Emergency Medical Dispatch

1. Emergency Medical Dispatch Bill Jermyn, DO, FACEP EMS Medical Director Missouri Department of Health and Senior Services Bill Jermyn, DO, FACEP

2. “Nothing endures but change.” Heraclitus 540 BC – 480 BC Bill Jermyn, DO, FACEP

3. Why should you care about dispatch? • Your constituency does • A visible “face” of your Department • “Scene Commander” until someone physically arrives • Fills the response time gap—5-10 minutes in the best of systems Bill Jermyn, DO, FACEP

4. Why should you care about dispatch? • Who do you want to help you if you get into trouble? • “OK, we’ll send someone.” and hang up the phone • Or, do you want trained personnel with written protocols to stay on the line with you and talk you through the event? Bill Jermyn, DO, FACEP

5. Studies show average times are: • 2 minutes to call for help • Excellent call processing time is 60-90 seconds • Excellent chute time is 2 minutes • Response time to scene is 5-10 minutes • Response time to patient is 1.5 minutes • Total is 12-17 minutes if all goes well Bill Jermyn, DO, FACEP

6. The First “First Responder”Concept of Zero-minute Response Bill Jermyn, DO, FACEP

7. What is my liability? • I am not a lawyer • Public’s expectations—the William Shatner effect—1995 letter from Ryan Insurance of Kingston, NY: “The company has in the past been made aware of situations where the caller requested medical advice, and was told that was beyond the system capabilities. The resulting worsened condition quickly turned into a liability claim against the system operators. It seems the currently running television shows depicting 9-1-1 situations which include pre-arrival instruction have caused the general public to expect this service from all 9-1-1 operators.” • What is the “standard of care”? Bill Jermyn, DO, FACEP

8. National Organizations • “The American College of Emergency Physicians (ACEP) believes that the Emergency Medical Dispatch (EMD) program is an integral and critical component of the medical care EMS system.” ACEP policy “Physician Medical Direction of Emergency Medical Dispatch Programs” Bill Jermyn, DO, FACEP

9. National Organizations • “The emergency medical dispatcher (EMD) is the principle link between the public caller requesting emergency medical assistance and the emergency medical service (EMS) resource delivery system. As such, the EMD plays a fundamental role in the ability of the EMS system to respond to a perceived medical emergency.” American Society for Testing and Materials (ASTM) F 1258 Bill Jermyn, DO, FACEP

10. National Organizations • “The trained Emergency Medical Dispatcher (EMD) is an essential part of a prehospital EMS system.” • “Pre-arrival instructions are a mandatory function of each EMD in a medical dispatch center.” • “Training as EMDs is required for all dispatchers functioning in medical dispatch agencies and requires unprecedented cooperation between the diverse disciplines….” National Association of EMS Physicians, policy statement, “Emergency Medical Dispatching” Bill Jermyn, DO, FACEP

11. Opposition • Fear of liability • Cost of training—initial and continuing • Personnel cost—higher training may demand higher salary Bill Jermyn, DO, FACEP

12. Bill Jermyn, DO, FACEP

13. Principles of the EMCS • Patient enters the system the second the phone rings in dispatch • Symptom onset to definitive care concept • Integration of the entire system improves patient outcomes • Dispatch is an important component of patient care Bill Jermyn, DO, FACEP

14. What Do I Ask Of You? • Awareness • Let’s start a discussion about how to best attack the problem in your local area • We have some resources we can share • Help us with our effort so we can help you Bill Jermyn, DO, FACEP