Abstract

Introduction: Historically, emergency medical dispatchers (EMDs) do not normally have the opportunity to learn about the outcomes of the patients who they have impacted. More often than not, ST-Elevation Myocardial Infarction (STEMI) cases are urgently transported and triaged within the hospital system, and dispatchers are not afforded the opportunity to learn "the rest of the story" about the patient's outcomes. This leaves the EMDs wondering about the patient, not only from a survival standpoint, but also as to whether or not their pre-arrival instructions (PAIs) made an impact on the patient's condition as a part of the chain of survival.

Objectives: This pilot study looked at information-sharing strategy/process between EMDs and the receiving hospital emergency medical services (EMS) coordinator as a method to promote a deeper understanding of the important role EMDs play in the swift and accurate identification of potential STEMI events, as well as the expedited initiation of bystander cardiopulmonary Resuscitation (CPR) instructions using International Academies of Emergency Dispatch (IAED)- approved standards.

Methods: STEMI calls often present as either high priority ECHO level calls (patient is not conscious or breathing), which require dispatch PAIs (dispatch assisted CPR), or they may be received as slightly lower-priority chest pain calls. Some non-ECHO calls may require aspirin administration instruction. To triage and prioritize 911 calls, Waukesha County Communications 911 center, Wisconsin, USA, uses Emergency Medical Dispatch Protocols approved by the International Academies of Emergency Dispatch (IAED), Salt Lake City, Utah, USA. In this pilot, when Waukesha Memorial Hospital (Pro Health Care) received STEMI patients from the EMS agencies served by Waukesha County Communications 911 Center, hospital staff generated a report within a few days and sent it to the Training and Operations Manager at the 9-1-1 center. The manager then shared the report with the EMD who took the initial call. As part of the report generation, the EMS coordinator at the hospital also called to receive time informational data from the call center, including time of the initial 911 call, time the EMS units were dispatched, and other important pre-EMS arrival information such as time of aspirin administration and time of bystander 'hands on chest,' or when CPR compressions were started by the bystander. The report is completed by the EMS coordinator, who fills in all of the appropriate times. A short history of the event, in-hospital times, EKG findings as well as photos of the pre-stent and post-stent placement, and a description of the culprit vessel is identified in the report. The report is shared with the responsible EMD and is also displayed on a bulletin board within the center so that other dispatchers are able to review it as well.

Results: Receiving hospitals are now able to more accurately record patient event history, including time of initial call to 911, time of dispatch (notification) to the EMS provider, time of aspirin administration (if appropriate), and time CPR was initiated. These pre-hospital event times can be critical to review of STEMI cases. Meanwhile, EMDs are able to have specific information on a patient they provided dispatch and/or PAIs for. This information and knowledge provides closure for the line calltakers, and it also lays a foundation for understanding their critical role in the chain of survival.

Conclusions: EMDs at Waukesha County Communications Center have responded very positively to receiving feedback information from the receiving hospitals. While the EMDs may not understand all of the information contained in the reports, they are able to fully digest the information disseminated by the photos of the blocked arteries and are able to see the times associated with the events—events they actively took part in mitigating. This reinforces positive, compliant work in their role as EMDs, and early indications reasonably predict that further cooperation and efforts substantiate the positive impact of this information-sharing strategy on EMDs' compliance to dispatch protocols.