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Zachrison KS, Nielsen VM, de la Ossa NP, Madsen TE, Cash RE, Crowe RP, Odom EC, Jauch EC, Adeoye OM, Richards CT. Prehospital Stroke Care Part 1: Emergency Medical Services and the Stroke Systems of Care. Stroke 2023; 54:1138-1147. [PMID: 36444720 PMCID: PMC11050637 DOI: 10.1161/strokeaha.122.039586] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute stroke care begins before hospital arrival, and several prehospital factors are critical in influencing overall patient care and poststroke outcomes. This topical review provides an overview of the state of the science on prehospital components of stroke systems of care and how emergency medical services systems may interact in the system to support acute stroke care. Topics include layperson recognition of stroke, prehospital transport strategies, networked stroke care, systems for data integration and real-time feedback, and inequities that exist within and among systems.
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Affiliation(s)
- Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (K.S.Z., R.E.C.)
| | | | - Natalia Perez de la Ossa
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias I Pujol, Badalona, Spain and Stroke Programme, Catalan Health Department, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (N.P.d.l.O)
| | - Tracy E Madsen
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI (T.E.M.)
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (K.S.Z., R.E.C.)
| | | | - Erika C Odom
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (E.C.O.)
| | - Edward C Jauch
- Department of Research, University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, NC (E.C.J.)
| | - Opeolu M Adeoye
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO (O.M.A.)
| | - Christopher T Richards
- Division of EMS, Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH (C.T.R.)
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Ngo H, Birnie T, Finn J, Ball S, Perera N. Emotions in telephone calls to emergency medical services involving out-of-hospital cardiac arrest: A scoping review. Resusc Plus 2022; 11:100264. [PMID: 35801232 PMCID: PMC9253842 DOI: 10.1016/j.resplu.2022.100264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/25/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022] Open
Abstract
Aims The purpose of this scoping review was to identify and synthesise existing research evidence on emotions in the context of emergency phone calls to emergency medical services (EMS) involving out-of-hospital cardiac arrest (OHCA). The specific objectives were to identify studies that (1) described emotions during emergency OHCA calls; (2) specified an instrument or method for measuring/assessing emotions; and (3) examined the relationship between emotions and call outcomes or patient outcomes. Methods/Data sources Five databases were searched on 18 November 2021: Medline, Embase, PsycInfo, CINAHL, and the Cochrane Review Database. Included studies required the following three concepts to be addressed: emotions in the context of EMS calls that involved OHCA. Calls also needed to be made by a ‘second-party’ caller; and each study needed to address at least one of the three specific objectives, as outlined above. The review was conducted in accordance with the Joanna Briggs Institute guidelines for evidence synthesis for scoping reviews. Results Thirteen eligible studies were included for synthesis. All studies met Objective 1; six studies met Objective 2; and seven met Objective 3. One study reported patient fatality due to heightened emotions and ensuing ineffective communications between callers and call-takers. Conclusion The review highlights a significant gap in the evidence base of emotions in emergency OHCA-related calls, and the need for a more comprehensive and effective method in assessing and measuring emotions in this context. Relationships between emotions (their expressions and perceptions) and call outcomes (including patient outcomes) also need more rigorous investigation.
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Richards CT, McCarthy DM, Markul E, Rottman DR, Lindeman P, Prabhakaran S, Klabjan D, Holl JL, Cameron KA. A mixed methods analysis of caller-emergency medical dispatcher communication during 9-1-1 calls for out-of-hospital cardiac arrest. PATIENT EDUCATION AND COUNSELING 2022; 105:2130-2136. [PMID: 35304072 DOI: 10.1016/j.pec.2022.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/15/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Recognition of out-of-hospital cardiac arrest (OHCA) during 9-1-1 calls is critically important, but little is known about how laypersons and emergency medical dispatchers (EMDs) communicate. We sought to describe 9-1-1 calls for OHCA. METHODS We performed a mixed-methods, retrospective analysis of 9-1-1 calls for OHCA victims in a large urban emergency medical services (EMS) system using a random sampling of cases containing the term "cardiopulmonary resuscitation" (CPR) in the EMS electronic report. A constant comparison qualitative approach with four independent reviewers continued until thematic saturation was achieved. Quantitative analysis employed computational linguistics. Callers' emotional states were rated using the emotional content and cooperation score (ECCS). RESULTS Thematic saturation was achieved after 46 calls. Three "OHCA recognition" themes emerged [ 1) disparate OHCA terms used, 2) OHCA mimics create challenges, 3) EMD questions influence recognition]. Three "CPR facilitation" themes emerged [ 1) directive language may facilitate CPR, 2) specific instructions assist CPR, 3) caller's emotions affect CPR initiation]. Callers were generally "anxious but cooperative." Callers saying "pulse" was associated with OHCA recognition. CONCLUSION Communication characteristics appear to influence OHCA recognition and CPR facilitation. PRACTICE IMPLICATIONS Dispatch protocols that acknowledge characteristics of callers' communication may improve OHCA recognition and CPR facilitation.
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Affiliation(s)
- Christopher T Richards
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Emergency Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA; Chicago EMS System, Chicago, IL, USA.
| | - Danielle M McCarthy
- Department of Emergency Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA.
| | - Eddie Markul
- Chicago EMS System, Chicago, IL, USA; Department of Emergency Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.
| | | | - Patricia Lindeman
- Department of Emergency Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA; Chicago EMS System, Chicago, IL, USA.
| | - Shyam Prabhakaran
- Department of Neurology, The University of Chicago Biological Sciences, Chicago, IL, USA.
| | - Diego Klabjan
- Department of Industrial Engineering and Management Sciences, Northwestern University McCormick School of Engineering, Evanston, IL, USA.
| | - Jane L Holl
- Department of Neurology, The University of Chicago Biological Sciences, Chicago, IL, USA.
| | - Kenzie A Cameron
- Division of General Internal Medicine & Geriatrics, Northwestern Feinberg School of Medicine, Chicago, IL, USA.
