Caller's Ability to Understand "Responding Normally" vs. "Completely Alert" Key Question in a Brazilian Portuguese Version of an Emergency Medical Dispatch Protocol
Valeria De Cassia Pereira, RN, EMD-QI, Sara Scott, Maristela Uta Nakano, MD, MBA, Greg Scott, MBA, EMD-QI, Christopher Olola, PhD, Isabel Gardett, PhD, Srilakshmi Sangaraju, MS, Irena Weight, Daniel Ashwood, PhD, Edward Trefts, MFA, Brett Patterson, and Jeff J. Clawson, MD
Aug 13, 2019|AEDR 2019 Vol. 7 Issue 2|Original Research
Introduction: Alertness is important to assess during many medical emergencies; however, assessing alertness proves difficult in a non-visual emergency dispatch environment. Little is understood about how to best gather an accurate report of patient alertness during an interaction between callers and Emergency Medical Dispatchers (EMDs).
Objectives: The primary objective of the study was to compare two versions of a Key Question (KQ) intended to gain an accurate report of alertness, to determine whether either demonstrates a higher degree of caller understanding and definitive response.
Methods: This was a descriptive quantitative study using retrospective and prospective data collected from Serviço de Atendimento Móvel de Urgência (SAMU), an emergency dispatch center in Sao Paolo, Brazil. A study version of the MPDS protocol was implemented that changed the original KQ ("Is s/he completely alert (responding appropriately)?" [Portuguese translation "Ele/a está completamente alerta (respondendo apropriadamente)?
(pre-test) to "Is s/he responding normally (completely alert)?" [Portuguese translation "Ele/a está respondendo normalmente (completamente alerta)?]") (post-test). Various outcomes related to caller understanding and definitive responses were measured.
Results: The pre-test and post-test groups varied greatly with respect to providing uncertain/"didn't understand" KQ responses (62.7% and 0.99% respectively). KQ clarification varied significantly by study group with almost half of the pre-test group (47.9%) using a clarifier compared with 7.8% of the post-test group. 22.4% of cases in the pre-test group made 2 or more attempts to clarify the KQ compared with none in the post-test group.
Conclusions: Callers in this study demonstrated a significantly higher degree of understanding when asked, "Is s/he responding normally," compared with the existing KQ, "Is s/he completely alert?" The findings suggest that callers understand the new phrasing better and are therefore more likely to provide accurate patient status responses.