Effect of a Comprehensive Quality Management Process on Compliance With Protocol in an Emergency Medical Dispatch Center☆,☆☆,★
Section snippets
INTRODUCTION
The American Society for Testing and Materials (ASTM) issued guidelines for emergency medical dispatch (EMD), EMD training and certification, and EMD management in designations F1258-95, F1552-94, and F1560-94.1, 2, 3 In these, the ASTM recommended not only that all emergency medical dispatchers use a medically approved emergency medical dispatch priority reference system (EMDPRS) but also that ongoing quality assurance activities include extensive case review and regular feedback to the
MATERIALS AND METHODS
Training on the use of the AMPDS was completed by the test center in July 1993. After a 1-month gap to allow the dispatchers to adjust completely to the new system, we began formal monitoring of their compliance with the protocol. During September and October 1993, we evaluated dispatchers’ performance in the absence of any feedback. At the end of October, a performance-feedback and CDE program was started; monitoring continued until the end of December to evaluate its effects.
The AMPDS uses
RESULTS
All 32 communications center dispatchers successfully completed the EMD course and received NAEMD certification on the use of the AMPDS. Approximately 100 cases were reviewed each month, including 25 to 29 dispatchers with an average of approximately 4 cases per dispatcher. The additional (NAEMD) reviewer did not identify any discrepancies between the in-house reviewer’s interpretation of the re-reviewed cases and the grading standard. The scores for those dispatchers who received multiple
DISCUSSION
This study evaluated how rigorously a group of 32 emergency medical dispatchers complied with an EMD protocol. During the first 2 months of the study, the dispatchers did not receive CDE or feedback on their levels of performance; during the last 3 months, they were given feedback concerning their previous performance and were provided with CDE.
The study examined overall compliance with the protocol and compliance in 6 key areas (which together covered all aspects of the dispatch process).
Acknowledgements
We acknowledge the invaluable assistance of Doug Smith-Lee, Emergency Medical Services Manager, and Thera Bradshaw, Director, Clark Regional Communications Agency, and of Lynn Wittwer, MD, Director, and Marc Muhr, Assistant Director, Clark County Medical Program, Vancouver, Washington, for sharing with us the details of the quality improvement program and the compliance-with-protocol performances of the Clark County dispatchers.
References (19)
- et al.
A priority dispatch system for emergency medical services
Ann Emerg Med
(1985) - et al.
Increasing the efficiency of emergency medical services by criteria based dispatch
Ann Emerg Med
(1994) - et al.
Emergency medical services priority dispatch
Ann Emerg Med
(1993) - et al.
Comparison of ambulance dispatch protocols for nontraumatic abdominal pain
Ann Emerg Med
(1995) Standard practice for training instructor qualification and certification eligibility of emergency medical dispatchers F1552-94, in Annual Book of ASTM Standards, 1994
(1994)Standard practice for emergency medical dispatch management F1560-94, in Annual Book of ASTM Standards, 1994
(1994)Standard practice for emergency medical dispatch F1258-90 and F1258-95, in Annual Book of ASTM Standards
(1990 and 1995)Dispatch priority training: Strengthening the weak link
JEMS
(1981)- et al.
Emergency medical services: dispatch and response
Fire Chief
(1983)
Cited by (46)
Impact of extreme temperatures on ambulance dispatches in London, UK
2020, Environmental ResearchUse of telephone CPR advice in Ireland: Uptake by callers and delays in the assessment process
2016, ResuscitationCitation Excerpt :Highly effective dispatch systems are required to maximise the use of limited NAS resources; T-CPR, volunteer Cardiac First Responders, use of off-duty staff in OHCA, centralisation of command and control and high quality audit are among the measures which have been introduced.12 The NAS control systems use the Advanced Medical Priority Dispatch System (AMPDS) Version 12.0 which requires a call-taker to complete a series of 21 questions/items in order to diagnose cardiac arrest and then offer T-CPR.13 The AMPDS protocols are installed within a computerised system known as ProQA (Priority Dispatch Corporation, Salt Lake City, UT, US) which was used throughout this study; manual cards with the same questions are available in the control room if required.
Are regional variations in activity of dispatcher-assisted cardiopulmonary resuscitation associated with out-of-hospital cardiac arrests outcomes? A nation-wide population-based cohort study
2016, ResuscitationCitation Excerpt :The final outcomes were measured at one month, although a longer observation period has been recommended.36 However, this study contains a notably large prospective cohort, and the results of this study suggest the requirement of a national initiative to establish a better DA-CPR protocol with qualified educational system for dispatchers and to improve the compliance with DA-CPR protocol.37 Wide variations in sensitivity of DA-CPR and proportion of bystanders to follow DA-CPR exist in Japan.
A standardized template for measuring and reporting telephone pre-arrival cardiopulmonary resuscitation instructions
2014, ResuscitationCitation Excerpt :Dispatch-assisted CPR, also known as Telephone CPR (TCPR), has been shown to double rates of bystander CPR4 and provides an opportunity to systematically increase bystander CPR rates and survival on a large scale.5 Previous work by Clawson et al. describing the development of pre-arrival instruction protocols for OHCA and subsequent quality improvement measures have improved bystander TCPR rates.6 TCPR instruction is defined as real-time CPR guidance offered to callers by emergency dispatchers or other trained call takers.
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From Medical Priority Consultants, Inc,* and National Academy of Emergency Medical Dispatch,‡ Salt Lake City, UT.
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Address for reprints: Jeff J Clawson, MD, Medical Priority Consultants, Inc, 139 East South Temple, Suite 500, Salt Lake City, UT 84111.
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0196-0644/98/$5.00 + 0 47/1/93445