Emergency Medical Dispatching
WE BELIEVE
Position Paper:
Emergency Medical Dispatching
National Association of Emergency Medical Services Physicians
The Following document expresses the Positions developed by the membership of the National Association of EMS Physicians (NAEMSP) . This Position is based on the Consensus Document for Emergen.::y Medical Dispatching, on file at the NAEMSP office.
Introduction Position Statements 7. Quality Assurance, Risk Man Medical Dispatching has been the last 1. The medical aspects of emer agement, and Medical Control and major area in the prehospital emer gency medical dispatching and com Direction are essential elements to the gency medical services chain of care to munications are an integral part of the management of medical dispatch op be identified and developed. The responsibilities of the Medical Direc erations within the EMS system. "health ·· of mam- EMS svstems can be tor of an EMS svstem. 8. Certification and authorization gauged bv the appropriateness of train 2. Proven knowledge and skills in by government agencies in accordance ing, protocols. and medical control and the area known as basic telecommuni with standards promulgated by direction of dispatchers. The in\'OlYe cations are requisite for all public safety NAEMSP in conjunction with other ment ofprehospital EMS physicians in telecommunicators. organizations must be required. the world of dispatch i s relativeh· new 3. Understanding the philosophy but unquestionablY essential. For this of medical interrogation and the psy Definitions reason, the l'\ati onal Association of EMS cholog\' of providing Pre-Arrival In Emergency Medical Dispatching: the re Physicians has taken the following structions is integral to the training ception and management of requests position relati\·e to EmergenC\· Medi and functioning of EMDs. for emergency medical assistance in an cal Dispatching. 4. Pre-arrival instructions are a EMS system. mandaton· function of each EMD in a Position medical dispatch center. Emergency Medical Dispatcher (EMD): a The trained Emergenc\· Medical Dis 5. Dispatch prioritization is an es specially trained public safety telecom patcher (EMO) is an essential part ofa sential element in any EMS system for municator with the specific emergency prehospital EMS svstem. Medical di it establishes the appropriate level of medical knowledge essential for the rection and control for the EMD and care including the urgency and type of appropriate and efficient functioning the dispatch center also constitutes part response. Standard medically approved of emergency medical dispatching. of the prescribed responsibilities of the telephone instructions by trained EMDs Medical Director of the EMS svstem. are safe to give and in manv instances Medical Dispatch Center: any agency that The functions o f eme rgency medical are a moral necessi tv. routinely accepts calls for EMD assis dispa tching must include the use of 6. Training as EMDs is required for tance from the public and/ or that dis predetermine d questi ons. pre-arri\'al all dispatchers functioning in medical patches prehospital emergency medi teleph one instructions. and pre-as dispatch agencies and requires un cal personnel pursuant to such requests. signed response: levels and modes. The precedented cooperation between the EMO must und erstand the philosophy diverse disciplines of telecommunica Public Safety Tel.ecommunicator: an indi and psvchology of interrogation and tions and emergency medicine neces vidual trained to communicate by elec telephone interventi ons. basic erner sary to provide this unique teaching tronic means with persons seeking gencv medical prioriti es and interYen forum. This training includes content emergency assistance and with agen tio ns. and be expert in dispatch life and results in competence which differ cies and individuals providing such , uppo n . ~linimum training levels must substantially from that standardly pro assistance. he establi shed, standardized. and all vided for EMTs and paramedics. It must EMDs must be certified b~•go vernmen- be tauglu by specially-trained instruc Basic Telecommunications Skills: the 1al authorit, . tors. generic body of knowledge and skills
C:onse11>th P.1nel Ch.m<'cl .rnd ( ,011s,·11s11, Dorn me LS n and Posiuon Paper wriuen by Jeff J. Clawson, MD, Salt Lake Cit)' and Salt Lake Count\' Fire Dept. October-December, 1989 Prehospital and Disaster Medicine We Believe / Dispatching 164
