The inaugural European Emergency Medical Dispatch conference was held in Stockholm, Sweden, in May 2013. We provide a synopsis of the conference proceedings, highlight key topic areas of emergency medical dispatch and suggest future research priorities

Bohm, Katarina

Castrén, Maaret

Christensen, Erika F

Lyon, Richard M

Olasveengen, Theresa M

PubMed

NORA - Norwegian Open Research Archives

COMMENTARY Open AccessThe inaugural European emergency medicaldispatch conference – a synopsis of proceedingsRichard M Lyon1,2*, Katarina Bohm3, Erika Frischknecht Christensen4, Theresa M Olasveengen5 and Maaret Castrén6AbstractThe inaugural European Emergency Medical Dispatch conference was held in Stockholm, Sweden, in May 2013. Weprovide a synopsis of the conference proceedings, highlight key topic areas of emergency medical dispatch andsuggest future research priorities.BackgroundEmergency medical dispatch is a vital link in any chainof medical care [1]. Upon receipt of a call requestingmedical assistance, the priorities are to characterise theurgency of the reported incident, give medical instruc-tions via telephone and coordinate the dispatch of ap-propriate medical resources to the correct location. Therole of emergency medical dispatch is particularly im-portant in certain conditions, such as out-of-hospitalcardiac arrest (OHCA), were the actions of call takersand dispatchers can have a direct effect on clinical out-come of the patient.The importance of dispatch has not always been rou-tinely recognised [1]. Only recently have elements ofdispatch been incorporated into the Utstein recommen-dations for OHCA [2]. There is a paucity of dispatch re-search in the published medical literature with many keyquestions remaining unanswered. Informal discussionshave suggested a significant variation in practice withregards to emergency medical dispatch systems acrossEurope, with the optimum methods of handling callsand dispatching emergency medical resources remaininglargely unknown.Following preliminary discussions at the European Re-suscitation Council conference in 2012, there was aperceived need to host a European conference with aspecific focus on emergency medical dispatching. Theinaugural conference was supported and endorsed bythe European Resuscitation Council.The inaugural European conference on emergencymedical dispatching was held on May 14 & 15, 2013 atthe Karolinska Institute, Department of Clinical Scienceand Education, Södersjukhuset, Stockholm, Sweden.The conference was attended by 54 delegates, repre-senting 8 countries.The primary aim of the conference was to facilitateintroductions and discussions between European emer-gency medical dispatch leaders, staff, scientists and stu-dents to foster initial collaboration. Conference delegateswere given the opportunity to compare and contrast dif-ferent emergency medical dispatch systems, highlightareas of key importance and suggest topics for futuredispatch research. We aim to provide a synopsis of theconference proceedings.Conference sessionsConference delegates took part in four facilitated discus-sion groups on timestamps, protocols, guidelines, identifi-cation and symptoms. The summaries of each workshopare incorporated into this conference summary.Dispatching systemsThe aim of any emergency medical dispatch system is toprovide the right resource to the right patient atthe right time. The demand placed on prehospitalemergency medical resources is increasing throughoutEurope. As ambulances become a more scare resource,the need for precise triage and management of the avail-able prehospital resources becomes paramount. Therewas discussion on the need for emergency medical ser-vices to offer alternative care pathways, particularly forpatients not requiring immediate transport to hospitalor referral to other, non-emergency medical services.* Correspondence: richardlyon@doctors.org.uk1Emergency Medicine Research Group, Edinburgh, UK2Kent, Surrey & Sussex Air Ambulance Trust, UKFull list of author information is available at the end of the article© 2013 Lyon et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.Lyon et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013, 21:73http://www.sjtrem.com/content/21/1/73Several European systems are introducing non-emergencytelephone numbers to offload emergency medical dispatchcentres and collaboration on the development of suchsystems and sharing of experience is likely to be beneficial.Call-handlingA variation in how emergency medical calls are handledwas highlighted. Some systems employ a single commonemergency number, sometimes with a separate numberfor emergency medical services, whilst