Re: MPDS and Patient Assessment

[Guest guest]

Someone should do that study.for real

MPDS and Patient Assessment

> > >

> > > I'd like to pose this question particularly to the

> > EMS educators

> > and

> > > QA/QI/QC folks...

> > >

> > > Do you believe (anecdotally or empirically) that

> > receiving

> > MPDS/EMD call

> > > information has any bearing on the field crews'

> > patient assessment?

> > > For example, if the dispatcher tells the crew that

> > the call is a

> > > " Priority 3 respiratory, " that the crew will,

> > perhaps

> > subconsciously,

> > > focus on a respiratory emergency and exclude other

> > possibilities?

> > >

> > > Thanks,

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

> > > Austin, Texas

> > >

> > >

> > > [Non-text portions of this message have been

> > removed]

> > >

> > >

> > >

> > >

> > >

[Guest guest]

I'm not saying that MPDS/EMD is not beneficial. What I will say is that, like

many things we do in EMS, there is little research outside of self-promotion

from the vendors. The foremost question in our minds should be -- does this help

our patients?

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

MPDS and Patient Assessment

> > >

> > > I'd like to pose this question particularly to the

> > EMS educators

> > and

> > > QA/QI/QC folks...

> > >

> > > Do you believe (anecdotally or empirically) that

> > receiving

> > MPDS/EMD call

> > > information has any bearing on the field crews'

> > patient assessment?

> > > For example, if the dispatcher tells the crew that

> > the call is a

> > > " Priority 3 respiratory, " that the crew will,

> > perhaps

> > subconsciously,

> > > focus on a respiratory emergency and exclude other

> > possibilities?

> > >

> > > Thanks,

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

> > > Austin, Texas

> > >

> > >

> > > [Non-text portions of this message have been

> > removed]

> > >

> > >

> > >

> > >

> > >

[Guest guest]

I'm not saying that MPDS/EMD is not beneficial. What I will say is that, like

many things we do in EMS, there is little research outside of self-promotion

from the vendors. The foremost question in our minds should be -- does this help

our patients?

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

MPDS and Patient Assessment

> > >

> > > I'd like to pose this question particularly to the

> > EMS educators

> > and

> > > QA/QI/QC folks...

> > >

> > > Do you believe (anecdotally or empirically) that

> > receiving

> > MPDS/EMD call

> > > information has any bearing on the field crews'

> > patient assessment?

> > > For example, if the dispatcher tells the crew that

> > the call is a

> > > " Priority 3 respiratory, " that the crew will,

> > perhaps

> > subconsciously,

> > > focus on a respiratory emergency and exclude other

> > possibilities?

> > >

> > > Thanks,

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

> > > Austin, Texas

> > >

> > >

> > > [Non-text portions of this message have been

> > removed]

> > >

> > >

> > >

> > >

> > >

[Guest guest]

Wes,

I don't think there is any data supporting that the public expects

EMD. And I didn't mean that my family asked about specific treatment

but what they expect when they call 9-1-1

Here at our Comm Center the biggest challenge we have is having to

get the the address and phone number from the caller after they have

given it to the PD dispatcher first.

Danny

> > > >

> > > > I believe that my first thought would lean toward

> > > a respiratory

> > > > emergency. However, I would also be looking for

> > > underlying issues

> > > that

> > > > could be the cause of the respiratory emergency or

> > > something more

> > > severe

> > > > than the pt complaint.

> > > >

> > > > Dan Bird, EMT-P, EM

> > > >

> > > > MPDS and Patient Assessment

> > > >

> > > > I'd like to pose this question particularly to the

> > > EMS educators

> > > and

> > > > QA/QI/QC folks...

> > > >

> > > > Do you believe (anecdotally or empirically) that

> > > receiving

> > > MPDS/EMD call

> > > > information has any bearing on the field crews'

> > > patient assessment?

> > > > For example, if the dispatcher tells the crew that

> > > the call is a

> > > > " Priority 3 respiratory, " that the crew will,

> > > perhaps

> > > subconsciously,

> > > > focus on a respiratory emergency and exclude other

> > > possibilities?

