This publication is distributed by the U.S. Department of Transportation, National Highway Traffic Safety Administration, in the interest of information exchange. The options, findings, and conclusions expressed in this publication are those of the author(s) and not necessarily those of the Department of Transportation or the National Highway Traffic Safety Administration. The United States Government assumes no liability for its contents or use thereof. If trade or manufacturer's names or products are mentioned, it is only because they are considered essential to the objective of the publication and should not be considered an endorsement. The United States Government does not endorse products or manufacturers.
A. The Purpose of the EMD Program Implementation and Administration Manager's Guide
This guide was developed with one primary assumption. It is assumed that the need for EMD training and implementation has been identified by some responsible agent and that public support and funding has been established. Without support and funding from citizens and public-safety officials, the program will likely lose momentum and fail. This manager's guide is intended to provide appropriate EMS personnel (like the EMS administrator and communications administrator) with a guide to assist them in the planning and implementation process.
The Manager's Guide was developed to provide guidance and suggestions regarding:
a. the establishment of EMD programs;
b. administration of EMD programs;
c. operation of EMD programs;
d. selection and training of EMD personnel and
e. evaluation and Quality Assurance/Improvement.
Another purpose of this guide is to:
a. provide guidance for the development of common expectations among EMD programs and training;
b. provide a training mechanism for EMD personnel and
c. provide direction and assistance in understanding, implementing and managing emergency medical dispatch programs.
B. Evolution of EMD
The concept of Emergency Medical Dispatch (EMD) has been evolving and advancing since the late 1970's. The evolution of professional Emergency Medical Services (EMS) began in the early 1970's with the primary focus on Emergency Medical Technician (EMT) training, followed by paramedic training. As training and advancement in the professional aspects of Emergency Medical Dispatch (EMD) delivery gained momentum nationally, many in the industry recognized another aspect of EMS delivery that had gone basically unattended, the role of the dispatcher.
One of the initial goals of EMS was to provide easy and rapid access to EMS and to subsequently mobilize a medical response to the scene. The intent was to provide rapid on-scene treatment or stabilization of the sick and injured and provide transport to a medical facility for definitive medical intervention.
During the middle to late 70's it became evident that the EMS dispatcher played an important role in this process. The dispatcher was the initial contact the calling public had with EMS and they were the ones that were going to mobilize the response. It was clear also that the dispatcher had no uniform or consistent method of caller interrogation and response decision making.
One dispatcher could assess a call and determine that it was a minor medical emergency while another might determine that it was a high level emergency.
This lack of consistency led to an over-utilization of Advanced Life Support (ALS) resources and an under-utilization of Basic Life Support (BLS) resources.
In many locales, first responders were also utilized on many calls, leading dispatchers to use these resources when they were not required and to fail to use them on cases that clearly needed them. Many dispatch centers were operating with minimal guidelines and most were operating without any professional Medical Oversight or direction.
During the late 1970's and early 1980's, EMD protocols began to be developed to provide the dispatcher with medically sound and clinically based direction. These protocols were designed to guide the emergency medical dispatcher in proper caller questioning techniques to:
a. identify the level of medical need;
b. identify situations that might require pre-arrival instructions;
c. gather information to be relayed to the responding crews to help them address the situation upon arrival and
d. obtain information regarding scene safety for the patient, bystanders and responding personnel.
As these Emergency Medical Dispatcher programs gained in popularity, it became evident that a training program was required to assist the dispatcher in applying a new tool called the Emergency Medical Dispatch Protocol Reference System (EMDPRS). Using a standard set of questioning protocols, this tool allows the dispatcher to consistently identify the level of need, identify situations that require pre-arrival instructions, gather information that should be relayed to responding personnel and gather scene safety information. As training programs have evolved, and the EMD concept has matured, it has become clear that an EMD program takes much more to implement than simply obtaining or developing EMS Dispatch protocols, providing training and then letting the dispatch center "run" with the program.
The EMS community determined that a comprehensive and integrated planning and implementation program must be established. Steps must be taken in sequence to ensure proper pre-planning, program selection, EMD training and protocol implementation. Without this integrated and comprehensive approach, the EMD program often loses its initial momentum and administrative support.
There are presently a number of commercially available EMD programs which provide planning and organizational assistance along with training and accompanying Emergency Medical Dispatch Protocol Reference System (EMDPRS) that go along with each particular program. In addition, many agencies have developed their own systems based upon their identified local needs and Medical Oversight direction.
Some EMD protocol systems have been developed without the assistance of a physician medical advisor and involvement from professional medical directors, while others have evolved with the direct involvement of Medical Oversight. EMD program status across the United States presently ranges from in-house developed protocols to professionally developed and marketed systems.
As a result of inconsistencies in program development and implementation, many states and municipalities have expressed a desire for uniform program standards. These are needed to assist in the proper development and/or selection of an EMD program that includes proper training and certification of EMDs along with medically approved and appropriate EMDPRS program protocols. This has been a driving force behind the development of national voluntary standards which have been developed by the American Society for Testing and Materials (ASTM) and the National Association of Emergency Medical Services Physicians (NAEMSP). Using these voluntary practice standards, The National Highway Traffic Safety Administration developed this Emergency Medical Dispatch: National Standard Curiculum.
