{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:21:46Z","timestamp":1790698906024,"version":"4.1.0"},"reference-count":62,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,11,15]],"date-time":"2024-11-15T00:00:00Z","timestamp":1731628800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,11,15]],"date-time":"2024-11-15T00:00:00Z","timestamp":1731628800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"OsloMet - Oslo Metropolitan University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Emerg Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Emergency Medical Communication Centers (EMCC) have a key role in the prehospital chain-of-stroke-survival by recognizing stroke patients and reducing prehospital delay. However, studies on EMCC stroke recognition report both substantial undertriage and overtriage. Since mis-triage at the EMCC challenges the whole chain-of-stroke-survival, by occupying limited resources for non-stroke patients or failing to recognize the true stroke patients, there is a need to achieve a more comprehensive understanding of the dispatchers\u2019 routines and experiences. The aim of this study was to explore factors affecting EMCC dispatcher\u2019s decision-making in stroke calls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>A qualitative exploratory study, based on individual semi-structured interviews of 15 medical dispatchers from EMCC Oslo, Norway. Interviews were conducted during August and October 2022 and analyzed using the principles of thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified four themes: [1] Pronounced stroke symptoms are easy to identify [2]. Non-specific neurological symptoms raise suspicion of acute stroke but are difficult to differentiate from other medical conditions [3]. Consistent use of the Criteria Based Dispatch (CBD) protocol may increase EMCC overtriage [4]. Contextual conditions at EMCC can affect dispatchers\u2019 decision-making process and the ability for experiential learning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Medical dispatchers at the EMCC perceive vague and non-specific stroke symptoms, such as dizziness, confusion or altered behaviour, challenging to differentiate from symptoms of other less time-critical medical conditions. They also perceive the current CBD protocol in use as less supportive in assessing such symptoms. High workload and strict EMCC response time interval requirements hinder the gathering of essential patient information and the ability to seek guidance in cases of doubt, potentially exacerbating both EMCC undertriage and overtriage. The absence of feedback loops and other strategies for experiential learning in the EMCC hampers the medical dispatcher\u2019s ability to evaluate their own assessments and improve dispatch accuracy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12873-024-01129-0","type":"journal-article","created":{"date-parts":[[2024,11,15]],"date-time":"2024-11-15T03:25:38Z","timestamp":1731641138000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Factors affecting emergency medical dispatchers decision making in stroke calls \u2013 a qualitative study"],"prefix":"10.1186","volume":"24","author":[{"given":"Bj\u00f8rn","family":"Jamtli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edel Jannecke","family":"Svendsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trine M\u00f8gster","family":"J\u00f8rgensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo","family":"Kramer-Johansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maren Ranhoff","family":"Hov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Hardeland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,11,15]]},"reference":[{"issue":"1","key":"1129_CR1","first-page":"67","volume":"13","author":"Emergency medical dispatching","year":"1995","unstructured":"Emergency medical dispatching. : rapid identification and treatment of acute myocardial infarction. National Heart Attack Alert Program Coordinating Committee Access to Care Subcommittee. Am J Emerg Med. 1995;13(1):67\u201373.","journal-title":"Am J Emerg Med"},{"issue":"4","key":"1129_CR2","doi-asserted-by":"publisher","first-page":"e059803","DOI":"10.1136\/bmjopen-2021-059803","volume":"12","author":"K