Emergency medical dispatchers' experiences of using the Medical Priority Dispatch System telephone triage to identify maternity emergencies: a qualitative focus group study.

OBJECTIVES: The ambulance service plays a pivotal role in the provision of care in out-of-hospital maternity emergencies. Telephone triage of this patient group is complex and must be sensitive to an emergency situation to prevent unnecessary delays in treatment. This study aimed to explore emergency medical dispatchers' (EMDs) perceptions of the structured protocol they use. DESIGN: Voluntary participation in semistructured phenomenological focus groups. The participants were asked to discuss their experiences of using Medical Priority Dispatch System Protocol 24 (pregnancy, childbirth and miscarriage). Thematic analysis was applied to code and group topics. Discussion between the EMDs is presented for each theme and their experiences, including quotes, are presented to offer an overview of the maternity protocol and its use. SETTING: A large urban UK ambulance service. PARTICIPANTS: 23 control room staff. RESULTS: Perceptions of maternity emergencies, challenges with key questions, the need for sensitivity surrounding miscarriage, using prearrival instructions and postdispatch instructions to help patients and ideas for additional ProQA functionality emerged as the five overarching themes. Protocol 24 was considered to reflect many of the clinical factors EMDs associate with maternity emergencies although further factors, including some non-clinical, were suggested for inclusion. Miscarriage and termination-related calls were thought to be challenging as the language of the protocol is designed for pregnancy. However, instructions were generally considered well written and user-friendly, although some were thought to be unnecessary. EMDs were largely positive regarding the ProQA software, but felt backward navigation was difficult if a situation changed. CONCLUSIONS: Maternity calls were considered rewarding but complex by EMDs. We suggest changes including the use of more sensitive language in response to miscarriage and termination and make recommendations for the omission and inclusion of specific instructions, as well as enhancements to key questions and functionality. Further research is needed to ensure focus group findings are generalisable to other services, particularly in other countries.

Barriers to the Initiation of Telecommunicator-CPR during 9-1-1 Out-of-Hospital Cardiac Arrest Calls: A Qualitative Study.

INTRODUCTION: Fewer than 10% of individuals who suffer out-of-hospital cardiac arrest (OHCA) survive with good neurologic function. Bystander CPR more than doubles the chance of survival, and telecommunicator-CPR (T-CPR) during a 9-1-1 call substantially improves the frequency of bystander CPR. OBJECTIVE: We examined the barriers to initiation of T-CPR. METHODS: We analyzed the 9-1-1 call audio from 65 EMS-treated OHCAs from a single US 9-1-1 dispatch center. We initially conducted a thematic analysis aimed at identifying barriers to the initiation of T-CPR. We then conducted a conversation analysis that examined the interactions between telecommunicators and bystanders during the recognition phase (i.e., consciousness and normal breathing). RESULTS: We identified six process themes related to barriers, including incomplete or delayed recognition assessment, delayed repositioning, communication gaps, caller emotional distress, nonessential questions and assessments, and caller refusal, hesitation, or inability to act. We identified three suboptimal outcomes related to arrest recognition and delivery of chest compressions, which are missed OHCA identification, delayed OHCA identification and treatment, and compression instructions not provided following OHCA identification. A primary theme observed during missed OHCA calls was incomplete or delayed recognition assessment and included failure to recognize descriptors indicative of agonal breathing (e.g., "snoring", "slow") or to confirm that breathing was effective in an unconscious victim. CONCLUSIONS: We observed that modifiable barriers identified during 9-1-1 calls where OHCA was missed, or treatment was delayed, were often related to incomplete or delayed recognition assessment. Repositioning delays were a common barrier to the initiation of chest compressions.

Barriers to CPR initiation and continuation during the emergency call relating to out-of-hospital cardiac arrest: A descriptive cohort study.