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Torlén Wennlund K, Kurland L, Olanders K, Khoshegir A, Kamil HA, Castrén M, Bohm K. Emergency medical dispatchers' experiences of managing emergency calls: a qualitative interview study. BMJ Open 2022; 12:e059803. [PMID: 35418440 PMCID: PMC9014079 DOI: 10.1136/bmjopen-2021-059803] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To explore the emergency medical dispatchers (EMDs) experiences of managing emergency medical calls. DESIGN A qualitative interview study with an inductive approach. EMDs were interviewed individually using a semistructured interview guide. The verbatim transcripts were analysed using a qualitative content analysis. SETTING EMDs, without a professional background as registered nurses, were recruited from emergency medical communication centers (EMCCs) within Sweden. PARTICIPANTS To achieve a varied description of EMDs' experiences, participants were included from several EMCCs nationally, using a convenience sampling. Interviews were performed up until saturation of data, resulting in 13 EMDs from 7 EMCCs being interviewed. All the EMDs were women, ranging in age from 28 to 61 years (mean 42 years), and had worked in emergency medical dispatching between 1 and 13.5 years (mean 6.5 years). RESULTS The analysis revealed the main category-to attentively manage a multifaceted, interactive task-made up of three categories: utilize creativity to gather information, continuously process and assess complex information, and engage in the professional role. The content of each category was reflected in several subcategories further described and illustrated with representative quotes. CONCLUSIONS Managing emergency medical calls was experienced by EMDs to attentively manage a multifaceted interactive task. Core parts were described as: the ability to utilize creativity to gather information, continuously process and asses complex information, and engage in the professional role. Our results could be beneficial for emergency care managers when designing training programmes and organising EMD work and the EMD work environment, including further development of dispatch protocols and implementation of regular feedback sessions. Moreover, the results indicate that aspects such as self-awareness and emotional challenges encountered during EMD work could be important matters to discuss during staff evaluations.
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Affiliation(s)
- Klara Torlén Wennlund
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Lisa Kurland
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Department of Medical Sciences, Örebro University, Örebro, Sweden
| | - Knut Olanders
- Department of Intensive and Perioperative Care, Skåne University Hospital Lund, Lund, Sweden
| | - Amanda Khoshegir
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Hussein Al Kamil
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Maaret Castrén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Department of Emergency Medicine, University of Helsinki, Helsinki, Finland
| | - Katarina Bohm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Emergency Department, Södersjukhuset, Stockholm, Sweden
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Dainty KN, Colquitt B, Bhanji F, Hunt EA, Jefkins T, Leary M, Ornato JP, Swor RA, Panchal A. Understanding the Importance of the Lay Responder Experience in Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation 2022; 145:e852-e867. [PMID: 35306832 DOI: 10.1161/cir.0000000000001054] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bystander cardiopulmonary resuscitation (CPR) is critical to increasing survival from out-of-hospital cardiac arrest. However, the percentage of cases in which an individual receives bystander CPR is actually low, at only 35% to 40% globally. Preparing lay responders to recognize the signs of sudden cardiac arrest, call 9-1-1, and perform CPR in public and private locations is crucial to increasing survival from this public health problem. The objective of this scientific statement is to summarize the most recent published evidence about the lay responder experience of training, responding, and dealing with the residual impact of witnessing an out-of-hospital cardiac arrest. The scientific statement focuses on the experience-based literature of actual responders, which includes barriers to responding, experiences of doing CPR, use of an automated external defibrillator, the impact of dispatcher-assisted CPR, and the potential for postevent psychological sequelae. The large body of qualitative and observational studies identifies several gaps in crucial knowledge that, if targeted, could increase the likelihood that those who are trained in CPR will act. We suggest using the experience of actual responders to inform more contextualized training, including the implications of performing CPR on a family member, dispelling myths about harm, training and litigation, and recognition of the potential for psychologic sequelae after the event.
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Kirby K, Voss S, Bird E, Benger J. Features of Emergency Medical System calls that facilitate or inhibit Emergency Medical Dispatcher recognition that a patient is in, or at imminent risk of, cardiac arrest: A systematic mixed studies review. Resusc Plus 2021; 8:100173. [PMID: 34841368 PMCID: PMC8605417 DOI: 10.1016/j.resplu.2021.100173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022] Open
Abstract
Aim To identify and appraise evidence relating to the features of an Emergency Medicine System call interaction that enable, or inhibit, an Emergency Medical Dispatcher’s recognition that a patient is in out-of-hospital cardiac arrest, or at imminent risk of out-of-hospital cardiac arrest. Methods All study designs were eligible for inclusion. Data sources included Medline, BNI, CINAHL, EMBASE, PubMed, Cochrane Database of Systematic Reviews, AMED and OpenGrey. Stakeholder resources were screened and experts in resuscitation were asked to review the studies identified. Studies were appraised using the Mixed Methods Appraisal Tool. Synthesis was completed using a segregated mixed research synthesis approach. Results Thirty-two studies were included in the review. Three main themes were identified: Key features of the Emergency Medical Service call interaction; Managing the Emergency Medical Service call; Emotional distress. Conclusion A dominant finding is the difficulty in recognising abnormal/agonal breathing during the Emergency Medical Service call. The interaction between the caller and the Emergency Medical Dispatcher is critical in the recognition of patients who suffer an out-of-hospital cardiac arrest. Emergency Medical Dispatchers adapt their approach to the Emergency Medical Service call, and regular training for Emergency Medical Dispatchers is recommended to optimise out-of-hospital cardiac arrest recognition. Further research is required with a focus on the Emergency Medical Service call interaction of patients who are alive at the time of the Emergency Medical Service call and who later deteriorate into OHCA. PROSPERO registration: CRD42019155458.