EMD standards will bring more consistency between programs and program implementation, uniformity in training and certification programs and reciprocal certification between EMD programs. This will lead to increased recognition of EMD programs and the EMD profession as a whole, increasing the professionalism of the EMD and enhancing the delivery of EMS to citizens served in the United States.
It will also enhance the efficiency and effectiveness of the delivery of EMS in the U.S. by providing EMDs with:
a. appropriate training and tools which enable them to make correct decisions on unit response configurations and modes and
b. tools to provide appropriate and consistent scripted telephone assistance to the patient through the caller before help arrives at the scene.
C. Future Roles Anticipated for the EMD
The goal of emergency medical dispatch is to make sure that the right kind of care is given to the right patient at the right time.
Today's emergency medical dispatchers are trained to interrogate callers in order to identify the nature and severity of the emergency; allocate the EMS system's resources, and give post dispatch prearrival emergency care instructions to callers. Methods of EMD vary dramatically from place to place, depending on the EMS assets available and the level of training and expertise of the EMD.
Tomorrow's emergency medical dispatchers will be taking on expanded roles as the field of emergency medical dispatch matures. As 9-1-1 and 9-1-1 Enhanced telephone systems reach into more and more communities, the emergency medical dispatch industry will identify new and valuable roles that it can fill to meet the growing needs of the communities it serves.
The reform of health care delivery is rapidly progressing. The advent of managed care and health maintenance organizations (HMO) is and will continue to change the manner in which health care, including emergency medical care, is delivered.
Emergency medical dispatch centers can affect how a person accesses the EMS system. By forming proactive supportive agreements, EMD systems, EMS systems, emergency departments and the HMO community can assure that both emergency and non-emergency patients get the right care at the right time and that the patient is delivered to the right facility. This "win-win" situation can be brought about by using the EMD system, supported by the HMO community, to screen callers and forward them to an emergency medical dispatcher or to non-emergency dispatchers. Once the initial call taker determines that the caller does not have a "true" emergency (by using medically driven and supervised protocols), the non-emergency medical dispatcher will be able to assist the caller in accessing the health care system in the most appropriate and cost effective manner. This would alleviate the overcrowding in emergency departments; better utilize the EMS system; and encourage HMO patients to seek help from their appropriate HMO health provider.
D. About Public Safety Telecommunications
Public safety telecommunications involves much more than someone simply answering the telephone, getting an address and then activating paging systems to dispatch response resources. Public safety telecommunications has evolved into a very specialized and professional field of endeavor requiring attributes and application of knowledge and skills that are not commonly found in other occupations.
1. Basic Telecommunications. Basic Telecommunications education is requisite for all individuals involved in any aspect of public safety telecommunications. Knowledge required includes: basic understanding of telecommunications equipment and FCC regulations, radio communications concepts, telephone communications and interrogation techniques. The practice of Emergency Medical Dispatch is a specialty of telecommunications and should be approached as advanced training for those already skilled and knowledgeable in basic public safety telecommunications.
2. Intent of Basic Telecommunicator Training. Basic telecommunicator training is not intended to give complete knowledge about all aspects of public safety communications. It is intended to give a foundation of knowledge about telecommunications to prepare the dispatcher for more advanced training.
There are other specialties of telecommunications that are specific to each dispatcher and their function. Some dispatch centers deal with police communications only. Calls for fire and EMS are then directed to another center or agency. Other dispatch centers, or public safety answering points, answer all incoming calls and requests for emergency services. Whichever type of communications operation the student is involved with determines the specialties in which they must be schooled.
The three primary specialties of telecommunications include:
a. Fire Communications. Dispatchers who work in communication centers, whose primary function is fire related topics, require specialized training in fire related areas of telecommunications. These include fire alarm dispatching, fire incident command systems, hazardous materials and, in some cases, specialized technical rescue operations among others. This requires specific training tailored for this particular specialty.
There is very little prioritization of fire related cases since fires are escalating emergencies which require immediate response in nearly all cases. These dispatchers need to clearly understand unit response configurations. The fire dispatcher sends different responses to dumpster fires than are sent to respond to an office building fire alarm. These responses are sometimes automatically determined by the Computer Aided Dispatch (CAD) system in computerized operations. In manual systems the response configurations are usually contained within the operational policies and procedures or in written dispatch protocols.
b. Law Enforcement Communications. Dispatchers working primarily with requests for police assistance require specialized training in officer safety, evidence preservation, witness interrogation and special case radio communications among many others. Police dispatchers often require training in the National Crime Information Computer (NCIC) system, and are required to maintain certification in its use.
c. Emergency Medical Communications. Dispatchers working primarily with requests for medical assistance require specialized training in caller questioning, emergency medical resource allocation, caller management and provision of medical instructions via the telephone. These dispatchers must also understand the differences between Advanced Life-Support (ALS) and Basic Life-Support (BLS) and require specific training in the use of the tool known as the Emergency Medical Dispatch Protocol Reference System (EMDPRS). All EMDs require this training in addition to their basic, solid foundation in general telecommunications education and training in telecommunications techniques.
3. Common Elements of Public Safety Telecommunications. Public safety telecommunicators share knowledge among their various fields and subspecialties.Common elements of telecommunication include:
4. Basic Telecommunications Training Content. A basic telecommunicator course includes training in:
5. Special Knowledge Requirements. There are special communications knowledge and requirements for each public safety telecommunications specialty. Each communications center establishes the unique requirements of training for that particular center.
