The Accuracy of Emergency Medical Dispatcher-Assisted Layperson-Caller Pulse Check Using the Medical Priority Dispatch System Protocol

AbstractIntroductionKnowing the pulse rate of a patient in a medical emergency can help to determine patient acuity and the level of medical care required. Little evidence exists regarding the ability of a 911 layperson-caller to accurately determine a conscious patient's pulse rate.HypothesisThe hypothesis of this study was that, when instructed by a trained emergency medical dispatcher (EMD) using the scripted Medical Priority Dispatch System (MPDS) protocol Pulse Check Diagnostic Tool (PCDxT), a layperson-caller can detect a carotid pulse and accurately determine the pulse rate in a conscious person.MethodsThis non-randomized and non-controlled prospective study was conducted at three different public locations in the state of Utah (USA). A healthy, mock patient's pulse rate was obtained using an electrocardiogram (ECG) monitor. Layperson-callers, in turn, initiated a simulated 911 phone call to an EMD call-taker who provided instructions for determining the pulse rate of the patient. Layperson accuracy was assessed using correlations between the layperson-caller's finding and the ECG reading.ResultsTwo hundred sixty-eight layperson-callers participated; 248 (92.5%) found the pulse of the mock patient. There was a high correlation between pulse rates obtained using the ECG monitor and those found by the layperson-callers, overall (94.6%, P < .001), and by site, gender, and age.ConclusionsLayperson-callers, when provided with expert, scripted instructions by a trained 911 dispatcher over the phone, can accurately determine the pulse rate of a conscious and healthy person. Improvements to the 911 instructions may further increase layperson accuracy.Scott G, Clawson J, Rector M, Massengale D, Thompson M, Patterson B, Olola CHO. The accuracy of emergency medical dispatcher-assisted layperson-caller pulse check using the Medical Priority Dispatch System protocol. Prehosp Disaster Med. 2012;27(3):1-8.

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Out-of-hospital cardiac arrest protocol comparison

Australasian Journal of Paramedicine ◽

10.33151/ajp.16.685 ◽

2019 ◽

Vol 16 ◽

Cited By ~ 1

Author(s):

Omer Perry ◽

Oren Wacht ◽

Eli Jaffe ◽

Zilla Sinuany-Stern ◽

Yuval Bitan

Keyword(s):

Cardiac Arrest ◽

Survival Rates ◽

Phone Call ◽

Healthcare Personnel ◽

Identification Process ◽

Emergency Medical ◽

Emergency Medical Dispatcher ◽

Clinical Background ◽

Hospital Cardiac Arrest

BackgroundEarly identification of out-of-hospital cardiac arrest (OHCA) has been proven to increase survival rates. Toward this goal, emergency medical dispatchers commonly use one of two types of emergency medical dispatcher systems, each with a unique OHCA protocol. The criteria-based dispatch (CBD) protocol is a set of guidelines and prompts intended for dispatchers with clinical background and experience, while the medical priority dispatch (MPD) is a scripted caller interrogation protocol intended for non-healthcare dispatchers. The objective of this study was to compare CBD and MPD protocols in terms of accuracy and duration of the identification process.MethodsTo compare the two protocols we conducted an OHCA simulation of an emergency phone call by a bystander. Two groups participated in the simulation: 1) emergency medical technicians during paramedic vocational training, in the role of CBD dispatchers, and 2) non-healthcare personnel in the role of MPD dispatchers. Dispatchers were asked to identify whether a patient was having a cardiac arrest based on the information they received from the bystander.ResultsDuration of the OHCA identification process was significantly shorter for participants using MPD (CBD 50 seconds vs. MPD 33 seconds, p=0.003). The OHCA accuracy was 86.49% for the CBD and 82.86% for MPD, but this difference was not statistically significant (p=0.60).ConclusionThe advantages of each protocol suggest that some combination of the two protocols may optimise the OHCA identification process, leading to increased accuracy and shorter duration of the identification process.

