Red-Letter Day

A scholarly journal designed to stimulate a deeper understanding into the science of emergency dispatch was a milestone in validating decades of emergency dispatch practice and research when it launched in March 2013. “We were optimistic about what we were creating,” said Chris Olola, Ph.D., Director, Biomedical Informatics & Research, International Academies of Emergency Dispatch^® (IAED^™). “There was nothing like it. We did not know how far it would go.”
Ten years later, the pages keep turning. The milestones progress.

The Annals of Emergency Dispatch & Response (AEDR) defines the direction that Dr. Jeff Clawson, creator of the Medical Priority Dispatch System™ (MPDS®), had always envisioned for the emergency dispatch protocols and science. As Dr. Clawson stated in the inaugural issue of AEDR (2013 Vol. 1, Issue 1): Today we have reached a truly historic moment—literally a “red-letter day” in Emergency Dispatch. This is the first journal in EMS and public safety history dedicated to the evidence-based foundation of the science of Emergency Dispatch and Response Determination.¹ The clinical and on-line observational-based evidence validated by experts in public safety was now complemented by the journal’s goal to further advance emergency dispatch practice and profession through published and peer-reviewed research.²

The journal added validity and credibility to a science that had mostly relied on expert consensus, observation, and survey. Articles from scholarly, peer-reviewed, academic journals are considered more credible than articles from popular or trade journals because they have gone through the most rigorous review process. “AEDR was monumental,” said Brett Patterson, IAED Chair of the Medical Council of Standards and Academics & Standards Associate. “Dispatch research was sporadic, at best, and Dr. Clawson latched on to evolving the science of emergency dispatch. AEDR represents the experience of all dispatchers, responders, patients, and public safety/health scientists. It teaches us. It’s been a real joy to watch it grow.” 

Absence makes the journey fonder

AEDR got its start from absence. An established platform for emergency (medical, fire and police) dispatch fraternity did not exist in the established scholarly journals. Dr. Clawson, who regularly attended meetings that included editors of emergency services research publications, would leave scratching his head. How could the IAED orient the research objectives toward a targeted journal when a targeted journal for dispatch did not exist? There was scientific merit to dispatch studies, but did it lend to discipline-specific knowledge in emergency services?

Dr. Olola tied their apprehension to interpretation. “They [the editors] had little understanding of emergency dispatch and the use of protocols,” he said. “Dispatch protocols are designed to be more sensitive than specific. Hospital outcome data was limited. This was a difficult concept for the editors to accept. To most of them, it was Greek to them—I figured most of the editors reviewed dispatch-based manuscripts as though they were emergency room/medicine-based manuscripts that must have hospital outcomes.” Think of it as a two-edged sword. On the one edge, despite the lack of understanding outside of the IAED, emergency dispatch was fully recognized—by most—as an integral part of emergency services. On the other edge, while credible research was available to substantiate the profession and protocols, few were willing to consider its publication.

How do you go about enhancing credibility to the evidence-based foundation of a science without a place willing to accept your research? As the mantra goes in academics: publish or perish. Researchers are under pressure to produce journal publications for credibility and to stimulate more scientific research to further advance the discipline.

 

Dr. Olola went on the hunt to introduce emergency dispatch into the scholarly world. The year was 2006, and he was the sole member of the IAED research department, hired by Dr. Clawson two years prior while he was completing his Ph.D. in Biomedical Informatics through the University of Utah School of Medicine.The journal required several steps before launching: an editor-in-chief, a panel of peer reviewers (emergency services centric subject matter experts), an Institutional Review Board (IRB), a publisher, and, of course, the researchers, particularly from outside the IAED, to write and submit articles. The task wasn’t easy, Dr. Olola said. While established researchers were already keen on the process to publish, the IAED was also set on encouraging proposals from a spectrum of protocol interested parties—and that included competitors. “We assume the researchers and readers already possess a basic understanding of emergency dispatch,” said Dr. Olola, AEDR’s inaugural editor-in-chief.   

