Emergency Medical Communication Centre Research Articles

Primary care doctors in acute call-outs to severe trauma incidents in Norway – variations by rural-urban settings and time factors

BackgroundA severely injured patient needs fast transportation to a hospital that can provide definitive care. In Norway, approximately 20% of the population live in rural areas. Primary care doctors (PCDs) play an important role in prehospital trauma care. The aim of this study was to investigate how variations in PCD call-outs to severe trauma incidents in Norway were associated with rural-urban settings and time factors.MethodsIn this study on severe trauma patients admitted to Norwegian hospitals from 2012 to 2018, we linked data from four official Norwegian registries. Through this, we investigated the call-out responses of PCDs to severe trauma incidents. In multivariable log-binomial regression models, we investigated whether factors related to rural-urban settings and time factors were associated with PCD call-outs.ResultsThere was a significantly higher probability of PCD call-outs to severe trauma incidents in the municipalities in the four most rural centrality categories compared to the most urban category. The largest difference in adjusted relative risk (95% confidence interval (CI)) was 2.08 (1.27–3.41) for centrality category four. PCDs had a significantly higher proportion of call-outs in the Western (RR = 1.46 (1.23–1.73)) and Central Norway (RR = 1.30 (1.08–1.58)) Regional Health Authority areas compared to in the South-Eastern area. We observed a large variation (0.47 to 4.71) in call-out rates to severe trauma incidents per 100,000 inhabitants per year across the 16 Emergency Medical Communication Centre areas in Norway.ConclusionsCentrality affects the proportion of PCD call-outs to severe trauma incidents, and call-out rates were higher in rural than in urban areas. We found no significant difference in call-out rates according to time factors. Possible consequences of these findings should be further investigated.

When do medical operators choose to use, or not use, video in emergency calls? A case study

BackgroundAn evaluation report for a pilot project on the use of video in medical emergency calls between the caller and medical operator indicates that video is only used in 4%...

Do emergency medical dispatchers choose the same response to serious injury in men and women – a qualitative study

BackgroundRecent research has indicated that sex is an important determinant of emergency medical response in patients with possible serious injuries. Men were found to receive more advanced prehospital treatment and more helicopter transportation and trauma centre destinations and were more often received by an activated trauma team, even when adjusted for injury mechanism.Emergency medical dispatchers choose initial resources when serious injury is suspected after a call to the emergency medical communication centre. This study aimed to assess how dispatchers evaluate primary responses in trauma victims, with a special focus on the sex of the victim.MethodsEmergency medical dispatchers were interviewed using focus groups and a semistructured interview guide developed specifically for this study. Two vignettes describing typical and realistic injury scenarios were discussed. Verbatim transcripts of the conversations were analysed via systematic text condensation. The findings were reported in accordance with the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist.ResultsThe analysis resulted in the main category “Tailoring the right response to the patient”, supported by three categories “Get an overview of location and scene safety”, “Patient condition” and “Injury mechanism and special concerns”. The informants consistently maintained that sex was not a relevant variable when deciding emergency medical response during dispatch and claimed that they rarely knew the sex of the patient before a response was implemented. Some of the participants also raised the question of whether the Norwegian trauma criteria reliably detect serious injury in women.ConclusionsThe results indicate that the emergency medical response is largely based on the national trauma criteria and that sex is of little or no importance during dispatch. The observed sex differences in the emergency medical response seems to be caused by other factors during the emergency medical response phase.

Telephone triage and dispatch of ambulances to patients with suspected and verified acute stroke - a descriptive study