> > > >

> > > > Thanks,

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

> > > > Austin, Texas

> > > >

> > > >

> > > > [Non-text portions of this message have been

> > > removed]

> > > >

> > > >

> > > >

> > > >

> > > >

[Guest guest]

Wes,

I don't think there is any data supporting that the public expects

EMD. And I didn't mean that my family asked about specific treatment

but what they expect when they call 9-1-1

Here at our Comm Center the biggest challenge we have is having to

get the the address and phone number from the caller after they have

given it to the PD dispatcher first.

Danny

> > > >

> > > > I believe that my first thought would lean toward

> > > a respiratory

> > > > emergency. However, I would also be looking for

> > > underlying issues

> > > that

> > > > could be the cause of the respiratory emergency or

> > > something more

> > > severe

> > > > than the pt complaint.

> > > >

> > > > Dan Bird, EMT-P, EM

> > > >

> > > > MPDS and Patient Assessment

> > > >

> > > > I'd like to pose this question particularly to the

> > > EMS educators

> > > and

> > > > QA/QI/QC folks...

> > > >

> > > > Do you believe (anecdotally or empirically) that

> > > receiving

> > > MPDS/EMD call

> > > > information has any bearing on the field crews'

> > > patient assessment?

> > > > For example, if the dispatcher tells the crew that

> > > the call is a

> > > > " Priority 3 respiratory, " that the crew will,

> > > perhaps

> > > subconsciously,

> > > > focus on a respiratory emergency and exclude other

> > > possibilities?

> > > >

> > > > Thanks,

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

> > > > Austin, Texas

> > > >

> > > >

> > > > [Non-text portions of this message have been

> > > removed]

> > > >

> > > >

> > > >

> > > >

> > > >

[Guest guest]

Wes,

I don't think there is any data supporting that the public expects

EMD. And I didn't mean that my family asked about specific treatment

but what they expect when they call 9-1-1

Here at our Comm Center the biggest challenge we have is having to

get the the address and phone number from the caller after they have

given it to the PD dispatcher first.

Danny

> > > >

> > > > I believe that my first thought would lean toward

> > > a respiratory

> > > > emergency. However, I would also be looking for

> > > underlying issues

> > > that

> > > > could be the cause of the respiratory emergency or

> > > something more

> > > severe

> > > > than the pt complaint.

> > > >

> > > > Dan Bird, EMT-P, EM

> > > >

> > > > MPDS and Patient Assessment

> > > >

> > > > I'd like to pose this question particularly to the

> > > EMS educators

> > > and

> > > > QA/QI/QC folks...

> > > >

> > > > Do you believe (anecdotally or empirically) that

> > > receiving

> > > MPDS/EMD call

> > > > information has any bearing on the field crews'

> > > patient assessment?

> > > > For example, if the dispatcher tells the crew that

> > > the call is a

> > > > " Priority 3 respiratory, " that the crew will,

> > > perhaps

> > > subconsciously,

> > > > focus on a respiratory emergency and exclude other

> > > possibilities?

> > > >

> > > > Thanks,

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

> > > > Austin, Texas

> > > >

> > > >

> > > > [Non-text portions of this message have been

> > > removed]

> > > >

> > > >

> > > >

> > > >

> > > >

[Guest guest]

Wes,

Again without having done a study, I know for a fact that using MPDS

(or EMD) has saved lives in our community. I have stood next to a

call-taker as they give instructions to a caller on how to perform

CPR and the medics arrive and find the family doing CPR, and the pt

lived. I know what you mean about the Medical Priority saying it

saves lives, thats to a certain point self-serving. Maybe some in gov

can shift funds from studing the migration of earth worms to a study

on EMD.

Danny

> > > >

> > > > I believe that my first thought would lean toward

> > > a respiratory

> > > > emergency. However, I would also be looking for

> > > underlying issues

> > > that

> > > > could be the cause of the respiratory emergency or

> > > something more

> > > severe

> > > > than the pt complaint.

> > > >

> > > > Dan Bird, EMT-P, EM

> > > >

> > > > MPDS and Patient Assessment

> > > >

> > > > I'd like to pose this question particularly to the

> > > EMS educators

> > > and

> > > > QA/QI/QC folks...

> > > >

> > > > Do you believe (anecdotally or empirically) that

> > > receiving

> > > MPDS/EMD call

> > > > information has any bearing on the field crews'

> > > patient assessment?