 
And that brings us to a goal set by Greg Scott, IAED Associate Director of Protocol Evolution and AEDR editor-in-chief since 2020, replacing the second editor-in-chief, Isabel Gardett, Ph.D. Scott is intent on creating the next generation of emergency dispatch researchers. It is a mission that coincides with the evolution of technology and the sophistication of technology users in current and coming generations.“A lot of research has been based on tradition and available technology,” Scott said. “Since the first 911 call [1968, Alabama, USA], technology has evolved to provide the technical tools to advance the science of emergency dispatch.” The tools—data science, software, and evolving protocol—transform the ability to perform research. With advances in technology, data can be effectively gathered, analyzed, and acted upon in close to real time. Technology replaces older research methods that relied heavily on manual data collection and analysis and resulted in higher costs and longer timelines to publishing the research. 

AEDR is there to capture the future of emergency dispatch. “Research helps us to focus on the science of emergency dispatch and how we can improve practices and protocols in a scientific way.”As a result, a respected and well-grounded profession is created, Scott said. “People take more active roles to advance the tools of their profession and that moves them beyond traditional job classifications and provides for the title of emergency dispatcher to be its own public safety career—alongside that of a police officer, firefighter, and paramedic.”

A change in job classification depends on several variables, whether at the federal level (U.S. Bureau of Labor Statistics (BLS) to elevate the profession from an administrative role) or at the state level (to provide greater access to benefits comparable to their counterparts in emergency services). The change in status, however, requires more than a shift based upon majority demand. The BLS bases its decision on systematic and standardized regulations, including consistent hiring standards, basic training and certification or licensing standards, established protocols, and continuing education standards. While these are all components of the protocols, they are reinforced through AEDR. For example, a study to investigate the Abdominal Pain Chief Complaint Protocol when using the Emergency Communication Nurse System^™ (ECNS^™) highlighted an opportunity for better training.

Abdominal pain is the most common symptom patients present to the emergency department with and, subsequently, it presents a greater burden on emergency service resources. According to the study’s results, secondary triage of patients calling 911 for an ambulance triaged as a non-urgent low-acuity caller can safely mitigate high usage of emergency department resources.³ The study highlighted areas for potential improvement for the ECNs in their triage skills and, also, reached a larger and potentially receptive audience through its publication in AEDR.

 

ECNS research has been widely published in both AEDR and outside scholarly journals. The selected subject matter depends on benefit to the ECNS, the ECNs, and the patients referred to ECNS. “It’s about discovering something interesting and important for current and potential users and patients,” said Dr. Conrad Fivaz, Medical Director, Priority Solutions Inc.^™ (PSI^™) and IAED Council of Standards Chair for ECNS. “We want something ECNS users can learn from and, also, open an opportunity for training in a specific protocol.”

In relation to training opportunities, and proper use of PAIs, there’s also the goal to better connect links in the emergency service chain of response. Patterson looks forward to technology’s application to facilitating outcome data. The availability of real-time data is key in giving emergency services providers and agencies the vital information that they need to make solid, evidence-based decisions and to provide the best patient care possible.“The ultimate is tying together data, and in the next few years, it will become routine,” he said. “It won’t be as tedious to hook up the dispatch record to the patient’s outcome record.” Dr. Olola anticipates broadening AEDR’s reach through the application to have AEDR indexed in MEDLINE/PubMed—the National Library of Medicine^® (NLM^®) journal citation database—which promotes more visibility of articles published in various indexed journals.⁴ PubMed and MEDLINE provide international access.

Take the plunge

 The research process can intimidate the uninitiated. There is the fear of failure or a feeling that research will never be a personal strength. Research is also viewed by some as an ominous practice reserved for ivory-tower academics.That did not stop Ivan Whitaker from taking the plunge. The former operations administrator at Polk County Emergency Communications Center (ECC), Winter Haven, Florida (USA), realized the value of data collected. There was something in all that data, and he wanted to narrow it down to a plausible study. As a Priority Dispatch Corp.^™ (PDC^™) trainer, he was also interested in filling the gaps in protocol-specific issues, such as assigning response Determinant Codes based on information the caller provides to the Emergency Medical Dispatcher (EMD) during the Key Question interrogation process. 

