![]() We hypothesized that the priority dispatching protocol currently used in Finland is suboptimal and would overestimate and underestimate the patients’ medical risk. To try to fill this gap we wanted to assess the usability of the NEWS in this context. There is a lack of data regarding the efficiency of the dispatch protocol. Accordingly, the Royal College of Physicians recommends the use of the NEWS to standardize the assessment of acute illness severity throughout the entire chain of medical care, including in the prehospital phase. Some previous findings demonstrate that elevated NEWS among unselected prehospital patients is associated with an increased risk of adverse outcomes, suggesting that NEWS may also be useful in the prehospital setting. Thus, use of the NEWS has been implemented in several hospitals in Finland, but not yet by EMSs. Ĭompared to most other scoring systems, the National Early Warning Score (NEWS) has shown better performance for medical risk assessment in the hospital setting. Different countries show substantial variation with regard to dispatch protocols and organization of emergency medical dispatch systems. Although there are no standards for evaluating dispatcher performance accuracy, studies have shown substantial discrepancies in priority assessment between dispatch centres and EMS personnel on the scene. Over-triage of calls leads to inappropriate use and overload of EMS units, whereas under-triage may negatively impact patient survival. Critical components of efficient emergency medical dispatching include correct risk assessment and emergency patient identification, management of available emergency medical service (EMS) resources, and maintaining an appropriate call processing time in life-threatening emergencies. On the other hand, only a quarter of the high risk NEWS patients were classified as the highest priority at dispatch, indicating considerable under-triage with the protocol.Įmergency medical dispatching plays an important role in the chain of medical care and patient survival. A substantial proportion of EMS missions assessed as highest priority were categorized as lower risk according to the NEWS determined at the scene, indicating over-triage with the protocol. The present results show that the current Finnish medical dispatch protocol is suboptimal and needs to be further developed. Of the low urgency missions (C and D), 10.7% were underestimated 32.0% of the patients who were assigned NEWS indicating high risk had initially been classified as low urgency C or D priorities at the dispatch. ![]() Of the highest dispatch priority missions A and B, 76.9 and 78.3%, respectively, were overestimated. Overall, 67.5% of the dispatch missions were correctly estimated according to NEWS. ResultsĪ total of 12,729 emergency medical services missions were evaluated, of which 616 (4.8%) were prioritized as A, 3193 (25.1%) as B, 5637 (44.3%) as C, and 3283 (25.8%) as D. Risk assessment was then re-categorized as low, medium, or high by calculating the National Early Warning Score (NEWS) based on the patients’ clinical variables measured at the scene. Using medical charts, clinical variables were prospectively recorded and evaluated for all emergency medical services missions in two hospital districts in Northern Finland during –. To evaluate dispatch protocol accuracy, we assessed association between priority assigned at dispatch and the patient’s condition assessed by emergency medical services on the scene using an early warning risk assessment tool. Discrepancies in triage may result in risk overestimation, leading to inappropriate use of emergency medical services units and to risk underestimation that can negatively impact patient outcome. In Finland, calls for emergency medical services are prioritized by educated non-medical personnel into four categories-from A (highest risk) to D (lowest risk)-following a criteria-based national dispatch protocol. ![]()
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