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A registry-based observational study comparing emergency calls assessed by emergency medical dispatchers with and without support by registered nurses
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Örebro University, School of Medical Sciences. Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Medical Sciences and Department of Emergency Medicine, Örebro University, Örebro, Sweden.ORCID iD: 0000-0003-3290-4111
Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden.
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Helsinki University, Helsinki, Finland; Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
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2022 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 30, no 1, article id 1Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The requirement concerning formal education for emergency medical dispatcher (EMD) is debated and varies, both nationally and internationally. There are few studies on the outcomes of emergency medical dispatching in relation to professional background. This study aimed to compare calls handled by an EMD with and without support by a registered nurse (RN), with respect to priority level, accuracy, and medical condition.

METHODS: A retrospective observational study, performed on registry data from specific regions during 2015. The ambulance personnel's first assessment of the priority level and medical condition was used as the reference standard. Outcomes were: the proportion of calls dispatched with a priority in concordance with the ambulance personnel's assessment; over- and undertriage; the proportion of most adverse over- and undertriage; sensitivity, specificity and predictive values for each of the ambulance priorities; proportion of calls dispatched with a medical condition in concordance with the ambulance personnel's assessment. Proportions were reported with 95% confidence intervals. χ2-test was used for comparisons. P-levels < 0.05 were regarded as significant.

RESULTS: A total of 25,025 calls were included (EMD n = 23,723, EMD + RN n = 1302). Analyses relating to priority and medical condition were performed on 23,503 and 21,881 calls, respectively. A dispatched priority in concordance with the ambulance personnel's assessment were: EMD n = 11,319 (50.7%) and EMD + RN n = 481 (41.5%) (p < 0.01). The proportion of overtriage was equal for both groups: EMD n = 5904, EMD + RN n = 306, (26.4%) p = 0.25). The proportion of undertriage for each group was: EMD n = 5122 (22.9%) and EMD + RN n = 371 (32.0%) (p < 0.01). Sensitivity for the most urgent priority was 54.6% for EMD, compared to 29.6% for EMD + RN (p < 0.01), and specificity was 67.3% and 84.8% (p < 0.01) respectively. A dispatched medical condition in concordance with the ambulance personnel's assessment were: EMD n = 13,785 (66.4%) and EMD + RN n = 697 (62.2%) (p = 0.01).

CONCLUSIONS: A higher precision of emergency medical dispatching was not observed when the EMD was supported by an RN. How patient safety is affected by the observed divergence in dispatched priorities is an area for future research.

Place, publisher, year, edition, pages
BioMed Central, 2022. Vol. 30, no 1, article id 1
Keywords [en]
Emergency Medical Communication Center, Emergency medical dispatch, Emergency medical dispatcher, Emergency medical services, Pre-hospital triage, Registered nurse
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:oru:diva-96412DOI: 10.1186/s13049-021-00987-yISI: 000741023200002PubMedID: 35012595Scopus ID: 2-s2.0-85122755121OAI: oai:DiVA.org:oru-96412DiVA, id: diva2:1626978
Funder
The Karolinska Institutet's Research FoundationSwedish Research Council, 20190939Available from: 2022-01-12 Created: 2022-01-12 Last updated: 2024-01-17Bibliographically approved

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