TELEPHONE TRIAGE OF CARDIAC EMERGENCY CALLS BY DISPATCHERS - A PROSPECTIVE-STUDY OF 1386 EMERGENCY CALLS - ABSTRACTS

Objectives-To evaluate the handling of potential cardiac emergency cal ls by dispatchers, to determine their final diagnosis and urgency, and to determine the value of the main complaint in predicting urgency an d the ability of the dispatchers to recognise non-urgent conditions. D esign-Prospective data collection and recording of main complaint of e mergency calls placed via the 06-11 alarm telephone number with follow up to hospital when the patients were transported and the general pra ctitioner when they were not. Setting-Dispatch centres of the emergenc y medical services in Amsterdam (urban area) and Enschede (rural area) . Patients-1386 consecutive adult subjects of emergency calls placed b y citizens about chest problems or unconsciousness not caused by injur y. Main outcome measures-Frequency of characteristics of the calls, ou tcome in diagnosis, and assessment of urgency. Results-69 (5%) patient s were dead when the ambulance arrived. Diagnosis was established in 1 071 patients (77%). The disorders most often reported were cardiac, wi th acute ischaemia in 15% of all subjects. In 28% of cases and for eac h presenting complaint no organic explanation was found. Overall 39% o f all emergency calls were urgent; the urgency rate was lowest for cal ls for people with abdominal discomfort. Dispatchers correctly identif ied 90% of the non-urgent calls, but 55% of the calls that they identi fied as urgent proved to be non-urgent. Conclusion-Currently, direct d ialling for an ambulance without the intervention of a general practit ioner imposes a high work load on emergency systems and hospitals beca use triage by dispatchers is not sufficiently accurate. It may be poss ible to increase the accuracy of triage by developing and testing deci sion algorithms.