Re: MPDS and Patient Assessment

[Guest guest]

Well, if you take into account that the AHA changes the way we do CPR every

5-10 years, you must ask yourself if any of us do what you would classify as

" good " CPR. :-)

-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]

Definitely some truth to that. That's one of the challenges of a dynamic

profession -- keeping up with the changes.

-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]

Definitely some truth to that. That's one of the challenges of a dynamic

profession -- keeping up with the changes.

-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]

Not sure who wrote that EMD is the standard of care, or who asked if there

was case law establishing EMD as being standard of care, but let me expound a

little bit on the role the courts play in establishing standard of care.

You won't find many appeals cases where the ruling in the case is to

establish a standard of care because standard of care is a question of fact to

be

determined by the trier of fact, usually the jury. In a jury trial, courts

decide

the law, and juries decide the facts. On appeal, the case is not usually

tried over again. The courts look to see whether the lower court made an error

in admitting testimony, a technical error that would invalidate the case, an

error in instructing the jury, and so forth. Review of factual testimony is

usually confined to a determination of whether or not there was sufficient

credible testimony which, if believed, would support the jury's verdict. The

jury decides the credibility of the witnesses, in other words, which of the

witnesses to believe and which not to believe.

Testimony is presented through expert witnesses by each side as to what the

standard of care is, and the jury actually decides the question. This, of

course, drives physicians to drink, since the idea of lay persons establishing

the standard of care is abhorrent and leads physicians into apoplexy, sphincter

failure, and all sorts of other demonstrations of shock and loathing.

Now, the case may go up on appeal based upon whether or not an expert who was

allowed to testimony on SOC possessed the requisites for being an expert

witness; whether there was sufficient evidence to support the jury's verdict,

whether the judge erred in allowing testimony from the inventor of Medical

Widget

Alpha, and so forth, but you will not generally find an appeals court stating

that the rule in Blah vs. Bones is that EMD is the standard of care. Or that

capnography is standard of care. Rather, you will have a court holding that

the jury was justified in finding that capnography is standard of care

because there was sufficient evidence from qualified experts to support the

jury's

findings.

These concepts are difficult even for lawyers to keep straight sometimes,

hence the number of cases that go up on appeal. However, the legal literature,

textbooks, and cases that comment on standard of care generally follow the

aforestated theme in their comments.

So don't waste time looking for a case that establishes that EMD is standard

of care. You probably won't find one. On the other hand, look at the

weight of evidence, the studies that have been done, the practices that are in

place, the arguments for and against, and make your own decision about EMD.

Just

as sure as Clawson will testify that it is the SOC, I am sure that there are

others of equal rank who would testify that, like CISM, it is a proprietary

program. That's a powerful ding when presented the right way. Testimony that

EMD cannot be proved to affect patient outcomes would be strong also. And

vice versa. Let the jury decide.

Gene Gandy, JD, LP

>

> >

> > --

> > 

> > Is there any caselaw to support your assertion that EMD is the

> standard of care?  And how does the public expect EMD?

> > 

>

> The EMD course I took in 2003 had various multimedia presentations of

> actual calls with dispatchers giving erroneous medical advice (before

> MPDS implementation) that resulted in mortality and litigation.  I'd

> have to dig up my MPDS book buried somewhere in my study, but that

> information is available...

>

> -Alfonso R. Ochoa

>

>

>

>

>

>

>

[Guest guest]

Not sure who wrote that EMD is the standard of care, or who asked if there

was case law establishing EMD as being standard of care, but let me expound a

little bit on the role the courts play in establishing standard of care.

You won't find many appeals cases where the ruling in the case is to

establish a standard of care because standard of care is a question of fact to

be

determined by the trier of fact, usually the jury. In a jury trial, courts

decide

the law, and juries decide the facts. On appeal, the case is not usually

tried over again. The courts look to see whether the lower court made an error

in admitting testimony, a technical error that would invalidate the case, an

error in instructing the jury, and so forth. Review of factual testimony is

usually confined to a determination of whether or not there was sufficient

credible testimony which, if believed, would support the jury's verdict. The

jury decides the credibility of the witnesses, in other words, which of the

witnesses to believe and which not to believe.

