*To take the corresponding CDE quiz, visit the College of Emergency Dispatch.*
For those ED-Qs who believe that the science of reviewing calls is black and white—wrong or right—I have some exciting news for you: YOU ARE CORRECT. Well, sort of, in the sense that black + white = gray. No matter which way you look at it, the ocean of quality assurance is gray, and it is our responsibility to make sure that ocean is navigable to our staff.
Of the few critical decision points using the protocol, the most debated is Chief Complaint Protocol selection. As ED-Qs, we must be thoughtful and consistent when reviewing the Emergency Dispatcher’s Chief Complaint selection, or we risk becoming irrelevant to the staff we are tasked with coaching, teaching, and mentoring.
When reviewing a case, the ED-Q should examine the Chief Complaint Protocol selection within the same time frame the Emergency Dispatcher had to make their decision. The Emergency Dispatcher under review could not hit pause during the call to go search through the Chief Complaint Selection Rules or call a friend to discuss the options.
Often, when Emergency Dispatchers have selected a protocol that wasn’t 100% correct, it is understandable how they came to that decision. Fortunately, there are built-in safety nets of similar questions and information on related protocols that can still provide for an appropriate response and DLS Instructions.
When addressing these situations, the ED-Q should approach the Emergency Dispatcher with a thoughtful conversation to reflect back on the Chief Complaint Protocol selection process and educate them on future-forward best practices so they can catch them doing it right next time.
Chief Complaint Selection Rules
In the Medical Priority Dispatch System™ (MPDS®), there are more than 20 Chief Complaint Selection Rules. If you dive into these rules, you will notice that most calls are covered by general guidance given in Chief Complaint Selection Rules 3 through 5.
The most consistently debated Chief Complaint Selection Rule is 5, which discusses choosing the patient’s foremost symptom (while prioritizing priority symptoms). Coincidentally, many of the remaining rules deal with specific medical complaints. It is common for an inexperienced Emergency Dispatcher to get stuck in the weeds or lost while navigating through these many rules. This is where you, as the ED-Q, have the very important role to help coach that Emergency Dispatcher.
The Fire Priority Dispatch System™ (FPDS®) and the Police Priority Dispatch System™ (PPDS®) have fewer Chief Complaint Selection Rules, each with fewer than 20, so it doesn’t take long to review these. The ED-Q must teach the Emergency Dispatcher to consistently choose the Chief Complaint Protocol that started the incident (e.g., for motor vehicle collision with HAZMAT, choose Protocol 77).
Rules pertaining to scene safety carry a heavy responsibility with no wiggle room for error. We must ensure that Emergency Dispatchers address scene safety, as appropriate, given the circumstances provided by the caller. As some of our newly trained individuals have had less exposure to these types of incidents, our role as the ED-Q is to expand their knowledge and understanding to identify the less common and less obvious potential scene hazards.
Providing feedback and identifying trends
As a best practice for ED-Qs, when giving feedback to an Emergency Dispatcher, use valuable, unbiased facts. Identify which Chief Complaint Selection Rule was missed, and provide a thoughtful rationale for this practice, not just an opinion or “I told you so” reaction. Use ProQA® (if appropriate) to show the Emergency Dispatcher the steps of how to successfully manage this type of call next time. Even better, ask the Emergency Dispatcher to navigate the scenario through the ProQA software in the correct way to retrain their own steps.
During your feedback session, you might also ask the Emergency Dispatcher to explain why they went in the direction they did (selecting the Chief Complaint Protocol) and listen to their reasoning. Over the years, we have heard a lot of interesting explanations for incorrect protocol selection. Even a few old wives’ tales and urban legends have been used for a rationale, which can provide opportunities for relevant education.
To address common missteps in protocol selection among all team members, consider reviewing your AQUA® data. Identifying problematic trends can help you develop targeted Continuing Education pieces for your team members, demonstrating the correct use of the appropriate Chief Complaint Selection Rule(s). After a few months, review your data again to determine whether your training improved Emergency Dispatchers’ understanding and use of Chief Complaint Selection Rules to correct the previous issues. You may remember this from your ED-Q Course manual in the “Quality Management Cycle” portion (ED-Q Performance Standards, 7th edition, Chapter 1, page 17).
Chief Complaint Selection Standards
Let’s face it, most of your reviews will be pretty straightforward in Chief Complaint Protocol selection. When the case is more complicated, the ED-Q has a great opportunity to coach the Emergency Dispatcher and even the entire team on the best practice for next time, most often referring to Performance Standards Chief Complaint Selection Standards 2 and 5.
It is effective for the ED-Q to include Chief Complaint Selection Standard 2 (CC Selection Rules) and all Chief Complaint Selection Rules that apply when giving feedback.
In our experience, Chief Complaint Selection Standard 5 (Multiple Chief Complaints) is convincingly underutilized by ED-Qs. We have received many questions on social media, through email, and in person where an ED-Q wants a definitive answer to which protocol should be selected where either one is acceptable. An ED-Q must also understand there is intentional redundancy built into the protocols.
There are many scenarios where either protocol will end up with a determinant that is the same level (OMEGA–ECHO). To gain greater familiarity and comfort with this concept, an ED-Q must spend some time in ProQA testing scenarios. In the MPDS, some of the more common “either/or” scenarios are Protocol 17: Falls vs. Protocol 30: Traumatic Injuries (Specific) or Protocol 10: Chest Pain/Chest Discomfort (Non-Traumatic) vs. Protocol 19: Heart Problems/A.I.C.D.
In the FPDS, some of the more common “either/or” scenarios include Protocol 57: Explosion vs. Protocol 69: Structure Fire (dealing with a dwelling). It is relatively common for Chief Complaint Selection Standard 5 to be considered often when Q-ing fire calls.
For the PPDS, these “either/or” scenarios can include Protocol 121: Mental Disorder vs. Protocol 127: Suicidal Person.
As a note of caution, when an Emergency Dispatcher is getting future-forward feedback, that Emergency Dispatcher can and will use Chief Complaint Selection Standard 5 to defend their protocol selection. Prepare for this with Chief Complaint Selection Rules, ED-Q Performance Standards, and ProQA scenarios to continue to guide appropriate selection.
A PFC (Proposal for Change) was submitted for EPD concerning the Philosophy of Reasonability. This reasonableness philosophy needs to be understood and applied by ED-Qs when performing day-to-day case reviews and providing feedback for all three disciplines. We highly recommend that all ED-Qs read the Introduction to the ED-Q Performance Standards and paragraph 3 of Universal Standard 11. Also, this Philosophy of Reasonability is a great topic to include in your agenda for your next QAU meeting (just saying!).
Conclusion
The Chief Complaint Selection Rules and Standards are your friend, and they will assist you and your staff in navigating the GRAY areas. When in doubt, give your Emergency Dispatcher the benefit of the doubt and refer to the Chief Complaint Selection Rules for clarity.
As Dr. Clawson loves to say, “Onward through the fog.” Happy Q-ing. Be reasonable, consistent, and thoughtful.
