Evaluating a training intervention for improving alignment between emergency medical telephone operators and callers: a pilot study of communication behaviours

Where Trouble Starts: Communication Breakdown in a Complex Emergency Call

Emergency calls require efficient communication between caller and call taker to establish a need for assistance and dispatch help quickly. Analyzing communication processes at this first link in the emergency medical care chain has important implications for improving the quality of emergency care across the health system. This paper examines an interaction between a call taker and a caller requesting assistance at the scene of a family murder, using a hybrid interactional sociolinguistic approach to analysis. We also draw from court testimony. We demonstrate how several factors contribute to communication breakdown, prolong the call, and lead to the call taker doubting the credibility of the emergency. These include the caller's inability to frame a believable request for help nor clarify his stance concerning the emergency, an absence of urgency and emotion in his description of the incident, an extended focus on and repair of the incident location, and his dysfluent speech behaviors. We demonstrate how communication breakdown is co-constructed and compounded by system-related trouble. This call has useful implications for call-taker training and highlights that when an interaction goes wrong, it has a cascading effect on health care not only for those patients who need the help urgently but also for the efficient running of the health system as a whole.

Can video streaming improve first aid for injured patients? A prospective observational study from Norway

BACKGROUND

Video streaming in emergency medical communication centers (EMCC) from caller to medical dispatcher has recently been introduced in some countries. Death by trauma is a leading cause of death and injuries are a frequent reason to contact EMCC. We aimed to investigate if video streaming is associated with recognition of a need for first aid during calls regarding injured patients and improve quality of bystander first aid.

METHODS

A prospective observational study including patients from three health regions in Norway, from November 2021 to February 2023 (registered in clinical trials 10/25/2021, NCT05121649). Cases where video streaming had been used as a supplement during the medical emergency call were compared to cases where video streaming was not used during the call. Patients were included by ambulance personnel on the scene of accident if they met the following criteria: 1. Ambulance personnel arrived at a patient who had an injury, 2. One or more bystanders had been present before their arrival, 3. One or more of the following first aid measures had been performed by bystander or should have been performed: airway management, control of external bleeding, recovery position, and hypothermia prevention. Ambulance personnel assessed quality of first aid performed by bystander, and information concerning use of video streaming and patient need for first aid measures recognized by dispatcher was collected through EMCC audio logs and patient charts. We present descriptive data and results from a logistic regression analysis.

RESULTS

Data was collected on 113 cases, and dispatchers used video streaming in addition to standard telephone communication in 12/113 (10%) of the cases. The odds for the dispatcher to recognize a need for first aid during a medical emergency call were more than five times higher when video streaming was used compared to no use of video streaming (OR 5.30, 95% CI 1.11-25.44). Overall quality of bystander first aid was rated as "high". The odds ratio for the patient receiving first aid of higher quality were 1.82 (p-value 0.46) when video streaming was used by dispatcher during the call.

CONCLUSION

Our findings show that video streaming is not frequently used by dispatchers in calls regarding patients with injuries, but that video streaming is associated with improved recognition of patients' first aid needs. We found no statistically significant difference in first aid quality comparing the calls where video streaming as a supplement were used with the calls with audio only.

The barriers and facilitators to initiation of telephone-assisted bystander cardiopulmonary resuscitation for patients experiencing out-of-hospital cardiac arrest in a private emergency dispatch centre in South Africa

Background

The incidence of cardiovascular diseases, and with it out-of-hospital cardiac arrest (OHCA), is on the increase in low- to middle-income countries (LMICs), like South Africa. Interventions such as mass public cardiopulmonary resuscitation (CPR) training campaigns and public access defibrillators are expensive and out of reach for many LMICs. Telephone-assisted CPR (tCPR) is a cost-effective, scalable alternative. This study explored the barriers and facilitators to tCPR uptake in OHCA in a private South African emergency dispatch centre.

Methods

This qualitative study applied inductive dominant content analysis to emergency call recordings of OHCA cases into a private emergency dispatch centre. Calls were analysed to the latent level to identify barriers and facilitators. Cases were sampled randomly, until data saturation.

Results

Saturation occurred after the analysis of 25 recordings. A further three recordings were analysed to confirm saturation of the facilitators; yielding a final sample size of 28 calls. Overall, t-CPR was offered in 23 (82.1%) cases, but only initiated in 8 (34.8%) of these calls. Five barriers ("Poor Communication"; "Lack of Support"; "Caller Hesitance or Uncertainty;" "Emotionality"; and "Practical Barriers") and three facilitators ("Caller Willingness"; "Support" and "CPR in Progress") were extracted.

Conclusion

Numerous barriers limit the initiation of tCPR in the South African private sector EMS. It is crucial to address these barriers and leverage the facilitators in order to improve tCPR uptake. This study highlights the importance of using specific language techniques and developing tailored tCPR algorithms to overcome these barriers, which is underpinned by standardised training of call-takers.

Identifying patients at imminent risk of out-of-hospital cardiac arrest during the Emergency Medical call: The views of call-takers

Introduction

There is little research on the triage of patients who are not yet in cardiac arrest when the emergency call is initiated, but who deteriorate and suffer a cardiac arrest during the prehospital phase of care. The aim of this study was to investigate Emergency Operation Centre staff views on ways to improve the early identification of patients who are at imminent risk of cardiac arrest, and the barriers to achieving this.

Methods

A qualitative interview and focus group study was conducted in two large Emergency Medical Services in England, United Kingdom. Twelve semi-structured interviews and one focus group were completed with Emergency Operations Centre staff. Data were analysed using reflexive thematic analysis.

Results

Three main themes were identified: The dispatch protocol and call-taker audit; Identifying and responding to deteriorating patients; Education, knowledge and skills. Barriers to recognising patients at imminent risk of cardiac arrest include a restrictive dispatch protocol, limited opportunity to monitor a patient, compliance auditing and inadequate education. Clinician support is not always optimal, and a lack of patient outcome feedback restricts dispatcher learning and development. Suggested remedies include improvements in training and education (call-takers and the public), software, clinical support and patient outcome feedback.

Conclusions

Emergency Operation Centre staff identified a multitude of ways to improve the identification of patients who are at imminent risk of out-of-hospital cardiac arrest during the Emergency Medical Service call. Suggested areas for improvement include education, triage software, clinical support redesign and patient outcome feedback.