Accuracy of Medically Experienced Emergency Dispatchers – A Unique Nationwide Model

Daniel Trotzky,1,2 Inon Dimand,3 Gal Pachys,4,5 Eli Jaffe,6,7 Daniel Edward Fordham,8 Tzachi Slutsky,9,10 Refael Strugo,6,7 Ella Khairish Ben Zeev,5,6,11 Joseph Leonard,12,13 Aya Cohen,14 Roman Sonkin6,9,15 1Medical Management, Tel Aviv Sourasky University Medical Center (Ichilov), Affiliated to the Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel; 2Department of Epidemiology and Preventive Medicine, School of Public Health, Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel; 3Israel Defense Forces, Medical Corps, Tel-Hashomer, Ramat-Gan, Israel; 4Division of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel; 5Faculty of Medicine, The Hebrew University, Jerusalem, Israel; 6Magen David Adom (MDA), Or-Yehuda, Israel; 7The Department of Emergency Medicine, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; 8Department of Emergency Medicine, Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel; 9Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; 10Department of Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel; 11Gynecology and Maternity Division, Kaplan Medical Center, Rehovot, Israel; 12The Department of Emergency Medicine, Jacobi Medical Center, New York, New York, US; 13The Department of Emergency Medicine, Montefiore Medical Center, New York, New York, US; 14Division of Emergency Medicine & Emergency Preparedness, Tel Aviv Sourasky University Medical Center (Ichilov), Affiliated to the Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel; 15Department of Internal Medicine E, Soroka Medical Center, Beer-Sheva, IsraelCorrespondence: Aya Cohen, Division of Emergency Medicine & Emergency Preparedness, Tel Aviv Sourasky University Medical Center (Ichilov), Affiliated to the Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, 6423906, Israel, Email [email protected]: This research examined the accuracy of the Israeli model of emergency medical dispatch by comparing dispatchers’ preliminary diagnosis with the working diagnosis of paramedics in the field.Methods: Data from emergency medical calls received by Magen David Adom between January 1st 2019 and December 31st 2019 were included. Primary analysis was done by directly comparing preliminary diagnoses made by dispatchers to the diagnoses made by paramedics. Secondary analysis was done by comparing the system identified by the dispatchers’ preliminary diagnoses to the system identified by the paramedics’ diagnoses. Tertiary analysis was done by subgrouping symptoms and syndromes by an expert panel to create a new preliminary diagnosis which was then compared with paramedic diagnosis.Results: Primary analysis showed a sensitivity of 48.8%, specificity of 97.3%, PPV of 53.0%, and NPV of 98.0%. Secondary analysis showed a sensitivity of 78.6%, specificity of 88.4%, PPV of 26.5%, and NPV of 99.2%. Tertiary analysis showed a sensitivity of 49.8%, specificity of 97.3%, PPV of 54.4%, and NPV of 97.9%.Conclusion: Medically experienced emergency dispatchers were able to obtain a high level of sensitivity determining preliminary diagnoses compared to ambulance crews in the field. Further research should focus on widening the variety of diagnoses investigated.Keywords: prehospital emergency care, emergency medical service, emergency medical dispatch, stroke, cardiopulmonary arrest, acute coronary syndrome