AIM: To describe the barriers to cardiopulmonary resuscitation (CPR) initiation and continuation in emergency calls for out-of-hospital cardiac arrest (OHCA). METHODS: We analysed 295 consecutive emergency calls relating to OHCA over a four-month period (1 January - 30 April 2021). Calls included were paramedic-confirmed, non-traumatic, non-EMS-witnessed OHCA, where the caller was with the patient. Calls were listened to in full and coded in terms of barriers to CPR initiation and continuation, and patient and caller characteristics. RESULTS: Overall, CPR was performed in 69% of calls and, in 85% of these, callers continued performing CPR until EMS arrival. Nearly all callers (99%) experienced barriers to CPR initiation and/or continuation during the call. The barriers identified were classified into eight categories: reluctance, appropriateness, emotion, bystander physical ability, patient access, leaving the scene, communication failure, caller actions and call-taker instructions. Of these, bystander physical ability was the most prevalent barrier to both CPR initiation and continuation, occurring in 191 (65%) calls, followed by communication failure which occurred in 160 (54%) calls. Callers stopping or interrupting CPR performance due to being fatigued was lower than expected (n = 54, 26% of callers who performed CPR). Barriers to CPR initiation that related to bystander physical ability, caller actions, communication failure, emotion, leaving the scene, patient access, procedural barriers, and reluctance were mostly overcome by the caller (i.e., CPR was performed). CONCLUSION: Barriers to CPR initiation and continuation were commonly experienced by callers, however they were frequently overcome. Future research should investigate the strategies that were successful.

"Calling for help: i need you to listen'': a qualitative study of callers' experience of calls to the emergency medical communication centre.

BACKGROUND: The Emergency Medical Communications Center (EMCC) is essential in emergencies and often represents the public's first encounter with the healthcare system. Previous research has mainly focused on the dispatcher's perspective. Therefore, there is a lack of insight into the callers' perspectives, the attainment of which may contribute significantly to improving the quality of this vital public service. Most calls are now made from mobile phones, opening up novel approaches for obtaining caller feedback using tools such as short-message services (SMS). Thus, this study aims to obtain a better understanding of callers' actual experiences and how they perceived their interaction with the EMCC. METHODS: A combination of quantitative and qualitative study methods was used. An SMS survey was sent to the mobile phone numbers of everyone who had contacted 113 during the last months. This was followed by 31 semi-structured interviews with people either satisfied or dissatisfied. Thematic analysis was used to investigate the interviews. RESULTS: We received 1680 (35%) responses to the SMS survey, sent to 4807 unique numbers. Most respondents (88%) were satisfied, evaluating their experience as 5 or 6 on a six-point scale, whereas 5% answered with 1 or 2. The interviews revealed that callers were in distress before calling 113. By actively listening and taking the caller seriously, and affirming that it was the right choice to call the emergency number, the EMCC make callers experience a feeling of help and satisfaction, regardless of whether an ambulance was dispatched to their location. If callers did not feel taken seriously or listened to, they were less satisfied. A negative experience may lead to a higher distress threshold and an adjusted strategy before the caller makes contact 113 next time. Callers with positive experiences expressed more trust in the healthcare systems. CONCLUSIONS: For the callers, the most important was being taken seriously and listened to. Additionally, they welcomed that dispatchers express empathy and affirm that callers made the right choice to call EMCC, as this positively affects communication with callers. The 113 calls aimed to cooperate in finding a solution to the caller's problem.

The MeSH heading "Call Center" is due for an update: why we recommend the more precise heading "Emergency Medical Communication Center".

Call centers can be found in various industries. However as a Medical Subject Heading (MeSH) the term "Call centers" does not reflect the critical purpose of handling emergency calls. We recommend "emergency medical communication center(s)", as this provides clarity and precision regarding the primary function and purpose of the center.

Dispatcher-assisted BLS for lay bystanders: A pilot study comparing video streaming via smart glasses and telephone instructions.

