search terms: Study, computerized system, computer-aided EMS priority dispatch, triage system. Spare paramedics, benefits, Annals of Emergency Medicine, 1990
Annals of Emergency Medicine, April 1990
Computer-Aided EMS Priority Dispatch: Ability of a computerized Triage System to Safely Spare Paramedics From Response Not Requiring Advance Life Support
Study Objective: To test the ability of a computerized priority dispatch system to safely excluded the need for advanced life support (ALS).
Design: Retrospective study of 35,075 emergency medical services [EMS] incident records generated during the second quarter of 1990 (April through June) to see how often lone dispatcher of basic life support units staffed with basic emergency medical technicians subsequently required or involved ALS care.
Setting: One centralized municipal EMS (including all dispatch, first-responder, and transport units) in a large urban center.
Intervention: A few questions that help dispatchers identify (or exclude) signs or symptoms indicating the need for ALS.
Results: ALS units were spared from initial dispatch in 14,100 of all EMS incidents (40.2%), thus increasing their availability and use for more serious calls. Only 1.8% of these cases (254) subsequently required or involved ALS procedures; most of these received only an IV line without volume infusion, drugs, or any other ALS therapy. On further review, the immediate presence of a paramedic would have been considered theoretically advantageous (e.g., posttraumatic arrest, hypoglycemia) in less than a dozen of the 14,100 cases. Even so, it still appeared unlikely that the brief delay in providing ALS care made any discernible difference in outcome for any of these patients.
Conclusion: A computer-aided dispatch triage algorithm can safely identify many EMS incidents requiring only basic life support care. Although paramedic arrival may be delayed in an extremely small number of "ALS case," negative effects on patient outcome are negligible. Instead, many operational and medical care benefits are provided by such a system.