> > > > For example, if the dispatcher tells the crew that

> > > the call is a

> > > > " Priority 3 respiratory, " that the crew will,

> > > perhaps

> > > subconsciously,

> > > > focus on a respiratory emergency and exclude other

> > > possibilities?

> > > >

> > > > Thanks,

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

> > > > Austin, Texas

> > > >

> > > >

> > > > [Non-text portions of this message have been

> > > removed]

> > > >

> > > >

> > > >

> > > >

> > > >

[Guest guest]

I've yet to hear that the public expects anything from EMS. That is, until they

call us.

-Wes

MPDS and Patient Assessment

> > > >

> > > > I'd like to pose this question particularly to the

> > > EMS educators

> > > and

> > > > QA/QI/QC folks...

> > > >

> > > > Do you believe (anecdotally or empirically) that

> > > receiving

> > > MPDS/EMD call

> > > > information has any bearing on the field crews'

> > > patient assessment?

> > > > For example, if the dispatcher tells the crew that

> > > the call is a

> > > > " Priority 3 respiratory, " that the crew will,

> > > perhaps

> > > subconsciously,

> > > > focus on a respiratory emergency and exclude other

> > > possibilities?

> > > >

> > > > Thanks,

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

> > > > Austin, Texas

> > > >

> > > >

> > > > [Non-text portions of this message have been

> > > removed]

> > > >

> > > >

> > > >

> > > >

> > > >

[Guest guest]

Was it good CPR? Definitely, there's anecdotal evidence on both sides of this

debate. However, without independent research, we'll never reach an answer that

will be scientifically valid.

On a larger note, this is but a small sample of what's wrong with EMS. We have

yet to develop our own scientific standards for research. And we wonder why the

doctors and nurses look at us with some contempt.

-Wes

MPDS and Patient Assessment

> > > >

> > > > I'd like to pose this question particularly to the

> > > EMS educators

> > > and

> > > > QA/QI/QC folks...

> > > >

> > > > Do you believe (anecdotally or empirically) that

> > > receiving

> > > MPDS/EMD call

> > > > information has any bearing on the field crews'

> > > patient assessment?

> > > > For example, if the dispatcher tells the crew that

> > > the call is a

> > > > " Priority 3 respiratory, " that the crew will,

> > > perhaps

> > > subconsciously,

> > > > focus on a respiratory emergency and exclude other

> > > possibilities?

> > > >

> > > > Thanks,

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

> > > > Austin, Texas

> > > >

> > > >

> > > > [Non-text portions of this message have been

> > > removed]

> > > >

> > > >

> > > >

> > > >

> > > >

[Guest guest]

Wes,

If you could do a study what would you look for exactly?

Danny

> > > > >

> > > > > I believe that my first thought would lean toward

> > > > a respiratory

> > > > > emergency. However, I would also be looking for

> > > > underlying issues

> > > > that

> > > > > could be the cause of the respiratory emergency or

> > > > something more

> > > > severe

> > > > > than the pt complaint.

> > > > >

> > > > > Dan Bird, EMT-P, EM

> > > > >

> > > > > MPDS and Patient Assessment

> > > > >

> > > > > I'd like to pose this question particularly to the

> > > > EMS educators

> > > > and

> > > > > QA/QI/QC folks...

> > > > >

> > > > > Do you believe (anecdotally or empirically) that

> > > > receiving

> > > > MPDS/EMD call

> > > > > information has any bearing on the field crews'

> > > > patient assessment?

> > > > > For example, if the dispatcher tells the crew that

> > > > the call is a

> > > > > " Priority 3 respiratory, " that the crew will,

> > > > perhaps

> > > > subconsciously,

> > > > > focus on a respiratory emergency and exclude other

> > > > possibilities?

> > > > >

> > > > > Thanks,

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

> > > > > Austin, Texas

> > > > >

> > > > >

> > > > > [Non-text portions of this message have been

> > > > removed]

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

[Guest guest]

Wes,

If you could do a study what would you look for exactly?

