Does the Norwegian emergency medical dispatch classification as non-urgent predict no need for pre-hospital medical treatment? An observational study

Abstract

Background: The number of ambulance call-outs in Norway is increasing owing to societal changes and increased demand from the public. Together with improved but more expensive education of ambulance staff, this leads to increased costs and staffing shortages. We wanted to study whether the current dispatch triage tools could reliably identify patients who only required transport, and not pre-hospital medical care. This could allow selection of such patients for designated transport units, freeing up highly trained ambulance staff to attend patients in greater need. Methods: A cross-sectional observational study was used, drawing on all electronic and paper records in our ambulance service from four random days in 2012. The patients were classified into acuity groups, based on Emergency Medical Dispatch codes, and pre-hospital interventions were extracted from the Patient Report Forms. Results: Of the 1489 ambulance call-outs included in this study, 82 PRFs (5 %) were missing. A highly significant association was found between acuity group and recorded pre-hospital intervention (p ≤ 0.001). We found no correlation between gender, distance to hospital, age and pre-hospital interventions. Ambulances staffed by paramedics performed more interventions (234/917, 26 %) than those with emergency medical technicians (42/282, 15 %). The strongest predictor for needing pre-hospital interventions was found to be the emergency medical dispatch acuity descriptor. Discussion: This study has demonstrated that the Norwegian dispatch system is able to correctly identify patients who do not need pre-hospital interventions. Patients with a low acuity code had a very low level of pre-hospital interventions. Evaluation of adherence to protocol in the Emergency Medical Dispatch is not possible due to the inherent need for medical experience in the triage process. Conclusions: This study validates the Norwegian dispatch tool (Norwegian index) as a predictor of patients who do not need pre-hospital interventions.