OBJECTIVE: To determine whether dispatcher assistance via smart glasses improves bystander basic life support (BLS) performance compared with standard telephone assistance in a simulated out-of-hospital cardiac arrest (OHCA) scenario. METHODS: Pilot study in which 28 lay people randomly assigned to a smart glasses-video assistance (SG-VA) intervention group or a smartphone-audio assistance (SP-AA) control group received dispatcher guidance from a dispatcher to provide BLS in an OHCA simulation. SG-VA rescuers received assistance via a video call with smart glasses (Vuzix, Blade) connected to a wireless network, while SP-AA rescuers received instructions over a smartphone with the speaker function activated. BLS protocol steps, quality of chest compressions, and performance times were compared. RESULTS: Nine of the 14 SG-VA rescuers correctly completed the BLS protocol compared with none of the SP-AA rescuers (p = 0.01). A significantly higher number of SG-VA rescuers successfully opened the airway (13 vs. 5, p = 0.002), checked breathing (13 vs. 8, p = 0.03), correctly positioned the automatic external defibrillator pads (14 vs.6, p = 0.001), and warned bystanders to stay clear before delivering the shock (12 vs. 0, p < 0.001). No significant differences were observed for performance times or chest compression quality. The mean compression rate was 104 compressions per minute in the SG-VA group and 98 compressions per minute in the SP-AA group (p = 0.46); mean depth of compression was 4.5 cm and 4.4 cm (p = 0.49), respectively. CONCLUSIONS: Smart glasses could significantly improve dispatcher-assisted bystander performance in an OHCA event. Their potential in real-life situations should be evaluated.

Swedish emergency medical dispatch centres' ability to answer emergency medical calls and dispatch an ambulance in response to out-of-hospital cardiac arrest calls in accordance with the American Heart Association performance goals: An observational study.

AIM: To investigate the ability of Swedish Emergency Medical Dispatch Centres (EMDCs) to answer medical emergency calls and dispatch an ambulance for out-of-hospital cardiac arrest (OHCA) in accordance with the American Heart Association (AHA) performance goals in a 1-step (call connected directly to the EMDC) and a 2-step (call transferred to regional EMDC) procedure over 10 years, and to assess whether delays may be associated with 30-day survival. METHOD: Observational data from the Swedish Registry for Cardiopulmonary Resuscitation and EMDC. RESULTS: A total of 9,174,940 medical calls were answered (1-step). The median answer delay was 7.3 s (interquartile range [IQR], 3.6-14.5 s). Furthermore, 594,008 calls (6.1%) were transferred in a 2-step procedure, with a median answer delay of 39 s (IQR, 30-53 s). A total of 45,367 cases (0.5%, 1-step) were registered as OHCA, with a median answer delay of 7.2 s (IQR, 3.6-14.1 s) (AHA high-performance goal, 10 s). For 1-step procedure, no difference in 30-day survival was found regarding answer delay. For OHCA (1-step), an ambulance was dispatched after a median of 111.9 s (IQR, 81.7-159.9 s). Thirty-day survival was 10.8% (n = 664) when an ambulance was dispatched within 70 s (AHA high-performance) versus 9.3% (n = 2174) > 100 s (AHA acceptable) (p = 0.0013). Outcome data in the 2-step procedure was unobtainable. CONCLUSION: The majority of calls were answered within the AHA performance goals. When an ambulance was dispatched within the AHA high-performance standard in response to OHCA calls, survival was higher compared with calls when dispatch was delayed.

Are smart glasses feasible for dispatch prehospital assistance during on-boat cardiac arrest? A pilot simulation study with fishermen.

The aim of the study was to explore feasibility of basic life support (BLS) guided through smart glasses (SGs) when assisting fishermen bystanders. Twelve participants assisted a simulated out-of-hospital cardiac arrest on a fishing boat assisted by the dispatcher through the SGs. The SGs were connected to make video calls. Feasibility was assessed whether or not they needed help from the dispatcher. BLS-AED steps, time to first shock/compression, and CPR's quality (hands-only) during 2 consecutive minutes (1st minute without dispatcher feedback, 2nd with dispatcher feedback) were analyzed. Reliability was analyzed by comparing the assessment of variables performed by the dispatcher through SGs with those registered by an on-scene instructor. Assistance through SGs was needed in 72% of the BLS steps, which enabled all participants to perform the ABC approach and use AED correctly. Feasibility was proven that dispatcher's feedback through SGs helped to improve bystanders' performance, as after dispatcher gave feedback via SGs, only 3% of skills were incorrect. Comparison of on-scene instructor vs. SGs assessment by dispatcher differ in 8% of the analyzed skills: greatest difference in the "incorrect hand position during CPR" (on-scene: 33% vs. dispatcher: 0%). When comparing the 1st minute with 2nd minute, there were only significant differences in the percentage of compressions with correct depth (1st:48 ± 42%, 2nd:70 ± 31, p = 0.02). Using SGs in aquatic settings is feasible and improves BLS. CPR quality markers were similar with and without SG. These devices have great potential for communication between dispatchers and laypersons but need more development to be used in real emergencies.