ObjectivesIn this study we aimed to explore EMCC triage of suspected and confirmed stroke patients to gain more knowledge about the initial phase of the acute stroke response chain. Accurate dispatch at the Emergency Medical Communication Center (EMCC) is crucial for optimal resource utilization in the prehospital service, and early identification of acute stroke is known to improve patient outcome.Materials and methodsWe conducted a descriptive retrospective study based on data from the Emergency Department and EMCC records at a comprehensive stroke center in Oslo, Norway, during a six-month period (2019–2020). Patients dispatched with EMCC stroke criteria and/or discharged with a stroke diagnosis were included. We identified EMCC true positive, false positive and false negative stroke patients and estimated EMCC stroke sensitivity and positive predictive value (PPV). Furthermore, we analyzed prehospital time intervals and identified patient destinations to gain knowledge on ambulance services assessments.ResultsWe included 1298 patients. EMCC stroke sensitivity was 77% (95% CI: 72 − 82%), and PPV was 16% (95% CI: 14 − 18%). EMCC false negative stroke patients experienced an increased median prehospital delay of 11 min (p < 0.001). Upon arrival at the scene, 68% of the EMCC false negative patients were identified as suspected stroke cases by the ambulance services. Similarly, 68% of the false positive stroke patients were either referred to a GP, out-of-hours GP acute clinic, local hospitals or left at the scene by the ambulance services, indicating that no obvious stroke symptoms were identified by ambulance personnel upon arrival at the scene.ConclusionsThis study reveals a high EMCC stroke sensitivity and an extensive number of false positive stroke dispatches. By comparing the assessments made by both the EMCC and the ambulance service, we have identified specific patient groups that should be the focus for future research efforts aimed at improving the sensitivity and specificity of stroke recognition in the EMCC.

“Calling for help: I need you to listen” - A qualitative study of callers’ experience of calls to the emergency medical communication centre

BackgroundThe Emergency Medical Communications Center (EMCC) is essential in emergencies and often represents the public’s first encounter with the healthcare system. Previous research has mainly focused on the dispatcher’s perspective. Therefore, there is a lack of insight into the callers’ perspectives, the attainment of which may contribute significantly to improving the quality of this vital public service. Most calls are now made from mobile phones, opening up novel approaches for obtaining caller feedback using tools such as short-message services (SMS). Thus, this study aims to obtain a better understanding of callers’ actual experiences and how they perceived their interaction with the EMCC.MethodsA combination of quantitative and qualitative study methods was used. An SMS survey was sent to the mobile phone numbers of everyone who had contacted 113 during the last months. This was followed by 31 semi-structured interviews with people either satisfied or dissatisfied. Thematic analysis was used to investigate the interviews.ResultsWe received 1680 (35%) responses to the SMS survey, sent to 4807 unique numbers. Most respondents (88%) were satisfied, evaluating their experience as 5 or 6 on a six-point scale, whereas 5% answered with 1 or 2. The interviews revealed that callers were in distress before calling 113. By actively listening and taking the caller seriously, and affirming that it was the right choice to call the emergency number, the EMCC make callers experience a feeling of help and satisfaction, regardless of whether an ambulance was dispatched to their location.If callers did not feel taken seriously or listened to, they were less satisfied. A negative experience may lead to a higher distress threshold and an adjusted strategy before the caller makes contact 113 next time. Callers with positive experiences expressed more trust in the healthcare systems.ConclusionsFor the callers, the most important was being taken seriously and listened to. Additionally, they welcomed that dispatchers express empathy and affirm that callers made the right choice to call EMCC, as this positively affects communication with callers. The 113 calls aimed to cooperate in finding a solution to the caller’s problem.

Description of the prehospital emergency healthcare system in Norway

BackgroundNorway has a long coastline, steep mountains, and wide fjords, which presents some challenges to the prehospital emergency healthcare system. In recent years, the prehospital emergency medical services (EMS) have undergone significant changes, structurally, in terms of professionalisation of the services and in the education level of the personnel. In this article, we aim to describe the current structure for handling prehospital medical emergencies. MethodsFor healthcare, Norway is divided into four Regional Health Authorities, consisting of 19 Health Trusts, where 18 have an EMS. There is a dedicated medical emergency number, 113, that terminates in 16 emergency medical communication centres. The use of air and boat ambulances, in addition to traditional ambulances, seeks to meet the challenges in the EMS system. Strengths and limitationsThe Norwegian EMS is an advanced system with highly educated staff; however, this level of care comes with an equally high cost. ConclusionThe Norwegian EMS can handle emergencies nationwide, providing advanced care at the scene and during transport. The geography and demography challenge the idea of equal care, but the open publishing of data from national quality registries seeks to identify and address potential differences.