Danny

> > > > >

> > > > > I believe that my first thought would lean toward

> > > > a respiratory

> > > > > emergency. However, I would also be looking for

> > > > underlying issues

> > > > that

> > > > > could be the cause of the respiratory emergency or

> > > > something more

> > > > severe

> > > > > than the pt complaint.

> > > > >

> > > > > Dan Bird, EMT-P, EM

> > > > >

> > > > > MPDS and Patient Assessment

> > > > >

> > > > > I'd like to pose this question particularly to the

> > > > EMS educators

> > > > and

> > > > > QA/QI/QC folks...

> > > > >

> > > > > Do you believe (anecdotally or empirically) that

> > > > receiving

> > > > MPDS/EMD call

> > > > > information has any bearing on the field crews'

> > > > patient assessment?

> > > > > For example, if the dispatcher tells the crew that

> > > > the call is a

> > > > > " Priority 3 respiratory, " that the crew will,

> > > > perhaps

> > > > subconsciously,

> > > > > focus on a respiratory emergency and exclude other

> > > > possibilities?

> > > > >

> > > > > Thanks,

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

> > > > > Austin, Texas

> > > > >

> > > > >

> > > > > [Non-text portions of this message have been

> > > > removed]

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

[Guest guest]

Wes,

If you could do a study what would you look for exactly?

Danny

> > > > >

> > > > > I believe that my first thought would lean toward

> > > > a respiratory

> > > > > emergency. However, I would also be looking for

> > > > underlying issues

> > > > that

> > > > > could be the cause of the respiratory emergency or

> > > > something more

> > > > severe

> > > > > than the pt complaint.

> > > > >

> > > > > Dan Bird, EMT-P, EM

> > > > >

> > > > > MPDS and Patient Assessment

> > > > >

> > > > > I'd like to pose this question particularly to the

> > > > EMS educators

> > > > and

> > > > > QA/QI/QC folks...

> > > > >

> > > > > Do you believe (anecdotally or empirically) that

> > > > receiving

> > > > MPDS/EMD call

> > > > > information has any bearing on the field crews'

> > > > patient assessment?

> > > > > For example, if the dispatcher tells the crew that

> > > > the call is a

> > > > > " Priority 3 respiratory, " that the crew will,

> > > > perhaps

> > > > subconsciously,

> > > > > focus on a respiratory emergency and exclude other

> > > > possibilities?

> > > > >

> > > > > Thanks,

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

> > > > > Austin, Texas

> > > > >

> > > > >

> > > > > [Non-text portions of this message have been

> > > > removed]

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

[Guest guest]

Wes,

Another side to this that we can ask is " Does MPDS do harm? "

Tater

ExLngHrn@... wrote:

I'm not 100% sure offhand, Danny. However, I'd want to determine if MPDS/EMD

improves patient outcomes by either (1) helping field providers recognize

patient's conditions earlier; or (2) providing appropriate interventions prior

to EMS through pre-arrival instructions.

-Wes

MPDS and Patient Assessment

> > > > >

> > > > > I'd like to pose this question particularly to the

> > > > EMS educators

> > > > and

> > > > > QA/QI/QC folks...

> > > > >

> > > > > Do you believe (anecdotally or empirically) that

> > > > receiving

> > > > MPDS/EMD call

> > > > > information has any bearing on the field crews'

> > > > patient assessment?

> > > > > For example, if the dispatcher tells the crew that

> > > > the call is a

> > > > > " Priority 3 respiratory, " that the crew will,

> > > > perhaps

> > > > subconsciously,

> > > > > focus on a respiratory emergency and exclude other

> > > > possibilities?

> > > > >

> > > > > Thanks,

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

> > > > > Austin, Texas

> > > > >

> > > > >

> > > > > [Non-text portions of this message have been

> > > > removed]

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

[Guest guest]

Wes,

Another side to this that we can ask is " Does MPDS do harm? "

Tater

ExLngHrn@... wrote:

I'm not 100% sure offhand, Danny. However, I'd want to determine if MPDS/EMD

improves patient outcomes by either (1) helping field providers recognize

patient's conditions earlier; or (2) providing appropriate interventions prior

to EMS through pre-arrival instructions.

-Wes

MPDS and Patient Assessment

> > > > >

> > > > > I'd like to pose this question particularly to the

> > > > EMS educators

> > > > and

> > > > > QA/QI/QC folks...

