*To take the corresponding CDE quiz, visit the College of Emergency Dispatch.*
Just like the lifeguard at the pool scanning among the summer swimmers or the EMD waiting for the next call on the line, EMS teams do their share of waiting for their lifesaving expertise to be needed, especially in the case of standby/staging events.
Unlike most Chief Complaint Protocols in the Medical Priority Dispatch System™ (MPDS®), Protocol 40: Incident Standby/Staging is not driven by a known patient. In fact, it is not appropriate to use for a known patient or situation (deferring to a more specific Chief Complaint Protocol that addresses scene safety and patient care). Protocol 40 is designed to address requests for EMS STANDBY or STAGING services as an assistance to other agencies, placing appropriate medical resources near or at a scene preemptively for specific event types.
Of course, the Incident Standby/Staging Protocol does not replace the need for specific fire or police protocols, nor does it interfere with Mutual Aid agreements to share resources in incidents that surpass routine needs (e.g., natural disasters or specialized rescues). Instead, Protocol 40 handles requests for medical resources to support routine incidents or responses to specific events.
Prior to the ProQA® release of Protocol 40 in November 2023, agencies had no standardized procedures for handling these common standby/staging requests from fire departments, police agencies, and other event coordinators.
“It’s a common call type, and now it has a home within the MPDS,” explained Mike Thompson, IAED™ Fire Protocol, Academics, and Standards Expert. “Previously, agencies would come up with their own method of addressing standby/staging requests. Sometimes they would enter reported information directly into CAD (computer-aided dispatch), which may work until their services need to be scheduled a day in advance.”
Beyond the convenience of scheduling ahead, the new Protocol 40 adds a professional familiarity for MPDS users who desire to use ProQA to handle these standby/staging requests for cohesive recordkeeping and consistent responses, reducing customer service variance and the exposure to liability in the calltaking process.
The Incident Standby/Staging Protocol not only streamlines the assignment of resources to these types of events but also facilitates advanced planning for each event type. Within Protocol 40 are 15 types of STANDBY and STAGING events, including various types of structure fires, wildland/wilderness fires, water/ice/mud rescues, TECHNICAL RESCUES, SWAT/Tactical team incidents, hostage/barricade incidents, bomb threat incidents, aircraft emergencies, and other scheduled and unscheduled STANDBY situations.
Definitions and distance
One key element to using Protocol 40 is to understand the distinction between STANDBY and STAGING procedures, though their definitions are very similar:
• A STANDBY request is defined as “the precautionary attendance of an operational support unit(s) to an incident with no known/current patients or situations for the crew to manage.”
• A STAGING request is defined as “the remote attendance of an operational support unit(s) to an incident with no known/current patients or situations for the crew to manage.”
In both cases, EMS is requested to be positioned at the ready, awaiting any potential medical need. However, a STANDBY request is an openly situated precaution at a safe scene (such as an ambulance standing by at a crowded sporting event), while a STAGING request is a purposely distanced “off-site” presence during a high-risk event (such as a police arrest or an office building on fire).
Carefully selecting the type of event in response to the Key Question “Select the reason for STANDBY” is especially important in the case of unsecured scenes.
Another unique aspect to Protocol 40 is the introduction of a new Determinant Level “S” into the MPDS, creating specific Determinant Codes and response assignments for each agency to evaluate and assign. The suffix “M” may be added if multiple units are needed.
Response information
After selecting the appropriate STANDBY/STAGING incident type, the remaining Key Questions collect information to coordinate the appropriate medical response:
• “Where exactly do you need the unit(s)?”
• (Appropriate) “What type of units are needed?”
• “How many units are needed?”
• (Scheduled) “When would you like this STANDBY scheduled?”
• (Appropriate) “Are there any specific response (approach) instructions or hazards?”
• (Appropriate) “Who will be our primary contact?”
• (Scheduled) “What is the expected duration of this event?”
• Is there a specific talk group or radio channel for this event?*
(*The final question is a Jurisdictionally Approved Question that can be enabled or disabled in ProQA’s Admin Utility. Jurisdictionally Approved Key Questions are designated by purple font color.)
Darren Judd, Priority Dispatch Corp.™ Implementations Medical Transfer Protocol Suite (MTPS) Protocol Expert, emphasized the importance of relaying approach and safety instructions for these situations: “If you have a house fire and you call EMS to be available, they might unknowingly drive right in front of hydrants or across the fire hoses,” he said. “If you’re planning a SWAT situation, you must provide exact staging location instructions to avoid attracting undue attention and adversely affecting the operation.”
Just as planning and coordinating a medical response is critical to prevent disruption at the scene, clear communication (with details at the scene such as wind direction or suspect location) from the primary contact is essential to relay to crews, prioritizing EMS crew safety.
As stated in Rule 2, “STANDBY crew safety is paramount. If current scene conditions are unknown, responding units should STAGE until sufficient information is obtained.”
Communication is further encouraged with the use of PDIs b and c, which instruct the requesting agency to notify EMS of changes and when they’re clear to enter the scene. As a reminder in the Critical EMD Information, the EMD is expected to provide responding EMS crews with information on potential hazards, changes to the incident, or known suspects who have fled the scene and may still be in the area.
The EMD’s First Law of STAGING applies: “If you are close enough to see the scene, you might be close enough to get hurt.” Or, as stated in the Second Law, you could “blow your cover.” Perhaps the Third Law goes without saying that “using a lights-and-siren response for STANDBY or STAGING is rarely a good idea.”
In some circumstances, these assignments can be a lengthy commitment that requires rotation. As Axiom 2 states, “STANDBY responses can be prolonged based on incident variables. Agencies should consider rotating crews, when necessary, to avoid prolonged incident exposure and crew fatigue.”
Brett Patterson, IAED Medical Council of Standards Chair, considers ambulance standby personnel as hidden gems in the profession, ready and waiting for the unknown, even in cases of preplanned STANDBY requests at concerts and other large-scale events.
“Caring for a plethora of challenging patient conditions can have unexpected complications,” he said. “Whether it be severe trauma, multiple patients, a complex medical malady, or treating a heat/cold exposure patient, you never know what you’re going to encounter.”
In that vein, Benjamin Franklin’s adage readily applies: “By failing to prepare, you are preparing to fail.” Fortunately, informed EMDs using Protocol 40 can put EMS responders in the right position to stand by, waiting for the events they can’t predict but can prepare for.