Prehospital identification of acute ischaemic stroke with large vessel occlusion: a retrospective study from western Norway

BackgroundIn 2019, the emergency medical services (EMS) covering the western Norway Regional Health Authority area implemented its version of the prehospital clinical criteria G-FAST (Gaze deviation, Facial palsy, Arm weakness,...

Telemedicine in Nursing Home Residents Requiring a Call to an Emergency Medical Communication Center

ObjectivesTo compare the proportion of nursing home residents dispatched to an emergency department (ED) after a call to the emergency medical communication center (EMCC) according to the availability or nonavailability of telemedicine. DesignThis prospective, observational trial was conducted in the EMCC and 74 nursing homes in a French county. Setting and ParticipantsAll nursing home residents who needed to contact the EMCC between June 2019 and April 2020 were included in the study. We excluded calls notifying the death of a resident, for completing data from a previous call, and for nursing home staff. MethodsThe primary outcome was the proportion of residents dispatched to an ED after their first call to the EMCC. The secondary outcomes were the proportion of second calls, proportion of residents dispatched to an ED after a second call, and proportion of death within 30 days. ResultsWe included 3103 calls in the final analysis (355 from equipped nursing homes and 2748 from unequipped nursing homes). The proportion of patients dispatched to an ED after the first call was lower among telemedicine-equipped than among telemedicine-unequipped nursing homes (41% vs 50%; odds ratio, 0.71; 95% CI, 0.56–0.90). The proportion of a second call for the same purpose within 72 hours, proportion of dispatching to an ED at the second call, and proportion of deaths within 30 days were similar between the groups. Conclusion and ImplicationsThe use of telemedicine by nursing home residents requiring a call to the EMCC is associated with a reduction in the number of dispatches to an ED without any increase in the number of 72-hour callbacks or 30-day mortality rates.

Telemedicine for the management of patients calling an Emergency Medical Communication Center for dyspnea: a before-after study.

Telemedicine for the management of patients calling an Emergency Medical Communication Center for dyspnea: a before-after study.

Can video communication in the emergency medical communication centre improve dispatch precision? A before–after study in Norwegian helicopter emergency medical services

ObjectivesDispatching helicopter emergency medical services (HEMS) to the patients with the greatest medical or logistical benefit remains challenging. The introduction of video calls (VC) in the emergency medical communication centres...

Dispatch of Volunteer Responders to Out-of-Hospital Cardiac Arrests

BackgroundSystems for dispatch of volunteer responders to collect automated external defibrillators and/or to provide cardiopulmonary resuscitation (CPR) in cases of nearby out-of-hospital cardiac arrest (OHCA) are widely implemented. ObjectivesThis study aimed to investigate whether the activation of a volunteer responder system to OHCAs was associated with higher rates of bystander CPR, bystander defibrillation, and 30-day survival vs no system activation. MethodsThis was a retrospective observational analysis within the ESCAPE-NET (European Sudden Cardiac Arrest network: Towards Prevention, Education, New Effective Treatment) collaborative research network. Included were cases of OHCA between 2015 and 2019 from 5 European sites with volunteer responder systems. At all sites, systems were activated by dispatchers at the emergency medical communication center in response to suspected OHCA. Exposed cases (system activation) were compared with nonexposed cases (no system activation). Risk ratios (RRs) were calculated for the outcomes of bystander CPR, bystander defibrillation, and 30-day survival after inverse probability treatment weighting. Missing data were handled using multiple imputation. ResultsIn total, 9,553 cases were included. In 4,696 cases, the volunteer responder system was activated, and in 4,857 it was not. The pooled RRs were 1.30 (95% CI: 1.15–1.47) for bystander CPR, 1.89 (95% CI: 1.36–2.63) for bystander defibrillation, and 1.22 (95% CI: 1.07–1.39) for 30-day survival. ConclusionsActivation of a volunteer response system in cases of OHCA was associated with a higher chance of bystander CPR, bystander defibrillation, and 30-day survival vs no system activation. A randomized controlled trial is necessary to determine fully the causal effect of volunteer responder systems.

Contribution of Live Video to Physicians' Remote Assessment of Suspected COVID-19 Patients in an Emergency Medical Communication Centre: A Retrospective Study and Web-Based Survey.