Torlen Wennlund","year":"2022","unstructured":"Torlen Wennlund K, Kurland L, Olanders K, Khoshegir A, Kamil HA, Castren M, et al. Emergency medical dispatchers\u2019 experiences of managing emergency calls: a qualitative interview study. BMJ Open. 2022;12(4):e059803.","journal-title":"BMJ Open"},{"issue":"3","key":"1129_CR3","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1161\/STR.0b013e318284056a","volume":"44","author":"EC Jauch","year":"2013","unstructured":"Jauch EC, Saver JL, Adams HP Jr., Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association. Stroke. 2013;44(3):870\u2013947.","journal-title":"Stroke"},{"issue":"10","key":"1129_CR4","doi-asserted-by":"publisher","first-page":"2666","DOI":"10.1161\/STROKEAHA.112.652644","volume":"43","author":"A Berglund","year":"2012","unstructured":"Berglund A, Svensson L, Sjostrand C, von Arbin M, von Euler M, Wahlgren N, et al. Higher prehospital priority level of stroke improves thrombolysis frequency and time to stroke unit: the Hyper Acute STroke Alarm (HASTA) study. Stroke. 2012;43(10):2666\u201370.","journal-title":"Stroke"},{"issue":"11","key":"1129_CR5","doi-asserted-by":"crossref","first-page":"798","DOI":"10.4045\/tidsskr.16.0512","volume":"137","author":"KW Faiz","year":"2017","unstructured":"Faiz KW, Sundseth A, Thommessen B, Ronning OM. Prehospital path in acute stroke. Tidsskr nor Laegeforen. 2017;137(11):798\u2013802.","journal-title":"Tidsskr nor Laegeforen"},{"issue":"1","key":"1129_CR6","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s13049-018-0584-0","volume":"27","author":"G Linderoth","year":"2019","unstructured":"Linderoth G, Moller TP, Folke F, Lippert FK, Ostergaard D. Medical dispatchers\u2019 perception of visual information in real out-of-hospital cardiac arrest: a qualitative interview study. Scand J Trauma Resusc Emerg Med. 2019;27(1):8.","journal-title":"Scand J Trauma Resusc Emerg Med"},{"issue":"4","key":"1129_CR7","doi-asserted-by":"publisher","first-page":"e007661","DOI":"10.1136\/bmjopen-2015-007661","volume":"5","author":"A Berglund","year":"2015","unstructured":"Berglund A, von Euler M, Schenck-Gustafsson K, Castren M, Bohm K. Identification of stroke during the emergency call: a descriptive study of callers\u2019 presentation of stroke. BMJ Open. 2015;5(4):e007661.","journal-title":"BMJ Open"},{"issue":"6","key":"1129_CR8","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1080\/10903127.2017.1332124","volume":"21","author":"CT Richards","year":"2017","unstructured":"Richards CT, Wang B, Markul E, Albarran F, Rottman D, Aggarwal NT, et al. Identifying key words in 9-1-1 calls for stroke: a mixed methods Approach. Prehosp Emerg Care. 2017;21(6):761\u20136.","journal-title":"Prehosp Emerg Care"},{"issue":"1","key":"1129_CR9","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1080\/10903120590891985","volume":"9","author":"WD Rosamond","year":"2005","unstructured":"Rosamond WD, Evenson KR, Schroeder EB, Morris DL, Johnson AM, Brice JH. Calling emergency medical services for acute stroke: a study of 9-1-1 tapes. Prehosp Emerg Care. 2005;9(1):19\u201323.","journal-title":"Prehosp Emerg Care"},{"issue":"7\u20138","key":"1129_CR10","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.1111\/jocn.12701","volume":"24","author":"B Ek","year":"2015","unstructured":"Ek B, Svedlund M. Registered nurses\u2019 experiences of their decision-making at an Emergency Medical Dispatch Centre. J Clin Nurs. 2015;24(7\u20138):1122\u201331.","journal-title":"J Clin Nurs"},{"issue":"3","key":"1129_CR11","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1161\/01.STR.0000204041.13466.4c","volume":"37","author":"PJ Hand","year":"2006","unstructured":"Hand PJ, Kwan J, Lindley RI, Dennis MS, Wardlaw JM. Distinguishing between stroke and mimic at the bedside: the brain attack study. Stroke. 