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