Potential to enhance telephone cardiopulmonary resuscitation with improved instructions - findings from a simulation-based manikin study with lay rescuers.

BACKGROUND: Telephone-Cardiopulmonary Resuscitation (T-CPR) significantly increases rate of bystander resuscitation and improves patient outcomes after out-of-hospital cardiac arrest (OHCA). Nevertheless, securing correct execution of instructions remains a difficulty. ERC Guidelines 2021 recommend standardised instructions with continuous evaluation. Yet, there are no explicit recommendations on a standardised wording of T-CPR in the German language. We investigated, whether a modified wording regarding check for breathing in a German T-CPR protocol improved performance of T-CPR. METHODS: A simulation study with 48 OHCA scenarios was conducted. In a non-randomised trial study lay rescuers were instructed using the real-life-CPR protocol of the regional dispatch centre and as the intervention a modified T-CPR protocol, including specific check for breathing (head tilt-chin lift instructions). Resuscitation parameters were assessed with a manikin and video recordings. RESULTS: Check for breathing was performed by 64.3% (n = 14) of the lay rescuers with original wording and by 92.6% (n = 27) in the group with modified wording (p = 0.035). In the original wording group the head tilt-chin manoeuvre was executed by 0.0% of the lay rescuers compared to 70.3% in the group with modified wording (p < 0.001). The average duration of check for breathing was 1 ± 1 s in the original wording group and 4 ± 2 s in the group with modified wording (p < 0.001). Other instructions (e.g. check for consciousness and removal of clothing) were well performed and did not differ significantly between groups. Quality of chest compression did not differ significantly between groups, with the exception of mean chest compression depth, which was slightly deeper in the modified wording group. CONCLUSION: Correct check for breathing seems to be a problem for lay rescuers, which can be decreased by describing the assessment in more detail. Hence, T-CPR protocols should provide standardised explicit instructions on how to perform airway assessment. Each protocol should be evaluated for practicability.

"If you miss that first step in the chain of survival, there is no second step"-Emergency ambulance call-takers' experiences in managing out-of-hospital cardiac arrest calls.

When a person has an out-of-hospital cardiac arrest (OHCA), calling the ambulance for help is the first link in the chain of survival. Ambulance call-takers guide the caller to perform life-saving interventions on the patient before the paramedics arrive at the scene, therefore, their actions, decisions and communication are integral to saving the patient's life. In 2021, we conducted open-ended interviews with 10 ambulance call-takers with the aim of understanding their experiences of managing these phone calls; and to explore their views on using a standardised call protocol and triage system for OHCA calls. We took a realist/essentialist methodological approach and applied an inductive, semantic and reflexive thematic analysis to the interview data to yield four main themes expressed by the call-takers: 1) time-critical nature of OHCA calls; 2) the call-taking process; 3) caller management; 4) protecting the self. The study found that call-takers demonstrated deep reflection on their roles in, not only helping the patient, but also the callers and bystanders to manage a potentially distressing event. Call-takers expressed their confidence in using a structured call-taking process and noted the importance of skills and traits such as active listening, probing, empathy and intuition, based on experience, in order to supplement the use of a standardised system in managing the emergency. This study highlights the often under-acknowledged yet critical role of the ambulance call-taker in being the first member of an emergency medical service that is contacted in the event of an OHCA.

Differences between the dispatch priority assessments of emergency medical dispatchers and emergency medical services: a prospective register-based study in Finland.

