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Association between Patient Unconscious or Not Alert Conditions and Cardiac Arrest or High-Acuity Outcomes within the Medical Priority Dispatch System “Falls” Protocol

Published online by Cambridge University Press:  28 June 2012

Jeff Clawson ,
Christopher Olola ,
Greg Scott ,
Bryon Schultz ,
Richard Pertgen ,
Don Robinson ,
Barry Bagwell  and
Brett Patterson
Jeff Clawson*
Affiliation:
International Academies of Emergency Dispatch, Salt Lake City, Utah, USA
Christopher Olola
Affiliation:
International Academies of Emergency Dispatch, Salt Lake City, Utah, USA Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
Greg Scott
Affiliation:
International Academies of Emergency Dispatch, Salt Lake City, Utah, USA
Bryon Schultz
Affiliation:
Emergency Medical Services Authority, Oklahoma City, Oklahoma, USA
Richard Pertgen
Affiliation:
Richmond Ambulance Authority, Richmond, Virginia, USA
Don Robinson
Affiliation:
Mecklenburg Emergency Medical Services Agency (MEDIC), Charlotte, North Carolina, USA
Barry Bagwell
Affiliation:
Mecklenburg Emergency Medical Services Agency (MEDIC), Charlotte, North Carolina, USA
Brett Patterson
Affiliation:
International Academies of Emergency Dispatch, Salt Lake City, Utah, USA
*
International Academies of Emergency Dispatch, 139 East South Temple, Suite 200, Salt Lake City, Utah 84111, USA E-mail: jeff.clawson@emergencydispatch.org
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Abstract

Introduction:

Falls are one of the most common types of complaints received by 9-1-1 emergency medical dispatch centers. They can be accidental or may be caused by underlying medical problems. Though not alert” falls patients with severe outcomes mostly are “hot” transported to the hospital, some of these cases may be due to other acute medical events (cardiac, respiratory, circulatory, or neurological), which may not always be apparent to the emergency medical dispatcher (EMD) during call processing.

Objectives:

The objective of this study was to characterize the risk of cardiac arrest and “hot-transport” outcomes in patients with “not alert” condition, within the Medical Priority Dispatch System (MPDS®) Falls protocol descriptors.

Methods:

This retrospective study used 129 months of de-identified, aggregate, dispatch datasets from three US emergency communication centers. The communication centers used the Medical Priority Dispatch System version 11.3–OMEGA type (released in 2006) to interrogate Emergency Medical System callers, select dispatch codes assigned to various response configurations, and provide pre-arrival instructions. The distribution of cases and percentages of cardiac arrest and hot-transport outcomes, categorized by MPDS® code, was profiled. Assessment of the association between MPDS® Delta-level 3 (D-3) “not alert” condition and cardiac arrest and hot-transport outcomes then followed.

Results:

Overall, patients within the D-3 and D-2 “long fall” conditions had the highest proportions (compared to the other determinants in the “falls” protocol) of cardiac arrest and hot-transport outcomes, respectively. “Not alert” condition was associated significantly with cardiac arrest and hot-transport outcomes (p < 0.001).

Conclusions:

The “not alert” determinant within the MPDS® “fall” protocol was associated significantly with severe outcomes for short falls (<6 feet; 2 meters) and ground-level falls. As reported to 9-1-1, the complaint of a “fall” may include the presence of underlying conditions that go beyond the obvious traumatic injuries caused by the fall itself.

Keywords

automated medical records systemcardiac arrestemergency medical servicesdispatch outcomesfallshigh acuitypatient outcome assessmentsprehospital emergency careunconsciousness
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 4 , August 2010 , pp. 302 - 308
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

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