By Tracey Barron
In 2009, the clinical backbone of the International Academies of Emergency Dispatch (IAED) grew even stronger with the addition of the UKE Clinical Focus group to evaluate the clinical and operational value of the Medical Priority Dispatch System (MPDS).
The group, which is made up of representatives of each U.K. ambulance service using the MPDS, decided early to promote conversation involving an MPDS topic rather than simply sending each member a prearranged questionnaire asking what they thought might contribute to the research process. The group agreed that joint fact-finding was a major part of their undertaking, and that included collecting data from the multiple communication centers for applied use in research projects and the Academy’s Proposals for Change (PFCs) to further validate and improve the protocol system and dispatch process.
The initial group and its emphasis on the UKE version of the MPDS soon attracted followers, leading to a consistent 20 members that meet regularly to discuss protocol and potential research projects incorporating data from the various centers, as mentioned. I am the chair, and for more than six years our group has grown to include members from Ireland, the Isle of Man, and the Channel Islands. A corollary EUG Clinical Focus group was organized in early 2015 to represent German-speaking users, chaired by Gernot Vergeiner, a member of the IAED College of Fellows. The EUG focus group met for the first time in summer 2015.
The UKE Clinical Focus group has established a solid reputation among its IAED clinical research team members in the U.S. and the international research community overall. We have developed and submitted several PFCs to the Academy, including a comprehensive PFC to modify Protocol 12: Convulsions/Seizures, resulting in core updates in MPDS version 12.2 to better detect seizures caused by pre-existing conditions other than epilepsy and atypical seizures through Key Questioning and EMD monitoring of the patient.
The UKE Clinical Focus group also works jointly—and over long distances—to draft and submit its completed research for publication in journals dedicated to prehospital and in-hospital emergency care. In 2013, the international peer-reviewed Emergency Medical Journal published the group’s manuscript, “Aspirin administration by emergency medical dispatchers using a protocol-driven aspirin diagnostic and instruction tool.”
The study analyzed EMD data collected between September 2008 and June 2010 from several international centers and included all calls recorded under MPDS Chief Complaint Protocol 10: Chest Pain (Non-Traumatic), and Protocol 19: Heart Problems/Automated Internal Cardiac Defibrillator. Results were based on the number of times the Aspirin Diagnostic Tool was used, the number of times it was successfully completed, the number of times aspirin administration was advised, and the percentage of patients who took aspirin when advised.
The authors concluded that a standardized protocol, used correctly by EMDs, supports early aspirin therapy to treat potential acute coronary syndrome and acute myocardial infarction (ACS/AMI) prior to responders’ arrival. The inability to complete the instruction was overwhelmingly due to the arrival of response (48 percent), followed by the call being lost or the caller hanging up (19 percent).
No protocol escapes our attention and, considering the expertise and experience of the people in our group, individual suggestions seldom go unchallenged. We certainly don’t promote adversity within our ranks. We respect what each member brings to the table. During discussions, we make sure the point raised relates to the point in question, and we allow responses to any point made.
The UKE and EUG groups work voluntarily to contribute to the knowledge bank necessary to further the research and understanding of effective dispatch through data collection, and they create compelling cases for meaningful change to the MPDS.