Abstracts

Rationale: Emergency medical services (EMS) ambulance dispatchers are critical for rapidly assigning appropriate providers to evaluate and treat patients with status epilepticus (SE), however, the role of dispatch decisions in the care of SE remains largely unexamined.  We aimed to describe dispatch decisions for patients with SE, determine whether patients were assigned an appropriate acuity level, and characterize associations between the dispatch acuity, ambulance readiness (priority level and certification level of the emergency personnel dispatched), and speed of the ambulance response.

Methods: We performed a cross-sectional analysis of prehospital encounters for status epilepticus using data from the ESO Data Collaborative from January 1, 2019, to December 31, 2019. This de-identified database contains records from approximately 2,000 EMS agencies in the United States. We included patients who were 18 years of age or older with an EMS diagnostic impression of status epilepticus. We excluded patients with cardiac arrest.

For each EMS encounter, we identified the Emergency Medical Dispatch (EMD) code, which includes the suspected diagnosis and level of acuity, the priority level of the ambulance (emergent versus non-emergent), certification level of the EMS personnel on the ambulance (advanced life support [ALS] versus basic life support [BLS]), response time to the patient, along with patient and agency level characteristics. We calculated the proportion correctly classified as seizure by the dispatch system and evaluated the relationship between the acuity assigned by the dispatch system, the priority level, EMS certification level, and response time._x000D_
Results: There were 52,936 encounters for SE that met the inclusion criteria. Of these, 19,609 were assigned an EMD code, and 33,327 had no associated EMD code.  Mean age was 39.6 years, and 45.9% were identified as women. Among encounters with an EMD code, 13,831 (70.5%) received an accurate code of seizures/convulsions, and of these, 6,412 (46.4%) were coded as high acuity.  Among those assigned high acuity by the dispatch system, 6,291 (98.1%) received emergency priority, and 5,855 (91.3%) received an ALS responder.  Proportions were similar for the 6,628 low acuity encounters, with 5,423 (81.8%) receiving emergency priority, and 6,101 (92.1%) receiving an ALS responder.  Median response times stratified by increasing acuity levels A, B, C and D were 9.1, 9.7, 9.1, and 8.3 minutes, respectively. Across high and low acuity level encounters, median response times were 8.4 min for those assigned as emergent, 10.4 min for non-emergent, and 8.5 min for ALS, 8.6 min for BLS._x000D_
Conclusions: A large proportion of patients with SE are designated as low acuity encounters by our EMS dispatch system.  In spite of this, dispatch-assigned acuity did not have a strong relationship with priority level, EMS certification level, or response time.  These findings suggest use of dispatch has not been optimized, highlighting a potential area to improve quality of EMS care.

Funding: Principal investigator E.G. receives funding from the National Institute of Neurological Disorders and Stroke, National Institute on Aging, and the American Academy of Neurology.