The COVID-19 pandemic had a major impact on emergency medical communication centres (EMCC). A live video facility was made available to second-line physicians in an EMCC with a first-line paramedic to receive emergency calls. The objective of this study was to measure the contribution of live video to remote medical triage. The single-centre retrospective study included all telephone assessments of patients with suspected COVID-19 symptoms from 01.04.2020 to 30.04.2021 in Geneva, Switzerland. The organisation of the EMCC and the characteristics of patients who called the two emergency lines (official emergency number and COVID-19 number) with suspected COVID-19 symptoms were described. A prospective web-based survey of physicians was conducted during the same period to measure the indications, limitations and impact of live video on their decisions. A total of 8957 patients were included, and 2157 (48.0%) of the 4493 patients assessed on the official emergency number had dyspnoea, 4045 (90.6%) of 4464 patients assessed on the COVID-19 number had flu-like symptoms and 1798 (20.1%) patients were reassessed remotely by a physician, including 405 (22.5%) with live video, successfully in 315 (77.8%) attempts. The web-based survey (107 forms) showed that physicians used live video to assess mainly the breathing (81.3%) and general condition (78.5%) of patients. They felt that their decision was modified in 75.7% (n = 81) of cases and caught 7 (7.7%) patients in a life-threatening emergency. Medical triage decisions for suspected COVID-19 patients are strongly influenced by the use of live video.

Abstract TP59: Prehospital Identification Of Acute Ischaemic Stroke With Large Vessel Occlusion

Background: The prehospital stroke scale B-FAST (Gaze deviation, Face paresis, Arm weakness, Visual loss and Speech disruptions ) was implemented in the Emergency Medical Services (EMS) in the Western Norway Regional Health Trust (1,1 million catchment population; eight primary stroke centres (PSC) ; two comprehensive stroke centres (CSC)) in 2019 to detect acute ischaemic stroke (AIS) patients with large vessel occlusion (LVO). Prehospital presence of gaze deviation (B-symptom)and at least one FAST symptom, may lead to PSC bypass and proceed directly to a CSC. The aim of the study was to investigate the sensitivity of the B-FAST scale detecting LVO in the prehospital setting. Methods: Retrospective study including patients with at least one B-FAST symptom at EMS arrival. We obtained patient data from all code red stroke dispatches from Emergency Medical Communication Centres (EMCC) and local endovascular treatment (EVT) registries in the period August-December 2020. Variables collected were clinical features, CT examination and reperfusion treatment. Definition of prehospital positive B-FAST was presence of Gaze deviation (B-symptom)and at least one FAST symptom at EMS arrival. Results: We collected data on 643 patients, 59 were diagnosed with a LVO stroke at hospital arrival. In the LVO group, 7 of 59 patients presented with prehospital positive B-FAST, resulting in a sensitivity of 12 %. EVT was performed in 38/59 (64%) cases. Two patients were false negative and positive predictive value was 78%. Specificity was 99% and negative predictive value 83%. Median transfer delay for patients initially admitted to a PSC before transfer to a CSC, was 130 min (IQR 60-167 min). Conclusion: The use of B-FAST by EMS personnel for identification of AIS patients with LVO has a low sensitivity, but presence of gaze deviation predicts LVO stroke with high certainty.

Critical incident debriefing of registered nurses working in Emergency Medical Communication Centres

Organised debriefing is not part of the regular routine. Instead, registered nurses process their reactions on their own by acquiring more knowledge or talking to colleagues and Emergency Medical Communication Centre physicians.

How often do nurses suspect violence and domestic violence in local emergency medical communication centre? A cross-sectional study

