Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Many dispatch systems send Advanced Life Support (ALS) resources to patientscomplaining of abdominal pain even though the majority of these incidents require only Basic LifeSupport (BLS). With increasing 911-call volume, resource utilization has become more important toensure that ALS resources are available for time-critical emergencies. In 2015, a large, urban firedepartment implemented an internally developed, tiered-dispatch system. Under this system, patientsreporting a chief complaint of abdominal pain received the closest BLS ambulance dispatched aloneemergency if located within three miles of the incident. The objective of this study was to determine thesafety of BLS-only dispatch to abdominal pain by determining the frequency of time-sensitive events.

Methods: This was a retrospective review of electronic health records of one emergency medicalservice provider agency from May 2015-2018. Inclusion criteria were a chief complaint of abdominalpain from a first- or second-party caller, age over 15, and the patient was reported to be alert andbreathing normally. The primary outcome was the prevalence of time-sensitive events, includingcardiopulmonary resuscitation (CPR), defibrillation, or airway management. Secondary outcomeswere hypotension (systolic blood pressure < 90 mmHg); or a prehospital 12 lead-electrocardiogram(ECG) demonstrating ST-elevation myocardial infarction (STEMI) criteria or a wide complex arrhythmia.Descriptive statistics were used.

Results: During the study period, there were 1,220,820 EMS incidents, of which 33,267 (2.72%) metinclusion criteria. The mean age was 49.9 years (range 16-111, standard deviation [SD] 19.6); 14,556patients (56.2%) were female. Time-sensitive events occurred in seven cases (0.021%), mean age was75.3 years (range 30-86, SD18.7); 85.7% were female. Airway management was required in sevencases (0.021%), CPR in six cases (0.018%), and defibrillation in one case (0.003%). Two of the seven(28.6%) cases involved dispatch protocol deviations. Hypotension was present in 240 (0.72%) cases;six (0.018%) cases had 12-lead ECGs meeting STEMI criteria; and no cases demonstrated widecomplex arrhythmia.

Conclusion: Among adult 911 patients with a dispatch chief complaint of abdominal pain, time-sensitiveevents were exceedingly rare. Dispatching a BLS ambulance alone appears to be safe.