Clawson Jeff, Olola Christopher, Scott Greg, Heward Andy, Patterson Brett
International Academies of Emergency Dispatch, 139 East South Temple, Suite 200, Salt Lake City, UT 84111, USA.
Resuscitation. 2008 Nov;79(2):257-64. doi: 10.1016/j.resuscitation.2008.06.006. Epub 2008 Jul 24.
To investigate the impact of a new assessment question in the Medical Priority Dispatch System (MPDS) seizure protocol on the ability of the Emergency Medical Dispatchers (EMDs) to identify the presence of agonal or ineffective breathing.
A retrospective comparative study was conducted using two datasets-each representing two versions of the MPDS protocols (version 10.4 and version 11.2) at the London Ambulance Service (LAS). The "before" dataset (April 2004 to March 2005, version 10.4) did not have a specific assessment Key Question to identify the presence of irregular/agonal breathing. The question was added in the "after" dataset (April 2005 to March 2006, version 11.2). The datasets comprised the number of patients, calls, responses, incidents, and outcome (i.e., cardiac arrest [CA] and blue-in [BI]) parameters categorized using MPDS determinant codes. A distribution of these parameters was stratified by protocol version. Two-by-two contingency tables to determine association between ("before" and "after") protocols and CA outcome were generated. The likelihood of classifying CA outcome under the "Not fitting now and breathing regularly (verified)"-protocol 12 ALPHA-level 1 (12-A-1) and combined DELTA descriptor codes, was established. Odds ratios (OR) and p-values at significance level of 0.05 cut-off were used to determine any significant associations.
For both datasets, the percentage of the emergency parameters increased with increasing determinant level from ALPHA to DELTA. The percentage of CA outcome in the 12-A-1 descriptor code in protocol version 11.2 was lower than that in version 10.4 (0.18% vs. 0.24%). Within protocol version 11.2, CA outcome was twice more likely in the combined DELTA descriptor codes when compared to other protocol 12 descriptor codes (OR(95%CI): 2.10(1.30, 1.40), p=0.002).
The addition of the new assessment question for "breathing regularly" to the dispatch question sequence in the MPDS seizure protocol provides a valuable tool for identifying true cardiac arrest patients. Most of these cases appeared to be specifically captured by the new code 12 DELTA-level 3 (12-D-3): "Irregular Breathing".
探讨医疗优先调度系统（MPDS）癫痫发作协议中的一个新评估问题对急救调度员识别濒死呼吸或无效呼吸能力的影响。
采用回顾性比较研究，使用两个数据集——每个数据集代表伦敦救护车服务（LAS）的两个版本的MPDS协议（版本10.4和版本11.2）。“之前”的数据集（2004年4月至2005年3月，版本10.4）没有用于识别不规则/濒死呼吸的特定评估关键问题。该问题在“之后”的数据集（2005年4月至2006年3月，版本11.2）中添加。数据集包括使用MPDS决定因素代码分类的患者数量、呼叫次数、响应次数、事件和结果（即心脏骤停[CA]和濒死状态[BI]）参数。这些参数的分布按协议版本分层。生成二乘二列联表以确定（“之前”和“之后”）协议与CA结果之间的关联。确定了在“目前不适用且呼吸正常（已核实）”-协议12 ALPHA级别1（12-A-1）和组合DELTA描述符代码下对CA结果进行分类的可能性。使用显著性水平为0.05的优势比（OR）和p值来确定任何显著关联。
对于两个数据集，随着决定因素水平从ALPHA增加到DELTA，紧急参数的百分比增加。协议版本11.2中12-A-1描述符代码中的CA结果百分比低于版本10.4（0.18%对0.24%）。在协议版本11.2中，与其他协议12描述符代码相比，组合DELTA描述符代码中的CA结果可能性高出两倍（OR(95%CI)：2.10(1.30, 1.40)，p = 0.002）。
在MPDS癫痫发作协议的调度问题序列中添加关于“呼吸正常”的新评估问题，为识别真正的心脏骤停患者提供了一个有价值的工具。这些病例中的大多数似乎被新代码12 DELTA级别3（12-D-3）：“呼吸不规则”专门捕获。
