Validation of the Emotional Content and Cooperation Score used in Emergency Call Taking Research.

Introduction: EMS prioritize patients based on information provided by 9-1-1 callers to emergency medical dispatchers (EMD). Call-taking effectiveness and efficiency can be adversely affected by a non-cooperative caller. Although the emotional content and cooperation score (ECCS) is the standard measure of a caller's cooperation with EMD questioning in emergency call-taking research, the scale has not been thoroughly validated. Objective: The study aimed to measure the inter-rater agreement of the ECCS applied to medical 9-1-1 calls. Methods: Using anonymized audio recordings of actual medical 9-1-1 calls, a panel of experts developed a working definition for five levels of emotional-content: 1) normal conversation; 2) anxious but cooperative; 3) moderately upset but cooperative; 4) uncooperative, not listening, yelling; and 5) uncontrollable, hysterical. The 11 panel members then rated 15-second clips from a random sample of 220 calls. Agreement between the ratings was assessed using the kappa statistic. Results: An average of 60.8% of the scores assigned by all the panel members were a level 1 (conversational tone) and 1.7% were a level 4 (uncooperative caller). None of the callers were rated as uncontrollable. Agreement across the raters was low (K=0.32) for the 5-level scale. Dichotomising the clips into cooperative (levels 1, 2 and 3) and uncooperative (levels 4 and 5) yielded near-perfect agreement (K=0.97). Conclusions: Our results align with the call-taking literature in suggesting that a high proportion of 91-1 callers are cooperative when responding to an EMD. However, our low inter-rater agreement should caution researchers in the use of the 5-level ECCS, as it is questionable whether multiple raters can reliably discriminate that level of nuance. Our results suggest that a binary classification (cooperative vs uncooperative) is reliable. Future research will assess the effects of a caller's expressed emotions on an EMD's ability to process the call in a timely and accurate way. [ABSTRACT FROM AUTHOR]