> > > > >

> > > > > Do you believe (anecdotally or empirically) that

> > > > receiving

> > > > MPDS/EMD call

> > > > > information has any bearing on the field crews'

> > > > patient assessment?

> > > > > For example, if the dispatcher tells the crew that

> > > > the call is a

> > > > > " Priority 3 respiratory, " that the crew will,

> > > > perhaps

> > > > subconsciously,

> > > > > focus on a respiratory emergency and exclude other

> > > > possibilities?

> > > > >

> > > > > Thanks,

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

> > > > > Austin, Texas

> > > > >

> > > > >

> > > > > [Non-text portions of this message have been

> > > > removed]

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

[Guest guest]

Wes,

Another side to this that we can ask is " Does MPDS do harm? "

Tater

ExLngHrn@... wrote:

I'm not 100% sure offhand, Danny. However, I'd want to determine if MPDS/EMD

improves patient outcomes by either (1) helping field providers recognize

patient's conditions earlier; or (2) providing appropriate interventions prior

to EMS through pre-arrival instructions.

-Wes

MPDS and Patient Assessment

> > > > >

> > > > > I'd like to pose this question particularly to the

> > > > EMS educators

> > > > and

> > > > > QA/QI/QC folks...

> > > > >

> > > > > Do you believe (anecdotally or empirically) that

> > > > receiving

> > > > MPDS/EMD call

> > > > > information has any bearing on the field crews'

> > > > patient assessment?

> > > > > For example, if the dispatcher tells the crew that

> > > > the call is a

> > > > > " Priority 3 respiratory, " that the crew will,

> > > > perhaps

> > > > subconsciously,

> > > > > focus on a respiratory emergency and exclude other

> > > > possibilities?

> > > > >

> > > > > Thanks,

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

> > > > > Austin, Texas

> > > > >

> > > > >

> > > > > [Non-text portions of this message have been

> > > > removed]

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

[Guest guest]

The goal of MPDS is not to " help field providers recognize patient's conditions

earlier. " That is still, appropriately, a function of clinical examination at

the scene. A major goal of MPDS is to assist with appropriate resource

utilization (i.e. non-emergency response to low priority incidents or BLS

response instead of ALS response when ALS is not warranted.) Want some science?

See below. There are many other studies out there, just search online. Though

not recent, this study is still valid and relevant. My anecdotal experience in

the urban environment (not TX, but I am sure it's occurring here too): frequent

callers learning the right words to initiate a high priority call (i.e. it seems

after a while that everyone, no matter what their chief complaint is, has

trouble breathing too) This is one flaw I would like to see addressed. And by

the way, it is nice to see relevant content on the listserv....very

refreshing....keep it up. -

ls of Emergency Medicine, April 1990, Vol. 19, No. 4

G. Kallsen, M.D. Nabors/ Department of Health, Fresno County; Department of

Emergency Medicine, Valley Medical Center, Fresno, California; Department of

Family and Community Medicine, University of California, San Francisco;

Department of Health, Fresno County, Fresno, California

The Use of Priority Medical Dispatch to Distinguish Between High- and Low-Risk

Patients

Objective: Requests for ambulances are commonly prioritized with little

published evidence validating the safety and efficacy of prioritization

techniques. This study was to determine if variation of Clawson's priority

medical dispatch ranks patients with prehospital cardiac arrest and other

critical conditions into higher priorities than patients with more routine

problems.

Design: This is a retrospective analysis of centralized dispatch data.

Setting: The study of emergency medical services [EMS] system serves a

population of 600,000 and an area of 6,004 square miles in central California.

All EMS calls are dispatched or tracked by one communication center using

medical protocols and certified dispatchers.

Participants: All 52,020 request for EMS dispatch in Fresno County in 1988 were

analyzed. Exclusions of scheduled requests, transfers, physician or nurse

requests, and nontransports resulted in 31,026 dispatches reported.

Interventions: Dispatches were ranked as life threatening (priority 1),

emergency (priority 2), or other (priority 3). Outcome was ranked as prehospital

arrest for patients requiring prehospital CPR, critical condition for patients

requiring lights and sirens to hospital, and routine for others. The indications

for lights and sirens to hospital are standardized with written guidelines.

