulance than by EMCC. FAST may be a useful prehospital tool to identify stroke/TIA but has limitations as the test can be negative in true strokes, can be positive in nonstrokes, and FAST symptoms may be present but not identified in the emergency call. For the prehospital care situation better identification tools are needed.