Emotional distress of callers requesting emergency medical communication center assistance and patient outcomes: a prospective observational study

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Abstract
Telephone triage, performed in Emergency Medical Communication Centers is the complex task of gathering key medical information in order to identify life-threatening emergencies and ensure timely and appropriate service deployment. This decision-making process is particularly challenging when the caller is in emotional distress. To determine the association between the caller’s emotional state, as prospectively measured by the emergency dispatcher using the Emotional Content and Cooperation Score (ECCS), and patient outcomes, and to evaluate the predictive performance of ECCS. Prospective, observational study conducted from February 15th to May 1st 2023 in a French Emergency Communication Center. Calls managed by emergency physicians following initial prioritization by emergency dispatchers were included. Emergency dispatchers prospectively assessed callers’ emotional state using the ECCS, without influencing subsequent management. The primary endpoint was the frequency of severe outcomes (death or ICU admission) based on the callers’ ECCS. The association between ECCS and patient outcomes was analyzed using Cochran-Armitage trend test. Secondary endpoints included standard call prioritization by emergency dispatchers (P0–4 codes), graded response by emergency physicians (R1–4 codes), and final severity assessment (B0–3 codes), as well as the ECCS performance in predicting patient outcomes. Of 1134 calls assessed, 805 were analyzed. Twenty-seven emergency dispatchers participated in the ECCS assessment; 63% were female, median experience was 3 years (Q1; Q3: 1; 8). Most callers were rated as calm: ECCS1 (n = 515, 64%) and ECCS2 (n = 228, 28%); distressed callers were less frequent: ECCS3 (n = 48, 6%) and ECCS4 (n = 14, 2%). Severe outcomes occurred in 25 patients (3% of calls), and were significantly associated with higher perceived emotional distress (p = 0.0007). ECCS was also significantly associated with initial call prioritization by emergency dispatchers (P codes) and with the graded response deployed (R codes). ECCS≥2 showed 68% sensitivity (95%CI: 50; 87), 65% specificity (95%CI: 62; 68) and 98% NPV (95%CI: 97; 99) in predicting severe outcomes. This study provides real-world evidence that dispatchers’ assessments of callers’ emotional states, assessed prior to medical management, are associated with patient outcomes. These findings support integrating emotional state assessment into emergency call triage to optimize timely and appropriate care. The online version contains supplementary material available at 10.1186/s12873-025-01446-y.

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