Summary
This preface has provided you with information regarding the focus of this guide, the background of EMD and an overview where EMD exists in relation to EMS and Public-Safety Telecommunications.
In the following parts of this guide, you will learn about implementing EMD programs (Part One), training your personnel (Part Two) and suggestions for QA/QI programs and other administrative and maintenance issues (Part Three).
Part One of the NHTSA Manager's Guide is over 125 pages long and is not
included here. See their Web
site for the full text.
Top
A. Introduction
Once you have set up an EMD program, it becomes necessary to train people to operate in it. Establishing training programs is complicated. You need to consider many variables, some of which we discuss here. This section does not provide a discourse on how to design training courses. Instead, we have designed it to give you an overview of the major concepts and variables that you will need to consider when establishing training programs.
B. Establishing a Training Program: Course Considerations
1. Introduction. The National Highway Traffic Safety Administration (NHTSA) has identified minimum training requirements for EMDs. NHTSA has also developed a course that can be used to help you develop training courses which meet local needs. This course is available for your review, but it is not designed for use as a training document until it is made to comply to local requirements and is reviewed and approved by the medical director. You may get a copy of the NHTSA course by contacting NHTSA. The title of the course is National Highway Traffic Safety Administration: Emergency Medical Dispatch, National Standard Curriculum. Commercial sources of EMD training are also available.
2. About the NHTSA Curriculum. The NHTSA curriculum is specifically designed to address the preparation of EMDs in performing EMS-related telecommunications functions. It does not include skills training in public safety dispatching or the use of telecommunications equipment.
The NHTSA curriculum is designed to be used to train public safety dispatchers in EMD-specific content and to provide the medical knowledge, skills and competencies required to round out the EMS aspect of a dispatcher's repertoire. Specific performance objectives for each unit of the course are presented at the beginning of each unit lesson plan. Trainees who take the course must have completed basic telecommunications training - or at least be able to demonstrate competence in the required telecommunications skills - and agency approved CPR training prior to attending the course. EMD trainees must also be able to use the general telecommunications knowledge, skills and competencies that they have already learned.
3. NHTSA Curriculum Goals. At the conclusion of the course, the trainee should be able to:
4. How to Tell What Effective EMD Training Programs Cover. Any effective training program should provide instruction in the proper handling of the four broad functions carried out by the EMD. Those four areas include:
You may want to compare other programs to the NHTSA curriculum. This way you can compare them for content. Remember the NHTSA program contains the minimum content of a training program.
C. The EMD Instructional Program
1. What Goes Into EMD Instructional Programs? When establishing an EMD training program, the following should be considered:
2. Course Planning Considerations. When you are planning a curriculum, there are many things that need to be considered. These include but are not limited to the following.
a. Instructor Qualifications. How would you qualify instructors for training? The NHTSA training program is designed to be delivered by one instructor, but the ideal situation is one instructor with one assistant.
The instructor(s) for this course shall possess thorough knowledge of emergency medical dispatching and the working environment of public safety telecommunicators. Instructors selected for this course shall also have proven competency as instructors in other courses, have proficiency in the skills and concepts that are being taught in this course and shall have successfully completed a recognized EMD training course.
It is essential that the instructors for this course be capable of understanding, presenting and defending ALS level-Dispatch Life Support information. For the medical portion of this course, the instructor(s) shall have training, skills and experiences at the advanced Emergency Medical Technician (EMT) level (equivalent to EMT - Intermediate/ EMT - Paramedic). Alternately, the medical portion of this course can be taught by a critical-care trained physician, nurse or physician's assistant.
This high level of instructor qualification is due to the need for the instructor to facilitate trainee learning and understanding of the medical content of this training, and to facilitate their ability to interrogate and evaluate the information provided by callers. It is also required because trainees will need to be able to categorize caller information and appropriately assign predetermined response configurations and modes (adapted from ASTM standard F1552-94, section 5).
b. Trainee Qualifications/Prerequisites. Who can take the training? When you are determining who qualifies for training, you need to consider:
1) trainee/mandatory prerequisites;
2) essential prerequisites and
3) recommended prerequisites (optional but nice to have).
Ideally, course participants will be from the same agencies; however, when this is not the case, participants will be expected to train with the EMD protocols from their respective employing agencies.
Trainees should have competency in basic dispatch telecommunications and have successfully completed an approved cardiopulmonary resuscitation (CPR) course within one year prior to taking EMD training.
Trainees need not have previous emergency care training or experience, though such training and experience would be helpful to the prospective trainee of EMS dispatching.
c. Other prerequisites for trainees include:
1) proficiency in reading and writing English;
2) ability to speak clearly and distinctly on the radio and telephone;
3) ability to function effectively in stressful situations and
4) basic training in and orientation to public safety dispatching equipment and techniques.
D. Course Planning Considerations
1. How Do I Schedule My Courses? When determining how to schedule courses you need to consider how to adapt the course schedule to the local area. You need to answer questions like "How will I handle losing my dispatchers to training? Do I have enough personnel to cover them in their absence? How will I handle pay?"
