Stewarding scarce response capacity: an inductive qualitative interview study of emergency medical dispatchers' prioritising ambulance resources.

Authors

Peter Hill, Jakob Lederman, Daniel Jonsson, Peter Bolin, Veronica Vicente

Published in

BMJ open. Volume 16. Issue 7. Pages e118269. Jul 02, 2026. Epub Jul 02, 2026.

Abstract

This study aimed to explore emergency medical dispatchers' (EMDs') experiences of prioritising patients and stewarding ambulance resources when system capacity was constrained.
Qualitative interview study using inductive qualitative content analysis.
Emergency medical communication centres (EMCCs) in Sweden, operated by the national emergency call provider and responsible for receiving 112 calls and dispatching ambulances.
13 purposively sampled EMDs with at least 1 year of professional experience.
Interviews were analysed inductively using qualitative content analysis (Elo and Kyngäs) through open coding, grouping into subcategories and abstraction into generic categories and one main category.
Dispatchers described prioritisation under scarcity as system work that simultaneously addressed individual patient acuity and population-level readiness. One main category captured this work: stewarding scarce response capacity. Three inter-related generic categories characterised stewardship: (1) prioritising by clinical urgency within geographic and operational constraints; (2) producing availability through anticipation, reassessment and queue governance in a 'virtual waiting room'; and (3) coordinating response through information infrastructures and interprofessional collaboration. Across categories, dispatchers described redistributing risk across patients and time, managing moral strain when delays could harm patients and using experience, reassessment and teamwork to avoid both under-response to urgent need and over-allocation that would leave areas without coverage.
Dispatch under scarcity is best understood as active stewardship of a safety-critical dispatch queue. Strengthening patient safety therefore requires organisational support for reassessment and escalation during prolonged waits, explicit governance of queue dynamics and geographic coverage trade-offs, safeguards for contextual judgement when automation is used and support for dispatchers exposed to morally difficult scarcity decisions.

PMID:
42392639
Bibliographic data and abstract were imported from PubMed on 03 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.