An Innovative Curriculum Development Experience: Emergency Medical Dispatch Role in the Healthcare Transformation Vision of Saudi Arabia

BackgroundHealthcare medical dispatch systems play a fundamental role in the daily operations of prehospital services. This includes facilitating the interpretation of various dispatch-related systems, receiving incident calls, categorizing cases, guiding proper resources deployment, and providing proper instructions before the arrival of healthcare providers. Considering the Kingdom of Saudi Arabia’s (KSA’s) health sector transformation plan as part of Vision 2030, developing an Emergency Medical Dispatch (EMD) Program as part of essential prehospital services will allow rapid and competent healthcare delivery. In this study, our purpose is to describe the curriculum development of the EMD Program to improve the training of dispatchers and to share the experience in the interest of better prehospital dispatch systems.MethodsA selected group of education experts and academics in emergency medical services dispatch were assigned to develop an EMD curriculum over six months. This study aims to describe the approach followed in developing an innovative EMD Program to share the experience and ultimately standardize dispatch-related training programs. The data of this study was collected by reviewing approved documents of the EMD Program including program curriculum, syllabus, logbook, and exam blueprint after approval letters received from the Health Academy, Saudi Commission for Health Specialties.ResultsThe development of the EMD program utilized a consecutive mixed approach staring with a competency-based with backward design method to ensure the achievement of targeted outcomes followed by the Kern Six-step curriculum development model, namely: (1) problem identification and general need assessment; (2) targeted need assessment; (3) goals and objectives; (4) educational strategies; (5) implementation; and (6) evaluation and feedback. This resulted in four comprehensive modules and seventeen competencies throughout the fourteen-week EMD Program. Conclusion As part of the health sector transformation plan in KSA, EMD services play a fundamental role in the daily operations of prehospital healthcare services. Developing an EMD Program with a consecutive mixed approach including a competency-based with backward design method followed by the Kern Six-step curriculum development model led to a set of learning outcomes in the EMD Program including interpreting various dispatch systems, prioritizing incidents, deploying proper resources, and providing pre-arrival instructions to improve the current operations of EMD services, allow rapid access to healthcare facilities, and ultimately save more lives.

Abstract 13237: Motivations and Barriers to Join an Automated External Defibrillator Network: A Nationwide Survey

Introduction: Since 2007, citizens have been able to register an automated external defibrillator (AED) with the Danish AED Network, which holds >23,000 AEDs (394 AEDs/100,000 inhabitants) linked directly to the Emergency Medical Dispatch Centers. In 2019, 60.8% of sold AEDs were registered in the network. This study aimed to identify motivations and barriers for registration with the nationwide Danish AED Network. Methods: A cross-sectional survey among owners of newly registered AEDs in the Danish AED Network was carried out from September 2017 to December 2020. Each month, 30-50 random AED-owners participated. The survey included items on motivations and barriers to join the AED network and items on AED accessibility. Results: In total, 1,540 AED-owners were included (25.3 % of newly registered in the period (n=6087)). The time from AED-purchase to AED-registration was “<1week” in 25.7%, “<1month” in 23.4%, “1month-1year” in 28.6%, “>1year” in 20.4%, and “Do not know” in 1.9%. Knowledge about the AED network is illustrated in Figure 1. Over half of the AED-owners registered their AED because they felt it was a ‘good cause’ (64.0%), followed by ‘registering upon request’ (20.6%), and ‘after a first aid course’ (5.5%). Of newly registered AEDs, 73.8% (n=1137) were 24/7-accessible. The most frequent reason for choosing limited AED accessibility (AED placed indoors/not available 24/7, n=403) was “greater expenses” (26.8%), whereas “fear of theft/vandalism” only accounted for 12.4%. Conclusion: Among AED-owners registering their AED to the Danish AED Network, most heard about the registry through word of mouth, registered their AED within the first year of purchase, and registered primarily because they felt it was a good cause. Most newly registered AEDs were 24/7-accessible. The biggest expressed barrier to AED accessibility was increased expenses whereas fear of theft or vandalism was a minor issue.