2. How Long Should My Courses Be? Minimum recommended course length is twenty-four hours. This recommendation is based on a written curriculum, however CBT curricula will require a different number of hours due to its unique structure and presentation method. Adding additional content to the NHTSA course materials will require modification of the allotted time frame.
The length of the course and the course schedule will depend on:
3. What is The Optimal Class Size? What is the maximum class size that your instructors can effectively handle? What is the maximum teacherstudent ratio for effective learning for your locale?
No specific number can be determined due to differences among locales and their specific needs and concerns; NHTSA recommends, however, that the maximum trainer-trainee ratio during lectures be 1:24 and during practical examinations 1:12. These ratios were determined based on the high degree of interaction required by the course.
4. Materials and Equipment. What training material do I have or need? What types of equipment will I need for this course and what do I already have? Three types of training materials and equipment will be needed for EMD training courses. These include:
a. Standard teaching aids;
b. Classroom Materials and Equipment (optional and optimal); For realism and learning reinforcement, trainees should be allowed to practice using equipment identical or similar to that of their dispatch center (if practical and available). This equipment includes:
c. Training facilities; Where should I have the training? How should I lay out the rooms? Will I need "break-out" rooms? For the EMD curriculum, you will need the following:
You may want to consider using a language lab. Language labs are useful because they allow trainees to practice call taking and language skills. Also, consider training in a room in the facility where trainees will work (familiarity with local equipment and surroundings, etc.)
All training rooms must be well lit and comfortable (air-conditioned or heated comfortably), with enough seats so that each trainee has a seat and table or desk on which to take notes. Flexible seating arrangements are best because they allow trainees to pair off for practice sessions, etc.
E. Choosing Appropriate Course Content
1. Who decides? The medical director, EMS director and/or the EMD guidance committee(s) should jointly determine what parts of the course structure or content are locally inappropriate. These same personnel are responsible for assessing if course goals are relevant to the local situation.
The NHTSA curriculum contains the basic, minimum information required. Any course that is selected should contain, at a minimum, the same types of information. Any alteration to an existing course should be checked to ensure that it contains the same types of information as found in the NHTSA curriculum. The NHTSA curriculum represents the minimum course content required for any EMD training program.
F. Customizing Courses for Local Needs
1. Why Customize? EMS dispatcher functions vary from locale to locale. This requires customization of training materials to meet the exact needs of each area. In general, you should:
2. Be Careful. ALL OF THE MATERIAL/CONTENT AREAS IN THE NHTSA COURSE MUST BE ADDRESSED IN YOUR COURSE(S). YOU CAN ONLY REORDER OR ADD MATERIAL. This does not mean that your context must be identical or in the same order. We understand that local medical, resource and organizational issues exist. We simply mean that all content areas must be addressed. When you add material to the course, you must be sure that it will help trainees attain the knowledge and/or skills required to meet the four functions defined for the EMS dispatcher. All changes must also be checked to assure that the goals of this NHTSA curricula are met. This is especially important if you choose to add an on-the-job training (OJT) component to your program.
You also need to consider your audience. All changes (and selections) need to answer the following: "What is the average reading-level of my trainees? Who are the people that will be taking my training? Are they experienced dispatchers or entry-level dispatchers?"
Another consideration is the local legal and medical environment. Changes must address: "What legal restrictions do I need to observe? Are there any special concerns for our area? What medical facilities and resources are available in my area?"
G. Assessing Trainee Achievement
1. Who Is Responsible? A good training course should incorporate methods for assessing trainee achievement. EMD Program Administrators and appropriate committee members (including the medical director) are responsible for development, validation and administration of all written and practical examinations. The instructor should not be asked to design the examination. This ensures consistent testing of the goals and objectives of the curriculum, regardless of who the instructor happens to be. All trainees will be asked to reach the same level of competence.
2. What Do I Look For When Assessing Trainee Achievement? Trainees must demonstrate that they have attained the knowledge and skills taught in the course. While it is difficult to recommend a specific passing score, we think it responsible and reasonable to ask for a passing score of at least 85%. It is the responsibility of the course administrator to assure that trainees attain proficiency in each topic area before they proceed to the next area. Trainee requirements for completing the course are as follows:
It may be necessary to confront the trainee (not during class) about their behavior to determine the reason for the inappropriate attitude.
d. Attendance - Trainees are required to attend a minimum 24 hours of training. This recommendation is based on a written curriculum, however CBT curricula will require a different number of hours due to its unique structure and presentation method. At the discretion of the instructor, trainees missing a lesson may demonstrate the fulfillment of all skills and knowledge covered in that lesson. Special examination sessions may be provided for trainees who miss tests for valid reasons (at the instructor's discretion).
3. Additional Measures. You should include assessments of subsequent dispatcher performance (on-the-job performance) by each trainee who has participated in the course as part of the ongoing process of training program evaluation. Reviewing trainee performance records allows you to assess the effectiveness of the training course.
Summary
Part Two of this Manager's Guide has introduced you to methods and recommendations for developing training for your EMD program. You've been introduced to the NHTSA National Standard Curriculum and have learned what types of content are found in good EMD training programs.
Part Two has also provided you with some insights into developing instructional programs and has given you information regarding course planning. Choosing course content as well as customization considerations were also discussed. Finally, you learned about assessing trainee achievement.
