Introduction: The difficulty of evaluating mental status, particularly alertness, is more pronounced in the medical dispatch context, where the Emergency Medical Dispatcher (EMD) must work through the eyes and ears of the caller, who is most likely a layperson. Determining true non-alertness and the level of its effects on outcome needs to be solved to perfect the interrogation and response-coding processes at dispatch.
Objectives: To quantify the caller’s ability to answer definitively “yes” or “no” to the dispatch Key Question (KQ) “Is s/he completely alert (responding appropriately)?” in the first attempt, and the number of times the caller was uncertain, as compared to the caller’s responses to the alternative KQ “Is s/he responding normally (completely alert)?”
Methods: The retrospective (pre-trial, using the existing KQ) and prospective (post-trial, using the new KQ) study reviewed random cases where the alertness KQ was used in the during the pre-trial (n=200) and post-trial (n=200) study phases—from March to December 2020, at four dispatch agencies in the United States. The outcome measures were (1) the number of times the caller provided a definitive “yes” or “no” answer to the KQs on the first attempt; (2) the number of times the EMD provided a clarifier; (3) the number of attempts made by the EMD in asking the KQs, and (4) specific caller statements for the uncertain responses to the KQs.
Results: 1,646 cases were evaluated, with an overall median age of 64 years. Overall, the way callers answered the KQs differed significantly between the study trials. Also, the level of uncertainty among callers in answering the KQ decreased from 11.3% (pre-trial) to 8.6% (post-trial). Callers provided varying uncertain/vague/imprecise answers to the initial KQ—much fewer uncertain answers in the pre-trial phase.
Conclusions: The new KQ yielded a significant difference in the type of answers that callers provided and reduced uncertainty of the answers. Also, it incrementally decreased the number of attempts to repeat the KQ and use a clarifier. Future studies should explore the effect of follow-up or clarifying statements as well as additional EMD training to find the optimal caller rendering of patient alertness.
Keywords: Not Alert; Completely Alert; Responding Normally; Level of Consciousness; Emergency Medical Dispatch.
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