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BACKGROUND: The importance of emergency systems accessible by telephone for the early attention of patients with ischemic cardiopathy is well known. In Andalusia, this service is provided by calling 061. However, studies show an insufficient use of the existing emergency system in this type of patient. OBJECTIVE: To identify explanations related to the decision regarding the method of transport to health-care systems, by private means of transport or 061 services, for people with ischemic cardiopathy from the onset of symptoms until their arrival at the Emergency Department. METHODS: Eleven focal groups were held with subjects diagnosed with ischemic cardiopathy. The discussions were related to the method of transport (using 061 or their own means of transport to a major hospital or to a nearby health facility for onward transfer), depending on the existence of previous experience and distance to the hospital. RESULTS: The method of transport is related to the degree of ignorance about what is happening, perceptions regarding the fastest way to reach the hospital, people available around the patient when the event takes place, vehicle availability and possible stressful situations. CONCLUSIONS: This study provides information about the reasons for using or not using the emergency transport systems for these patients and understanding how decisions were made. The study's importance lies in the possibility of improving individuals' access to health care systems through education-based actions and a strategic information and training plan that targets patients, families and health professionals.

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Introducción: En los centros de coordinación de urgencias y emergencias sanitarias, disponer de un instrumento científicamente validado permitiría una más adecuada asignación de los recursos. Esto es fundamental en los casos de disnea, en los que una rápida actuación mejorará la supervivencia y la calidad de vida posterior. El objetivo ha sido la validación de un protocolo telefónico para la identificación de afección emergente, entre los pacientes demandantes de asistencia sanitaria por disnea, a través del teléfono 061 de la Comunidad Andaluza. Material y método: Diseño: transversal de base extrahospitalaria. Ámbito de estudio: Comunidad Autónoma de Andalucía. Sujetos de estudio: selección aleatoria de 1.700 pacientes extraídos de un total de 21.000 demandas asistenciales al 061. Instrumentalización: se ha diseñado un cuestionario telefónico por un comité de expertos que se aplicó a todas las llamadas asistenciales cuyo motivo de demanda ha sido el síntoma de disnea los días 1, 5, 10, 15, 20 y 25 de cada mes y durante un año. Se ha realizado una identificación de los casos emergentes mediante los registros hospitalarios, diagnóstico del equipo de emergencias o seguimiento telefónico. Se ha construido un modelo, mediante regresión logística, determinando su calibración y discriminación. Resultados: El protocolo final, según modelo de regresión logística, incluyó las siguientes variables: comienzo súbito de la disnea, antecedentes de asma o de bronquitis crónica reagudizada. El test de calibración presentó una 2 con p < 0,05. El valor del área bajo la curva ROC fue de 0,8500 y p < 0,05. Conclusiones: El protocolo propuesto selecciona adecuadamente a los pacientes con disnea que son emergentes de los que no lo son

Introduction: In emergency coordination centers, the availability of a scientifically validated instrument would improve resource allocation. This is especially important in patients reporting dyspnea, in whom rapid action can improve survival and subsequent quality of life. The objective of this study was to validate a telephone protocol for the identification of emergency disease among patients requesting healthcare for dyspnea using the 061 emergency service of Andalusia (Spain). Material and method: Design: Cross-sectional study. Study setting: Region of Andalusia. Study subjects: A randomized sample of 1700 patients was selected from a wider sample of 21000 patients with dyspnea calling 061 for healthcare. Instruments: A telephone questionnaire was designed by a panel of experts. This questionnaire was applied to all calls reporting dyspnea on days 1, 5, 10, 15, 20 and 25 of each month during a 1-year period. Emergency cases were subsequently identified by a search of the hospital records, and the diagnosis of the emergency team and telephone follow-up of patients were recorded. Logistic regression was used to construct the model, and its calibration and discrimination were then determined. Results: A final protocol was obtained from the logistic regression model and included the following variables: sudden onset of dyspnea and a history of asthma or exacerbation of chronic bronchitis. The calibration test showed a 2 with p < 0.05. The area under the ROC curve was 0.8500 (p < 0.05). Conclusions: The proposed protocol identifies emergency from nonemergency patients from among those calling 061 for dyspnea

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