PP27 Features of emergency medical system calls that facilitate or inhibit call-taker recognition that a patient is in, or at risk of, cardiac arrest: a systematic mixed studies review

AimTo identify and appraise evidence relating to the features of an Emergency Medicine System call interaction that enable, or inhibit, an Emergency Medical Dispatcher’s recognition that a patient is in out-of-hospital cardiac arrest, or at imminent risk of out-of-hospital cardiac arrest.MethodsAll study designs were eligible for inclusion. Data sources included Medline, BNI, CINAHL, EMBASE, PubMed, Cochrane Database of Systematic Reviews, AMED and OpenGrey. Stakeholder resources were screened and experts in resuscitation were asked to review the studies identified. Studies were appraised using the Mixed Methods Appraisal Tool. Synthesis was completed using a segregated mixed research synthesis approach.ResultsTwenty-five studies were included in the review. ‘Recognition studies’ involving patients already in out-of-hospital cardiac arrest dominated this SMSR and challenges associated with recognition of out-of-hospital cardiac arrest were apparent. Four main themes were identified: Recognising abnormal/agonal breathing during the emergency call, Managing the emergency call, Emotional distress, Patient’s colour.ConclusionA dominant finding is the difficulty in recognising abnormal/agonal breathing during the Emergency Medical Service call. The interaction between the caller and the Emergency Medical Dispatcher is critical in the recognition of patients who suffer an out-of-hospital cardiac arrest. Emergency Medical Dispatchers adapt their approach to the Emergency Medical Service call, and regular training for Emergency Medical Dispatchers is recommended to optimise out-of-hospital cardiac arrest recognition. Further research is required with a focus on the Emergency Medical Service call interaction of patients who are alive at the time of the Emergency Medical Service call and who later deteriorate into OHCA.

Stroke recognition efficiency by emergency medical dispatchers

Background: Delaying treatment for an acute stroke can typically lead to further severity and disastrous consequences. The majority of patients, however, did not arrive at the hospital in time to get thrombolysis. While the accuracy of stroke diagnosis by emergency medical dispatchers (EMDs) remains uncertain. The focus of this research was to assess the accuracy of the stroke detection (face-arm-speech-time tool) (FAST) utilized by EMDs for the management of acute stroke was as well as how it affected patients' time from door to CT and door-to-needle time.Methods: From 1 January 2020 to 31 December 2020, this research was performed retrospectively. We included all patients over the age of 18 who had an acute stroke identified by incident dispatch code 18. Data was gathered using pre-hospital forms and hospital records. The CT scan findings were used to predict the overall diagnosis.Results: Overall 244 patients, only 143 likely cases (62.4%) were identified by EMDs out of 181 final stroke diagnosis. Conversely, the specificity was 44.4 percent and the sensitivity was 63.5 percent. Only 19 patients (10.5%) obtained a CT scan within 60 minutes, per the data from acute stroke patients, whereas only 40 patients with acute ischemic stroke acquired r-TPA (22.1%).Conclusions: It remains undecided if the failure to use FAST, the inability to recognize positive FAST indicators, or the failure to report FAST findings involves issues with EMDs assessments.

Medical dispatchers’ perception of the interaction with the caller during emergency calls - a qualitative study

Background Medical dispatching is a highly complex procedure and has an impact upon patient outcome. It includes call-taking and triage, prioritization of resources and the provision of guidance and instructions to callers. Whilst emergency medical dispatchers play a key role in the process, their perception of the process is rarely reported. We explored medical dispatchers’ perception of the interaction with the caller during emergency calls. Secondly, we aimed to develop a model for emergency call handling based on these findings. Methods To provide an in-depth understanding of the dispatching process, an explorative qualitative interview study was designed. A grounded theory design and thematic analysis were applied. Results A total of 5 paramedics and 6 registered nurses were interviewed. The emerging themes derived from dispatchers’ perception of the emergency call process were related to both the callers and the medical dispatchers themselves, from which four and three themes were identified, respectively. Dispatchers reported that for callers, the motive for calling, the situation, the perception and presentation of the problem was influencing factors. For the dispatchers the expertise, teamwork and organization influenced the process. Based on the medical dispatchers´ perception, a model of the workflow and interaction between the caller and the dispatcher was developed based on themes related to the caller and the dispatcher. Conclusions According to medical dispatchers, the callers seem to lack knowledge about best utilization of the emergency number and the medical dispatching process, which can be improved by public awareness campaigns and incorporating information into first aid courses. For medical dispatchers the most potent modifiable factors were based upon the continuous professional development of the medical dispatchers and the system that supports them. The model of call handling underlines the complexity of medical dispatching that embraces the context of the call beyond clinical presentation of the problem.

