Clinical PaperEvaluation of emergency medical dispatch in out-of-hospital cardiac arrest in Taipei☆
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
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Emotions in telephone calls to emergency medical services involving out-of-hospital cardiac arrest: A scoping review
2022, Resuscitation PlusCitation Excerpt :Ma et al.,18 however, did not stipulate whether the ECCS rating applied to the entire call, or to certain segment(s) of the call. Two investigators performed the ECCS rating, with a good inter-rater reliability (kappa = 0.65).18 Chin et al.14 devised a novel approach, involving AI, to assess caller emotions in OHCA emergency calls.
Features of Emergency Medical System calls that facilitate or inhibit Emergency Medical Dispatcher recognition that a patient is in, or at imminent risk of, cardiac arrest: A systematic mixed studies review
2021, Resuscitation PlusCitation Excerpt :Where breathing is adequately addressed on the EMS call an OHCA is more likely to be recognised.32,33,36,40,47,35 Although the studies recognised the importance of recognising abnormal/agonal breathing a frequent reason for not recognising OHCA during the EMS call is the misinterpretation, or lack of clarity, regarding breathing status.26,30,33,34,37,39,41,47,52,55 Assessment of breathing can be delayed in an OHCA presenting with seizure activity and in patients where an incorrect medical condition is described.42,43
Early recognition of a caller's emotion in out-of-hospital cardiac arrest dispatching: An artificial intelligence approach
2021, ResuscitationCitation Excerpt :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
2020 recommendations on basic cardiopulmonary resuscitation: Main points
2021, Journal Europeen des Urgences et de ReanimationEuropean Resuscitation Council Guidelines 2021: Basic Life Support
2021, ResuscitationEuropean Resuscitation Council Guidelines 2021: Systems saving lives
2021, Resuscitation
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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.