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Accuracy of a Priority Medical Dispatch System in Dispatching Cardiac Emergencies in a Suburban Community

  • Michael J. Reilly (a1)

Abstract

Introduction:

Over-triage of patients by emergency medical services (EMS) dispatch is thought to be an acceptable alternative to under-triage, which may delay how quickly life-saving care reaches a patient. Previous studies have looked at advanced life support (ALS) misutilization in urban- and county-based EMS systems and have attempted to analyze how dispatch methods either contribute to or alleviate this problem.1–5

Objective:

The purpose of this study is to assess the relationship between dispatches of a cardiac nature in a Medical Priority Dispatch (MPD) system, and the actual clinical diagnosis as determined by an emergency department physician.

Methods:

Calls for emergency medical assistance in a suburban community outside of a major metropolitan area were surveyed over a three-month period. Medical Priority Dispatch protocols determined that 104 of these calls were cardiac-related. Of these emergency calls, 56 (53.8%) patients were transported to the local community hospital and treated by the emergency physician. A retrospective review of the medical records was conducted to determine whether the patient had a cardiac-related discharge diagnosis from the emergency department.

Results:

Sixteen (28.6%) of the patients in this cohort were diagnosed with a cardiac-related condition upon discharge from the emergency department. Forty (71.4%) were diagnosed with a non-cardiac-related condition. The positive, predictive value of the dispatch protocol for the detection of an actual cardiac emergency in this EMS system was 28.6%.

Conclusion:

In this suburban community, the MPD system may over-triage emergency medical responses to cardiac emergencies. This can result in the only ALS (paramedic) unit in the community being unavailable in certain situations. Future studies should be conducted to determine what level (in any) of over-triage is appropriate in EMS systems using a MPD system.

Copyright

Corresponding author

Correspondence:Michael J.Reilly, MPH,NREMT-P Columbia University 722 W. 186th Street, 10th Floor New York, NY 10032 USA E-mail: mr2381@columbia.edu

References

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1Bailey, ED, O'Connor, RE, Ross, RW: The use of emergency medical dispatch protocols to reduce the number of inappropriate scene responses made by advanced life support personnel. Prehosp Emerg Care 2000;4:186189.
2Palumbo, L, Kubincanek, J, Emerman, C., et al. : Performance of a system to determine EMS dispatch priorities. Am J Emerg Med 1996;((14)4:388390.
3Dale, J, Higgins, J, Williams, S, et al. : Computer assisted assessment and advice for “non-serious” 999 ambulance service callers: The potential impact on ambulance dispatch. Emerg Med J 2003;20:178183.
4Neely, KW, Eldurkar, JA, Drake, MER: Do emergency medical services dispatch nature and severity codes agree with paramedic field findings? Acad Emerg Med 2000;7:174180.
5Neely, KW, Norton, RL, Schmidt, TA: The strength of specific EMS dispatcher questions for identifying patients with important clinical field findings. Prehosp Emerg Care 2000;4:322326.
6Richards, JR, Ferrall, SJ: Inappropriate use of emergency medical services transport: Comparison of provider and patient perspectives. Acad Emerg Med 1999;6:1420.

Keywords

Accuracy of a Priority Medical Dispatch System in Dispatching Cardiac Emergencies in a Suburban Community

  • Michael J. Reilly (a1)

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