Testimony is presented through expert witnesses by each side as to what the

standard of care is, and the jury actually decides the question. This, of

course, drives physicians to drink, since the idea of lay persons establishing

the standard of care is abhorrent and leads physicians into apoplexy, sphincter

failure, and all sorts of other demonstrations of shock and loathing.

Now, the case may go up on appeal based upon whether or not an expert who was

allowed to testimony on SOC possessed the requisites for being an expert

witness; whether there was sufficient evidence to support the jury's verdict,

whether the judge erred in allowing testimony from the inventor of Medical

Widget

Alpha, and so forth, but you will not generally find an appeals court stating

that the rule in Blah vs. Bones is that EMD is the standard of care. Or that

capnography is standard of care. Rather, you will have a court holding that

the jury was justified in finding that capnography is standard of care

because there was sufficient evidence from qualified experts to support the

jury's

findings.

These concepts are difficult even for lawyers to keep straight sometimes,

hence the number of cases that go up on appeal. However, the legal literature,

textbooks, and cases that comment on standard of care generally follow the

aforestated theme in their comments.

So don't waste time looking for a case that establishes that EMD is standard

of care. You probably won't find one. On the other hand, look at the

weight of evidence, the studies that have been done, the practices that are in

place, the arguments for and against, and make your own decision about EMD.

Just

as sure as Clawson will testify that it is the SOC, I am sure that there are

others of equal rank who would testify that, like CISM, it is a proprietary

program. That's a powerful ding when presented the right way. Testimony that

EMD cannot be proved to affect patient outcomes would be strong also. And

vice versa. Let the jury decide.

Gene Gandy, JD, LP

>

> >

> > --

> > 

> > Is there any caselaw to support your assertion that EMD is the

> standard of care?  And how does the public expect EMD?

> > 

>

> The EMD course I took in 2003 had various multimedia presentations of

> actual calls with dispatchers giving erroneous medical advice (before

> MPDS implementation) that resulted in mortality and litigation.  I'd

> have to dig up my MPDS book buried somewhere in my study, but that

> information is available...

>

> -Alfonso R. Ochoa

>

>

>

>

>

>

>

[Guest guest]

Not sure who wrote that EMD is the standard of care, or who asked if there

was case law establishing EMD as being standard of care, but let me expound a

little bit on the role the courts play in establishing standard of care.

You won't find many appeals cases where the ruling in the case is to

establish a standard of care because standard of care is a question of fact to

be

determined by the trier of fact, usually the jury. In a jury trial, courts

decide

the law, and juries decide the facts. On appeal, the case is not usually

tried over again. The courts look to see whether the lower court made an error

in admitting testimony, a technical error that would invalidate the case, an

error in instructing the jury, and so forth. Review of factual testimony is

usually confined to a determination of whether or not there was sufficient

credible testimony which, if believed, would support the jury's verdict. The

jury decides the credibility of the witnesses, in other words, which of the

witnesses to believe and which not to believe.

Testimony is presented through expert witnesses by each side as to what the

standard of care is, and the jury actually decides the question. This, of

course, drives physicians to drink, since the idea of lay persons establishing

the standard of care is abhorrent and leads physicians into apoplexy, sphincter

failure, and all sorts of other demonstrations of shock and loathing.

Now, the case may go up on appeal based upon whether or not an expert who was

allowed to testimony on SOC possessed the requisites for being an expert

witness; whether there was sufficient evidence to support the jury's verdict,

whether the judge erred in allowing testimony from the inventor of Medical

Widget

Alpha, and so forth, but you will not generally find an appeals court stating

that the rule in Blah vs. Bones is that EMD is the standard of care. Or that

capnography is standard of care. Rather, you will have a court holding that

the jury was justified in finding that capnography is standard of care

because there was sufficient evidence from qualified experts to support the

jury's

findings.

