title: Medical priority dispatch codes-comparison with National Early Warning Score.
abstract: BACKGROUND
  In Finland, calls for emergency medical services are prioritized by educated non-medical personnel into four categories-from A (highest risk) to D (lowest risk)-following a criteria-based national dispatch protocol. Discrepancies in triage may result in risk overestimation, leading to inappropriate use of emergency medical services units and to risk underestimation that can negatively impact patient outcome. To evaluate dispatch protocol accuracy, we assessed association between priority assigned at dispatch and the patient's condition assessed by emergency medical services on the scene using an early warning risk assessment tool.
  
  
  METHODS
  Using medical charts, clinical variables were prospectively recorded and evaluated for all emergency medical services missions in two hospital districts in Northern Finland during 1.1.2014-30.6.2014. Risk assessment was then re-categorized as low, medium, or high by calculating the National Early Warning Score (NEWS) based on the patients' clinical variables measured at the scene.
  
  
  RESULTS
  A total of 12,729 emergency medical services missions were evaluated, of which 616 (4.8%) were prioritized as A, 3193 (25.1%) as B, 5637 (44.3%) as C, and 3283 (25.8%) as D. Overall, 67.5% of the dispatch missions were correctly estimated according to NEWS. Of the highest dispatch priority missions A and B, 76.9 and 78.3%, respectively, were overestimated. Of the low urgency missions (C and D), 10.7% were underestimated; 32.0% of the patients who were assigned NEWS indicating high risk had initially been classified as low urgency C or D priorities at the dispatch.
  
  
  CONCLUSIONS
  The present results show that the current Finnish medical dispatch protocol is suboptimal and needs to be further developed. A substantial proportion of EMS missions assessed as highest priority were categorized as lower risk according to the NEWS determined at the scene, indicating over-triage with the protocol. On the other hand, only a quarter of the high risk NEWS patients were classified as the highest priority at dispatch, indicating considerable under-triage with the protocol.
authors.affiliation: Medical Research Centre, Research Unit of Surgery, Anaesthesia and Intensive Care and Department of Anaesthesiology, Division of Intensive Care, University of Oulu and Oulu University Hospital, PO BOX 21, , FI-90029, Oulu, OYS, Finland. marko.hoikka@student.oulu.fi.
authors.forename: Marko
authors.initials: M
authors.lastname: Hoikka
authors.affiliation: Emergency Medical Service, Department of Emergency Medicine, Helsinki University Central Hospital and University of Helsinki, FI-00029, Helsinki, HUS, Finland.
authors.forename: Sami
authors.initials: S
authors.lastname: Länkimäki
authors.affiliation: Emergency Medical Service, Department of Emergency Medicine, Helsinki University Central Hospital and University of Helsinki, FI-00029, Helsinki, HUS, Finland.
authors.forename: Tom
authors.initials: T
authors.lastname: Silfvast
authors.affiliation: Medical Research Centre, Research Unit of Surgery, Anaesthesia and Intensive Care and Department of Anaesthesiology, Division of Intensive Care, University of Oulu and Oulu University Hospital, PO BOX 21, , FI-90029, Oulu, OYS, Finland.
authors.forename: Tero I
authors.initials: TI
authors.lastname: Ala-Kokko
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D004631:Emergency Medical Service Communication Systems / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D014218:Triage / Q000379:methods*; D014947:Wounds and Injuries / Q000175:diagnosis*
keywords: Early warning score; Emergency medical services; Medical dispatch codes; Triage