Dispatcher Performance and Prehospital Outcomes in Telephone-Assisted Airway Management following Foreign Body Obstruction: A Cross-Sectional Study
Archives of Academic Emergency Medicine,
Vol. 14 No. 1 (2026),
1 October 2025
,
Page e32
https://doi.org/10.22037/aaem.v14i1.3011
Abstract
Introduction: Prehospital care plays a crucial role in early recognition and timely management of foreign body airway obstruction (FBAO). This study aimed to identify factors associated with dispatcher performance and prehospital outcomes in the telephone-assisted management of FBAO.
Methods: This cross-sectional study was conducted through a review of recorded emergency telephone calls related to FBAO. Data were collected from the prehospital emergency medical services center over a one-year period, from March 20, 2024 to March 20, 2025. Demographic characteristics of dispatcher were obtained through self-reported questionnaires. Recorded calls were assessed using validated 13-item researcher-developed checklist based on the standardized telephone assistance algorithm for FBAO, categorized across three age groups (score range 0-1). Patient demographic characteristics, clinical characteristics, and prehospital outcomes, including recovery without dispatch of an operational team and dispatch of an operational team, were extracted from electronic medical records. Data were entered and analyzed using SPSS version 16. A p-value < 0.05 was considered statistically significant
Results: A total of 262 telephone assistance FBAO cases were included in the final analysis, of which 45.8% involved infants. The overall mean dispatcher performance score was 0.87 ± 0.10. Multivariable logistic regression analysis demonstrated that patient’s age (adjusted odds ratio (AOR) = 1.60, 95% confidence interval (CI): 1.13–2.26, p = 0.008) and dispatcher’s clinical experience (AOR = 1.44, 95% CI: 1.05–1.98, p = 0.023) were significant positive predictors of better performance of dispatcher. In contrast, contractual employment (AOR = 0.37, 95% CI: 0.21–0.68, p = 0.001), higher monthly overtime hours (AOR = 0.33, 95% CI: 0.16–0.68, p = 0.002), and non-participation in stress management workshops (AOR = 0.40, 95% CI: 0.23–0.68, p = 0.001) were negatively associated with dispatcher performance. Complete airway obstruction (AOR = 0.08, 95% CI: 0.03–0.17, p < 0.001), occurrence in an outdoor setting (AOR = 4.86, 95% CI: 1.60–16.40, p = 0.007), and involvement of non-edible foreign bodies (AOR = 0.16, 95% CI: 0.06–0.37, p < 0.001) were significant predictors of outcomes.
Conclusion: The findings indicate that dispatcher performance in telephone-assisted management of FBAO was generally acceptable. Enhancing performance requires not only simulation-based training but also consideration of individual and occupational factors affecting dispatchers. Moreover, improving patient outcomes depends on dispatchers’ awareness of patient-specific characteristics to ensure timely and context-appropriate interventions.
- Employee performance appraisal
- Emergency medical dispatcher
- Outcome assessment, health care
- Foreign bodies
- Airway obstruction
How to Cite
References
1. Bazyar, J., et al., Accuracy of Triage Systems in Disasters and Mass Casualty Incidents; a Systematic Review. Arch Acad Emerg Med, 2022. 10(1): p. e32.
2. Rydell, E., U. Jakobsson, and S. Stjernswärd, Nurses' experiences of text-based digital triage at primary healthcare centres in Sweden: a qualitative interview study. BMC Nurs, 2025. 24(1): p. 48.
3. Abbasi Ghocham, S., et al., Level of Self-Care and Patient Care Against COVID-19 Among Emergency Medical Services Personnel; a Cross-sectional Study. Arch Acad Emerg Med, 2023. 11(1): p. e4.
4. Møller, T.P., et al., Why and when citizens call for emergency help: an observational study of 211,193 medical emergency calls. Scand J Trauma Resusc Emerg Med, 2015. 23: p. 88.
5. Sexton, V., et al., Service use, clinical outcomes and user experience associated with urgent care services that use telephone-based digital triage: a systematic review. BMJ Open, 2022. 12(1): p. e051569.
6. Birkun, A., Toward development of the standardized dispatcher algorithm for telephone assistance in choking. Acad Emerg Med, 2022. 29(11): p. 1401-1402.
7. White, J.J., et al., Evaluation and Management of Airway Foreign Bodies in the Emergency Department Setting. J Emerg Med, 2023. 64(2): p. 145-155.
8. Habibelahi, A., et al., Clinical cause of neonatal mortality in Iran: analysis of the national Iranian Maternal And Neonatal network. BMJ Paediatr Open, 2024. 8(1): p. 1-7.
9. Nakubulwa, M.A., et al., To what extent do callers follow the advice given by a non-emergency medical helpline (NHS 111): A retrospective cohort study. PLoS One, 2022. 17(4): p. e0267052.
10. Birkun, A.A., Dispatcher Telephone Assistance on First Aid: An Important but Unexplored Area for Research. Prehospital and Disaster Medicine, 2022. 37(6): p. 858-859.
11. Birkun, A.A., Public Comments on social media Regarding Self-management of Foreign Body Airway Obstruction; a Letter to Editor. Arch Acad Emerg Med, 2024. 12(1): p. e68.
12. Ro, Y.S., et al., Effect of Dispatcher-Assisted Cardiopulmonary Resuscitation Program and Location of Out-of-Hospital Cardiac Arrest on Survival and Neurologic Outcome. Ann Emerg Med, 2017. 69(1): p. 52-61.e1.