Part Three of this guide will cover EMD program administration issues, including QA/QI. You will also be presented information regarding continuing dispatch education, certification and the basics of program evaluation.
A. Conduct Orientation of Ancillary Public Safety Agencies in the Geographic Region
Every ancillary public safety agency in the region that will be affected by the EMD program must be oriented to the purpose and effect of the program. Ancillary Public Safety agencies must be informed of the new functions of the EMDs, and it must be explained that the methods used by EMDs for dispatch or providing instructions will change. Any time a new program is implemented this orientation should be conducted so that the left hand knows what the right hand is doing.
B. Provide Public Education to Orient Service Population to the New EMD Program
The public education program should focus on what the EMD program will consist of and how the EMDs will provide better service. In this way, the public becomes aware that they are being questioned by a dispatcher in order to determine which resources should be sent and to give the caller assistance until help arrives.
The education should not focus just on when to call 9-1-1 or other specific 9-1-1 education. The information should be EMD specific, to orient the calling public with information about how calls are processed and how instructions may be given over the telephone.
Multiple media sources may be utilized including direct mail brochures, public service announcements on radio and television, newspaper announcements, feature articles and editorials. Special feature human interest stories on local news and in the paper are particularly useful. School programs and videos also have been common avenues of public education.
There are a number of techniques to help individuals understand a particular topic and they all begin with a PLAN. A Public Awareness & Education Plan has many facets and following are some concepts which could be included in public awareness efforts.
Regardless of the stage of implementation that your EMD program is in, it is important to educate the political influences in your area. These include council members, county commissioners, public safety agency officials, and the media.
If these parties were involved in the overall planning and conceptualization for the EMD program, then obtaining and maintaining their support is much easier as your system goes on-line or in the event that problems develop. Remember that EMD affects everyone in the community and it is their involvement and education that will make or break the success of your system.
In identifying your Public Information and Education Plan, some goals have to be set. Equally important is identifying your target groups.
Who needs to be educated? The media, the general public, including schoolage children, public safety agency personnel such as dispatchers, paramedics/EMTs, fire fighters, patrol officers, all affected public safety departments and supervisors should be included.
How can this education be accomplished? Which advertising medium works best? Information flyers, brochures, bill inserts, posters, coloring books, activity books, mascots, balloons, telephone stickers, educational videotapes, public service announcements (radio and television), speaker's bureau, newspapers and publications should all be considered.
The avenues to facilitate your public awareness efforts are numerous. The key is just deciding what works best for your area. Will the local telephone company be responsible for any portion of your public awareness plan? Are funding resources available?
Some telephone companies will contribute their resources in providing public education materials. This may be in the form of bill inserts to be included in telephone bills, coloring books for the lower grade school levels, listing on the inside cover of the telephone directory that 9-1-1 is available and speakers to talk to civic club groups. Check with your local telephone companies and get them involved with this mutual effort.
If you have a funding source allocated towards public education materials, regardless of how large or small those funds are, make sure that you get the best "bang for the buck" out of those dollars. Your annual operating budget should include a line item for ongoing public education-type materials. These materials do not have to be expensive; however, they should be of the highest affordable quality and not easily outdated. Check in your area for an advertising federation or organization and solicit their help in launching a public awareness PUBLIC SERVICE effort. They can contact various media and print vendors who also have a PUBLIC SERVICE commitment, who may donate their time or reduce the normal price for their services. In this approach the creative talent and professional advice is usually given at no charge, and any of the ideas suggested can be implemented by incurring just the production costs. This avenue should yield a quality product which is timeless.
Television and radio stations all have public service directors who can be contacted and solicited for help in getting a public service announcement worked into their schedules. With enough notice, some television stations will help to produce a 30 second public service announcement spot, and as long as it is "generic," will make the spot available to the other local television stations.
Radio stations work more with scripts; however, once they understand the intended message, some will develop a public service message which can be played or read at regular intervals. Local colleges, which include media relations or communications in their curriculum, can also be tapped to develop a public education plan as part of their course work. In addition to developing a lesson plan, some school districts may have the means to develop public service messages or an educational program on the proper use of the 9-1-1 system, which can be utilized throughout their networking system.
At the very least, these school districts can be instrumental in being a distribution point for public education materials. Set up a network of contacts and utilize them more than once during the school year. Also, time your distribution to their study curriculum when they cover health and safety topics and during special events, such as fire prevention month.
When should the public be informed, and how often? There are numerous opinions on what works best and how often this should be done; once a year, only as the system goes on-line, quarterly, monthly, daily, etc.
The decision is not simple for a number of reasons. However, it is crucial that affected citizens be informed of the proper use of your 9-1-1 system and the EMD program.
Once you have involved political officials and the media and have trained public safety agency personnel (including supervisors), your ongoing public awareness efforts should then be focused on school-age children and the general public. Remember to set GOALS for your Public Information and Education Plan. These goals should include:
1. telling the public that the way calls are taken will change, that you are still going to come to them but that you are going to ask some questions first in an effort to better serve their emergency medical needs;
2. defining what is considered an emergency according to the input from the serving public safety agencies;
3. what situations EMDs should be used for and educating your community that EMD service is available;
4. where EMD service is available;
5. keeping down the number of prank or false calls on your system;
6. setting an objective regarding the number of "real" EMD calls which you expect to receive and realistic timelines to reach these objectives;
7. use of the regular 7-digit number for non-emergency situations;
8. how to access EMDs from certain types of telephones, such as detached extensions off of PBX's, coin phones, TTY/TDD devices, mobile phones, cordless telephones, and radio-activated phones;
9. the importance of knowing and communicating the address of where the help is needed and the type of emergency and
10. how to address the needs of special interest groups such as non-English speaking callers, deaf/hearing-impaired callers, theme parks, business complexes, and shopping malls. Include their input on acceptable callhandling procedures.
Public awareness and education is an ongoing process. It is not a task which occurs just once in the life of your EMD system.
C. The Circular Evolution of EMD Programs
An ongoing EMD QA/QI and CDE program is in constant evolution and enhancement. After training and implementation, feedback guides the advancement and improvement of the system. Without this process the program falters and becomes stale.
D. Begin Dispatch Feedback and Performance Monitoring
A vital part of the feedback process includes the use of a formal process of dispatch feedback reporting, submitted by all dispatch related parties, including EMS field personnel (public and private), law enforcement, hospitals and dispatchers themselves.
This written clarification of "what happened" at dispatch is researched by the QA/QI personnel and shared with the dispatchers, supervisors, and/or, in interesting or judgment-call cases, the guidance committee. This helps to organize the process of case review.
The QA/QI process provides useful information that can alert the administrative personnel of possible dispatch problems related to the medical dispatch operation.
Dispatchers should receive feedback on a weekly basis with respect to their protocol compliance and how their performance effects the system generally. Weekly feedback and remediation keeps the education and evaluation process going and communicates to the dispatchers that the EMD program is seen by administration as a serious and permanent operation.
E. Replacement Training for Attrition
Just like QA, training is also a process, not an event. A sound ongoing program of continuing dispatcher education is essential. Without routine monthly education, an initially sound EMD program gets slowly weaker. CDE at a minimum, is one hour per month and includes review of dispatch priorities, practical "mock" scenario drills, BLS level techniques, appropriate reading, and even field experience with EMS crews.
As professional medical personnel, EMD's should have access to and be directed to routinely read professional and trade journals representing the fields of both telecommunications and emergency medical services. Dispatchers and their supervisors should be allowed to attend remote conferences and seminars that, in essence, bring new life into the local center. A CDE tracking process for each dispatcher should be established and maintained by the quality assurance staff to insure that all necessary elements of CDE are received.
The continuing education programs must be well designed and address topics based upon QA findings. Through consistent and ongoing line case review, the reviewer is able to identify and measure system efficiency based on the dispatcher's compliance to identified performance standards. More attention should be paid to the medical aspects of dispatch. This knowledge enhances the dispatcher's confidence in dealing with various medical emergencies. Ongoing supervised scenario drills, lectures, in service presentations, etc. familiarize the dispatchers with the proper utilization of the protocols, the rationale behind their design and the logic of their operation. Having immediate resource ability and feedback, in these sessions, enhances the dispatcher's knowledge and understanding of the protocols.
Using continuing education to remediate weaknesses found during the QA process further enhances the risk management of the system. Discovering errors, retraining to correct the errors and tracking employee performance through QA allows for disciplinary due process when cumulative measures to correct individual performance are not effective. In this way you are able to identify unsafe practitioners and maintain the desired level of operational integrity and consistency within the system.
F. Continuing Dispatch Education (CDE) Objectives
The CDE program must be organized around the standards of care, practice and responsibilities of the EMD and meet the following specific objectives:
1. Maintain and develop the EMD's understanding of medical conditions, incident types and the priorities necessary when performing caller assessment and prioritization of medical calls.
2. Maintain and improve skills in providing telephone pre-arrival instructions offered in the scope of the EMD's certified training.
3. Maintain and improve the EMD's ability to use the EMDPRS.
4. Maintain knowledge of seldom used technical aspects of the system such as phone patching, emergency procedures, etc.
5. Provide opportunities for discussions, skill practice and critique of skill performance.
6. Review and understand issues and findings identified by the dispatch quality assurance process.
These objectives may be accomplished in the following ways:
1. Group Training
Provide workshops, seminars and conferences that relate to the required skills of an Emergency Medical Dispatcher. Some examples include: CPR, airway management, patient assessment, reviewing the thirty-two chief-complaints, use of equipment and refresher courses.
Organize local training meetings to review emergency medical services procedures and communications. Have guest speakers present material related to emergency care procedures, medical-legal requirements or other topics which are directly related to the function of an Emergency Medical Dispatcher.
Coordinate demonstration or practice sessions utilizing available dispatch life support equipment. Have community emergency exercises and disaster drills if possible and appropriate.
Show audiovisuals (films, videos) which illustrate and review proper emergency medical dispatch procedures. Specific college courses may also be utilized.
2. Teaching Classes
EMDs can teach the general public (schools, scouts, clubs, or church groups) any topic within the scope of the Emergency Medical Dispatcher.
3. Scenario Training Practical training and role playing using the EMDPRS should be ongoing.
4. "Ride-Alongs"
EMDs should ride with paramedic or ambulance units to understand the EMS system from the other side of the radio. It may also be useful to have paramedics and ambulance unit personnel visit the EMDs to see the environment in which EMDs work.
G. Modifying the EMDPRS
The enhancement and modification of EMDPRS processes and response configurations requires the adoption of a formal department policy outlining this process as identified by the guidance committees.
Any changes that are identified that need to be made to the EMDPRS should be based on verifiable data and patterns of error over time vs. isolated incidents. If the protocol was not followed and the error was made as result of this omission, no change should be recommended. If the EMDPRS was followed and a pattern of similar mistakes is identified over time, then a recommendation should be made to the appropriate guidance committees for a change.
Any recommended change should include all data that the change is based upon, all taped cases demonstrating the error, and recommendations for change to reduce the likelihood of error in the future. Some proprietary systems have an established review process for implementing changes.
Changes should not be made based on isolated incidents or without sufficient data to back up the recommended change. There is a tendency to modify protocols before the practice has been examined. This is a major error in protocol modification schemes.
All modifications must be approved by the supplier of the EMDPRS, all guidance committees and the medical director before any changes are made. Changes should then be tracked carefully to determine appropriateness of the change and the effect of the change on the error rate.
H. Certification Requirements and Re-certification Requirements
This guideline is designed to assist Emergency Medical Dispatchers (EMDs) to understand and complete common two year re-certification requirements.
Each EMD is usually individually responsible for completing and submitting the required re-certification material to the certifying entity. However, the EMD may work with an EMS organization which may organize and conduct continuing dispatch education (CDE) programs to compile and submit recertification materials on behalf of the EMD.
Re-certification allows the agency, supervisor and medical director to formally assure continued adherence by the EMD to state and national requirements and standards. Documentation of objective criteria in the form of hours and types of CDE, practical and written examinations, and established processes for decertifying individuals who cannot meet such minimal criteria is crucial.
Re-certification is normally required every two to four years to maintain certification. There are commonly twenty four hours of CDE requirement to recertify. Some certifying entities often have a certification, re-certification or testing fee. This should be taken into consideration when budgeting.
Previous certification can be checked by contacting the certifying entity and requesting records of certification.
There are state certification programs along with certification programs offered by national organizations and proprietary agencies. At present, many states are in the process of creating formal certification requirements, but there are very few that provide training and certification. Most local programs rely on programs already marketed by proprietary agencies.
I. Reciprocal Certification Requirements
Reciprocal certification should be established at the state level to deal with the various EMD programs. The diversified EMDPRS protocols require specific training and knowledge in their proper use. Therefore, the emergency medical dispatcher wishing reciprocal certification must receive formal training on the specific EMDPRS which is used for the certification being sought and as used within the EMDs employing agency. For further information on certification and reciprocal certification, refer to ASTM standard F1560-94, Sections 9 through 11.
Any reciprocal certification should require that the EMD demonstrate knowledge of the philosophy and use of a specific EMDPRS. The EMD should also be tested, using a practical examination to ensure the proper use of the new system.
Each agency and guidance committee should establish their own in-house criteria for reciprocity and skill demonstration. Performance thresholds should be established to educate and test the EMD to ensure that everyone seeking reciprocity meet a minimum standard of care within the new agency.
J. EMD Skills Checklist
Each training entity should adopt a formal written policy delineating the skills to be demonstrated by the dispatcher after training. Upon completion of training the EMD should, at a minimum, be able to:
K. Refusal, Suspension or Revocation of Certification
While the goal of quality assurance is always to correct deficiencies and encourage excellence (not just adherence to minimum standards) there comes a time when, for EMD's failing to meet standards, or who are involved in activities not becoming a professional, terminal action is required.
Demonstrated inability and failure to perform adequate patient care through approved pre-arrival instructions and failure to perform according to the predetermined medically approved EMDPRS protocols are very significant failures and cannot be tolerated in a well run comprehensive EMD system.
EMD certification or re-certification, may be suspended or revoked by the agency or certifying entity for any of the following causes (adapted from ASTM Standard F1560-94):
L. Program Evaluation
The best means of dispatch system and protocol evaluation, validation, and dispatcher performance monitoring is through on-line random tape review by trained dispatch QA personnel. This gives the QA personnel pertinent information regarding protocol compliance and the effects of noncompliance on the system. Errors in response level selection should be related to system performance policies and assessments.
Errors should relate to compliance, protocol or external factors that are beyond the dispatcher's control. Errors in compliance cases should be remediated and feedback given to the dispatcher. Errors in the protocol should be documented and forwarded with data showing error patterns (instead of isolated incidents) and reported to the guidance and QA/QI committees for a possible change in protocol. Errors related to external factors (those beyond the EMD's control) case should be documented and filed, and feedback should be given to the dispatcher indicating that the error was out of the control of the EMD handling the case.
Conclusion
This manager's guide has walked you through the basics of implementing and administering EMD programs. In Part One you learned the basics of constituency building, selection of personnel and committees, training considerations and EMDPRS selection. In Part Two you learned what kinds of things to consider when establishing a training program, from design through OJT considerations. In Part Three, you learned how to follow-up your implementation and training strategies with the basics of on-going QA/QI programs. You also learned about certification, re-certification and reciprocal certification.
