| Barry Furey |
Emergency
Medical Dispatch
| Barry Furey is the Executive Director of the Knox County (TN) Emergency Communications District. The current President of the Tennessee Chapter of APCO and a member of APCOís Fire-Rescue Services and Operating Procedures/Training Committees, he has been involved in public safety for 25 years and managed PSAPs in three states. Barry has been a frequent contributor to Firehouse magazine, Fire Engineering, Law & Order, APCO Bulletin, and other publications. |
This article can be found on
page 52 of the Mar/Apr 1997
issue of 9-1-1 Magazine.
When we look back on some of the more recent advancements in the delivery of pre-hospital care, the introduction of Emergency Medical Dispatch (EMD) protocols will have its place of honor. From the standpoint of both resource management and patient survivability, this cost effective tool has certainly made its mark. EMS itself, as we know it today, is certainly the new kid on the block. It wasn't all that long ago that the "grab 'em and slab 'em" mentality flourished, and a measurable number of ambulances were hearses, converted or otherwise, that were operated by funeral homes; a sadly ironic comment on the overall quality of care. The introduction of MAST trousers, paramedics in the field, a resurgence of fire service involvement in first response, and semi-automatic defibrillation devices have certainly saved their share of lives and have greatly enhanced the level of service. But for an investment of some forty hours worth of training and the appropriate supporting manuals, EMD protocols can be used to screen or assist every call received.
The reasons for using EMD are many. The most obvious is the benefit achieved through pre-arrival instructions, especially in life-threatening situations. There are numerous cases where a dispatcher has been able to successfully talk a caller through CPR, the Heimlich maneuver, or controlling severe bleeding on a patient. In the past, these individuals would have been on their own, and more than likely would have provided little or no assistance to the victim. The presence (or lack) of training on the caller's part is usually not an issue. A measurable amount of the emergency dispatch instructions provided by our center are given to someone who has had training, but has never had to use the skill, or has forgotten some of the basics. EMD is of benefit in reinforcing the proper steps to follow.
The use of EMD is also appropriate in terms of psychological first aid. Keeping the caller on the line and involved in the process provides an additional level of support, and the feeling that some form of help is being rendered. The time between the initial 9-1-1 call and the arrival of the first unit always seems like an eternity. No matter how short or long, the provision of EMD information during this time puts it to a most productive use.
Resource management is another reason behind the growth in acceptance of EMD. Ambulance providers must deal with a problem that law enforcement has long encountered; having more active incidents than units to respond. In these situations having approved protocols for prioritizing requests for service is a must. Clearly "first in/first out" will not do, especially when some cases may be clearly life threatening while others are not.
Along these same lines, the use of call screening and prioritization makes for a more cost efficient operation. Although this facet is often associated with the preponderance of private sector providers of EMS, there is benefit to the public sector as well. Take, for example, a situation where a community provides both Advanced Life Support and Basic Life Support services. It doesn't make any sense to commit your ALS resource to a call that, quite frankly, might have been handled by a taxi cab. If there is public ALS, but private BLS, the system may want to route lesser emergencies and transportation events to the private provider. On the other hand, if the entire system is privatized, the vendor may have time-sensitive performance obligations to the municipality. If this is the case, they are clearly going to want to manage their ALS responses accordingly.
Still another reason put forth for adapting EMD is community expectations. The public has become an increasingly educated and demanding consumer. Television shows highlight medical advice being given to callers, creating the assumption that this is universal. When it's not, all it usually takes is one or two visible incidents for public pressure to lobby for such service. I've heard many agencies say that their primary reason for instituting pre-arrival instructions was the perception of assumed level of care. The fear of a lawsuit for lack of providing a readily available enhancement became a motivating factor. In all fairness, I've known administrators who took the other side of the argument, citing fear of litigation and the inability to guarantee 24-hour staffing of trained personnel as the reason for not implementing. As a personal observation, people these days will readily sue for errors of commission as well as errors of omission; a polite way of saying that in our business you're damned if you do and damned if you don't. The final decision as to the provision of any service should be made on a careful analysis of all factors involved.
Providing EMD requires some commitment, and it may not be for everybody. Obviously, a standardized set of guidelines must be adopted, and there are several to chose from. Training, including recertification, must be given to a sufficient number of personnel to assure adequate staffing. Single seat facilities will have to weigh the effectiveness of EMD. The lone person on duty may be hard pressed to provide uninterrupted instructions while dispatching the ambulance, rescue squad, and answering other telephones. A local review of instructions by a medical body is also appropriate, as is the establishment of a quality assurance plan which provides for random review of call handling. If anything is worse than not having guidelines, it is having a false sense of security when your guidelines are in place, but are not being followed. Emergency Medical Dispatch protocols have a favorable record in court when properly administered. Random review protects both the patient and the PSAP.
As a final note, agencies will have to choose between using a flip card or computerized means of reference. While computers are obviously the long term technology trend, take a good hard look at how the EMD program interfaces with your CAD. See which method works best for you. In any event, keep a copy of the cards around for those times when your CAD is out of service. EMD is an effective tool. But, like any tool, it must be used properly and placed in the hands of trained personnel to be truly effective.
