title: Effect and accuracy of emergency dispatch telephone guidance to bystanders in trauma: post-hoc analysis of a prospective observational study.
abstract: BACKGROUND
  Emergency medical communication centres (EMCCs) dispatch and allocate ambulance resources, and provide first-aid guidance to on-scene bystanders. We aimed to 1) evaluate whether dispatcher guidance improved bystander first aid in trauma, and 2) to evaluate whether dispatchers and on-scene emergency medical services (EMS) crews identified the same first aid measures as indicated.
  
  
  METHODS
  For 18 months, the crew on the first EMS crew responding to trauma calls used a standard form to assess bystander first aid. Audio recordings of the corresponding telephone calls from bystanders to the EMCC were reviewed.
  
  
  RESULTS
  A total of 311 trauma calls were included. The on-scene EMS crew identified needs for the following first-aid measures: free airway in 26 patients, CPR in 6 patients, and hypothermia prevention in 179 patients. EMCC dispatchers advised these measures, respectively, in 16 (62%), 5 (83%), and 54 (30%) of these cases. Dispatcher guidance was not correlated with correctly performed bystander first aid. For potentially life saving first aid measures, all (20/20) callers who received dispatcher guidance attempted first aid, while only some few (4/22) of the callers who did not receive dispatcher guidance did not attempt first aid.
  
  
  CONCLUSIONS
  Overall, the EMCC dispatchers had low sensitivity and specificity for correctly identifying trauma patients requiring first-aid measures. Dispatcher guidance did not significantly influence whether on-scene bystander first aid was performed correctly or attempted in this study setting, with a remarkably high willingness to perform first-aid. However, the findings for potentially lifesaving measures suggests that there may be differences that this study was unable to detect.
  
  
  CONCLUSIONS
  This study found a high rate of first-aid willingness and performance, even without dispatcher prompting, and a low precision in dispatcher advice. This underlines the need for further knowledge about how to increase EMCC dispatchers' possibility to identify trauma patients in need of first aid. The correlation between EMCC-guidance and bystander first aid should be investigated in study settings with lower spontaneous first-aid rates.
authors.affiliation: Mo i Rana Hospital, Helgeland Hospital Trust, Mo i Rana, Norway. hakonkvalebakke@gmail.com.|Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, IKM, University of Tromsø, Tromsø, Norway. hakonkvalebakke@gmail.com.
authors.forename: Håkon Kvåle
authors.identifier: http://orcid.org/0000-0003-4813-8909
authors.initials: HK
authors.lastname: Bakke
authors.affiliation: Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, IKM, University of Tromsø, Tromsø, Norway.
authors.forename: Tine
authors.initials: T
authors.lastname: Steinvik
authors.affiliation: University Hospital of Northern Norway, Department of Emergency and Acute Care, Harstad, Norway.
authors.forename: Håkon
authors.initials: H
authors.lastname: Ruud
authors.affiliation: Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, IKM, University of Tromsø, Tromsø, Norway.|Hammerfest Hospital, Department of Anaesthesiology and Intensive Care, Finnmark Health Trust, Hammerfest, Norway.|Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
authors.forename: Torben
authors.initials: T
authors.lastname: Wisborg
mesh_terms: D000071822:Emergency Medical Dispatcher; D004631:Emergency Medical Service Communication Systems; D005392:First Aid / Q000592:standards*; D006379:Helping Behavior; D006801:Humans; D011446:Prospective Studies; D013637:Tape Recording; D014947:Wounds and Injuries / Q000628:therapy*
keywords: Dispatch; First aid; Trauma