Emergency Medical Communication Research Articles

Positive Impact of an Aortic Center Designation

In January 2015, we created a multidisciplinary Aortic Center with the collaboration of Vascular Surgery, Cardiac Surgery, Interventional Radiology, Anesthesia and Hospital Administration. We report the initial success of creating a Comprehensive Aortic Center. All aortic procedures performed from January 1, 2015 until December 31, 2016 were entered into a prospectively collected database and compared with available data for 2014. Primary outcomes included the number of all aortic related procedures, transfer acceptance rate, transfer time, and proportion of elective/emergent referrals. The Aortic Center included 5 vascular surgeons, 2 cardiac surgeons, and 2 interventional radiologists. Workflow processes were implemented to streamline patient transfers as well as physician and operating room notification. Total aortic volume increased significantly from 162 to 261 patients. This reflected an overall 59% (P=0.0167) increase in all aorta-related procedures. We had a 65% overall increase in transfer requests with 156% increase in acceptance of referrals and 136% drop in transfer denials (P<0.0001). Emergent abdominal aortic cases accounted for 17% (n=45) of our total aortic volume in 2015. The average transfer time from request to arrival decreased from 515 to 352min, although this change was not statistically significant. We did see a significant increase in the use of air-transfers for aortic patients (P=0.0041). Factorial analysis showed that time for transfer was affected only by air-transfer use, regardless of the year the patient was transferred. Transfer volume and volume of aortic related procedures remained stable in2016. Designation as a comprehensive Aortic Center with implementation of strategic workflow systems and a culture of "no refusal of transfers" resulted in a significant increase in aortic volume for both emergent and elective aortic cases. Case volumes increased for all specialties involved in the center. Improvements in transfer center and emergency medical services communication demonstrated a trend toward more efficient transfer times. These increases and improvements were sustainable for 2 years after this designation.

Disaster Coverage Predication for the Emerging Tethered Balloon Technology: Capability for Preparedness, Detection, Mitigation, and Response.

A disaster is a consequence of natural hazards and terrorist acts, which have significant potential to disrupt the entire wireless communication infrastructure. Therefore, the essential rescue squads and recovery operations during a catastrophic event will be severely debilitated. To provide efficient communication services, and to reduce casualty mortality and morbidity during the catastrophic events, we proposed the Tethered Balloon technology for disaster preparedness, detection, mitigation, and recovery assessment. The proposed Tethered Balloon is applicable to any type of disaster except for storms. The Tethered Balloon is being actively researched and developed as a simple solution to improve the performance of rescues, facilities, and services of emergency medical communication in the disaster area. The most important requirement for rescue and relief teams during or after the disaster is a high quality of service of delivery communication services to save people's lives. Using our proposed technology, we report that the Tethered Balloon has a large disaster coverage area. Therefore, the rescue and research teams are given higher priority, and their performance significantly improved in the particular coverage area. Tethered Balloon features made it suitable for disaster preparedness, mitigation, and recovery. The performance of rescue and relief teams was effective and efficient before and after the disaster as well as can be continued to coordinate the relief teams until disaster recovery. (Disaster Med Public Health Preparedness. 2018;12:222-231).

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

Pictogram-based mobile first medical aid communicator

Recent progress in communications technology has been very rapid. High-speed mobile Internet access and mobile devices have enabled the development of robust technologies such as machine translation, automated speech recognition, voice synthesis, and even speech-to-speech translation. Communication applications that support sign language recognition are also being introduced and upgraded. Nonetheless, people with speech, hearing, or mental impairment still require special communication assistance, especially for medical purposes; this makes their health and life dependent on other people. Automatic solutions for speech recognition or voice synthesis from the text are poor fits for communication in the medical domain because they are dependent on error-prone statistical models. Additionally, in emergency cases, rapid information exchange is essential. Systems dependent on manual text input are insufficient. Recently introduced systems for automatic sign language recognition are dependent on statistical models and image and gesture quality. Such systems remain in early development and are based mostly on minimal hand gestures unsuitable for medical purposes. Furthermore, Internet-dependent solutions cannot be used in most countries requiring humanitarian aid. We propose a high-speed, intuitive, Internet-free, voice-free, and text-free tool suited for emergency medical communication. Our solution is a pictogram-based communication application that provides easy communication means for individuals who are speech- or hearing-impaired, have mental health issues impairing communication, or non-natives who do not speak the local language. It provides support and clarification in communication with such people using intuitive icons and interactive symbols easy to find on a mobile device. Such pictogram-based communication can be quite effective and, ultimately, make some people’s lives happier, easier, and safer. We have developed a conceptual prototype of a patient-physician communicator on a smartwatch that can be used for local as well as remote communication.

