Contribution of Live Video to Physicians' Remote Assessment of Suspected COVID-19 Patients in an Emergency Medical Communication Centre: A Retrospective Study and Web-Based Survey.

The COVID-19 pandemic had a major impact on emergency medical communication centres (EMCC). A live video facility was made available to second-line physicians in an EMCC with a first-line paramedic to receive emergency calls. The objective of this study was to measure the contribution of live video to remote medical triage. The single-centre retrospective study included all telephone assessments of patients with suspected COVID-19 symptoms from 01.04.2020 to 30.04.2021 in Geneva, Switzerland. The organisation of the EMCC and the characteristics of patients who called the two emergency lines (official emergency number and COVID-19 number) with suspected COVID-19 symptoms were described. A prospective web-based survey of physicians was conducted during the same period to measure the indications, limitations and impact of live video on their decisions. A total of 8957 patients were included, and 2157 (48.0%) of the 4493 patients assessed on the official emergency number had dyspnoea, 4045 (90.6%) of 4464 patients assessed on the COVID-19 number had flu-like symptoms and 1798 (20.1%) patients were reassessed remotely by a physician, including 405 (22.5%) with live video, successfully in 315 (77.8%) attempts. The web-based survey (107 forms) showed that physicians used live video to assess mainly the breathing (81.3%) and general condition (78.5%) of patients. They felt that their decision was modified in 75.7% (n = 81) of cases and caught 7 (7.7%) patients in a life-threatening emergency. Medical triage decisions for suspected COVID-19 patients are strongly influenced by the use of live video.

[Medical dispatch and interprofessionalism : Who, what training, and for what missions ?] / Régulation médicale et interprofessionnalité : qui, quelle formation et pour quelles missions ?

The missions of the emergency medical communication centers (EMCC) are to provide a response to calls related to emergencies (emergency medical dispatch) or to on-call medicine. The medical dispatch process is complex. The dispatch process tends to become fragmented and specialized for the different dispatch tasks, medical and non-medical, involving the collaboration of several health and non-health professionals in the same centre. A real chain of competences inside the EMCC has thus been created, within the pre-hospital emergency chain itself. Cross-disciplinary training based on simulated situations can be used to strengthen inter-professional collaboration within the EMCC.

Les missions des centres de communication médicale d'urgence (CCMU) sont d'apporter une réponse aux appels liés à l'urgence (répartition médicale d'urgence) ou à la médecine de garde. Le processus de régulation médicale est complexe et la réponse à distance de type conseil téléphonique ou téléconsultation s'est fortement développée. Le processus de régulation tend à se fragmenter et à se spécialiser pour les différentes tâches de régulation, médicales et non médicales, impliquant la collaboration de plusieurs corps de métiers, de la santé ou non, dans une même centrale. Une véritable chaîne de compétences dans le CCMU a été ainsi créée, au sein même de la chaîne de secours préhospi­talier. Des formations transversales basées sur des situations simulées pourront servir à renforcer la collaboration interprofessionnelle au sein des CCMU.

Symptom-Based Dispatching in an Emergency Medical Communication Centre: Sensitivity, Specificity, and the Area under the ROC Curve.

BACKGROUND: Measuring the performance of emergency medical dispatch tools used in paramedic-staffed emergency medical communication centres (EMCCs) is rarely performed. The objectives of our study were, therefore, to measure the performance and accuracy of Geneva's dispatch system based on symptom assessment, in particular, the performance of ambulance dispatching with lights and sirens (L&S) and to measure the effect of adding specific protocols for each symptom. Methods: We performed a prospective observational study including all emergency calls received at Geneva's EMCC (Switzerland) from 1 January 2014 to 1 July 2019. The risk levels selected during the emergency calls were compared to a reference standard, based on the National Advisory Committee for Aeronautics (NACA) scale, dichotomized to severe patient condition (NACA ≥ 4) or stable patient condition (NACA < 4) in the field. The symptom-based dispatch performance was assessed using a receiver operating characteristic (ROC) curve. Contingency tables and a Fagan nomogram were used to measure the performance of the dispatch with or without L&S. Measurements were carried out by symptom, and a group of symptoms with specific protocols was compared to a group without specific protocols. Results: We found an acceptable area under the ROC curve of 0.7474, 95%CI (0.7448-0.7503) for the 148,979 assessments included in the study. Where the severity prevalence was 21%, 95%CI (20.8-21.2). The sensitivity of the L&S dispatch was 87.5%, 95%CI (87.1-87.8); and the specificity was 47.3%, 95%CI (47.0-47.6). When symptom-specific assessment protocols were used, the accuracy of the assessments was slightly improved. Conclusions: Performance measurement of Geneva's symptom-based dispatch system using standard diagnostic test performance measurement tools was possible. The performance was found to be comparable to other emergency medical dispatch systems using the same reference standard. However, the implementation of specific assessment protocols for each symptom may improve the accuracy of symptom-based dispatch systems.