Emergency medical dispatchers' experiences using MPDS Protocol 24 for maternity telephone triage: a questionnaire...

This study explored emergency medical dispatchers' (EMDs) experiences of using the Medical Priority Dispatch System (MPDS) Protocol 24 (P24) to gain insights into its usability and appropriateness for triaging maternity calls.

A semi-structured cross-sectional survey comprising a combination of 43 closed and open-ended questions was administered to EMDs in a large UK urban ambulance service. EMDs were invited to anonymously complete the questionnaire over a six-week period; a total of 89 EMDs responded. Six key themes were explored.

Participants felt confident in their knowledge of maternal emergencies, but desired further training (89.9%). When a part of the baby was visible (87.6%) and known complications with the current pregnancy (85.4%) were the clinical factors mostly associated with maternal emergencies and were already well accounted for by P24. The patient being alone (47.2%) or in a public place (42.7%) was seen as an increased risk. However, in general, participants were less likely to associate these non-clinical factors with maternity emergencies.Specific questions were reported to be challenging to elicit a clear answer from callers, particularly those around the presence of known high-risk complications (44.9%), contractions (60.7%), miscarriage (51.7%) or complications with a newborn (52.8%). P24 instructions could do more to assist with difficult calls (68.5%) and with calls related to miscarriage (49.4%) or termination (29.2%). Participants felt the acuity level associated with certain calls could be refined, such as those related to uncomplicated births (25.8%), first-trimester serious haemorrhage (18.0%) and abdominal pain <5 weeks with no tissue or foetus (7.9%).

Overall, participants felt that maternity emergencies were mostly identified well but that improvements could be made to both the P24 questions and instructions, and that further training would improve user experience. Future research should assess the diagnostic accuracy of P24 and determine, if necessary, which questions could be refined to improve the effectiveness of EMD triage of maternity emergencies.