The accuracy of medical dispatch - a systematic review

Abstract

BackgroundIt is a challenge to dispatch Emergency medical Services (EMS) appropriately with limited resources and maintaining patient safety; this requires accurate dispatching systems. The objective of the current systematic review was to examine the evidence, according to GRADE, for medical dispatching systems to accurately dispatch EMS according to level of acuity and in recognition of specific conditions.A systematic search was performed trough PubMed, Web of Science, Embase (free text in all fields), Centre for Reviews and Dissemination (CRD), and Cochrane Central Register of Controlled Trials up to 16th of May, 2017. A combination of keywords and Medical Subject Heading (MeSH) terms relevant to “emergency medical dispatch criteria” were used, to search for articles published between 2012 and 2017. Publications were included according to the inclusion/exclusion criteria using the Systematic Reviews and Meta-Analyses (PRISMA) protocol. Level of evidence was evaluated in accordance with Grading of Recommendations Assessment, Development and Evaluation (GRADE). Articles included were those that provided evidence for at least one of the measures of dispatch system accuracy; i.e. sensitivity, specificity, positive and negative predictive and/or over- and under-triage. The search identified 1445 articles. After the removal of duplicates, 382 titles were reviewed for relevance and an additional 359 articles were excluded based on manuscript title and abstract. An additional five articles were excluded after review of the full text versions of the remaining articles. The current review included 18 publications which all were based on primary research.ConclusionsThe 18 articles addressed the identification of cardiac arrest, stroke, medical priority and major trauma using different dispatching systems. The results of the current review show that there is a very low to low overall level of evidence for the accuracy of medical dispatching systems. We suggest that it is necessary to create a consensus on common standards for reporting before consensus can be reached for the level of accuracy in medical dispatching systems.

Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study

“…All data were recorded in a standardized case form (standard clinical history used by the EMS). During the first EMS contact with the patient, the ERN recorded: Administrative data; times of arrival, assistance, and evacuation; reason for calling according to the Advanced Medical Priority Dispatch System [24,25]; the set of vital signs (respiratory rate, oxygen saturation, use of supplemental oxygen, heart rate, systolic blood pressure, temperature, and level of consciousness); and the pLA value.…”

Live video footage from scene to aid helicopter emergency medical service dispatch: a feasibility study

“…5 GoodSAM, 1 CurtainRd, London, UK. 6 South East Coast Ambulance Service NHS Foundation Trust, Crawley, UK.…”

“…This may result in a delayed or inaccurate dispatch. Previous studies have shown that mechanism of injury together with interrogation by the dispatcher had a sensitivity of 80.2% and under-triage of 19.7% for the identification of major trauma [6,7], and a Dutch study showed an overall over-triage of 44% [8].…”

Symptom-Based Dispatching in an Emergency Medical Communication Centre: Sensitivity, Specificity, and the Area under the ROC Curve

“…Without accurate measurement and classification of the prevalence (pre-test probabilities) of severe patient conditions, neither the positive or negative predictive values nor the rates of underor over-triage are interpretable. Finally, measurement is also imprecise because there is no consensus on common standards for reporting, particularly on the reference standard against which to compare the dispatch decision [16].…”