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Affiliation(s)
- Kim Kirby
- South Western Ambulance Service NHS Foundation Trust, Eagle Way, Exeter EX2 7HY, United Kingdom
- University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD, United Kingdom
- Corresponding author at: South Western Ambulance Service NHS Foundation Trust, Eagle Way, Exeter EX2 7HY, United Kingdom.
| | - Sarah Voss
- University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD, United Kingdom
| | - Emma Bird
- University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD, United Kingdom
| | - Jonathan Benger
- University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD, United Kingdom
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Early recognition of a caller's emotion in out-of-hospital cardiac arrest dispatching: An artificial intelligence approach. Resuscitation 2021; 167:144-150. [PMID: 34461203 DOI: 10.1016/j.resuscitation.2021.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 11/23/2022]
Abstract
AIM This study aimed to develop an AI model for detecting a caller's emotional state during out-of-hospital cardiac arrest calls by processing audio recordings of dispatch communications. METHODS Audio recordings of 337 out-of-hospital cardiac arrest calls from March-April 2011 were retrieved. The callers' emotional state was classified based on the emotional content and cooperative scores. Mel-frequency cepstral coefficients extracted essential information from the voice signals. A support vector machine was utilised for the automatic judgement, and repeated random sub-sampling cross validation (RRS-CV) was applied to evaluate robustness. The results from the artificial intelligence classifier were compared with the consensus of expert reviewers. RESULTS The audio recordings were classified into five emotional content and cooperative score levels. The proposed model had an average positive predictive value of 72.97%, a negative predictive value of 93.47%, sensitivity of 38.76%, and specificity of 98.29%. If only the first 10 seconds of the recordings were considered, it had an average positive predictive value of 84.62%, a negative predictive value of 93.57%, sensitivity of 52.38%, and specificity of 98.64%. The artificial intelligence model's performance maintained preferable results for emotionally stable cases. CONCLUSION Artificial intelligence models can possibly facilitate the judgement of callers' emotional states during dispatch conversations. This model has the potential to be utilised in practice, by pre-screening emotionally stable callers, thus allowing dispatchers to focus on cases that are judged to be emotionally unstable. Further research and validation are required to improve the model's performance and make it suitable for the general population.
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Abramson TM, Sanko S, Eckstein M. Emergency Medical Services Utilization by Homeless Patients. PREHOSP EMERG CARE 2020; 25:333-340. [PMID: 32501745 DOI: 10.1080/10903127.2020.1777234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Homelessness is a rapidly growing issue throughout the United States and has important public health implications. Los Angeles, like other large urban cities, has seen a recent increase in homelessness. However, little is known about emergency medical service (EMS) utilization by those experiencing homelessness. Objective: Describe the utilization of emergency medical services by homeless patients. Methods: This is a 12-month retrospective review of electronic health records of all 911-incidents attended by the Los Angeles Fire Department (LAFD) from January to December 2018. The City of Los Angeles is 480 square miles and has a population of 3,949,776 with a homeless population of 31,285 (0.8% of city population). The primary outcome is the frequency of EMS 911-calls for homeless patients. Secondary outcomes include call characteristics. Results: There were 355,411 911-incidents during the study period. Homeless patients were involved in 36,122 (10.2%) incidents. Incidents for the homeless population occurred at a rate of 1155 per 1000 homeless residents or 14 times the rate of housed residents. Of the 217,972 calls resulting in transport to the emergency department, 28,917 (13.3%) were for homeless patients. This translates into a rate of 924 per 1000 homeless patients, which is 19 times higher than housed patients. Homeless patients were younger (mean 46.1 v 52.6 years) and more likely to be male (71% v 49.1%). Acuity was lower in the homeless group, 31.4% v 42.5% received advanced life support. Conclusion: In the City of Los Angeles, people experiencing homelessness demonstrated disproportionately high use of EMS services and ambulance transports, were more frequently younger, male, and had lower acuity conditions when compared with housed patients.
