Chief Complaint selection is one of the most important skills for an emergency dispatcher to develop—and one of the most critical moments in any emergency call for help. Selecting the correct Chief Complaint at the opening of the call helps ensure that the correct information will be gathered, the most appropriate response sent, and the most life-critical instructions provided. For many emergency medical dispatchers (EMDs), the selection of Protocol 26 – Sick Person (Specific Diagnosis) is among the most challenging. This is due to the complexity of the protocol, since this requires a specific diagnosis choice from two different lists. In a communications center where time is a key factor reading through these lists are difficult and consuming.
The overall objective of this study is to compare the EMD's selection of the Sick Person Protocol with the on-scene responder's finding when patient contact is made.
This is a retrospective study using data from a single, urban, high performance EMS system in central Virginia, USA. The Richmond Ambulance Authority (RAA) continues to be an Accredited Center of Excellence with the International Academy of Emergency Dispatch (IAED) since 2001. Data from ProQA (the software version of the MPDS) and electronic patient care records (EPCRs) will be collected in Richmond, VA for the fiscal year 2017 (July 2016-June 2017). The ePCR data collected for the study period includes paramedic primary and secondary impression, vital signs including GCS and transport priority with disposition (treated and transported, patient refusal, etc.). By collecting these data points we can examine if the EMD was indeed, correct.
The sample size of 5,952 call Alpha level responses were by far the largest number of responses with Charlie, Delta and Omega levels 3rd, 4th and 5th respectively and only a small number of Bravo levels identified. The top three chief complaints documented by field paramedics are Pain, GI/GU and Neuro complaints. This is in line with the data from PRO/QA with both call takers final coding and paramedics finding low acuity complaints when arriving on scene. It should be noted of 5,952 call included in this study only 7 patients were transported "hot" to the hospital indicating the specificity of the call taker, together with field providers, are giving the correct response to the patients served.
We found the Chief Complaint selection by the EMD is correct in most cases with few outliers assumedly by caller information rather than incorrect CC selection. One area of concern is the neurological factors identified in the data sample, further study should be done with other agencies to determine if further shunts should be added to Protocol 26.