scholarly journals Paediatric medical emergency calls to a Danish Emergency Medical Dispatch Centre: a retrospective, observational study

2018 ◽  
Vol 26 (1) ◽  
Author(s):  
Kasper Andersen ◽  
Søren Mikkelsen ◽  
Gitte Jørgensen ◽  
Stine Thorhauge Zwisler
Keyword(s):  
Observational Study ◽  
Retrospective Observational Study ◽  
Medical Emergency ◽  
Emergency Medical Dispatch ◽  
Emergency Calls ◽  
Emergency Medical ◽  
Dispatch Centre

scholarly journals Emergency physician’s dispatch by a paramedic-staffed emergency medical communication centre: sensitivity, specificity and search for a reference standard

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Victor Nathan Chappuis ◽  
Hélène Deham ◽  
Philippe Cottet ◽  
Birgit Andrea Gartner ◽  
François Pierre Sarasin ◽  
...  
Keyword(s):  
Reference Standard ◽  
Medical Systems ◽  
Operating Characteristics ◽  
First Line ◽  
Emergency Calls ◽  
Emergency Medical ◽  
Dispatch Centre ◽  
Second Tier ◽  
Low Sensitivity ◽  
Level Of Risk

Abstract Background Some 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. Methods This 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. Results 97′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]. Conclusion The 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.

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

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.

scholarly journals The "unclear problem" category: An analysis of its implications and effects on the emergency medical dispatch process in Copenhagen, Denmark

2021 ◽  
Author(s):  
Helle Collatz Christensen ◽  
Sterre Otten ◽  
Cassandra Rehbock ◽  
Thomas Krafft ◽  
Martin Vang Haugaard ◽  
...  
Keyword(s):  
Patient Safety ◽  
Prehospital Care ◽  
Sustainable Use ◽  
The Elderly ◽  
Public Welfare ◽  
Emergency Call ◽  
Medical Emergency ◽  
Emergency Medical Dispatch ◽  
Emergency Medical ◽  
The Impact

Abstract ObjectiveAn effective emergency medical dispatch process is vital to provide appropriate prehospital care to patients. It increases patient safety and ensures the sustainable use of medical resources. Although Copenhagen has a sophisticated emergency medical services (EMS) system with a significant focus on public welfare, more than 10% of emergency calls are still being categorized as an "unclear problem" and are thus not categorized as "symptom-specific". Therefore, the objective of this research is to gain a better understanding of underlying implications that lead to the categorization of an emergency call as "unclear". This research investigates the effects of the "unclear problem" category (UPC) on the medical dispatching process at the emergency medical dispatch center in Copenhagen. Also, it explores the effectiveness of educating medical dispatchers about the use of the UPC to reduce its use. MethodsThis was a register-based study based on medical emergency call data. Descriptive analyses were conducted to investigate the effect of using the UPC on the medical dispatching process and determine the impact of alerting medical dispatchers to reduce its use. ResultsThe UPC accounted for 11.4% of the calls. Elderly patients were most often dispatched with the UPC. The UPC could impact the medical dispatching process in several potentially harmful, ways. Namely, it could lead to under or over triage and lead to inefficient use of EMS resources. Sensitizing medical dispatchers about the use of the UPC could have contributed to the decrease in the use of the UPC. ConclusionThe use of the UPC could have negative implications on patients' outcomes and the efficient use of EMS resources due to its possible impact on over-or under triage. The UPC is mainly used when dispatching the elderly. Nonetheless, the use of the UPC decreased throughout the study period after the medical dispatchers were alerted about the implications of its use.

