The Annual Conference of the
National Academy for Emergency Medical Dispatch
August 29 - September 1, 2000
Aladdin Hotel - Las Vegas (Nev.)
The Annual Conference of the National Academy for Emergency Medical Dispatch August 29 - September 1, 2000 |
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by Gary Allen
On Day #2 of the annual conference, it has become even clearer where the Academy is headed, and how it intends to get there.
In afternoon session, NAEMD trainer Bill Kinch explained the new fire cards, showed a prototype of the law enforcement cards, and waxed enthusiastic about the possibility of every public safety agency in the country adopting a protocol-based dispatch system. At a working luncheon of the College of Fellows of the academy, several academy committee chairs gave their annual reports, which sketched out even more about the future.
A long afternoon session introduced the changes in the academy's main product--Version 11.0 of the EMD protocols. The room was packed, and some even brought their card sets to see exactly how the changes will affect their operation.
We also jumped on a tour bus to visit the comm centers of the Las Vegas Fire Department and AMR ambulance service--both have nice looking centers, spacious workstations and up-to-date equipment.
Fire Cards Cover All The Bases
The academy's Fire Protocol Dispatch System (FPDS) is real---the academy
gave its first training course on the system as a pre-conference session.
And the law enforcement cards are ready for beta testing.
Project manager Bill Kinch (photo right) said he developed the idea for a fire protocol system some five years ago, in response to agencies who asked him if the protocol method could be applied to fire incidents. It took that long to develop the cards and bring them to the market.
"I believe that structured call-taking is where we're going in the next millennium, for everybody," Kinch told the group. "I think we're going to level the playing field all across the board." He explained that structured questioning leads to resource allocation, post-dispatch and pre-arrival instructions, all concepts that have been proven on the EMS side.
Kinch explained that policy or procedure-based questioning isn't as effective as protocol-based systems, which are interactive and "moves with the situation." Policies are simply reactive, and can't handle a fluid situation. Protocols also allow supervisors and managers to determine the rate of compliance by the dispatchers, while policies and procedures do not.
"Are we saying we're doing to take the brains of people, and put them onto the table, and put this protocol in front of them, and make make them mindless," Kinch asked. "Absolutely not," he answered. Instead, the protocols help give new and veteran employees the benefit of others' experience and knowledge, while policies and procedures do not.
They also does not set out a specific response for a particular situation. "If you want to send the cavalry out for every call, every time, every day, go to it. Be my guest," Kinch. Instead, the fire protocols systemitize the process of obtaining information from the caller to prioritize the incident, and to feed information back to the caller.
Kinch pointed out that extensive use of symbols in the new fire cards, which are carried over into the new Version 11.0 of the EMD cards. In fact, there are 17 so-called "directors and warning" symbols, five notification symbols and five response symbols. While they are all fairly intuitive, the sheer number of them might overwhelm the ordinary dispatcher.
Kinch then went step-by-step through the fire and law enforcement cards, explaining the case entry (initial) card questions, why they were selected, and the reasons behind the wording. He also provided peeks at the various other sections of the cards and some of the specific incident cards themselves.
All of Kinch's explanations sounded reasoned and sensible. There obviously has been some thought given to the objective of each question, the order in which they're asked, and how the dispatcher should proceed according to the caller's answers. But like the development of the EMD cards, there are certain to be glitches and odd situations that will require revision of the cards.
The law enforcement cards will be beta-tested at the Colorado Springs (Colo.) police department, and are scheduled to be finished in time for Navigator 2001 in New Orleans. Kinch said they will be software-based only, as a law enforcement card set would be too big and unwieldy.
Lastly, as for combining the three cards sets, "That's easier said than done," Kinch said. He said that each type of public safety agency wants their own questions asked first. "So I guess it's going to take me two years to sit three groups of people in the same room together, to make them play nice in the sandbox, so they agree that, this is how it should go."
