Ellensen Eirin N, Wisborg Torben, Hunskaar Steinar, Zakariassen Erik
Department of Research, Norwegian Air Ambulance Foundation, PB 94, 1441, Drøbak, Norway.
Department of Global Public Health and Primary Care, University of Bergen, PB 7800, 5020, Bergen, Norway.
BMC Emerg Med. 2016 Oct 13;16(1):40. doi: 10.1186/s12873-016-0105-2.
The Emergency Medical Communication Centre (EMCC) operators in Norway report using the Norwegian Index for Medical Emergency Assistance (Index), a criteria-based dispatch guideline, in about 75 % of medical emergency calls. The main purpose of a dispatch guideline is to assist the operator in securing a correct response as quickly as possible. The effect of using the guideline on EMCC response interval is as yet unknown. We wanted to ascertain an objective measure of guideline adherence, and explore a possible effect on emergency medical dispatch (EMD) response interval.
Observational cross-sectional study based on digital telephone recordings and EMCC records; 299 random calls ending in acute and urgent responses from seven strategically selected EMCCs were included. Ability to confirm location and patient consciousness within an acceptable time interval and structural use of criteria cards were indicators used to create an overall guideline adherence variable. We then explored the relationship between different levels of guideline adherence and EMD response interval.
The overall guideline adherence was 80 %. Location and patient consciousness were confirmed within 1 min in 83 % of the calls. The criteria cards were used systematically as intended in 64 % of the cases. Total median response interval was 2:28, with 2:01 for acute calls and 4:10 for urgent calls (p < 0.0005). Lower guideline adherence was associated with higher EMD response interval (p < 0.0005).
The measured guideline adherence was higher than previously reported by the operators themselves. Patient consciousness was rapidly confirmed in the majority of cases. Failure to use Index criteria as intended result in delayed ambulance dispatch and a potential risk of undertriage.
挪威的紧急医疗通信中心（EMCC）接线员报告称，在约75%的医疗紧急呼叫中使用了基于标准的调度指南——挪威医疗紧急援助索引（索引）。调度指南的主要目的是帮助接线员尽快确保做出正确响应。使用该指南对EMCC响应间隔的影响尚不清楚。我们希望确定一种衡量指南依从性的客观方法，并探讨其对紧急医疗调度（EMD）响应间隔可能产生的影响。
基于数字电话录音和EMCC记录的观察性横断面研究；纳入了从7个经过战略选择的EMCC随机拨打的299个以急性和紧急响应结束的电话。在可接受的时间间隔内确认位置和患者意识的能力以及标准卡片的结构化使用是用于创建总体指南依从性变量的指标。然后，我们探讨了不同水平的指南依从性与EMD响应间隔之间的关系。
总体指南依从率为80%。在83%的电话中，位置和患者意识在1分钟内得到确认。在64%的案例中，标准卡片按预期被系统使用。总中位响应间隔为2分28秒，急性呼叫为2分01秒，紧急呼叫为4分10秒（p<0.0005）。较低的指南依从性与较高的EMD响应间隔相关（p<0.0005）。
测得的指南依从性高于接线员自己之前报告的水平。在大多数情况下，患者意识能迅速得到确认。未按预期使用索引标准会导致救护车调度延迟，并存在分诊不足的潜在风险。
