According to a new study, researchers aimed to compare the accuracy, measured as priority level, between two Swedish dispatch protocols, the three-graded priority protocol Medical Index and a newly developed prototype, the four-graded priority protocol, RETTS-A. Emergency medical dispatching should be as accurate as possible to ensure patient safety and optimize the use of ambulance resources.  

Emergency medical dispatching is the first link in the chain of Emergency Medical Services (EMS), and constitutes the basis for further medical assessment and treatment. Hence, the assessment of the emergency medical call should be as accurate as possible with respect to priority level in order to ensure patient safety and optimize the use of ambulance resources. Each telecommunicator handled 26 emergency medical calls, simulated by experienced standard patients.

Manuscripts for the scenarios were based on recorded real-life calls, representing the six most common complaints. A cross-over design with 13 + 13 calls was used. Priority level and medical condition for each scenario was set through expert consensus and used as gold standard in the study. A total of 1293 calls were included in the analysis. For priority level, n = 349 (54.0%) of the calls were assessed correctly with Medical Index and n = 309 (48.0%) with RETTS-A (p = 0.012).

Sensitivity for the highest priority level was 82.6% (95% confidence interval: 76.6–87.3%) in the Medical Index and 54.0% (44.3–63.4%) in RETTS-A. Overtriage was 37.9% (34.2–41.7%) in the Medical Index and 28.6% (25.2–32.2%) in RETTS-A. The corresponding proportion of undertriage was 6.3% (4.7–8.5%) and 23.4% (20.3–26.9%) respectively. In this recreation study, Medical Index had a higher accuracy for priority level and less undertriage than the new prototype for dispatch protocol, RETTS-A.

For further estimation and to improve the deliverance of health care in emergency medicine, investigation of real triage situations rather than scenarios is needed. Standard patients are commonly used in studies on medical communication and in certification, and have been reported to perform patient presentation with moderate to high levels of accuracy with the highest accuracy achieved for the history and management cases.

Despite Medical Index being the superior tool, the overall accuracy of both protocols is to be considered as low. Overtriage challenges resource utilization while undertriage threatens patient safety. Outcome from this study is to improve patient safety both protocols need revisions to guarantee safe emergency medical dispatching.