A Cross-Lingual Mobile Medical Communication System Prototype for Foreigners and Subjects with Speech, Hearing, and Mental Disabilities Based on Pictograms

People with speech, hearing, or mental impairment require special communication assistance, especially for medical purposes. Automatic solutions for speech recognition and voice synthesis from text are poor fits for communication in the medical domain because they are dependent on error-prone statistical models. Systems dependent on manual text input are insufficient. Recently introduced systems for automatic sign language recognition are dependent on statistical models as well as on image and gesture quality. Such systems remain in early development and are based mostly on minimal hand gestures unsuitable for medical purposes. Furthermore, solutions that rely on the Internet cannot be used after disasters that require humanitarian aid. We propose a high-speed, intuitive, Internet-free, voice-free, and text-free tool suited for emergency medical communication. Our solution is a pictogram-based application that provides easy communication for individuals who have speech or hearing impairment or mental health issues that impair communication, as well as foreigners who do not speak the local language. It provides support and clarification in communication by using intuitive icons and interactive symbols that are easy to use on a mobile device. Such pictogram-based communication can be quite effective and ultimately make people's lives happier, easier, and safer.

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

A Design of Emergency Medical Image Communication System EMICS based on DICOM suitable for Emergency medical system

In this paper, we designed a emergency medical image communication system EMICS added concept of emergency medical image to the existing emergency medical information system based on DICOM. Also we suggested a emergency medical image object EMISPS of EMICS. Using EMICS, the emergency medical technician can work together with emergency doctor. Therefore the patient can take more stable care than existing emergency medical information system. Using EMISPS, the emergency medical technician can get exact situation information of the patient.

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.

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.

Mobile videoconferencing for enhanced emergency medical communication - a shot in the dark or a walk in the park? ‒‒ A simulation study.

BackgroundVideoconferencing on mobile phones may enhance communication, but knowledge on its quality in various situations is needed before it can be used in medical emergencies. Mobile phones automatically activate loudspeaker functionality during videoconferencing, making calls particularly vulnerable to background noise. The aim of this study was to investigate if videoconferencing can be used between lay bystanders and Emergency Medical Dispatch (EMD) operators for initial emergency calls during medical emergencies, under suboptimal sound and light conditions.MethodsVideoconferencing was tested between 90 volunteers and an emergency medical dispatcher in a standardized scenario of a medical emergency. Three different environments were used for the trials: indoors with moderate background noise, outdoors with daylight and much background noise, and outdoors during nighttime with little background noise. Thirty participants were recruited for each of the three locations. After informed consent, each participant was asked to use a video mobile phone to communicate with an EMD operator. During the video call the EMD operator gave instructions for tasks to be performed by the participant. The video quality from the caller to the EMD was evaluated by the EMD operator and rated on a five step scale ranging from "not able to see" to "good video quality". Sound quality between participants and EMD operators was assessed by a method developed for this trial. Kruskal – Wallis and Chi-square tests were used for statistical analysis.ResultsVideo quality was significantly different between the groups (p <0.001), and the nighttime group had lower video quality. For most sessions in the nighttime group it was still possible to see actions done at the simulated emergency site. All participants were able to perform their tasks according to the instructions given by dispatchers, although with a need for more repetitions during sessions with much background noise. No calls were rated by dispatchers as incomprehensible due to low sound quality and only 3% of the calls were considered somewhat difficult or very difficult to understand.ConclusionsVideoconferencing on mobile phones can be used for the initial emergency call during medical emergencies also in suboptimal conditions.