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EMD Protocols

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383535_10150788246064508_2083522327_n_max50

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Posted almost 7 years ago

 

I'm a firefigter and MFR (EMT-R) and one of the 4 counties we serve uses the EMD protocols. Here is my question with it... why can a 72 yr old male who is having radiating pain from the left side of his chest into his arm, but is responsive and breathing be Priority 3 (P3).. i.e. no lights/siren?? But if a 26 yr old female who is complaining of neck paing 14 hours after falling off a bike who is reponsive and breathing be Priority 1 (P1) i.e. lights/siren?

Squiers_june_09_max50

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Rate This | Posted almost 7 years ago

 

Which protocols does your agency use? In my experience each agency or medical directors of the ems agencies make the determinate responses. Priority Dispatch is my only experience so I cannot speak for other EMD protocols.

383535_10150788246064508_2083522327_n_max50

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Rate This | Posted almost 7 years ago

 

There is a flip chart they use.... if its a cardiac arrest, the go to that section and start asking questions from the answer they get the priority. I 'm working on seeing the central dispatch center to see it... they wanted FD protcols too and we saw the charts for that... we said no. Its like by the time you asked them there house would be burnt down.

911clr_max50

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Rate This | Posted almost 7 years ago

 

ahk - We would need to know which EMD protocol system they use, there are several. Those EMD cards were created by Doctors, so there content is valid to the best of those doctors abilities. The EMD system an agency uses also has to have "medical control" (usually a MD) approve their use.

To address the timing issue, my agency asks only the case entry questions prior to dispatch. We ask the pre-dispatch questions AFTER the dispatch to save time.

In my opinion Fire and Police protocol cards are the biggest waste of time and money and an insult to my intelligence, but that's another topic.......


Someone once told me that time is a predator that stalks us all our lives. But maybe time is also a companion who goes with us on our journey, and reminds us to cherish the moments of our lives because they will never come again.

383535_10150788246064508_2083522327_n_max50

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Rate This | Posted over 6 years ago

 

I'm checking into the type of EMD protocol we use.... and MrJim i've seen the fire protocols and they are stupid.... The protocols the EMS and Central Dispatch wanted us to use had for a possible housefire with smoke is Priority 3 and with flames is a Priority 1.. it made no sense to me at all.

383535_10150788246064508_2083522327_n_max50

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Rate This | Posted over 6 years ago

 

It's called CLAWSENS EMD Protocols

911clr_max50

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Rate This | Posted over 6 years ago

 

Ok, it's not called that, but Jeff J. Clawson, M.D created the system. The cards are handled through National Academy of Emergency Medical Dispatch. Alot of info can be found on their webiste at http://www.naemd.org/ You can also email them questions and concerns about certain protocols.

Anyway, getting back to your initial question.... I don't know...... But I do have a solution. Don't follow the cards so literally. My agency does not use those response determinants located at the bottom of every card, we completely ignore them. The field units respond how they want to respond based on the call info and their own in house policies. My EMD cards do not and should not determine if they use lights and sirens. Those cards can be used in anyway your agency sees fit as long as the way you use them is approved by your medical control person and the agencies you dispatch for.

I provided an example of this in my last post, we don't ask pre-dispatch questions pre-dispatch because it's a waste of time. We ask only the entry questions and dispatch after that. It has saved many seconds, and in some instances minutes, of questioning callers about info that can be obtained post dispatch while they suit up and go en route.

All of the agencies handled by your center need to sit down discuss, and agree upon a specific way of using the EMD system that will benefit you and the dispatch center.


Someone once told me that time is a predator that stalks us all our lives. But maybe time is also a companion who goes with us on our journey, and reminds us to cherish the moments of our lives because they will never come again.

P1010285_max50

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Rate This | Posted over 6 years ago

 

Wow. That could be potentially dangerous, depending on how much liability your agency is willing to take on. An agency's decision to be totally reliant upon what the cards recommend can eliminate a lot of liability primarily due to the fact that NAEMD is designed/written by doctors. After all, we arent physically on scene, so self diagnosing all EMS patients is dangerous territory.

911clr_max50

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Rate This | Posted over 6 years ago

 

If your "wow" was directed at me I would disgaree, blindly following all protocols written by people who work in a hospital can be equally dangerous. Regardless NAEMD makes it quite clear the card should and can be used by an agency in anyway they see fit as long as the changes are approved by your medical control. The result for us has been much time saved from asking the pre-dispatch questions. Any liability for how they respond rests with the individual departments, not the 911 center.


Someone once told me that time is a predator that stalks us all our lives. But maybe time is also a companion who goes with us on our journey, and reminds us to cherish the moments of our lives because they will never come again.

P1010285_max50

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Rate This | Posted over 6 years ago

 

I disagree, sorry. The cards were designed by actual medical providers, so who am I with my self appointed bachelor's degree to determine what should and should not be asked? I dont have the conscience to make that kind of decision on my own. I agree that your agency dictates how these protocols should be used, but seriously, taking anything away from them is dangerous territory. That is just my professional opinion based upon years of using these protocols.

Meintraining_max50

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Rate This | Posted over 6 years ago

 

We use Powerphone EMD for our program, but all medical calls are priority one-lights and sirens... I think its more an agency thing to prioritize certain type calls versus your EMD program? I could be very wrong however!