Neurosurgical Admission Later Than 4 h After the Emergency Call Does Not Result in Worse Long-Term Outcome in Subarachnoid Haemorrhage

Background: Few studies have investigated the importance of the time interval between contact to the emergency medical service and neurosurgical admission in patients with spontaneous subarachnoid haemorrhage. We hypothesised that longer time to treatment would be associated with an increased risk of death or early retirement.Methods: This was a retrospective observational study with 4 years follow-up. Those who reached a neurosurgical department in fewer than 4 h were compared with those who reached it in more than 4 h. Individual level data were merged from the Danish National Patient Register, medical records, the Copenhagen Emergency Medical Dispatch Centre, the Civil Registration System, and the Ministry of Employment and Statistics Denmark. Patients were ≥18 years and had a verified diagnosis of spontaneous subarachnoid haemorrhage. The primary outcome was death or early retirement after 4 years.Results: Two hundred sixty-two patients admitted within a three-and-a-half-year time period were identified. Data were available in 124 patients, and 61 of them were in their working age. Four-year all-cause mortality was 25.8%. No significant association was found between time to neurosurgical admission and risk of death or early retirement (OR = 0.35, 95% confidence interval [CI]: 0.10–1.23, p = 0.10).Conclusion: We did not find an association between the time from emergency telephone call to neurosurgical admission and the risk of death or early retirement.

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

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.

The perspectives of Swedish registered nurses about managing difficult calls to emergency medical dispatch centres: a qualitative descriptive study

Background Telephone triage at emergency medical dispatch centres is often challenging for registered nurses due to lack of visual cues, lack of knowledge about the patient, and time pressure – and making the right decision can be a matter of life and death. Some calls may be more difficult to handle, and more knowledge is needed about these calls to develop education and coping strategies. Therefore, the aim of this study was to describe the perspectives of registered nurses’ views about managing difficult calls to emergency medical dispatch centres. Methods A descriptive design with a qualitative inductive approach was used. Three dispatch centers in mid-Sweden were investigated, covering about 950,000 inhabitants and handling around 114,000 calls per year. Individual interviews were carried out with a purposeful sample of 24 registered nurses. Systematic text condensation was conducted. Results Seven themes were generated: calls with communication barriers, calls from agitated or rude callers, calls about psychiatric illness, calls from third parties, calls about rare or unclear situations, calls with unknown addresses and calls regarding immediate life-threatening conditions. There was a strong consensus among the registered nurses about which calls were experienced as difficult, with the exception of calls about immediate life-threatening conditions. Some registered nurses thought calls about immediate life-threatening conditions were easy to handle as they simply adhered to protocol, while others described these calls as difficult and were emotionally affected. Conclusion The registered nurses’ descriptions of difficult calls focused on the callers, while their own role, the organisational framework, and leadership were not mentioned. Many types of calls included difficulties, which could be related to the caller, their symptoms, or different circumstances. The registered nurses pointed to language barriers and rude, agitated callers as increasing problems. An investigation of actual emergency calls is warranted to examine the extent and nature of such calls.

Description of call handling in emergency medical dispatch centres in Scandinavia: recognition of out-of-hospital cardiac arrests and dispatcher-assisted CPR

Background The European resuscitation council have highlighted emergency medical dispatch centres as an important key player for early recognition of Out-of-Hospital Cardiac Arrest (OHCA) and in providing dispatcher assisted cardiopulmonary resuscitation (CPR) before arrival of emergency medical services. Early recognition is associated with increased bystander CPR and improved survival rates. The aim of this study is to describe OHCA call handling in emergency medical dispatch centres in Copenhagen (Denmark), Stockholm (Sweden) and Oslo (Norway) with focus on sensitivity of recognition of OHCA, provision of dispatcher-assisted CPR and time intervals when CPR is initiated during the emergency call (NO-CPRprior), and to describe OHCA call handling when CPR is initiated prior to the emergency call (CPRprior). Methods Baseline data of consecutive OHCA eligible for inclusion starting January 1st 2016 were collected from respective cardiac arrest registries. A template based on the Cardiac Arrest Registry to Enhance Survival definition catalogue was used to extract data from respective cardiac arrest registries and from corresponding audio files from emergency medical dispatch centres. Cases were divided in two groups: NO-CPRprior and CPRprior and data collection continued until 200 cases were collected in the NO-CPRprior-group. Results NO-CPRprior OHCA was recognised in 71% of the calls in Copenhagen, 83% in Stockholm, and 96% in Oslo. Abnormal breathing was addressed in 34, 7 and 98% of cases and CPR instructions were started in 50, 60, and 80%, respectively. Median time (mm:ss) to first chest compression was 02:35 (Copenhagen), 03:50 (Stockholm) and 02:58 (Oslo). Assessment of CPR quality was performed in 80, 74, and 74% of the cases. CPRprior comprised 71 cases in Copenhagen, 9 in Stockholm, and 38 in Oslo. Dispatchers still started CPR instructions in 41, 22, and 40% of the calls, respectively and provided quality assessment in 71, 100, and 80% in these respective instances. Conclusions We observed variations in OHCA recognition in 71–96% and dispatcher assisted-CPR were provided in 50–80% in NO-CPRprior calls. In cases where CPR was initiated prior to emergency calls, dispatchers were less likely to start CPR instructions but provided quality assessments during instructions.