Objective To assess the extent of violence that is revealed by screening at first contact with a local out-of-hours emergency medical communication centre (LEMC; Norwegian ‘Legevaktsentral’). Design Cross-sectional study. Setting Arendal LEMC, covering 10 municipalities in south-eastern Norway. All contacting patients (telephone or personal attendance) were asked by nurse whether the encounter was related to violence. Subjects All first patient encounters at Arendal LEMC. Main outcome measures Number and proportion of cases where the nurses suspected violence, both domestic violence and other violence. Incidence rate of violence, age and gender distribution of patients, time of day and reason for encounter. Results Violence was suspected in 336 of 103,467 first patient encounters (0.3%), of which 132 (0.1%) was domestic violence. Patients were female in 50.6% of all violence cases, and in 79% of domestic violence cases. Incidence rates were 137 per 100,000 person-years for all violence, and 53 for domestic violence. Conclusions This study indicates violence may be revealed in three of 1000 first encounters to an LEMC when nurses screen systematically for domestic or other violence. Key points Violence as underlying reason for encounter with primary care emergency health services is probably often not discovered by health personnel. • We examined how often nurses reveal violence upon first contact when systematically asking all patients. • Violence was suspected in 0.3% of cases, and domestic violence in 0.1%. • Among patients with disclosed domestic violence, 79% were female.

Comparing the Number of Emergency Medical Dispatchers (EMDs) Scheduled Based on the Judgment of the Managers with Predictions of the Erlang C Formula: A Brief Report

Introduction Currently, at Tehran Emergency Medical Service (EMS) centre, Emergency Medical Dispatchers (EMDs) are scheduled based on the managers’ experimental estimates. In this study, we planned to evaluate the conformity of managers’ predictions with the Erlang C formula estimates in scheduling EMDs. Methods First, the Emergency Medical Communication Centre (EMCC) performance was evaluated over one week. Afterwards, the number of required EMDs was calculated using the Erlang C formula. Finally, the predictions of the Erlang C formula were compared with those of managers’ judgments. Results During the study period, 79,583 calls were received by the Tehran EMCC. The average number of EMDs per hour ranged between 9.5 and 22.7. The actual number of EMDs was more than Erlang C formula predictions during the 24 hours in all but three time points, i.e. 14:00-1 4:59, 1 5:00-1 5:59 and 1 8:00-1 8:59. In all hours, 90% of calls were answered in less than 10 seconds, and the average waiting time for a total of one week was 7.3 seconds. Also, only 2.1 % of all calls were answered after 10 seconds. Conclusion In the current study, we found that the number of EMDs scheduled based on the managers’ experimental estimates was higher than that of the Erlang C formula calculations. Also, it was found that the waiting time for emergency calls was lower than the defined standards. Although the primary results of the current study indicated that, at least on paper, the Erlang C formula has the potential to be used as a predicting model in the Tehran EMCC, further research is required to evaluate its effect on the actual performance of the EMCCs.

A woman in her forties with chest pain and life-threatening bradycardia.

A woman contacted the emergency medical communication centre in the morning with chest pain and dyspnoea. Her condition rapidly deteriorated and became life-threatening in less than an hour. In an urgent situation with combined respiratory and circulatory failure, it is essential to take a broad approach and not to tie oneself to the initial differential diagnosis.

Interhospital transport of critically ill patients: A prospective observational study of patient and transport characteristics.

The cohort of critically ill patients transported between Intensive Care Units (ICUs) in Norway has not been studied previously. The aim of this study was to describe the characteristics of patients and transports for different types of interhospital transfers and explore whether there were differences in morbidity and mortality between the different transfer categories and the general Norwegian ICU population. All transports of critically ill adult patients transferred between two geographically different Intensive Care Units during a one-year period were registered. Patient and transport data were obtained from The Norwegian Intensive Care Registry, The Norwegian Cause of Death Registry, the hospital Electronic Patient Journal, the Air Ambulance Journal System, and the Emergency Medical Communication Centre database. 821 transports of 788surgical and medical patients were enrolled. Simplified Acute Physiology Scores (SAPSII) were 43, 36 and 38 for urgent secondary transport, non-urgent secondary transport and return transfers, respectively. These were comparable to nationwide SAPSII scores that were 40 for university hospitals and 34 for local hospitals during the same time period. The return transfers had a median SOFA-score of 4.7 and 53% were mechanically ventilated. Only 33% of return transfers were performed by established teams. Intensive care patients transferred between ICUs are as critically ill as the rest of the ICU population, with a similar morbidity and mortality. The return transfers of ICU-patients appear under-triaged compared to secondary transports in terms of allocated resources.

