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

ABSTRACT

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.

Topics

completely alert EMD emergency medical dispatch protocols level of consciousness Medical Priority Dispatch System MPDS not alert not awake responding appropriately