Elsevier

Resuscitation

Volume 73, Issue 2, May 2007, Pages 236-245
Resuscitation

Clinical Paper
Evaluation of emergency medical dispatch in out-of-hospital cardiac arrest in Taipei

https://doi.org/10.1016/j.resuscitation.2006.09.005Get rights and content

Summary

Introduction

Emergency medical dispatchers are the entry points to the emergency medical services (EMS). The overall performances of the dispatchers are imperative determinants of the emergency medical services dispatching system. There is little data on the cultural and language impacts on emergency medical dispatch.

Objective

This study examined the emotional content and cooperation score (ECCS) among Mandarin Chinese speaking callers for cardiac arrests, and evaluated the performances of emergency medical services dispatching system in Taipei.

Methods

This retrospective, observational study examined dispatching audio recordings obtained from the Taipei City Fire Department Dispatching Center between January 2004 to April 2004. The tapes of call relating to adult (age ≥18 years), non-traumatic cases with a presumed or field diagnosis of out-of-hospital cardiac arrest (OHCA) underwent systemic review. The caller's ECCS and the dispatcher's performances, including interview skills, provision of telephone-assisted cardiopulmonary resuscitation (T-CPR), and dispatcher's ability to identify OHCA were examined. Interrater reliability for determining ECCS and interview skills were assessed using kappa statistic.

Results

A total of 199 audio recordings were reviewed. A mean ECCS of 1.42 ± 0.64 (95% CI: 1.33–1.51) demonstrated that most callers were emotionally stable and cooperative when calling for help, even when facing cardiac arrest patients. There was a good association between ECCS and the sex of the callers (male 1.32 versus female 1.49; p < 0.05). In 82% of interviews, the interview skills of the dispatchers was high (4 or 5 points); while in one fifth the interview skills were suboptimal. About one third of the cases were provided with T-CPR by the dispatchers. The sensitivity and positive predictive value (PPV) for predicting OHCA by dispatchers were 96.9% and 97.9%, respectively. A κ value of 0.65 and 0.68 were obtained for the interrater reliability of ECCS and interview skills.

Conclusion

Most callers were found to be emotional stable and cooperative with dispatcher's interrogations when calling for cardiac arrest victims in this Mandarin speaking population. The dispatchers have shown satisfactory interview skills in approaching emergency calls and a good ability to identify OHCA. There is a low rate of T-CPR offered to the callers in the investigation. Efforts should be made to address the deficiencies in order to maximise the function of the EMS.

Introduction

Emergency medical dispatchers are the entry points to the emergency medical services (EMS) in the community. They process incoming calls seeking emergency assistance, and dispatch the emergency response selectively by asking key questions for appropriate triage. It has been shown that the implementation of dispatching system has brought substantial gains in EMS performance with improved patient outcomes, including increased survival rate, reduced response time,1 and increased efficiency of the EMS system.2 The decision of the dispatcher is especially critical in a two-tiered system of emergency medical services (EMS) where resources of advanced life support (ALS) teams are limited.3 Indeed, only when the urgency of an incoming call is recognised by the dispatcher, will appropriate help be sent by immediate dispatch of EMS to the patient. The dispatcher can also provide supports to the caller while waiting ambulance arrival. By using medically approved and written pre-arrival instruction (PAI), the dispatcher can instruct the caller or layperson to start treatment immediately, especially in the cases of out-of-hospital cardiac arrest (OHCA). In a study, telephone-assisted cardiopulmonary resuscitation (T-CPR) by dispatcher has found to be associated with a 50% improvement in the odds of survival to hospital discharge compared with those who received no CPR before the arrival of EMS.4 T-CPR can provide early guidance in resuscitation that could create a longer window of opportunity before paramedics reach the patient.5 If the caller has prior experiences with CPR or is a trained rescuer, T-CPR can be a quick reminder for the caller and thus helps in improving the quality of bystander CPR.6