13. Igarashi, Y., et al., Airway obstruction time and outcomes in patients with foreign body airway obstruction: multicenter observational choking investigation. Acute Med Surg, 2022. 9(1): p. e741.
14. Otomune, K., et al., Neurological outcomes associated with prehospital advanced airway management in patients with out-of-hospital cardiac arrest due to foreign body airway obstruction. Resusc Plus, 2021. 7: p. 100140.
15. Olasveengen, T.M., et al., European Resuscitation Council Guidelines 2021: Basic Life Support. Resuscitation, 2021. 161: p. 98-114.
16. Wise, S.L., C.L. Freeman, and P.F. Edemekong, EMS pre-arrival instructions. 2017.
17. Panchal, A.R., et al., Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 2020. 142(16_suppl_2): p. S366-S468.
18. Greif, R., et al., 2024 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces. Circulation, 2024. 150(24): p. e580-e687.
19. Zheng, P., et al., Global, regional, and national assessment of foreign body aspiration (1990-2021): novel insights into incidence, mortality, and disability-adjusted life years. Scand J Trauma Resusc Emerg Med, 2025. 33(1): p. 40.
20. Wu, Y., et al., Changes in the global burden of foreign body aspiration among under-5 children from 1990 to 2019. Front Pediatr, 2023. 11: p. 1235308.
21. Abo Elmagd, E., et al., Etiological profile of upper airway obstruction in infants. The Egyptian Journal of Otolaryngology, 2020. 36(1): p. 36.
22. Islam, F., et al., Are telephone-triage services less safe and efficient for managing unplanned care needs of older adults? Health Policy and Technology, 2024. 13(2): p. 100866.
23. Blank, L., et al., The appropriateness of, and compliance with, telephone triage decisions: a systematic review and narrative synthesis. J Adv Nurs, 2012. 68(12): p. 2610-21.
24. Holmström, I.K., et al., The perspectives of Swedish registered nurses about managing difficult calls to emergency medical dispatch centres: a qualitative descriptive study. BMC Nursing, 2021. 20(1): p. 150.
25. Mohammadi, F., et al., Exploring the challenges to telephone triage in pre-hospital emergency care: a qualitative content analysis. BMC Health Serv Res, 2022. 22(1): p. 1195.
26. Wennlund, K.T., et al., Emergency medical dispatchers’ experiences of managing emergency calls: a qualitative interview study. BMJ open, 2022. 12(4): p. e059803.
27. Møller, T.P., et al., Medical dispatchers' perception of the interaction with the caller during emergency calls - a qualitative study. Scand J Trauma Resusc Emerg Med, 2021. 29(1): p. 45.
28. Muñoz Medina, F., et al., Employees Perceptions of Job Insecurity and Performance: A Qualitative Approach. Int J Environ Res Public Health, 2022. 19(24): p. 1-14.
29. Sverke, M., et al., A Meta-Analysis of Job Insecurity and Employee Performance: Testing Temporal Aspects, Rating Source, Welfare Regime, and Union Density as Moderators. Int J Environ Res Public Health, 2019. 16(14): p. 1-29.
30. Rivard, M.K., et al., The Impact of Working Overtime or Multiple Jobs in Emergency Medical Services. Prehosp Emerg Care, 2020. 24(5): p. 657-664.
31. Olds, D.M. and S.P. Clarke, The effect of work hours on adverse events and errors in health care. J Safety Res, 2010. 41(2): p. 153-62.
32. Brachet, T., G. David, and A.M. Drechsler, The effect of shift structure on performance. American Economic Journal: Applied Economics, 2012. 4(2): p. 219-246.
33. Osório, C., et al., Systematic review and meta-analysis on the mental health of emergency and urgent call-handlers and dispatchers. Occupational Medicine, 2025. 75(6): p. 282-291.
34. Lilly, M., et al., Destress 9-1-1—an online mindfulness-based intervention in reducing stress among emergency medical dispatchers: a randomised controlled trial. Occupational and environmental medicine, 2019. 76(10): p. 705-711.
35. Babamiri, G. and Z. Karimiankakolaki, Investigating the impact of crisis management training on clinical decision-making and management of stress factors in the personnel of emergency medical services: randomized controlled trial. BMC Medical Education, 2025. 25(1): p. 1180.
36. Dunne, C.L., et al., Evaluation of basic life support interventions for foreign body airway obstructions: A population-based cohort study. Resuscitation, 2024. 201: p. 110258.
37. Dodson, H., S. Sharma, and J. Cook, Foreign body airway obstruction, in StatPearls [Internet]. 2024, StatPearls Publishing.
38. Wang, W.-y., et al., Analysis of risk factors for complications of foreign body aspiration in children. Respiratory Medicine, 2025. 248: p. 108363.
39. Wanstreet, T., J. Ramadan, and M.M. Carr, Airway foreign bodies in pediatric patients: an analysis of composition and age via HCUP KID. International Journal of Pediatric Otorhinolaryngology, 2021. 142: p. 110559.
40. Uçar, M.T. and E. Donmez, Epidemiological Insights from Media Reports on Foreign Body Aspiration in the Trachea: A Retrospective Descriptive Study. Eurasian Journal of Medical Investigation, 2025. 9(2): p. 79.
41. Johnson, K., M. Linnaus, and D. Notrica, Airway foreign bodies in pediatric patients: anatomic location of foreign body affects complications and outcomes. Pediatric surgery international, 2017. 33(1): p. 59-64.
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