“Publishing research based on data and experience was the pie in the sky for me to consider; it was intimidating,” said Whitaker, VP of Partner Success, MD Ally, New York, New York (USA), and former Implementation Director for PDC, Salt Lake City, Utah (USA).Whitaker was uncertain in his approach to the investigative process. He contacted the IAED research team, presenting them with a general outline of his proposal. The topic of falls was inspired by his protocol-specific interests and a recent investigation from a 911 center’s local fire department involving a case dispatched through the MPDS using a BRAVO-level response for a fall patient.⁵ 

 

Whitaker was sole investigator in the study (“Second-Party Caller Information for a Falls Case,” AEDR 2014, Vol. 2, Issue 2). He was principal investigator among 10 contributors in a second published study, which appeared in AEDR 2015 Vol. 3, Issue 2, entitled “Emergency Medical Dispatchers’ Ability to Determine Obvious or Expected Death Outcomes Using a Medical Priority Dispatch Protocol.” He credits the “stars” of the IAED research team. “They were with me all the way.” Mike Thompson is not intimidated by research. He is confident in following steps in the research process and contributes to AEDR. Research, however, is not his favorite thing to do. Research is part of his job.“I research by default,” said Thompson, IAED Fire Protocol, Academics and Standards Expert, Chair of the IAED Fire Curriculum Council, and retired Fire Service Battalion Chief with 29 years of fire service and paramedic experience. “We receive a steady source of information from our users. That’s important. I also feel we need solid research to validate what we do and/or we plan to do. Data supports—or not—the information they give us.”

While research isn’t necessarily the most fun, he admits that the issues and subject matters studied influence the way protocol is used and evolves. AEDR is the conduit, a place in public view to aid in the understanding of the protocol process. It’s a welcome mat of sorts.“AEDR is accessible,” Thompson said. “The information is concise and easy to navigate [compared to websites]. People read AEDR and know there is a way for them to participate in fire’s evolution. AEDR is also a vehicle to validate and clarify the protocols. “AEDR was begging for Police Priority Dispatch System^™ (PPDS^®) research,” said Eric Parry, emergency police dispatch (EPD) Standards Council member since 2002 and former PDC Police Protocol consultant. “There were no peer-reviewed avenues open for PPDS research articles, as there was nothing to research.” 

The data till was dry. A functional version of EPD ProQA^® software did not exist until 2005, and there were only a handful of Public Safety Answering Points (PSAPs) using it. Parry’s article (“The Need for Police Protocol Research,” AEDR 2013 Vol. 1, Issue 1) presented a dichotomy in policing and the accuracy and quality of event information. While structured protocols greatly improve the standard of care and practice, according to Parry’s article, there is still a lack of understanding of how structured protocols mitigate most of the problematic issues facing police calltaking and dispatch.⁶ “AEDR has greatly influenced emergency services research but having said that, there is a long way to go, and the gist of my article applies now more than ever,” he said. At the same time, we’ve come a long way.Patterson said AEDR perpetuates the protocol. “Our readers want to know more about dispatch. AEDR and the IAED Data Center helps us explore what we can do better.”Kim Rigden, IAED Associate Director of Accreditation, perhaps summed up the best reason to pursue research into emergency dispatch. “It’s about us,” said the former Commander of Education and Quality Improvement for the Toronto (Canada) Paramedic Service. “It’s essential to what we do.” 

Sources

1 Clawson J. “The Holy Grail of Emergency Medical Dispatching.” AEDR Journal. 2013; March 1. https://www.aedrjournal.org/the-holy-grail-of-emergency-medical-dispatching (accessed Feb. 22, 2023).
2 See note 1.
3 Fivaz MC, Clawson J, Olola C, Scott G, Zavadsky M, Marshall G, Messerli E. “Emergency Communication Nurses' Ability to Correctly Select Abdominal Pain as the Appropriate Protocol in Telephonic Nurse Triage System.” AEDR Journal. 2020; Oct. 1. https://www.aedrjournal.org/emergency-communication-nurses-ability-to-correctly-select-abdominal-pain-as-the-appropriate-protocol-in-telephonic-nurse-triage-system (accessed March 27, 2023).
4 “MEDLINE, PubMed, and PMC (PubMed Central): How are they different?” National Library of Medicine. 2022; Oct. 25. https://www.nlm.nih.gov/bsd/difference.html (accessed March 10, 2023).
5 Whitaker I. “Second-Party Caller Information for a Falls Case.” AEDR Journal. 2014; Aug. 12. https://www.aedrjournal.org/second-party-caller-information-for-a-falls-case (accessed March 3, 2023).
6 Parry E. “The Need for Police Protocol Research.” AEDR Journal. 2013; March 1. https://www.aedrjournal.org/the-need-for-police-protocol-research (accessed Feb. 22, 2023).