Performance of the medical priority dispatch system in correctly classifying out-of-hospital cardiac arrests as appropriate for resuscitation.

Female Humans Aged Male Out-of-Hospital Cardiac Arrest / therapy Cardiopulmonary Resuscitation Emergency Medical Dispatch Emergency Medical Services Registries
Dispatch Heart arrest Medical priority dispatch system Out-of-hospital cardiac arrest

Journal

Resuscitation
ISSN: 1873-1570
Titre abrégé: Resuscitation
Pays: Ireland
ID NLM: 0332173

Informations de publication

Date de publication:
12 2022
Historique:
received: 25 07 2022
revised: 30 10 2022
accepted: 03 11 2022
pubmed: 15 11 2022
medline: 17 12 2022
entrez: 14 11 2022
Statut: ppublish

Résumé

Emergency dispatch centres receive emergency calls and assign resources. Out-of-hospital cardiac arrests (OHCA) can be classified as appropriate (requiring emergent response) or inappropriate (requiring non-emergent response) for resuscitation. We sought to determine system accuracy in emergency medical services (EMS) OHCA response allocation. We analyzed EMS-assessed non-traumatic OHCA records from the British Columbia (BC) Cardiac Arrest registry (January 1, 2019-June 1, 2021), excluding EMS-witnessed cases. In BC the "Medical Priority Dispatch System" is used. We classified EMS dispatch as "emergent" or "non-emergent" and compared to the gold standard of whether EMS personnel decided treatment was appropriate upon scene arrival. We calculated sensitivity, specificity, and positive and negative predictive values (PPV, NPV), with 95% CI's. Of 15,371 non-traumatic OHCAs, the median age was 65 (inter quartile range 51-78), and 4834 (31%) were women; 7152 (47%) were EMS-treated, of whom 651 (9.1%) survived). Among EMS-treated cases 6923/7152 had an emergent response (sensitivity = 97%, 95% CI 96-97) and among EMS-untreated cases 3951/8219 had a non-emergent response (specificity = 48%, 95% CI, 47 to 49). Among cases with emergent dispatch, 6923/11191 were EMS-treated (PPV = 62%, 95% CI 61-62), and among those with non-emergent dispatch, 3951/4180 were EMS-untreated (NPV = 95%, 95% CI 94-95); 229/4180 (5.5%) with a non-emergent dispatch were treated by EMS. The dispatch system in BC has a high sensitivity and moderate specificity in sending the appropriate responses for OHCAs deemed appropriate for treatment by paramedics. Future research may address strategies to increase system specificity, and decrease the incidence of non-emergent dispatch to EMS-treated cases.

Sections du résumé

BACKGROUND
Emergency dispatch centres receive emergency calls and assign resources. Out-of-hospital cardiac arrests (OHCA) can be classified as appropriate (requiring emergent response) or inappropriate (requiring non-emergent response) for resuscitation. We sought to determine system accuracy in emergency medical services (EMS) OHCA response allocation.
METHODS
We analyzed EMS-assessed non-traumatic OHCA records from the British Columbia (BC) Cardiac Arrest registry (January 1, 2019-June 1, 2021), excluding EMS-witnessed cases. In BC the "Medical Priority Dispatch System" is used. We classified EMS dispatch as "emergent" or "non-emergent" and compared to the gold standard of whether EMS personnel decided treatment was appropriate upon scene arrival. We calculated sensitivity, specificity, and positive and negative predictive values (PPV, NPV), with 95% CI's.
RESULTS
Of 15,371 non-traumatic OHCAs, the median age was 65 (inter quartile range 51-78), and 4834 (31%) were women; 7152 (47%) were EMS-treated, of whom 651 (9.1%) survived). Among EMS-treated cases 6923/7152 had an emergent response (sensitivity = 97%, 95% CI 96-97) and among EMS-untreated cases 3951/8219 had a non-emergent response (specificity = 48%, 95% CI, 47 to 49). Among cases with emergent dispatch, 6923/11191 were EMS-treated (PPV = 62%, 95% CI 61-62), and among those with non-emergent dispatch, 3951/4180 were EMS-untreated (NPV = 95%, 95% CI 94-95); 229/4180 (5.5%) with a non-emergent dispatch were treated by EMS.
CONCLUSION
The dispatch system in BC has a high sensitivity and moderate specificity in sending the appropriate responses for OHCAs deemed appropriate for treatment by paramedics. Future research may address strategies to increase system specificity, and decrease the incidence of non-emergent dispatch to EMS-treated cases.

Identifiants

DOI: 10.1016/j.resuscitation.2022.11.001 PMID: 36375652
pubmed: 36375652
pii: S0300-9572(22)00707-9
doi: 10.1016/j.resuscitation.2022.11.001
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

123-131

Informations de copyright

Copyright © 2022 Elsevier B.V. All rights reserved.

Auteurs

Justin Yap (J)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Science, University of British Columbia, British Columbia, Canada. Electronic address: justinyap.ubc@gmail.com.

Jennie Helmer (J)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada; School of Population & Public Health, University of British Columbia, British Columbia, Canada.

Marc Gessaroli (M)

British Columbia Emergency Health Services, British Columbia, Canada.

Jacob Hutton (J)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada.

Laiba Khan (L)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Science, University of British Columbia, British Columbia, Canada.

Frank Scheuermeyer (F)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia and St. Paul's Hospital, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, British Columbia, Canada.

Nechelle Wall (N)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada.

Jennifer Bolster (J)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada.

Sean Van Diepen (S)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Division of Critical Care, University of Alberta, Alberta, Canada.

Joseph Puyat (J)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, British Columbia, Canada.

Michael Asamoah-Boaheng (M)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia and St. Paul's Hospital, British Columbia, Canada.

Ron Straight (R)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada.

Jim Christenson (J)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia and St. Paul's Hospital, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, British Columbia, Canada.

Brian Grunau (B)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia and St. Paul's Hospital, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, British Columbia, Canada.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Performance of the medical priority dispatch...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Performance of the medical priority dispatch...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Arrêt cardiaque › Arrêt cardiaque hors hôpital › Performance of the medical priority dispatch...
questionsmedicales.fr › Thérapeutique › Traitement d'urgence › Réanimation › Réanimation cardiopulmonaire › Performance of the medical priority dispatch...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services des urgences médicales › Répartition des urgences médicales › Performance of the medical priority dispatch...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services des urgences médicales › Performance of the medical priority dispatch...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enregistrements › Performance of the medical priority dispatch...