UNUSUAL MEDICAL CONDITION

Brett: 

While conducting an Emergency Telecommunicator Course (ETC), I had a student inquire about which Medical Priority Dispatch System (MPDS) Protocol would be most appropriate to handle a condition called solar urticaria. In basic terms it appears that the patient would be experiencing an allergic reaction but the resultant reaction manifests itself with burned skin in addition to the urticaria (chronic hives) common in many kinds of allergic reactions.

Should it be coded Protocol 2: Allergies (Reactions)/Envenomations (Stings, Bites) or Protocol 7:Burns (Scalds)/Explosion (Blast)? I thought Protocol 7 may be appropriate for the sunburn, but I would rather have you weigh in on it. I appreciate your time.

Lisa S. Ellington EMT-P, EMD, EMD-Q, ETC-I

System Training Coordinator

Rockingham County 911

Wentworth, N.C., USA

Lisa: 

My first bit of advice to an EMD would be to not accept a caller’s “diagnosis” but rather repeat “Tell me exactly what happened” in an effort to obtain signs/symptoms/events that can be classified in the MPDS. This sounds like a hypothetical scenario from a class where that information was available, i.e., solar urticaria was translated to hives caused by sun exposure.

I think it would be unusual for someone to call an ambulance for this disorder, as the patients are usually aware of the problem and know that the condition normally reverses itself rather quickly when the patient gets out of the sun. There are, however, rare exacerbations that include nausea, vomiting, and even fainting, bronchospasm, or tongue/lip swelling.

As we cannot, nor should not, expect an EMD to know the pathophysiology of this disorder, I think we should advise EMDs to instead rely on the Chief Complaint of signs/symptoms/events which, as I mentioned, should be encouraged by repeating “Tell me exactly what happened.” 

If the Chief Complaint description is simply a rash, Protocol 26: Sick Person (Specific Diagnosis) will rule out Priority Symptoms and handle it well. If it is described as an allergic reaction, as it may well be because it essentially is, Protocol 2 handles any potential difficulty breathing or swallowing or decreased level of consciousness associated with severe reactions. As you mentioned, if it is described as a sunburn, Protocol 7 would work. However, I wouldn’t think the latter complaint would be common because patients know it is not a sunburn; these reactions happen with very brief exposure to the sun and are caused by an antigen-antibody reaction to ultraviolet light rather than actual burns to the skin caused by the ultraviolet light itself.

I’m sorry about the long response, but I think it is an interesting question that deserves a little explanation.

Brett A. Patterson

Academics & Standards Associate

Medical Council of Standards Chair

Brett:

My question is regarding address verification from wireless callers during Case Entry. We practice asking the address of the caller’s emergency, and then we ask them to repeat the address for verification because ANI/ALI normally shows something different.

The question came up if a second verification was needed if the caller stated the address with the business name (i.e., 3615 Crater Lake Highway, Medford—Wal-Mart) and the dispatcher could visually verify the wireless 9-1-1 call plotted to that location on the map?

Thank you for your time,

Johnna Pellam

Performance Manager

Emergency Communications of
Southern Oregon

Medford, Ore., USA

Johnna:

Thank you for your question; it’s timely, as there seems to be significant confusion on this issue.

First of all, verification policy is locally determined. The Academy strongly recommends that each agency has a written verification policy and that all emergency dispatchers are trained with regard to that policy, and that they receive regular quality improvement feedback to ensure compliance and reduce variation. In the absence of advanced technologies that identify a caller’s location/telephone number, the Academy cautions that repeating an address to a caller as a primary (first line) verification method is potentially inaccurate and litigious, as callers in crisis may accidentally “agree” with even an incorrect address/phone number. Instead, the Academy recommends, as a primary method of verification, asking the caller to repeat the address/phone number. This method is what is taught in initial certification classes that are obviously void of location/phone number identification technologies.

With that said, advanced technologies such as ANI/ALI and now Phase II E9-1-1 have provided opportunities for faster verification of a caller’s address/phone number. This has enabled faster recognition of life-threatening emergencies that enable prompt treatment and improved morbidity and mortality. Many agencies take advantage of these technologies by incorporating them into their verification policies, i.e., verification is completed if the address and/or phone number provided by the caller matches the technology’s displayed information. This policy is sound and effective. Again, what is important is that each agency has a verification policy in place and that everyone follows it. More information can be found in “Principles of Emergency Medical Dispatch,” 4th ed., pages 2.9 and 11.10.

Brett

ABOUT THE AUTHOR:
Brett A. Patterson is an Academics & Standards Associate and Medical Council of Standards Chair for the IAED.

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