How many emergency dispatches occurred per cardiac arrest?☆

Abstract 

Background

The Medical Priority Dispatch System (MPDS) is an emergency medical dispatch (EMD) system that is widely used to prioritize 9-1-1 calls and optimize resource allocation. Calls are assigned an MPDS determinant, which includes a number (1–32) representing chief complaint and priority (Alpha through Echo) representing acuity.

Objective

This study evaluates the number of emergency dispatches per cardiac arrest (NOD-CA) in cardiac arrest and non-cardiac arrest MPDS determinants.

Methods

All patients assigned a determinant by MPDS from January 1, 2008 to June 30, 2009 in a large metropolitan area were included. Prehospital electronic patient care records were linked with dispatch data. For each MPDS determinant, the number of calls for which the paramedic impression was listed as “Cardiac Arrest – Non-Traumatic” was tabulated. The NOD-CA was calculated for each cardiac arrest and non-cardiac arrest MPDS determinant. Non-MPDS calls with cardiac arrests were analyzed separately.

Results

A total of 101,642 patients were included. Among them, 555 had “Cardiac Arrest – Non-Traumatic” listed as the paramedic impression. The Cardiac/Respiratory Arrest/Death protocol had the highest number of cardiac arrests (285), followed by Breathing Problems (99) and Unconscious/Fainting (76). Overall, 183 dispatched occurred for each cardiac arrest, 131 of which resulted in a lights and sirens response. The NOD-CA was 7 in the Cardiac Arrest/Death protocol, 122 in Breathing Problems, and 104 in Unconscious/Fainting. 31 Cardiac arrests occurred in non-MPDS dispatch categories (N=62,989), most of which were calls for medical assistance from police or fire units.

Conclusions

MPDS was designed to detect cardiac arrest with high sensitivity, leading to a significant degree of mistriage. The number of dispatches for each cardiac arrest may be a useful way to quantify the degree of mistriage and optimize EMS dispatch. This large descriptive study revealed a low NOD-CA in most cardiac arrest MPDS determinants. We demonstrated significant variability in the NOD-CA among non-cardiac arrest MPDS determinants, and few cardiac arrests in non-MPDS dispatch categories.

Keywords: Out-of-hospital cardiac arrest, Ambulances/utilization, Emergencies/classification, Emergency Medical Dispatch, Emergency Medical Service Communication Systems/Standards, Emergency Medical Services/Standards, Emergency Medical Services/Utilization, Risk assessment, Triage