• Stephen J Ball, Teresa A Williams, Karen Smith, Peter Cameron, Daniel Fatovich, Kay L O'Halloran, Delia Hendrie, Austin Whiteside, Madoka Inoue, Deon Brink, Iain Langridge, Gavin Pereira, Hideo Tohira, Sean Chinnery, Janet E Bray, Paul Bailey, and Judith Finn.
• Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
• Emerg Med Australas. 2016 Dec 1; 28 (6): 716-724.

ObjectiveTo compare chief complaints of the Medical Priority Dispatch System in terms of the match between dispatch priority and patient condition.MethodsThis was a retrospective whole-of-population study of emergency ambulance dispatch in Perth, Western Australia, 1 January 2014 to 30 June 2015. Dispatch priority was categorised as either Priority 1 (high priority), or Priority 2 or 3. Patient condition was categorised as time-critical for patient(s) transported as Priority 1 to hospital or who died (and resuscitation was attempted by paramedics); else, patient condition was categorised as less time-critical. The χ2statistic was used to compare chief complaints by false omission rate (percentage of Priority 2 or 3 dispatches that were time-critical) and positive predictive value (percentage of Priority 1 dispatches that were time-critical). We also reported sensitivity and specificity.ResultsThere were 211 473 cases of dispatch. Of 99 988 cases with Priority 2 or 3 dispatch, 467 (0.5%) were time-critical. Convulsions/seizures and breathing problems were highlighted as having more false negatives (time-critical despite Priority 2 or 3 dispatch) than expected from the overall false omission rate. Of 111 485 cases with Priority 1 dispatch, 6520 (5.8%) were time-critical. Our analysis highlighted chest pain, heart problems/automatic implanted cardiac defibrillator, unknown problem/collapse, and headache as having fewer true positives (time-critical and Priority 1 dispatch) than expected from the overall positive predictive value.ConclusionScope for reducing under-triage and over-triage of ambulance dispatch varies between chief complaints of the Medical Priority Dispatch System. The highlighted chief complaints should be considered for future research into improving ambulance dispatch system performance.© 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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