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. 7. Quality Assurance, Risk Man­ Introduction Position Statements agement, and Medical Control and Medical Dispatching has been the last 1. The medical aspects of emer­ Direction are essential elements to the major area in the prehospital emer­ gency medical dispatching and com­ management of medical dispatch op­ gency medical services chain of care to munications are an integral part of the erations within the EMS system. be identified and developed. The responsibilities of the Medical Direc­ 8. Certification and authorization "health ·· of mam- EMS svstems can be tor of an EMS svstem. by government agencies in accordance gauged bv the appropriateness of train­ 2. Proven knowledge and skills in with standards promulgated by ing, protocols. and medical control and the area known as basic telecommuni­ NAEMSP in conjunction with other direction of dispatchers. The in\'OlYe­ cations are requisite for all public safety must be required. ment ofprehospital EMS physicians in telecommunicators. organizations the world of dispatch i s relativeh· new 3. Understanding the philosophy but unquestionablY essential. For this of medical interrogation and the psy­ Definitions the re­ reason, the l'\ati onal Association of EMS cholog\' of providing Pre-Arrival In­ Emergency Medical Dispatching: of requests Physicians has taken the following structions is integral to the training ception and management in an position relati\·e to EmergenC\· Medi­ and functioning of EMDs. for emergency medical assistance 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 dispatching must include the use of 6. Training as EMDs is required for tance from the public and/ or that dis­ predetermined questi ons. pre-arri\'al all dispatchers functioning in medical patches prehospital emergency medi­ telephone 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 understand 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 interventions. basic erner­ sary to provide this unique teaching tronic means with persons seeking gencv medical priorities 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 , uppon . ~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~•governmen- 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 men LS 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<lvice, and qual­ responder" care through the surrogate ity control through an official authori­ Vehicle R.esponse Configuration: the spe­ caller. Such skills have been shown to tative position within the prehospital cific set ofvehicle(s) in terms of types, help preserTe li\'es. pre,·ent further EMS svstem. capabilities, and numbers responding injuries. and e,·en assist 1,·ith the deli\·· as the direct result of actions taken bv erY of babies. ,\1edical Priority Di.ipatclt System: a medi­ the emergency medical dispatch svs­ Without these speciall\' trained. cally approved ~ys tcm used by' a medi­ tem. talented. dedicated. and skilled profes­ cal dispatch center to dispatch appro­ sionals. an EMS svstem cannot func­ priate aid LO medical emergencies, Vehide R.esponse Mode: the manner of tion optimally. Unfortunate ly. in most which include: I ) ~ystematized caller response used by the personnel and situa tions, persons performing the interrogation: 2) svste matized Pre­ vehicles dispatched which reflects the dispatch functions have had little more Arrival Instructio ns: and 3) protocols level of urgency ofa particular required training than the a\'erage layperson. which match I he dispatcher's evalu­ treatment or transport (e.g., use of Inadequate personnel and equipment ation of the inJun1 or illness type and emergency driving techniques such as may be dispatched for major problems sevcritv with velucle response mode red-lights-and-siren vs. routine driving). while too comprehensive a portion of ,md co11figura1ion . the system may be mobilized for minor Discussion problems. This latter circumstance may Pr,-.Amual lnstrortwm: telephone-ren­ The Emergency Medical Dispatcher result in depriving o thers in need of dered, medicallv Jpproved, written (EMD) is the principal link between the committed services to be deprived ins1rucuor1) giw11 hv trained EMDs the public in need of emergency medi­ of them. Any break in these important thro u){h ,alkr, wluch hdp 10 provide cal assistance and the EMS system. As functions result in failure of the entire .ud to 1lw vit 11111 .lll<l < 0111rol of the such, the DID plays a kev ro le in the EYIS svstem. An EMS wstem o nlv can ,1111a11011 pr 1111 to .11111.d of preho)pt1al Jbilitv of the E~IS :.vstem to respond to he as good as its DID;. ' fWt ~t)llllt'I a perceived medical emergenc\'. \lost Si nee emergen c~· mec~ical dispatch­ often ..111 of the information obtained ing is ke\' to the:! succe,sf11l opl'ration of /)/\p1111h I ,f,. ~uppmt tlw i...nowkdge. i) through telephone communications ,uw pn :ho,pital E~ IS ~,·stem . 1he poli­ pt oet:·d111 c·, . .111<1 ,kill, uwcl bv trained with a caller who often 1:. di~tres~ect and cies a nd procedure~ 11tili,ed bl' 1rained FMD, 111 pt m 1di11 1.\ 1.11 t' through t> re­ o ut of concrol. The EMD must h avt· EMDs must conform 10 11 ,11io 11al ~tan· \J n, ,\I I thlf11c11011, II> 1 .1llen It con­ , J...ill s \\ hich .1llm, him, hc::r 10 match dards ,rnd loc,d c 1pahdi1ie,. fhe his- ' ''" 111 thc"c· IU1, .ind AL', pnnctplc, chc personnel and cqu1pmc::n t di,­ 1orv 01>1ain1•d lw 1clcplw nc and ho th IO h, 1h.11 ,II<' .1pprupn,ll<' .1pphra11on p;uched 10 the:: pcrcc::1vc::d c: me1 ~enc\' lh c:: medical r an· dinatc cl bv 1hc EMO o•p11lll and Dl'lUt.-r M.-dicint' Pr.-h Vol.