Results: Priority 1 detected arrests with a sensitivity of .90 and specificity

of .50. Priority 1 patients suffered prehospital arrest and critical condition

more often than priority 2 patients, who suffered prehospital arrest and

critical condition more often that priority 3 patients [P < .01 by two-tailed

analysis of proportions].

Conclusion: This version of the Clawson model of priority medical dispatch

successfully differentiates patients who suffer prehospital cardiac arrest or

critical condition from less critical patients.

MPDS and Patient Assessment

>> > > > >

>> > > > > I'd like to pose this question particularly to the

>> > > > EMS educators

>> > > > and

>> > > > > QA/QI/QC folks...

>> > > > >

>> > > > > Do you believe (anecdotally or empirically) that

>> > > > receiving

>> > > > MPDS/EMD call

>> > > > > information has any bearing on the field crews'

>> > > > patient assessment?

>> > > > > For example, if the dispatcher tells the crew that

>> > > > the call is a

>> > > > > " Priority 3 respiratory, " that the crew will,

>> > > > perhaps

>> > > > subconsciously,

>> > > > > focus on a respiratory emergency and exclude other

>> > > > possibilities?

>> > > > >

>> > > > > Thanks,

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

>> > > > > Austin, Texas

>> > > > >

>> > > > >

>> > > > > [Non-text portions of this message have been

>> > > > removed]

>> > > > >

>> > > > >

>> > > > >

>> > > > >

>> > > > >

[Guest guest]

Wasn't the whole point of this to find out who dispatches based on MPDS and

how this works? Simple 1-2 word chief complaints work well to keep radio

traffic down. I do not need a detailed history of someone enroute to a

scene, just tell me what the complaint is and I will deal with the rest when

I get on scene.

In a large urban environment this only helps promote system abuse. People

are smart and they know what to say in order to get a faster response. My

formal training is in communications and I feel the Clawson system does work

but does need some modifications to it. No matter what the complaint is, if

the caller feels the patient is having breathing difficulty then that is an

automatic priority response. I can't count the number of " close calls " I

have had rushing to save a life only to find the person on the curb with

luggage in hand. You can come back and say that this helps prevent

accidents as well.

_____

From: [mailto: ] On

Behalf Of W. Graham

Sent: Wednesday, January 11, 2006 3:02 PM

To:

Subject: Re: MPDS and Patient Assessment

The goal of MPDS is not to " help field providers recognize patient's

conditions earlier. " That is still, appropriately, a function of clinical

examination at the scene. A major goal of MPDS is to assist with

appropriate resource utilization (i.e. non-emergency response to low

priority incidents or BLS response instead of ALS response when ALS is not

warranted.) Want some science? See below. There are many other studies out

there, just search online. Though not recent, this study is still valid and

relevant. My anecdotal experience in the urban environment (not TX, but I

am sure it's occurring here too): frequent callers learning the right words

to initiate a high priority call (i.e. it seems after a while that everyone,

no matter what their chief complaint is, has trouble breathing too) This is

one flaw I would like to see addressed. And by the way, it is nice to see

relevant content on the listserv....very refreshing....keep it up. -

ls of Emergency Medicine, April 1990, Vol. 19, No. 4

G. Kallsen, M.D. Nabors/ Department of Health, Fresno County; Department of

Emergency Medicine, Valley Medical Center, Fresno, California; Department of

Family and Community Medicine, University of California, San Francisco;

Department of Health, Fresno County, Fresno, California

The Use of Priority Medical Dispatch to Distinguish Between High- and

Low-Risk Patients

Objective: Requests for ambulances are commonly prioritized with little

published evidence validating the safety and efficacy of prioritization

techniques. This study was to determine if variation of Clawson's priority

medical dispatch ranks patients with prehospital cardiac arrest and other

critical conditions into higher priorities than patients with more routine

problems.

Design: This is a retrospective analysis of centralized dispatch data.

Setting: The study of emergency medical services [EMS] system serves a

population of 600,000 and an area of 6,004 square miles in central

California. All EMS calls are dispatched or tracked by one communication

center using medical protocols and certified dispatchers.

