Evidence-based medicine (sometimes called scientific medicine) has existed in some form since at least the 16th century, when Andreus Vesalius, the "father of human anatomy," published diagrams of the human body actually based on anatomical investigation. William Harvey's publication of the first accurate description of the cardiovascular system, the 1665 discovery of the cell by Robert Hooke, and the 19th-century revelation of the neuron as the basic unit of the brain were also critical milestones. In the 1960s, the push toward evidence-based medicine became stronger, and basic science research began..
Clinical call handlers at a contact center in Queensland Health, Australia, use a clinical decision support system (CDSS) called Priority Solutions Integrated Access Management (PSIAM™) (PSIAM version 3.6.1.1, 2012 release, Priority Solutions Inc., Salt Lake City, USA) to provide community members with telephonic triage, referrals, and health information. The contact center operates 24 hours a day, 7 days a week, and all calls are handled by Registered Nurses (RNs). Callers requiring emergency services, usually an ambulance attendance, are transferred to Emergency Medical...
The value of dispatch in modern Emergency Medical Services (EMS) systems cannot be understated. Among many other roles, an Emergency Medical Dispatcher (EMD) is responsible for accurate response selection. Response is based on EMD-assigned dispatch codes upon completion of caller-interrogation questions in a dispatch protocol system. When two or more signs, symptoms, or situational conditions are encountered in a calltaker evaluation, but are assigned and reported as a single, dispatch-defined code descriptor during the call-taking process by an EMD, a data hiding...
Emergency Medical Dispatchers (EMDs), at emergency communication centers that have implemented the Medical Priority Dispatch System® (MPDS) protocols, use scripted questions to interrogate people calling 9-1-1. Based on this interrogation, case determinant codes are assigned– to identify the specific patient condition and enable optimal allocation and deployment of resources to ensure appropriate field responses. MPDS determinant codes for both OBVIOUS and EXPECTED DEATH exist for patients that are clearly and irreversibly dead, or have a terminal illness accompanied...
Telephone nurse triage at the 9-1-1 dispatch point is relatively new in the United States despite its ability to significantly reduce expensive and scarce Emergency Medical Services (EMS) resource use and emergency department visits. A previous study investigated the distribution of 9-1-1-triaged call incident types within the Emergency Communications Nurse System (ECNS) and found that 9-1-1 triage systems yielded a variety of low acuity complaints that were handled by the Emergency Communications Nurse (ECN). This study explored the current and potential utilization...
Research has shown that two-thirds of emergency visits occur after business hours (weekdays 9am – 5pm). Therefore, identifying primary healthcare providers available after business hours is one strategy for improving appropriate access to healthcare services. Previous studies have also shown a high and steady volume of secondary triage-eligible calls throughout the day and into the evening. However, because the Emergency Communication Nurse (ECN) performing the secondary triage has some discretion on selecting the Recommended Care Level (RCL) based on resource...
Seizures are episodes of sudden, severe, disorganized neurological activity in the brain, characterized by uncontrolled movement and, in many cases, altered consciousness. Seizures account for 1% of all emergency department visits, and are a leading cause of Emergency Medical Services (EMS) activation and transport. Patients who experience a seizure with no medical history of seizure disorder challenge the prehospital provider to identify an underlying cause for the event and attempt to treat immediately. s:This study aimed to identify the clinical profile of...
9-1-1 telecommunicators are uniquely exposed to numerous occupational stressors on an ongoing basis. Yet little is known about the sources of occupational stress and symptoms of stress in these workers and even less is known about variables that can serve as stressors or buffers to stress in the 9-1-1 call center work environment. We sought to explore the inter-relationships amongst job stressors, potential risk and protective factors, and symptoms of stress in 9-1-1 telecommunicators. Our long-term goal was to use outcomes of this study to guide and...
The traffic stop began like any other. The officer radioed to dispatch with the license plate number and a National Crime Information Center (NCIC) search was conducted. The search turned up negative – showing nothing unusual about the vehicle or its owner – and the officer started a routine approach to the vehicle. The dispatcher then searched the license plate number through the Federal Bureau of Investigation's (FBI) newest System, the National Data Exchange (N-DEx). for short. Moments before the officer reached the driver's side window, dispatch returned with some relevant information...
Without bystander CPR, cardiac arrest survival decreases 7%-10% for every minute of delay until defibrillation. Dispatcher-assisted CPR (D-CPR) has been shown to increase the rates of bystander CPR and cardiac arrest survival. Other reports suggest that the most critical component of bystander CPR is chest compressions with minimal interruption. Beginning with version 11.2 of the Medical Priority Dispatch System™ (MPDS) protocols, instructions for mouthto-mouth ventilation (MTMV) and pulse-check were removed and a compressions-first pathway introduced to facilitate rapid delivery of...
