1. Emergency Medical Dispatch EMD Deidre Snyder EMD Q Unit Duty Officer Broward Sheriff’s Office

3. National Academy of Emergency Medical Dispatch The Broward Sheriff’s Office Regional Communications Division is an Accredited Center of Excellence (ACE) with the National Academy of Emergency Medical Dispatch (NAEMD). The NAEMD outlines the process by which the agency is expected to execute in handling 911 medical calls and the quality management/assurance of those calls.

4. The acronym of EMD can be used in two ways: EMD – Emergency Medical Dispatch EMD – Emergency Medical Dispatcher

5. What is Emergency Medical Dispatch (EMD)? Reception and management of requests for emergency medical assistance in an EMS system

6. What is an Emergency Medical Dispatcher? (EMD) EMS personnel specifically trained and certified in interrogation techniques, pre-Arrival Instructions, and call prioritization They have a minimum of 24 hours of training including techniques of airway and hemorrhage control, CPR, Heimlich maneuver and childbirth.

7. Key points of EMD structured environment Provides the ability to focus clearly on each medical situation. Eliminates inconsistency and vagueness Provides a standard, precise approach to each call

8. Steps of a 911 medical call Call receipt Signal type obtained Address of emergency obtained Call is entered for Dispatch Launch Pro QA (or utilize the EMD card set) Case Entry Interrogation Four Commandments/questions (breathing and consciousness status) Key Question Interrogation – Based on specific protocol Dispatch code selection Post Dispatch Instructions Dispatch Life Support Instructions (If applicable) Pre-Arrival Instructions

9. So what does this look like to the Operator using Pro QA?

10. Case Entry

11. Key Questions

18. Post Dispatch Instructions (PDI)

19. Dispatch Life Support Instructions

22. Case Exit

23. Let’s take a look at the EMD Quality Assurance/Improvement Unit * what happens after the call

24. EMD Q Unit In order to maintain our accredited status, a strong quality assurance process must be in place. The process of quality management and assurance promotes the continual improvement of service to the public. 1 Certified EMD - Q Duty Officer 8 Certified EMD–Q reviewers (EMD Qs) Reviewers attend a three day course and must successfully pass an exam and recertify biennially

25. Duties for the EMD Q Case Review QI meetings (with employees) Medical Dispatch Review Committee (MDRC) meetings EMD Practicality classes CPR Certifications

26. Case Review Statistics EMD Q’s conduct random spot checks on between 2% and 3% of our incoming medical calls for service This number is derived via a sliding scale calculator set by NAEMD and is based on agency call volume for medical events The Broward Sheriff’s Office receives approximately 14,000 calls each month and are only required to conduct reviews on 1% of our medical calls according to the aforementioned scale

27. Case Review Statistics continued.. At this time the EMD Q unit reviews between 2% and 3% each month simply to maintain consistency in educating each employee. Each employee has at least one medical call reviewed and discussed each month. Each EMD Q has a specific list of employees that they are responsible for reviewing and educating each month. These lists are rotated amongst the 8 Q’s every 6 month to maintain objectivity. Employees are met with within the same month to discuss the outcome of the review.

28. Case Review The process of reviewing cases is conducted in the Quality Improvement Unit by EMD-Qs EMD-Qs listen to audio tapes of selected calls and compare the EMD’s actions to the protocol Check whether or not all the questions were asked

29. Case Review continued… Check whether or not all the questions were asked as written Check whether or not the EMD operator deviated from the protocol Check that post-dispatch/pre-arrival instructions were given correctly if necessary An Incident Performance Review is created and presented to the employee during a QI meeting

30. Case Evaluation Record Case review is accomplished using AQUA, a Quality Improvement Software that automates the entire emergency dispatch review process Case review is accomplished through the completion of the Case Evaluation Record It is used to provide an objective scoring of the case Each component of the protocol is assigned a weighted value based on the relative value of the activity as it relates to the entire EMD process

31. Case Evaluation Record continued… The case review process is maintained by the Academy and measures and EMD’s compliance to performance standards that are routinely updated by the Board of Accreditation. Seven areas are evaluated based on the standards and methods taught in the Academy’s EMD- Q Certification Course. These and a composite Compliance Summary are maintained in each center, shift, individual EMD throughout her/his career.

32. Case Evaluation Record continued… The seven areas that are evaluated are: Case Entry – 95% Chief Compliant – 95% Key Questions – 90% Post-Dispatch Instructions – 90% Pre-Arrival instructions – 95% Final Coding Accuracy – 90% Total Compliance – 90%

33. Monthly Statistics of EMD Performance June 2015July 2015 Total calls: 14,188 Calls reviewed: 368 Percentage of calls evaluated: 2.59% Total # of operators reviewed: 307 Total # of operators 100% complaint: 140 Total # of operators non – compliant (under 90%): 45 Areas of improvement: Chief Complaint Areas of concern: Case Entry and PAI Instructions Total calls: 14,657 Calls reviewed: 368 Percentage of calls evaluated: 2.51% Total # of operators reviewed: 307 Total # of operators 100% complaint: 161 Total # of operators non – compliant (under 90%): 32 Areas of improvement: Chief Complaint Areas of concern: Case Entry and PAI Instructions

34. Special Cases Special cases can be requested by the Operators, Duty Officers & Management For the operators when they have questions about using the cards correctly For questions about applying EMD to a call in the most appropriate manner Any other questions the operator might have If we don’t know the answer, we will research it with NAEMD and get back to the employee in a timely manner

35. Running a case through AQUA and Incident Performance Reviews

43. Medical Dispatch Review Committee (MDRC) Meetings Once a month the EMD Duty Officer meets with the EMD Q’s to discuss EMD protocols, possible changes to submit to the academy and any trending patterns or issues they may have come across while conducting reviews. These meetings are an integral part in ensuring consistency in the review process. These items, along with planned agenda topics are addressed, minutes are taken and the outcome is presented to the Steering Committee

44. Steering Committee Representatives from each of the agencies that the Regional Communications Division provides services will be in attendance quarterly An effective way to ensure the field user’s perspective in regard to the utilization of the protocols and their effect on patient care, pre hospital These meetings are a requirement of maintaining our ACE accredidation

45. EMD Awards Certificate of Excellence from administration and silver lapel pin for 3 months of 100% protocol compliance scores Certificate of Excellence from administration and gold lapel pin from administration for 6 months of 100% compliance scores Certificate of Excellence from administration and gold lapel pin from Fire Rescue for 9 months of 100% compliance scores Doretta Walker Award given to the EMD operator with the most 100% protocol compliance scores within a calendar year

46. Questions