ISDS Annual Conference Proceedings 2019. This is an Open Access article distributed under the terms of the Creative Commons 

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Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 11(1): e416, 2019 

ISDS 2019 Conference Abstracts 

Use of ambulance dispatch calls for surveillance of severe 
acute respiratory infections? 

Susana Monge1, 2, Janneke Duijster1, Geert Jan Kommer1, Jan van de Kassteele1, Gé 
Donker3, Thomas Krafft4, Paul Engelen5, Jens P. Valk6, 7, Jan de Waard8, Jan de Nooij8, Wim 
van der Hoek1, Liselotte van Asten1 

1
Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Utrecht, Bilthoven, 

Netherlands, 
2

European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden, 
3

Nivel Primary Care Database – sentinel 

practices, Utrecht, Netherlands, 
4

Maastricht Centre for Global Health, Maastricht University, Maastricht, Netherlands, 
5

Meldkamersupport, 

Hellevoetsluis, Netherlands, 
6

Dispatch Center Regional Ambulance Services Noord Nederland, Drachten, Netherlands, 
7

University Medical 

Center Groningen, Groningen, Netherlands, 
8

Regional Ambulance Service Hollands Midden, Den Haag, Netherlands 

Objective 

We aim to assess whether influenza circulation, as measured through influenza-like-illness (ILI) in primary care, is reflected 

in ambulance dispatch (AD) calls. 

Introduction 

Surveillance of severe influenza infections is lacking in the Netherlands. Ambulance dispatch (AD) data may provide 

information about severity of the influenza epidemic and its burden on emergency services. The current gold standard, primary 

care-based surveillance of influenza-like-illness (ILI), mainly captures mild to moderate influenza cases, and does not provide 

adequate information on severe disease. Monitoring the severity of the annual epidemic, particularly among groups most at 

risk of complications, is of importance for the planning of health services and the public health response. 

Methods 

We analysed all calls from four ambulance dispatch centers serving 4.3 million people in the Netherlands, between January 

2014 and December 2016. The main complaint and urgency level is recorded during triage; those possibly caused by 

respiratory infections were grouped as respiratory syndrome calls (RSC). We modelled the proportion of all RSC calls against 

the weekly ILI incidence (we allowed up to 4-week lags and leads), from sentinel primary-care surveillance. We used 

binomial regression with identity link to obtain differences in proportions. We built separate models by age group, urgency 

level and time of day. We tested heterogeneity of effects by season. 

Results 

We included 289,307 calls; 6.7% were RSC. Overall, proportion of RSC increased by 0.114 percentage points for each increase 

of 1/10,000 population in ILI incidence. In our study population, this translated into 550 ambulance calls attributable to 

influenza (as measured by ILI) per year. Association was stronger in the models including only out-of-office hours, children 

(<15 years) and highest urgency level calls. In the latter two, the effect varied by season. RSC was best associated  with ILI 

from the previous 1-3 weeks in all models, except in children where RSC preceded ILI by 1 week. 

Conclusions 

Our results demonstrate the potential usefulness of ambulance dispatch data to complement existing influenza surveillance by 

providing information on the volume and timing of severe cases attributable to influenza within the yearly epidemics. 

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