9-1-1 Caller-Described Heart Attack Symptoms.

Introduction: Heart attacks (HAs) present clinically with varying symptoms, which are not always described by patients as chest pain (CP) or chest discomfort (CD). Emergency Medical Dispatchers (EMDs) select the CP/CD dispatch protocol for non-chest pain HA symptoms or classic HA complaint of CP/CD. Nevertheless, it is still unknown how often callers report HA symptoms other than CP/CD.

Prone Dispatch-Directed CPR in Out-of-Hospital Cardiac Arrest: Two Successful Cases.

Historically, dispatch-directed cardiopulmonary resuscitation (CPR) protocols only allow chest compression instructions to be delivered for patients able to be placed in the traditional supine position. For patients who are unable to be positioned supine, the telecommunicator and caller have no option except to continue attempts to position supine, which may result in delayed or no chest compressions being delivered prior to emergency medical services arrival. Any delay or lack of bystander chest compressions may result in worsening clinical outcomes of out-of-hospital cardiac arrest (OHCA) victims.

Ability of Layperson Callers to Apply a Tourniquet Following Protocol-Based Instructions From an Emergency Medical Dispatcher.

: One of the greatest casualty-care improvements resulting from US military operations in Iraq and Afghanistan has been the reduction of preventable death from massive extremity hemorrhage - largely due to the widespread use of limb tourniquets. More recently, tourniquet use in civilian, prehospital settings has shown promise in reducing deaths in cases of catastrophic arterial limb hemorrhage. Telephone instructions by trained emergency medical dispatchers (EMDs) on applying an available tourniquet may help achieve such a benefit.

Availability and Use of an Automated External Defibrillator at Emergency Medical Dispatch.

: The aim of this study was to determine the frequency of automatic external defibrillator (AED) retrieval and placement by bystander callers when prompted by an Emergency Medical Dispatcher (EMD). : This retrospective descriptive study utilized a convenience sample of emergency dispatch data collected from 23 Emergency Communication Centers (ECCs) spanning 14 states across the United States (U.S.

Can a Software-Based Metronome Tool Enhance Compression Rate in a Realistic 911 Call Scenario Without Adversely Impacting Compression Depth for Dispatcher-Assisted CPR?

Unlabelled: IntroductionImplementation of high-quality, dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is critical to improving survival from out-of-hospital cardiac arrest (OHCA). However, despite some studies demonstrating the use of a metronome in a stand-alone setting, no research has yet demonstrated the effectiveness of a metronome tool in improving DA-CPR in the context of a realistic 911 call or using instructions that have been tested in real-world emergency calls.HypothesisUse of the metronome tool will increase the proportion of callers able to perform CPR within the target rate without affecting depth.

Hospital-Confirmed Acute Myocardial Infarction: Prehospital Identification Using the Medical Priority Dispatch System.

Unlabelled: Introduction Early recognition of an acute myocardial infarction (AMI) can increase the patient's likelihood of survival. As the first point of contact for patients accessing medical care through emergency services, emergency medical dispatchers (EMDs) represent the earliest potential identification point for AMIs. The objective of the study was to determine how AMI cases were coded and prioritized at the dispatch point, and also to describe the distribution of these cases by patient age and gender.

9-1-1 Triage of Non-Traumatic Chest Pain: Association with Hospital Diagnosis.

Objective: Chest pain is one of the most common reasons people seek emergency care-and one of the most critical. In the United States, chest pain is the second most common reason for emergency department (ED) visits. A patient's primary complaint of "chest pain" may reflect a broad range of underlying causes; therefore, it is important that emergency medical service (EMS) agencies gain a thorough understanding of these cases, beginning with the initial management of chest pain in the 9-1-1 center.

Predictive Ability of an Emergency Medical Dispatch Stroke Diagnostic Tool in Identifying Hospital-Confirmed Strokes.

Background: Early hospital notification of a possible stroke arriving via emergency medical services (EMS) can prepare stroke center personnel for timely treatment, especially timely administration of tissue plasminogen activator. Stroke center notification from the emergency dispatch center-before responders reach the scene-may promote even earlier and faster system activation, meaning that stroke center teams may be ready to receive patients as soon as the ambulance arrives. This study evaluates the use of a Medical Priority Dispatch System (MPDS; Priority Dispatch Corp.

