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Medical Priority Dispatch System Breathing Problems Protocol Key Question Combinations are Associated with Patient Acuity

  • Jeff Clawson (a1), Tracey Barron (a2), Greg Scott (a1), A. Niroshan Siriwardena (a3), Brett Patterson (a1) and Christopher Olola (a1)
  • DOI: http://dx.doi.org/10.1017/S1049023X1200101X
  • Published online: 24 July 2012
Abstract
AbstractIntroduction

The Breathing Problems Chief Complaint (CC) protocol in the Medical Priority Dispatch System (MPDS) was the system's most frequently used protocol. While “severe breathing problems” is a significant predictor of cardiac arrest (CA), previous data have demonstrated that the DELTA-level determinant codes in this CC contain patients across a wide spectrum of acuity.

Hypothesis

The hypothesis in this study was that certain combinations of caller answers to the breathing problems protocol key questions (KQs) are correlated with different but specific patient acuities.

Methods

This was a retrospective study conducted at one International Academies of Emergency Dispatch (IAED) Accredited Center of Excellence. Key Question combinations were generated and analyzed from 11 months of dispatch data, and extracted from MPDS software and the computer assisted dispatch system. Descriptive statistics were used to evaluate measures between study groups.

Results

Forty-two thousand cases were recorded; 52% of patients were female and the median age was 61 years. Overall, based on the original MPDS Protocol (before generating KQ combinations), patients with abnormal breathing and clammy conditions were the youngest. The MPDS DELTA-level constituted the highest percentage of cases (74.0%) and the difficulty speaking between breaths (DSBB) condition was the most prevalent (50.3%). Ineffective breathing and not alert conditions had the highest cardiac arrest quotient (CAQ). Based on the KQ combinations, the CA patients who also had the not alert condition were significantly older than other patients. The percentage of CA outcomes in asthmatic patients was significantly higher in DSBB plus not alert; DSBB plus not alert plus changing color; and DSBB plus not alert plus clammy conditions cases, compared to asthmatic abnormal breathing cases.

Conclusions

The study findings demonstrated that MPDS KQ answer combinations relate to patient acuity. Cardiac arrest patients are significantly less likely to be asthmatic than those without CA, and vice versa. Using a prioritization scheme that accounts for the presence of either single or multiple signs and/or symptom combinations for the Breathing Problems CC protocol would be a more accurate method of assigning DELTA-level cases in the MPDS.

Clawson J, Barron T, Scott G, Siriwardena AN, Patterson B, Olola C. Medical Priority Dispatch System breathing problems protocol key question combinations are associated with patient acuity. Prehosp Disaster Med. 2012;27(4):1-6.

Copyright
Corresponding author
Correspondence: Tracey Barron, BSc International Academies of Emergency Dispatch – UK Suite 7a, Froomsgate House, Rupert Street Bristol, BS1 2QJ UK E-mail tracey.barron@emergencydispatch.org
Linked references
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1.J Clawson , C Olola , A Heward , Patterson, G Scott . Profile of emergency medical dispatch calls for breathing problems within the medical priority dispatch system protocol. Prehosp Disaster Med. 2008;23(5):412-419.

2.F Sax , M Charlson . Medical patients at high risk for catastrophic deterioration. Crit Care Med. 1987;15(5):510-515.

3.T Olsson , L Lars . Comparison of the rapid emergency medicine score and APACHE II in nonsurgical emergency department patients. Acad Emerg Med. 2003;10:1040-1048.

4.T Olsson , A Terrent , L Lind . Rapid emergency medicine score: a new prognostic tool for in-hospital mortality in nonsurgical emergency department patients. J Intern Med. 2004;255:579-587.

5.DR Goldhill , AF McNarry . Physiological abnormalities in early warning scores are related to mortality in adult inpatients. Br J Anaesth. 2004;92(6):882-884.

6.RM Schein , N Hazday , M Pena , CL Sprung . Clinical antecedants to inhospital cardiopulmonary arrest. Chest. 1990;98:1388-1392.

8.TJ Hodgetts , G Kenward , IG Vlachonikolis , S Payne , N Castle . The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team. Resuscitation. 2002;54:125-131.

10.J Clawson , C Olola , A Heward , B Patterson . Cardiac arrest predictability in seizure patients based on emergency medical dispatcher identification of previous seizure or epilepsy history. Resuscitation. 2007;75(2):298-304.

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Prehospital and Disaster Medicine
  • ISSN: 1049-023X
  • EISSN: 1945-1938
  • URL: /core/journals/prehospital-and-disaster-medicine
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