Re: EMD Dispatching Controversy?

[Guest guest]

Rob -- About a year or so ago, I discussed EMD (and MPDS in particular) on

another list and was thoroughly bashed by the MPDS proponents as violently as

Dr. Bledsoe gets attacked by the CISM folks. I'd be very curious to see any

literature relating to MPDS and EMD other than that which is promulgated by Dr.

Clawson et al in Salt Lake City.

I've seen some examples of EMD going awry in my field experiences, leading me to

at least question the efficacy of the current triaging and pre-arrival

instructions.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

EMD Dispatching Controversy?

I recall a recent discussion where it was mentioned that the validity

of the whole EMD concept is in question, as if it is headed for Dr.

Bledsoe's list of EMS myths.

Can anybody point me towards any literature on this controversy, or at

least give me a little info?

Rob

[Guest guest]

Rob -- About a year or so ago, I discussed EMD (and MPDS in particular) on

another list and was thoroughly bashed by the MPDS proponents as violently as

Dr. Bledsoe gets attacked by the CISM folks. I'd be very curious to see any

literature relating to MPDS and EMD other than that which is promulgated by Dr.

Clawson et al in Salt Lake City.

I've seen some examples of EMD going awry in my field experiences, leading me to

at least question the efficacy of the current triaging and pre-arrival

instructions.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

EMD Dispatching Controversy?

I recall a recent discussion where it was mentioned that the validity

of the whole EMD concept is in question, as if it is headed for Dr.

Bledsoe's list of EMS myths.

Can anybody point me towards any literature on this controversy, or at

least give me a little info?

Rob

[Guest guest]

Rob -- About a year or so ago, I discussed EMD (and MPDS in particular) on

another list and was thoroughly bashed by the MPDS proponents as violently as

Dr. Bledsoe gets attacked by the CISM folks. I'd be very curious to see any

literature relating to MPDS and EMD other than that which is promulgated by Dr.

Clawson et al in Salt Lake City.

I've seen some examples of EMD going awry in my field experiences, leading me to

at least question the efficacy of the current triaging and pre-arrival

instructions.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

EMD Dispatching Controversy?

I recall a recent discussion where it was mentioned that the validity

of the whole EMD concept is in question, as if it is headed for Dr.

Bledsoe's list of EMS myths.

Can anybody point me towards any literature on this controversy, or at

least give me a little info?

Rob

[Guest guest]

Wes, EMD systems like MPDS are a useful, and life saving tool. But, like

anything else we do, without the three levels of Improvement (retrospective,

concurrent and prospective), and system will have flaws. Another important

note, if you do Improvement activities, have a feedback function at all levels

incuding field and the communications center staff, and share the findings!

[Guest guest]

Wes, EMD systems like MPDS are a useful, and life saving tool. But, like

anything else we do, without the three levels of Improvement (retrospective,

concurrent and prospective), and system will have flaws. Another important

note, if you do Improvement activities, have a feedback function at all levels

incuding field and the communications center staff, and share the findings!

[Guest guest]

Wes, EMD systems like MPDS are a useful, and life saving tool. But, like

anything else we do, without the three levels of Improvement (retrospective,

concurrent and prospective), and system will have flaws. Another important

note, if you do Improvement activities, have a feedback function at all levels

incuding field and the communications center staff, and share the findings!

[Guest guest]

Useful and live saving - how? I'm just asking, not trying to intentionally pick

an argument. My personal opinion (not necessarily backed by research) is that

EMD/MPDS is most appropriate when EMS is not dispatched by a trained EMS

provider. I've seen cases where the " cards " may provide instructions that are

contraindicated (or not fully expanded upon) by our EMS training. For example,

I've personally seen a case where a patient with difficulty breathing was placed

supine on the floor, per pre-arrival instructions. The only problem was that the

patient had CHF, which was exacerbated by laying down.

My preference is for MPDS to be used when the dispatcher is not EMS trained. I

believe there's a need for a different sort of dispatching protocol when the

dispatcher is EMS certfied.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

Re: EMD Dispatching Controversy?

Wes, EMD systems like MPDS are a useful, and life saving tool. But, like

anything else we do, without the three levels of Improvement (retrospective,

concurrent and prospective), and system will have flaws. Another important

note, if you do Improvement activities, have a feedback function at all levels

incuding field and the communications center staff, and share the findings!