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Chien CY, Chien WC, Tsai LH, Tsai SL, Chen CB, Seak CJ, Chou YS, Ma M, Weng YM, Ng CJ, Lin CY, Tzeng IS, Lin CC, Huang CH. Impact of the caller’s emotional state and cooperation on out-of-hospital cardiac arrest recognition and dispatcher-assisted cardiopulmonary resuscitation. Emerg Med J 2019; 36:595-600. [PMID: 31439715 DOI: 10.1136/emermed-2018-208353] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 07/24/2019] [Accepted: 08/02/2019] [Indexed: 11/04/2022]
Abstract
ObjectiveThis study determined the impact of the caller’s emotional state and cooperation on out-of-hospital cardiac arrest (OHCA) recognition and dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) performance metrics.MethodsThis was a retrospective study using data from November 2015 to October 2016 from the emergency medical service dispatching centre in northern Taiwan. Audio recordings of callers contacting the centre regarding adult patients with non-traumatic OHCA were reviewed. The reviewers assigned an emotional content and cooperation score (ECCS) to the callers. ECCS 1–3 callers were graded as cooperative and ECCS 4–5 callers as uncooperative and highly emotional. The relation between ECCS and OHCA recognition, time to key events and DA-CPR delivery were investigated.ResultsOf the 367 cases, 336 (91.6%) callers were assigned ECCS 1–3 with a good inter-rater reliability (k=0.63). Dispatchers recognised OHCA in 251 (68.4%) cases. Compared with callers with ECCS 1, callers with ECCS 2 and 3 were more likely to give unambiguous responses about the patient’s breathing status (adjusted OR (AOR)=2.6, 95% CI 1.1 to 6.4), leading to a significantly higher rate of OHCA recognition (AOR=2.3, 95% CI 1.1 to 5.0). Thirty-one callers were rated uncooperative (ECCS 4–5) but had shorter median times to OHCA recognition and chest compression (29 and 122 s, respectively) compared with the cooperative caller group (38 and 170 s, respectively). Nevertheless, those with ECCS 4–5 had a significantly lower DA-CPR delivery rate (54.2% vs 85.9%) due to ‘caller refused’ or ‘overly distraught’ factors.ConclusionsThe caller’s high emotional state is not a barrier to OHCA recognition by dispatchers but may prevent delivery of DA-CPR instruction. However, DA-CPR instruction followed by first chest compression is possible despite the caller’s emotional state if dispatchers are able to skilfully reassure the emotional callers.
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Abstract
There are 240 million 9-1-1 calls in the United States every year. The burden of managing these emergencies until first responders can arrive is on the dispatchers working in the 5806 public safety answering points, more commonly known as dispatch centers. They are the first link in the chain of survival between the public and the remainder of the health care system. Dispatchers play a critical role in the early identification of emergencies, assignment of appropriate emergency resources, and provision of life-sustaining interventions like dispatcher-assisted cardiopulmonary resuscitation and disaster management.
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Affiliation(s)
- Saman Kashani
- Los Angeles Fire Department, EMS Bureau, 200 North Main Street, Suite 1860, Los Angeles, CA 90012, USA; Division of Emergency Medical Services, Department of Emergency Medicine, Keck School of Medicine of USC, 1200 North State Street, Room 1011, Los Angeles, CA 90033, USA.
| | - Stephen Sanko
- Los Angeles Fire Department, EMS Bureau, 200 North Main Street, Suite 1860, Los Angeles, CA 90012, USA; Division of Emergency Medical Services, Department of Emergency Medicine, Keck School of Medicine of USC, 1200 North State Street, Room 1011, Los Angeles, CA 90033, USA
| | - Marc Eckstein
- Los Angeles Fire Department, EMS Bureau, 200 North Main Street, Suite 1860, Los Angeles, CA 90012, USA; Division of Emergency Medical Services, Department of Emergency Medicine, Keck School of Medicine of USC, 1200 North State Street, Room 1011, Los Angeles, CA 90033, USA
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Richards CT, Wang B, Markul E, Albarran F, Rottman D, Aggarwal NT, Lindeman P, Stein-Spencer L, Weber JM, Pearlman KS, Tataris KL, Holl JL, Klabjan D, Prabhakaran S. Identifying Key Words in 9-1-1 Calls for Stroke: A Mixed Methods Approach. PREHOSP EMERG CARE 2017; 21:761-766. [PMID: 28661784 DOI: 10.1080/10903127.2017.1332124] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Identifying stroke during a 9-1-1 call is critical to timely prehospital care. However, emergency medical dispatchers (EMDs) recognize stroke in less than half of 9-1-1 calls, potentially due to the words used by callers to communicate stroke signs and symptoms. We hypothesized that callers do not typically use words and phrases considered to be classical descriptors of stroke, such as focal neurologic deficits, but that a mixed-methods approach can identify words and phrases commonly used by 9-1-1 callers to describe acute stroke victims. METHODS We performed a mixed-method, retrospective study of 9-1-1 call audio recordings for adult patients with confirmed stroke who were transported by ambulance in a large urban city. Content analysis, a qualitative methodology, and computational linguistics, a quantitative methodology, were used to identify key words and phrases used by 9-1-1 callers to describe acute stroke victims. Because a caller's level of emotional distress contributes to the communication during a 9-1-1 call, the Emotional Content and Cooperation Score was scored by a multidisciplinary team. RESULTS A total of 110 9-1-1 calls, received between June and September 2013, were analyzed. EMDs recognized stroke in 48% of calls, and the emotional state of most callers (95%) was calm. In 77% of calls in which EMDs recognized stroke, callers specifically used the word "stroke"; however, the word "stroke" was used in only 38% of calls. Vague, non-specific words and phrases were used to describe stroke victims' symptoms in 55% of calls, and 45% of callers used distractor words and phrases suggestive of non-stroke emergencies. Focal neurologic symptoms were described in 39% of calls. Computational linguistics identified 9 key words that were more commonly used in calls where the EMD identified stroke. These words were concordant with terms identified through qualitative content analysis. CONCLUSIONS Most 9-1-1 callers used vague, non-specific, or distractor words and phrases and infrequently provide classic stroke descriptions during 9-1-1 calls for stroke. Both qualitative and quantitative methodologies identified similar key words and phrases associated with accurate EMD stroke recognition. This study suggests that tools incorporating commonly used words and phrases could potentially improve EMD stroke recognition.
