Background & aim: Foreign body airway obstruction (FBAO) is a time-critical medical emergency with high mortality, where patient survival depends on immediate first aid within the initial moments. Emergency dispatchers, as the first point of contact in the emergency response chain, play a vital role in providing telephone guidance to callers for performing life-saving maneuvers. Despite the significant burden of this condition in Iran and the crucial role of dispatchers in its management, no studies have examined dispatcher performance in telephone triage and guidance for FBAO cases in the country. This study aimed to determine dispatcher performance in providing telephone guidance for FBAO and its association with prehospital outcomes.
Methods: In this cross-sectional study, 262 recorded telephone calls made to the Kurdistan Emergency Dispatch Center (EMS 115) between March 20, 2024, and March 20, 2025, concerning foreign body airway obstruction (94 adults, 48 children, 120 infants) were reviewed. Dispatcher performance was evaluated using a researcher-developed 13-item checklist based on the 2025 American Heart Association (AHA) guidelines and algorithms approved by the Iran Emergency Organization, separately for the three age groups. The checklist was validated for content validity (CVR = 0.82, CVI = 0.84) and inter-rater reliability (κ = 0.87). Data were analyzed at a significance level of P<0.05.
Results: The overall mean performance score of dispatchers was 0.87. Complete airway obstruction was associated with a 92% reduction in the odds of clinical improvement (AOR = 0.08, 95% CI: 0.03-0.17, P<0.001), while out-of-home incidents (AOR = 4.86, 95% CI: 1.60-16.40, P = 0.007) and food-related foreign body type (AOR = 0.16, 95% CI: 0.06-0.37, P<0.001) were associated with altered odds of clinical improvement. Among dispatcher characteristics, greater clinical experience (AOR = 1.44, 95% CI: 1.05-1.98, P = 0.023) and attendance at stress management training (AOR = 0.40, 95% CI: 0.23-0.68, P = 0.001) were associated with better performance, while 10-20 hours of monthly overtime (AOR = 0.33, 95% CI: 0.16-0.68, P = 0.002) and contractual employment status (AOR = 0.37, 95% CI: 0.21-0.68, P = 0.001) were associated with poorer performance.
Conclusion: Although dispatchers demonstrated generally acceptable performance in technical and critical skills, serious deficiencies were identified in communication skills and caller stress management, particularly in cases involving infant choking. Complete airway obstruction, incident location, and foreign body type were identified as the main predictors of patient outcomes. Clinical experience, stress management training, overtime hours, and employment status were significant factors affecting dispatcher performance. Protocol revision, overtime reduction, stress management training, and public awareness improvement are recommended as key strategies for enhancing patient outcomes. |