Although prompt initiation of CPR could improve the chances of surviving OHCA substantially however, a low rate of T-CPR was reported in a study done by Clark et al.7 Most people who witness a person in cardiac arrest may not have been trained in CPR6 or lack the knowledge to provide this life-saving intervention even when facing the victim as a close relative.4, 8 Potential barriers to performing CPR have been reported in several previous studies, including presences of agonal respiration, physical barriers and limitations of the layperson, and difficulties in performing CPR.8, 9

In addition, there are also several studies that have investigated the psychological components in the dispatching interview involving both dispatchers and callers.10, 11 In a study carried out by Clawson et al., a set protocol was developed specifically to assess the caller's emotional content and cooperation score (ECCS). It has been shown that the mean ECCS of emergency callers is remarkably low with an average score of 1.05 in a study conducted in British Columbia (BC) and an average score of 1.21 for a study conducted in Monroe County (MC).10 Mandarin is the most widespread form of the Chinese language; it is also the official language in Taiwan. Although there has been no similar study before regarding the cultural or linguistic impact on callers who request emergency medical assistance, it is of interest to investigate issues such as the association of language and ECCS.

Many studies have focused on OHCA cases to evaluate the performances of dispatcher.12, 13 Heart disease is the third leading cause of death for the general population in Taiwan in 2002 and it is the second leading cause of death for the population in the city of Taipei.14 Such deaths are often the result of a cardiac arrest occurring outside hospital settings. Heart disease-related mortality and morbidity is a great burden on the society with the associated health care expenditure and loss of productivity. This study aims at evaluating the performance of EMS dispatching system in Taipei city by examining the audio recordings from calls of non-traumatic cardiac arrests. The patients, events, characteristics of the callers, the ECCS in Mandarin Chinese speaking population, and various aspects of dispatch performances were examined. We hypothesized that the ECCS in the Mandarin Chinese speaking population will be different from that in the western population.

Section snippets

Study populations and settings

Taipei City is the capital city of Taiwan with a population of 2.65 million. Since early 1998, Taipei city has implemented a two-tiered EMS system as a pilot project by providing hospital-based ALS team from the emergency department (ED) of a major university teaching hospital, the National Taiwan University Hospital (NTUH). The project was later expanded throughout the whole city in April 2000. It consisted of basic life support (BLS) and ALS teams. The EMS is a joint-venture of the city fire

Patients characteristics

From January 2004 to April 2004, a total of 301 cases were included. There were 52 cases excluded due to suicide, fall, accidents, gas poisoning, drowning, or other traumatic causes. Data missing due to failure of computer retrieval and failure of tape recording accounted for 15 and 35 cases, respectively. Finally there were 199 audio recordings included in this study. Of the data collected, 131 were males (65.8%) and 68 females (34.2%). The overall mean age was 71.6 ± 16.3 years (median 70.2

Discussion

This study took place at the time when quality improvement efforts were initiated in the Taipei City EMS. This is the first attempt to evaluate the quality of emergency dispatch in the Taipei EMS systematically. The major findings of the study include the following.

Conclusion

In this first attempt to examine caller's emotional response in the Mandarin speaking population, most callers were emotionally stable and cooperative when calling for help, even when facing cardiac arrest patients. The callers for cardiac arrest victims in Taipei showed a slightly higher level of anxiety than callers in the North America English-speaking communities (1.42 versus 1.05 and 1.21); however, the average ECCS was much lower than generally expected. Moreover, the dispatchers have

References (22)

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    However, the possible panic caused by the urgency of the situation could affect the dispatcher’s judgement in terms of identification of OHCA and DA-CPR instructions.13–17 Several studies have used the emotional content and cooperation score (ECCS) to quantify the caller’s emotional stability into five levels (Table 1).18–21 Furthermore, Chien et al. reported that the caller’s emotional state might not be a barrier to OHCA recognition but could hinder the delivery of the DA-CPR instructions.21

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A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2006.09.005.

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