Abstract 290: Association Between Hourly Call Volume in Emergency Medical Dispatch Center and Dispatcher -Assisted Cardiopulmonary Resuscitation Instruction Time in Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Jong Hwan Kim ◽  
Tae Han Kim ◽  
Sang Do Shin ◽  
Ki Jeong Hong ◽  
Jeong Ho Park ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Multivariable Logistic Regression Model ◽  
Emergency Medical Dispatch ◽  
Emergency Calls ◽  
Multivariable Logistic Regression ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

Objectives: cardiac arrest recognition, ambulance dispatch and dispatcher assisted CPR by emergency medical dispatch (EMD) is crucial for good outcome of out-of-hospital cardiac arrest (OHCA).In EMD, crowding is caused by mismatch between numerous emergency calls and dispatchers per duty available Crowding in emergency department has been shown to decrease the performance and outcome, however little is known about effect of crowding in EMD. We aimed to evaluate incidence of crowding in emergency medical dispatch center and effect of emergency call crowding on dispatcher assisted CPR instruction performance in OHCA calls. Methods: We used nationwide OHCA database from 2013 to 2016, consisted of patients with presumed cardiac origin and dispatched by Seoul EMD. Main exposure was hourly number of total incoming emergency calls to EMD. Number of hourly calls were categorized into quartile (~4o calls, 41~51 calls, 52 ~61 calls and ~62 calls). Primary outcome was successful DA-CPR instruction provision within 120 seconds. Adjusted ratios (AORs) and 95% confidence intervals (CIs) were estimated to evaluate association between EMD crowding and outcome in multivariable logistic regression model. Results: Of a total of 12,722 patients, proportion of successful DA instruction were highest in least crowded quartile and lowest in the most crowded quartile (22.7% vs. 15.o% , p<0.01). The adjusted odds ratios is 0.85 (95% CI 0.74 - 0.98) in most crowded EMD quartile with lesser proportion of DA instruction within 120 seconds. Crowding quartile 4 and quartile 3 was associated lesser favorable neurological outcome in multivariable logistic regression model.(adjusted OR(95% CI) 0.78 (0.60-0.99) and 0.70 (0.54- 0.91) respectively) . Conclusion: Crowding in emergency medicine dispatch caused by increased hourly call volume was associated with delayed dispatcher assisted CPR instruction provision. Medical directors might consider strategy approach to solve crowding in EMD according to crowding distribution.

scholarly journals Impact of a visual indicator on the noise level in an emergency medical dispatch centre - a pilot study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Justin Outrey ◽  
Jean-Baptiste Pretalli ◽  
Sophie Pujol ◽  
Alice Brembilla ◽  
Thibaut Desmettre ◽  
...  
Keyword(s):  
Noise Level ◽  
Ambient Noise ◽  
Visual Noise ◽  
Noise Levels ◽  
Emergency Medical Dispatch ◽  
Baseline Phase ◽  
Ambient Noise Level ◽  
Emergency Medical ◽  
Dispatch Centre ◽  
The Impact

Abstract Background Noise levels are monitored in call centres. A maximum of 52 to 55 dB(A) is recommended in order to prevent adverse events. We aimed at assessing the noise level and the impact of a visual noise indicator on the ambient noise level in a French Regional Emergency Medical Dispatch Centre (EMDC). Methods We conducted an observational study in the EMDC of the SAMU25 (University Hospital of Besancon). We measured the noise level using a SoundEarII® noise indicator (Dräger Medical SAS, France). The measurement took place in two phases on three consecutive days from 00:00 to 11:59 PM. At baseline, phase 1, the device recorded the average ambient noise for each minute without visual indication. Secondly, phase 2 included a sensor mounted with a light that would turn on green if noise was below 65 dB(A), orange if noise ever exceeded 65 and red if it exceeded 75 dB(A). Results In the presence of the visual noise indicator, the LAeq was significantly lower than in the absence of visual noise indicator (a mean difference of − 4.19 dB; P < 10–3). It was higher than 55 dB(A) in 84.9 and 43.9% of the time in phases 1 and 2, respectively. Conclusions The noise levels were frequently higher than the standards, and sometimes close to recommended limits, requiring preventive measures. The noise indicator had a positive effect on the ambient noise level. This work will allow the implementation of effective prevention solutions and, based on future assessments, could improve operators’ well-being and better care for patient.

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