2006;37(3):769\u201375.","journal-title":"Stroke"},{"issue":"17\u201318","key":"1129_CR12","doi-asserted-by":"publisher","first-page":"2553","DOI":"10.1111\/jocn.16073","volume":"31","author":"F Brigo","year":"2022","unstructured":"Brigo F, Zaboli A, Rinaldi F, Ausserhofer D, Nardone R, Pfeifer N, et al. The Manchester Triage System\u2019s performance in clinical risk prioritisation of patients presenting with headache in emergency department: a retrospective observational study. J Clin Nurs. 2022;31(17\u201318):2553\u201361.","journal-title":"J Clin Nurs"},{"issue":"22","key":"1129_CR13","doi-asserted-by":"publisher","first-page":"2123","DOI":"10.1212\/WNL.0000000000003981","volume":"88","author":"A Meretoja","year":"2017","unstructured":"Meretoja A, Keshtkaran M, Tatlisumak T, Donnan GA, Churilov L. Endovascular therapy for ischemic stroke: save a minute-save a week. Neurology. 2017;88(22):2123\u20137.","journal-title":"Neurology"},{"issue":"23","key":"1129_CR14","doi-asserted-by":"publisher","first-page":"2480","DOI":"10.1001\/jama.2013.6959","volume":"309","author":"JL Saver","year":"2013","unstructured":"Saver JL, Fonarow GC, Smith EE, Reeves MJ, Grau-Sepulveda MV, Pan W, et al. Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke. JAMA. 2013;309(23):2480\u20138.","journal-title":"JAMA"},{"key":"1129_CR15","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/s12873-015-0058-x","volume":"15","author":"F Dami","year":"2015","unstructured":"Dami F, Golay C, Pasquier M, Fuchs V, Carron PN, Hugli O. Prehospital triage accuracy in a criteria based dispatch centre. BMC Emerg Med. 2015;15:32.","journal-title":"BMC Emerg Med"},{"issue":"1","key":"1129_CR16","doi-asserted-by":"publisher","first-page":"e000300","DOI":"10.1136\/tsaco-2019-000300","volume":"4","author":"JL Ryan","year":"2019","unstructured":"Ryan JL, Pracht E, Langland-Orban B, Crandall M. Association of mechanism of injury with overtriage of injured youth patients as trauma alerts. Trauma Surg Acute Care Open. 2019;4(1):e000300.","journal-title":"Trauma Surg Acute Care Open"},{"key":"1129_CR17","volume-title":"Time for action - personnel in a sustainable health and care service","year":"2023","unstructured":"Services NMoHaC. In: Services, NMoHaC, editors. Time for action - personnel in a sustainable health and care service. Norway: Oslo; 2023."},{"key":"1129_CR18","unstructured":"Bank TW. Life expectancy at birth, total (years). https:\/\/data.worldbank.org\/: The World Bank; 2021."},{"key":"1129_CR19","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1186\/1472-6963-14-380","volume":"14","author":"V Pittet","year":"2014","unstructured":"Pittet V, Burnand B, Yersin B, Carron PN. Trends of pre-hospital emergency medical services activity over 10 years: a population-based registry analysis. BMC Health Serv Res. 2014;14:380.","journal-title":"BMC Health Serv Res"},{"issue":"11","key":"1129_CR20","doi-asserted-by":"publisher","first-page":"574","DOI":"10.5694\/j.1326-5377.2011.tb03107.x","volume":"194","author":"JA Lowthian","year":"2011","unstructured":"Lowthian JA, Jolley DJ, Curtis AJ, Currell A, Cameron PA, Stoelwinder JU, et al. The challenges of population ageing: accelerating demand for emergency ambulance services by older patients, 1995\u20132015. Med J Aust. 2011;194(11):574\u20138.","journal-title":"Med J Aust"},{"issue":"4","key":"1129_CR21","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1007\/s10389-015-0675-6","volume":"23","author":"A Veser","year":"2015","unstructured":"Veser A, Sieber F, Gross S, Pruckner S. The demographic impact on the demand for emergency medical services in the urban and rural regions of Bavaria, 2012\u20132032. Z Gesundh Wiss. 2015;23(4):181\u20138.","journal-title":"Z Gesundh Wiss"},{"key":"1129_CR22","doi-asserted-by":"crossref","unstructured":"Wenstrup J, Hestoy BH, Sagar MV, Blomberg SNF, Christensen H, Christensen HC et al. Emergency Medical Services dispatcher recognition of stroke: a systematic review. Eur Stroke J. 2024:23969873231223339.","DOI":"10.1177\/23969873231223339"},{"issue":"1","key":"1129_CR23","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s12873-024-00962-7","volume":"24","author":"B Jamtli","year":"2024","unstructured":"Jamtli B, Hov MR, Jorgensen TM, Kramer-Johansen J, Ihle-Hansen H, Sandset EC, et al. Telephone triage and dispatch of ambulances to patients with suspected and verified acute stroke - a descriptive study. BMC Emerg Med. 