These concepts are difficult even for lawyers to keep straight sometimes,

hence the number of cases that go up on appeal. However, the legal literature,

textbooks, and cases that comment on standard of care generally follow the

aforestated theme in their comments.

So don't waste time looking for a case that establishes that EMD is standard

of care. You probably won't find one. On the other hand, look at the

weight of evidence, the studies that have been done, the practices that are in

place, the arguments for and against, and make your own decision about EMD.

Just

as sure as Clawson will testify that it is the SOC, I am sure that there are

others of equal rank who would testify that, like CISM, it is a proprietary

program. That's a powerful ding when presented the right way. Testimony that

EMD cannot be proved to affect patient outcomes would be strong also. And

vice versa. Let the jury decide.

Gene Gandy, JD, LP

>

> >

> > --

> > 

> > Is there any caselaw to support your assertion that EMD is the

> standard of care?  And how does the public expect EMD?

> > 

>

> The EMD course I took in 2003 had various multimedia presentations of

> actual calls with dispatchers giving erroneous medical advice (before

> MPDS implementation) that resulted in mortality and litigation.  I'd

> have to dig up my MPDS book buried somewhere in my study, but that

> information is available...

>

> -Alfonso R. Ochoa

>

>

>

>

>

>

>

[Guest guest]

Safer is better.

Safe resource deployment is also a key component of MPDS.

Dispatchers put EMS responders and patients (...do no harm???) in danger

when they fail to prioritize calls by degree of emergency. EMS crews, no

matter what level of care, rushing with emergency lights flashing and sirens

blaring to what they think is an emergency call that turns out to be

non-urgent is a real problem across the country.

It is unethical and negligent to hurt someone on the way to a call because

you were responding with lights and sirens to a call for someone with a

minor illness. As everyone on this list knows (and this you do not need

science to prove), every call to 911 is not a true medical emergency.

Any call other than a true emergency run should be considered a routine

response and responded to without the use of sirens, beacons, or flashers.

During routine responses, an ambulance should be safely driven and not

afforded any emergency vehicle privileges. The use of lights and sirens

should be limited to true emergency runs (defined as events in which there

is a high probability of impending death or serious injury). MPDS or other

priority based dispatcher protocols can help reduce the number of " lights

and sirens " responses, based on predetermined medical interrogation.

As defined by the U.S. Department of Transportation Emergency Vehicle

Operator's Course, a true emergency is any situation in which there is a

high probability of death or significant injury to an individual or group of

individuals or a significant loss of property, which can be reduced by the

actions of an emergency service. This definition has gained legal acceptance

nationwide. How many of your lights and siren responses truly fit this court

definition?

Also....NAEMSP supports medical priority dispatching......

http://www.naemsp.org/Position%20Papers/EmerMedDisptch.html

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]

Safer is better.

Safe resource deployment is also a key component of MPDS.

Dispatchers put EMS responders and patients (...do no harm???) in danger

when they fail to prioritize calls by degree of emergency. EMS crews, no

matter what level of care, rushing with emergency lights flashing and sirens

blaring to what they think is an emergency call that turns out to be

non-urgent is a real problem across the country.

It is unethical and negligent to hurt someone on the way to a call because

you were responding with lights and sirens to a call for someone with a

minor illness. As everyone on this list knows (and this you do not need

science to prove), every call to 911 is not a true medical emergency.

Any call other than a true emergency run should be considered a routine

response and responded to without the use of sirens, beacons, or flashers.

During routine responses, an ambulance should be safely driven and not

afforded any emergency vehicle privileges. The use of lights and sirens

should be limited to true emergency runs (defined as events in which there

is a high probability of impending death or serious injury). MPDS or other

priority based dispatcher protocols can help reduce the number of " lights

and sirens " responses, based on predetermined medical interrogation.