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Ball SJ, Williams TA, Smith K, Cameron P, Fatovich D, O'Halloran KL, Hendrie D, Whiteside A, Inoue M, Brink D, Langridge I, Pereira G, Tohira H, Chinnery S, Bray JE, Bailey P, Finn J. Association between ambulance dispatch priority and patient condition. Emerg Med Australas 2016; 28:716-724. [PMID: 27592247 DOI: 10.1111/1742-6723.12656] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 05/03/2016] [Accepted: 07/11/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare chief complaints of the Medical Priority Dispatch System in terms of the match between dispatch priority and patient condition. METHODS This was a retrospective whole-of-population study of emergency ambulance dispatch in Perth, Western Australia, 1 January 2014 to 30 June 2015. Dispatch priority was categorised as either Priority 1 (high priority), or Priority 2 or 3. Patient condition was categorised as time-critical for patient(s) transported as Priority 1 to hospital or who died (and resuscitation was attempted by paramedics); else, patient condition was categorised as less time-critical. The χ2 statistic was used to compare chief complaints by false omission rate (percentage of Priority 2 or 3 dispatches that were time-critical) and positive predictive value (percentage of Priority 1 dispatches that were time-critical). We also reported sensitivity and specificity. RESULTS There were 211 473 cases of dispatch. Of 99 988 cases with Priority 2 or 3 dispatch, 467 (0.5%) were time-critical. Convulsions/seizures and breathing problems were highlighted as having more false negatives (time-critical despite Priority 2 or 3 dispatch) than expected from the overall false omission rate. Of 111 485 cases with Priority 1 dispatch, 6520 (5.8%) were time-critical. Our analysis highlighted chest pain, heart problems/automatic implanted cardiac defibrillator, unknown problem/collapse, and headache as having fewer true positives (time-critical and Priority 1 dispatch) than expected from the overall positive predictive value. CONCLUSION Scope for reducing under-triage and over-triage of ambulance dispatch varies between chief complaints of the Medical Priority Dispatch System. The highlighted chief complaints should be considered for future research into improving ambulance dispatch system performance.
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Affiliation(s)
- Stephen J Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Teresa A Williams
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia.,Discipline of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniel Fatovich
- Discipline of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia.,Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.,Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Kay L O'Halloran
- School of Education, Curtin University, Perth, Western Australia, Australia
| | - Delia Hendrie
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | | | - Madoka Inoue
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Deon Brink
- St John Ambulance (WA), Perth, Western Australia, Australia
| | - Iain Langridge
- St John Ambulance (WA), Perth, Western Australia, Australia
| | - Gavin Pereira
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Hideo Tohira
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Sean Chinnery
- St John Ambulance (WA), Perth, Western Australia, Australia
| | - Janet E Bray
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paul Bailey
- St John Ambulance (WA), Perth, Western Australia, Australia.,Emergency Medicine, St John of God Hospital Murdoch, Perth, Western Australia, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Discipline of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia
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Fukushima H, Panczyk M, Spaite DW, Chikani V, Dameff C, Hu C, Birkenes TS, Myklebust H, Sutter J, Langlais B, Wu Z, Bobrow BJ. Barriers to telephone cardiopulmonary resuscitation in public and residential locations. Resuscitation 2016; 109:116-120. [PMID: 27521469 DOI: 10.1016/j.resuscitation.2016.07.241] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 07/24/2016] [Accepted: 07/29/2016] [Indexed: 11/25/2022]
Abstract
AIM Emergency medical telecommunicators can play a key role in improving outcomes from out-of-hospital cardiac arrest (OHCA) by providing instructions for cardiopulmonary resuscitation (CPR) to callers. Telecommunicators, however, frequently encounter barriers that obstruct the Telephone CPR (TCPR) process. The nature and frequency of these barriers in public and residential locations have not been well investigated. The aim of this study is to identify the barriers to TCPR in public and residential locations. METHODS We conducted a retrospective study of audio recordings of EMS-confirmed OHCAs from eight regional 9-1-1 dispatch centers between January 2012 and December 2013. RESULTS We reviewed 1850 eligible cases (public location OHCAs: N=223 and residential location OHCAs: N=1627). Telecommunicators less frequently encountered barriers such as inability to calm callers in public than in residential locations (2.1% vs 8.5%, p=0.002) or inability to place victims on a hard flat surface (13.9% vs 25.4%, p<0.001). However, the barrier where callers were not with patients was more frequently observed in public than in residential locations (11.8% vs 2.7%, p<0.001). CONCLUSIONS This study revealed that barriers to TCPR are distributed differently across public and residential locations. Understanding these differences can aid in the development of strategies to enhance bystander CPR and improve overall patient outcomes.
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Affiliation(s)
- Hidetada Fukushima
- Arizona Department of Health Services, Bureau of EMS and Trauma System, 150 North 18th Avenue, Phoenix, AZ 85007, United States; University of Arizona, Department of Emergency Medicine, Arizona Emergency Medicine Research Center, 714 East Van Buren St, Phoenix, AZ 85006, United States; Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara 6348522, Japan.
