Medical Dispatching Systems for Emergency Medical Services (EMS)

1. Medical Dispatching Systems for Emergency Medical Services (EMS) Jim Holliman, M.D., F.A.C.E.P. Professor of Military and Emergency Medicine Uniformed Services University of the Health Sciences Clinical Professor of Emergency Medicine George Washington University Bethesda, Maryland, U.S.A.

2. Medical Dispatching Systems for EMS : Lecture Goals • Describe different types of medical dispatch systems now in use • Present "structural" options to consider in designing EMS dispatch systems • Stimulate interest in research projects comparing different types of dispatch systems

3. Definition of "Dispatching" • The process of sending prehospital care (Emergency Medical Services or EMS) vehicles and personnel to respond to requests for medical aid • Involves personnel, facilities, vehicles, and communications

4. General Structural Components Which Vary Between Different Dispatching Systems • Size and caseload of the EMS system • Financial resources • Local and regional government structures • Historical factors

5. Key Structural Components to Include in Any EMS Dispatch System • Capability to coordinate medical dispatch with fire, police, & heavy rescue units • Plans to modify dispatch to deal with disasters • "Back-up" communications system (in case the primary communications system fails)

6. General Variable Structural Components of an EMS Dispatch System • Training level of the dispatchers • Training levels of the ambulance personnel • Physical location of the dispatch center • Sequence or types of response units which can be dispatched for different types of cases

7. Considerations Regarding Advanced or Complex EMS Dispatching Systems • Advantages : • Broader capabilities • Greater flexibility • Disadvantages : • More expensive • More difficult to operate or supervise

8. Considerations Regarding Facility Location for EMS Dispatch • Combined or in same facility as fire & police dispatch • Efficient and eases coordinated multiple unit dispatch • May require fewer personnel if cross-trained • If EMS dispatch is in separate facility, both direct and back-up communications links to fire & police dispatch are important

9. Considerations Regarding Background of EMS Dispatchers • One main aspect to decide in organizing an EMS dispatch system is whether the dispatchers will work full time just as dispatchers, or if "field" personnel will be utilized (or "rotated") as dispatchers

10. Considerations in Having Personnel Work Only as Dispatch Specialists • Advantages : • Maintain skills because of continued experience • Easy to provide training updates • More consistent adherence to protocols • Disadvantages : • May not have a good "feel" for field conditions • May become bored with their work

11. Considerations in Utilizing "Field" Personnel to Rotate as Dispatchers • Advantages : • Can use their "field" experience and knowledge to better direct field units (such as knowledge of details of street access routes) • Maintains their work interest and prevents job "burnout" • Disadvantages : • Must be retrained each time they rotate back to dispatch work • Perhaps less consistency in following protocols

12. Considerations About Level of Training of the EMS Dispatchers • Some systems (as in Europe) utilize physicians for EMS dispatch • May just answer incoming calls from the public and other non-physician dispatchers then actually send the EMS units • Other systems utilize nurses to screen calls and provide medical advice to the callers

13. Advantages of Using Physicians as EMS Dispatchers • Can utilize their greater medical training to evaluate cases over the phone • May then be able to give treatment advice obviating the need for evaluation by EMS personnel or the need for ambulance transport • Can provide more in-depth medical communications with other doctors or health care facilities

14. Disadvantages of Using Physicians as EMS Dispatchers • May be more expensive • May be more effectively utilized in providing direct medical care rather than being mainly involved just with communications • Depends on relative "supply" of physicians in the country • May have tendency to delay dispatch or transport in trying to find out non-relevant medical information

15. Other Options for Training Requirements for EMS Dispatchers • Emergency Medical Technician (EMT) or paramedic • May communicate medical information better than non-medical dispatchers • Military trained medics have been used successfully in some systems • Are good at following preset protocols • Physician Assistants or Nurse Practitioners can be considered in some systems • Personnel without prior medical training but with specific dispatch training

16. The "Priority Medical Dispatch" Training System • Developed by Dr. Jeff Clawson of Salt Lake City, Utah, U.S.A. • Designed to train dispatchers who do not necessarily have prior medical training • Purchase of the program includes formal training of the dispatchers • Main component is providing prearrival instructions to the person calling for EMS help • Also allows the dispatcher to select the best types of responding ambulance units (advanced versus basic life support units)

17. Components of the "Priority Medical Dispatch" Program • Can use flip chart cards or the same information on computer screen • Presents a preset series of questions the dispatcher asks the caller • Each response then follows a flow chart for the next question or instruction to the caller • Use of this system may result in higher % of bystander CPR for cardiac arrest cases and improvement in survival from cardiac arrest • Also prearrival instructions help the caller to signal the location to the responding EMS unit