BACKGROUND: Responsive and efficient emergency medical services (EMS) require accurate telephone triage. In Finland, such services are provided by Emergency Response Centre Agency (ERC Agency). In 2018, a new Finnish computer-assisted emergency dispatch system was introduced: the Emergency Response Integrated Common Authorities (ERICA). After the introduction of ERICA, the appropriateness of EMS dispatch has not been investigated yet. The study´s objective is to determine the consistency between the priority triage of the emergency medical dispatcher (EMD) and the on-scene priority assessment of the EMS, and whether the priority assessment consistency varied among the dispatch categories. METHODS: This was a prospective register-based study. All EMS dispatches registered in the Tampere University Hospital area from 1 August 2021 to 31 August 2021 were analysed. The EMD's mission priority triaged during the emergency call was compared with the on-scene EMS's assessment of the priority, derived from the pre-set criteria. The test performance levels were measured from the crosstabulation of true or false positive and negative values of the priority assessment. Statistical significance was analysed using the chi-square test and the Kruskal-Wallis H test, and p-values < 0.05 were considered significant. RESULTS: Of the 6416 EMS dispatches analysed in this study, 36% (2341) were urgent according to the EMD's dispatch priority, and of these, only 29% (688) were urgent according to the EMS criteria. On the other hand, 64% (4075) of the dispatches were non-urgent according to the EMD's dispatch priority, of which 97% (3949) were non-urgent according to the EMS criteria. Moreover, there were differences between the EMD and EMS priority assessments among the dispatch categories (p < 0.001). The overall efficiency was 72%, sensitivity 85%, specificity 71%, positive predictive value 29%, and negative predictive value 97%. CONCLUSION: While the EMD recognised the non-urgent dispatches with high consistency with the EMS criteria, most of the EMD's urgent dispatches were not urgent according to the same criteria. This may diminish the availability of the EMS for more urgent missions. Thus, measures are needed to ensure more accurate and therefore, more efficient use of EMS resources in the future.

Rescue coordination common operating picture: Enhancement through satellite technology.

Natural hazards and human-made disasters are increasing in magnitude and frequency due to climate change. The increase in response assets across agencies is complicating synchronization and communication during lifesaving operations. Technological advancements in wireless communication systems are improving resource tasking, tracking, and awareness but are vulnerable to interruption from the destruction inflicted by natural hazards. However, satellite technology offers solutions to safeguard lifesaving coordination in austere environments. Through a focused review of the relevant literature and policy documents, this study analyzes disaster response command and control, emerging communication capabilities, and satellite technology related to developing a common operating picture for all actors. The aim is to provide practicing emergency managers with the means to overcome communication gaps in wireless and satellite technology to maintain this common picture, save lives in the wake of disasters, and protect emergency responders during hazardous mass rescue operations. Results indicate that communication technology does aid emergency managers in the highly pressurized response environment but the systems being relied upon are themselves vulnerable to disasters. The existing literature also establishes that response actors are leveraging satellite technology to fill gaps in communications connectivity during disasters to reduce risk, which has both national and international -implications.

When the machine is wrong. Characteristics of true and false predictions of Out-of-Hospital Cardiac arrests in emergency calls using a machine-learning model.

BACKGROUND: A machine-learning model trained to recognize emergency calls regarding Out-of-Hospital Cardiac Arrest (OHCA) was tested in clinical practice at Copenhagen Emergency Medical Services (EMS) from September 2018 to December 2019. We aimed to investigate emergency call characteristics where the machine-learning model failed to recognize OHCA or misinterpreted a call as being OHCA. METHODS: All emergency calls were linked to the dispatch database and verified OHCAs were identified by linkage to the Danish Cardiac Arrest Registry. Calls with either false negative or false positive predictions of OHCA were evaluated by trained auditors. Descriptive analyses were performed with absolute numbers and percentages reported. RESULTS: The machine-learning model processed 169,236 calls to Copenhagen EMS and suspected 5,811 (3.4%) of the calls as OHCA, resulting in 84.5% sensitivity and 97.1% specificity. Among OHCAs not recognised by machine-learning model, a condition completely different from OHCA was presented by caller in 31% of the cases. In 28% of unrecognised calls, patient was reported breathing normally, and language barriers were identified in 23% of the cases. Among falsely suspected OHCA, the patient was reported unconscious in 28% of the cases, and in 13% of the false positive cases the machine-learning model interpreted calls regarding dead patients with irreversible signs of death as OHCA. CONCLUSION: Continuous optimization of the language model is needed to improve the prediction of OHCA and thereby improve sensitivity and specificity of the machine-learning model on recognising OHCA in emergency telephone calls.

