Ambulance dispatch of older patients following primary and secondary telephone triage in metropolitan Melbourne, Australia: a retrospective cohort study

Abstract

BackgroundMost calls to ambulance result in emergency ambulance dispatch (direct dispatch) following primary telephone triage. Ambulance Victoria uses clinician-led secondary telephone triage for patients identified as low-acuity during primary triage to refer them to alternative care pathways; however, some are returned for ambulance dispatch (secondary dispatch). Older adult patients are frequent users of ambulance services; however, little is known about the appropriateness of subsequent secondary dispatches.ObjectivesTo examine the appropriateness of secondary dispatch through a comparison of the characteristics and ambulance outcomes of older patients dispatched an emergency ambulance via direct or secondary dispatch.DesignA retrospective cohort study of ambulance patient data between September 2009 and June 2012 was conducted.SettingThe secondary telephone triage service operated in metropolitan Melbourne, Victoria, Australia during the study period.ParticipantsThere were 90 086 patients included aged 65 years and over who had an emergency ambulance dispatch via direct or secondary dispatch with one of the five most common secondary dispatch paramedic diagnoses.Main outcome measuresDescriptive analyses compared characteristics, treatment and transportation rates between direct and secondary dispatch patients.ResultsThe dispatch groups were similar in demographics, vital signs and hospital transportation rates. However, secondary dispatch patients were half as likely to be treated by paramedics (OR 0.51; CI 0.48 to 0.55; p<0.001). Increasing age was associated with decreasing treatment (p<0.005) and increasing transportation rates (p<0.005).ConclusionSecondary triage could identify patients who would ultimately be transported to an emergency department. However, the lower paramedic treatment rates suggest many secondary dispatch patients may have been suitable for referral to alternative low-acuity transport or referral options.

Evaluation of a training program for emergency medical service physician dispatchers to reduce emergency departments visits

“…Alternatives could be considered by using secondary triage by community nurses or trained paramedics to perform a clinical assessment before transfer to the ED 42 . Indeed, in our study, more than half of the patients were transported by private ambulance, and it has been shown that training of paramedics and secondary triage after assessment could limit referrals to the ED 43,44 . Our study emphasized the importance of reinforcing primary care, particularly for older patients with numerous comorbidities (polymedication, cardiovascular comorbidity, fall‐related injury) for whom the risk of hospital‐acquired complications is highest and may be exacerbated in the busy context of the EDs 45…”

“…42 Indeed, in our study, more than half of the patients were transported by private ambulance, and it has been shown that training of paramedics and secondary triage after assessment could limit referrals to the ED. 43,44 Our study emphasized the importance of reinforcing primary care, particularly for older patients with numerous comorbidities (polymedication, cardiovascular comorbidity, fallrelated injury) for whom the risk of hospital-acquired complications is highest and may be exacerbated in the busy context of the EDs. 45 To our knowledge, no previous study to date has investigated the training of medical dispatchers in conjunction with geriatricians to improve the dispatch procedure of older patients.…”

Differences between the dispatch priority assessments of emergency medical dispatchers and emergency medical services: a prospective register-based study in Finland

“…A/B dispatch: EMS dispatch with lights and siren. C/D dispatch: EMS dispatch without lights and siren 1 SpO2 < 95% for which the patient received bronchodilators; convulsion for which the patient received an anticonvulsant; allergic reaction for which the patient received epinephrine; any airway management, CPR or blood glucose < 4 for which the patient received IV glucose; SpCO > 5 for which the patient received oxygen; or overdosage or poisoning for which the patient received an antidote A/B dispatch and the patient did not receive any significant treatment 1 and was not transported with A/B priority C/D dispatch and no transport but the patient received significant treatment 1 C/D dispatch and transportation with A/B priority the Emergency Department if transported, transportation code and priority or non-transportation code. These records were then collected into a Microsoft Excel ® table to which the research assistants manually inputted additional data from the patient's EMS records (i.e., the patient's medical history, vital signs, and any treatment received), which were validated by the authors TS and KK.…”

“…Author details 1 Tampere University of Applied Sciences, Kuntokatu 3, 33520 Tampere, Finland. 2 Centre for Prehospital Emergency Care, Emergency Medical Services, Wellbeing Services County of Pirkanmaa, Satakunnankatu 16, 33100 Tampere, Finland.…”

“…Over the last few decades, the demand for emergency medical services (EMSs) has risen in many developed countries [1][2][3]. However, high non-conveyance rates and other measures suggest a possibly considerable over-triage in the dispatch of the EMS [4].…”