title: Evaluation of emergency medical dispatch in out-of-hospital cardiac arrest in Taipei.
abstract: BACKGROUND
  Emergency medical dispatchers are the entry points to the emergency medical services (EMS). The overall performances of the dispatchers are imperative determinants of the emergency medical services dispatching system. There is little data on the cultural and language impacts on emergency medical dispatch.
  
  
  OBJECTIVE
  This study examined the emotional content and cooperation score (ECCS) among Mandarin Chinese speaking callers for cardiac arrests, and evaluated the performances of emergency medical services dispatching system in Taipei.
  
  
  METHODS
  This retrospective, observational study examined dispatching audio recordings obtained from the Taipei City Fire Department Dispatching Center between January 2004 to April 2004. The tapes of call relating to adult (age >or=18 years), non-traumatic cases with a presumed or field diagnosis of out-of-hospital cardiac arrest (OHCA) underwent systemic review. The caller's ECCS and the dispatcher's performances, including interview skills, provision of telephone-assisted cardiopulmonary resuscitation (T-CPR), and dispatcher's ability to identify OHCA were examined. Interrater reliability for determining ECCS and interview skills were assessed using kappa statistic.
  
  
  RESULTS
  A total of 199 audio recordings were reviewed. A mean ECCS of 1.42+/-0.64 (95% CI: 1.33-1.51) demonstrated that most callers were emotionally stable and cooperative when calling for help, even when facing cardiac arrest patients. There was a good association between ECCS and the sex of the callers (male 1.32 versus female 1.49; p<0.05). In 82% of interviews, the interview skills of the dispatchers was high (4 or 5 points); while in one fifth the interview skills were suboptimal. About one third of the cases were provided with T-CPR by the dispatchers. The sensitivity and positive predictive value (PPV) for predicting OHCA by dispatchers were 96.9% and 97.9%, respectively. A kappa value of 0.65 and 0.68 were obtained for the interrater reliability of ECCS and interview skills.
  
  
  CONCLUSIONS
  Most callers were found to be emotional stable and cooperative with dispatcher's interrogations when calling for cardiac arrest victims in this Mandarin speaking population. The dispatchers have shown satisfactory interview skills in approaching emergency calls and a good ability to identify OHCA. There is a low rate of T-CPR offered to the callers in the investigation. Efforts should be made to address the deficiencies in order to maximise the function of the EMS.
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan.
authors.forename: Matthew Huei-Ming
authors.initials: MH
authors.lastname: Ma
authors.forename: Tsung-Chien
authors.initials: TC
authors.lastname: Lu
authors.forename: Josh Chian-Shuin
authors.initials: JC
authors.lastname: Ng
authors.forename: Chih-Hao
authors.initials: CH
authors.lastname: Lin
authors.forename: Wen-Chu
authors.initials: WC
authors.lastname: Chiang
authors.forename: Patrick Chow-In
authors.initials: PC
authors.lastname: Ko
authors.forename: Fuh-Yuan
authors.initials: FY
authors.lastname: Shih
authors.forename: Chien-Hua
authors.initials: CH
authors.lastname: Huang
authors.forename: Kuang-Hua
authors.initials: KH
authors.lastname: Hsiung
authors.forename: Shyr-Chyr
authors.initials: SC
authors.lastname: Chen
authors.forename: Wen-Jone
authors.initials: WJ
authors.lastname: Chen
mesh_terms: D000368:Aged; D004631:Emergency Medical Service Communication Systems; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest; D006785:Hospitals, University; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013624:Taiwan; D013689:Telephone; D013997:Time Factors