Determinant Codes

Art Braunschweiger

In my travels for Priority Dispatch®, “We don’t use Determinant Codes” is something I’ve heard more than once. This is especially true in areas with single-tier EMS systems, where every ambulance is staffed with ALS (advanced life support) providers. If that’s your world, read on—you might not be taking advantage of some good information.

Among other things, ProQA® acts as a resource calculator: The appropriate resources are dispatched based on the Key Question answers you select. There’s a little more to it than that, but it’s essentially what happens. The dispatcher doesn’t need to memorize the response criteria for every conceivable situation.

In version 13.0 of the Medical Priority Dispatch System (MPDS®) there are 1,828 possible Determinant Codes. Each can be associated with a specific response assignment: the resources that an agency deems appropriate and—if an agency chooses—whether it should respond “HOT” (lights-and-siren) or “COLD” (no lights-and-siren). Typically, ALPHA, BRAVO, and OMEGA-level codes are associated with calls requiring basic life support (BLS) and CHARLIE, DELTA, and ECHO-level codes with advanced life support. OMEGA-level codes reflect patient conditions that may not require an EMS response. Accredited Centers of Excellence (ACE) have the option of utilizing a nurse triage system[i] to discuss non-EMS options with the patient before sending an ambulance.

Even in single-tier systems, sooner or later the number of calls in progress will exceed the number of ambulances available. A well-thought-out agency policy could allow a dispatcher to send the only available transport unit to the patient with the greatest clinical need, with first responders sent to the others. ALPHA- and BRAVO-level responses usually require only a BLS level of care, with BRAVO being more urgent. CHARLIE- and DELTA-level resources usually require an ALS level of care, with DELTA being more urgent. As noted above, the Determinant Level can also be used to decide which patients merit a HOT response and which do not. The Determinant Level can also help the calltaker make the decision of whether to stay on the line, as DELTA-level codes generally indicate unstable or potentially unstable patients whose conditions can suddenly worsen.

Responders can also benefit from the information contained within the Determinant Code. For example, on a fall injury coding as a 17-D-5, the Determinant Descriptor is “Chest or Neck injury (with difficulty breathing.)” I don’t know of any responder who wouldn’t want to know that.

In my travels for Priority Dispatch®, “We don’t use Determinant Codes” is something I’ve heard more than once. This is especially true in areas with single-tier EMS systems, where every ambulance is staffed with ALS (advanced life support) providers. If that’s your world, read on—you might not be taking advantage of some good information.

Among other things, ProQA® acts as a resource calculator: The appropriate resources are dispatched based on the Key Question answers you select. There’s a little more to it than that, but it’s essentially what happens. The dispatcher doesn’t need to memorize the response criteria for every conceivable situation.

In version 13.0 of the Medical Priority Dispatch System (MPDS®) there are 1,828 possible Determinant Codes. Each can be associated with a specific response assignment: the resources that an agency deems appropriate and—if an agency chooses—whether it should respond “HOT” (lights-and-siren) or “COLD” (no lights-and-siren). Typically, ALPHA, BRAVO, and OMEGA-level codes are associated with calls requiring basic life support (BLS) and CHARLIE, DELTA, and ECHO-level codes with advanced life support. OMEGA-level codes reflect patient conditions that may not require an EMS response. Accredited Centers of Excellence (ACE) have the option of utilizing a nurse triage system[i] to discuss non-EMS options with the patient before sending an ambulance.

Even in single-tier systems, sooner or later the number of calls in progress will exceed the number of ambulances available. A well-thought-out agency policy could allow a dispatcher to send the only available transport unit to the patient with the greatest clinical need, with first responders sent to the others. ALPHA- and BRAVO-level responses usually require only a BLS level of care, with BRAVO being more urgent. CHARLIE- and DELTA-level resources usually require an ALS level of care, with DELTA being more urgent. As noted above, the Determinant Level can also be used to decide which patients merit a HOT response and which do not. The Determinant Level can also help the calltaker make the decision of whether to stay on the line, as DELTA-level codes generally indicate unstable or potentially unstable patients whose conditions can suddenly worsen.

Responders can also benefit from the information contained within the Determinant Code. For example, on a fall injury coding as a 17-D-5, the Determinant Descriptor is “Chest or Neck injury (with difficulty breathing.)” I don’t know of any responder who wouldn’t want to know that.

Some CADs are capable of accepting the Determinant Descriptor and passing it to mobile devices in responder vehicles. For responders without that technology, a Field Responder Guide, which is available in pocket-sized, spiral-bound flipbook form and as an app for smartphones[ii], allows a responder to look up the Determinant Code. Even for a dispatch center that doesn’t have CAD and uses manual cardsets instead of ProQA, the Determinant Code can be given over the air.

Determinant Codes can also drive notifications to stroke centers. A patient with CLEAR evidence of stroke and a time of onset less than the window set by local Medical Control will be identified by the suffix “J.” For many stroke centers around the country, early notification is the key to mobilizing a stroke team prior to the patient’s arrival. (This is the primary reason why the Stroke Diagnostic Tool is included in ProQA medical and is not optional.)

Calltakers and dispatchers are information processors, and ProQA is a superb information-gathering tool. Sometimes we don’t realize how much we can do with that information. Making good use of that information benefits everyone, especially the patient.

[i] Information about the Emergency Communication Nurse System developed by the International Academies of Emergency Dispatch can be found at https://www.emergencydispatch.org/sites/default/files/downloads/ecns/Academy_ECNS.pdf

[ii] Information about the Mobile Field Responder Guide (MobileFRG) can be found at http://www.prioritydispatch.net/support_products/

ABOUT THE AUTHOR :
Art Braunschweiger is a software instructor and IAED-certified ED-Q instructor for Priority Dispatch Corp. He has been a fire and EMS dispatcher for 18 years and works at Union County Regional Communications in Westfield, N.J.

 

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