Rapid recognition of out-of-hospital cardiac arrest by emergency medical dispatchers is associated with improved survival

Background Emergency medical dispatchers' (EMD) recognition of out-of-hospital cardiac arrest (OHCA) is an essential part of the first link in the Chain of Survival. However, it is unknown whether the time-to-recognition of OHCA by EMD during an emergency call is associated with survival. Purpose To investigate the effect of time-to-recognition on 30-day survival among patients with recognised OHCA. Methods We linked data on OHCAs occurring in the Capital Region of Denmark from 2016 through 2017 to records of corresponding emergency calls. We defined recognition as dispatching an ambulance with an appropriate priority level and subsequently defined time-to-recognition as the time from start of the call to the time of dispatching the ambulance. Among patients with recognised OHCA, we performed uni- and multivariate logistic regression to investigate the association of time-to-recognition and 30-day survival and reported odds ratios (OR) with 95% confidence intervals (CI). Results Among 2,382 patients with OHCA, 94.2% were recognised, in which median age was 73.6 years, 61.6% were males and median time-to-recognition was 0.8 minutes (interquartile range 0.7 minutes). Patients for whom time-to-recognition was up to (but not including) one minute had more than three-fold higher probability of surviving 30 days (15.5%) compared to patients for whom time-to-recognition was three or more minutes (4.5%) (Figure 1). Time-to-recognition was significantly associated with 30-day survival: OR 0.75 per minute (95% CI 0.62–0.91, P<0.005), and results were similar in the adjusted analysis: OR 0.72 per minute (95% CI 0.58–0.90, P<0.005). Conclusion Rapid recognition of OHCA by EMD resulted in improved survival rate of patients. This was particularly evident when time-to-recognition was three or more minutes. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Hjerteforeningen

Out-of-hospital cardiac arrest diagnosis by emergency medical dispatchers; a diagnostic accuracy study

IntroductionThis study was conducted to assess the diagnostic accuracy of out-of-hospital cardiac arrest (OHCA) made by emergency medical dispatchers (EMDs) in Tehran, Iran.MethodsPatients more than 18 years of age who were suspected of having an OHCA by EMDs or emergency medical service (EMS) technicians at the patient’s bedside were eligible for inclusion in the study. The initial diagnosis, results of primary assessment and monitoring, and the final outcome of the mission (gold standard) were all recorded. Related archived audios were extracted from the system and listened to by the researcher (MM). Other required data were extracted from EMS mission forms and recorded in a pre-prepared checklist. After statistical analysis the accuracy was calculated.ResultsA total of 4732 patients were included (mean age 68.1 ± 19.7 years) of which 2830 (59.8%) were men. These cases reported by 173 EMDs that the EMDs mean age was 27.7±3.7 years, and they were all women. Cardiac arrest prevalence based on final diagnosis (gold standard) was 37.4% (95% CI: 36.0–38.8). Sensitivity and specificity of OHCA diagnosis by EMDs was 78.6% and 92.4%, respectively. Positive predictive value, negative predictive value and accuracy were 86.1% (95% CI: 84.5–87.6), 87.8% (95% CI: 86.8–88.8) and 87.3% (95% CI: 86.3–88.2), respectively. The sensitivity of diagnosis increased with increasing EMD’s work experience and also increasing the number of reported OHCA cases.ConclusionBased on the results, accuracy of OHCA diagnosis by EMDs was almost 87%. It is likely that more experienced EMDs or those with more experience diagnosing OHCA are better at recognising OHCA.

Destress 9-1-1—an online mindfulness-based intervention in reducing stress among emergency medical dispatchers: a randomised controlled trial

ObjectivesEmergency medical dispatchers (EMDs) experience significant stress in the workplace. Yet, interventions aimed at reducing work-related stress are difficult to implement due to the logistic challenges associated with the relatively unique EMD work environment. This investigation tested the efficacy of a 7-week online mindfulness-based intervention (MBI) tailored to the EMD workforce.MethodsActive-duty EMDs from the USA and Canada (n=323) were randomly assigned to an intervention or wait list control condition. Participants completed surveys of stress and mindfulness at baseline, post intervention, and 3 months follow-up. Repeated measures mixed effects models were used to assess changes in stress and mindfulness.ResultsDifferences between the intervention group and control group in pre–post changes in stress using the Calgary Symptoms of Stress Inventory were statistically significant, with a difference of −10.0 (95% CI: −14.9, −5.2, p<0.001) for change from baseline to post intervention, and a difference of −6.5 (95% CI: −11.9, −1.1, p=0.02) for change from baseline to 3 months follow-up. Change in mindfulness scores did not differ between groups. However, increases in mindfulness scores were correlated with greater reductions in stress for all participants, regardless of group (r=−0.53, p<0.001).ConclusionsDevelopment of tailored online MBIs for employees working in challenging work environments offer a promising direction for prevention and intervention. This study found that a short, weekly online MBI for EMDs resulted in reductions in reports of stress. Implications of online MBIs in other emergency responding populations and directions for future research are discussed.