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Performance measures of the medical priority dispatch system in an urban basic life support system
Vittorio Nicoletta1,2, Maxime Robitaille-Fortin3, Valérie Bélanger4
1Department of Logistics and Operations Management, HEC Montréal, 3000 Côte-Sainte-Catherine Road, Montreal, QC, H3T 2A7, Canada.
Summary
Emergency Medical Services (EMS) dispatch prioritization in Quebec shows high overtriage, meaning too many urgent calls are sent, straining resources. Recent changes decreased undertriage but worsened overtriage, highlighting a need for improved dispatch criteria.
Area of Science:
- Emergency Medicine
- Public Health Systems
- Healthcare Resource Management
Background:
- Effective emergency medical services (EMS) dispatch prioritization is crucial for resource allocation and timely response.
- Quebec, Canada uses a modified Medical Priority Dispatch System (MPDS) with regional priority definitions.
- The performance of this adapted EMS dispatch system has not been formally evaluated.
Purpose of the Study:
- To evaluate the effectiveness of Quebec's adapted EMS dispatch prioritization system.
- To compare call-taking priority levels with on-scene paramedic assessments.
- To analyze the system's performance evolution over three years and across chief complaints.
Main Methods:
- Retrospective observational study of 96,099 EMS dispatches in Quebec (2021-2023).
- Performance assessment using sensitivity, specificity, overtriage, undertriage, predictive values, and accuracy.
- Statistical analysis including chi-square and t-tests; examination of chief complaint variations.
Main Results:
- A high overtriage rate was observed, with 79.7% of cases deemed stable/non-urgent by paramedics despite initial urgent dispatch.
- High overtriage rates (>90%) were noted for abdominal pain, falls, and psychiatric issues.
- Allergic reactions, diabetic problems, and heart conditions showed the highest undertriage rates (>10%).
- Priority modifications over three years decreased undertriage by 2.5% but increased overtriage by 3.7% (p<0.05).
Conclusions:
- The system effectively identifies non-urgent cases but suffers from significant overtriage, impacting EMS resources.
- Recent priority adjustments exacerbated overtriage, complicating resource management.
- Refining dispatch criteria and exploring AI decision support may enhance accuracy and efficiency.
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