But Kinch vowed to make it happen. "What's going to come out of this is a thing called Public Safety Priority Dispatch (PSPD)," in a software-only version. The protocol will shunt the dispatcher to not only the proper questions to ask the procedures to perform, but to the proper agency.
When will this integrated set be available? "My guess--five years," Kinch said, "and I might be way too soon." The first step will be integrating fire and EMS, he said, and once the law enforcement cards are finalized, he can begin work on integrating all three.
Version 11.0 of MPDS Explained
In a 4-hour session, EMD trainers Brett Patterson and Chris Bradford explained every detail of the newest version of the MPDS--V11.0. According to the academy, the changes "integrate to form a new product that is fundamentally safer, more user-friendly, and easier to learn."
They effectively used slides to show side-by-side comparisons of the older V10.3 and the new cards. The academy handed out well-designed, 4-color materials to explain the changes, including a Bridge Course Workbook, EMD Update Guide, and the Quality Assurance Guide for V11.0. Few companies would take this much trouble or produce this amount of material for even basic documentation, let alone an upgrade explanation.
The revision is the "single most comprehensive upgrade in the history of the protocol," according to the academy. While it's impossible fully explain all the changes here, we can summarize some of what Patterson and Bradford covered.
First if all, the protocols are vastly more conversational
in nature--no more stilted sentences that didn't quite roll off your tongue.
Now, it sounds like you're actually using your own words.
There are a new pair of cards for managing tracheostomy airway control (Y), four new cards for AED support (Z), and a new response determination methodology instruction card.
There is also a new Echo level determinant, when dispatch is made directly from the case entry card. This allows the dispatcher to send units earlier in the interrogation sequence when certain life-threatening conditions are obvious. According to NAEMD, it also allows the dispatch of units that wouldn't normally respond to a routine emergency--law enforcement units, chiefs, fire inspectors, etc.
Lots of symbols--for all sorts of reasons. Some alert you to take actions, some some indicate an agency (law enforcement, fire, poison control, HAZMAT, EMS).
Many of the chief complaint protocols have been augmented to address unconscious or arrest situations, and the complaints that involve scene safety issues now have specific directives to handle them.
Perhaps most on point, the protocols have been overhauled, the academy said, to reorganize and re-order the questions, determinants, instructions, definitions, classifications and other information. No doubt they also took into account the new fire and upcoming law enforcement cards, and worked to create a structure that will work with all three, and allow them to eventually be integrated.
Lastly, Version 11.0 "is more medically correct and current," NAEMD said. It takes into account medical research, other EMD work, and other industry standards.
Agencies wishing to upgrade to the new version must "qualify" their dispatchers, which involves being taught an upgrade course by a trainer qualified on V11. There is a fee for the update course workbook, which includes the processing and certification fee.
New LVFD Center Has Windows!
When we visited the Las Fire Department's comm center several years ago during a NENA conference, it was buried under the main firehouse in old, downtown Las Vegas. Well, it's been elevated four floors, to a top-floor addition built onto the headquarters building. And they have a view, even though the smallish windows are bullet-proofed glass.
They handle about 126,000 incidents a year for the city of Las Vegas, North Las Vegas and unincorporated areas of the county. They report that 80% of their incidents are medically-related. They have a direct CAD link to the AMR comm center for the dispatch of ambulances, and can cross-patch AMR's radios to the LVFD system if needed.
The center is uncluttered, uncrowded and has a nice workstation-type layout. There is one supervisor's console that has extra equipment, while the nine other positions have similar gear for handling call-taking, radio dispatch or the hospital radio network coordination (8 med radio channels). The radio workstations typically have four screens--one phones, two CAD and one automatic vehicle location (AVL). Call-taking positions have just three screens. Staffing is typically three call-takers, one LV fire, one county fire, one hospital net and one supervisor.
At the time we visited, the lights we turned down very low, so it's difficult to see the entire center. At one end of the center is a large projected image of the TriTech CAD software, which can be configured to show any combination of units or incidents.