2024;24(1):43.","journal-title":"BMC Emerg Med"},{"issue":"1","key":"1129_CR24","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s13049-021-00860-y","volume":"29","author":"TP Moller","year":"2021","unstructured":"Moller TP, Jensen HG, Viereck S, Lippert F, Ostergaaard D. Medical dispatchers\u2019 perception of the interaction with the caller during emergency calls - a qualitative study. Scand J Trauma Resusc Emerg Med. 2021;29(1):45.","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"1129_CR25","doi-asserted-by":"publisher","first-page":"391","DOI":"10.2147\/JMDH.S159593","volume":"11","author":"SMR Hosseini","year":"2018","unstructured":"Hosseini SMR, Maleki M, Gorji HA, Khorasani-Zavareh D, Roudbari M. Factors affecting emergency medical dispatchers\u2019 decision-making: a qualitative study. J Multidiscip Healthc. 2018;11:391\u20138.","journal-title":"J Multidiscip Healthc"},{"issue":"1","key":"1129_CR26","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1186\/s13049-023-01161-2","volume":"31","author":"TB Spjeldnaes","year":"2023","unstructured":"Spjeldnaes TB, Nilsen KAV, Myrmel L, Sornes JO, Brattebo G. Calling for help: i need you to listen\u2019\u2019: a qualitative study of callers\u2019 experience of calls to the emergency medical communication centre. Scand J Trauma Resusc Emerg Med. 2023;31(1):94.","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"1129_CR27","unstructured":"Patton MQ. Qualitative research & evaluation methods. 4 th edition ed. Thousand Oaks, California: Sage Publications; 2014."},{"issue":"8","key":"1129_CR28","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1177\/1403494812465030","volume":"40","author":"K Malterud","year":"2012","unstructured":"Malterud K. Systematic text condensation: a strategy for qualitative analysis. Scand J Public Health. 2012;40(8):795\u2013805.","journal-title":"Scand J Public Health"},{"key":"1129_CR29","doi-asserted-by":"publisher","first-page":"100509","DOI":"10.1016\/j.resplu.2023.100509","volume":"17","author":"HK Kjaervoll","year":"2024","unstructured":"Kjaervoll HK, Andersson LJ, Bakkelund KEN, Harring AKV, Tjelmeland IBM. Description of the prehospital emergency healthcare system in Norway. Resusc Plus. 2024;17:100509.","journal-title":"Resusc Plus"},{"key":"1129_CR30","unstructured":"Regulation on prehospital emergency medical care (akuttmedisinforskriften). (2015)."},{"key":"1129_CR31","unstructured":"Association TNM. Norwegian Index for Emergency Medical Assistance 3rd edition The Norwegian Medical Association. 2009."},{"issue":"1","key":"1129_CR32","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1161\/01.STR.0000044170.46643.5E","volume":"34","author":"J Harbison","year":"2003","unstructured":"Harbison J, Hossain O, Jenkinson D, Davis J, Louw SJ, Ford GA. Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test. Stroke. 2003;34(1):71\u20136.","journal-title":"Stroke"},{"issue":"6","key":"1129_CR33","doi-asserted-by":"publisher","first-page":"1355","DOI":"10.1161\/01.STR.0000128529.63156.c5","volume":"35","author":"AM Nor","year":"2004","unstructured":"Nor AM, McAllister C, Louw SJ, Dyker AG, Davis M, Jenkinson D, et al. Agreement between ambulance paramedic- and physician-recorded neurological signs with Face Arm Speech Test (FAST) in acute stroke patients. Stroke. 2004;35(6):1355\u20139.","journal-title":"Stroke"},{"issue":"6","key":"1129_CR34","doi-asserted-by":"publisher","first-page":"2050","DOI":"10.1161\/STROKEAHA.121.036084","volume":"53","author":"K Larsen","year":"2022","unstructured":"Larsen K, Jaeger HS, Hov MR, Thorsen K, Solyga V, Lund CG, et al. Streamlining Acute Stroke Care by Introducing National Institutes of Health Stroke Scale in the Emergency Medical services: a prospective cohort study. Stroke. 2022;53(6):2050\u20137.","journal-title":"Stroke"},{"issue":"6","key":"1129_CR35","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","volume":"19","author":"A Tong","year":"2007","unstructured":"Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349\u201357.","journal-title":"Int J Qual Health Care"},{"key":"1129_CR36","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.resuscitation.2016.09.027","volume":"109","author":"C Hardeland","year":"2016","unstructured":"Hardeland C, Sunde K, Ramsdal H, Hebbert SR, Soilammi L, Westmark F, et al. Factors impacting upon timely and adequate allocation of prehospital medical assistance and resources to cardiac arrest patients. Resuscitation. 