EMS World

FEB 2019

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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EMSWORLD.com | FEBRUARY 2019 29 an ambulance; • D: Nonurgent condition requiring supine patient transport; and • E: Condition requiring other ser vice or advice/instruction, including taxi transportation (no ambulances are dispatched for emergency level E calls). 3 Both MPDS and CBD have been independently compared against a non-systems-based approach to assess for reductions in the number of ALS-categorized calls. A 2000 study compared a chief complaint-based triage system against MPDS. 4 This was a prospective obser vational study in which the patients ser ved as their own controls, first in the chief complaint-based triage system and subsequently in MPDS. The original system deter- mined the need for ALS or BLS by chief complaint alone. Following implementation of the MPDS protocol, there was a statistically significant decrease in unnecessar y ALS dispatches. Similarly, following implementation of the CBD system in King County, a study was conducted to evaluate whether the number of ALS dispatches for cerebrovascular accidents (age 50 or more) and febrile seizures (age 6 or less) decreased. The frequency with which the responding BLS units requested an ALS unit on scene decreased. While this study did not fur ther investigate the outcomes of these patients, it did note an overall increase in ef ficiency (defined as "the appropriate unit at the scene for the patient"). 2 Effects on Outcomes While the individual efficiencies and tests of dispatch systems are interesting, even more so is the ef fect each system has on actual patient outcomes. A large amount of outcomes data has been published with regard to dispatch and out-of-hospital cardiac arrest (OHCA). The most recent statistics from the American Heart Association repor t a sur vival rate of 12% for this time-sensitive diagnosis. 5 Dispatcher-assisted CPR has been shown to be nearly as effective at helping its victims as trained bystander CPR. 6 Fur thermore, the dispatcher's experience level and quick recognition of car- diac arrest has been shown to correlate with improved OHCA outcomes. 7,8 Studies in both the United States and Europe have looked at OHCA identification and patient outcome. In a 2004 study imple- mentation of the AMPDS for the London Ambulance Ser vice led to a 200% increase in accurate identification of cardiac arrests. Protocol compliance correlated similarly. 9 A study conducted in Richmond, Va., and Oslo, Nor way, sought to compare the CBD and MPDS with regard to OHCA. This one- year obser vational study compared multiple categorical variables, including recognition of cardiac arrest, time to ambulance dis- patch, and time to chest compression deliver y. 10 Most variables showed no dif ference bet ween the t wo s ystems, but ambu- Dispatchers' experience level and quick recognition of car- diac arrest has been shown to correlate with improved outcomes.

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