[Guest guest]

Useful and live saving - how? I'm just asking, not trying to intentionally pick

an argument. My personal opinion (not necessarily backed by research) is that

EMD/MPDS is most appropriate when EMS is not dispatched by a trained EMS

provider. I've seen cases where the " cards " may provide instructions that are

contraindicated (or not fully expanded upon) by our EMS training. For example,

I've personally seen a case where a patient with difficulty breathing was placed

supine on the floor, per pre-arrival instructions. The only problem was that the

patient had CHF, which was exacerbated by laying down.

My preference is for MPDS to be used when the dispatcher is not EMS trained. I

believe there's a need for a different sort of dispatching protocol when the

dispatcher is EMS certfied.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

Re: EMD Dispatching Controversy?

Wes, EMD systems like MPDS are a useful, and life saving tool. But, like

anything else we do, without the three levels of Improvement (retrospective,

concurrent and prospective), and system will have flaws. Another important

note, if you do Improvement activities, have a feedback function at all levels

incuding field and the communications center staff, and share the findings!

[Guest guest]

Useful and live saving - how? I'm just asking, not trying to intentionally pick

an argument. My personal opinion (not necessarily backed by research) is that

EMD/MPDS is most appropriate when EMS is not dispatched by a trained EMS

provider. I've seen cases where the " cards " may provide instructions that are

contraindicated (or not fully expanded upon) by our EMS training. For example,

I've personally seen a case where a patient with difficulty breathing was placed

supine on the floor, per pre-arrival instructions. The only problem was that the

patient had CHF, which was exacerbated by laying down.

My preference is for MPDS to be used when the dispatcher is not EMS trained. I

believe there's a need for a different sort of dispatching protocol when the

dispatcher is EMS certfied.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

Re: EMD Dispatching Controversy?

Wes, EMD systems like MPDS are a useful, and life saving tool. But, like

anything else we do, without the three levels of Improvement (retrospective,

concurrent and prospective), and system will have flaws. Another important

note, if you do Improvement activities, have a feedback function at all levels

incuding field and the communications center staff, and share the findings!

[Guest guest]

I'm not sure what " cards " you might be using, but MPDS does not at

anypoint instruct that the pt be told to lay down during a difficulty

breathing call.

In fact it specifically states " in conscious patients, breathing may

be helped by sitting up. "

I stongly believe in what Micheal said, How can you know if it is

working or not unless you audit the call-taker to make sure they

follow protocol, and then have feed back from the medics, when you

have calls that might have been coded wrong.

How many times do we take a patient to the ER and they tell the Doc a

totally diffent chief complaint than what we were told at the scene.

believe it or not it also happen when people call 9-1-1.

my 2 cents

EMT-P/ EMD

Director of Communications

Med-Care EMS

>

> Useful and live saving - how? I'm just asking, not trying to

intentionally pick an argument. My personal opinion (not necessarily

backed by research) is that EMD/MPDS is most appropriate when EMS is

not dispatched by a trained EMS provider. I've seen cases where

the " cards " may provide instructions that are contraindicated (or not

fully expanded upon) by our EMS training. For example, I've

personally seen a case where a patient with difficulty breathing was

placed supine on the floor, per pre-arrival instructions. The only

problem was that the patient had CHF, which was exacerbated by laying

down.

>

> My preference is for MPDS to be used when the dispatcher is not EMS

trained. I believe there's a need for a different sort of dispatching

protocol when the dispatcher is EMS certfied.

>

> -Wes Ogilvie, MPA, JD, EMT-B

> Austin, Texas

>

> Re: EMD Dispatching Controversy?

>

>

> Wes, EMD systems like MPDS are a useful, and life saving tool.

But, like

> anything else we do, without the three levels of Improvement

(retrospective,

> concurrent and prospective), and system will have flaws. Another

important

> note, if you do Improvement activities, have a feedback function at

all levels

> incuding field and the communications center staff, and share the

findings!

>

>

>

[Guest guest]

I'm not sure what " cards " you might be using, but MPDS does not at

anypoint instruct that the pt be told to lay down during a difficulty

breathing call.

In fact it specifically states " in conscious patients, breathing may

be helped by sitting up. "

I stongly believe in what Micheal said, How can you know if it is

working or not unless you audit the call-taker to make sure they

follow protocol, and then have feed back from the medics, when you

have calls that might have been coded wrong.