others use separ-ate numbers for different emergency services. A keycharacterisation was whether an emergency call enteredthe emergency medical dispatch centre directly or wasinitially routed via an intermediary; either a telecommu-nications provider or general emergency service centre.Some centres employed a co-listening system with mul-tiple parties listening to a single call, whilst othersemployed single call takers.Guidelines & protocolsThere was discussion and comparison of the threemain dispatch platforms used in Europe: criteria-based,priority-based and keyword-based. There was a consen-sus view that all platforms have advantages and disad-vantages and further research is warranted to determinethe optimum elements of dispatch platforms.The value of audio review and call transcription ofemergency calls was highlighted. It was acknowledgedthat listening to audio recording is time consuming butis the method of choice for detailed dispatch research.Call transcription and comparison to dispatch protocolallows for individual protocol steps to be analysed indetail and could form the basis of protocol improve-ment. Listening to audio recordings is not practical on alarge scale or for system-wide quality assurance orbenchmarking. It was suggested that use of voice recog-nition software might, in future, facilitate this process.Analysis of progress through electronic protocols mayprovide data for this purpose but a validation study is re-quired to compare voice calls to computer algorithm ad-herence and progression.The use of key word triggers to assist call-taking washighlighted as an area in need of further research anddevelopment.Specific conditionsEmergency medical dispatch has an important role toplay in determining outcome from immediately life-threatening conditions including out-of-hospital cardiacarrest, major trauma, stroke, acute myocardial infarction,acute respiratory distress, upper airway obstructionand seizures. These conditions, however, make up theminority of calls to emergency medical communicationcentres, with non-urgent calls representing a largeproportion.Out-of-hospital cardiac arrestDispatch for out-of-hospital cardiac arrest is critical interms of the need for rapid recognition, early dispatch andprovision of telephone CPR advice [3,4]. Several key per-formance indicators are linked to OHCA call handlingand the majority of dispatch research has been conductedin this field. It was felt OHCA should remain as a key con-dition for any emergency medical communication centrebut other conditions should not be overlooked.Accuracy of cardiac arrest recognition was highlightedas important. Delay in recognition can lead to a delay intelephone CPR instructions and emergency medical ser-vices dispatch. OHCA recognition is often confoundedby the initial call reporting signs such as collapse, diffi-culty in breathing, chest pain or seizure. Research iswarranted on optimising OHCA recognition rates and itwas felt this should be reported as a key performance in-dicator for any emergency medical dispatch system.Time to telephone CPR was highlighted as being ofkey importance and potential causes of delay werediscussed [5]. The need to accurately assess breathing,particularly recognition of agonal breathing, airwayopening manoeuvres and moving the OHCA patient toa hard surface were all highlighted as causing potentialdelays to telephone-CPR [6-8]. Several protocols now in-corporate steps aimed at identifying agonal respirationand a comparison of these, particularly for sensitivity,has yet to be undertaken.Major traumaEarly, accurate dispatch of emergency medical services,particularly advanced trauma or physician-lead teamsmay have the potential to improve outcome for victimsof major trauma [9-11]. Specific telephone instructionson airway maintenance, haemorrhage control and pre-vention of hypothermia all have the potential to improvecare for the major trauma victim. Several centres havedeveloped call-out criteria for physician-lead traumateams but there is little evidence underpinning these.Some systems prefer to over-triage for major traumawhilst others rely on a scene report from the first emer-gency medical resources to arrive on scene beforedispatching further resources.Several conference delegates expressed concern thatcurrent dispatch protocols do not allow for accurate as-sessment of the major trauma victim. Little is knownabout the optimum interrogation strategy for callersreporting accidents and further research is warranted inthis area.Lyon et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013, 21:73 Page 2 of 4http://www.sjtrem.com/content/21/1/73StrokeSeveral