18. Main Components of Prearrival Instructions • Description of the location of the incident • Maintain open communication line till arrival of the EMS unit(s) • First aid for the victim(s) • Determining scene safety hazards for the caller and for the responding unit(s) • Signaling by the caller to the EMS unit the exact incident location • Easing access for the EMS unit to the scene

19. Types of Communications to be Used in EMS Dispatch Systems • Land phone lines • Direct links needed between EMS dispatch center and fire/police/rescue dispatch center and between local and regional hospitals • Short wave radios • Mainly for communication with EMS vehicles • Intercom lines • Useful as backup between centers and hospitals • Cellular phones (less reliable in mountain areas) • Internet or email

20. Advantages of Internet or Email Communication Links in Dispatch Centers • Still function even when phone lines are overloaded (as in most disaster situations) • Due to "delay routing" of messages • If advanced fiberoptic cable lines are in place, can transmit live video • Enable rapid paper printout of messages • Enable rapid simultaneous receipt of messages by multiple units

21. Choices for Dispatchers Regarding Types of EMS Units to be Dispatched • Varies according to training and capabilities of the EMS system in place • Simplest system is for all response units to have maximally trained personnel • Not the most efficient however because highly trained personnel are then sent to less severe cases where their extra skills are not needed • If different unit types are used, then the first responding unit should be able to call for other units after patient assessment

22. Choices for Types of EMS Units to Consider for Dispatching • First Responders • Police or firemen trained in a 40 hour course • Usually respond in non-transport vehicles • Basic Life Support (BLS) • Staffed by EMT's or other technicians • Advanced Life Support (ALS) • Choices for staffing : • Paramedics, Nurses, and / or Doctors • May be 2 levels available (standard ALS and Mobile ICU)

23. Choices for Sequence of Dispatch for EMS Units • Routine First Responder Unit and a BLS and/or ALS unit • Screening of the call severity, then : • BLS unit for a case that sounds not to be severe • May call for ALS unit after arrival if needed • BLS and ALS units co-dispatched if case sounds severe (may also involve "rendezvous" dispatch) • BLS may cancel ALS response if it arrives first and determines case is not severe • Patient may be transported in BLS vehicle with ALS personnel if ALS vehicle is non-tansport

24. Choices of Crew Composition for ALS Vehicles • One ALS and one BLS person per vehicle • Two ALS persons per vehicle • All units then have same capabilities • Two ALS and one BLS • One ALS, one BLS, and one driver (perhaps only trained as "first responder") Note that if using only 2 person vehicle crews, there needs to be available other personnel (such as senior managers in non-transport vehicles) to respond to help with severe cases such as cardiac arrests)

25. EMS Dispatch Considerations for Aeromedical (Helicopter) Units • Should be preset specific criteria for dispatch of helicopter units • First arriving ground units should be able to communicate to cancel helicopter response if it is not needed • Dispatchers and ground unit personnel need pre-training in landing zone safety considerations

26. Computer System Considerations for EMS Dispatch Systems • Currently available systems can : • Identify phone number and location of the caller • Monitor emergency department and hospital bed capacity in the region • By using the Global Positioning System (GPS) with monitor units on vehicles, dispatchers can see the exact geographic location of all vehicles in the system at all times • Electronically transfer information about patients directly from field units to the hospitals and dispatch centers

27. Other Dispatch Uses for Current Computer Systems • Can provide summary reports of units' and vehicles' response times • Can analyze geographic occurence of cases to allow better future response planning to decrease response times (enabling true "Systems Status Management") • Can monitor personnel performance and provide quality assurance reports

28. Considerations About Maintaining Work Satisfaction by Dispatch Personnel • Should have regular meetings between dispatch personnel and field personnel • Allows discussion of communication problems or modification of protocols • Having social events for all personnel is helpful at maintaining comraderie • Should have at least liason meetings with fire, police, and rescue dispatch personnel • May be useful to have regular educational meetings to review interesting cases

29. Research Projects Related to EMS Dispatching to Consider • Improvements in response times using GPS systems • Improvements in cardiac arrest or trauma survivals using prearrival instructions • Comparison of outcomes between systems using physicians and those using medics • Comparisons of adherence to protocols using different training systems • Computer modeling of caseload capacity differences in disaster situations

30. Medical Dispatching Systems for EMS : Lecture Summary • Medical dispatching systems are extremely important components of any EMS system • Design of the EMS dispatch system depends on a number of factors related to caseload, finances, government, and history • Use of new computer systems offer a number of advantages to expand the capabilities of EMS dispatch systems • There is great potential for research projects related to EMS dispatch