Dispatcher-led triage to reduce futile EMS transport for suspected out-of-hospital cardiac arrest in Japan: a narrative review and phased implementation framework.

Dispatcher-led triage for suspected out-of-hospital cardiac arrest (OHCA) may help reduce nonbeneficial emergency medical service (EMS) responses and transport by enabling conservative response modification in narrowly defined cases of obvious death (e.g., clear postmortem changes or catastrophic injury incompatible with life) or expected death (e.g., verifiable do-not-attempt-resuscitation/advance care planning documentation). In Japan, EMS generally initiates resuscitation and transports patients with suspected OHCA unless unequivocal signs of death are present. Drawing on international systems (e.g., the United Kingdom and Ontario) and recent evidence on dispatcher recognition accuracy, this narrative review summarizes practical safeguards relevant to call-stage triage, including high-sensitivity protocols, escalation rules when uncertainty persists, and structured quality assurance and quality improvement to detect false-negative decisions. It also proposes a phased implementation framework for Japan comprising (1) protocol refinement and monitoring of recognition accuracy, (2) legal and governance preparation with physician oversight, (3) simulation-based training and audit infrastructure, and (4) technology-supported triage (e.g., video) with prospective evaluation. Because direct evidence for dispatcher-stage triage in the specific form proposed for Japan remains limited, any transport-reduction policy should remain narrowly scoped and be supported by physician oversight, transparent auditing, and equity monitoring to ensure that efficiency gains do not come at the cost of missed potentially salvageable arrests.