Emergency Medical Dispatch (EMD) involves a systematic medical program that handles medical calls at the first point of contact for individuals who may need emergency services. The trained telecommunication professionals utilize locally approved EMD Guide cards to rapidly and appropriately respond to the calls. Meanwhile, as the callers wait for the emergency medical services (EMS) response unit to arrive, they can be offered instructions to help treat the patient. A comprehensive EMD program greatly reduces agency liability through the provision of consistent dispatch instructions, which can help meet the growing public expectation for distress calls to 911 (The IAED Journal, 2018). The literature review on the benefits of implementing an EMD in my agency, with a selection of an EMD program, will help analyze the key areas of the program including, call triage, dispatch of appropriate materials, medical director involvement, quality assurance, and training and continuing education.
EMD systems strive to match response resources with emergency patient needs. Despite the varied EMD systems across healthcare systems, there is no consensus on the optimal organization and operation of an EMD service. However, EMS calls are fundamentally handled by an emergency medical communication center (EMCC), which assesses the nature of the call to determine the priority level to respond appropriately ( Clawson, 2015 ). The EMCC comprise of some trained personal in firefighters, and paramedics including nurses and doctors who carry out the EMD services per the Criteria-based dispatch (CBD) and Medical Priority Dispatch Systems (MPDS) as the fundamental predefined framework guiding their operations ( Bohm, & Kurland, 2018 ). In this regard, as a member of the paramedic team in the National Public Safety Telecommunications Council (NPSTC), I would provide the most current, best practice recommendations to enhance the benefits of EMS to patient care as below.
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Training and Continuing Education
According to Ageron et al. (2016), EMD’s should possess a unique set of duties and responsibilities that are significantly different from other field EMS providers. As a basic requirement for partial paramedic training, there is a possibility for the in-house program to lack consistency and appropriateness ( Andersen et al., 2013 ). Therefore, specific departments still require specialized training for their dispatchers. For an effective MPDS protocol utilization, the dispatchers require a competent, effective, and safe understanding of the specific underlying philosophy to receive specialized training ( Clawson, 2019 ). Confer & Fame (2000), highlights the four basic components needed by students to understand the MPDS protocol, including determining the case entry, key questions, post-Dispatch and Pre-arrival instructions, and Response Determinants, which form the four commandments of interrogation elements to enhance obtaining and relaying of the responses on each particular calls. Continuous learning enhances the ability to understand non-lights-and-non-siren response concepts to differentiate them with dire emergencies ( Ageron et al., 2016 ).
Call Triage Tools
Andersen et al. (2013) raises concerns about getting alternatives to the traditional 911 services, the emphasis is that the alternatives complicate the appropriate dispatch process, requiring a high level of reproducibility of the triage, and increased effects to coordinated access to the health care services. A good EMD program should reduce agency liability by providing thorough and consistent dispatch instructions that help meet the growing demand when individuals call the 911, and appropriate medical care offered to them as quickly as possible ( Bohm, & Kurland, 2018 ). However, many health care providers are already using a range of alternatives to the traditional 911. There is a possibility that they can deny claims when inappropriate services were provided ( Clawson, 2015 ). Confer, & Fame (2000) insists that 911 dispatchers are effective in triaging calls into the required medical emergencies and non-emergencies calls effectively handed off to the respective modes of healthcare.
Medical Director Involvement (MDI)
The role of MDI is to oversee and reaffirm the commitment to support varied principles involved in the EMD program. The IAED Journal (2018) posits that MDs should be conversant and familiar with the aspects of the EMS system to relate patient safety and specific outcomes. They should pose as leaders in the EMS system and serve with ultimate clinical authority, to guide the system on evidence-supported clinical practice and outcome ( Clawson, 2019 ). Further, they need to oversee the provision of education, protocols, training, testing, certification, advice, and quality control standards within the EMS system.
Dispatch of Appropriate Resources
In this regard, Dispatch prioritization is an essential element in the EMS system that requires e careful attention. Ageron et al., (2016) states that there should be an appropriate response in terms of the personnel, mode of response—whether there is a need for red-light-and-siren or simply routine and response configuration—the mode of vehicle responses involved. Critical dispatch decisions therefore, protect victims of illness or injuries, preventing them from unnecessary risks and significant liabilities because of following essential procedures, policies, and protocols ( Bohm, & Kurland, 2018 ).
Quality Assurance (QA)
Any EMS system should essentially integrate QA and risk management for the success of an EMS system. According to Clawson (2015), there should be routine medical reviews, and the entire activities of the EMS are vital for the well-being of the EMS system. Besides, the QA should be an ongoing process that reviews the medical issues, patient care, and operations to set standards and monitor the performance.
References
Ageron, F. X., Debaty, G., Gayet-Ageron, A., Belle, L., Gaillard, A., Monnet, M. F., ... & Savary, D. (2016). Impact of an emergency medical dispatch system on survival from out-of-hospital cardiac arrest: a population-based study. Scandinavian journal of trauma, resuscitation and emergency medicine , 24 (1), 53.
Andersen, M. S., Johnsen, S. P., Sørensen, J. N., Jepsen, S. B., Hansen, J. B., & Christensen, E. F. (2013). Implementing a nationwide criteria-based emergency medical dispatch system: a register-based follow-up study. Scandinavian journal of trauma, resuscitation and emergency medicine , 21 (1), 53.
Bohm, K., & Kurland, L. (2018). The accuracy of medical dispatch-a systematic review. Scandinavian journal of trauma, resuscitation and emergency medicine , 26 (1), 94.
Clawson, J. (2015). The Description of Hierarchy Bias Concept in Emergency Dispatch Coding and its Implications for Accuracy in Response and Outcome-based Studies Jeff Clawson, MD1; Rich Saalsaa1; Christopher Olola, PhD1; Jerry Overton, MPA1. Annals of Emergency Dispatch and Response , 3 (2), 38-43.
Clawson, Jeff J. "Emergency medical dispatching." Prehospital and disaster medicine 4, no. 2 (2019): 163-166.
Confer, P. A., & Fame, T. G. (2000). HOPE COLLEGE news from.
The IAED Journal. (2018). Retrieved 10 December 2019, from https://iaedjournal.org/everyone-benefits/