383535_10150788246064508_2083522327_n_max50

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Rate This | Posted over 6 years ago

 

I guess the biggest thing i see for us is the distance between stations. The 2 other counties ( to the north and west) do not use EMD protcols. Alcona County has 2 EMS stations for the county... and Ogemaw County had 3. The biggest problem I see, with us being in a country setting, is when 2 of our 3 ambulances, the remaining ambulance goes on county standby... which is ok, but it takes between 18 minutes ( P1) and 30 minutes (P3) to repond to any emergency on the west side of our county. Take for example that PI i had in DEC... ST 2 responded b/c the infor gathered stated 1 male PT... when we got on scene we had 2, a male and female PT.... the next closest ambulance (if it wasn't for the other county being at our station) would have taken over 30 minutes to get there b/c they were paged out P3 ( we ran P1 since we were 3 miles away and never was given a priority).

383535_10150788246064508_2083522327_n_max50

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Rate This | Posted over 6 years ago

 

BMBarker said:

I disagree, sorry. The cards were designed by actual medical providers, so who am I with my self appointed bachelor's degree to determine what should and should not be asked? I dont have the conscience to make that kind of decision on my own. I agree that your agency dictates how these protocols should be used, but seriously, taking anything away from them is dangerous territory. That is just my professional opinion based upon years of using these protocols.

So i have a question on this.... Are doctors the only "actual medical providers"? Because the last time i knew.... u see EMTs and Paramedics and MFRs on the scene of a car accident, or someone having a heart attack, not a doctor. besides aren't we supose to proved the same care no matter what? How can you give a priority to one thing and another to something simular... same call just one is breathing and one isn't?

Photo_user_blank_big

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Rated +1 | Posted over 6 years ago

 

I guess my first question would be have you contacted your dispatch center? I am sure someone there would be more than happy to sit down with you and explain how the system works within your county. I would also have to agree with BMBarker, your agency does dictate how these protocols should be used.... in partner with your medical control, your bosses and your county's lawyers. I know its hard but public safety has to look out for all public, not just the one needing help right now but also those put in danger along the way.

Funny_avatar_0490_www

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Rate This | Posted almost 5 years ago

 

As an emergency dispatcher that is trained using the EMD Protocols from NAEMD, I think it is a great tool.  Take the class and go through the training it will make sense.    


I personnally think that if the communication center is going to use this system then the first responders should have an understanding of how EMD works.  


What determines the priority of a call?   If the person is breathing, they are still alive.  If breathing is labored, discoloration due to lack of oxygen, etc... A fall more than 14 hours ago?   What is the current complaint?  Symptoms have to be graded into greater or less than a certain time frame.   When following the card set you must make sure that the sequence if followed.  Are they breathing YES or NO, if yes then go to the appropriate protocol or if No then start CPR.   CPR can be started before EMS are dispatched.


Yes, it is taught that once the initial assessment is made, then dispatch EMS to the scene and stay on the phone to provide Pre arrival intructions if necessary.   If it is not a high priority call then the call can be terminated with instructions for the caller to call back if the situation changes or gets worse, while EMS are en-route.  Another thing that we are taught is to instruct the caller, to turn on an outside porch light, put any pets in a bedroom or bathroom and close the door, and to make sure the front door is unlocked.   Little things that makes the job easier for the EMS crews upon arrival.   We are not making a diagnosis, we are just going by the complaints/symptoms that are given to us, then we can instruct (basic first aid) the caller on how to manage the scene while you are on your way.   We don't tell them how to reset a broken limb, but we do give instructions on how to make the injured person comfortable and to prevent any further harm to themselves.    


You asked how could someone who has pain radiating down his arm , responsive and breathing be Priority 3?   Because the person was responsive and breathing.   If the person was having respiratory distress, then it would have changed the priority.   Neck pain from a fall more than 14 hours prior, resulting in a higher priority because it was a head and neck injury. 

911_patch_2_max160_max50

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Rate This | Posted almost 5 years ago

 

We use the APCO Institute guidecards.  They are specifically written for OUR agency and our regional Med Control Physician has to approve them.  Also, if you don't follow what the cards say, APCO will NOT stand behind you as an EMD.  I hold a state license for EMT and some of the cards are "fuzzy" on some parts, but I have to go by the card and not my EMT training when I am on duty as a Telecommunicator at 911.

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Rate This | Posted almost 5 years ago

 

 


We're trained in EMD by Powerphone and I think their program is the best.


I went to a NAED/Priority Dispatch Fire course and it was ridiculous, sure, I learned somethings I wouldn't have otherwise, but some of their protocols are rather awkward.


We don't have a policy on giving pre-arrivals, but we only have one Dispatcher working and it would be really tough to try to do EVERYTHING and give pre-arrivals. I use the books for the questions, because you can obtain a lot of information from the interviews to pass on to your responders.


Our FD and EMS all respond lights and siren regardless of the nature of the call, unless it's for a stand-by or something routine. We do not advise them to run lights/siren.


Our PD will advise if they are running lights/siren, and the only time we'll advise is if the call is serious/life threatening and needs and immediate response.