Medical Priority Dispatch System Breathing Problems Protocol Key Question Combinations are Associated with Patient Acuity

Abstract

AbstractIntroductionThe Breathing Problems Chief Complaint (CC) protocol in the Medical Priority Dispatch System (MPDS) was the system's most frequently used protocol. While “severe breathing problems” is a significant predictor of cardiac arrest (CA), previous data have demonstrated that the DELTA-level determinant codes in this CC contain patients across a wide spectrum of acuity.HypothesisThe hypothesis in this study was that certain combinations of caller answers to the breathing problems protocol key questions (KQs) are correlated with different but specific patient acuities.MethodsThis was a retrospective study conducted at one International Academies of Emergency Dispatch (IAED) Accredited Center of Excellence. Key Question combinations were generated and analyzed from 11 months of dispatch data, and extracted from MPDS software and the computer assisted dispatch system. Descriptive statistics were used to evaluate measures between study groups.ResultsForty-two thousand cases were recorded; 52% of patients were female and the median age was 61 years. Overall, based on the original MPDS Protocol (before generating KQ combinations), patients withabnormal breathingandclammyconditions were the youngest. The MPDS DELTA-level constituted the highest percentage of cases (74.0%) and thedifficulty speaking between breaths(DSBB) condition was the most prevalent (50.3%).Ineffective breathingandnot alertconditions had the highest cardiac arrest quotient (CAQ). Based on the KQ combinations, the CA patients who also had thenot alertcondition were significantly older than other patients. The percentage of CA outcomes in asthmatic patients was significantly higher inDSBBplusnot alert; DSBBplusnot alertpluschanging color;andDSBBplusnot alertplusclammyconditions cases, compared to asthmaticabnormal breathingcases.ConclusionsThe study findings demonstrated that MPDS KQ answer combinations relate to patient acuity. Cardiac arrest patients are significantly less likely to be asthmatic than those without CA, and vice versa. Using a prioritization scheme that accounts for the presence of either single or multiple signs and/or symptom combinations for the Breathing Problems CC protocol would be a more accurate method of assigning DELTA-level cases in the MPDS.Clawson J, Barron T, Scott G, Siriwardena AN, Patterson B, Olola C. Medical Priority Dispatch System breathing problems protocol key question combinations are associated with patient acuity.Prehosp Disaster Med.2012;27(4):1-6.