Emergency Services

Quality Improvements

to Emergency Communications


What is the Emergency Priority Dispatch System?

In the early days of 9-1-1, dispatchers were on their own without a protocol system to accurately and consistently dispatch needed support or assign the necessary resources to the variety of calls coming in to their centers. There were no key questions to narrow and focus calls or pre-arrival instructions such as CPR to help the caller until the needed help arrived. For the most part, dispatchers told callers that help was on its way and after that, the dispatcher would disconnect the line to move on to the next caller.

The quick and often hasty response ultimately wasted time and resources. Without sufficient information about the situation, the agency risked sending the wrong emergency vehicles and the caller was left without the benefit of further, life-saving instructions while waiting for whatever was sent to help. The response system was lacking at its most critical period, and call centers throughout the country were providing varied levels of care to a public in crisis. Response teams were stretched to the limits, responding to simple problems while across the city someone was in need of critical care. Something had to be done.

Protocol was the answer?

Dr. Jeff Clawson designed a set of protocols that would standardize the way dispatchers communicated with callers and, in turn, improves the emergency response system. The original set of protocols published in 1978 contained 29 sets of two 8-inch-by-5-inch cards. Each caller complaint was listed in alphabetical order, as they are today, and reflected either a symptom (e.g., abdominal pain, burns, cardiac/respiratory arrest) or an incident (e.g., electrocutions, drowning, or traffic injury accident). The core card contained three color-coded areas: key questions, pre-arrival instructions, and dispatch priorities, and they were distributed on for the good of dispatch. “We gave away the cards just so they [the public safety agencies] would do something about their dispatch,” Clawson said.

The doctor believed in the protocol system, and he wanted others to share in the success of a well-coordinated response team that included dispatchers as the “first, first responders” - a phrase he coined in 1981 for the first national meeting that included emergency medical dispatch (Source: Jim Page’s “EMD in the Fire Service: Born of Necessity)

What is Medical Priority Dispatch System? (MPDS)

The MPDS is in part based on published standards by the National Association of EMS Physicians (NAEMSP), the American Society for Testing and Materials (ASTM), the American College of Emergency Physicians (ACEP), the U.S. Department of Transportation (USDOT), the National Institutes of Health (NIH), the American Medical Association (AMA), and more than 20 years of research, development, and field testing throughout the world.

The protocol contains 34 Chief Complaint Protocols, Case Entry and Exit information, call termination scripts, and additional verbatim instruction protocols for AED support, cardiopulmonary resuscitation (CPR), childbirth assistance, tracheostomy airway and breathing, and the Heimlich maneuver. Special protocols for stroke identification, aspirin administration, pandemic flu triage, and lost person locating are coming out this year.

Course Outline

The 24-hour course teaches practical case review skills, the use of the NAED case review scoring standards, and an introduction to data analysis. Students learn how to identify appropriate Dispatch Life Support policies and how to use case review data to improve EMD performance. Each class includes time for questions, and the certification test is given at the conclusion of the classroom experience. Candidates must achieve a standard pass rate to qualify for certification. The case review elements are outlined below.

  • Case review scoring standards
  • Case Entry Protocol review
  • Chief Complaint Protocol review
  • Emotional Content and Cooperation Scoring
  • Key Questions review
  • Post-Dispatch Instructions review
  • Scoring of final coding
  • Live tape review
  • An “how to” on providing case review feedback

 

The Goal of Quality Management

To ensure that all employees understand policy, practice, procedures, and protocol. To ensure that all employees comply with policy, practice, procedure, and protocol. To determine if policy, practice, procedure, and protocol themselves are safe , efficient, and effective. The final goal is to fix what is missing (understanding, compliance, safety, efficiency, or effectiveness). Dispatching is not a job for just anyone. EMD’s must have the ability to handle complex situations at a rapid pace (multi-tasking) and have the ability to appropriately deal with human beings in great distress (empathize). Quality Management improves compliance.

How does your Emergency Communications Center rate your dispatchers?

  1. An average of 20 to 25 calls are randomly pulled weekly for grading
  2. Grading is done by window based software called AQUA
  3. Each dispatcher most achieve a compliance score of 96% per quarter
    Dispatchers are required to read the protocol as written, unless clarifying questions are added to help enhance the answer to questions.
  4. Dispatcher’s percentage points are deducted when they deviate from written protocols.

The ED-Q’s primary purpose is to objectively measure call takers performance through random case review in a consistent manner.