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Contents The International Standard ..... 1.2 Impact on Quality Patient Care ...................... 1.3 Impact on the EMD ............ 1.3 Impact on Prehospital Providers .................. 1.6 Impact on Equipment.......... 1.8 Impact on the Community at Large ................... 1.8 Profile of EMD Duties . 1.9 Misconceptions and the Facts about EMD........... 1.10 Medical Control and the EMD . 1.20 The Spock Principle .......... 1.21 Traditional Roadblocks to Change ................ 1.21 The EMD as a Medical Professional .............. 1.22 Summary: A New Era in EMS . 1.25 CHAPTER 1 The First, First Responder Chapter Overview This chapter lays the groundwork for understanding the complex role of the Emergency Medical Dispatcher (EMD) as the “first, first responder.” EMDs have the potential to make the difference, literally, between life and death, through proper application of the principles described in this book. The EMD’s specialized skills and equipment can minimize the risks faced by field personnel and enhance the quality of patient care. This chapter describes the many purposes of Emergency Medical Dispatch. It includes the broader historical and anecdotal perspective and research collected since this book’s first edition. It also summarizes the reasons the EMD system has become the national standard for Emergency Medical Dispatchers. Emergency Medical Dispatch is the jewel upon which the watch movement of public safety turns. —F. Hurtado 1.2 THE FIRST, FIRST RESPONDER CHAPTER 1 he team approach to emergency medicine is well information comes through it. Priority dispatch pro- established. As patients traverse the medical sys- vides the capability to focus clearly on each situation, Ttem, they generally encounter prehospital life sup- eliminating inconsistency and vagueness through its port providers—first basic, then advanced. Then come standard, precise approach to each call. the healthcare providers in the emergency department, followed typically by in-hospital personnel. Within the The calltaker has the ability to have a profound effect process, however, there is one group of people well on all patients. This is why dispatch is the hub of the insulated from the sights, sounds, and activities of EMS circle of care. The chance to give CPR (cardiopul- hands-on emergency assistance: the dispatchers. Because monary resuscitation), deliver a baby, or use an auto- of their isolation, they have not traditionally been matic defibrillator happens on a case-by-case basis for regarded as members of the emergency medical team. field crews, but these situations may be happening all at once for the EMD. Thus the EMD has an impact When emergency medical services (EMS) were modern- on 100 percent of emergency medical calls. A system ized, beginning in the late 1960s, development of the that promotes EMD excellence—focusing the EMD’s people in the alarm office or radio room, as it was efforts and talents on customer service to the caller, called, was overlooked. If anything, these people were patient care to the victim, and on the rational, maligned and misunderstood. Fortunately, the inter- informed dispatching of EMS responders—improves vening years have been kinder. Increasingly, Emergen- the quality of service to the entire community. cy Medical Dispatchers (EMDs) are recognized as the spearhead of the emergency medical services team.1 Numerous factors identify the EMD and priority dis- EMDs know what to do and how to help in their own patch as the international standard of care. Since their special way. Instead of being the weak link in the initial development in 1976, the concepts described in chain of medical care (the historical perception), they this book have been refined and disseminated to thou- are increasingly the hub of a worthwhile community sands of municipalities throughout every U.S. state and service.2 Canadian province, all ambulance trusts in the United Kingdom, and 19 other countries. As cases of successful The purposes of Emergency Medical Dispatch (EMD) are telephone instruction have been increasingly reported numerous and impact many aspects of emergency in the media, public expectations have changed. medical care.3, 4 A properly train ed EMD utilizing a fully implemented Industry use of Medical Priority Dispatch EMD tends to fol- Educating EMDs can save Properly trained EMDs SystemTM (MPDS®) has a low a generally emergency agencies money, can positively influence significant and posi- accepted format. resour ces, and time. It can all aspects of EMS. tive influence in the Position papers even save lives. following areas: from influential organizations (see references) and other supportive documentation of the principles of EMD have solidified its place in the evolu- tion of EMS. Administrative rules and regulations con- providers cerning dispatch roles and procedures have been bolstered, in many places, by legislation. Finally, certain cases have been brought to the judicial system for