From hearing to seeing: medical dispatchers' experience with use of video streaming in medical emergency calls - a qualitative study.

OBJECTIVES: Video streaming has recently been introduced as an additional tool for communication between medical dispatchers and caller. Research implies that video streaming may be a useful tool for the dispatchers, but more knowledge is needed. With this study, we wanted to explore how the dispatchers experience using video streaming as an additional tool in medical emergency calls. DESIGN: An explorative, qualitative study using semi-structured focus group interviews. SETTING: Two emergency medical communications centres in Norway where video streaming recently had been introduced. Interviews were conducted during 24 June 2020 and 26 June 2020. PARTICIPANTS: We recruited 25 medical dispatchers, either nurses or emergency medical technicians who worked at the two centres. RESULTS: The results are categorised into three themes: (1) change in dispatcher's perception of the patient and the situation, (2) reassurance for the dispatcher and (3) worries about increased time consumption and the possibility of unpleasant images. CONCLUSION: The dispatchers experienced that the use of video streaming in medical emergency calls might contribute to a better comprehension of the situation and following more precise resource allocation, as well as greater reassurance for the dispatcher and improved relationship between the dispatcher and the caller. Further research with an aim to measure effects and safety of video streaming during medical emergency calls is needed.

Do Video Calls Improve Dispatcher-Assisted First Aid for Infants with Foreign Body Airway Obstruction? A Randomized Controlled Trial/Simulation Study.

BACKGROUND: Because choking quickly leads to cardiopulmonary arrest, it is crucial that bystanders remove foreign bodies effectively. Although oral instructions in video calls by dispatchers have improved the quality of cardiopulmonary resuscitation, it is unclear whether video calls improve the quality of first aid for choking infants. Therefore, this simulation study aimed to determine whether video calls with dispatchers improve the quality of first aid for infants with foreign body airway obstruction (FBAO). METHODS: Seventy first-year college students randomly assigned in pairs to communicate by video or audio calls participated in simulated emergency calls for infants with FBAO. Both groups began with oral instruction in voice calls until the transition was made to video calls in the video group. The primary outcome was quality of first aid performance, which was categorized as excellent, acceptable, or poor on the basis of existing guidelines. RESULTS: There were 17 simulations in the video-call groups and 16 in the voice-call groups. After initial oral instruction, the proportion of rescuers that received an evaluation of excellent or acceptable did not differ significantly between the groups (video, 41% vs. voice, 50%; P=0.61); however, evaluations for seven rescuers improved after transitioning to video calls. Ultimately, the proportion receiving a poor evaluation was significantly lower in the video-call group than in the voice-call group (50% vs. 82%, P=0.049). CONCLUSION: Oral instruction communicated by video calls improved the quality of first aid for infants with FBAO.

Video Emergency Calls in Medical Dispatching: A Scoping Review.

BACKGROUND: Video emergency calls (VCs) represent a feasible future trend in medical dispatching. Acceptance among callers and dispatchers seems to be good. Indications, potential problems, limitations, and directions of research of adding a live video from smartphones to an emergency call have not been reviewed outside the context of out-of-hospital cardiac arrest (OHCA). OBJECTIVE: The main objective of this study is to examine the scope and nature of research publications on the topic of VC. The secondary goal is to identify research gaps and discuss the potential directions of research efforts of VC. DESIGN: Following PRISMA-ScR guidelines, online bibliographic databases PubMed, Web of Science, SCOPUS, Google Scholar, ClinicalTrials.gov, and gray literature were searched from the period of January 1, 2012 through March 1, 2022 in English. Only studies focusing on video transfer via mobile phone to emergency medical dispatch centers (EMDCs) were included. RESULTS: Twelve articles were included in the qualitative synthesis and six main themes were identified: (1) cardiopulmonary resuscitation (CPR) guided by VC; (2) indications of VCs; (3) dispatchers' feedback and perception; (4) technical aspects of VCs; (5) callers' acceptance; and (6) confidentiality and legal issues. CONCLUSION: Video emergency calls are feasible and seem to be a well-accepted auxiliary method among dispatchers and callers. Some promising clinical results exist, especially for video-assisted CPR. On the other hand, there are still enormous knowledge gaps in the vast majority of implementation aspects of VC into practice.

