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

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

Emergency medical services, Call centers, Emergency medical dispatch, Prospective studies, Emotional
distress, emotions, Emotional content and cooperation score, Outcome assessment, Critical care outcomes

Background 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.
Objectives 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.
Design, settings and participants 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.
Outcome measures and analysis 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.
Results 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

Marie Christina Ng Ping Cheung1

, Juline Beringer1

, Lionel Moulis2

, Joana Pissarra2

, Sophie Lefebvre1
and

Mustapha Sebbane1,3,4,5*

https://doi.org/10.1186/s12873-025-01446-y

2026

PERI IRAWAN

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