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‘Is the patient completely alert?’ – accuracy of emergency medical dispatcher determination of patient conscious state

Australasian Journal of Paramedicine ◽

10.33151/ajp.18.858 ◽

2021 ◽

Vol 18 ◽

Author(s):

Jason Belcher ◽

Judith Finn ◽

Austin Whiteside ◽

Stephen Ball

Keyword(s):

Predictive Value ◽

Conscious State ◽

Emergency Medical ◽

Level Of Consciousness ◽

Dispatch System ◽

Emergency Ambulance ◽

Chief Complaints ◽

Emergency Medical Dispatcher ◽

Key Issues

Introduction During emergency ambulance calls, one of the key issues assessed is the patient’s level of consciousness. An altered conscious state can be indicative of a need for a high priority response; however, the reliability of the resulting triage depends on how accurately alertness can be ascertained over the phone. This study investigated the accuracy of emergency medical dispatcher (EMD) determination of conscious state in emergency ambulance calls in Perth, Western Australia. Methods The study compared EMD determination of patient alertness based on the Medical Priority Dispatch System (MPDS), with conscious state as recorded by paramedics on arrival, for all emergency ambulance calls in a 1-year period in metropolitan Perth. Diagnostic accuracy was reported across the whole system and stratified by MPDS chief complaint. Results There were 109,678 calls included for analysis. In terms of identifying patients as not alert, the overall positive predictive value was 6.62% and negative predictive value was 99.93%, with 10 times as many patients dispatched as not alert than found to be not alert at scene. Sensitivity was only 69.94%. There was significant variation in accuracy between chief complaints. Conclusion The study found high levels of inaccuracy between dispatch identification of not-alert patients, and what paramedics found on scene. While not-alert dispatch was 10 times more common than patients being determined not-alert on scene, only 70% of not-alert patients on scene were classified as such during dispatch. Further research is suggested into the factors that affect the accuracy of EMD determination of patient conscious state.

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“Medical Miranda”—Improved Emergency Medical Dispatch Information From Police Officers

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00027345 ◽

1999 ◽

Vol 14 (2) ◽

pp. 61-64 ◽

Cited By ~ 3

Author(s):

Jeff J. Clawson ◽

Bob Sinclair

Keyword(s):

Emergency Medical Service ◽

Police Officers ◽

Medical Service ◽

Low Cost ◽

Cost Effective ◽

Medical Emergency ◽

Emergency Medical Dispatch ◽

Emergency Medical ◽

Emergency Medical Dispatcher ◽

Communication Center

AbstractIntroduction:Medical Miranda, also called Secondary Emergency Notification of Dispatch (Secondary Emergency Notification of Dispatch), is a low cost, effective, and welcome addition to emergency medical dispatching systems. The benefits are recognized by emergency medical dispatchers who receive feeder calls from associated public safety agencies that have trained both their field staff and call-takers in the Medical Miranda protocol.Hypothesis:The dispatchers would be more satisfied with feeder agencies that used the Secondary Emergency Notification of Dispatch protocol.Methods:A survey was conducted and analyzed, taking advantage of a situation in which two agencies (one used Secondary Emergency Notifi-cation of Dispatch) fed calls to the same communication center.Results:Dispatchers were more satisfied with the information gained from the feeder agency that used the Secondary Emergency Notification of Dispatch protocol and believed that the officers and dispatchers of that agency had afar better understanding of the emergency medical dispatcher's needs.Conclusions:When the emergency medical dispatcher does not talk directly with the reporting scene personnel or caller, Medical Miranda increases the usefulness of the information the dispatcher receives, helps the dispatcher better understand the reported medical emergency, and improves response appropriateness in emergency medical service (Emergency Medical Service) systems where responses routinely are prioritized.

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Association between Patient Unconscious or Not Alert Conditions and Cardiac Arrest or High-Acuity Outcomes within the Medical Priority Dispatch System “Falls” Protocol

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00008232 ◽

2010 ◽

Vol 25 (4) ◽

pp. 302-308 ◽

Cited By ~ 2

Author(s):

Jeff Clawson ◽

Christopher Olola ◽

Greg Scott ◽

Bryon Schultz ◽

Richard Pertgen ◽

...

Keyword(s):

