Austin Whiteside

Association between ambulance dispatch priority and patient condition

To compare chief complaints of the Medical Priority Dispatch System in terms of the match between dispatch priority and patient condition.

The linguistic and interactional factors impacting recognition and dispatch in emergency calls for out-of-hospital cardiac arrest: a mixed-method linguistic analysis study protocol

Introduction Emergency telephone calls placed by bystanders are crucial to the recognition of out-of-hospital cardiac arrest (OHCA), fast ambulance dispatch and initiation of early basic life support. Clear and efficient communication between caller and call-taker is essential to this time-critical emergency, yet few studies have investigated the impact that linguistic factors may have on the nature of the interaction and the resulting trajectory of the call. This research aims to provide a better understanding of communication factors impacting on the accuracy and timeliness of ambulance dispatch. Methods and analysis A dataset of OHCA calls and their corresponding metadata will be analysed from an interdisciplinary perspective, combining linguistic analysis and health services research. The calls will be transcribed and coded for linguistic and interactional variables and then used to answer a series of research questions about the recognition of OHCA and the delivery of basic life-support instructions to bystanders. Linguistic analysis of calls will provide a deeper understanding of the interactional dynamics between caller and call-taker which may affect recognition and dispatch for OHCA. Findings from this research will translate into recommendations for modifications of the protocols for ambulance dispatch and provide directions for further research. Ethics and dissemination The study has been approved by the Curtin University Human Research Ethics Committee (HR128/2013) and the St John Ambulance Western Australia Research Advisory Group. Findings will be published in peer-reviewed journals and communicated to key audiences, including ambulance dispatch professionals.

Hijacking the dispatch protocol: When callers pre-empt their reason-for-the-call in emergency calls about cardiac arrest:

This article examines emergency ambulance calls made by lay callers for patients found to be in cardiac arrest when the paramedics arrived. Using conversation analysis, we explored the trajectories of calls in which the caller, before being asked by the call-taker, said why they were calling, that is, calls in which callers pre-empted a reason-for-the-call. Caller pre-emption can be disruptive when call-takers first need to obtain an address and telephone number. Pre-emptions have further implications when call-takers reach the stage when they are required to deliver the scripted turn ‘tell me exactly what happened’. When there has been a pre-emption earlier on, callers tend to treat the scripted turn as a request for more information and may not repeat their reason-for-the-call. This can occasion delays and important information can be lost. We identified an effective alternative strategy used by some call-takers, pre-emption repeat, which callers treat as a request for confirmation.

26 The influence of agonal breathing on call-taker recognition of out-of-hospital cardiac arrest

Aim Call-taker recognition of out-of-hospital cardiac arrest (OHCA) contributes significantly to patient survival, through reduced response time and dispatch-assisted cardiopulmonary resuscitation. A potential barrier to OHCA recognition is agonal breathing, whereby patients are often described as breathing. Our aim was to determine the role of agonal breathing in non-recognition, and delayed recognition, of OHCA. Method We analysed cases of non-traumatic OHCA where paramedics performed resuscitation, in Perth, Australia in 2014–2015. Calls in this system were processed using the Medical Priority Dispatch System. We excluded cases where the patient was clearly alive during the call. Listening to calls, we categorised answers to the question ‘Is s/he breathing?’ as ‘No’, ‘Agonal/Ineffective’, ‘Unsure’ or ‘Yes’. These data were compared to OHCA recognition, as determined from computer aided dispatch data. Results Among 902 OHCA cases, 87% (782/902) were recognised as OHCA by call-takers. In total, 21% of calls (193/902) had answers consistent with agonal breathing (e.g. ‘gasping’, ‘only just’). However, such calls comprised 38% (46/120) of the cases not recognised as OHCA, and 45% (112/250) of the cases of delayed recognition (recognised after initial ambulance dispatch). Only 18% (35/193) of cases with agonal descriptions were recognised as OHCA at initial dispatch. Conclusion Calls with descriptions of agonal breathing comprise a large proportion of cases that are either not recognised as OHCA or have delayed recognition. Call-taker response to caller descriptions of agonal breathing remains a major opportunity for improved OHCA recognition. Conflict of interest A Whiteside, P Bailey and J Finn receive salary support from St John Ambulance Western Australia. Funding Funding for this research was received from an NHMRC (Australian National Health and Medical Research Council) Partnership Project: APP1076949 ‘Improving ambulance dispatch to time-critical emergencies’.

15 The importance of staying on the call: recognition of cardiac arrest after initial dispatch

Aim We compared survival in out-of-hospital cardiac arrest (OHCA) cases recognised at initial dispatch (“primary recognition”) with those subsequently recognised as OHCA ?(“secondary recognition”) and those not recognised as OHCA (“non-recognition”). Methods We analysed cases of paramedic-confirmed OHCA in Perth, Western Australia (WA), from January 2014 to December 2015. We excluded traumatic OHCA, paramedic-witnessed arrests, and cases where paramedics did not attempt resuscitation. Emergency ambulance calls in WA are processed using the Medical Priority Dispatch System, via ProQA software. We analysed the ProQA data of each call for the presence of OHCA-specific dispatch codes (including code revisions) and call-taker instructions for cardiopulmonary resuscitation (CPR). Results Among 1430 cases of OHCA, 84% (n=1195) were recognised by call-takers as OHCA. Of the 1195 recognised cases, 32% (n=386) were identified through secondary recognition. Survival to 30 days was significantly higher among cases with secondary recognition (13.2%) than among cases with primary recognition (7.9%) and non-recognised cases (7.7%) (p=0.008). More than half of all cases of secondary recognition were initially dispatched as Unconscious/Fainting patient. Conclusion Nearly one third of call-taker recognition of OHCA occurs after initial dispatch. The higher survival probability of patients recognised by secondary recognition is consistent with those patients arresting more recently relative to the timing of the call. For many cases of OHCA, the call-taker’s ability to stay on the call and remain alert to the possibility of OHCA may strengthen the chain of survival. Conflict of interest A. Whiteside and D. Brink receive full salary support, and P. Bailey, M. Inoue and J. Finn receive partial salary support from St John Ambulance. Funding Funding for this research was received from an Australian NHMRC (National Health and Medical Research Centre) Partnership Project: #1076949 ‘Improving ambulance dispatch to time-critical emergencies’. J. Finn. and J. Bray receive partial salary support from the NHMRC ‘Aus-ROC’ Centre for Research Excellence #1029983. J. Bray receives salary support from an NHMRC/NHF (National Heart Foundation) Early Career Fellowship.