Jeff Clawson, M.D.; Brett Patterson; Irena Weight
My name is Jennifer Taylor, and I’m an instructional writer in the curriculum department. I’m currently working on the Medical CDE #77 Electrocution/Lightning lesson and am needing help understanding a Determinant Descriptor. Can you help me understand the “Unknown status/Other codes not applicable” (15-D-9) descriptor and code? In electrocution and lightning situations, what function does this Determinant Descriptor have? In what situations would this code be used by an EMD?
Thank you for your help!
Instructional Design Dept.
The Unknown status code is available on Protocol 15 for cases where the Chief Complaint is known, but we cannot confirm alert and breathing normally, and no higher priority descriptor applies. This is obviously rare, with consciousness and breathing confirmed at Case Entry but not enough to choose another code. You will find these codes primarily on trauma protocols where we want to be using a specific Chief Complaint Protocol, rather than Protocol 32, when possible, so that we at least have the nature of the call to provide within the code.
I’m going to copy Doc on this to be sure my answer is complete and also to ask…
Is there a unique reason for having this code on Protocol 19? It’s the only other Medical Protocol I could find this on with the unique exception of Protocol 23, which could be argued to be either trauma or medical. My guess, for both of them, is to ensure an ALS response when criteria in the ALPHA Level cannot be confirmed or are not applicable.
Brett A. Patterson
Academics & Standards Associate
Chair, Medical Council of Standards
Thanks for the nudge. Since there can be a myriad of combinations of CE and KQ answers on many protocols, this code provides a selection for cases containing a bunch of unknown answers that don’t logically and directly fit any other specific code. At times we use what is called in logic terms a “dirty default” code selection where we say situationally, safety-wise, and response level-wise, that case is then “forced” into one of the Determinant Codes that is “closest” to it. That at times causes confusion in ProQA® land when the code descriptor says, “It’s a XYZ”—but it really isn’t—hence the “Other codes not applicable” descriptor rings truer to both the EMD and responders. In P-15, since safety is a huge issue, by using this defined (not a dirty default) code, it prevents dangerous assumptions being possibly made by responders to their detriment.
I’m copying Irena to see if she can check in Logos (the logic/text/translation builder software tool) to see specifically what combinations of answers can lead to a 15-D-9. Then we can be more specific for Jennifer in explaining this “Rubik’s Cube” issue in the lesson.
Irena, what can you provide us in this regard? Also, if you have any better explanations you could provide, that would be most appreciated…
Standing by for further instructions … Thanks, Doc
Doc and Brett,
The code 15-D-9 does not have any specific logic conditions assigned to it. Its only function is being a “dirty default” code for Protocol 15. If none of the criteria for any other code on Protocol 15 is met, ProQA will recommend the dirty default code.
Below are a couple of ProQA scenarios using this code. The easiest way to generate it is to exclude all other conditions and answer Conscious and Alert as Yes but Breathing normally as Unknown. Since 15-D-2, 15-D-7, 15-D-8, 15-C-1, and all other codes are excluded, ProQA logic forces 15-D-9 as the dirty default.