EMERGENCY MEDICAL-SERVICES PRIORITY DISPATCH

Study objective: To test the ability of a locally designed priority di spatch system to safely exclude the need for advanced life support (AL S). Design: Retrospective review of emergency medical services (EMS) i ncident records to determine how often the lone dispatch of basic life support (BLS) units, staffed with basic emergency medical technicians , subsequently required or involved ALS care. Setting: A large central ized municipal EMS system with a tiered ALS/BLS ambulance response. Al l BLS units carry automated defibrillators. Measurements: Consecutive EMS records (35,075) were reviewed by computerized search for ALS proc edures. Records indicating ALS procedures were tabulated and then manu ally reviewed for the nature of and probable indication for the ALS in tervention. Intervention: Brief sequences of computer-stored questions that help dispatchers identify (or exclude) signs and symptoms indica ting the need for ALS. Results: The dispatch triage system spared ALS units from initial dispatch in 14,100 of the EMS incidents (40.2%), in creasing their availability and use for more serious calls. Among thes e 14,100 cases, only 41 patients (0.3%) later received drugs such as n itroglycerin and naloxone; another 27 patients (0.2%) received resusci tative interventions such as epinephrine or defibrillation. Furthermor e, on closer analysis, the immediate presence of a paramedic might hav e provided a true potential for advantage in outcome for only five or six patients (less than 0.04 of the 14,100 BLS dispatches). Meanwhile, many important operational, fiscal, and cost-effective patient care b enefits were realized with this system. Conclusion: A computer-aided d ispatch triage algorithm can facilitate improvements in both EMS syste m operations and prehospital patient care by safely and reliably ident ifying EMS incidents requiring only BLS.