Improving the first link in the chain of survival: the Antwerp experience.
OBJECTIVE
To evaluate the effects of a training programme for emergency medical dispatchers held between 1996 and 1997 in the Belgian city of Antwerp on decision-making regarding tiered emergency medical system responses (mobile intensive care unit teams or basic life support ambulances).


METHODS
Two training sessions based on standardized dispatching protocols were given to the dispatchers. To evaluate the effect of this training, 3000 emergency medical system calls were reviewed. Before and after each training session, audio recordings registered in the dispatch centre, hospital records and in-field provider registrations were analysed. The need for advanced life support was retrospectively assessed.


RESULTS
Increased dispatching sensitivity: the proportion of calls in which a mobile intensive care unit team was not dispatched along with the basic life support ambulance, although necessary, dropped from 64% at baseline to 55 and 40%, respectively, after the first and second training sessions. The main effect of the training sessions was a reduction in the amount of errors caused by lack of information. The specificity of the dispatching process, e.g. avoiding sending out mobile intensive care unit teams unnecessarily, was decreased by the first training session but returned to baseline after the second session.


CONCLUSIONS
Results suggest that only repetitive training efforts can result in increased dispatching sensitivity without decreasing dispatching specificity. We recommend the implementation of medically supervised and standardized dispatching protocols in a continuous education programme.
Gijsenbergh
François
F
Department of Emergency Medicine and EMS of the Stuivenberg General Hospital, Antwerp, Belgium.
Nieuwenhof
Arthur
A
Machiels
Katia
K
D001530:Belgium; D016009:Chi-Square Distribution; D003625:Data Collection; D004496:Education, Continuing / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000379:methods / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data*; D004635:Emergency Medicine / Q000193:education* / Q000706:statistics & numerical data; D005188:False Negative Reactions; D006801:Humans; D009026:Mortality / Q000639:trends; D010348:Patient Care Team / Q000458:organization & administration / Q000706:statistics & numerical data; D016730:Program Development / Q000706:statistics & numerical data; D015397:Program Evaluation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014218:Triage / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data