Cardiac Arrest ◽

Ground Level ◽

Medical Problems ◽

Emergency Medical Dispatch ◽

Emergency Medical ◽

Call Processing ◽

Dispatch System ◽

High Acuity ◽

Emergency Medical Dispatcher ◽

Level 3

AbstractIntroduction:Falls are one of the most common types of complaints received by 9-1-1 emergency medical dispatch centers. They can be accidental or may be caused by underlying medical problems. Though not alert” falls patients with severe outcomes mostly are “hot” transported to the hospital, some of these cases may be due to other acute medical events (cardiac, respiratory, circulatory, or neurological), which may not always be apparent to the emergency medical dispatcher (EMD) during call processing.Objectives:The objective of this study was to characterize the risk of cardiac arrest and “hot-transport” outcomes in patients with “not alert” condition, within the Medical Priority Dispatch System (MPDS®) Falls protocol descriptors.Methods:This retrospective study used 129 months of de-identified, aggregate, dispatch datasets from three US emergency communication centers. The communication centers used the Medical Priority Dispatch System version 11.3–OMEGA type (released in 2006) to interrogate Emergency Medical System callers, select dispatch codes assigned to various response configurations, and provide pre-arrival instructions. The distribution of cases and percentages of cardiac arrest and hot-transport outcomes, categorized by MPDS® code, was profiled. Assessment of the association between MPDS® Delta-level 3 (D-3) “not alert” condition and cardiac arrest and hot-transport outcomes then followed.Results:Overall, patients within the D-3 and D-2 “long fall” conditions had the highest proportions (compared to the other determinants in the “falls” protocol) of cardiac arrest and hot-transport outcomes, respectively. “Not alert” condition was associated significantly with cardiac arrest and hot-transport outcomes (p < 0.001).Conclusions:The “not alert” determinant within the MPDS® “fall” protocol was associated significantly with severe outcomes for short falls (<6 feet; 2 meters) and ground-level falls. As reported to 9-1-1, the complaint of a “fall” may include the presence of underlying conditions that go beyond the obvious traumatic injuries caused by the fall itself.

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Investigating Occupational Stress of Disaster and Emergency Medical Management Center 115 and the Role of Demographic Variables in Kermanshah, Iran

10.21203/rs.3.rs-17181/v1 ◽

2020 ◽

Author(s):

Reza Pourmirza Kalhori ◽

Parvin Abdi Gheshlaghi ◽

Razie Toghroli ◽

Vahid Hatami Garosi ◽

Jaffar Abbas ◽

...

Keyword(s):

Occupational Stress ◽

Stress Level ◽

Medical Management ◽

Work Experience ◽

Demographic Variables ◽

Medical Emergency ◽

Work Place ◽

Significance Level ◽

Emergency Medical

Abstract Background: The first and one of the most important chains of providing care to patients is pre-hospital emergency medical services. Personnel employed in this sector are at risk of occupational stress due to the nature of their job which can affect their health and quality of services provided to patients. Therefore, the present study was conducted to investigate the occupational stress of the personnel of disaster and emergency medical management center 115 and the role of demographic variables in 2019.Methods: This is a descriptive-analytical study. 200 medical emergency personnel of Kermanshah province were selected through stratified sampling and according to inclusion criteria. A two-part questionnaire including demographic information and HSE standard questionnaire were used for collecting data. Finally, descriptive and inferential statistics (t-test and one-way ANOVA) were used for data analysis. Significance level was considered P<0.05. Results: The mean score of total occupational stress was 3.41±0.26. The highest and the lowest stress levels related to the role dimensions was calculated (4.34±0.35) and changes (2.72±0.86). There was a significant relationship between stress level with age, marital status, educational level, type of base of work place and hours of work per month, while there was no relationship between type of employment and work experience with stress level. Conclusion: Emergency medical personnel experience a high level of occupational stress. Senior managers can use the results of similar studies to think measures to reduce the experience of employees' stress.

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Symptom-Based Dispatching in an Emergency Medical Communication Centre: Sensitivity, Specificity, and the Area under the ROC Curve

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17218254 ◽

2020 ◽

Vol 17 (21) ◽

pp. 8254

Author(s):

Robert Larribau ◽

Victor Nathan Chappuis ◽

Philippe Cottet ◽

Simon Regard ◽

Hélène Deham ◽

...

Keyword(s):