Participants: All 52,020 request for EMS dispatch in Fresno County in 1988

were analyzed. Exclusions of scheduled requests, transfers, physician or

nurse requests, and nontransports resulted in 31,026 dispatches reported.

Interventions: Dispatches were ranked as life threatening (priority 1),

emergency (priority 2), or other (priority 3). Outcome was ranked as

prehospital arrest for patients requiring prehospital CPR, critical

condition for patients requiring lights and sirens to hospital, and routine

for others. The indications for lights and sirens to hospital are

standardized with written guidelines.

Results: Priority 1 detected arrests with a sensitivity of .90 and

specificity of .50. Priority 1 patients suffered prehospital arrest and

critical condition more often than priority 2 patients, who suffered

prehospital arrest and critical condition more often that priority 3

patients [P < .01 by two-tailed analysis of proportions].

Conclusion: This version of the Clawson model of priority medical dispatch

successfully differentiates patients who suffer prehospital cardiac arrest

or critical condition from less critical patients.

MPDS and Patient Assessment

>> > > > >

>> > > > > I'd like to pose this question particularly to the

>> > > > EMS educators

>> > > > and

>> > > > > QA/QI/QC folks...

>> > > > >

>> > > > > Do you believe (anecdotally or empirically) that

>> > > > receiving

>> > > > MPDS/EMD call

>> > > > > information has any bearing on the field crews'

>> > > > patient assessment?

>> > > > > For example, if the dispatcher tells the crew that

>> > > > the call is a

>> > > > > " Priority 3 respiratory, " that the crew will,

>> > > > perhaps

>> > > > subconsciously,

>> > > > > focus on a respiratory emergency and exclude other

>> > > > possibilities?

>> > > > >

>> > > > > Thanks,

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

>> > > > > Austin, Texas

>> > > > >

>> > > > >

>> > > > > [Non-text portions of this message have been

>> > > > removed]

>> > > > >

>> > > > >

>> > > > >

>> > > > >

>> > > > >

[Guest guest]

Wes,

In this case, I would hazard a guess to say the CPR was " good " (since the

patient lived)!

-Thom Seeber

MPDS and Patient Assessment

> > > >

> > > > I'd like to pose this question particularly to the

> > > EMS educators

> > > and

> > > > QA/QI/QC folks...

> > > >

> > > > Do you believe (anecdotally or empirically) that

> > > receiving

> > > MPDS/EMD call

> > > > information has any bearing on the field crews'

> > > patient assessment?

> > > > For example, if the dispatcher tells the crew that

> > > the call is a

> > > > " Priority 3 respiratory, " that the crew will,

> > > perhaps

> > > subconsciously,

> > > > focus on a respiratory emergency and exclude other

> > > possibilities?

> > > >

> > > > Thanks,

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

> > > > Austin, Texas

> > > >

> > > >

> > > > [Non-text portions of this message have been

> > > removed]

> > > >

> > > >

> > > >

> > > >

> > > >

[Guest guest]

Wes,

In this case, I would hazard a guess to say the CPR was " good " (since the

patient lived)!

-Thom Seeber

MPDS and Patient Assessment

> > > >

> > > > I'd like to pose this question particularly to the

> > > EMS educators

> > > and

> > > > QA/QI/QC folks...

> > > >

> > > > Do you believe (anecdotally or empirically) that

> > > receiving

> > > MPDS/EMD call

> > > > information has any bearing on the field crews'

> > > patient assessment?

> > > > For example, if the dispatcher tells the crew that

> > > the call is a

> > > > " Priority 3 respiratory, " that the crew will,

> > > perhaps

> > > subconsciously,

> > > > focus on a respiratory emergency and exclude other

> > > possibilities?

> > > >

> > > > Thanks,

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

> > > > Austin, Texas

> > > >

> > > >

> > > > [Non-text portions of this message have been

> > > removed]

> > > >

> > > >

> > > >

> > > >

> > > >

[Guest guest]

Wes,

In this case, I would hazard a guess to say the CPR was " good " (since the

patient lived)!

-Thom Seeber

MPDS and Patient Assessment

> > > >

> > > > I'd like to pose this question particularly to the

> > > EMS educators

> > > and

> > > > QA/QI/QC folks...

