Hostname: page-component-77c89778f8-sh8wx Total loading time: 0 Render date: 2024-07-16T11:39:16.475Z Has data issue: false hasContentIssue false
  • English
  • Français

Profile of Emergency Medical Dispatch Calls for Breathing Problems within the Medical Priority Dispatch System Protocol

Published online by Cambridge University Press:  28 June 2012

Jeff Clawson ,
Christopher Olola ,
Andy Heward ,
Brett Patterson  and
Greg Scott
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
Andy Heward
Affiliation:
London Ambulance Service NHS Trust, London UK
Brett Patterson
Affiliation:
International Academies of Emergency Dispatch, Florida USA
Greg Scott
Affiliation:
International Academies of Emergency Dispatch, Salt Lake City, Utah USA
*
International Academies of Emergency Dispatch139 East South Temple, Suite 200Salt Lake City, Utah 84111USA E-mail: jeff.clawson@emergencydispatch.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

A common chief complaint to emergency dispatch communication centers worldwide is “breathing problems”. The chief complaint of breathing problems represents a wide spectrum of underlying diseases, patient conditions, and onset types. The current debate is on the potential ability of a dispatch protocol to safely and with high specificity, differentiate patients with minor or non-critical conditions from those conditions that pose risk to the patient and require advanced life support evaluation and care. This issue also has extended into the paramedic prehospital evaluation realm.

Objective:

The objective of this study was to describe the distribution of Medical Priority Dispatch System (MPDS) codes representing the spectrum of clinical descriptions within the breathing problems chief complaint and their associated outcomes, at the scene and during transport, as determined by [UK] paramedics.

Methods:

A retrospective, one-year study (September 2005 to August 2006) of a de-identified aggregate dataset from the London Ambulance Service (LAS) Trust was evaluated. A profile of the distribution of calls, incidents, patients, and outcomes (cardiac arrest [CA] and blue-in [BI] high acuity i.e., patients transported with lights and siren based on paramedic protocol) for the breathing problems chief complaint was evaluated.Odds ratios and 95% confidence intervals (CI) were used to quantify associations between the MPDS priority level's concurrent asthmatic conditions and outcomes. Two-sided Fisher's exact p-values were obtained to determine statistically significant associations, at a level of 0.05.

Results:

Sixteen percent (95,848/599,093) of all the patients were classified under the breathing problems chief complaint.Of these 95,848 patients,367 (0.38%) were CA outcomes, and 7.82% (n = 7,493) were BI outcomes.The Cardiac Arrest Quotient (i.e., the number of CA cases as a percentage of the number of patients) for the ECHO priority level was 46 times higher than was that of non-ECHO priority levels: DELTA and CHARLIE (17.05% vs. 0.37%). Asthmatics were associated with CA outcome (OR(95%CI): 0.60(0.47, 0.77), p <0.001), but not with BI outcome.

Conclusions:

The MPDS coding yielded a richer mix of severe outcomes in the higher priority levels. The Severe Respiratory Distress coding had the greatest number of patients and severe outcomes. Future studies that help refine the Severe Respiratory Distress code in the MPDS by more specific subgroups of patients would be beneficial.

Keywords

0-0-0 calls1-1-2 calls9-1-1 calls9-9-9 callsbreathing problemscardiac arrestcardiac arrest quotientdispatch codingdispatch systemhigh acuitymedical priority dispatch protocolsensitivitysevere respiratory distressspecificity
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 23 , Issue 5 , October 2008 , pp. 412 - 419
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Clawson, J. ProQA Report coding statistics. (Unpublished data).Google Scholar
2.Feldman, MJ, Verbeek, PR, Lyon, G, Chad, SJ, Craig, AM, Schwartz, B: Comparison of the Medical Priority Dispatch System to an out-of-hospital patient acuity score. Acad Emerg Med 2006;13(9):954–960.Google Scholar
3.Ackerman, R, Waldron, RL: Difficulty breathing: Agreement of paramedic and emergency physician diagnoses. Prehosp Emerg Care 2006;10(1):77–80.CrossRefGoogle ScholarPubMed
4.Clawson, JJ, Dernocoeur, KB: Principles of Emergency Medical Dispatch. 3rd ed. Salt Lake City, UT: Priority press; 2006:6.33–6.37.Google Scholar
5. The International Academies of Emergency Dispatch (IAED): Emergency Medical Dispatch (EMD) v11.2 UKE-ω Protocol. Advanced Medical Priority Dispatch System (AMPDS)®. 2006.Google Scholar
6.London Ambulance Services NHS Trust: CAS MEET Blue Call System, London Ambulance Service NHS Trust Central Ambulance Control Training Department–Training Brief, 2002.Google Scholar
7.Brown, R, Warwick, J: Blue calls–Time for a change? Emerg Med J 2001;18(4):289–292.CrossRefGoogle ScholarPubMed
8.Clawson, J, Olola, C., Heward, A, Patterson, B: Cardiac arrest predictability in seizure patients based on emergency medical dispatcher identification of previous seizure or epilepsy history. Resuscitation 2007;75(2):298–304.CrossRefGoogle ScholarPubMed
9.Clawson, J, Olola, C., Heward, A, Patterson, B, Scott, G: Ability of the Medical Priority Dispatch System protocol to predict acuity of “unknown problem” dispatch response levels. Prehosp Emerg Care 2008;12(3):290–296.CrossRefGoogle ScholarPubMed
10.Clawson, J: Manhunt! Improve AED Response: Helping Police Enrich “The Cardiac Arrest Quotient”.The National Center for Early Defibrillation from the special educational supplement, “The Life You Save…Community Defibrillation Programs and the Public Safety Responder” February, 2002.Google Scholar
11.Clawson, J, Olola, C.H, Heward, A, Scott, G, Patterson, B: Accuracy of emergency medical dispatchers' subjective ability to identify when higher dispatch levels are warranted over a Medical Priority Dispatch System automated protocol's recommended coding based on paramedic outcome data. Emerg Med J 2007;24(8):560–563.CrossRefGoogle Scholar
12.NHS Executive Committee: Review of ambulance performance standards; Final report of steering group. HMSO. London; 1996.Google Scholar
13.Clawson, J, Cady, G, Martin, R, Sinclair, R: Effect of a comprehensive quality management process on compliance with protocol in an emergency medical dispatch center. Ann Emerg Med 1998;32:578–584.CrossRefGoogle Scholar
14.Hinchey, P, Myers, B, Zalkin, J, Lewis, R, Garner, D Jr. : Low acuity EMS dispatch criteria can reliably identify patients without high-acuity illness or injury. Prehosp Emerg Care 2007;11(1):42–48.CrossRefGoogle ScholarPubMed
15. International Academy of Emergency Medical Dispatch (IAED): The 20 Points of accreditation. Revised, 2000. National Academies of Emergency Dispatch Web site. Available at: http://www.emergencydispatch.org/acc_20 points.php?a=accHome&b=acc20Points. Accessed 10 April 2008.Google Scholar
16. International Academy of Emergency Medical Dispatch (IAED): Accreditation Approved Compliance Score Minimums, 1992. National Academies of Emergency Dispatch Web site.Available at: http://www.emergencydispatch. org/acc_20points.php?a=accHome&b=acc20Points. Accessed 10 April 2008.Google Scholar
17.Clawson, J, Olola, C., Scott, G, Heward, A, Patterson, B: 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 July 23 [Epub ahead of print].CrossRefGoogle Scholar