Priority Dispatching

[FL_Medic]

My system has been trying to implement a priority dispatching system for some time now. Is anyone currently working for or have you ever worked for a service that uses a similar system?

What are the pros and cons?

If you had a lot of experience with the system please message me.

[reaper]

My system has been trying to implement a priority dispatching system for some time now. Is anyone currently working for or have you ever worked for a service that uses a similar system?

What are the pros and cons?

If you had a lot of experience with the system please message me.

A lot of systems are using it. I have never seen anything bad come from it. It does cut down of the number of L&S responses, so that is always a good thing. You still get the low level calls that slip through, due to "Just being careful" with the response.

But , I see no cons to it.

[celticcare]

We use it here, when a call comes in from the operator, the call taker then uses a system known as ProQA. A series of questions are asked and if certain answers come up then the call is deemed as being priority one, two, three or four (one being Lights and Sirens). With this system, alot of calls are catagorised into mainly a priority two and three area and it works cutting down on the number of unnecessary p1 jobs. However the ultimate decision can lay with the dispatcher who can take the information from the call taker and think that just doesnt suond like a priority two response.

I'm still nervously waiting to hear back from Comms to see if I got the job in there, so I've just spent the last few days immersed in the computers and equipment.

Hope this helps. I personally cant see any cons with it but no doubt some people will in their posts, look forward to seeing them.

Scotty

[Dustdevil]

But , I see no cons to it.

The cons are:

1. No proven benefit to patient outcomes.

1. Rigid protocol results in frequently mis-triaged responses.

If eliminating unnecessary hot responses were the only effect, that would be a good thing. But unfortunately, it also results in a slowing down of responses that are later found to have warranted a higher priority.

[HERBIE1]

We only have one type of response- lights and siren, and only one type of transport- same. We do have a tiered dispatch- ALS or BLS-and that is a total failure, but that's fuel for another thread.

[FL_Medic]

Devil do you have references that support your statements?

[RatPack]

We only have one type of response- lights and siren, and only one type of transport- same. We do have a tiered dispatch- ALS or BLS-and that is a total failure, but that's fuel for another thread.

You transport everyone light and sirens?

What is the reasoning behind that?

We do use the Emergency medical dispatching, however we dont base response on it. Every call we respond to. Transport priority is based on pt condition. The majority are without lights and sirens.

As far as the dispatchng our system is geared more towards pre-arrival instructions then triaging calls. Bleeding control, CPR, Pt positioning, things of that nature. In my opinion it does work for us and would state that it has benefited more then one pt.

[wrmedic82]

We use priority dispatch in our system. I have never been too fond of it. One draw back to it is that people are getting "smart" and learning what to say to get a ambulance to them quick. So they know what to say to get a P1 or P2 response (L&S). I have noticed that in our system there has been more critical patient's with P3 response (no L&S) in which we have run to the hospital P2.

So I do think that is hinders the system to a certain point. Also our dispatchers rarely use discretion so that may also play a part in it as well. Some that have played in the field do. But for the most part its all scripted.

[JPINFV]

You transport everyone light and sirens?

What is the reasoning behind that?

I know Boston EMS responds and transports everything hot (I witnessed an emergency transport that went around the block. Literally 3 right turns to reach the ER entrance. For bonus points, if there is a paramedic and basic unit on scene, both go to the hospital with lights and sirens). I have absolutely no clue as to why they do this, but it is really... really... really stupid. Especially with some of the driving that I've witnessed in the past year and a half.

[Dustdevil]

Dr. Bledsoe has done research and published on the subject, along with his papers on SSM and the PUM. We've had this discussion here in the past, complete with references to meta-analyses showing a lack of evidence of any patient-based benefits to MPDS. Unfortunately, the discussion seems to have been lost in the server move, because I can no longer find it here. And to complicate matters, Dr. Clawson and his minions are experts at spamming the Internet with their bogus "studies" and papers, all cooked up in their war room and posted under several organisational names that all trace back to him. That makes it hard to separate the wheat from the chaff on the Google. But here's a handful of studies I managed to find for review:

http://www.pubmedcentral.nih.gov/articlere...i?artid=2464449

http://pdm.medicine.wisc.edu/21-2%20PDFs/morgans.pdf

http://www.ncbi.nlm.nih.gov/pubmed/12540150

http://pdm.medicine.wisc.edu/21-2%20PDFs/reilly.pdf

http://cnylink.com/cnynews/view_news.php?n...2t4863d53a323a0

There's a start. Basically, all the studies say that MPDS is about 70 percent specific, give or take. That's a pretty significant margin of error. And all that 70 percent specificity accomplishes is to reduce a minimal amount of code-3 runs. MPDS does nothing to address improving outcomes for critical patients.

But really, you're looking at this backwards. Priority Dispatch is a commercial product. The burden of proof lies upon them to prove with evidence -- not theory -- that it works. There is no burden for us to prove that it does not. You cannot prove a negative. MPDS is simply one of those silly "well, everyone else is doing it, so it must be good" myths in EMS that keeps making Clawson richer without saving a single patient. If you're looking for info to take to the powers that be, I'd contact Dr. Bledsoe for assistance.