Analysis of emergency medical services triage and dispatch errors by registered nurses in Italy.

INTRODUCTION: The major elements of an effective emergency medical services (EMS) system include a single telephone access number, accurate assessment of the urgency of the health problem, and timely dispatch of appropriate personnel and equipment. In Italy, EMS calls are managed by emergency operations centers by registered nurses who have received specialized education in this function. The nurses determine the criticality of the situations and assign an EMS response priority level identified by a color code, ranging from red (very critical) to green (not critical). At times, the severity of a situation may be underestimated, resulting in assignment of a lower EMS response priority and the potential for patient death (code black). The purpose of this study was to analyze factors associated with registered nurse under-triage of EMS calls subsequently found to be associated with deaths, termed "green-black code" cases. METHODS: We carried out a retrospective qualitative analysis of EMS telephone conversations using Fele's conversation analysis method. The characteristics of green-black code calls were compared with the characteristics of the population of all EMS calls during the study period. RESULTS: The study patients were older, with a mean age of 81.6 years. The callers were individuals calling on behalf of the patients, rather than the patients themselves. The callers reported symptoms that were not life-threatening. Nurse operators did not always inquire about the patients' vital signs as required by the Medical Priority Dispatch System protocol. The phone conversations were shorter than normal (54.26 seconds vs 65 seconds). DISCUSSION: Although the importance of dispatch system protocols is wellknown, it is also important that nurse triage operators have proper training to ensure that major parameters such as vital signs and symptomatology are obtained and to reduce caller stress level.

Influence of summer tourist flows on occurrence of out-of-hospital cardiac arrest in an Italian tourist-intensive area.

INTRODUCTION: The study aims to evaluate the seasonal variation of out-of hospital cardiac arrest (OHCA) in a tourist-intensive area. METHODS: Data of all OHCA treated by the Emergency Medical Service of Lecce (LE-EMS), Italy, between 2013 and 2017, were retrospectively analyzed and complemented with information about tourist flows, in order to determine the influence of the seasonal variation of population on incidence and outcome. RESULTS: Tourist arrivals were around 1,700,000 per year, mostly in summer, adding up to 803,161 residents. The occurrence of OHCA did not show a monthly variation when referring to the resident population (p = 0.90). When taking into account the tourist flows, a difference in occurrence of OHCA across months was found, with the highest rate of arrests in December and the lowest in August (10.3 vs 3.4 per 100,000 persons, p < 0.01). No difference was found in terms of EMS arrival time and event survival rate between summer and the rest of the year (13.6 vs 13.8 min, p = 0.55, and 4.4% vs 4.5%, p = 0.86, respectively). CONCLUSION: In summer tourism areas, the occurrence of OHCA is unchanged throughout the year, while the actual population presents seasonal increases. Summer enhancement of provincial EMS may contribute to maintain the performance of emergency care.