Emergency Medical Dispatch Bill Jermyn, DO, FACEP EMS Medical Director Missouri Department of Health and Senior Services 12/6/2018 Bill Jermyn, DO, FACEP

“Nothing endures but change.” Heraclitus 540 BC – 480 BC 12/6/2018 Bill Jermyn, DO, FACEP

Why should you care about dispatch? Your constituency does A visible “face” of your Department “Scene Commander” until someone physically arrives Fills the response time gap—5-10 minutes in the best of systems 12/6/2018 Bill Jermyn, DO, FACEP

Why should you care about dispatch? Who do you want to help you if you get into trouble? “OK, we’ll send someone.” and hang up the phone Or, do you want trained personnel with written protocols to stay on the line with you and talk you through the event? 12/6/2018 Bill Jermyn, DO, FACEP

Studies show average times are: 2 minutes to call for help Excellent call processing time is 60-90 seconds Excellent chute time is 2 minutes Response time to scene is 5-10 minutes Response time to patient is 1.5 minutes Total is 12-17 minutes if all goes well 12/6/2018 Bill Jermyn, DO, FACEP

The First “First Responder” Concept of Zero-minute Response 12/6/2018 Bill Jermyn, DO, FACEP

What is my liability? I am not a lawyer Public’s expectations—the William Shatner effect—1995 letter from Ryan Insurance of Kingston, NY: “The company has in the past been made aware of situations where the caller requested medical advice, and was told that was beyond the system capabilities. The resulting worsened condition quickly turned into a liability claim against the system operators. It seems the currently running television shows depicting 9-1-1 situations which include pre-arrival instruction have caused the general public to expect this service from all 9-1-1 operators.” What is the “standard of care”? 12/6/2018 Bill Jermyn, DO, FACEP

National Organizations “The American College of Emergency Physicians (ACEP) believes that the Emergency Medical Dispatch (EMD) program is an integral and critical component of the medical care EMS system.” ACEP policy “Physician Medical Direction of Emergency Medical Dispatch Programs” 12/6/2018 Bill Jermyn, DO, FACEP

National Organizations “The emergency medical dispatcher (EMD) is the principle link between the public caller requesting emergency medical assistance and the emergency medical service (EMS) resource delivery system. As such, the EMD plays a fundamental role in the ability of the EMS system to respond to a perceived medical emergency.” American Society for Testing and Materials (ASTM) F 1258 12/6/2018 Bill Jermyn, DO, FACEP

National Organizations “The trained Emergency Medical Dispatcher (EMD) is an essential part of a prehospital EMS system.” “Pre-arrival instructions are a mandatory function of each EMD in a medical dispatch center.” “Training as EMDs is required for all dispatchers functioning in medical dispatch agencies and requires unprecedented cooperation between the diverse disciplines….” National Association of EMS Physicians, policy statement, “Emergency Medical Dispatching” 12/6/2018 Bill Jermyn, DO, FACEP

Opposition Fear of liability Cost of training—initial and continuing Personnel cost—higher training may demand higher salary 12/6/2018 Bill Jermyn, DO, FACEP

12/6/2018 Bill Jermyn, DO, FACEP

Principles of the EMCS Patient enters the system the second the phone rings in dispatch Symptom onset to definitive care concept Integration of the entire system improves patient outcomes Dispatch is an important component of patient care 12/6/2018 Bill Jermyn, DO, FACEP

What Do I Ask Of You? Awareness Let’s start a discussion about how to best attack the problem in your local area We have some resources we can share Help us with our effort so we can help you 12/6/2018 Bill Jermyn, DO, FACEP