How many times do we take a patient to the ER and they tell the Doc a

totally diffent chief complaint than what we were told at the scene.

believe it or not it also happen when people call 9-1-1.

my 2 cents

EMT-P/ EMD

Director of Communications

Med-Care EMS

>

> Useful and live saving - how? I'm just asking, not trying to

intentionally pick an argument. My personal opinion (not necessarily

backed by research) is that EMD/MPDS is most appropriate when EMS is

not dispatched by a trained EMS provider. I've seen cases where

the " cards " may provide instructions that are contraindicated (or not

fully expanded upon) by our EMS training. For example, I've

personally seen a case where a patient with difficulty breathing was

placed supine on the floor, per pre-arrival instructions. The only

problem was that the patient had CHF, which was exacerbated by laying

down.

>

> My preference is for MPDS to be used when the dispatcher is not EMS

trained. I believe there's a need for a different sort of dispatching

protocol when the dispatcher is EMS certfied.

>

> -Wes Ogilvie, MPA, JD, EMT-B

> Austin, Texas

>

> Re: EMD Dispatching Controversy?

>

>

> Wes, EMD systems like MPDS are a useful, and life saving tool.

But, like

> anything else we do, without the three levels of Improvement

(retrospective,

> concurrent and prospective), and system will have flaws. Another

important

> note, if you do Improvement activities, have a feedback function at

all levels

> incuding field and the communications center staff, and share the

findings!

>

>

>

[Guest guest]

Just relating along my anecdotal experience, which is of course, not proven by

research. Is there empirical research that shows that MPDS/EMD improves patient

outcomes?

-Wes

Re: EMD Dispatching Controversy?

>

>

> Wes, EMD systems like MPDS are a useful, and life saving tool.

But, like

> anything else we do, without the three levels of Improvement

(retrospective,

> concurrent and prospective), and system will have flaws. Another

important

> note, if you do Improvement activities, have a feedback function at

all levels

> incuding field and the communications center staff, and share the

findings!

>

>

>

[Guest guest]

Just relating along my anecdotal experience, which is of course, not proven by

research. Is there empirical research that shows that MPDS/EMD improves patient

outcomes?

-Wes

Re: EMD Dispatching Controversy?

>

>

> Wes, EMD systems like MPDS are a useful, and life saving tool.

But, like

> anything else we do, without the three levels of Improvement

(retrospective,

> concurrent and prospective), and system will have flaws. Another

important

> note, if you do Improvement activities, have a feedback function at

all levels

> incuding field and the communications center staff, and share the

findings!

>

>

>

[Guest guest]

Just relating along my anecdotal experience, which is of course, not proven by

research. Is there empirical research that shows that MPDS/EMD improves patient

outcomes?

-Wes

Re: EMD Dispatching Controversy?

>

>

> Wes, EMD systems like MPDS are a useful, and life saving tool.

But, like

> anything else we do, without the three levels of Improvement

(retrospective,

> concurrent and prospective), and system will have flaws. Another

important

> note, if you do Improvement activities, have a feedback function at

all levels

> incuding field and the communications center staff, and share the

findings!

>

>

>

[Guest guest]

well to quaote Dr B, its evidence based and scientific. Those protocols are

studied, evaluated and re-studied and evaluated contantly.

I do agree with you about NO medical training. When the cards are used AS

WRITTEN with no deviation, they work great. When you Free-lance is when errors

happen. And, no matter how many protocols you write, you can't include everyone

and everything. EMS trained people spend too much time trying to diagnose the

person over the phone, instead of doing the proper triage, and giving

appropriate pre-arrival instructions. Again, GO QI programs help to alleviate

those scenarios you were associated with.

[Guest guest]

Somone suggested EMD may deserve nomination for 's scrutiny as a myth

of EMS; such examination is probably not unwarranted, though it's probably

too early to relegate it to " Swindelrs' List " of EMS bijoonas. There'a a

lot of mystique surrounding this stuff, but I've been underwhelmed by

actual data. MOst data I've encountered centers on resource allocation

matters, not on prospective outcome data--to wit, there are local data

regarding whether a drop in response status leads to further " lights and

siren " returns, but these are all proxies for actual outcomes; there are

data concerning compliance with protocols but not necessarily that

compliance yields imporved clinical outcome. I cannot put my mental finger

on anything that establishes prospectively that utilization of EMD

protocols results in decreased morbidity or mortality, but I haven't

searched exhaustively for same. It's a good set of queations to raise,

however . . . but let's stick to data (rather than personal anecdotes and

perceptions) in our analysis.

Gist, Ph.D.

