Emergency Medical Dispatch

The System Evolves

I remember witnessing a car accident in my small hometown in Indiana back around 1967 or so. One of the drivers was hurt pretty badly after running a stop sign and getting hit. The local mortician pulled up in a grey hearse with a detachable rotating red light on the roof. Someone had called him at his place of business to tell him about the accident. The patient was loaded into the back of the hearse that was now an ambulance and both the driver and the attendant got into the front seat. Away they drove, headed for the nearest hospital some 23 miles away, with the badly hurt woman lying by herself in the back of the hearse.

Emergency medical care has undergone an amazing evolution since then. Within 30 years we’ve seen the emergence of a 3-digit emergency telephone number, fully-equipped ambulances with medical professionals on board, highly trained emergency services dispatchers using priority dispatch protocols and computer-aided dispatch systems, and global positioning satellite systems.

Approximately 85% of the United States and 90% of its population is covered by a 9•1•1 system, and 99% of the adults in those areas know they should call 9•1•1 to report an emergency.

So today, when someone falls off the roof of a house while trying to adjust a new TV satellite dish and a neighbor dials 9•1•1 on his cellular phone, a skilled dispatcher trained in the protocols of Emergency Medical Dispatch (EMD) verifies the address that’s showing on the computer screen, leads the neighbor through a series of pertinent questions, and assures the caller that help is on the way. While the neighbor is still on the phone with the dispatcher, the sound of a siren bringing help is heard in the distance.

We have all seen this on television. The show Emergency 9•1•1 introduced all of America to the cards used by 9•1•1 operators to tell people how to perform CPR or deliver a baby or control a cut that is bleeding badly.

What is EMD?

EMD allows the dispatcher to instruct the caller in pre-arrival medical care for the patient. Under the direction of a jurisdictional medical director, the dispatcher performs medical interrogation based on standardized key questions, dispatches the appropriate emergency medical units based on medical needs identified, and provides the earliest possible emergency medical intervention by giving the 9•1•1 caller standardized, medically approved prearrival and post-dispatch instructions.

Emergency Medical Dispatch is being seen as a standard of care in many jurisdictions, and more and more agencies are adopting EMD programs and training dispatch personnel to provide prearrival instructions either through internally-developed programs or through national EMD programs such as those developed by Medical Priority Consultants, PowerPhone, and the APCO Institute. I received my training and certification from Medical Priority Consultants.

The Emergency Medical Dispatcher is now recognized as an essential component of an effective EMS system. Proper and timely training, continuing education, and sound medical protocol allow a dispatcher to deliver quality care to the public before anyone else can.

EMD Training

Although 9•1•1 has saved thousands of lives, some lives have been lost as a result of errors made by poorly trained dispatchers who wrote down an incorrect address, dismissed the call as a nonemergency, or simply refused to give prearrival instructions because they were afraid of losing their jobs if they did so. Unfortunately, those are the calls that make newspaper headlines and undermine public confidence in a system that is touted as the solution for all emergencies.

Obtaining national certification as an Emergency Medical Dispatcher entailed taking a 3-day, 24-hour course that included practical application of the training material. The class covered such things as:

It is essential for the dispatcher to have step-by-step protocols and training. Dispatchers need confidence, and confidence comes through training.

Ours is a nonvisual environment. Dispatchers often talk to a second-party caller, who has to look at the patient and make determinations. We also make certain assumption based upon the information the caller provides. For example, the first instruction we give the caller for managing a patient’s airway is: If there’s a pillow or anything behind his head, please remove it now. If someone is unconscious or unresponsive, a lot of people put a pillow behind the patient’s head because they think it makes him more comfortable. Actually, it obstructs his airway. We assume the pillow is there, and the card compensates for the fact that we can’t see the patient.

The philosophy here is a simple one: the person who answers the phone in a police, fire, or medical emergency is the first person on scene. We make certain that that person is trained and capable of providing assistance to the patient by instructing the caller what can be done until the field responders arrive on scene.

It works. That’s the bottom line. A friend of mine took a call a few years ago from a worker at a day care center who had discovered an infant lying in a crib not breathing and with no detectable pulse. The woman was hysterical, crying and screaming into the phone. The dispatcher, using the tactic of repetitive persistence learned in the EMD class, kept saying to the woman, “If you want to help the baby, you have to listen to me.” The fifth time she repeated that litany to the caller, the caller suddenly snapped out of her panicked state and replied quite calmly, “Of course, I want to help the baby.” The dispatcher then instructed the caller in infant CPR. The child survived.

EMD Works

There is no debate about the usefulness of EMD protocols, training, and application. It saves lives. It has saved lives.

Those were two of my calls, so I know the system works. They aren’t always that dramatic, of course. Sometimes the instruction are as simple as to keep applying direct pressure to a cut until the paramedics get there or to just let the patient rest comfortably and keep monitoring their condition until the paramedics get there. Still, the caller is receiving help to know what to do and the patient is receiving immediate help instead of having to await the arrival of field responders.
 
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