title: Preventable deaths following emergency medical dispatch--an audit study.
abstract: BACKGROUND
  Call taker triage of calls to the 112 emergency number, can be error prone because rapid decisions must be made based on limited information. Here we investigated the preventability and common characteristics of same-day deaths among patients who called 112 and were not assigned an ambulance with lights and sirens by the Emergency Medical Communication Centre (EMCC).
  
  
  METHODS
  An audit was performed by an external panel of experienced prehospital consultant anaesthesiologists. The panel focused exclusively on the role of the EMCC, assessing whether same-day deaths among 112 callers could have been prevented if the EMCC had assessed the situations as highly urgent. The panels' assessments were based on review of patient charts and voice-log recordings of 112 calls. All patient related material was reviewed by the audit panel and all cases where then scored as preventable, potentially preventable or non-preventable during a two day meeting. The study setting was three of five regions in Denmark with a combined population of 4,182,613 inhabitants, which equals 75% of the Danish population. The study period was 18 months, from mid-2011 to the end of 2012.
  
  
  RESULTS
  Linkage of prospectively collected EMCC data with population-based registries resulted in the identification of 94,488 non-high-acuity 112 callers. Among these callers, 152 (0.16% of all) died on the same day as the corresponding 112 call, and were included in this study. The mean age of included patients was 74.4 years (range, 31-100 years) and 45.4% were female. The audit panel found no definitively preventable deaths; however, 18 (11.8%) of the analysed same-day deaths (0.02% of all non-high-acuity callers) were found to be potentially preventable. In 13 of these 18 cases, the dispatch protocol was either not used or not used correctly.
  
  
  CONCLUSIONS
  Same-day death rarely occurred among 112 callers whose situations were assessed as not highly urgent. No same-day deaths were found to be definitively preventable by a different EMCC call assessment, but a minority of same-day deaths could potentially have been prevented with more accurate triage. Better adherence with dispatch protocol could improve the safety of the dispatch process.
authors.affiliation: Research Department, Prehospital Emergency Medical Services, Aarhus, Central Denmark Region, Olof Palmes Allé 34, 8200, Aarhus N, Denmark. mikkel.andersen@ph.rm.dk.|Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. mikkel.andersen@ph.rm.dk.|Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark. mikkel.andersen@ph.rm.dk.
authors.forename: Mikkel S
authors.initials: MS
authors.lastname: Andersen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. spj@dce.au.dk.
authors.forename: Søren Paaske
authors.initials: SP
authors.lastname: Johnsen
authors.affiliation: Emergency Medical Communication Center, Oslo University Hospital, Oslo, Norway. Andreas.Ernst.Hansen@oslo-universitetssykehus.no.
authors.forename: Andreas Ernst
authors.initials: AE
authors.lastname: Hansen
authors.affiliation: Helicopter Emergency Medical Services, St. Olavs Hospital, Trondheim, Norway. Eivinn.Skjaerseth@stolav.no.
authors.forename: Eivinn
authors.initials: E
authors.lastname: Skjaerseth
authors.affiliation: Department of Anaesthesia, Center of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. christian.muff.hansen@regionh.dk.
authors.forename: Christian Muff
authors.initials: CM
authors.lastname: Hansen
authors.affiliation: Emergency Medical Communication Center, Capital Region of Denmark, Denmark. jan.noertved@regionh.dk.
authors.forename: Jan Nørtved
authors.initials: JN
authors.lastname: Sørensen
authors.affiliation: Mobile Emergency Care Unit, Department Anaesthesiology Intensive Care Medicine, Odense University Hospital, Odense, Denmark. soeren.jepsen@rsyd.dk.
authors.forename: Søren Bruun
authors.initials: SB
authors.lastname: Jepsen
authors.affiliation: Research Department, Prehospital Emergency Medical Services, Aarhus, Central Denmark Region, Olof Palmes Allé 34, 8200, Aarhus N, Denmark. jesper.hansen@ph.rm.dk.
authors.forename: Jesper Bjerring
authors.initials: JB
authors.lastname: Hansen
authors.affiliation: Research Department, Prehospital Emergency Medical Services, Aarhus, Central Denmark Region, Olof Palmes Allé 34, 8200, Aarhus N, Denmark. erika.christensen@ph.rm.dk.
authors.forename: Erika Frischknecht
authors.initials: EF
authors.lastname: Christensen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances / Q000592:standards*; D002423:Cause of Death / Q000639:trends; D054869:Clinical Audit / Q000379:methods*; D003718:Denmark / Q000453:epidemiology; D004631:Emergency Medical Service Communication Systems / Q000458:organization & administration*; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014218:Triage / Q000379:methods*