Emergency Medical Communication Research Articles

Emergency Medical Communication in North Carolina: Past, Present, and Future Challenges

Ifthe best equipped ambulance arrives unannounced at the emergency room door and the hospital is unprepared for the arrival, the system has broken down and patients can be lost because of it. There must be good reliable communications between the person reporting the accident, the dispatcher of the appropriate vehicle and personnel, the police and fire departments (when called for), the hospital emergency department, the medical specialists available to the hospital and those bigger hospitals (trauma centers) to which the patient might in some cases be sent directly.

Low Acuity EMS Dispatch Criteria Can Reliably Identify Patients without High-Acuity Illness or Injury

Objective: This retrospective study evaluated the appropriateness of requests assigned the alpha determinant at the time of dispatch by Emergency Medical Dispatchers using the Medical Priority Dispatch System (MPDS). Methods: The primary end point was the proportion of EMS calls assigned the alpha dispatch determinant that resulted in a high-acuity patient encounter. Patient care reports from January 1 to June 30, 2004, were eligible for inclusion; reports with known errors in data entry or those that were not the result of caller interrogation via the 9-1-1 emergency medical dispatch center (EMDC) were excluded. High-acuity patients were defined as those who met trauma triage criteria or received treatment for acute coronary syndrome, respiratory distress, altered mental status, acute stroke, allergic reaction, or abnormal vital signs. Secondary end points included call-processing time, the proportion of included patients who were transported emergently to hospital, andthe adherence of the EMDC to National Academy of Emergency Dispatch (NAED) quality assurance guidelines. Results: There were 23,939 dispatches; 2,703 were recorded as alpha dispatches in the electronic patient care report (ECR), of which 582 were excluded. Twenty-one of 2,121 calls (< 1%) meeting inclusion criteria met high-acuity criteria andwere considered as inappropriate alpha dispatches. Fourteen of 2,121 (< 1%) were transported emergently to the hospital, eight of whom also met the high-acuity criteria. The call-processing time at the 90th percentile was 2 minutes and29 seconds. The EMDC demonstrated 99% compliance with NAED quality assurance standards. Conclusion: The use of standard MPDS protocols can successfully identify patients who do not demonstrate high-acuity illness or injury more than 99% of the time. Key words: emergency medical services communication system; transportation of patients; emergency medical services; triage of patients.

Validation of Low-Acuity Emergency Medical Services Dispatch Codes

Background. Computer-aided dispatch systems are used to assess the severity of a 9-1-1 caller's complaint andthen assign an appropriate level of emergency medical services (EMS) response. Objective. To evaluate a group of low-acuity codes (defined as requiring advanced life support [ALS] intervention in fewer than 10% of cases) that has been derived andvalidated in one community. Methods. All of the 9-1-1 medical calls assigned to these predetermined emergency medical dispatch codes between January 1, 2004, andJuly 1, 2004, were analyzed. ALS care was defined as receiving one or more of the following: pulse oximetry measurement, blood glucose measurement, cardiac defibrillation, administration of any medication, airway maneuvers, or the placement of an intravenous (IV) catheter. A more restrictive definition of ALS care (use of IV fluid bolus, medication administration, intubation, or defibrillation) was also calculated. Results. A total of 1,799 calls were assigned low-acuity dispatch codes, and1,597 met inclusion criteria. None of the 26 dispatch codes were found to be low-acuity by the study definition. Fifty-six percent of these patients received ALS care. Placement of an IV-catheter was the ALS intervention used most frequently (45% of cases), followed by pulse oximetry measurement (32%), glucose measurement (22%), medication administration (11%), intubation (0.13%), anddefibrillation (0%). The medication administered most frequent was morphine. When using the more restrictive definition of acuity, patients in 19 of the 28 categories received ALS intervention less than 10% of the time. Patients in the other seven categories were considered high-acuity 13% to 36% of the time. Conclusion. Dispatch codes that had previously been determined to be low-acuity were found not to be so in this community. The variation in clinical practice is likely explained by a more precautionary approach to care in this EMS system andthe increased use of analgesics. This study demonstrates the need to define the optimal subset of prehospital patients who would benefit from these treatments. Key words: ambulances; cardiopulmonary resuscitation; emergencies; emergency medical service communication systems; emergency medical services; retrospective studies; risk assessment; triage; acuity; wounds andinjuries; dispatch codes.

Cellular telephone communication between hospitals and ambulances

Cellular telephones provide a new means of wireless telephone communication. In an experimental design study comparing the clarity of receiving and transmitting communications with cellular telephones versus conventional emergency medical radio/microwave equipment, cellular telephones proved to be superior in all aspects of clarity and ease. Cellular telephones have numerous cost and equipment advantages over radio equipment and should replace conventional radio/microwave equipment for emergency medical communication in areas where reliable cellular telephone networks are available. This will improve an important facet of prehospital emergency care.

Emergency medical services communication system design

Emergency medical service (EMS) communication system design is discussed. The emphasis is on the development of communication systems to meet the needs of a patient in a medical emergency. Specific factors influencing patient-side portable communications are presented.