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).
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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., the definitive work on the subject. As of Oct. 2001, the book (in its 4th Edition) is only available in conjunction with certification and training in EMD given by Medical Priority Consultants. However, we understand this situation may change--we'll keep you posted here.
The main sources of EMD information and training are:
- U.S. Department of Transportation--A national standard curriculum originally developed in 1976. It did not include flip-cards for pre-arrival instructions, but could be used in conjugation with any source of flip cards. It consists of an Instructor's Guide, Trainee Guide, and Manager's Guide, all in Acrobat (pdf) format--surf the entire list of documents to download them.
- National Highway Transportation Safety Administration (NHTSA)--This federal agency now distributes the updated 1996 version of the EMD materials, which consist of a manager's guide, instructor's guide and trainee's guide, all available for download in Acrobat (pdf) format.
- Medical Priority Consultants, Inc.--Developed by Dr. Jeff Clawson in 1979 while he worked at the Salt Lake City (UT) Fire Department. He then formed this company in 1987 to market an expanded set of protocols for a fee (now at Version 11). [Web site]
- National Academy of Emergency Medical Dispatch--Organization founded in 1988 that manages and administers the EMD protocols originated by Dr. Clawson. [Web site] [call evaluation form, pdf]
- Association of Public-Safety Communications Officials (APCO)--Introduced in 1990 and available for a fee. [Web site]
- PowerPhone--A private company that provides EMD training and protocols. [Web site]
- National Emergency Communications Institute (NECI) - 911 training including basic, EMD, train-the-trainer and supervisors.
- American Society for Testing Materials (ASTM)--This standards-setting body has several related to EMD, available for a $30 each:
- State of California's EMS Authority Web page on EMD, including guidelines and plan
- For your convenience, we have posted a major portion of the NHTSA initial study on our Web site. The curriculum consists of a manager's guide, a student guide and an instructor's guide. Other EMD links are also included:
- Manager's Guide, 80k
- EMD Protocol Reference System 154k
- EMS Model Flowchart [GIF graphic]
- Milwaukee EMS Performance Standards & Questioning
- California EMD Training Guidelines
- The state of New Jersey has posted its standardized EMD guidecards.
- Raleigh - Wake County EMD Description
- Articles from 9-1-1 Magazine [overview] [Clawson interview]
- Firehouse.com Bookstore on EMD
- The Communications Committee of the National Association of State EMS Directors (NASEMSD) voted to recommend endorsement of the Model Emergency Medical Dispatch (EMD) Legislation proposed by the National Academies of Emergency Dispatch (NAEMD). Check their Web site for more information. 11-21-2001
- Model Statute Legislation [Acrobat, pdf version, 112k]
- Model Rules and Regulations [Acrobat, pdf version, 112k]
- A 2001 British study of 999 calls concluded that a two-tier system of prioritizing medical responses would reduce dispatches and improve service. [Acrobat, pdf, format] 3-1-2002
- The State of New Jersey has developed a complete set of guide cards for EMD, which they've posted on-line in Acrobat format, or as individual files. However, please read the above explanation of EMD before you even consider downloading and using the materials at your own site--an EMD program is not as simple as a file download! 3-23-2002
- The EMS subcommittee of ITSA America, the intelligent transportation trade group, issued a 25-page report with recommendations on improving EMS services, and which focused mainly on communications. [Acrobat, pdf format, 850k] 10-7-2002
- The Ontario (Canada) government commissioned a consultant to study Hamilton's EMS comm center, and came back with recommendations on staffing, etc.
- The law firm Page, Wolfberg & Wirth specializes in medical and emergency medical legal matters. They have lots of resources on privacy, billing and other issues. 12-16-2002
- The state of California has finalized their draft Emergency Medical Dispatch Guidelines, intended to, "to provide a consistent, statewide standard for emergency medical dispatch agencies and dispatchers that choose to implement an EMD program." The state does not yet have an EMD program-- this is the first step for training, continuing education, medical direction, continuous quality improvement, and for pre-approved medical protocols. [Acrobat, pdf format] 9-4-2003
- A scientific medical article showing there was a significant difference in the accuracy of EMS dispatchers' diagnosis of cardiac arrest depending on the type of caller.
- State of Utah EMD program instruction materials
