title: Using On-scene EMS Responders' Assessment and Electronic Patient Care Records to Evaluate the Suitability of EMD-triaged, Low-acuity Calls for Secondary Nurse Triage in 911 Centers.
abstract: BACKGROUND
  Using the Medical Priority Dispatch System (MPDS) - a systematic 911 triage process - to identify a large subset of low-acuity patients for secondary nurse triage in the 911 center is a largely unstudied practice in North America. This study examines the ALPHA-level subset of low-acuity patients in the MPDS to determine the suitability of these patients for secondary triage by evaluating vital signs and necessity of lights-and-siren transport, as determined by attending Emergency Medical Services (EMS) ambulance crews.
  
  
  OBJECTIVE
  The primary objective of this study was to determine the clinical status of MPDS ALPHA-level (low-acuity) patients, as determined by on-scene EMS crews' patient care records, in two US agencies. A secondary objective was to determine which ALPHA-level codes are suitable candidates for secondary triage by a trained Emergency Communication Nurse (ECN).
  
  
  METHODS
  In this retrospective study, one full year (2013) of both dispatch data and EMS patient records data, associated with all calls coded at the ALPHA-level (low-acuity) in the dispatch protocol, were collected. The primary outcome measure was the number and percentage of ALPHA-level codes categorized as low-acuity, moderate-acuity, high-acuity, and critical using four common vital signs to assign these categories: systolic blood pressure (SBP), pulse rate (PR), oxygen saturation (SpO2), and Glasgow Coma Score (GCS). Vital sign data were obtained from ambulance crew electronic patient care records (ePCRs). The secondary endpoint was the number and percentage of ALPHA-level codes that received a "hot" (lights-and-siren) transport.
  
  
  RESULTS
  Out of 19,300 cases, 16,763 (86.9%) were included in the final analysis, after excluding cases from health care providers and those with missing data. Of those, 89% of all cases did not have even one vital sign indicator of unstable patient status (high or critical vital sign). Of all cases, only 1.1% were transported lights-and-siren.
  
  
  CONCLUSIONS
  With the exception of the low-acuity, ALPHA-level seizure cases, the ALPHA-level patients are suitable to transfer for secondary triage in a best-practices, accredited, emergency medical dispatch center that utilizes the MPDS at very high compliance rates. The secondary nurse triage process should identify the few at-risk patients that exist in the low-acuity calls.
authors.affiliation: 1Research and Standards Division,International Academies of Emergency Dispatch,Salt Lake City,UtahUSA.
authors.forename: Greg
authors.initials: G
authors.lastname: Scott
authors.affiliation: 1Research and Standards Division,International Academies of Emergency Dispatch,Salt Lake City,UtahUSA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Clawson
authors.affiliation: 2Administration,Priority Solutions Inc.,Salt Lake City,UtahUSA.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Fivaz
authors.affiliation: 2Administration,Priority Solutions Inc.,Salt Lake City,UtahUSA.
authors.forename: Jennie
authors.initials: J
authors.lastname: McQueen
authors.affiliation: 1Research and Standards Division,International Academies of Emergency Dispatch,Salt Lake City,UtahUSA.
authors.forename: Marie I
authors.initials: MI
authors.lastname: Gardett
authors.affiliation: 4Emergency Medical Services Authority,Tulsa,OklahomaUSA.
authors.forename: Bryon
authors.initials: B
authors.lastname: Schultz
authors.affiliation: 5Salt Lake City Fire Department,Salt Lake City,UtahUSA.
authors.forename: Scott
authors.initials: S
authors.lastname: Youngquist
authors.affiliation: 1Research and Standards Division,International Academies of Emergency Dispatch,Salt Lake City,UtahUSA.
authors.forename: Christopher H O
authors.initials: CH
authors.lastname: Olola
mesh_terms: D016208:Databases, Factual; D057286:Electronic Health Records; D004632:Emergency Medical Services; D060731:Emergency Responders; D006801:Humans; D062072:Patient Acuity; D012189:Retrospective Studies; D014187:Transportation of Patients; D014218:Triage; D014481:United States
keywords: ACE Accredited Center of Excellence; BLS Basic Life Support; ECN Emergency Communication Nurse; ECNS Emergency Communication Nurse System; EMD Emergency Medical Dispatcher; EMS Emergency Medical Services; EMS communication systems; EMT Emergency Medical Technician; GCS Glasgow Coma Score; IAED International Academies of Emergency Dispatch; MPDS Medical Priority Dispatch System; Medical Priority Dispatch System; PR pulse rate; SBP systolic blood pressure; SpO2 pulse oximetry reading; dispatch priority levels; ePCR electronic patient care record; electronic patient care record; low-acuity calls; secondary nurse triage system