Emergency Medical Dispatch

Rhode Island E-911 is adopting Emergency Medical Dispatch (EMD) effective July 26, 2022 to better serve the citizens of Rhode Island. EMD is a structured, systematic way of rapidly processing medical 911 calls to ensure that the best patient care is provided to every Rhode Islander. The trained 911 Telecommunicator uses a software-based decision support tool called “ProQA” to ask appropriate questions and provide medically correct care before responders arrive. At the beginning of each call, 911 will ask callers to “Tell me exactly what happened” to understand very clearly what the emergency is and how it happened. In place of caller self-diagnosis, the telecommunicator will ask questions that are clear and objective such as what symptoms the patient is having or exactly how someone got injured. Every situation is different, so 911 will ask different questions and provide different instructions based on the unique needs of each situation. Some calls will have significant scene safety issues that have to be managed before instructions can be given to protect the caller’s safety. There is a protocol for every type of medical emergency. It is important for the caller to listen to the telecommunicator’s questions and instructions carefully, and to cooperate fully so the patient can be helped. The telecommunicator will be able to provide step-by-step “pre-arrival instructions” to the caller for time/critical situations such as CPR, choking, childbirth, bleeding, allergic reaction, opiate overdose, and many other emergencies.

911 Telecommunicators (along with dispatchers) are the “First, first responders” in any medical event, and EMD protocol helps telecommunicators enhance patient outcomes, save lives, and provide consistent care to all Rhode Islanders and visitors. The first few minutes of a medical emergency are often the most critical, and now the telecommunicator has an opportunity to provide care while responders are on the way. The telecommunicator will not need to ask any information that is obvious or has already been provided spontaneously by the caller, but the telecommunicator may seek to confirm that information because things can change rapidly. The questions that are asked are important because the protocol uses a logic-based engine of “if this, then that” to determine the proper sequence, number, and types of additional questions and instructions. Together with dispatchers and first responders (Police, Rescue, Fire) EMD will save more lives and improve the outcomes of patients.

The 911 telecommunicator will conference in the appropriate dispatcher early in the call and will provide a brief summary of the incident, including the patient’s age, sex, type of emergency and whether the patient is awake and breathing. Once the 911 telecommunicator has relayed that information to the appropriate dispatcher, 911 will continue to ask the caller for important information about the patient so that pre-arrival care can be provided. If you don’t know the answer to a question, that’s ok-tell the 911 telecommunicator that you don’t know. Once the telecommunicator has enough information to understand what care is needed, he or she will provide instructions to the caller including how to prepare for rescue’s arrival. In some cases, the 911 telecommunicator will stay on the line to monitor the patient and provide additional instructions to callers until responders arrive to take over.

Each telecommunicator completed 24 hours of Emergency Medical Dispatch classroom training followed by 8 hours of workshop training, operational policy reviews, and the completion of 75 simulation exercises. Additionally, oversight committees have been established to ensure that the system is launched successfully and that operational changes identified based on feedback after go live are swiftly evaluated. These committees include an Executive Steering Committee, EMD Users Group, Quality Assurance Team, and Statewide Dispatchers Committee. The International Academies of Emergency Dispatch and Priority Dispatch Corp. of Salt Lake City, Utah provided the training, certification, and project coordination. EMD was developed 40 years ago by Dr. Jeff Clawson as a way to standardize medical care in the non-visual environment of 911.

Each week, approximately 80 medical calls will be reviewed from beginning to end to identify trends where telecommunicator education and development are needed to improve use of the protocol and delivery of care over the phone. Trained quality assurance team members will focus on call flow, caller management techniques, and compliance to protocol. The goal of quality assurance is to “catch them doing it right” and to celebrate the telecommunicator’s efforts to provide care in the challenging non-visual environment where the telecommunicator often has to overcome many barriers such as caller emotion, language barriers, and inability to see what the caller is describing. The initial focus on quality assurance feedback will also target areas of deviation from protocol that present a high impact or high risk to the outcome of the call. Peer support, coaching, feedback, and continuing education are an integral part quality improvement. Moreover, EMD data will allow the Department of Health to better understand how bystander CPR instructed by the 911 telecommunicator in the early minutes of a cardiac arrest impacts patient outcomes. The majority of quality assurance case reviews will be provided by an independent contractor called Quality Performance Review.

911 Telecommunciators are trained to ask specific questions in order to understand the severity of each medical call. This allows appropriate care and instructions to be provided while rescue is driving to each emergency. The TC can only understand how to proceed by asking “Key Questions”. The TC may also ask you about such things as aspirin (if the patient is having chest pain) or to gather specific information about the patient’s current status. All questions are designed to be very specific and objective.

If the 911 Telecommunicator advises you that they are going to stay on the line, it’s because the incident or patient is not stable. There are some types of medical calls where 911 will attempt to stay on the line with the caller until rescue arrives. This is because the patient needs to be monitored or provided with pre-arrival instructions. Sometimes if 911 is very busy they may not be able to stay on the line with every call where it is desired. In time/life critical situations, the 911 telecommunicator will attempt to stay on the line until rescue takes over.