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Emergency Nursing Staff Dispatch: Sensitivity and Specificity in Detecting Prehospital Need for Physician Interventions During Ambulance Transport in Rovigo Emergency Ambulance Service, Italy

Published online by Cambridge University Press:  15 August 2013

Marco Leopardi  and
Marco Sommacampagna
Marco Leopardi*
Affiliation:
Centrale Operativa Provinciale Rovigo Emergenza, Ospedale S. Maria della Misericordia, Rovigo, Italy
Marco Sommacampagna
Affiliation:
Centrale Operativa Provinciale Rovigo Emergenza, Ospedale S. Maria della Misericordia, Rovigo, Italy
*
Correspondence: Marco Leopardi, MD SOC 118 Centrale Operativa Provinciale Rovigo Emergenza Azienda ULSS18 Viale Tre Martiri 45100, Rovigo, Italy E-mail [email protected]
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Abstract

Introduction

In Italy, administration of medications or advanced procedures dictates the prehospital presence of a physician to initiate treatment. Nursing staff is often used as dispatchers in Italian emergency medical ambulance services. There is little data about nursing dispatch performance in detecting high-acuity patients who need prehospital medications and procedures.

Objective

To determine the ability of a dispatch center staffed by emergency ambulance nurses to detect prehospital need for physician interventions in the context of a semi-rural area Emergency Medical Services system.

Methods

A retrospective analysis of 53,606 calls from the Rovigo Emergency Ambulance Services’ database was undertaken. Physician prehospital interventions were defined as the administration of medications or procedures (advanced airway management and ventilation, pneumothorax decompression, fluid replacement therapy, external defibrillation, cardioversion and pacing). The dispatch codes (assigned by a subjective decision-making process as Red, Yellow, or Green) of all transported prehospital patient calls were matched with an out-of-hospital triage system staffed by clinicians to determine the number of correctly identified prehospital need of physician interventions. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.

Results

The sensitivity of subjective experience-based nursing dispatch in detecting the need for physician interventions was 78.0% (95% CI, 76.9%-79.1%), with a PPV of 36.6% (95% CI, 35.8%-37.5%). Specificity was 83.8% (95% CI: 83.4%-84.1%), with an NPV of 96.9% (95% CI, 96.8%-97.1%).

Conclusion

A dispatch center staffed by nurses with six years of experience and three months of training correctly identified when not to send a doctor to the scene in the absence of need for physician interventions, using a subjective decision-making process. The nurses staffing the dispatch center also worked in the field. Dispatch center staff were not able to predict when there was no need for physician interventions in high-acuity dispatch code patients, resulting in an over-triage and use of emergency physicians on scene.

LeopardiM, SommacampagnaM.Emergency Nursing Staff Dispatch: Sensitivity and Specificity in Detecting Prehospital Need for Physician Interventions During Ambulance Transport in Rovigo Emergency Ambulance Service, Italy. Prehosp Disaster Med. 2013;28(5):1-6.

Keywords

communication systememergency careEmergency Medical Servicesphysicianprehospitaltriage
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 28 , Issue 5 , October 2013 , pp. 523 - 528
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2013 

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References

1.Withelaw, AS, Hsu, R, Corfield, AR, Hearns, S. Establishing a rural emergency medical retrieval service. Emerg Med J. 2006;23(1):76-78.CrossRefGoogle Scholar
2.Feldman, MJ, Verbeek, PR, Lyons, DG, et al. Comparison of the medical priority dispatch system to an out-of-hospital patients acuity score. Acad Emerg Med. 2006;13(9):950-960.Google Scholar
3.Wilson, S, Cooke, M, Morrell, R, Bridge, P, Allan, T. A systematic review of the evidence supporting the use of priority dispatch of emergency ambulances. Prehosp Emerg Care. 2002;6(1):42-49.CrossRefGoogle ScholarPubMed
4.Eisenberg, MS, Hallstrom, AP, Carter, WB, Cummins, RO, Bergner, L, Pierce, J. Emergency CPR instruction via telephone. Am J Public Health. 1985;75(1):47-50.CrossRefGoogle ScholarPubMed
5.Bailey, ED, O'Connor, RE, Ross, RW. The use of emergency medical dispatch protocols to reduce the number of inappropriate scene responses made by advanced life support personnel. Prehosp Emerg Care. 2000;4(2):186-189.CrossRefGoogle ScholarPubMed
6.Schmidt, TA, Cone, DC, Mann, NC. Criteria currently used to evaluate dispatch triage systems: where do they leave us? Prehosp Emerg Care. 2004;8(2):126-129.Google ScholarPubMed
7.Sporer, KA, Johnson, NJ, Yeh, CC, et al. Can emergency medical dispatch codes predict prehospital interventions for common 9-1-1 call types? Prehosp Emerg Care. 2008;12(4):470-478.CrossRefGoogle ScholarPubMed
8.Guidetti, A, Serantoni, C, Menarini, M. Il Sistema 118 e la Centrale Operativa. Milan: McGraw-Hill; 1999:13-30.Google Scholar
9. Il Ministro della Sanità Visto. Gazzetta Ufficiale n. 121 del 25/5/92: Serie Generale Criteri e requisiti per la classificazione degli interventi di emergenza. http://www.118er.it/internet/documenti/DM_118_15_maggio_1992.pdf. Published May 15, 1992. Accessed August 1, 2012.Google Scholar
10.Nolan, JP, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation. 2010;81(10):1219-1276.CrossRefGoogle ScholarPubMed
11.Dunham, CM, Barraco, RD, Clark, DE, et al. EAST Practice Management Guidelines Work Group. Guidelines for emergency tracheal intubation immediately after traumatic injury. J Trauma. 2003;55(1):162-179.CrossRefGoogle ScholarPubMed
12.Raynolds, SF, Heffner, J. Airway management of the critically ill patient – RSI. Chest. 2005;127(4):1397-1412.Google Scholar
13.McGuire, BE. Emergency airway access equipment. Anaesthesia. 2004;59(10):1029-1030.CrossRefGoogle ScholarPubMed
14.Eckstein, M, Suyehara, D. Needle thoracostomy in the prehospital setting. Prehosp Emerg Care. 1998;2(2):132-135.CrossRefGoogle ScholarPubMed
15.Spahn, D, et al. Management of bleeding following major trauma: a European guideline. Crit Care. 2007;11(1):R17.CrossRefGoogle ScholarPubMed
16.Clawson, J, Olola, C, Heward, A, Scott, G, Patterson, B. Accuracy of emergency medical dispatchers’ subjective ability to identify when higher dispatch levels are warranted over a Medical Priority Dispatch System automated protocol's recommended coding based on paramedic outcome data. Emerg Med J. 2007;24(8):560-563.CrossRefGoogle Scholar