> > > >

> > > > Do you believe (anecdotally or empirically) that

> > > receiving

> > > MPDS/EMD call

> > > > information has any bearing on the field crews'

> > > patient assessment?

> > > > For example, if the dispatcher tells the crew that

> > > the call is a

> > > > " Priority 3 respiratory, " that the crew will,

> > > perhaps

> > > subconsciously,

> > > > focus on a respiratory emergency and exclude other

> > > possibilities?

> > > >

> > > > Thanks,

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

> > > > Austin, Texas

> > > >

> > > >

> > > > [Non-text portions of this message have been

> > > removed]

> > > >

> > > >

> > > >

> > > >

> > > >

[Guest guest]

" Danny " <firedawg_2445@y...> wrote:

>

> Again without having done a study, I know for a fact that using MPDS

> (or EMD) has saved lives in our community. I have stood next to a

> call-taker as they give instructions to a caller on how to perform

> CPR and the medics arrive and find the family doing CPR, and the pt

> lived.

But are there not just as many (if not more) instances of that patient

not surviving, or of a patient not receiving pre-arrival instructions

being revived by the crew? So how do you credibly establish a cause

and effect relationship between MPDS and the patient's survival? If

there was truly a corelation, would not the percentage be much higher?

Again, without validated research, it's all just speculation.

Rob

[Guest guest]

" Danny " <firedawg_2445@y...> wrote:

>

> Again without having done a study, I know for a fact that using MPDS

> (or EMD) has saved lives in our community. I have stood next to a

> call-taker as they give instructions to a caller on how to perform

> CPR and the medics arrive and find the family doing CPR, and the pt

> lived.

But are there not just as many (if not more) instances of that patient

not surviving, or of a patient not receiving pre-arrival instructions

being revived by the crew? So how do you credibly establish a cause

and effect relationship between MPDS and the patient's survival? If

there was truly a corelation, would not the percentage be much higher?

Again, without validated research, it's all just speculation.

Rob

[Guest guest]

" Danny " <firedawg_2445@y...> wrote:

>

> Again without having done a study, I know for a fact that using MPDS

> (or EMD) has saved lives in our community. I have stood next to a

> call-taker as they give instructions to a caller on how to perform

> CPR and the medics arrive and find the family doing CPR, and the pt

> lived.

But are there not just as many (if not more) instances of that patient

not surviving, or of a patient not receiving pre-arrival instructions

being revived by the crew? So how do you credibly establish a cause

and effect relationship between MPDS and the patient's survival? If

there was truly a corelation, would not the percentage be much higher?

Again, without validated research, it's all just speculation.

Rob

[Guest guest]

Thom -- it was probably " good " in the outcome, but the outcome doesn't alone

make it good. There are people who survive being shot in the head too, but I

don't recognize that as a good prehospital intervention. ;-)

-wes

MPDS and Patient Assessment

> > > >

> > > > I'd like to pose this question particularly to the

> > > EMS educators

> > > and

> > > > QA/QI/QC folks...

> > > >

> > > > Do you believe (anecdotally or empirically) that

> > > receiving

> > > MPDS/EMD call

> > > > information has any bearing on the field crews'

> > > patient assessment?

> > > > For example, if the dispatcher tells the crew that

> > > the call is a

> > > > " Priority 3 respiratory, " that the crew will,

> > > perhaps

> > > subconsciously,

> > > > focus on a respiratory emergency and exclude other

> > > possibilities?

> > > >

> > > > Thanks,

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

> > > > Austin, Texas

> > > >

> > > >

> > > > [Non-text portions of this message have been

> > > removed]

> > > >

> > > >

> > > >

> > > >

> > > >

[Guest guest]

" W. Graham " <brandon.graham@v...> wrote:

>

> Want some science? See below.

>

> Conclusion: This version of the Clawson model of priority medical

> dispatch successfully differentiates patients who suffer

> prehospital cardiac arrest or critical condition from less

> critical patients.

So this study concludes that using MPDS, a dispatcher can usually

determine that the victim is in cardiac arrest? Doesn't sound

particularly revolutionary to me. I could determine that much from a

caller ten years before Clawson ever dreamed of EMD. Again, the

research is invalidated by a failure to compare to a control group not

utilizing the Clawson model.

Rob