![]() The process begins by asking the patient’s age and chief complaint followed by "Are they conscious?" and then "Are they breathing?" 2 If the answer is "no" to both of these questions, the call-taker determines that the patient is likely in cardiac arrest and will require the highest level response ("ECHO") as well as pre-arrival instructions for the caller to perform bystander cardiopulmonary resuscitation (CPR). Depending on the answers, the call-taker is prompted to ask different follow-up questions. 3 The system involves use of a computer-based script that helps the call-taker guide the caller through a series of yes/no questions. MPDS is a set of protocolized decision tools designed to allow the identification of the complaint, determine the appropriate resource response, and provide pre-arrival instructions. 2 An example of this approach is known as the Medical Priority Dispatch System (MPDS). Therefore, many agencies choose to employ a standardized interrogation of the caller designed to elicit key information that allows the chief complaint to be categorized as one of 33 standard chief complaints. For example, a patient with altered mental status may be having a stroke, toxic exposure, metabolic emergency, or hypoxia. 2 Challenges quickly arise as callers may not fully understand or may not be able to describe effectively a patient's condition. Once the nature and location of the emergency has been confirmed, the call-taker's responsibility turns to identifying the chief complaint, age, level of consciousness and breathing status of the patient. 5 However, call-takers are trained in dealing with this challenge and can promptly help callers identify their location and then direct the appropriate first responders to the closest location. This can be difficult as callers may not know their location, cell phones may ping a tower that is outside the jurisdiction of the local PSAP, or automatic location technology (E911) may be inaccurate. The first priority of the call-taker is to determine the nature of the emergency in other words, are police, fire, or EMS assistance needed? The first immediate challenge can be determining the location of the emergency. These calls are routed to a designated Public Safety Answering Point (PSAP). Generally, in the United States, once a prehospital emergency becomes apparent, most patients gain access to the emergency medical system by dialing or having a bystander call 911. Even today, the availability of EMD is not standardized and different answering points may deploy different avenues for emergency response. Service providers wanted to send the right resource, to the right person, for the right complaint, and provide direction prior to that resource’s arrival. 4 It wasn't until the 1980s that the first structured EMD protocols and training started to be adopted. ![]() In 1978 Salt Lake Fire/EMS identified the dispatcher as the "weak link" in the chain of survival. In the 1970s it was recognized that calls for emergency medical help were on the rise and systems needed to be developed to deploy resources appropriately. 2 However, the expertise of EMDs, together with their calm demeanor and guiding nature, has led to improvements in patient outcomes.Įmergency medical dispatching, similar to other aspects of EMS, is a relatively new concept. 2,3 Historically, these providers were overlooked as key links in the EMS and emergency health care system, leading to low standards, poor funding, and inadequate training. 2 Without ever seeing the patient or the scene, these individuals are tasked with identifying the complaint, triaging the patient’s severity, and providing pre-arrival instructions to callers. 1 For the majority of callers, it is their first interaction with the emergency medical services (EMS) system.Īt the other end of the call is often a specially trained call-taker who is referred to as an Emergency Medical Dispatcher (EMD). Each year, an estimated 240 million calls are made to 911 by patients or bystanders for the full range of emergencies.
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