title: Association between patient unconscious or not alert conditions and cardiac arrest or high-acuity outcomes within the Medical Priority Dispatch System "Falls" protocol.
abstract: BACKGROUND
  Falls are one of the most common types of complaints received by 9-1-1 emergency medical dispatch centers. They can be accidental or may be caused by underlying medical problems. Though "not alert" falls patients with severe outcomes mostly are "hot" transported to the hospital, some of these cases may be due to other acute medical events (cardiac, respiratory, circulatory, or neurological), which may not always be apparent to the emergency medical dispatcher (EMD) during call processing.
  
  
  OBJECTIVE
  The objective of this study was to characterize the risk of cardiac arrest and "hot-transport" outcomes in patients with "not alert" condition, within the Medical Priority Dispatch System (MPDS®) Falls protocol descriptors.
  
  
  METHODS
  This retrospective study used 129 months of de-identified, aggregate, dispatch datasets from three US emergency communication centers. The communication centers used the Medical Priority Dispatch System version 11.3-OMEGA type (released in 2006) to interrogate Emergency Medical System callers, select dispatch codes assigned to various response configurations, and provide pre-arrival instructions. The distribution of cases and percentages of cardiac arrest and hot-transport outcomes, categorized by MPDS® code, was profiled. Assessment of the association between MPDS® Delta-level 3 (D-3) "not alert" condition and cardiac arrest and hot-transport outcomes then followed.
  
  
  RESULTS
  Overall, patients within the D-3 and D-2 "long fall" conditions had the highest proportions (compared to the other determinants in the "falls" protocol) of cardiac arrest and hot-transport outcomes, respectively. "Not alert" condition was associated significantly with cardiac arrest and hot-transport outcomes (p<0.001).
  
  
  CONCLUSIONS
  The "not alert" determinant within the MPDS® "fall" protocol was associated significantly with severe outcomes for short falls (<6 feet; 2 meters) and ground-level falls. As reported to 9-1-1, the complaint of a "fall" may include the presence of underlying conditions that go beyond the obvious traumatic injuries caused by the fall itself.
authors.affiliation: International Academies of Emergency Dispatch, Salt Lake City, UT 84111, USA. jeff.clawson@emergencydispatch.org
authors.forename: Jeff
authors.initials: J
authors.lastname: Clawson
authors.forename: Christopher
authors.initials: C
authors.lastname: Olola
authors.forename: Greg
authors.initials: G
authors.lastname: Scott
authors.forename: Bryon
authors.initials: B
authors.lastname: Schultz
authors.forename: Richard
authors.initials: R
authors.lastname: Pertgen
authors.forename: Don
authors.initials: D
authors.lastname: Robinson
authors.forename: Barry
authors.initials: B
authors.lastname: Bagwell
authors.forename: Brett
authors.initials: B
authors.lastname: Patterson
mesh_terms: D000058:Accidental Falls; D002985:Clinical Protocols / Q000592:standards; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D006323:Heart Arrest / Q000150:complications*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D014218:Triage / Q000379:methods*; D014474:Unconsciousness / Q000150:complications*