The Breathing Problems Chief Complaint (CC) protocol in the Medical Priority Dispatch System (MPDS) was the system's most frequently used protocol. While “severe breathing problems” is a significant predictor of cardiac arrest (CA), previous data have demonstrated that the DELTA-level determinant codes in this CC contain patients across a wide spectrum of acuity.

The hypothesis in this study was that certain combinations of caller answers to the breathing problems protocol key questions (KQs) are correlated with different but specific patient acuities.

This was a retrospective study conducted at one International Academies of Emergency Dispatch (IAED) Accredited Center of Excellence. Key Question combinations were generated and analyzed from 11 months of dispatch data, and extracted from MPDS software and the computer assisted dispatch system. Descriptive statistics were used to evaluate measures between study groups.

Forty-two thousand cases were recorded; 52% of patients were female and the median age was 61 years. Overall, based on the original MPDS Protocol (before generating KQ combinations), patients with abnormal breathing and clammy conditions were the youngest. The MPDS DELTA-level constituted the highest percentage of cases (74.0%) and the difficulty speaking between breaths (DSBB) condition was the most prevalent (50.3%). Ineffective breathing and not alert conditions had the highest cardiac arrest quotient (CAQ). Based on the KQ combinations, the CA patients who also had the not alert condition were significantly older than other patients. The percentage of CA outcomes in asthmatic patients was significantly higher in DSBB plus not alert; DSBB plus not alert plus changing color; and DSBB plus not alert plus clammy conditions cases, compared to asthmatic abnormal breathing cases.

The study findings demonstrated that MPDS KQ answer combinations relate to patient acuity. Cardiac arrest patients are significantly less likely to be asthmatic than those without CA, and vice versa. Using a prioritization scheme that accounts for the presence of either single or multiple signs and/or symptom combinations for the Breathing Problems CC protocol would be a more accurate method of assigning DELTA-level cases in the MPDS.

Clawson J, Barron T, Scott G, Siriwardena AN, Patterson B, Olola C. Medical Priority Dispatch System breathing problems protocol key question combinations are associated with patient acuity. Prehosp Disaster Med. 2012;27(4):1-6.

A common chief complaint to emergency dispatch communication centers worldwide is “breathing problems”. The chief complaint of breathing problems represents a wide spectrum of underlying diseases, patient conditions, and onset types. The current debate is on the potential ability of a dispatch protocol to safely and with high specificity, differentiate patients with minor or non-critical conditions from those conditions that pose risk to the patient and require advanced life support evaluation and care. This issue also has extended into the paramedic prehospital evaluation realm.

The objective of this study was to describe the distribution of Medical Priority Dispatch System (MPDS) codes representing the spectrum of clinical descriptions within the breathing problems chief complaint and their associated outcomes, at the scene and during transport, as determined by [UK] paramedics.

A retrospective, one-year study (September 2005 to August 2006) of a de-identified aggregate dataset from the London Ambulance Service (LAS) Trust was evaluated. A profile of the distribution of calls, incidents, patients, and outcomes (cardiac arrest [CA] and blue-in [BI] high acuity i.e., patients transported with lights and siren based on paramedic protocol) for the breathing problems chief complaint was evaluated.Odds ratios and 95% confidence intervals (CI) were used to quantify associations between the MPDS priority level's concurrent asthmatic conditions and outcomes. Two-sided Fisher's exact p-values were obtained to determine statistically significant associations, at a level of 0.05.

Sixteen percent (95,848/599,093) of all the patients were classified under the breathing problems chief complaint.Of these 95,848 patients,367 (0.38%) were CA outcomes, and 7.82% (n = 7,493) were BI outcomes.The Cardiac Arrest Quotient (i.e., the number of CA cases as a percentage of the number of patients) for the ECHO priority level was 46 times higher than was that of non-ECHO priority levels: DELTA and CHARLIE (17.05% vs. 0.37%). Asthmatics were associated with CA outcome (OR(95%CI): 0.60(0.47, 0.77), p <0.001), but not with BI outcome.

The MPDS coding yielded a richer mix of severe outcomes in the higher priority levels. The Severe Respiratory Distress coding had the greatest number of patients and severe outcomes. Future studies that help refine the Severe Respiratory Distress code in the MPDS by more specific subgroups of patients would be beneficial.