| | - Micah Panczyk
- Arizona Department of Health Services, Bureau of EMS and Trauma System, 150 North 18th Avenue, Phoenix, AZ 85007, United States
| | - Daniel W Spaite
- University of Arizona, Department of Emergency Medicine, Arizona Emergency Medicine Research Center, 714 East Van Buren St, Phoenix, AZ 85006, United States
| | - Vatsal Chikani
- Arizona Department of Health Services, Bureau of EMS and Trauma System, 150 North 18th Avenue, Phoenix, AZ 85007, United States
| | - Christian Dameff
- University of Arizona College of Medicine Phoenix, 550 East Van Buren St, Phoenix, AZ 85004, United States; Maricopa Medical Center, 2601 East Roosevelt St, Phoenix, AZ 85008, United States
| | - Chengcheng Hu
- University of Arizona, Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, 1295 North, Martin Avenue, Tucson, AZ 85724, United States
| | - Tonje S Birkenes
- Laerdal Medical AS, Tanke Svilandsgate 30, N-4002 Stavanger, Norway
| | - Helge Myklebust
- Laerdal Medical AS, Tanke Svilandsgate 30, N-4002 Stavanger, Norway
| | - John Sutter
- University of Arizona College of Medicine Phoenix, 550 East Van Buren St, Phoenix, AZ 85004, United States
| | - Blake Langlais
- Arizona State University, School of Mathematical and Statistical Science, University Drive and Mill Avenue, Tempe, AZ 85287, United States
| | - Zhixin Wu
- Arizona Department of Health Services, Bureau of EMS and Trauma System, 150 North 18th Avenue, Phoenix, AZ 85007, United States; University of Arizona, Department of Emergency Medicine, Arizona Emergency Medicine Research Center, 714 East Van Buren St, Phoenix, AZ 85006, United States
| | - Bentley J Bobrow
- Arizona Department of Health Services, Bureau of EMS and Trauma System, 150 North 18th Avenue, Phoenix, AZ 85007, United States; University of Arizona, Department of Emergency Medicine, Arizona Emergency Medicine Research Center, 714 East Van Buren St, Phoenix, AZ 85006, United States; University of Arizona College of Medicine Phoenix, 550 East Van Buren St, Phoenix, AZ 85004, United States
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14
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Alfsen D, Møller TP, Egerod I, Lippert FK. Barriers to recognition of out-of-hospital cardiac arrest during emergency medical calls: a qualitative inductive thematic analysis. Scand J Trauma Resusc Emerg Med 2015; 23:70. [PMID: 26382934 PMCID: PMC4573479 DOI: 10.1186/s13049-015-0149-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 09/08/2015] [Indexed: 11/17/2022] Open
Abstract
Background The chance of surviving out-of-hospital cardiac arrest (OHCA) depends on early and correct recognition of cardiac arrest by the emergency medical dispatcher during the emergency call. When cardiac arrest is identified, telephone guided cardiopulmonary resuscitation (CPR) and referral to an automated external defibrillator should be initiated. Previous studies have investigated barriers to recognition of OHCA, and found the caller’s description of sign of life, the type of caller, caller’s emotional state, an inadequate dialogue during the emergency call, and patient’s agonal breathing as influential factors. Though many of these factors are included in the algorithms used by medical dispatchers, many OHCA still remain not recognised. Qualitative studies investigating the communication between the caller and dispatcher are very scarce. There is a lack of knowledge about what influences the dispatchers’ recognition of OHCA, focusing on the communication during the emergency call. The purpose of this study is to identify factors affecting medical dispatchers’ recognition of OHCA during emergency calls in a qualitative analysis of calls. Methods An investigator triangulated inductive thematic analysis of recordings of out-of-hospital cardiac arrest emergency calls from December 2012. Participants were the callers (bystanders) and the emergency medical dispatchers. Data were analysed using a hermeneutic approach. Results Based on the concept of data saturation, 13 recordings of not recognised cardiac arrest and 8 recordings of recognised cardiac arrests were analysed. Three main themes, six subthemes and an embedded theme emerged from the analysis: caller’s physical distance (caller near patient, caller not near patient), caller’s emotional distance (keeping calm, losing control), caller is a healthcare professional (responsibility is handed over to the caller, caller assumes responsibility), and the embedded theme: caller assesses the patient. Conclusion The physical and emotional proximity of the caller (bystander) as well as the caller’s professional background affect the dispatcher’s chances of correct recognition and handling of cardiac arrest. The dispatcher should acknowledge the triple roles of conducting patient assessment, instructing the caller, and reassuring the emotionally affected caller.
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Affiliation(s)
- David Alfsen
- Emergency Medical Services Copenhagen, The Capital Region of Denmark, Telegrafvej 5, 2750, Ballerup, Denmark.
| | - Thea Palsgaard Møller
- Emergency Medical Services Copenhagen, The Capital Region of Denmark, Telegrafvej 5, 2750, Ballerup, Denmark. .,University of Copenhagen, Faculty of Health and Medical Sciences, 2200, Copenhagen N, Denmark.
| | - Ingrid Egerod
- University of Copenhagen, Faculty of Health and Medical Sciences, 2200, Copenhagen N, Denmark. .,Rigshospitalet, Trauma Centre, HOC 3193, 2100, Copenhagen Ø, Denmark.
| | - Freddy K Lippert
- Emergency Medical Services Copenhagen, The Capital Region of Denmark, Telegrafvej 5, 2750, Ballerup, Denmark. .,University of Copenhagen, Faculty of Health and Medical Sciences, 2200, Copenhagen N, Denmark.
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15
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Lindström V, Heikkilä K, Bohm K, Castrèn M, Falk AC. Barriers and opportunities in assessing calls to emergency medical communication centre--a qualitative study. Scand J Trauma Resusc Emerg Med 2014; 22:61. [PMID: 25385311 PMCID: PMC4234828 DOI: 10.1186/s13049-014-0061-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 10/15/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Previous 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). AIM The aim of the study was to identify overall factors influencing the registered nurses' (RNs) assessment of calls to the EMCC. METHOD A qualitative study design was used; a purposeful selection of calls to the EMCC was analysed by content analysis. RESULTS One 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. CONCLUSION Barriers 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.