2016;109:56\u201363.","journal-title":"Resuscitation"},{"issue":"1","key":"1129_CR37","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s13049-016-0343-z","volume":"25","author":"HK Bakke","year":"2017","unstructured":"Bakke HK, Steinvik T, Ruud H, Wisborg T. Effect and accuracy of emergency dispatch telephone guidance to bystanders in trauma: post-hoc analysis of a prospective observational study. Scand J Trauma Resusc Emerg Med. 2017;25(1):27.","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"1129_CR38","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/1757-7241-22-2","volume":"22","author":"EN Ellensen","year":"2014","unstructured":"Ellensen EN, Hunskaar S, Wisborg T, Zakariassen E. Variations in contact patterns and dispatch guideline adherence between Norwegian emergency medical communication centres\u2013a cross-sectional study. Scand J Trauma Resusc Emerg Med. 2014;22:2.","journal-title":"Scand J Trauma Resusc Emerg Med"},{"issue":"1","key":"1129_CR39","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1111\/aas.13032","volume":"62","author":"EN Ellensen","year":"2018","unstructured":"Ellensen EN, Naess H, Wisborg T, Hunskaar S, Zakariassen E. Stroke identification by criteria based dispatch - a register based study. Acta Anaesthesiol Scand. 2018;62(1):105\u201315.","journal-title":"Acta Anaesthesiol Scand"},{"issue":"3","key":"1129_CR40","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1097\/MEJ.0b013e32801464cf","volume":"14","author":"L Hjalte","year":"2007","unstructured":"Hjalte L, Suserud BO, Herlitz J, Karlberg I. Initial emergency medical dispatching and prehospital needs assessment: a prospective study of the Swedish ambulance service. Eur J Emerg Med. 2007;14(3):134\u201341.","journal-title":"Eur J Emerg Med"},{"issue":"4","key":"1129_CR41","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1097\/00063110-200312000-00006","volume":"10","author":"AC Wahlberg","year":"2003","unstructured":"Wahlberg AC, Cedersund E, Wredling R. Factors and circumstances related to complaints in emergency medical dispatching in Sweden: an exploratory study. Eur J Emerg Med. 2003;10(4):272\u20138.","journal-title":"Eur J Emerg Med"},{"issue":"9","key":"1129_CR42","doi-asserted-by":"publisher","first-page":"1096","DOI":"10.1111\/acem.12736","volume":"22","author":"EK Choo","year":"2015","unstructured":"Choo EK, Garro AC, Ranney ML, Meisel ZF, Morrow Guthrie K. Qualitative Research in Emergency Care Part I: Research principles and Common Applications. Acad Emerg Med. 2015;22(9):1096\u2013102.","journal-title":"Acad Emerg Med"},{"issue":"2","key":"1129_CR43","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","volume":"3","author":"V Braun","year":"2006","unstructured":"Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77\u2013101.","journal-title":"Qualitative Res Psychol"},{"issue":"20","key":"1129_CR44","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","volume":"310","author":"A World Medical","year":"2013","unstructured":"World Medical A. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191\u20134.","journal-title":"JAMA"},{"issue":"15","key":"1129_CR45","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1001\/jama.282.15.1458","volume":"282","author":"MD Cabana","year":"1999","unstructured":"Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, et al. Why don\u2019t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282(15):1458\u201365.","journal-title":"JAMA"},{"key":"1129_CR46","unstructured":"Benner PH, Sutphen RG. M. Patient safety and quality: an evidence-based handbook for nurses, clinical reasoning, decisionmaking, and action: thinking critically and clinically. Agency for Healthcare Researchand Quality; 2008."