I have written in the recent past about my frustrations with Medical Priority Dispatch (MPD), as well as the recent research that has been published pointing out its failings. The posts include Troublesome, Unformed Idea, Fair Enough and Dispatchers.
Bryan E. Bledsoe, DO, FACEP, who has made a name for himself debunking EMS myths in addition to being the author of the standard EMS text, has now weighed in on Medical Dispatch, commenting on the latest research, which shows that on half the MPD protocols, flipping a coin does a better job of correctly prediciting priority than the protocol.
Anecdote Based EMS
I agree with his conclusion: "Either the system needs to be evidence-based (that is, it works) or it should be abandoned."
"Sixteen of the 32 protocols performed no better than chance alone at identifying high-acuity patients."-Comparison of the medical priority dispatch system to an out-of-hospital patient acuity score.
Acad Emerg Med. 2006 Sep;13(9):954-60.
Feldman MJ, Verbeek PR, Lyons DG, Chad SJ, Craig AM, Schwartz B.
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In one town where I work, someone calls 911, the town dispatcher answers, takes the information, and then kicks the call to a regional medical dispatch center to "EMD" the call. The town dispather calls us, gives us the address, nature and a priority code. "Code Three" is lights and sirens. "Code One" is no lights and sirens. We then get in the ambulance and contact the regional medical dispatch center, who provides us with "EMD" information after interviewing the caller. We basically get more info and another dispatch code. "Hot" is lights and sirens. "Cold" is no lights and sirens. We then call our town dispatcher in the event we have either been upgraded to lights and sirens or downgraded.
Yesterday one of our calls was for a person with swollen legs who had fallen a few days before, and who's son wanted her to go to the hospital. The town dispatcher send us in nonemergency mode. The medical dispatch center upgraded us to hot because the woman had a heart history. The call was strictly BLS, nonemergency to the hospital.
We do have the ability to overrule the medical dispatch code, which is just "recommended." I have a pretty good feel for what the call will be, particuarly if I have been to the same address before. I often just continue in the nonemergency mode if the time difference between lights and sirens and non lights and sirens will be minimal.
I think it would be interesting to do a small study comparing the accuracy of the town dispatcher, who uses their "common sense" versus the medical dispatcher who follows the algorithm.
Both have their advantages and disadvantages. I have found the medical dispatch center seems to always overtriage us by sending us "hot" if the patient has any kind of cardiac history. The town dispatchers tend to undertriage us when they send us non emergency for any kind of broken bone and overtriage us when they don't understand what the caller is talking about just as when a G-tube comes out. They tell us to go lights and sirens. We say "ah, no."
