EMS World

FEB 2019

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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ISSUE FOCUS: CARDIAC AND STROKE CARE 28 FEBRUARY 2019 | EMSWORLD.com Y ou take a medical control call for a crew that's been been working on a cardiac arrest for 35 minutes. The patient was down for about 10 min- utes prior to EMS arrival. A bystander began CPR about four minutes after the arrest. You wonder whether anything could have been done differently upon initial dispatch. How does all of that work, any way? Do different dispatch systems make a differ- ence to cardiac arrest sur vival? Literature Review Emergency medical dispatch has a rela- tively brief histor y. The Medical Priority Dispatch System (MPDS), the 197 7 brain- child of Utah physician Jeff Clawson, MD, gave the EMS community one of its first formal dispatch s ys tems . The title of emergency medical dispatcher was con- ferred for the first time in 1979. In 1983 Utah became the first state to establish a certificate program for emergency medi- cal dispatchers, and the first computer- ized version of these protocols was put into place in 1986. 1 Th e MPDS is a co m p uter disp atch s ystem that a ssigns a priorit y level to each call based on a series of questions designed to triage the caller's complaint. Re s p o n s e level s are alp ha (lowe s t), bravo, charlie, delta, and echo (high- est). MPDS is used in the majority of the United States. A version of the MPDS, the Advanced Medical Priority Dispatch System (AMPDS), is used in the United Kingdom and Ireland. The other giant in the field, Criteria Based Dispatch (CBD), was developed by Wa shing ton's King Count y EMS in 1990. Whereas MPDS uses a protocol- based dispatch formula, CBD utilizes a tiered approach. CBD guidelines allow dispatcher s to determine the level of re s p o n s e re q uire d (i.e., ad van ce d o r basic life support), followed by the time urgency (urgent or nonurgent). Criteria includes "specific signs, symptoms, and mechanism of injur y or circumstances that indicate the level of urgenc y of a medical condition." 2 Of fshoot s of this s ystem are found thro ugh o u t Sc an dinav ia an d Euro p e. The Danish Index for Emergency Care, for instance, uses a five-tiered system of severity: • A: Life -threatening o r p otentially life-threatening conditions requiring immediate response ("blue lights and sirens"); • B: Urgent but not life-threatening condition; • C: Nonurgent condition that requires By Sonya Naganathan, MD, and Hawnwan Philip Moy, MD Photo: Aaron Webster DISPATCH PROTOCOLS AND CARDIAC ARREST How do various approaches impact patient care and outcomes?

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