Thus, the EMD must be able to discern necessary to function as a Public Safety medical dispatchers. the nature and the urgency o f the Telecommunicator whether perform illness(es) and/ or injury(ies) in a ing specifically in the role of medical, Quality Assurance: the comprehensive manner which allows selection of 1he fire, law enforcement, aeromedical, program of setting standards and response configu: ,I· park senice dispatcher, or in any monitoring the performance of the most appropriate combination of these roles. clinical. o perational, and personnel tion and mode. components of the medical dispatch Therefore. the E~ID must possess spe· ,'vledicalDirection:"'the management and center in relation to these accepted cial knowledge and a set of medic d accountability for die medical care standards. and technological skills which ,tre aspects ofan EMD program including: unique for the EMS system. They net·d l ) the direction and oversight of the Risk Management: a sub-component of to know sufficient medical knowled\{e training of the EYID; 2) development the Quality Assurance program de in lay terminology to acquire an app1 ,,... and monitoring ofboth the o perational signed to identify problematic situ priate medical history and be cogni and the emergency medical priority ations and to assist EMS Medical Direc zant of all of the characteristics inher• dispatch protocol systems; 3) participa tors, dispatch supervisors, and EMDs ent within the E:VIS system in which tion in EMD system evaluation; and 4) in modifying practice behaviors found the\· function. Furthermore, recent directing the medical care rendered by to be deficient by quality assessment studies indicate that EY!Ds may play an the EMDs. procedures; to protect the public \'ery important role in the pro,~sion of against incompetent practitioners; and instructio ns by which a caller may iniu ,'vledical Control:* the EMS physician (s) to modify structural, resource, and ate appropriate treatment and life responsible for the provision of educa protocol deficiencies that may exist in support prior to the arri\'al ofanvofthe tion, training1 protoco ls, critiques, the emergency medical dispatch sys EYIS responding \·ehicles and person leadership, testing, certification, decer tem. nel. The capable EYID provides "first tification, standards, a
o•p11lll and Dl'lUt.-r M.-dicint' Pr.-h Vol. 4, No. 2 NAEMSP 165 a n d thl' re !->.pon , l'' initia te d a re f11n r - tia l re sp o n sib ilities d e lega te d to the ful a tte ntio n by b o th the EMO, h is or 1iun, (>I thl' 1,·1w and len·l of m e dical E MD b,· the \iledical Director a nd the h er supe rvisor , and the EMS physician l ,ll l' pm , ib k h 0111 tht· ,pec ili c [ \IS \lledica l Dispatch Center. Each of the se r esp o n sible for med.ical control. These ' "-ll'l11 . Thl' cp1a li1 \'!>f a ll o f the m edica l ste p s re quires sp ec ia l training a nd the p rio rities must reflect the level of ap t ,11 l' ckiin ·rl'cl h, a s,·ste m i, t li e re sµ on de\'elo pme nt o f diffe r e nt skills. This pro pria te r e sp o n se includin g cypes of ,ihi 111 , of lhl' m edical director of that knowle d Rc and sp ecia l se t o f skills are p ersonne l (ALS vs. BLS vs. fi rst re prehmµi tal s,·,1t·m. Therefore . a ll of 11 0 1 pan o f tht' standardized EMT or sp ond e r ) . resp o n se configur a tio n thl' p1Jli cil', a n d pruet·dures used h, parame dic curr ic ula. Each is spe cific to (numbers and cypes ofv ehicles respo nd thl' \kdiLa l Di,patch Ce nte r in te nm m edical disp a tc h tra inin g . ing) , a nd m o de ofrespo n se (red-lights uf medical ea rl' re ndered art· part o f Since the ,·alue o fE\1!0s provid ing a nd-siren vs. routine) . H a phazard or 1he respnn,ihilitie s of th e \ile dica l P re-Arri\·a l Instruc tio n s to calle rs in arbitrary d ispatch decisio n s h ave be e n Director a nd hen ce. must he a pprm ·e ct a n e nda n ce " 'ith victims of cardio pul sho wn to place victims of seriou s illness b, tlw \ k ct ical Dirt·ctor o f the s,·stem. mon a r\' a rrest was first d e m o n strated o r injury a t unnecessary risk a n d have Ke, 10 thl' \le dical Direc tor·~ role in 1-1 ,·ea rs ago. Pre-Arri\·al Instructions resulte d in significant liability to sys the m a n age m ent o f m e dical disp a tch h a,·e b eco m e a manda to rv functio n of te m s lacking these essential protocols, center, i, hi~ or h e r d e ta iled 11n d e r the E \ID. In essence, the EMO is the p rocedures, and p o licies. , tanding of the con cept~ o f E\ID a nd first "first-respo nder·· and throug h With the use o f unifie d , standard it, ph,,ica l ope ra tio n . in\'Cih·e m e nt in imme dia te actio n effective I\' can elimi pro toco ls. the eme rgency m edical dis a ll a, pect, o f qua lit, assura n ce o f nate the o ft e n d eadly gaps whic h m a\' patche r 's conduct will be less vulner medical di, patc h . and m e dical d irec o crnr h e twet:n receipt o f the call a nd able to c harg es of care less or reckless tion a nd ;H co untabilit, fo r the p roto the beg inning of treatme nt which is judgm e nt. Fo r example , with o u t a cok po licin. and procedu re~ re le \'an t dela1 ed until a fte r th e arri\'a l o f the unified svste m of standa rd p rotocols. to the med ical d i,pa tc h a cti,·itie , ofthl' respondin g \'ehicles and personne l. o n e d isp a tc her m ay d ecid e that a cru E\10. In , um man . thC' m e dical a,pi:ct, Fi r~t res pom t· con sists of te le pho n e cial situation exists p r imarily on the of e m erg e 11 n · medical dispatching and in~m ,ction s pro\'ide cl b,· traine d EMDs basis o f the level o f e m otion h e / sh e cu mmunica u o n , are a n in tegral p a rt functio n ing from standard. m e dicall~ d e tects in the calle r 's voice. while a n uf the rt.•,p1J n ,ibilitie, o f the \le d ir al a p p ron·d protocols. Su ch instructio n s o ther m av d e pend o n h is or h er own Director o f ea c h E\I~ ,,,te rn . art , a lt' and. in mam · instances. are a "gut" reactio n without be ing able to C.t:rtain ,kill, an· cc,111111 0 11 1<1 all m o ral n ece~sitY. T he telepho ne instruc articula te a cle ar re aso n for a decision . publi l , afe t, commu nica to r , . Thnl' u u n , are g i,·e n throug h the call e r to A unified procedure prO\i cles an excel 1nclud" the tht:on a n d operation of h e lp another person o r th e caller pro le nt m e thod of s afegu a rding against co m plex com m11 11i catio11 eq1iipmen h . te ct the \'i ctim (sl fro m furthe r h a rm or arbitrar, decision-making . Similarly, 11nuhlt ·.,h o u tin g thl' ,arm · . .1 11 cl ba,i< i11jun·. tu initiate life-impacting treat- EMS e mployers can po int to su ch guide 1a d ro a nd te lephrnw com1111111i t atillll 111e nh. and to tran sform an undirec ted lin es a~ a svstem o frisk m anage m e nt in , kill-. '-,1: n o u , liahilit, !0 1 di~pa1ch ca ller into a calmer scene "rescuer" an area in which human error a n d its (t'lllt'I' ((lfnn10 11h , e ,ul!, cllJl• Ill till' who n o lo 11 ger ne e d s 10 be h e lp less. d ire conseq u e n ces clearly are foresee l,ll l.. nl tl H''-t' t'"-t'llt1.tl ,l.. ill,. T h<' 1r; 1111 - T raining. certification. and recertifica- able. T h e a ppropr ia te p rioritization o f 111g ,111d t 1·11i li<, 1t io11 t1I th<' I· \II) i, 11 0 11 in D1:.pa1c h Life Suppo rt (D LS). the typ e. number. a nd manne r of r e h111 1! 11 pn 11 tl11, li,1" ·1111 ,· of l..11111'1l·dg,· "hicl1 i11 t lude, that po rtio n of BLS spo nses is e ssen tia l t o e ffect a n ap pro .wd,l..ilk1, l1J( li 1,g,·1H·11c l01 pt·1l n 1111- .1pprnpr ia1e to a p plicatio n bv m e dical pria te reduc tio n of respo n ding ve h icles 111g 111 till· rllk ,ii nlt'd1cd. li1t·. l.1" cl ispatcl1t'r, i, n ecessan to m aintain travelin g red-lig hts-and-siren. a n d <· 11l or I t'lllt'lll. ., ~·, u 111<•d1 c .ti . p.11 k ,en- .md r ontin ualh uµgrad e 1his unique. the refore u nnecessary vehicle a cci 1c t· d 1,p.11 1 lll'1 . ( /1 .1111 tn11 1b 111.1t io11 o l a 11 cl ..111i111 e:.. life-sa,ing. non-visual skill. den ts. This will assure that e m e rgen n · crews will n o t be committed inapp ro th,·" · \I ' )\ I(,., 1-frnr e . it i, e:,:.em ia l th a t E MDs uncle r I ti,· .1hd 11 , 1u lll l<' rac t "'ith a 11:-. - , 1a11cl the philn:.ophv o f med ical inter pria te !\' to n o n-e m ergen cv cases. an d 111 11 , 1111( ttt>pt•J .Ill\(' , .11 1d . . II llllH',. ' og.111 0 11a 11 d tht: p~1 ch u logYassocia ted th a t th e rig h t care will be sen t i n the l11,1 , 11, .ti, .ill1·1, 1, ·,ts 011 tht• .1hil111 nl ,, 11 It I he pr111·i~ion of Pre-Ar rival I 11- ri):{h l wa\' to the right pa tient a t th e ti" I \I I 1 ,,. 111IH 1p. 11 ,· tl1< .ll 111111, nt ,11 11, 111111, T hi, l..111l1,ledge a nd the 1ig h 1 11 m e . T he n ecessi t\' to priori 111e rt: ti,, IJl)dll t, II ti I .tilt-, ·'"''I thl' l .illt-1 ,h,l>< 1.11ecl ,1..tl l, 11111,1 bt: inte gra l pares 111 J t L: ,llllllli.: t Ollll Ill. .111d 111 <'11 t tllll<'I I ol tlw 11 .1111111 g . directio n , and m an agt:· ~po n , t:s is e\'ide nt in the m,uorn, o f tl1,· , .illt·1 11111,.11 ,tl111c1 li1 ,11t·,po11Clc1 1111·111 of E\ 11 h .111d ,1111 \ledica l Di, EMS svstems today. In o rd e r tn prio ri h · ' 'I)('( 1.tl (1111 f ,I\ h ,, .Ill\' "( 111).tl ,1 ,·p p.11, Ii ( t' nlt'l . tize calb properly. th e EMO m ust be 1 Ill IIH p 1•tlt1llll.llll (' t1I 1h1 I'' l'\l 11h,·d !)"pate h l 11nritit a t1 0 11 i~ an esse11- we ll-\'e rsecl in th e med ical conditi o ns d 11 1tt·, .111 d t (11111 " ""''' 1(1 11!,· ,11 1>,1.111 11.tl clt·n1 t·n1 Ill E\ IS a nd requires care- a n d in ciden t tvpes tha t con sti tute the ir