Using On-scene EMS Responders' Assessment and Electronic Patient Care Records to Evaluate the Suitability of EMD-triaged, Low-acuity Calls for Secondary Nurse Triage in 911 Centers.

Introduction: Using the Medical Priority Dispatch System (MPDS) - a systematic 911 triage process - to identify a large subset of low-acuity patients for secondary nurse triage in the 911 center is a largely unstudied practice in North America. This study examines the ALPHA-level subset of low-acuity patients in the MPDS to determine the suitability of these patients for secondary triage by evaluating vital signs and necessity of lights-and-siren transport, as determined by attending Emergency Medical Services (EMS) ambulance crews.

Objectives: The primary objective of this study was to determine the clinical status of MPDS ALPHA-level (low-acuity) patients, as determined by on-scene EMS crews' patient care records, in two US agencies.

Outcome accuracy of the Emergency Medical Dispatcher's initial selection of a diabetic problems protocol.

Introduction: Diabetes mellitus, although a chronic disease, also can cause acute, sudden symptoms requiring emergency intervention. In these cases, Emergency Medical Dispatchers (EMDs) must identify true diabetic complaints in order to determine the correct care. In 911 systems utilizing the Medical Priority Dispatch System (MPDS), International Academies of Emergency Dispatch-certified EMDs determine a patient's chief complaint by matching the caller's response to an initial pre-scripted question to one of 37 possible chief complaints protocols.

The accuracy of emergency medical dispatcher-assisted layperson-caller pulse check using the medical priority dispatch system protocol.

Introduction: Knowing the pulse rate of a patient in a medical emergency can help to determine patient acuity and the level of medical care required. Little evidence exists regarding the ability of a 911 layperson-caller to accurately determine a conscious patient's pulse rate. Hypothesis The hypothesis of this study was that, when instructed by a trained emergency medical dispatcher (EMD) using the scripted Medical Priority Dispatch System (MPDS) protocol Pulse Check Diagnostic Tool (PCDxT), a layperson-caller can detect a carotid pulse and accurately determine the pulse rate in a conscious person.

Aspirin administration by emergency medical dispatchers using a protocol-driven aspirin diagnostic and instruction tool.

Background: The American College of Cardiology and the American Heart Association recommend early aspirin administration to patients with symptoms of acute coronary syndrome (ACS)/acute myocardial infarction (AMI). The primary objective of this study was to determine if Emergency Medical Dispatchers (EMD) can provide chest pain/heart attack patients with standardised instructions effectively, using an aspirin diagnostic and instruction tool (ADxT) within the Medical Priority Dispatch System (MPDS) before arrival of an emergency response crew.

Methods: This retrospective study involved three dispatch centres in the UK and USA.

Medical Priority Dispatch System breathing problems protocol key question combinations are associated with patient acuity.

Introduction: The Breathing Problems Chief Complaint (CC) protocol in the Medical Priority Dispatch System (MPDS) was the system's most frequently used protocol. While "severe breathing problems" is a significant predictor of cardiac arrest (CA), previous data have demonstrated that the DELTA-level determinant codes in this CC contain patients across a wide spectrum of acuity.

Hypothesis: The hypothesis in this study was that certain combinations of caller answers to the breathing problems protocol key questions (KQs) are correlated with different but specific patient acuities.

Association between patient unconscious or not alert conditions and cardiac arrest or high-acuity outcomes within the Medical Priority Dispatch System "Falls" protocol.

Introduction: Falls are one of the most common types of complaints received by 9-1-1 emergency medical dispatch centers. They can be accidental or may be caused by underlying medical problems. Though "not alert" falls patients with severe outcomes mostly are "hot" transported to the hospital, some of these cases may be due to other acute medical events (cardiac, respiratory, circulatory, or neurological), which may not always be apparent to the emergency medical dispatcher (EMD) during call processing.

Profile of emergency medical dispatch calls for breathing problems within the medical priority dispatch system protocol.

