Dispatch Disparity: How Does a Chest Pain Call Turn Into Sore Feet?

The answer isn’t the dispatchers. Anyone who has spent any time at all in a communications center answering 911 calls for service understands that you are utterly at the mercy of the person on the other end of the phone for correct information. And, you have mere seconds to get the crucial details.

And all kinds of factors can skew that information:  language barriers, bad connections, callers who hang up, uncooperative callers, hysterical callers, and those who just don’t want to be, well, truthful. More often than the industry would care to admit, the call that responders are dispatched to, and the situation they find when they get there are sometimes miles apart.

You’re only as good as your information. Let’s break down the process. For the sake of example, I’m going to focus on the state of Florida. A call for service is placed through E911 (911 enhanced). A trained, state-certified Public Safety Telecommunicator (PST) answers the call. They determine immediately if the nature of the caller’s emergency is police, fire or medical, and after a couple of quick differential questions, they reroute that call to the correct dispatch agency.

If it is a medical emergency, some agencies send that 911 call to an actual paramedic, who will go through a specific set of cards for the scenario presented by the caller in order to (1) get the correct help to them immediately, (2) determine if the emergency is critical enough to warrant pre-arrival instructions to help the patient, and (3) provide post-dispatch instructions to the caller on what to do before the first responders arrive. (Note:  EMDs and PSTs do not have to be paramedics to do this; all over the country, lay people perform the job exactly the same way.)

As someone who has spent time on either side of that radio, I can tell you there are only a few seconds to determine what is needed. And we have stringent deciding factors:  difficulty breathing, chest pain, altered level of consciousness and uncontrolled bleeding situations are where you stop and render instructions on how to help before rescue gets there. These have the potential to be life-threatening situations, requiring airway assistance, CPR, bleeding control direction, medication administration over the phone, and stroke diagnostics.

Emergency Medical Dispatchers are highly trained, and use a standardized, unified triage method called the Medical Priority Dispatch System, which is divided into a set of cards for each chief complaint the caller or patient (or both) can come up with. Sometimes you have to make a judgment call, especially when a 911 caller says something vague like “I just don’t feel well.”

These cards are alphabetized by chief complaint, and are scripted in their key questions, information input, pre-arrival assistance and post-dispatch instructions. MPDS was developed by Dr. Jeff Clawson – considered “the father of modern emergency dispatch” and the co-founder of the National Academies of Emergency Dispatch (NAED) – between the years of 1976 and 1979. He considered EMDs the very first first responders to render patient care.

DispatchPhysical card sets sit at every dispatch console, and many agencies use a computerized version called ProQA. The chief complaints are organized as follows:

  • (1) Abdominal Pain/Problems
  • (2) Allergies (Reactions)/Envenomations (Stings, Bites)
  • (3) Animal Bites/Attacks
  • (4) Assault/Sexual
  • (5) Back Pain (Non-Traumatic/Non-Recent)
  • (6) Breathing Problems
  • (7) Burns (Scalds)/Explosions
  • (8) Carbon Monoxide/Inhalation/HAZMAT/CBRN
  • (9) Cardiac or Respiratory Arrest/Death
  • (10) Chest Pain
  • (11) Choking
  • (12) Convulsions/Seizures
  • (13) Diabetic Problems
  • (14) Drowning/Diving/SCUBA Accident
  • (15) Electrocution/Lightning
  • (16) Eye Problems/Injuries
  • (17) Falls
  • (18) Headache
  • (19) Heart Problems/AICD
  • (20) Heat/Cold Exposure
  • (21) Hemorrhage/Lacerations
  • (22) Inaccessible Incidents/Entrapments
  • (23) Overdose/Poisoning (Ingestion)
  • (24) Pregnancy/Childbirth/Miscarriage
  • (25) Psychiatric/Suicide Attempt
  • (26) Sick Person
  • (27) Stab/Gunshot/Penetrating Trauma
  • (28) Stroke (CVA)/Transient Ischemic Attack (TIA)
  • (29) Traffic/Transportation Injuries
  • (30) Traumatic Injuries
  • (31) Unconscious/Fainting (Near)
  • (32) Unknown Problem (Man Down)
  • (33) Inter-Facility Transfer/Palliative Care
  • (34) Automatic Crash Notification (ACN)

Seems straightforward. But again, you are only as good as the information you receive from that caller. Sometimes, you don’t know what’s wrong with that patient and neither do they. So EMDs usually start on the 26 card – “Sick Person” and go from there. If during the scripted key questioning an actual chief complaint is revealed, the ProQA will shunt the dispatcher to another card to better handle the medical emergency, and potentially provide life-saving instructions.

For instance, if the man at the payphone at the gas station down the street is calling because his feet hurt, but tells you instead that he has chest pain, there’s your disparity. You run down the chest pain protocol with him, dispatch units emergency, and when the paramedics get there they find a gentleman who has been walking all night and needs a ride somewhere. He’s not having chest pain.

The opposite also frequently happens. A nursing facility, for example, will call 911 for a patient that needs to be transported on doctor’s orders for, say, abnormal lab values. The EMD runs through the appropriate protocol with the caller, determines that a nonemergency (downgraded) response is warranted and the crew walks in to three nurses performing CPR on the same patient. Where the disconnect happened in this situation is anyone’s guess – but it does happen.

The keys to changing this are more effective communication and education for not only the public, but the first responders as well. It wouldn’t hurt to have them sit and shadow the EMDs for a shift and listen to those 911 calls. Having an idea about what the other side deals with can sometimes change perspectives for the good of all involved.

Disclaimer: The content in this article is the opinion of the writer and does not necessarily reflect the policies or opinions of US Patriot Tactical.

Leah Dallaire

Leah G. Dallaire is a highly accomplished freelance writer, editor and consultant with 28 years of experience. She has also concurrently been a paramedic for 20 years; the last 17 she spent serving the citizens of Pinellas County, Florida, which has a call volume of about 209,000 runs per year. She holds an M.A. and a B.A. in Writing & Literature from Union University. She has also just finished her first novel.
Leah Dallaire
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