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

ObjectiveTo explore emergency medical dispatchers (EMD) experiences of prioritising patients and stewarding ambulance resources when system capacity is constrained. DesignQualitative interview study using inductive qualitative content analysis. SettingEmergency medical communication centres (EMCCs) in Sweden operated by the national emergency call provider, responsible for receiving 112 calls and dispatching ambulances. ParticipantsThirteen purposively sampled EMDs with at least one year of professional experience. Data analysisInterviews were analysed inductively using qualitative content analysis (Elo and Kyngas) through open coding, grouping into subcategories and abstraction into generic categories and one main category. ResultsDispatchers described prioritisation under scarcity as system work that simultaneously addresses individual patient acuity and population-level readiness. One main category captured this work: Stewarding scarce response capacity. Three interrelated 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 while attempting to avoid both under-response to urgent need and over-allocation that would leave areas without coverage. ConclusionsDispatch 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, and governance that makes queue dynamics and geographic coverage trade-offs visible, rather than relying solely on initial triage decisions or aggregate response-time targets. Strengths and limitations of this studyO_LIStrengths and limitations of this study C_LIO_LIAn inductive qualitative content analysis allowed categories to emerge from dispatchers own descriptions, rather than imposing predefined theoretical frameworks. C_LIO_LIInclusion of emergency medical dispatchers with varied ages, professional experience and EMCC locations enhanced the richness of the data and potential transferability. C_LIO_LIAnalyst triangulation, an explicit abstraction pathway and data-to-category quotations strengthened analytic transparency and trustworthiness. C_LIO_LIInterviews were conducted via video, which may have limited access to non-verbal cues compared with in-person interviews. C_LIO_LIThe study was conducted within a single national dispatch system, and participation was voluntary, which may limit transferability and introduce self-selection of more experienced or engaged dispatchers. C_LI