Trends in reasons for emergency calls during the COVID-19 crisis in the department of Gironde, France using artificial neural network for natural language classification

ObjectivesDuring periods such as the COVID-19 crisis, there is a need for responsive public health surveillance indicators in order to monitor both the epidemic growth and potential public health consequences of preventative measures such as lockdown. We assessed whether the automatic classification of the content of calls to emergency medical communication centers could provide relevant and responsive indicators.MethodsWe retrieved all 796,209 free-text call reports from the emergency medical communication center of the Gironde department, France, between 2018 and 2020. We trained a natural language processing neural network model with a mixed unsupervised/supervised method to classify all reasons for calls in 2020. Validation and parameter adjustment were performed using a sample of 39,907 manually-coded free-text reports.ResultsThe number of daily calls for flu-like symptoms began to increase from February 21, 2020 and reached an unprecedented level by February 28, 2020 and peaked on March 14, 2020, 3 days before lockdown. It was strongly correlated with daily emergency room admissions, with a delay of 14 days. Calls for chest pain and stress and anxiety, peaked 12 days later. Calls for malaises with loss of consciousness, non-voluntary injuries and alcohol intoxications sharply decreased, starting one month before lockdown. No noticeable trends in relation to lockdown was found for other groups of reasons including gastroenteritis and abdominal pain, stroke, suicide and self-harm, pregnancy and delivery problems.DiscussionThe first wave of the COVID-19 crisis came along with increased levels of stress and anxiety but no increase in alcohol intoxication and violence. As expected, call related to road traffic crashes sharply decreased. The sharp decrease in the number of calls for malaise was more surprising.ConclusionThe content of calls to emergency medical communication centers is an efficient epidemiological surveillance data source that provides insights into the societal upheavals induced by a health crisis. The use of an automatic classification system using artificial intelligence makes it possible to free itself from the context that could influence a human coder, especially in a crisis situation. The COVID-19 crisis and/or lockdown induced deep modifications in the population health profile.

Emergency physician\u2019s dispatch by a paramedic-staffed emergency medical communication centre: sensitivity, specificity and search for a reference standard

BackgroundSome emergency medical systems (EMS) use a dispatch centre where nurses or paramedics assess emergency calls and dispatch ambulances. Paramedics may also provide the first tier of care “in the field”, with the second tier being an Emergency Physician (EP).In these systems, the appropriateness of the decision to dispatch an EP to the first line at the same time as the ambulance has not often been measured. The main objective of this study was to compare dispatching an EP as part of the first line emergency service with the severity of the patient’s condition. The secondary objective was to highlight the need for a recognized reference standard to compare performance analyses across EMS.MethodsThis prospective observational study included all emergency calls received in Geneva’s dispatch centre between January 1st, 2016 and June 30th, 2019. Emergency medical dispatchers (EMD) assigned a level of risk to patients at the time of the initial call. Only the highest level of risk led to the dispatch of an EP. The severity of the patient’s condition observed in the field was measured using the National Advisory Committee for Aeronautics (NACA) scale. Two reference standards were proposed by dichotomizing the NACA scale. The first compared NACA≥4 with other conditions and the second compared NACA≥5 with other conditions. The level of risk identified during the initial call was then compared to the dichotomized NACA scales.Results97′861 assessments were included. Overall prevalence of sending an EP as first line was 13.11, 95% CI [12.90–13.32], and second line was 2.94, 95% CI [2.84–3.05]. Including NACA≥4, prevalence was 21.41, 95% CI [21.15–21.67], sensitivity was 36.2, 95% CI [35.5–36.9] and specificity 93.2 95% CI [93–93.4]. The Area Under the Receiver-Operating Characteristics curve (AUROC) of 0.7507, 95% CI [0.74734–0.75397] was acceptable. Looking NACA≥5, prevalence was 3.09, 95% CI [2.98–3.20], sensitivity was 64.4, 95% CI [62.7–66.1] and specificity 88.5, 95% CI [88.3–88.7]. We found an excellent AUROC of 0.8229, 95% CI [0.81623–0.82950].ConclusionThe assessment by Geneva’s EMD has good specificity but low sensitivity for sending EPs. The dichotomy between immediate life-threatening and other emergencies could be a valid reference standard for future studies to measure the EP’s dispatching performance.