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Performance of the medical priority dispatch system in correctly classifying out-of-hospital cardiac arrests as appropriate for resuscitation

  • Justin Yap
    Correspondence
    Corresponding author at: Resuscitation Research Collaborative, 1190 Hornby St., 4th Floor, Vancouver, B.C. V6Z 2K5, Canada.
    Affiliations
    British Columbia Resuscitation Research Collaborative, British Columbia, Canada

    Faculty of Science, University of British Columbia, British Columbia, Canada
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  • Jennie Helmer
    Affiliations
    British Columbia Resuscitation Research Collaborative, British Columbia, Canada

    British Columbia Emergency Health Services, British Columbia, Canada

    School of Population & Public Health, University of British Columbia, British Columbia, Canada
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  • Marc Gessaroli
    Affiliations
    British Columbia Emergency Health Services, British Columbia, Canada
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  • Jacob Hutton
    Affiliations
    British Columbia Resuscitation Research Collaborative, British Columbia, Canada

    British Columbia Emergency Health Services, British Columbia, Canada

    Faculty of Medicine, University of British Columbia, British Columbia, Canada
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  • Laiba Khan
    Affiliations
    British Columbia Resuscitation Research Collaborative, British Columbia, Canada

    Faculty of Science, University of British Columbia, British Columbia, Canada
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  • Frank Scheuermeyer
    Affiliations
    British Columbia Resuscitation Research Collaborative, British Columbia, Canada

    Department of Emergency Medicine, University of British Columbia and St. Paul’s Hospital, British Columbia, Canada

    Centre for Health Evaluation and Outcome Sciences, British Columbia, Canada
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  • Nechelle Wall
    Affiliations
    British Columbia Resuscitation Research Collaborative, British Columbia, Canada

    British Columbia Emergency Health Services, British Columbia, Canada
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  • Jennifer Bolster
    Affiliations
    British Columbia Resuscitation Research Collaborative, British Columbia, Canada

    British Columbia Emergency Health Services, British Columbia, Canada
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  • Sean Van Diepen
    Affiliations
    British Columbia Resuscitation Research Collaborative, British Columbia, Canada

    Division of Critical Care, University of Alberta, Alberta, Canada
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  • Joseph Puyat
    Affiliations
    British Columbia Resuscitation Research Collaborative, British Columbia, Canada

    Centre for Health Evaluation and Outcome Sciences, British Columbia, Canada
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  • Michael Asamoah-Boaheng
    Affiliations
    British Columbia Resuscitation Research Collaborative, British Columbia, Canada

    Department of Emergency Medicine, University of British Columbia and St. Paul’s Hospital, British Columbia, Canada
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  • Ron Straight
    Affiliations
    British Columbia Resuscitation Research Collaborative, British Columbia, Canada

    British Columbia Emergency Health Services, British Columbia, Canada
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  • Jim Christenson
    Affiliations
    British Columbia Resuscitation Research Collaborative, British Columbia, Canada

    Department of Emergency Medicine, University of British Columbia and St. Paul’s Hospital, British Columbia, Canada

    Centre for Health Evaluation and Outcome Sciences, British Columbia, Canada
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  • Brian Grunau
    Affiliations
    British Columbia Resuscitation Research Collaborative, British Columbia, Canada

    British Columbia Emergency Health Services, British Columbia, Canada

    Department of Emergency Medicine, University of British Columbia and St. Paul’s Hospital, British Columbia, Canada

    Centre for Health Evaluation and Outcome Sciences, British Columbia, Canada
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      Abstract

      Background

      Emergency dispatch centres receive emergency calls and assign resources. Out-of-hospital cardiac arrests (OHCA) can be classified as appropriate (requiring emergent response) or inappropriate (requiring non-emergent response) for resuscitation. We sought to determine system accuracy in emergency medical services (EMS) OHCA response allocation.

      Methods

      We analyzed EMS-assessed non-traumatic OHCA records from the British Columbia (BC) Cardiac Arrest registry (January 1, 2019-June 1, 2021), excluding EMS-witnessed cases. In BC the “Medical Priority Dispatch System” is used. We classified EMS dispatch as “emergent” or “non-emergent” and compared to the gold standard of whether EMS personnel decided treatment was appropriate upon scene arrival. We calculated sensitivity, specificity, and positive and negative predictive values (PPV, NPV), with 95% CI’s.

      Results

      Of 15,371 non-traumatic OHCAs, the median age was 65 (inter quartile range 51–78), and 4834 (31%) were women; 7152 (47%) were EMS-treated, of whom 651 (9.1%) survived). Among EMS-treated cases 6923/7152 had an emergent response (sensitivity = 97%, 95% CI 96–97) and among EMS-untreated cases 3951/8219 had a non-emergent response (specificity = 48%, 95% CI, 47 to 49). Among cases with emergent dispatch, 6923/11191 were EMS-treated (PPV = 62%, 95% CI 61–62), and among those with non-emergent dispatch, 3951/4180 were EMS-untreated (NPV = 95%, 95% CI 94–95); 229/4180 (5.5%) with a non-emergent dispatch were treated by EMS.

      Conclusion

      The dispatch system in BC has a high sensitivity and moderate specificity in sending the appropriate responses for OHCAs deemed appropriate for treatment by paramedics. Future research may address strategies to increase system specificity, and decrease the incidence of non-emergent dispatch to EMS-treated cases.

      Keywords

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