Oc111lwr-01·r rmbrr. l 9H9 Prehospital and Disaster Medicine 166 We Believe / Dispatching
daily routine. Training in these priori patch priorities. All instructors should the delivery of prehospital emergency ties must be detailed and dispatch have successfully completed a credible medical services by responsible go1· specific (not EMT or paramedic train EMO course prior to assuming a teach ernmental agencies, and by the public ing per se). The development of dis ing role. Essentially, training of EMOs in general, is important for the public patch priorities for an agency or local is required for all dispatchers function health and protection. Without such ity must be carefully thought out and ing in medical dispatch agencies, and recognition and action, it is unlikel1 ultimately approved by those physicians contains significant content and com that the training of these imponam responsible for medical control. petence which differs substantially from professionals will be mandated. An ever• Since, much of the knowledge and that standardly provided to EMTs and increasing number of states, regiom. many of the skills required by the EMO paramedics. counties, and municipalities certifv ur are dispatch-specific, a curriculum for Quality assurance, risk manage at least require standard training ot their training differs substantially from ment, and medical direction and con EMOs. This constitutes an essential pre those used in the preparation ofEMTs trol are essential elements for the requisite to the practice by E:vtD\. or paramedics. Training as an EMT or ongoing well-being of any EMS system. Minimum standards must be developed paramedic does not adequately pre Routine medical reviews of the activi and promulgated for the training. pare a person for the role of an EMO. ties of EMOs and medical dispatch certification, and or licensure o f all Much of the required EMO curriculum centers in general is vital to the health public safety telecommunicators, spe cannot be found in standard EMS train of all EMS systems. Dispatch review cifically Emergency Medical Dispatch ing curricula. It consists of content and committees constitute one method of ers. emphasis which differ significantly from providing quality assurance for EMO that used for the training of all other activities and the medical aspects of the Conclusion health professionals and public safety operation of a medical dispatch cen In order to assure the professionalism dispatchers. The unique teaching fo ter. Such committees should be com of this key aspect of pre hospital emer rum necessary to provide this essential posed of prehospital EMS physicians gency medical care, EMS physician~ training requires unprecedented co and those responsible for the provision should participate actively in the devel operation between the diverse disci of medical control, dispatch supervi opment, training, qualirv assurance. pline~ of telecommunications and sion and management personnel, EMTs medical control and direction ofEMOs prehospiwl and emergency medicine. and/ or paramedics, and EMOs. Eac h and medical dispatch centers. The lnstruc1or requirements sho uld include must be familiar with all aspects of EMS Emergency Medical Dispatcher pro line dbpatch experience as a trained communications, specifically the medi vides an all-important professional link EM O fo r the Primary Dispatch Instruc cal dispatch process, and must be in in the overall EMS chain of care and tor and a minimum of advanced life volved in an ongoing way with its func survival. , upporc 1raining and experience for tion relative to medical issues, opera the Medical Dispatch Instruccor who is tions, and patient care. * Relates specifically to Emergency Medical role Dispatch 1 esponsible for teaching the core course Recognition of the important materials. specifically the medical dis- of emergency medical dispatchers in
Vol. 4, No. 2 Prebospital and Disaster Medicine