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Affiliation(s)
- Veronica Lindström
- Karolinska Institutet, Department of Clinical Science and Education Södersjukhuset and Academic EMS, Stockholm, Sweden.
| | - Kristiina Heikkilä
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden. .,Department of Health and Care Sciences, Faculty of Health and Life Sciences, Linneaus University, Kalmar, Sweden.
| | - Katarina Bohm
- Karolinska Institutet, Department of Clinical Science and Education and Section of Emergency Medicine Södersjukhuset, Stockholm, Sweden.
| | - Maaret Castrèn
- Karolinska Institutet, Department of Clinical Science and Education and Section of Emergency Medicine Södersjukhuset, Stockholm, Sweden.
| | - Ann-Charlotte Falk
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden.
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16
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Effect of a Medical Priority Dispatch System key question addition in the seizure/convulsion/fitting protocol to improve recognition of ineffective (agonal) breathing. Resuscitation 2008; 79:257-64. [DOI: 10.1016/j.resuscitation.2008.06.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 05/14/2008] [Accepted: 06/04/2008] [Indexed: 11/22/2022]
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Bohm K, Rosenqvist M, Hollenberg J, Biber B, Engerström L, Svensson L. Dispatcher-assisted telephone-guided cardiopulmonary resuscitation: an underused lifesaving system. Eur J Emerg Med 2007; 14:256-9. [PMID: 17823559 DOI: 10.1097/mej.0b013e32823a3cd1] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Our purpose with this investigation was to (i) estimate how often telephone-guided cardiopulmonary resuscitation was offered from emergency medical service dispatchers in Stockholm, (ii) study the willingness to perform cardiopulmonary resuscitation, and (iii) assess factors that could mislead the dispatcher in identifying the patient as a cardiac arrest victim. METHODS In this prospective study, 313 consecutive emergency calls of out-of-hospital cardiac arrest were obtained from the Swedish Cardiac Arrest Register. Seventy-six cases of out-of-hospital cardiac arrest fulfilled the inclusion criteria. All alarm calls were tape-recorded and analyzed according to a standardized protocol. RESULTS Dispatchers offered bystanders telephone instructions for cardiopulmonary resuscitation in 47% (n=36) of the cases and, among these, cardiopulmonary resuscitation instructions were given in 69% (n=25). Only 6% (n=2) of bystanders were not willing to perform cardiopulmonary resuscitation. Signs of breathing (suspected agonal breathing) were described in 45% of the cases. Cardiopulmonary resuscitation was offered to 23% (n=10) of patients with signs of breathing versus 92% (n=23) of those who were not breathing (P<0.001). CONCLUSIONS Despite the fact that the vast majority of bystanders are willing to take part in telephone-guided cardiopulmonary resuscitation, emergency medical service dispatchers offer telephone-guided cardiopulmonary resuscitation in about only half of cases. Signs of breathing (agonal breathing) are often mistaken for normal breathing and are a cause of delay in the diagnosis of cardiac arrest.
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Affiliation(s)
- Katarina Bohm
- Department of Cardiology, Department of Clinical Science and Education Karolinska Institutet, Södersjukhuset bSOS Alarm, Swedish.
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18
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Ma MHM, Lu TC, Ng JCS, Lin CH, Chiang WC, Ko PCI, Shih FY, Huang CH, Hsiung KH, Chen SC, Chen WJ. Evaluation of emergency medical dispatch in out-of-hospital cardiac arrest in Taipei. Resuscitation 2007; 73:236-45. [PMID: 17241736 DOI: 10.1016/j.resuscitation.2006.09.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Revised: 09/04/2006] [Accepted: 09/08/2006] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Emergency medical dispatchers are the entry points to the emergency medical services (EMS). The overall performances of the dispatchers are imperative determinants of the emergency medical services dispatching system. There is little data on the cultural and language impacts on emergency medical dispatch. OBJECTIVE This study examined the emotional content and cooperation score (ECCS) among Mandarin Chinese speaking callers for cardiac arrests, and evaluated the performances of emergency medical services dispatching system in Taipei. METHODS This retrospective, observational study examined dispatching audio recordings obtained from the Taipei City Fire Department Dispatching Center between January 2004 to April 2004. The tapes of call relating to adult (age >or=18 years), non-traumatic cases with a presumed or field diagnosis of out-of-hospital cardiac arrest (OHCA) underwent systemic review. The caller's ECCS and the dispatcher's performances, including interview skills, provision of telephone-assisted cardiopulmonary resuscitation (T-CPR), and dispatcher's ability to identify OHCA were examined. Interrater reliability for determining ECCS and interview skills were assessed using kappa statistic. RESULTS A total of 199 audio recordings were reviewed. A mean ECCS of 1.42+/-0.64 (95% CI: 1.33-1.51) demonstrated that most callers were emotionally stable and cooperative when calling for help, even when facing cardiac arrest patients. There was a good association between ECCS and the sex of the callers (male 1.32 versus female 1.49; p<0.05). In 82% of interviews, the interview skills of the dispatchers was high (4 or 5 points); while in one fifth the interview skills were suboptimal. About one third of the cases were provided with T-CPR by the dispatchers. The sensitivity and positive predictive value (PPV) for predicting OHCA by dispatchers were 96.9% and 97.9%, respectively. A kappa value of 0.65 and 0.68 were obtained for the interrater reliability of ECCS and interview skills. CONCLUSION Most callers were found to be emotional stable and cooperative with dispatcher's interrogations when calling for cardiac arrest victims in this Mandarin speaking population. The dispatchers have shown satisfactory interview skills in approaching emergency calls and a good ability to identify OHCA. There is a low rate of T-CPR offered to the callers in the investigation. Efforts should be made to address the deficiencies in order to maximise the function of the EMS.