screening tools (eg FAST) have been developedfor the lay person to rapidly identify signs of stroke. Ap-plication and piloting of these tools in the dispatch set-ting may help to improve accuracy and speed of strokediagnosis [12-14].It was highlighted that there is limited knowledge onthe optimum means of interrogating key specific condi-tions such as sepsis, although research in this area iscurrently on-going in Sweden.Non-urgent callsNon-urgent calls represent a large proportion of ambu-lance service workload [15]. Increasingly, patients withchronic conditions are putting strain on dispatch sys-tems. Several systems now employ physicians within theemergency medical dispatch centre to provide medicaladvice on the triage and management of such cases. ADanish study is currently underway aiming to character-ise the nature and epidemiology of all calls to an emer-gency medical dispatch centre.PersonnelThe qualifications and skill mix of call handlers and dis-patchers were discussed in detail. Scandinavian systems,except Finland, frequently employ nurses as calls takerswith paramedics being used in a dispatch role. In theUnited Kingdom, both call takers and dispatchers haveminimal medical training. The optimum qualificationand staffing of emergency medical communicationcentres remains a key area for comparison andinvestigation.Call taker and dispatcher trainingThere is great variation in call taker and dispatchertraining across Europe with training periods rangingfrom several weeks to nearly 2 years. Dispatch personnelencounter variable numbers of calls per year and varyingproportions of high-acuity calls across services. Previousresearch has shown that outcome from OHCA can beinfluenced by the experience of call taker handling theinitial emergency call [16].The use of experimental scenarios and simulationtraining may be of benefit in training both call takersand dispatchers. Translation into different languageswould allow protocol and system comparison acrosscountries.DataThe storage, handling and analysis of dispatch data wasdiscussed in detail. It was agreed emergency medicaldispatch was a data-rich environment with the potentialfor valuable future research. Some European prehospitalemergency medical systems have developed integrateddispatch and ambulance data systems that are populatedin real-time using tablet technology. Even in the pres-ence of the Utstein dispatch criteria, it was agreed astandardised minimum dispatch data set is needed toallow comparison between dispatch systems [2,17]. Ac-curate linkage of dispatch, prehospital and hospital datasets is required to allow outcome analysis and to evalu-ate dispatch accuracy.The legal definition of the caller and dispatcher patientrecord appeared to vary greatly amongst the representedcountries. In some countries the legal record com-mences in the prehospital setting, whilst in other it doesnot commence until the patient reaches hospital.Quality assuranceThere was consensus agreement that quality assurance isan integral part of any emergency medical dispatch sys-tem. Most quality assurance focuses on time targets.Time to answer the emergency call, time to dispatch andtime to arrival on-scene are routinely measured but theprecise definition of each time point is variable andconsistency is required.Many emergency dispatch centres collect some timestamp data as recommended in the Utstein criteria butthese are variable [2].It was agreed non-automated quality assurance indica-tors, such as time or accuracy of cardiac arrest diagnosisor time to telephone-assisted CPR were important. Suchvariables have been shown to influence survival fromOHCA but are not routinely measured or reported. Pre-cise definitions and novel data interrogation systems areneeded to allow quality assurance on a system-widebasis and allow comparison between systems.Future researchSeveral potential areas of future dispatch research werediscussed. The role of telemedicine, in particular the useof mobile telephone technology to transmit real timephotos and video from the scene was discussed. Mobiletechnology now exists that also allows for transmissionof physiological data, including electrocardiography,which may facilitate more accurate dispatch. Following apresentation from Edinburgh, Scotland, the role of be-havioural psychology and language analysis could pro-vide a platform for future work on dispatch protocolsand call taker behaviour.Further research is warranted on automated dispatchsystems to facilitate call prioritisation and allow rapiddispatch.ConclusionThe inaugural European emergency medical dispatchmeeting proved to be successful and positive feedbackwas received from all delegates. Variation in emergencyLyon et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013, 21:73 Page 3 of 4http://www.sjtrem.com/content/21/1/73medical dispatch was highlighted, as was the need tocollaborate internationally in order to undertake futuredispatch research.Author details1Emergency Medicine Research Group, Edinburgh, UK. 2Kent, Surrey & SussexAir Ambulance Trust, UK. 3Karolinska Institute, Stockholm, Sweden.4Prehospital Emergency Medical Services, Aarhus, Denmark. 