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


CONCLUSIONS
Current dispatcher-assigned NCs and SCs do not appear adequate to detect callers with study-developed sentinel criteria.
Neely
K W
KW
Department of Emergency Medicine, Oregon Health Sciences University, Portland 97291-3098, USA. neely@ohsu.edu
Eldurkar
J
J
Drake
M E
ME
D000368:Aged; D004631:Emergency Medical Service Communication Systems; D004632:Emergency Medical Services / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D009922:Oregon; D017063:Outcome Assessment, Health Care; D010561:Personnel Staffing and Scheduling; D011361:Professional Competence; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014218:Triage; D000078329:Workforce