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Affiliation(s)
- Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan
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Karlsten R, Elowsson P. Who calls for the ambulance: implications for decision support. A descriptive study from a Swedish dispatch centre. Eur J Emerg Med 2004; 11:125-9. [PMID: 15167169 DOI: 10.1097/01.mej.0000114640.63700.68] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The dispatcher plays a key role in allocating the right resource to patients in cases of medical emergency. In order to evaluate the performance of the dispatcher, it is necessary to analyse who is the caller, because this has an impact on the development of decision support systems. In the present study, all calls for an ambulance (n=565) during a one-week period at the dispatch centre in Uppsala, Sweden, were analysed with respect to the caller's relationship to the patient, the location of the caller, and the dispatcher's priority of the case. In emergencies, significantly fewer calls were made by the patients themselves, and significantly more callers had no relationship to the patient. In low priority cases most calls were made by healthcare providers. During a 2-week period we also analysed the physiological impairment of patients in cases dispatched as medical emergencies (n=595) by using the rapid acute physiological score. The rapid acute physiological score was significantly higher in the group dispatched as potentially life-threatening by the dispatcher compared with other emergencies. The study highlights the fact that dispatching often has to be carried out using second or third-hand information, and those patients prioritized as suffering from potentially life-threatening conditions have a more impaired physiological status.
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Affiliation(s)
- Rolf Karlsten
- Department of Anaesthesiology and Centre of Emergency Medicine, University Hospital, S-751 85 Uppsala, Sweden.
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20
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Wahlberg AC, Cedersund E, Wredling R. Factors and circumstances related to complaints in emergency medical dispatching in Sweden: an exploratory study. Eur J Emerg Med 2003; 10:272-8. [PMID: 14676503 DOI: 10.1097/00063110-200312000-00006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are 20 SOS Alarm emergency dispatch centres in Sweden, and from these centres approximately one million ambulances are dispatched each year. The aim of the study was to explore factors and circumstances that contributed to misjudgements or filed complaints in emergency medical dispatching filed at the Patient Advisory Committees (n=24), the Swedish National Board of Health and Welfare (n=20) and the Medical Responsibility Board (n=10). This is a retrospective study of all decisions on complaints made between 1991 and 2000, and the data were analysed in two phases. In the first phase, categories of cause were revealed, and in the second phase, factors and circumstances were identified that related to misjudgements or filed complaints. The findings show that in nearly half (23/54) of the complaints, the assessments were stated as been made on the basis of second-hand consultations, e.g. the SOS operators had not spoken directly to the ill person. In 19 out of 21 complaints dealing with the decision-making process, the assessments were made on second-hand information. Second-hand information may constitute an aggravating circumstance in assessing the urgency of the care needed on the telephone. The findings suggest that the call receivers should be more cautious when undertaking assessments on the basis of information provided by a third person.
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Bång A, Herlitz J, Martinell S. Interaction between emergency medical dispatcher and caller in suspected out-of-hospital cardiac arrest calls with focus on agonal breathing. A review of 100 tape recordings of true cardiac arrest cases. Resuscitation 2003; 56:25-34. [PMID: 12505735 DOI: 10.1016/s0300-9572(02)00278-2] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIM One of the objectives of this study was to assess the emergency medical dispatchers (EMDs) ability for the identification and prioritisation of cardiac arrest (CA) cases, and offering and achievements of dispatcher-assisted bystander cardiopulmonary resuscitation (CPR). The other objective was to give an account of the frequency of agonal respiration in cardiac arrest calls and the caller's descriptions of breathing. METHODS Prospective study evaluating 100 tape recordings of the EMD calls of emergency medical service (EMS)-provided advanced life support- (ALS) cases, of out-of-hospital cardiac arrest. RESULTS The quality of EMD-performed interviews was highly commended in 63% of cases, but insufficient or unapproved in the remaining 37%. The caller's state of mind was not a major problem for co-operation. Among the 100 cases, 24 were suspected to be unconscious and in respiratory arrest. A further 38 cases were presented as unconscious with abnormal breathing. In only 14 cases dispatcher-assisted bystander CPR was offered by the EMD, and in 11 of these it was attempted, and completed in eight. Only four of the cases were unconscious patients with abnormal breathing. The incidence of suspected agonal breathing was estimated to be approximately 30% and the descriptions were; difficulty, poorly, gasping, wheezing, impaired, occasional breathing. CONCLUSIONS Among suspected cardiac arrest cases, EMDs offer CPR instruction to only a small fraction of callers. A major obstacle was the presentation of agonal breathing. Patients with a combination of unconsciousness and agonal breathing should be offered dispatcher-assisted CPR instruction. This might improve survival in out-of hospital cardiac arrest.
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Affiliation(s)
- Angela Bång
- Department of Cardiology, Sahlgrenska University Hospital, SE-413 45, Göteborg, Sweden.
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Abstract
EMD will always remain somewhat of an imprecise science by nature. 911 is, after all, the access point for lifesaving assistance, and citizens must have absolute freedom to this service. The consequence of having the freedom to request help from any location at any time is that some individuals will use it for the wrong reasons. Present-day dispatchers must serve ever-broadening communities with multiple languages, cultural diversity, and unique health needs. Along with other essential personnel that make up the fabric of the public safety net, emergency medical dispatchers have now become essential to the provision of time-critical skills and compassion for perceived medical emergency.
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Affiliation(s)
- James V Dunford
- Department of Emergency Medicine, University of California, San Diego Medical Center, 200 West Arbor Drive, San Diego, CA 92103-8676, USA.
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