Ambulance Dispatch and Paramedic Services

Accessing Paramedic Services

• Traditionally via ambulance services.
• Increasingly in workplaces, special events, venues, and hospitals.
• Access can be direct (patient to paramedic in a clinic) or via dispatch.
• Special events: Contact security who liaise with a medical control center.
• Workplaces: Internal dispatch systems may be in place.
• Healthcare Facilities: Paramedics handle emergency responses within the hospital, dispatched via a central system.
• Focus will be on ambulance service dispatch due to its complexity and scale.

Why People Call Ambulances: A Multi-Step Process

1. Noticing an Abnormality:

   • Recognizing something has changed and isn't normal.
   • Can be obvious (e.g., falling off a house) or subtle (gradual symptom onset). Difficulty in recognizing slowly developing symptoms as an emergency.
   • Importance of recognizing something as an "emergency" or "unscheduled health event."

2. Identifying the Need for Help:

   • Realizing personal resources are insufficient to handle the problem.
   • Motivated by fear or concern, especially with unfamiliar symptoms (e.g., chest pain).
   • Unsurety and checking behaviors: People often consult family or friends because they worry about being a burden.

3. Deciding an Ambulance is Necessary:

   • Concluding that an ambulance is the correct service.

4. Morgan's Model of Ambulance Patient Decision Making:

   • Encompasses the above four stages.

Ambulance Call-Taking Process

• Emergency Numbers:
  • Australia: 000
  • New Zealand: 111
  • USA & Canada: 911
  • UK: 999
  • Europe: 112
  • 112 is widely used internationally. 911 primarily in the Americas.
• The discussed model is common in Australia, New Zealand and The UK.
• Dispatch System Variations:
  • Vary from centralized national systems (New Zealand) to regional or private systems (South Africa).

Primary Triage

1. Primary Triage Call Taker:

   • Uses a protocol-driven system to gather information.
   • Options: Dispatch ambulance OR send to secondary triage.

2. Telstra Operator (Australia):

   • Before primary triage, a Telstra operator asks for police, fire, or ambulance and location.
   • Routes call to appropriate ambulance call center.

3. Call Taker Qualifications:

   • Typically not paramedics, but specially trained in primary triage.

4. Dispatch Protocols:

   • Medical Priority Dispatch System (MPDS) is most common internationally, used in all Australian services.

5. MPDS Script Structure:

   • Asks a series of questions:
     • The seven primary questions
   • States they are organizing an ambulance
   • Moves into chief complaint protocol questions.

6. Chief Complaint Protocol:

   • Classifies the problem (e.g., abdominal, breathing).
   • Asks further questions related to the classification

7. Dispatch Timing:

   • In Australia and New Zealand: Collect information before dispatching (except time-critical cases).
   • Time-critical cases (e.g., suspected cardiac arrest) are dispatched early.

8. Chief Complaint Protocol Components:

   • Key questions.
   • Pre-arrival instructions.
   • Life support instructions (e.g., CPR coaching, AED use, positioning unconscious patient).
   • Pre-arrival instructions (e.g., advising against eating/drinking, callback instructions).

9. Example: MPDS Protocol 12 (Convulsions/Fitting):

   • Key questions: Seizure details, ongoing fitting, etc.
   • Dispatch instructions: Actions to take while waiting.
   • Call taker support: May stay on the line or hang up depending on caller needs; sometimes still on the line when paramedics arrive.

10. MPDS Dispatch Levels (General):

    • Correspond to a dispatch priority, ranging from green (not very serious) to delta (very serious).

Secondary Triage

1. Nature:

   • Telehealth assessment via phone (and increasingly video).
   • Conducted by health professionals, typically nurses or triage paramedics.
   • Triage paramedic is an evolving specialty; major employer in New Zealand is a telehealth center.

2. Process:

   • Exhaustive assessment and risk assessment.
   • Identifies alternatives to ambulance transport.

3. Outcomes:

   • May send call back to ambulance dispatch.
   • Alternative pathways, including:
     • Self-care advice.
     • Referral to chemist, GP, urgent care center.
     • Scheduled visit by extended care paramedic.
     • Locum GP service (house calls).
     • Alternative transport (taxi, private vehicle) to the emergency department.

4. Impact:

   • Secondary triage rates:
     • Australia: Approximately 25% (estimate).
     • UK services aiming for up to 60% into secondary triage for alternative pathways.

5. Goals:

   • Finding the right care for the patient.
   • Education and empowerment of patients.
   • Addressing systems navigation needs often met by ambulance calls.

Ambulance Dispatch Process

1. Information Flow:

   • Information goes from primary triage call taker to the dispatcher.

2. Resource Allocation:

   • Appropriate resources dispatched based on case nature.

3. Ambulance Vehicle Locator (AVL):

   • AVL uses GPS tracking to recommend the nearest ambulance.

4. Dispatch Variations:

   • Canada and US: System pre-notifies the nearest ambulance.
   • Australia: More "cold response" cases, allowing for logistical considerations (fatigue, caseload).

5. Logistical Considerations:

   • Cold responses might prioritize fresher crews over the absolute nearest ambulance.

6. Hot Responses:

   • Almost always the nearest vehicle as recommended by the AVL.

7. Pre-booked Cases:

   • Air medical transfers (helicopter/fixed-wing aircraft to hospital).
   • Urgent hospital-to-hospital transfers (not via patient transport services).

8. Cold Response Timeframes:

   • Increasing time frames based on risk profile.
   • Example: Sprained ankle at home with ice pack allows for a longer response time (e.g., two hours).
   • Life-threatening problems are time-critical.

9. Dispatch Communication:

   • Dispatched via radio.
   • Information from call taker summarized and sent to ambulance data terminal.