Principal Assistant to the Director

Kansas City, Missouri Fire Department

Office:

FAX:

Page:

ExLngHrn@...

Sent by:

@yahoog To

roups.com

cc

01/10/2006 11:56 Subject

AM Re: EMD Dispatching

Controversy?

Please respond to

@yahoog

roups.com

Useful and live saving - how? I'm just asking, not trying to intentionally

pick an argument. My personal opinion (not necessarily backed by research)

is that EMD/MPDS is most appropriate when EMS is not dispatched by a

trained EMS provider. I've seen cases where the " cards " may provide

instructions that are contraindicated (or not fully expanded upon) by our

EMS training. For example, I've personally seen a case where a patient

with difficulty breathing was placed supine on the floor, per pre-arrival

instructions. The only problem was that the patient had CHF, which was

exacerbated by laying down.

My preference is for MPDS to be used when the dispatcher is not EMS

trained. I believe there's a need for a different sort of dispatching

protocol when the dispatcher is EMS certfied.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

Re: EMD Dispatching Controversy?

Wes, EMD systems like MPDS are a useful, and life saving tool. But, like

anything else we do, without the three levels of Improvement

(retrospective,

concurrent and prospective), and system will have flaws. Another important

note, if you do Improvement activities, have a feedback function at all

levels

incuding field and the communications center staff, and share the findings!

[Guest guest]

Somone suggested EMD may deserve nomination for 's scrutiny as a myth

of EMS; such examination is probably not unwarranted, though it's probably

too early to relegate it to " Swindelrs' List " of EMS bijoonas. There'a a

lot of mystique surrounding this stuff, but I've been underwhelmed by

actual data. MOst data I've encountered centers on resource allocation

matters, not on prospective outcome data--to wit, there are local data

regarding whether a drop in response status leads to further " lights and

siren " returns, but these are all proxies for actual outcomes; there are

data concerning compliance with protocols but not necessarily that

compliance yields imporved clinical outcome. I cannot put my mental finger

on anything that establishes prospectively that utilization of EMD

protocols results in decreased morbidity or mortality, but I haven't

searched exhaustively for same. It's a good set of queations to raise,

however . . . but let's stick to data (rather than personal anecdotes and

perceptions) in our analysis.

Gist, Ph.D.

Principal Assistant to the Director

Kansas City, Missouri Fire Department

Office:

FAX:

Page:

ExLngHrn@...

Sent by:

@yahoog To

roups.com

cc

01/10/2006 11:56 Subject

AM Re: EMD Dispatching

Controversy?

Please respond to

@yahoog

roups.com

Useful and live saving - how? I'm just asking, not trying to intentionally

pick an argument. My personal opinion (not necessarily backed by research)

is that EMD/MPDS is most appropriate when EMS is not dispatched by a

trained EMS provider. I've seen cases where the " cards " may provide

instructions that are contraindicated (or not fully expanded upon) by our

EMS training. For example, I've personally seen a case where a patient

with difficulty breathing was placed supine on the floor, per pre-arrival

instructions. The only problem was that the patient had CHF, which was

exacerbated by laying down.

My preference is for MPDS to be used when the dispatcher is not EMS

trained. I believe there's a need for a different sort of dispatching

protocol when the dispatcher is EMS certfied.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

Re: EMD Dispatching Controversy?

Wes, EMD systems like MPDS are a useful, and life saving tool. But, like

anything else we do, without the three levels of Improvement

(retrospective,

concurrent and prospective), and system will have flaws. Another important

note, if you do Improvement activities, have a feedback function at all

levels

incuding field and the communications center staff, and share the findings!

[Guest guest]

Somone suggested EMD may deserve nomination for 's scrutiny as a myth

of EMS; such examination is probably not unwarranted, though it's probably

too early to relegate it to " Swindelrs' List " of EMS bijoonas. There'a a

lot of mystique surrounding this stuff, but I've been underwhelmed by

actual data. MOst data I've encountered centers on resource allocation

matters, not on prospective outcome data--to wit, there are local data

regarding whether a drop in response status leads to further " lights and

siren " returns, but these are all proxies for actual outcomes; there are

data concerning compliance with protocols but not necessarily that

compliance yields imporved clinical outcome. I cannot put my mental finger

on anything that establishes prospectively that utilization of EMD

protocols results in decreased morbidity or mortality, but I haven't

searched exhaustively for same. It's a good set of queations to raise,

however . . . but let's stick to data (rather than personal anecdotes and

perceptions) in our analysis.

