Variation in accessibility of the population to an Emergency Medical Communication Centre: a multicentre observational study

Background Access to an Emergency Medical Communication Centre is essential for the population in emergency situations. Handling inbound calls without delay requires managing activity, process and outcome measures of the Emergency Medical Communication Centre to improve the workforce management and the level of service. France is facing political decisions on the evolution of the organisation of Emergency Medical Communication Centres to improve accessibility for the population. First, we aim to describe the variation in activity between Emergency Medical Communication Centres, and second, to explore the correlation between process measures and outcome measures. Methods Using telephone activity data extraction, we conducted an observational multicentre study of six French Emergency Medical Communication Centres from 1 July 2016 to 30 June 2017. We described the activity (number of incoming calls, call rate per 1000 inhabitants), process measure (agent occupation rate), and outcome measure (number of calls answered within 20 s) by hourly range and estimated the correlation between them according to the structural equation methods. Results A total of 52,542 h of activity were analysed, during which 2,544,254 calls were received. The annual Emergency Medical Communication Centre call rate was 285.5 [95% CI: 285.2–285.8] per 1000 inhabitants. The average hourly number of calls ranged from 29 to 61 and the call-handled rate from 75 to 98%. There are variations in activity between Emergency Medical Communication Centres. The mean agent occupation rate was correlated with the quality of service at 20 s (coefficient at − 0.54). The number of incoming calls per agent was correlated with the mean occupation rate (coefficient at 0.67). Correlation coefficients varied according to the centres and existed between different process measures. Conclusions The activity dynamics of the six Emergency Medical Communication Centres are not identical. This variability, illustrating the particularity of each centre, must be accurately assessed and should be taken into account in managerial considerations. The call taker occupation rate is the leverage in the workforce management to improve the population accessibility.

Predicting acute coronary syndrome in males and females with chest pain who call an emergency medical communication centre

Background Chest pain is a frequent reason for calls in emergency medical communication centre (EMCC). Detecting a coronary origin by phone is a challenge. This is especially so as the presentations differ according to gender. We aimed to establish and validate a sex-based model to predict a coronary origin of chest pain in patients calling an EMCC. Methods This prospective cohort study enrolled patients at 18 years of age or older who called the EMCC because of non-traumatic chest pain. The main outcome was the diagnosis of acute coronary syndrome (ACS) determined by expert evaluation of patient files. Results During 18 months, 3727 patients were enrolled: 2097 (56%) men and 1630 (44%) women. ACS was diagnosed in 508 (24%) men and 139 (9%) women. For men, independent factors associated with an ACS diagnosis were age, tobacco use, severe and permanent pain; retrosternal, breathing non-related and radiating pain; and additional symptoms. The area under the receiver operating characteristic curve (AUC) was 0.76 (95% confidence interval [CI] 0.73–0.79) for predicting ACS. The accuracy of the male model to predict ACS was validated in a validation dataset (Hosmer-Lemeshow test: p = 0.554); the AUC was 0.77 (95%CI 0.73–0.80). For women, independent factors associated with an ACS diagnosis were age ≥ 60 years, personal history of coronary artery disease, and breathing non-related and radiating pain. The AUC was 0.79 (95%CI 0.75–0.83). The accuracy of the female model to predict ACS was not validated in the validation dataset (Hosmer-Lemeshow test: p = 0.035); the AUC was 0.67 (95%CI 0.60–0.74). Conclusions Predictors of an ACS diagnosis in patients calling an EMCC for chest pain differ between men and women. We developed an accurate predictive model for men, but for women, the accuracy was poor. Trial registration This study is registered with ClinicalTrials.gov (NCT02042209).

Help we are sinking! Stories from Norwegian dispatch centers on decision-making in unfamiliar and ambiguous situations

The aim of this exploratory case study was to examine whether sensemaking processes may influence decision-making of emergency call center dispatchers when dealing with maritime crises. This article focuses on sensemaking and decision-making in an emergency services context using Norwegian operators as a case and reports on data collected from five focus-group interviews with emergency dispatchers at five different locations. Each focus group consisted of three dispatchers, representing the three main Norwegian emergency response dispatch centers: police, fire and rescue, and the Emergency Medical Communication Centre (AMK). The study’s purpose was to see whether choices made when responding to maritime crisis calls are influenced by sensemaking processes, and whether these processes may have influenced the dispatcher’s choice of which search and rescue resources to contact. The study found that the sensemaking processes that occurred prior to the decision-making might have been influenced by the dispatcher’s past experiences, in particular, experiences from land-based operations. The findings also suggested that the emergency dispatchers made decisions based on intuitive sensemaking, as they were perceived pressed on time and experienced maritime crisis in a more transboundary nature than everyday land-based emergencies. The effects of sensemaking processes and intuitive decision-making shown in this study are of possible relevance to emergency services educators and managers outside a Norwegian framework.