Downstairs from the comm center is a very nice EOC, with a large meeting desk, workstations around the perimeter, a radio position, and three giant-screen TVs for monitoring the media.
Just a few minutes away from LVFD is the AMR ambulance comm center (photo
below), that handles 200,000 incidents a year, including non-emergency medical
transports. The uniformed dispatchers work 12-hour shifts using a GEAC CAD
system linked to LVFD's comm center to receive emergency incidents directly.
They have from five to 10 dispatchers on-duty at any one time to manage
a maximum of 40 to 50 ambulances on the road. At off-peak times, there might
be as few as 13 ambulances on the street.
They also have
windows that have a nice view of the distant mountains.
Besides Las Vegas, the center also fields phone calls and handles radio traffic for AMR in Las Cruces, New Mexico. Yes, that's right! It's over 1,000 miles away, linked by a T-1 telephone line. In the backroom are the dual Hewlett-Packard CAD computers, back-up battery system, Meridien telephone switch, fiber-optic patch panel, and other banks of electronic gear.
There are 10 consoles, two of which are occupied weekdays by non-emergency transport dispatchers. The consoles are cranberry and gray, and use Zetron radio and paging gear, and a regular-looking Meridien phone instrument. The MPDS card set is always nearby. There are tunable scanners at most positions (just above right side Zetron paging panel), so dispatchers can monitor other agencies.
The dispatchers work 12-hour shift: 3 days-on and 3 days-off one week, and then 4 days-on and 4 days-off the next week. This gives them built-in 8 hours of overtime every two weeks. They don't have formal breaks and meal periods, but they're worked out during the 12-hour shifts. They have 28 full-time dispatchers, but are hoping to increase staffing to 36. AMR has a performance requirement by contract: eight minutes and 59 seconds for emergency incidents, although response times average more like four minutes. They use ProQA for EMD in Las Cruces, but not for the incidents they receive from LVFD.
Man With A Mission
There's one man who may be key to NAEMD's mission of achieving its goal of providing dispatch protocols and training to all type of public safety agencies---Stephen L'Heureux.
He's a firefighter, paramedic and medical dispatch supervisor for the state of New Hampshire's Bureau of Emergency Communications, the first in the country to create a state-operated PSAP that fields every 911 call in the state, and then parcels them out to local agencies.
L'Heureux (photo left) is also the new chair of NAEMD's
Affiliation Council, tasked with reaching out to other public safety communications
organizations on issues of mutual interest. The council has held just one
meeting with L'Heureux at the helm, but he's already bubbling over with
enthusiasm.
He says the council is talking about model legislation to help states establish training standards and an administrative structure for their local EMD programs. They also intend to contact NENA, APCO, IMSA and any other organization that has an interest in the process of handling public safety communications.
Why is L'Heureux so key? Well, it has to be taken in context. NAEMD is transitioning to an organization that could be "all things to all people." They intend to provide protocol-based dispatch system for all three types of public safety agencies, not just medical agencies.
But to do that, it may have to step around some toes of people and organizations who feel they're more qualified as experts in the field. If they have to run that minefield, any chance of a nationally-recognized training curriculum for public safety dispatching is doomed. If the politics, envy and jealousies can't be overcome, we'll continue to see local comm center dispatchers trained to some arbitrary--and usually poor--standard.
But if L'Heureux can get all the organizations talking, get them focused on the reason for their existence, and get some working agreements among them, in not too many years there could be state standards of training for dispatchers, or even a national standard.
When you think about it, someone has to get the ball rolling on standardized and minimum training for dispatchers. Local center managers are asking for it, politicians are looking for guidance on what they should require, and the public's expectation of performance just keeps growing.
L'Heureux has lot of energy, is totally conversant on the subject of EMD (he's worked with Dr. Clawson for years) and has a mandate. That combination may just enable him to make a break-through move a long-needed changes in dispatcher training.
Bits & Pieces...
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