The Continuing Need for the Validation of Priority Dispatching

Although it is a standard that a majority of communities take for granted, the concept of Emergency Medical Dispatch (EMD) is still in question in many places throughout the United States. In February 1968, the first emergency call to 9-1-1 was placed in Haleyville Alabama.[1] Since the late 1970’s the concept of EMD has grown from a flip chart system into an integrated module within Computer Aided Dispatch (CAD) systems to provide a more streamlined process for telecommunicators. Contained within this new and more complete approach are the fundamental concepts of EMD that include medical information gathering, pre-arrival instructions, priority dispatching, and quality improvement. Dr. Jeff Clawson, an innovator of training programs for EMD elaborates upon the primary tasks necessary for the telecommunicator in a comprehensive EMD program. One of those tasks is the “identification of the proper response configuration and mode.”[2] The public generally buys into all constituent parts, however some emergency responders have difficulty with accepting the practice of priority dispatching. These difficulties are often problematic and may prevent the execution of good policy that is intended to benefit the general public.

Priority Dispatching

This element of the EMD system focuses on identifying the needs of the incident, identifying the type of equipment required for incident, and to ensure the response of appropriate resources in an appropriate manner. Under this format, the dispatcher is better able to identify the units and manpower necessary for the incident. In comparison to older, more antiquated systems, the typical response of resources is decreased, reserving those resources for other calls. Additionally, some emergency calls may be handled without lights and sirens. This reduces the overall liability of the agencies responding and enhances the safety of the public. It is not necessary to respond all units with lights and sirens.

The priority dispatching system helps to ensure that there are decreased response times and a greater number of units available in the event of a more severe emergency. An early study upon the effects of the utilization of such a system demonstrated that dispatchers utilizing priority dispatching shortened the “average response times from 14.2 minutes to 10.4 minutes for 30% of patients deemed most urgent.”[3] The implementation of EMD, has demonstrated the ability to rapidly improve the efficiency of the EMS system; this is especially true in areas with limited resources. W. Ann Maggiore who has experience as both a paramedic and attorney explains: “priority dispatching is now, without question, the standard of care for EMS agencies nationwide.”[4] Hindrance of this process results in a decrease of a standard of care and overall liability.

Responder Apprehension

But some people may ask: “Why would any area EMD system be prevented from establishment?” Dorothea St. John of the Alexandria, Virginia Fire Department in Fire Chief Magazine explains that there are several reasons for the rejection of a priority dispatch, EMD system:

By dispatching for and responding maximally to all requests, run volume increases. This is seen as desirable for many reasons:

  • Increased visibility for the agency (theoretically good public relations)
  • Possible increased justification for additional personnel and vehicles (and everything that goes with them-training personnel, supplies, facilities)
  • Increased productivity of present personnel (translated from less idle time)[5]

None of these justifications is to provide good, quality and rapid patient care, but this should be the primary consideration of the communications center when performing EMD. Despite some continuing apprehension from the responder, all agencies should understand that the telecommunicator is the Incident Commander and is responsible for the management of an incident until an emergency responder unit arrives on scene. This is because the telecommunicator is the only responder able to obtain information about the incident prior to an emergency responder taking on the responsibilities of scene management; the telecommunicator must act on this information to the best of his/her ability and make appropriate determinations for the patient. Interference with this process stalls emergency response in other areas in the event of over-response and it may hamper the provision of adequate care in the event not enough units are dispatched to the incident. The problem with a failure to submit to a proven system results in increased casualty rates, decreased response times and delays in patient care. In 1993, the American Heart Association referred to EMDs as a “vital but often neglected part of the EMS system.” [6] Unfortunately in 2008, this continues to be the case. Despite training, a recognized dispatching system which is well established and proven successful time and time again, EMD still has difficulty gaining acceptance from emergency responders.

But EMD is the “Gold Standard” for current communication centers. Tangible benefits of the standard include cost reduction associated with prudent resource management, deployment of manpower and reduced liability.  Intangible benefits include the health and safety of people who reside in communities where EMD resides and the countless lives that will continue to be saved by pre-arrival instructions. The EMD Program cuts out the unnecessary middleman that has resulted in long-time and wasteful duplication. Clawson explains that responders who are not trained to the EMD level do not understand the complexities of Emergency Medical Dispatching; they fail “to take into account the nonvisual nature of medical dispatching.” Additionally, responder “training is based on having a patient in front of you and being able to ‘look, listen and feel.’ Dispatch is different. EMDs cannot look or feel.”[7]

Solution

The most reasonable solution to promote an EMD program appears to be to have a strong working relationship with emergency responders and to involve them as much as possible in the continuing process of change within the communications center. This might entail including agencies in the planning processes for upgraded equipment, having outside supervisor participate in the interview of new employees, and including other agencies in daily operations planning. These small practices go a long way in establishing an effective relationship with working partners, however, there are times where a telecommunications manager must put his or her foot down in order to preserve autonomy and respect and let us not forget about the most important aspect—the customer. If it is not possible to collaborate and build partnerships, a communications center will do well to make partnerships with government and community representatives.

Additionally, small amounts of public relations and training help to provide the community support sometimes necessary to ensure the approval of these sensible practices. This is an important yet often neglected part of public safety. The important part is that a communications center must realize that it is working for the general public and that it is always necessary to garner support for initiatives when encountering difficulty. It may be a complicated process to initiate, but eventually, these practices will help others to become more involved in the process and hopefully make for a better overall response system. Although a telecommunications manager may appear unsympathetic when on the lookout for these goals, flexibility is necessary to achieve them; cooperation is the eventual key to success in such matters under debate.

 

[1] Wanda McCarley, “Written Statement of Wanda McCarley, President of the Association of Public-Safety Communications Officials (APCO) International and Operations and Training Manager, Tarrant Count 9-1-1 District, Ft. Worth, TX,” Before the United States Senate Committee On Commerce, Science and Transportation, April 10, 2007, 2.

[2] Jeff Clawson et all, “Protocols vs. Guidelines-Choosing a Medical-Dispatching Program,” Emergency Medical Services, October 1994 http://www.emergencydispatch .org/articles/protocolsvsguideliens1.htm (accessed March 9, 2008).

[3] Stratton.

[4] W. Ann Maggiore, JD, EMT-P, “Priority Dispatching is the Standard of Care,” NAED, http://www.emergencydispatch.org/articles/standardofcare.htm, (accessed March 9, 2008).

[5] Dorothea St. John et all, “Emergency Medical Services-EMS dispatch and response,” Fire Chief Magazine, August, 1983, http://www.emergencydispatch.org/articles/emsdispatch1.htm, (accessed March 9, 2008).

[6] American Heart Association, 1993 in Jeff Clawson et all, “Protocols vs. Guidelines-Choosing a Medical-Dispatching Program,” Emergency Medical Services, October 1994 http://www.emergencydispatch .org/articles/protocolsvsguideliens1.htm (accessed March 9, 2008).

[7] Ibid.

Follow/Like: