A fire engine or ambulance doesn't have to be the first unit on the scene of a medial emergency--a dispatcher can be there within milliseconds, by phone, providing medical information and pre-arrival instructions via phone. That's the concept behind emergency medical dispatching (EMD).
EMD consists of three parts: First, triaging the in-coming request for medical service to determine the level of response--no response, non-emergency transport, emergency transport. This feature depends heavily on the area's emergency medical facilities, and the availability of alternate, non-emergency transport methods and treatment facilities. Many jurisdictions do not implement this feature of EMD, but it is an important component in reducing abuse or overcrowding of the local emergency medical system, reducing incidents (which helps conserve available resoures for the fire department, ambulance provider, emergency rooms, etc.), and helping to reduce accidents.
The second part of EMD consists of providing pre-arrival instructions to the caller, so they can immediately help the victim. The level of telephone assistance can vary from just simple advice (call your doctor), to complete instructions for CPR. This is the most visible component of EMD and, if you're the victim, perhaps the most valuable feature--saving lives. Pre-arrival instructions are most commonly provided on flip cards, arranged so the dispatcher can question the caller and, based on the answers, quickly go the card that contains the correct advice, instructions, etc.
The third and most critical feature of EMD is quality assurance. Each EMD program must originate with the complete involvement and cooperation of local emergency medical officials. Each aspect of the EMD protocol selected must be reviewed, revised as needed and approved by the local or regional EMS agency. This ensures that the information and procedures being given by the dispatchers is correct, and appropriate for local conditions. In addition, there must be an on-going review of the use of the EMD protocols by the dispatchers, to ensure they're following them correctly, and that the protocols have a positive impact on the victims. This review could involve random selection of several incidents each month for analysis, grading, providing feedback to the dispatcher, and revision of the protocols if necessary.
This concept--an immediate "arrival" of medical help--was born in the late 1970s and had two roots for the "protocols," or methods used. First, the U.S. Department of Transportation (DOT) developed a set of protocols in the late 1970s as part of a program to improve survivability of vehicle crash victims on the nation's highways. A second set of protocols was developed by Dr. Jeff Clawson in 1979 as part of an attempt to reduce the number of Code 3 medical runs and, therefore, the number of fire department-related vehicle accidents. Now, at least three groups or companies market materials based in some part on the DOT materials, while Clawson's materials are marketed by the company he founded, Medical Priority Consultants, Inc.
For background information on EMD and the companies who provide it, read our definitive three-part story that appeared in a 1991 issue of DISPATCH Monthly. You should also consider purchasing the primary book on the subject, "Principles of Emergency Medical Dispatch," by Jeff J. Clawson, M.D. and Kate Boyd Dernoceur, EMT-P, B.S., available used on Amazon.
The main sources of EMD information and training are: