Fusion of dispatching centres into one entity: effects on performance

Määttä, Teuvo; Kuisma, Markku; Väyrynen, Taneli; Nousila-Wiik, Maria; Porthan, K.; Boyd, James; Kuosmanen, J.; Räsänen, Pirjo

doi:10.1111/j.1399-6576.2010.02243.x

Cited by 12 publications

(11 citation statements)

References 18 publications

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“…This result is in concordance with a previous study which showed that a well-trained and functioning EMCC is able to detect high-risk patients who require highest-priority [7]. However Määttä and colleagues conclude that the EMCC organization reform in Finland did not affect the accuracy of assessing potentially life-threatening conditions [5]. The varying results between our studies may be caused by the fact that different variables were used to evaluate the organization changes.…”

Section: Discussionsupporting

confidence: 91%

“…The public media and local EMS organizations discussed whether the new EMCC organization was worse for the patient and they argued that there was a risk that patients would not get an ambulance when needed. A recently published study by Määttä and colleagues describes that the EMCC organization reform in Finland had negative effects on the appropriate use of ambulances, and the reform caused prolongation in the answering and processing times of emergency calls in Helsinki, the capital of Finland [5]. …”

Section: Introductionmentioning

confidence: 99%

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Implementation of a new emergency medical communication centre organization in Finland - an evaluation, with performance indicators

Lindström

Pappinen

Falk

et al. 2011

Scand J Trauma Resusc Emerg Med

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BackgroundThere is a great variety in how emergency medical communication centers (EMCC) are organized in different countries and sometimes, even within countries. Organizational changes in the EMCC have often occurred because of outside world changes, limited resources and the need to control costs, but historically there is often a lack of structured evaluation of these organization changes. The aim of this study was to evaluate if the performance in emergency medical dispatching changed in a smaller community outside Helsinki after the emergency medical call centre organization reform in Finland.MethodsA retrospective observational study was conducted in the EMCC in southern Finland. The data from the former system, which had municipality-based centers, covered the years 2002-2005 and was collected from several databases. From the new EMCC, data was collected from January 1 to May 31, 2006. Identified performance indicators were used to evaluate and compare the old and new EMCC organizations.ResultsA total of 67 610 emergency calls were analyzed. Of these, 54 026 were from the municipality-based centers and 13 584 were from the new EMCC. Compared to the old municipality-based centers the new EMCC dispatched the highest priority to 7.4 percent of the calls compared to 3.6 percent in the old system. The high priority cases not detected by dispatchers increased significantly (p < 0.001) in the new EMCC organization, and the identification rate of unexpected deaths in the dispatched ambulance assignments was not significantly (p = 0.270) lower compared to the old municipality-based center data.ConclusionAfter implementation of a new EMCC organization in Finland the percentage and number of high priority calls increased. There was a trend, but no statistically significant increase in the emergency medical dispatchers' ability to detect patients with life-threatening conditions despite structured education, regular evaluation and standardization of protocols in the new EMCC organization.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Implementation of a new emergency medical communication centre organization in Finland - an evaluation, with performance indicators

Lindström

Pappinen

Falk

et al. 2011

Scand J Trauma Resusc Emerg Med

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“…In 2006, Finland implemented a nationwide standardization of the EMCCs. However, it has been previously reported that this change did not improve the accuracy of risk assessment as evaluated by correct recognition of cardiac arrest, stroke, and STEMI patients in one of the regional dispatch centres [17]. This fact further highlights the need for focused studies to re-evaluate the current protocol.…”

Section: Discussionmentioning

confidence: 97%

Medical priority dispatch codes—comparison with National Early Warning Score

Hoikka

Länkimäki

Silfvast

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundIn Finland, calls for emergency medical services are prioritized by educated non-medical personnel into four categories—from A (highest risk) to D (lowest risk)—following a criteria-based national dispatch protocol. Discrepancies in triage may result in risk overestimation, leading to inappropriate use of emergency medical services units and to risk underestimation that can negatively impact patient outcome. To evaluate dispatch protocol accuracy, we assessed association between priority assigned at dispatch and the patient’s condition assessed by emergency medical services on the scene using an early warning risk assessment tool.MethodsUsing medical charts, clinical variables were prospectively recorded and evaluated for all emergency medical services missions in two hospital districts in Northern Finland during 1.1.2014–30.6.2014. Risk assessment was then re-categorized as low, medium, or high by calculating the National Early Warning Score (NEWS) based on the patients’ clinical variables measured at the scene.ResultsA total of 12,729 emergency medical services missions were evaluated, of which 616 (4.8%) were prioritized as A, 3193 (25.1%) as B, 5637 (44.3%) as C, and 3283 (25.8%) as D. Overall, 67.5% of the dispatch missions were correctly estimated according to NEWS. Of the highest dispatch priority missions A and B, 76.9 and 78.3%, respectively, were overestimated. Of the low urgency missions (C and D), 10.7% were underestimated; 32.0% of the patients who were assigned NEWS indicating high risk had initially been classified as low urgency C or D priorities at the dispatch.Discussion and conclusionThe present results show that the current Finnish medical dispatch protocol is suboptimal and needs to be further developed. A substantial proportion of EMS missions assessed as highest priority were categorized as lower risk according to the NEWS determined at the scene, indicating over-triage with the protocol. On the other hand, only a quarter of the high risk NEWS patients were classified as the highest priority at dispatch, indicating considerable under-triage with the protocol.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0336-y) contains supplementary material, which is available to authorized users.

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“…Police dispatching centre was integrated into emergency medical and fire dispatching centre in October 2005. 9 Helsinki EMS is three tiered, and the services for urgent calls are provided by the fire department. The first tier consists of 7-9 basic life support (BLS) ambulances (depending on the time of the day) manned by EMTs.…”

Section: Emsmentioning

confidence: 99%

“…The median (interquartile range) times for all 120 operations were time from request to dispatching 120 sec (66-240), time from dispatching to the arrival of the first unit on the scene 10 min (7)(8)(9)(10)(11)(12)(13)(14), time from dispatching to the arrival of the medical supervisor unit on the scene 15 min (11-17) and duration of the…”

Section: Time Intervalsmentioning

confidence: 99%