Leadership-Driven Development of a National Emergency Medical Dispatch and Triage Protocol in Thailand: An Electronic...

Effective telephone triage is a critical leadership function within emergency medical systems, supporting timely decision-making, appropriate resource allocation, and improved patient outcomes. This role is particularly important in countries with developing prehospital infrastructures, where emergency medical dispatchers are central to guiding early emergency responses.

This study aimed to develop and achieve expert consensus on Thailand's Emergency Medical Triage Protocol and Criteria-Based Dispatch Code (EMTP-CBDC) using an electronic Delphi expert consensus (EDEC) approach, in order to produce an accurate, up-to-date, and nationally applicable dispatch protocol aligned with international standards.

A two-round Delphi process was conducted involving 40 emergency medical experts with at least one year of dispatch or prehospital oversight experience. Experts evaluated 30 chief complaints and key operational components of the EMTP-CBDC developed by the National Institute for Emergency Medicine. Round 1 consisted of an onsite panel discussion to review protocol logic and content, followed by structured online assessments across three domains: protocol structure, application, and coding. Items were rated on a 5-point Likert scale, with a mean score ≥3.41 indicating acceptance. Revised items were reassessed in Round 2 to confirm clarity, appropriateness, and consensus.

High-to-highest levels of expert agreement were achieved across all protocol domains. Overall structure scored highly ([Formula: see text]= 4.54 ± 0.48), while pre-arrival instructions received the highest ratings ([Formula: see text]= 4.77 ± 0.51). Emergency medical conditions and injury categories demonstrated high agreement ([Formula: see text]= 3.96 and 4.01, respectively). Telephone guidance, triage and dispatch processes, and CBD code application standards also showed strong consensus, confirming clarity and usability for national dispatch operations.

The revised EMTP-CBDC demonstrates high clarity, practicality, and expert consensus, supporting its suitability for nationwide implementation. Adoption of this protocol, alongside continuous dispatcher training and system monitoring, may enhance dispatch accuracy, operational consistency, and overall emergency medical service performance in Thailand.