Performance Measurement ◽

Roc Curve ◽

Test Performance ◽

Reference Standard ◽

Emergency Medical Dispatch ◽

Medical Communication ◽

Emergency Calls ◽

Emergency Medical ◽

Dispatch System ◽

Specific Assessment

Background: Measuring the performance of emergency medical dispatch tools used in paramedic-staffed emergency medical communication centres (EMCCs) is rarely performed. The objectives of our study were, therefore, to measure the performance and accuracy of Geneva’s dispatch system based on symptom assessment, in particular, the performance of ambulance dispatching with lights and sirens (L&S) and to measure the effect of adding specific protocols for each symptom. Methods: We performed a prospective observational study including all emergency calls received at Geneva’s EMCC (Switzerland) from 1 January 2014 to 1 July 2019. The risk levels selected during the emergency calls were compared to a reference standard, based on the National Advisory Committee for Aeronautics (NACA) scale, dichotomized to severe patient condition (NACA ≥ 4) or stable patient condition (NACA < 4) in the field. The symptom-based dispatch performance was assessed using a receiver operating characteristic (ROC) curve. Contingency tables and a Fagan nomogram were used to measure the performance of the dispatch with or without L&S. Measurements were carried out by symptom, and a group of symptoms with specific protocols was compared to a group without specific protocols. Results: We found an acceptable area under the ROC curve of 0.7474, 95%CI (0.7448–0.7503) for the 148,979 assessments included in the study. Where the severity prevalence was 21%, 95%CI (20.8–21.2). The sensitivity of the L&S dispatch was 87.5%, 95%CI (87.1–87.8); and the specificity was 47.3%, 95%CI (47.0–47.6). When symptom-specific assessment protocols were used, the accuracy of the assessments was slightly improved. Conclusions: Performance measurement of Geneva’s symptom-based dispatch system using standard diagnostic test performance measurement tools was possible. The performance was found to be comparable to other emergency medical dispatch systems using the same reference standard. However, the implementation of specific assessment protocols for each symptom may improve the accuracy of symptom-based dispatch systems.

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Utilization Criteria for Prehospital Ultrasound in a Canadian Critical Care Helicopter Emergency Medical Service: Determining Who Might Benefit

Prehospital and Disaster Medicine ◽

10.1017/s1049023x1700646x ◽

2017 ◽

Vol 32 (5) ◽

pp. 536-540 ◽

Cited By ~ 8

Author(s):

Domhnall O’Dochartaigh ◽

Matthew Douma ◽

Chris Alexiu ◽

Shell Ryan ◽

Mark MacKenzie

Keyword(s):

Critical Care ◽

Emergency Medical Service ◽

Medical Service ◽

Helicopter Emergency Medical Service ◽

Outcome Variable ◽

Trauma Patients ◽

Medical Patients ◽

Shock Index ◽

Patient Acuity ◽

Emergency Medical

AbstractIntroductionPrehospital ultrasound (PHUS) assessments by physicians and non-physicians are performed on medical and trauma patients with increasing frequency. Prehospital ultrasound has been shown to be of benefit by supporting interventions.ProblemWhich patients may benefit from PHUS has not been clearly identified.MethodsA multi-variable logistic regression analysis was performed on a previously created retrospective dataset of five years of physician- and non-physician-performed ultrasound scans in a Canadian critical care Helicopter Emergency Medical Service (HEMS). For separate medical and trauma patient groups, the a-priori outcome assessed was patient characteristics associated with the outcome variable of “PHUS-supported intervention.”ResultsBoth models were assessed (Likelihood Ratio, Score, and Wald) as a good fit. For medical patients, the characteristics of heart rate (HR) and shock index (SI) were found to be most significant for an intervention being supported by PHUS. An extremely low HR was found to be the most significant (OR=15.86 [95% confidence interval (CI), 1.46-171.73]; P=.02). The higher the SI, the more likely that an intervention was supported by PHUS (SI 0.9 to<1.3: OR=9.15 [95% CI, 1.36-61.69]; P=.02; and SI 1.3+: OR=8.37 [95% CI, 0.69-101.66]; P=.09). For trauma patients, the characteristics of Prehospital Index (PHI) and SI were found to be most significant for PHUS support. The greatest effect was PHI, where increasing ORs were seen with increasing PHI (PHI 14-19: OR=13.36 [95% CI, 1.92-92.81]; P=.008; and PHI 20-24: OR=53.10 [95% CI, 4.83-583.86]; P=.001). Shock index was found to be similar, though, with lower impact and significance (SI 0.9 to<1.3: OR=9.11 [95% CI, 1.31-63.32]; P=.025; and SI 1.3+: OR=35.75 [95% CI, 2.51-509.81]; P=.008).Conclusions:In a critical care HEMS, markers of higher patient acuity in both medical and trauma patients were associated with occurrences when an intervention was supported by PHUS. Prospective study with in-hospital follow-up is required to confirm these hypothesis-generating results.O’DochartaighD, DoumaM, AlexiuC, RyanS, MacKenzieM. Utilization criteria for prehospital ultrasound in a Canadian critical care Helicopter Emergency Medical Service: determining who might benefit. Prehosp Disaster Med. 2017;32(5):536–540.

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