5UllevålUniversity Hospital, Oslo, Norway. 6European Resuscitation Council, Edegem,Belgium.Received: 24 July 2013 Accepted: 8 September 2013Published: 23 September 2013References1. Ornato JP: Science of emergency medical dispatch. Circulation 2009,119:2023–2025.2. Castrén M, Karlsten R, Lippert F, et al: Recommended guidelines forreporting on emergency medical dispatch when conducting research inemergency medicine: the Utstein style. Resuscitation 2008, 79:193–197.3. Lerner EB, Sayre MR, Brice JH, et al: Cardiac arrest patients rarely receivechest compressions before ambulance arrival despite the availability ofpre-arrival CPR instructions. Resuscitation 2008, 77:51–56.4. Bohm K, Vaillancourt C, Charette ML, et al: In patients with out-of-hospitalcardiac arrest, does the provision of dispatch cardiopulmonaryresuscitation instructions as opposed to no instructions improveoutcome: a systematic review of the literature. Resuscitation 2011,82:1490–1495.5. Roppolo LP, Westfall A, Pepe PE, et al: Dispatcher assessments for agonalbreathing improve detection of cardiac arrest. Resuscitation 2009,80:769–772.6. Bobrow BJ, Panczyk M, Subido C: Dispatch-assisted cardiopulmonaryresuscitation: the anchor link in the chain of survival. Curr Opin Crit Care2012, 18:228–233.7. Scott G, Clawson J, Rector M, et al: The accuracy of emergency medicaldispatcher-assisted layperson-caller pulse check using the medicalpriority dispatch system protocol. Prehosp Disaster Med 2012, 27:252–259.8. Van Vleet LM, Hubble MW: Time to first compression using medicalpriority dispatch system compression-first dispatcher-assistedcardiopulmonary resuscitation protocols. Prehosp Emerg Care 2012,16:242–250.9. Hesselfeldt R, Steinmetz J, Jans H, et al: Impact of a physician-staffedhelicopter on a regional trauma system: a prospective, controlled,observational study. Acta Anaesthesiol Scand 2013, 57:660–668.10. Franschman G, Andriessen TMJC, Boer C, et al: Physician-based emergencymedical service deployment characteristics in severe traumatic braininjury: A Dutch multicenter study. Injury. Published Online First: 28 June2013. doi:10.1016/j.injury.2013.06.002.11. Littlewood N, Parker A, Hearns S, et al: The UK helicopter ambulancetasking study. Injury 2010, 41:27–29.12. the ESCORTT group: The identification of acute stroke: an analysis ofemergency calls. Int J Stroke. Published Online First: 15 February 2012.doi:10.1111/j.1747-4949.2011.00749.x.13. Buck BH, Starkman S, Eckstein M, et al: Dispatcher recognition of strokeusing the national academy medical priority dispatch system.Stroke 2009, 40:2027–2030.14. Deakin CD, Alasaad M, King P, et al: Is ambulance telephone triage usingadvanced medical priority dispatch protocols able to identify patientswith acute stroke correctly? Emerg Med J 2009, 26:442–445.15. Studnek JR, Thestrup L, Blackwell T, et al: Utilization of prehospitaldispatch protocols to identify low-acuity patients. Prehosp Emerg Care2012, 16:204–209.16. Kuisma M, Boyd J, Väyrynen T, et al: Emergency call processing andsurvival from out-of-hospital ventricular fibrillation. Resuscitation 2005,67:89–93.17. Krüger AJ, Lockey D, Kurola J, et al: A consensus-based template fordocumenting and reporting in physician-staffed pre-hospital services.Scand J Trauma Resusc Emerg Med 2011, 19:71.doi:10.1186/1757-7241-21-73Cite this article as: Lyon et al.: The inaugural European emergencymedical dispatch conference – a synopsis of proceedings. ScandinavianJournal of Trauma, Resuscitation and Emergency Medicine 2013 21:73.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color ﬁgure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitLyon et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013, 21:73 Page 4 of 4http://www.sjtrem.com/content/21/1/73

The inaugural European emergency medical dispatch conference – a synopsis of proceedings

Richard M Lyon

Katarina Bohm

Erika Christensen

Theresa M Olasveengen

Maaret Castrén

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The inaugural European emergency medical dispatch conference – a synopsis of proceedings

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