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51 Evaluation of ambulance dispatch when two triage scales are used in the pre-hospital system
  1. Veronica Lindström1,2,
  2. Blake Langlais3,
  3. Glenn Larsson4,5,
  4. Lizbet Todorova6,
  5. Katarina Bohm2,7
  1. 1Karolinska Institutet, Department of neurobiology, care sciences and society, Division of nursing and Academic EMS in Stockholm, Sweden
  2. 2Karolinska Institutet, Department of clinical science and education, Södersjukhuset
  3. 3Phoenix, Arizona, USA
  4. 4Department of Ambulance and Prehospital Care, Region Halland, Sweden
  5. 5Department of Orthopaedics, Lund University, Sweden
  6. 6Region Skåne Prehospital Unit, Region Skåne, Sweden
  7. 7Department of Emergency medicine, Södersjukhuset, Stockholm

Abstract

Aim Most of the Emergency medical communication centres (EMCC) in Sweden uses the criteria based dispatch protocol (CBD), Medical Index1 which has three levels of priority. In the ambulance service, RETTS (Rapid Emergency Triage and Treatment System)2 is used and consists of four levels. This study evaluates the accuracy of dispatching ambulances, by evaluating the feedback sent from the ambulance crew after the first evaluation of the patients’ severity and condition.

Method This is a retrospective study from October 2014 to June 2015. Sensitivity and specificity were used to estimate the agreement of assessed priority levels between ambulance priority Red to EMCC priority 1. The priority level assessed by ambulance crew was considered the ‘gold standard.’ Over and under triage was described for the six most frequent conditions assessed.

Results There were 66 983 missions during the study period. Sensitivity for detecting highest priority indicated 67.1% correctly identified (95% confidence interval (CI): 65.6 to 68.7) and specificity indicated 61.8% of non-highest priority missions not dispatched as priority 1 (95% CI: 61.2 to 62). Consistency of condition between EMCC and ambulance for the six most common dispatched assignments was: chest pain 82%, minor injuries 81%, stroke 78%, breathing difficulties 74%, abdomen 71%, and undefined problems 29%. The rate of over- and under triage for highest priority was 33.49% and 4.02% respectively.

Conclusion Compared to the first evaluation of the patients’ severity and condition by the ambulance crew, EMCC assessment had moderate sensitivity and specificity. The lack of universal metrics is a limitation when concluding dispatch accuracy.

References

  1. . Andersen MS, Johnsen SP, Sørensen JN, Jepsen SB, Hansen JB, Christensen EF. Implementing a nationwide criteria-based emergency medical dispatch system: A register-based follow-up study. Scand J Trauma Resusc Emerg Med2013;21:53.

  2. . Predicare. Rapid Emergency Triage and Treatment System (REETS ): Predicare AB. [Available from: http://predicare.se/en/].

Conflict of interest None

Funding None

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-EMS.51

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