Validiteit van de Belgische Handleiding voor de Medische Regulatie 5.0

Test performance of the Belgian Medical Regulation Manual A key component of Emergency Medical Assistance is the emergency call centre. Emergency call centres, staffed by operators, process calls to the European emergency number 112. An operator assigns a severity level using the Belgian Medical Regulation Manual (BMRM). The BMRM consists of 77 thematic protocols. Protocols, consisting of flow charts, provide a systematic approach. The 8 levels of urgency defined within the manual are MUG1-2, PIT3-4, ZW5 and HA6-8. These severity levels, as can be inferred from the name, are related to a resource. Respectively, mobile emergency group, paramedical intervention team, ambulance and finally the GP. The BMRM additionally provides general and specific pre-arrival instructions (PAI), to help the caller administer initial care. A survey containing 60 fictitious cases was submitted to 33 operators of emergency centres in West and East Flanders. A gold standard was drawn up by the medical director anddeputy medical director of the East Flanders emergency centre. The gold standard allows to calculate percentages ofagreement (validity), overestimation (efficiency) and underestimation (safety). Additionally, the disagreement that would hypothetically lead to a different resource than suggested by the gold standard was calculated for both chosen protocol andseverity level. Agreement to the gold standard regarding chosen severity level is 66.7%. Overestimation is 7.2%, underestimation 26.4%. Agreement regarding chosen resource is 77.6%, overestimation is 4.7% and underestimation17.6%. A limitation of this study is the use of a gold standard without knowing the real outcome of the cases. The casesare fictitious which makes the resource hypothetical. The strength of the study is that cases were uniform and unambiguous.