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One of the benefits of having a living, breathing emergency dispatch protocol is that it’s constantly being evaluated and evolving to best fit the needs of you, the Emergency Medical Dispatcher, and the patient who needs your services.
As Dr. Jeff Clawson, inventor of the Medical Priority Dispatch System™ (MPDS®) and founder of the International Academies of Emergency Dispatch® (IAED™), likes to say, “The Protocol is perfect, again.”
There are the usual logic and back-end changes and additions that you might not notice, but the following sections outline the ones that you won’t be able to miss. They’re also the changes that received the most buzz when Brett Patterson, chair of
the Medical Council of Standards, presented them at NAVIGATOR 2024.
Protocol 41: Caller in Crisis (1st Party Only)
Protocol 41: Caller in Crisis (1st Party Only) and its companion Protocol V: Separate/Distance from Means of Suicide have been years in the making. EMDs from all over the country—and the world—have requested help knowing what exactly to say to a person who is at risk of suicide that will help them connect with the caller and that won’t make the situation worse.
The first key takeaway about this update is stated in the Chief Complaint title—Protocol 41: Caller in Crisis (1st Party Only) should only be used when the person at risk of suicide is the caller themselves. If the caller is reporting someone else’s suicidal behavior or ideation, it will be handled on Protocol 25: Psychiatric/Mental Health Condition/Suicide Attempt/Abnormal Behavior.
The second key takeaway is Protocol V: Separate/Distance from Means of Suicide. Getting the caller to put down the gun, knife, or pills is a necessary step in guiding them away from taking their own life. As with every other Chief Complaint, context is crucial! Separating the caller from the means of suicide will look different depending on what the means is and where the caller is now. For instance, if the caller has a gun, having them put it down and walk away will have a different impact if the caller is at home (where putting it down and walking away is a good idea) rather than in a park (where it becomes a scene safety concern).
The third key takeaway is that Protocol 41: Caller in Crisis (1st Party Only) provides a tool that gives the EMD different phrases to use based on the caller’s mood. Similar to the Target Tool, you can access the “Emotional Control Tool” at any time to build rapport with or soothe the caller, whether they are agitated, depressed, grieving, or paranoid.
There are some important tasks to complete before you and your center can utilize Protocol 41: Caller in Crisis (1st Party Only). Before the software license can be received, EMDs must pass a mandatory four-hour course on the College of Emergency Dispatch. Unlike other licenses, this one doesn’t require a fee, so it’s the training certification that will allow your center to access the Protocol. This minimum training is mandatory because of the complexity of the Protocol and the potential impacts of the situations in which you will use it. Additionally, although it’s not mandatory to access the license, EMDs are strongly encouraged to take the 911 Training Institute’s two-day course called “LifeBridges to Suicide Callers.”
You can learn more details about Protocol 41: Caller in Crisis (1st Party Only) by reading “An EMD Milestone.”1
Pregnancy, Childbirth, and Miscarriage Protocols
Another much-anticipated update was to Protocol 24: Pregnancy/Childbirth/Miscarriage and Protocol G: Miscarriage. The IAED recently re-formed its High Risk Obstetrics Council to revisit the way things like postpartum bleeding and umbilical cord care are handled, as well as provide new evidence-based instructions that keep newborns warm.
Medical clinical standards evolve the same way that protocol standards do. Suprapubic pressure (pressing a fist against the mother’s pubic bone) is no longer the standard of care in other medical environments, so it’s been removed from Protocol G: Miscarriage. Instead, in cases of confirmed miscarriage (the mother has delivered a fetus or fetal parts), the EMD should direct the caller to perform a fundal massage.
Beginning with the fall 2023 release of the MPDS, EMDs no longer instruct the caller to perform a cord pulse check in cases of cord-only (prolapse) presentation. While this practice may remain as an option for on-scene providers, other clinical factors are needed to make this decision, and patient position should be—and now is—the primary focus in the pre-arrival environment.
Pre-Arrival Instruction (PAI) Protocol F also has an exciting new addition—keeping the baby warm. A research study conducted in Brazil found that the “presence of hypothermia soon after birth was the main contributor to hypothermia at NICU admission, which increased the chance of early neonatal death by 64%.”2 This is especially important with prematurely born infants.
In the new version of Protocol F, the EMD instructs the caller to get towels and warm the room. That includes having them close or open windows, turn on the heater, and turn off any fans. In keeping with this principle, you will no longer have the caller place the baby between the mother’s legs. First you will have them put the baby on the mother’s belly for initial evaluation, then remove any wet clothing from the mother’s belly, place the baby directly on her skin, and cover the baby with a dry towel and blanket to keep them warm until EMS arrives. There are additional reminders throughout the Protocol meant to keep the EMD actively involved in this important effort.
Other changes
Other notable updates to the Protocol are as follows:
New Determinant Descriptors on Protocol 17: Falls now appropriately code instances of fainting and near fainting. There have been many Proposals for Change (PFCs) submitted over the years about this issue! It eliminates the shunt from Protocol 17: Falls to Protocol 31: Unconscious/Fainting (Near) when the cause of the fall is fainting or near fainting. While the medical cause for a ground-level fall remains paramount in these cases, both the medical and traumatic nature of the call can now be addressed on one protocol rather than having to shunt. Notably, the shunt will remain for cases where no
injuries are reported.
We have added instructions to have the caller use the speakerphone function in all places where the caller’s hands may be needed. Many EMDs were already providing these instructions to enhance the Protocol—now it’s official and has evidence-based wording.
EMDs can now specify exactly which parts of the body are involved in situations where NOT DANGEROUS/POSSIBLY DANGEROUS/DANGEROUS Body Areas are asked for. ProQA® autopopulates the information into the fields being sent to the EMS responders, giving them the information they need to prepare to assist the patient.
The requirements for remaining on the line with a caller in case of bleeding have been strengthened. “Controlled” is now a clarifier, and any bleeding that is described as “uncontrolled” is part of the SERIOUS bleeding definition. Even if the caller describes uncontrolled bleeding as “oozing” rather than “spurting” or “pouring,” you should stay on the line and continue to actively treat the bleeding until it is controlled.
Button battery ingestion has been added to Protocol 23: Overdose/Poisoning (Ingestion) at the request of MPDS users in the U.K. Disc or “button” batteries are 5–25 millimeters in diameter and 1–7 millimeters thick and, if swallowed, can get stuck in the esophagus, causing internal electric burns. Instructions have been added for the patient to swallow one tablespoon of honey every 10 minutes to slow the tissue damage until the battery can be removed. Protocol 26: Sick Person (Specific Diagnosis) now specifies “not button battery” when you select “Object swallowed.”
For more information on MPDS version 14, be sure to check out the corresponding course on the College of Emergency Dispatch called “June 2024 ProQA Changes for MPDS v14.0.”
If you love these updates, let us know! If you have any PFCs for future updates, we’d love to hear them too. The Protocol can’t evolve without input from those of you who are in the trenches, working with it day in and day out.
And if you haven’t seen these updates in your center yet, check in with your system administrator to make sure that ProQA has been updated to the most recent version.
Sources
1. Fraizer, A. “An EMD Milestone.” The Journal of Emergency Dispatch. 2024; Jan. 26. iaedjournal.org/an-emd-milestone (accessed June 4, 2024).
2. de Almeida, M.F.B., Guinsburg, R., Sancho, G.A., et. al. “Hypothermia and early neonatal mortality in preterm infants.” The Journal of Pediatrics. 2013; Nov. 8. jpeds.com/article/S0022-3476(13)01220-1/abstract#%20 (accessed June 4, 2024).