[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.

"Like a rainy weather inside of me": Qualitative content analysis of telephone consultations concerning back pain preceding out-of-hospital cardiac arrest.

INTRODUCTION: Cardiac arrest patients presenting with back pain are at risk of not receiving the appropriate help when calling emergency medical services. In telephone consultations regarding patients with back pain preceding an out-of-hospital cardiac arrest, we investigated how communication between caller and call-taker influenced the call-taker's interpretation of back pain descriptions and decision-making about choice of response. METHOD: The study was conducted using 20 recorded phone calls from 17 patients who contacted the Copenhagen Emergency Medical Services (Denmark) reporting back pain up to 24 hours before an out-of-hospital cardiac arrest. Qualitative content analysis was applied. RESULTS: Two main categories emerged: (1) reasons, including subcategories: reported conditions, descriptions of conditions, patient's interpretation of condition and patient's own remedial actions; and (2) considerations, including subcategories: assessment of the severity, call-taker's interpretation of the condition, arguments for chosen response and conditions not facilitating further communication by the call-taker. CONCLUSION: In telephone consultations regarding patients with back pain preceding an out-of-hospital cardiac arrest the communication was influenced by the communicative preconditions of the call-taker. Communication in consultations where ambulances were not dispatched was characterized by complex descriptions of symptoms not easily fitting into the health system's interpretations of conditions warranting an urgent response.

Cortical symptoms described in emergency calls for patients with suspected large vessel occlusion: a descriptive analysis of 157 emergency calls.

BACKGROUND: Emergency medical dispatchers typically use the dispatch code for suspected stroke when the caller brings up one or more symptoms from the face-arm-speech triad. Paramedics and emergency department physicians are trained to suspect large vessel occlusion stroke when the stroke patient presents with hemiparesis and cortical symptoms: neglect, aphasia, and conjugate eye deviation (CED). We hypothesized that these symptoms could be evident in the emergency call. In this study, we aimed to describe common symptoms mentioned in the emergency calls for paramedic-suspected thrombectomy candidates. Secondly, we wanted to explore how the question about CED arises in the Finnish suspected stroke dispatch protocol. Our third aim was to find out if the symptoms brought up in suspected stroke and non-stroke dispatches differed from each other. METHODS: This was a retrospective study with a descriptive analysis of emergency calls for patients with paramedic-suspected large vessel occlusion stroke. We listened to the emergency calls for 157 patients transported to Tampere University Hospital, a Finnish comprehensive stroke centre. Two researchers listened for symptoms brought up in these calls and filled out a pre-planned case report form. RESULTS: Speech disturbance was the most common symptom brought up in 125 (80%) calls. This was typically described as an inability to speak any words (n = 65, 52% of calls with speech disturbance). Other common symptoms were falling down (n = 63, 40%) and facial asymmetry (n = 41, 26%). Suspicion of stroke was mentioned by 44 (28%) callers. When the caller mentioned unconsciousness the emergency dispatcher tended to use a non-stroke dispatch code. The dispatchers adhered poorly to the protocol and asked about CED in only 57% of suspected stroke dispatches. We found CED in 12 emergency calls and ten of these patients were diagnosed with large vessel occlusion. CONCLUSION: In cases where paramedics suspected large vessel occlusion stroke, typical stroke symptoms were described during the emergency call. Speech disturbance was typically described as inability to say anything. It is possible to further develop suspected stroke dispatch protocols to recognize thrombectomy candidates from ischemic cortical signs such as global aphasia and CED.