},{"issue":"5\u20136","key":"1129_CR47","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1111\/jocn.14151","volume":"27","author":"CW Nibbelink","year":"2018","unstructured":"Nibbelink CW, Brewer BB. Decision-making in nursing practice: an integrative literature review. J Clin Nurs. 2018;27(5\u20136):917\u201328.","journal-title":"J Clin Nurs"},{"key":"1129_CR48","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1038\/s41746-020-0221-y","volume":"3","author":"RT Sutton","year":"2020","unstructured":"Sutton RT, Pincock D, Baumgart DC, Sadowski DC, Fedorak RN, Kroeker KI. An overview of clinical decision support systems: benefits, risks, and strategies for success. NPJ Digit Med. 2020;3:17.","journal-title":"NPJ Digit Med"},{"issue":"1","key":"1129_CR49","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1186\/s13049-021-00917-y","volume":"29","author":"J Gerwing","year":"2021","unstructured":"Gerwing J, Steen-Hansen JE, Mjaaland T, Jensen BF, Eielsen O, Thomas OMT, et al. Evaluating a training intervention for improving alignment between emergency medical telephone operators and callers: a pilot study of communication behaviours. Scand J Trauma Resusc Emerg Med. 2021;29(1):107.","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"1129_CR50","volume-title":"When time counts: emergency medical dispatch. Exploring, understanding and addressing issues that impact upon timely and adequate allocation of prehospital medical assistance and resources to cardiac arrest patients","author":"C Hardeland","year":"2017","unstructured":"Hardeland C. When time counts: emergency medical dispatch. Exploring, understanding and addressing issues that impact upon timely and adequate allocation of prehospital medical assistance and resources to cardiac arrest patients. Oslo: University of Oslo; 2017."},{"issue":"6","key":"1129_CR51","doi-asserted-by":"publisher","first-page":"e200197","DOI":"10.1212\/CPJ.0000000000200197","volume":"13","author":"J Wenstrup","year":"2023","unstructured":"Wenstrup J, Blomberg SN, Christensen H, Folke F, Christensen HC, Kruuse C. Dispatcher Stroke\/TIA Recognition in Emergency Medical Call Center and out-of-hours service calls in Copenhagen, Denmark. Neurol Clin Pract. 2023;13(6):e200197.","journal-title":"Neurol Clin Pract"},{"issue":"3","key":"1129_CR52","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1097\/00063110-199509000-00002","volume":"2","author":"BS Zachariah","year":"1995","unstructured":"Zachariah BS, Pepe PE. The development of emergency medical dispatch in the USA: a historical perspective. Eur J Emerg Med. 1995;2(3):109\u201312.","journal-title":"Eur J Emerg Med"},{"issue":"9","key":"1129_CR53","doi-asserted-by":"publisher","first-page":"e0181970","DOI":"10.1371\/journal.pone.0181970","volume":"12","author":"H Lyu","year":"2017","unstructured":"Lyu H, Xu T, Brotman D, Mayer-Blackwell B, Cooper M, Daniel M, et al. Overtreatment in the United States. PLoS ONE. 2017;12(9):e0181970.","journal-title":"PLoS ONE"},{"issue":"1","key":"1129_CR54","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1186\/s13049-018-0528-8","volume":"26","author":"K Bohm","year":"2018","unstructured":"Bohm K, Kurland L. The accuracy of medical dispatch - a systematic review. Scand J Trauma Resusc Emerg Med. 2018;26(1):94.","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"1129_CR55","unstructured":"(SSB) SN. Ambulance service. Number of ambulances, operating hours, assignments and kilometers driven, by heslth enterprise 2011\u20132023. 2023."},{"key":"1129_CR56","unstructured":"Time for Action. Personnel in a Sustainable Health and Care Service. In: 4 NOR, editor. Oslo2023."},{"issue":"1","key":"1129_CR57","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1186\/s12913-019-4370-0","volume":"19","author":"AC Leonardsen","year":"2019","unstructured":"Leonardsen AC, Ramsdal H, Olasveengen TM, Steen-Hansen JE, Westmark F, Hansen AE, et al. Exploring individual and work organizational peculiarities of working in emergency medical communication centers in Norway- a qualitative study. BMC Health Serv Res. 2019;19(1):545.","journal-title":"BMC Health Serv Res"},{"issue":"17\u201318","key":"1129_CR58","doi-asserted-by":"publisher","first-page":"2486","DOI":"10.1111\/jocn.16061","volume":"31","author":"IK Holmstrom","year":"2022","unstructured":"Holmstrom IK, Kaminsky E, Lindberg