Can current EMS dispatch protocols identify layperson-reported sentinel conditions?

Abstract

Introduction: Managed care organizations are seeking opportunities to capitate for emergency medical services (EMS). These and others pressures are motivating EMS planners to find innovative ways to redeploy existing EMS resources. A successful redeployment of resources implies a mechanism for more carefully matching EMS resources to need than currently exists.

Objective: To determine whether the methods dispatchers currently use to assign nature codes (NCs) and severity codes (SCs) also can distinguish between patients with important sentinel conditions and those without.

Methods: This was a six-month prospective study (June to November 1997). Portland Fire Bureau (PFB) paramedic units documented dispatcher-assigned NCs and SCs and the presence or absence of study-established sentinel findings. The PFB paramedics also verified or corrected dispatcher-assigned NCs and SCs using dispatch algorithms identical to those in use at this urban dispatch center. Cross-tabulation tables (SPSS version 6.1) with chi-square statistics were established to illustrate the relationship between SC strata within specific NCs and the presence or absence of sentinel findings.

Results: One thousand two hundred eighty-five usable cases fell into 25 unique NCs. The designation SC 1 (emergent) was assigned by the dispatcher 307 (24%) times, SC 3 (urgent) was assigned 907 (71%) times, and SC 9 (neither emergent nor urgent) was assigned 26 (2%) times. The SC was missing 45 (3%) times. The PFB records were matched to 1,040 (82%) dispatch records. Sentinel conditions were identified in 411 (40%) of these cases. Eight (32%) of 25 NCs were stratified into two or more levels of dispatcher-determined SCs. One cross-tabulation table for each of these eight NCs was developed to display the relationship between SC strata and the presence or absence of a sentinel condition. Five tables produced statistically significant chi-square tables (p < 0.05). None achieved the study-specified level of 95% sensitivity.

Conclusion: Current dispatcher-assigned NCs and SCs do not appear adequate to detect callers with study-developed sentinel criteria.