Introduction: A common chief complaint to emergency dispatch communication centers worldwide is "breathing problems". The chief complaint of breathing problems represents a wide spectrum of underlying diseases, patient conditions, and onset types. The current debate is on the potential ability of a dispatch protocol to safely and with high specificity, differentiate patients with minor or non-critical conditions from those conditions that pose risk to the patient and require advanced life support evaluation and care.

Effect of a Medical Priority Dispatch System key question addition in the seizure/convulsion/fitting protocol to improve recognition of ineffective (agonal) breathing.

Objective: To investigate the impact of a new assessment question in the Medical Priority Dispatch System (MPDS) seizure protocol on the ability of the Emergency Medical Dispatchers (EMDs) to identify the presence of agonal or ineffective breathing.

Methods: A retrospective comparative study was conducted using two datasets-each representing two versions of the MPDS protocols (version 10.4 and version 11.

Ability of the medical priority dispatch system protocol to predict the acuity of "unknown problem" dispatch response levels.

Objective: To determine if Medical Priority Dispatch System's (MPDS's) Protocol 32-Unknown Problem interrogation-based differential dispatch coding distinguishes the acuity of patients as found at the scene by responders, when little (if any) clinical information is known.

Methods: "Unknown problem" situations (i.e.

The Medical Priority Dispatch System's ability to predict cardiac arrest outcomes and high acuity pre-hospital alerts in chest pain patients presenting to 9-9-9.

Objective: To establish emergency medical dispatcher (EMD) predictability of cardiac arrest (CA) and high acuity (blue in - BI) outcomes in chest pain patients by using the Medical Priority Dispatch System's (MPDS) priority levels, and its more specific clinical determinant codes.

Methods: A retrospective descriptive study was done on a one year's worth of aggregate 999 call data comprising number of patients, calls, incidences, and outcomes (as determined by paramedics) obtained from the London Ambulance Service (LAS). We used Fisher's exact test to establish and quantify associations (through odds ratios, 95% CI and p-values) between MPDS priority levels and patient outcomes, stratifying by various pairing of MPDS priority level determinant codes.

Accuracy of emergency medical dispatchers' subjective ability to identify when higher dispatch levels are warranted over a Medical Priority Dispatch System automated protocol's recommended coding based on paramedic outcome data.

Objectives: To establish the accuracy of the emergency medical dispatcher's (EMD's) decisions to override the automated Medical Priority Dispatch System (MPDS) logic-based response code recommendations based on at-scene paramedic-applied transport acuity determinations (blue-in) and cardiac arrest (CA) findings.

Methods: A retrospective study of a 1 year dataset from the London Ambulance Service (LAS) National Health Service (NHS) Trust was undertaken. We compared all LAS "bluing in" frequency (BIQ) and cardiac arrest quotient (CAQ) outcomes of the incidents automatically recommended and accepted as CHARLIE-level codes, to those receiving EMD DELTA-overrides from the auto-recommended CHARLIE-level.

Cardiac arrest predictability in seizure patients based on emergency medical dispatcher identification of previous seizure or epilepsy history.

Objective: To determine predictability of at-scene cardiac arrest from a dispatch determined patient history of seizure or epilepsy ("E" history).

Design And Methods: A retrospective study of a 1 year dataset from the London Ambulance Service (LAS) National Health Service (NHS) Trust was undertaken. Each of the nine determinant codes on the Medical Priority Dispatch System (MPDS) seizure protocol [Heward A, Damiani M, Hartley-Sharpe C.

Modified cardiopulmonary resuscitation (CPR) instruction protocols for emergency medical dispatchers: rationale and recommendations.

Background: International consensus guidelines now support the use of "chest compressions-only" cardiopulmonary resuscitation (CPR) instructions (CCOIs) by emergency medical dispatch (EMD) personnel providing telephone assistance to untrained bystanders at a cardiac arrest scene. These guidelines are based largely on evolving experimental data and a clinical trial conducted in one venue with distinct emergency medical services (EMS) system features. Accordingly, the Council of Standards for the National Academies of Emergency Dispatch was asked to adapt a modified telephone CPR protocol, and specifically one that could be applied more broadly to the spectrum of EMS systems.