As defined by the U.S. Department of Transportation Emergency Vehicle

Operator's Course, a true emergency is any situation in which there is a

high probability of death or significant injury to an individual or group of

individuals or a significant loss of property, which can be reduced by the

actions of an emergency service. This definition has gained legal acceptance

nationwide. How many of your lights and siren responses truly fit this court

definition?

Also....NAEMSP supports medical priority dispatching......

http://www.naemsp.org/Position%20Papers/EmerMedDisptch.html

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]

There is a great need for research of all types. The biggest problem is

that research costs money and the only ones who have been willing to

invest the money have been the ones who are making money off the

activity being researched. That creates a serious problem with the

research. We need to find ways to fund independent research.

GETAC with the Data, Informatics, and Research Taskforce has been

seeking to promote research, but has run into this very problem. The

Injury Prevention Committee is also pursuing avenues to encourage research.

The place to begin is to identify the most important topics to be

studied and then work with independent researcher to find the funding to

do the research. Work with your local politicians to get them to

allocate state and federal funds for research. Encourage any foundations

in your area to do likewise. If we all work together, the research will

happen.

Bob

ExLngHrn@... wrote:

> 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]

Once again, the original purpose of EMD was to priortize use of limited

resources, i.e., who gets the medic unit. A unit went to every call, but

not necessarily a medic unit. The " Priority " system as discussed in the

article.

Forrest C. Wood, Jr. (Woody)

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]

Once again, the original purpose of EMD was to priortize use of limited

resources, i.e., who gets the medic unit. A unit went to every call, but

not necessarily a medic unit. The " Priority " system as discussed in the

article.

Forrest C. Wood, Jr. (Woody)

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]

Prehosp Emerg Care.\

A systematic review of the evidence supporting the use of priority dispatch

of emergency ambulances.

S, Cooke M, Morrell R, Bridge P, Allan T; Emergency Medicine Research

Group (EMeRG)

Department of Primary Care & General Practice, University of Birmingham,

Edgbaston, United Kingdom. s.wilson@...

OBJECTIVES: Systematic reviews of the literature assist in the location,

appraisal, and synthesis of available evidence. This systematic review aimed

to 1) assess the existing literature evaluating the effect of the priority

dispatch of emergency ambulances on clinical outcome and ambulance

utilization and 2) assess the relative effectiveness of sources of

literature relevant to prehospital care. METHODS: Systematic review. The

quality of each paper was assessed using a standardized seven-point scoring

schedule. Sources used were: Medline, the Cumulative Index to Nursing &

Allied Health Literature (CINAHL), Bath Information & Data Services (BIDS),

bibliographic searching, contacting researchers active in the field, and

hand-searching relevant journals. Key words used were: " ambulance, "

" prioritisation, " " dispatch, " and " triage. " RESULTS: Three hundred

twenty-six papers were identified: 64 (19.6%) were related to the

prioritization of emergency ambulances, and only 20 (6.1%) contained

original data. The overall quality of publications was poor, seven (35%)

papers having a quality score > or = 4. Only half were identified by

electronic databases, 55% were identified by people working in the field,

and two (10%) were identified by hand-searching (some papers were identified

by more than one source). Two high-quality papers support the concept that

criteria-based dispatch (CBD) improves clinical outcome; two other papers

support CBD's role in improving ambulance utilization. CONCLUSIONS: There is

very little evidence to support the effect of the prioritization of

emergency ambulances on patient outcome. Electronic databases identify only

approximately half of all relevant prehospital literature. Future systematic

reviews in this area should use electronic databases, supplemented by

contact with appropriate experts

________________________________

From: [mailto: ] On

Behalf Of TxWoody_wood

Sent: Sunday, January 15, 2006 11:59 AM

To:

Subject: Re: Re: MPDS and Patient Assessment

Once again, the original purpose of EMD was to priortize use of limited

resources, i.e., who gets the medic unit. A unit went to every call, but

not necessarily a medic unit. The " Priority " system as discussed in the

article.

Forrest C. Wood, Jr. (Woody)

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]

> >> > > > >

> >> > > > >

> >> > > > >

> >> > > > >

> >> > > > >