reso- lution, and legal outcomes have universally supported proper implementation of a priority dispatch system. It is a human characteristic to resist change. But dis- patchers with no previous medical training can cer- tainly learn to make informed decisions using priority The International Standard dispatch when properly trained. Before the advent of Emergency Medical Dispatch and the Medical Priority Dispatch System (together known The EMD is the sole authority over an emergency as priority dispatch), much of the information gathered scene until the first responding crew can make initial by dispatchers was unclear, incomplete, or distorted. A assessments and establish scene control. (In essence, critical purpose of priority dispatch is to create for the the “scene commander” until someone physically EMS system the same benefit that a lens creates for a reaches the scene.) Until that moment, the EMD camera. Priority dispatch is the lens of EMS. All initial knows more about the scene than anyone else in the CHAPTER 1 THE FIRST, FIRST RESPONDER 1.3 ! Authors’ Note An excellent average response time, once wheels are rolling to the address, would range from five to ten Since the methodology of EMD minutes. Then, additional time (average 1½ minutes) became accepted as the U.S. ticks by while crews leave the emergency vehicle and national standard of dispatch care make actual contact with the patient (see fig. 1-1). and practice, EMS systems that have lagged behind appear to be in Thus, the best to-the-patient time often exceeds eight mounting jeopardy, a trend being minutes, during which time the patient may not be copied internationally. The success receiving any care. of EMD as the standard of care in the U.S., Canada, the U.K., Austria, Italy, A properly-trained EMD can effectively eliminate this and Switzerland has prompted other time gap for many situations. Willing bystanders can countries to adopt EMD, to the point provide first aid via telephone instructions. In fact, that the science of EMD is now callers increasingly expect to be coached in this way.170 generally accepted as the international If oxygenated blood can be pumped to a clinically dead standard of care and practice. brain within one minute due to the combined efforts of an EMD and the people at the scene, this response is obviously better than waiting seven—and sometimes emergency care pipeline. Through telephone inter- ten or more—minutes for trained people to arrive at rogation, the EMD can continually access patient the patient’s side. This concept, trademarked as the i n f o r m a t i o n . Zero-Minute Response, is changing the complexion of This information emergency care. EMS and public safety is then used to Impact on quality patient care also stems from sending systems place themselves at select the appro- the appropriate EMS response. A prime objective of risk if they fail to appropriately priate response priority dispatch is to send the right resources to each develop and support their for each call. call. The positive impact on patients is obvious when communication specialists. Unsafe situations an EMD can differentiate minor from possibly severe can be identified situations. Someone with a cardiac emergency receives and relayed almost instantly to responding crews. Advanced Life Support (ALS) help, and someone with a Additionally, the EMD can provide directions to the cut finger receives a perfectly suitable Basic Life Support caller about what to do, or what not to do, on the (BLS) provider. Or, in a differently designed EMS sys- patient’s behalf. tem, the whole volunteer squad is toned out for a All these actions can help avert unnecessary tragedy. three-car crash with multiple injuries—but only the EMS and public safety systems place themselves at risk two volunteers on first call need to drop everything to if they fail to appropriately develop and support their respond to a single-car accident with minor injuries. communication specialists. Appropriate resource allocation depends on a proper interrogation-based evaluation, which depends on knowing the necessary questions to ask. Impact on Quality Patient Care The welfare of the patient is of primary importance to the EMS system. The mission of EMS is to help others, Impact on the EMD not just to save lives. One of the finest examples of how Historically, many public safety administrators EMD benefits each patient is the concept of Zero- believed all it took to be a dispatcher was the ability to Minute Response™. push buttons and talk on the phone; anybody (liter- ally) could do it. The dispatch office and those stuck Much attention has been placed on the importance of there were not well-respected. quick response times by emergency medical crews. Peo- EMD education has now given dispatchers a new lease ple in life-threatening circumstances need immediate 2, 7 help. Yet a certain amount of response time always on their professional life. A cycle of improved pride exists.

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