Determinant Codes - Emergency Dispatch

1 Determinant CodesVersusResponseUnderstanding How It Is DoneNational Academy of Emergency Medical Dispatchexerpts from:The Principles of Emergency Medical DispatchThird Edition ( )Jeff J. Clawson, MD. Kate Boyd Dernocoeur, EMT-PLibrary of Congress Catalogue Number: 00-133298 AUTHORS:Jeff J. Clawson, Kate Boyd DernocoeurCONTRIBUTING AUTHORS:Geoff Cady, Bob SinclairDESIGN:Kris Berg, Mindy Warlick, Dustin PikeEDITORS: Gordon W. Cottle, Nancy Hayes,Gary Horewitz, William Lloyd, Robert L. Martin,Harley Pebley III, Bob :Liberty PressPUBLISHER:Priority PressCopyright 1988 First Edition Printing 1998 Second Edition Printing 2000 Third Edition Printing 2001 Third Edition Reprinting, have been registered for this textbook and its prede-cessor editions by the National/International Academy ofEmergency Medical Dispatch , Inc.

2 Salt Lake City, Utah, USA. AllIntellectual Property Rights Reserved. In addition, the Academyhas secured Medical Priority Consultants, Inc. s (MPC) permis-sion to use and refer to certain intellectual properties of MPC,including without exception MPC s proprietary Medical PriorityDispatch System (MPDS) Protocols, Cards and Software whichare described in this textbook, and which are covered by separate-ly registered copyrights of all editions. Patents have also beengranted for the the MPDS Software and Cards. Protections pro-vided under Patent and Copyright Laws, and underInternational Conventions on Intellectual Property Rights make itan illegal offense to duplicate anything from this textbook, inwhole or in part and in any form, without the express, prior, writ-ten consent of the copyright and patent holders (who are receptiveto resonable requests for such permission).

3 The content of this text is furnished for informational use only andis subject to change without notice. The copyright holders andauthors assume no responsibility of liability for any errors, omis-sions, or inaccuracies within this following patents may apply to portions of the MPDSTM depicted in this manual:5,857,966; 5,989,187; 6,004,266; 6,010,451; 6,053,864; 6,076,065; 6,078,894; 6,106,459 The National/International Academy of EMD139 E. South Temple, Suite 530 Salt Lake City, Utah 84111 United States of : in the United States of America10 9 8 7 6 5 4 3 2 ISBN: 0-9658890-2-5010323 Medical Priority, Priority Dispatch , AMPDS, MPDS, DispatchLife Support, Zero-Minute Response Time, First at HelpingPeople First, ProQA, AQUA, the ProQA logo, the AQUA logo,and the caduceus logo are trademarks or service marks of MedicalPriority Consultants, Inc.

4 The Academy accepts no other liabilityor obligation with respect to references to such products and serv-ices which may be made in this book with , Windows, Windows 95, Windows 98, and Microsoftare registered trademarks of Microsoft of third-party products is for informational purpose onlyand constitutes neither an endorsement nor a Training and CertificationThe Academy maintains a cadre of trained and certified instructorswho are qualified to teach the proper use of the Medical PriorityDispatch System (MPDS). These instructors are continuallyupdated as to new curricula and MPDS version updates. Academyapproved EMD courses use the MPDS EMD Course Manual andaudiovideo materials.

5 Any MPDS instruction without such materials is not authorized,accepted, or approved by the not currently certified by the Academy as EMDI nstructors are not qualified to safely instruct dispatchers in theproper and effective use of the MPDS. Using this book and asso-ciated manual to teach the use of alternative protocols or guide-line-based systems is neither advised nor authorized by theauthors or the of this textbook for teaching may not occur outside of a currently licensed training organization or should be asSimpleas possible, but not simpler. Albert Einsteinexerpts from:The Principles of Emergency Medical DispatchThird Edition ( )Jeff J.

6 Clawson, MD. Kate Boyd Dernocoeur, EMT-PDispatch Determinant the EMDdetermines the level of concern using the answers tokey questions and the additional information, theproper Dispatch Determinant can be selected. There aresix Dispatch Determinant categories:E= ECHO-levelD= DELTA-levelC= CHARLIE-levelB = BRAVO-levelA = ALPHA-level = OMEGA-levelA vital principle is that the names ECHO, DELTA,CHARLIE, BRAVO, ALPHA, and OMEGA of the dispatchdeterminant levels do not change. EMS systemsimplementing priority Dispatch must understand thatthe system can design responses to each Determinant asbest fits their needs (see Response Theory and Local Development in this chapter).

7 Each EMS systemmust decide which resources the six levels best example, ALPHA-level may mean basic life supportCOLDand DELTA-level mean advanced life support E-D-C-B-A- Determinant levels are vital formeaningful data collection and quality assurance. Theability to gather meaningful statistical data with thisstandard coding system allows performancecomparisons between cities, regions, and even this sense, priority Dispatch is the first EMS datacollec-tion systemwith more than a local meaning ithas an inter-national capacity toparticipate in abroad-spectrumpriority dispatchdatabase using this system is useful in an era whereprocedures, outcomes, and, more recently, paymentsfor Emergency services are increasingly scrutinized.

8 Use of the statistics generated through use of thedispatch Determinant Codes can demonstrate accuratelywhat types and severity of calls an EMS system has spentits resources handling. For example, there is a perceptionwithin EMS that about 5 to 10 percent of calls are of alife-threatening nature, but no one really knows if thisis accurate. Priority Dispatch allows for evaluation andverification that the system is being used appropriatelyand determinants do not indicate the sever-ity ofa situation. That is, the E-D-C-B-A- levels are notrelated in a linear sense of becoming progressively , they have to do with how many responders willgo and (when there are tiers of capa-bility), which levelsof expertise are needed, and how rapidly they areneeded.

9 The system operates as a two-dimensional, non-linear matrix (see figure 3-14).The vertical axison the grid relatesto response responderstravel COLD, orare they neededHOT? The horizontal axis relates to rescuer ability. Couldbasic life support providers handle this or are advancedlife support providers needed? Priority Dispatch has replaced the traditional more isbetter concept. When a crew s training and manpoweris matched to a particular situation, that crew can moreefficiently handle it. For example, basic-level EMTs areexperts at splinting, bandaging, and other basic is no reason they cannot be trusted to handlebasic-level situations, freeing advanced life supportproviders (who are invariably fewer in number) foradvanced-level 3 STRUCTURE AND FUNCTION OF PRIORITY Response Level Theory.

10 The MPDS, 1978-2001 ability to gather meaning-ful statistical data with thisstandard coding systemallows performancecomparisons between cities,regions, and even Dispatch promotes theconcept of using the mostappropriate a study of the Long Beach, California systempublished in the Journal of Prehospital and DisasterMedicinein 1992, Stratton, et al., concluded: Emergency Medical Dispatchers, medically controlledand trained in a nationally recognized dispatchertriage system, were able to provide medical triage toincoming Emergency medical 9-1-1 calls with minimalerror for under-triage of ALS runs and high selectivityfor non- Emergency Determinant TerminologyFirst-time users of priority Dispatch are sometimesconfused by the terminology, especially in thedeterminant response section of the protocol whereterms such as Determinant , Determinant code , Determinant level, response code and responsemode sound so similar.