Please remember that the recommendations made in this manual are just that: recommendations. As such, you should feel free to use these recommendations to help you establish your own policies and procedures. As long as the requirements of the NHTSA curriculum are met, there are no hard and fast rules about implementing, QA/QI, training or EMD program management. What works in your area, might not work for another and vice versa.
Emergency Medical Dispatch Protocol Reference Systems (EMDPRSs) are available from several sources, both proprietary and public domain. These sources are listed below. Those items and companies listed are for reference purposes only. The list is not all inclusive. The Federal Government does not endorse any products, courses or companies included in this list.
Please be sure to read Section E of this appendix on using/developing locally approved EMDPRS protocols.
A. PROPRIETARY SOURCES
Proprietary sources include materials available commercially from:
1. Medical Priority Consultants, Inc. (MPC, Inc.) 139 East South Temple, Suite 500 Salt Lake City, UT 84111 - 1103 Phone: (801) 363 - 9127 Fax: (801) 363 - 9144
This set of EMDPRS cards is maintained by The Academy for Emergency Medical Dispatch. It includes a rigorous methodology for revising and updating its materials, through the direction of The College of Fellows. The card sets are serialized and are updated by the company.
2. Association of Public-Safety Communications Officials-International, Inc. (APCO, Inc.) 2040 South Ridgewood Avenue South Daytona, FL 32119 - 8437 Phone: (904) 322 - 2500 Phone: (800) 949 - APCO FAX: (904) 322 - 2501 FAX: (904) 322 - 2502 BBS: (904) 322 - 2503
This set of EMDPRS cards is managed by the APCO Institute, Inc. It is customized based on the requirements of the purchasing agency.
3. Powerphone, Inc. P.O. Box 1911 1317 Boston Post Road Madison, CT 06443 - 0900 Phone: (800) 537-6937 Phone: (203) 245-8911 Fax: (203) 245-3022
This commercially available training and card set is derived from the early (1979) DOT-NHTSA public domain card set. Powerphone offers EMD training and/or protocol guides.
4. National Communications Institute (NCI) 1084 Country Court, NW Suite 200 Lawrenceville, GA 30244 - 3110 Phone: (404) 381 - 6732 FAX: (404) 926 - 1252
This set of cards is based on an early NHTSA public-domain card set and meets the current US. DOT NHTSA Standard 11 and ASTM standard 1552-94. Local agencies are provided copies of the card set (on disk) and are permitted to modify their cards based on local needs and medical direction.
B. PUBLIC DOMAIN SOURCES
Public domain sources for EMDPRSs are available from several public sources. You might think of these as analogous to computer programs known as "shareware." They are usually available at low (or no) cost and typically have no warranty or implied "litigation protection." Sources include:
1. State card sets
Sources include:
a. Colorado EMS Division Larry McNatt 4300 Cherry Creek Drive South Denver, CO 80222-1530 Phone: (303) 692 - 2985 Fax: (303) 782 - 0904
b. others may be available; You may want to check with other states' EMS officials to see who else has developed their own card sets
C. OTHER EMDPRS SOURCES
There may be other sources for EMDPRS selection. One source is King County, Washington. Their Criteria Based Dispatch program, which includes an EMDPRS and training materials, was developed specifically for King County. King County encourages the use of Criteria Based Dispatch by publicly funded agencies, however their materials are copyrighted and a licensing agreement is required between your agency and King County. For more information, contact them at the address and phone listed below.
King County Contact: Linda Culley King County EMS Division 900 Fourth Avenue, Suite 850 Seattle, WA 98164 Phone: (206) 296 - 4693 Fax: (206) 296 - 4866
Other sources may be available. EMS personnel in other metropolitan areas may be good sources to call and ask if they know of any other public domain sources for EMDPRSs.
D. MISCELLANEOUS
Should you decide to include an OJT component to your EMD training program, you might find it difficult to locate EMD-specific OJT materials. One source of materials that are available for your review can be obtained from the State of Oregon. The OJT component of their EMD program is available in an easy to read, comprehensive format. Other sources may be available. EMS personnel in other metropolitan areas may be good sources to call and ask if they know of any other sources of OJT specific materials.
Oregon Contact: Eriks Gabliks Board on Public Safety State of Oregon Standards and Training 550 North Monmouth Avenue Monmouth, OR 97361 Phone: (503) 378 - 2100, ext. 255
E. LOCALLY DEVELOPED EMDPRSs
With the appropriate resources and personnel, an agency could conceivably develop its own card set. However, this is not advised, for several reasons:
1. The developing agency may have the required medical expertise to develop a protocol, but may lack the experience and historical perspective to develop a protocol that will be initially useful;
2. The development of local protocols may place an economic burden on the agency due to the costs of hiring consultants and document design specialists, among others, who will participate in the development process;
3. The protocol may not be in agreement with other protocols developed by other agencies within the local geographic region;
4. All medical events may not be anticipated or accounted for during the development process;
5. The time required to develop, modify and test protocols may require too many personnel to be away from their main job functions, thereby placing an unfair strain on the personnel who will take over their roles in their absence and
6. Local medical directors may be reluctant to approve locally developed emergency medical protocols.
Agencies may find it faster and far less inexpensive to purchase a commercially available or public domain card set. Using these will most likely address the concerns addressed in Section E, Locally Developed EMDPRSs, of this appendix.