Gist, Ph.D.

Principal Assistant to the Director

Kansas City, Missouri Fire Department

Office:

FAX:

Page:

ExLngHrn@...

Sent by:

@yahoog To

roups.com

cc

01/10/2006 11:56 Subject

AM Re: EMD Dispatching

Controversy?

Please respond to

@yahoog

roups.com

Useful and live saving - how? I'm just asking, not trying to intentionally

pick an argument. My personal opinion (not necessarily backed by research)

is that EMD/MPDS is most appropriate when EMS is not dispatched by a

trained EMS provider. I've seen cases where the " cards " may provide

instructions that are contraindicated (or not fully expanded upon) by our

EMS training. For example, I've personally seen a case where a patient

with difficulty breathing was placed supine on the floor, per pre-arrival

instructions. The only problem was that the patient had CHF, which was

exacerbated by laying down.

My preference is for MPDS to be used when the dispatcher is not EMS

trained. I believe there's a need for a different sort of dispatching

protocol when the dispatcher is EMS certfied.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

Re: EMD Dispatching Controversy?

Wes, EMD systems like MPDS are a useful, and life saving tool. But, like

anything else we do, without the three levels of Improvement

(retrospective,

concurrent and prospective), and system will have flaws. Another important

note, if you do Improvement activities, have a feedback function at all

levels

incuding field and the communications center staff, and share the findings!

[Guest guest]

, I just forwarded this email to Carlynn Page of the National Academy Of

EMD, we'll see what the answer is!

[Guest guest]

, I just forwarded this email to Carlynn Page of the National Academy Of

EMD, we'll see what the answer is!

[Guest guest]

Agreed Dr. Gist. Anecdotal information is just that - anecdotal. I would love

to find some independent research that might shed some light on the actual

efficacy of EMD.

-Wes Ogilvie

Re: EMD Dispatching Controversy?

Wes, EMD systems like MPDS are a useful, and life saving tool. But, like

anything else we do, without the three levels of Improvement

(retrospective,

concurrent and prospective), and system will have flaws. Another important

note, if you do Improvement activities, have a feedback function at all

levels

incuding field and the communications center staff, and share the findings!

[Guest guest]

Agreed Dr. Gist. Anecdotal information is just that - anecdotal. I would love

to find some independent research that might shed some light on the actual

efficacy of EMD.

-Wes Ogilvie

Re: EMD Dispatching Controversy?

Wes, EMD systems like MPDS are a useful, and life saving tool. But, like

anything else we do, without the three levels of Improvement

(retrospective,

concurrent and prospective), and system will have flaws. Another important

note, if you do Improvement activities, have a feedback function at all

levels

incuding field and the communications center staff, and share the findings!

[Guest guest]

The National Academy of EMD is affiliated with Dr. Clawson and his *proprietary*

method of Emergency Medical Dispatching, correct?

Would that be like Zoll, , or PhysioControl saying that defibrillation

only works when you use their device? Or perhaps like a college or training

program saying that EMS only works when the EMTs and paramedics are graduates of

their school?

In my opinion, there's too many proprietary solutions out there for EMS.

EMD/MPDS and the various other " card " courses all fall into that category. Some

marketing guru finds a niche, then starts claiming their product/system is the

" standard of care, " and lo and behold, the lemmings of EMS follow behind.

We've got to get away from proprietary methods and move towards open-source

standards that are backed by research.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

Re: EMD Dispatching Controversy?

, I just forwarded this email to Carlynn Page of the National Academy Of

EMD, we'll see what the answer is!

[Guest guest]

The National Academy of EMD is affiliated with Dr. Clawson and his *proprietary*

method of Emergency Medical Dispatching, correct?

Would that be like Zoll, , or PhysioControl saying that defibrillation

only works when you use their device? Or perhaps like a college or training

program saying that EMS only works when the EMTs and paramedics are graduates of

their school?

In my opinion, there's too many proprietary solutions out there for EMS.

EMD/MPDS and the various other " card " courses all fall into that category. Some

marketing guru finds a niche, then starts claiming their product/system is the

" standard of care, " and lo and behold, the lemmings of EMS follow behind.

We've got to get away from proprietary methods and move towards open-source

standards that are backed by research.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

Re: EMD Dispatching Controversy?

, I just forwarded this email to Carlynn Page of the National Academy Of

EMD, we'll see what the answer is!

[Guest guest]

Agreed, but do you know of anyone else doing the research right now?