Y, Spangler D, Winblad U. Better safe than sorry: registered nurses\u2019 strategies for handling difficult calls to emergency medical dispatch centres - an interview study. J Clin Nurs. 2022;31(17\u201318):2486\u201394.","journal-title":"J Clin Nurs"},{"issue":"8","key":"1129_CR59","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1136\/emj.2007.047928","volume":"24","author":"J Clawson","year":"2007","unstructured":"Clawson J, Olola CH, Heward A, Scott G, Patterson B. Accuracy of emergency medical dispatchers\u2019 subjective ability to identify when higher dispatch levels are warranted over a Medical Priority Dispatch System automated protocol\u2019s recommended coding based on paramedic outcome data. Emerg Med J. 2007;24(8):560\u20133.","journal-title":"Emerg Med J"},{"issue":"1","key":"1129_CR60","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1186\/s13643-019-1040-6","volume":"8","author":"N Chamane","year":"2019","unstructured":"Chamane N, Kuupiel D, Mashamba-Thompson TP. Experiential learning for primary healthcare workers in low- and middle-income countries: a scoping review protocol. Syst Rev. 2019;8(1):123.","journal-title":"Syst Rev"},{"issue":"4","key":"1129_CR61","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1007\/s10459-007-9090-2","volume":"14","author":"K Mann","year":"2009","unstructured":"Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Educ Theory Pract. 2009;14(4):595\u2013621.","journal-title":"Adv Health Sci Educ Theory Pract"},{"key":"1129_CR62","volume-title":"Standard practice for emergency medical dispatch management F1560-94","author":"Materials ASfTa","year":"1994","unstructured":"Materials ASfTa. Standard practice for emergency medical dispatch management F1560-94. West Conshohocken, PA: American Society for Testing and Materials; 1994."}],"container-title":["BMC Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12873-024-01129-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12873-024-01129-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12873-024-01129-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,15]],"date-time":"2024-11-15T04:03:42Z","timestamp":1731643422000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcemergmed.biomedcentral.com\/articles\/10.1186\/s12873-024-01129-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,15]]},"references-count":62,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["1129"],"URL":"https:\/\/doi.org\/10.1186\/s12873-024-01129-0","relation":{},"ISSN":["1471-227X"],"issn-type":[{"value":"1471-227X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,15]]},"assertion":[{"value":"5 August 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 November 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 November 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study is part of The Dispatch \u2013Norwegian Acute Stroke Prehospital Project (Dispatch NASPP). The study was performed according to the principles stated in the Declaration of Helsinki and was based on informed, voluntary, and written informed consent to participate, including the right to withdraw from the study at any time. We informed all participants about the principles for anonymity and confidentiality concerning publication of the results from the interviews. We emphasized that the researchers would not exchange information with the department management regarding individuals\u2019 performances or answers. Protocol for the Dispatch NASPP project was approved by the Regional Committees for Medical Research Ethics South East Norway, University of Oslo, Faculty of Medicine (REC) (ref. no. 2018\/1909) and the local data protection officer at OUS (ref. no. 18\/25297). Informed Consent to participate was deemed unnecessary according to the Norwegian Health Research Act. All patient data collected are anonymized and registered using Medinsight<sup>\u00ae<\/sup> Release 2.17.4.0 and TSD - Service for Sensitive Data, at the University of Oslo, Norway, a platform to collect, store, analyze and share sensitive data in compliance with the Norwegian regulation regarding individual\u2019s privacy.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"214"}}