Fire Dept. Tries To Decrease EMD Time

A Los Angeles newspaper has revealed an internal city fire department report that is critical of the emergency medical dispatching (EMD) protocols used by the city, including that it takes an average of 4 minutes and 12 seconds to begin CPR even when a bystander is ready and willing to perform it. However, the creator of the protocols says the delays stem from the fire department using out-dated protocols and dispatchers who don’t strictly follow the protocols. The Los Angeles Times story said the fire department began an investigation of medical response times after a Times story last May noted over the past five years fewer medical incidents were dispatched within the department’s goal of 60 seconds. The department then examined the dispatch process, the newspaper says, and came up with several recommendations to speed the process of providing EMD, especially in cases of cardiac arrest. According to the LAFD, just two percent of 911 calls report a cardiac incident, and that in only about 31 percent of those incidents is CPR performed by a bystander. But when even when a bystander is agreeable, it takes the dispatcher over four minutes to begin giving instructions. Update: After this story appeared, Dr. Jeff Clawson of the International Academies of Emergency Dispatch (IAED) provided the Times with a response to the story, calling into question LAFD’s proper use of the protocols, and noting the protocols are successfully used by almost 3,000 comm centers in 43 countries. Download (pdf) Clawson’s full response here.

The Times posted a 48-page slide show that was part of dispatcher re-training sessions this past summer intended to speed the process of EMD. The training was accompanied by tapes of 911 calls where there was delayed provision of CPR instructions. One slide noted that decreasing the time to pre-arrival instructions, “will require a magnitude of changes, but we have begun the process.”

The fire department uses the ProQA EMD protocols marketed by Priority Dispatch Corp. The dispatcher training noted that the department’s medical director recommended a deviation from one section of the ProQA protocols to lessen the time to CPR, skipping what the slides call a “too long” and “very cumbersome” questioning process designed to make absolutely sure the patient is in cardiac arrest. The slides noted, “The reality is that chest compressions are SAFE, even if it turns out that they are not indicated.”

The dispatcher training also noted that the fire department is considering other changes to the so-called “ABC protocols,” including removing some steps. The dispatchers were also told to save time during other points of a 911 call, including the use of a standardized greeting.

Read the entire newspaper story with 911 call audio, and view the city EMD slide show here.