Telephone triage of cardiac emergency calls by dispatchers: a prospective study of 1386 emergency calls.
OBJECTIVE
To evaluate the handling of potential cardiac emergency calls by dispatchers, to determine their final diagnosis and urgency, and to determine the value of the main complaint in predicting urgency and the ability of the dispatchers to recognise non-urgent conditions.


METHODS
Prospective data collection and recording of main complaint of emergency calls placed via the 06-11 alarm telephone number with follow up to hospital when the patients were transported and the general practitioner when they were not.


METHODS
Dispatch centres of the emergency medical services in Amsterdam (urban area) and Enschede (rural area).


METHODS
1386 consecutive adult subjects of emergency calls placed by citizens about chest problems or unconsciousness not caused by injury.


METHODS
Frequency of characteristics of the calls, outcome in diagnosis, and assessment of urgency.


RESULTS
69 (5%) patients were dead when the ambulance arrived. Diagnosis was established in 1071 patients (77%). The disorders most often reported were cardiac, with acute ischaemia in 15% of all subjects. In 28% of cases and for each presenting complaint no organic explanation was found. Overall 39% of all emergency calls were urgent; the urgency rate was lowest for calls for people with abdominal discomfort. Dispatchers correctly identified 90% of the non-urgent calls, but 55% of the calls that they identified as urgent proved to be non-urgent.


CONCLUSIONS
Currently, direct dialling for an ambulance without the intervention of a general practitioner imposes a high work load on emergency systems and hospitals because triage by dispatchers is not sufficiently accurate. It may be possible to increase the accuracy of triage by developing and testing decision algorithms.
Srámek
M
M
Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
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D000208:Acute Disease; D000552:Ambulances; D002637:Chest Pain / Q000628:therapy; D004630:Emergencies; D004631:Emergency Medical Service Communication Systems; D004632:Emergency Medical Services; D005069:Evaluation Studies as Topic; D006331:Heart Diseases / Q000628:therapy*; D006801:Humans; D009426:Netherlands; D011446:Prospective Studies; D013689:Telephone; D014218:Triage / Q000379:methods*; D014474:Unconsciousness / Q000628:therapy