Emergency medical dispatcher - AbsoluteAstronomy.com

An Emergency medical dispatcher is a professional telecommunicator, tasked with the gathering of information related to medical emergencies, the provision of assistance and instructions by voice, prior to the arrival of Emergency Medical Services

Emergency medical services

Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...

, and the dispatching and support of EMS

Emergency medical services

resources responding to an emergency call. The term Emergency Medical Dispatcher is also a certification

Certification

Certification refers to the confirmation of certain characteristics of an object, person, or organization. This confirmation is often, but not always, provided by some form of external review, education, assessment, or audit...

level and a professional designation, certified through the Association of Public-Safety Communications Officials-International (APCO), the National Academies of Emergency Dispatch, and PowerPhone, Inc. Many dispatchers, whether certified or not, will dispatch using a standard Emergency Medical Dispatch

Emergency medical dispatch

Emergency Medical Dispatch refers to a system that enhances services provided by Public Safety Answering Point call takers, such as municipal emergency services dispatchers...

protocol.

History

A dispatch function of sorts has always been a feature of both emergency medical service and its predecessor, ambulance

Ambulance

An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...

service. The information processing, if only to identify the problem and the location of the patient, has always been a logical part of the process of call completion. Prior to the professionalization of emergency medical services

Emergency medical services

, this step in the process was often informal; the caller would simply call the local ambulance service, the telephone

Telephone

The telephone , colloquially referred to as a phone, is a telecommunications device that transmits and receives sounds, usually the human voice. Telephones are a point-to-point communication system whose most basic function is to allow two people separated by large distances to talk to each other...

call would be answered (in many cases by the ambulance attendant who would be responding to the call), the location and problem information would be gathered, and an ambulance assigned to complete the detail. The ambulance would then complete the call, return to the station, and wait for the next telephone call. Although earlier experiments with the use of radio communication in ambulances did occur, it was not until the 1950s that the use of radio dispatch became widespread in the U.S. and Canada

Canada

Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...

. Indeed, during the 1950s the presence of radio dispatch was often treated as a marketing

Marketing

Marketing is the process used to determine what products or services may be of interest to customers, and the strategy to use in sales, communications and business development. It generates the strategy that underlies sales techniques, business communication, and business developments...

inducement, and was prominently displayed on the sides of ambulances, along with other technological advances, such as carrying oxygen

Oxygen

Oxygen is the element with atomic number 8 and represented by the symbol O. Its name derives from the Greek roots ὀξύς and -γενής , because at the time of naming, it was mistakenly thought that all acids required oxygen in their composition...

. Dispatch methodology was often determined by the business arrangements of the ambulance company. If the ambulance were under contract to the town, it might be dispatched as an 'add-on' to the fire department

Fire department

A fire department or fire brigade is a public or private organization that provides fire protection for a certain jurisdiction, which typically is a municipality, county, or fire protection district...

or police department resources. In some cases, it might be under contract to the local hospital, and dispatched from there. In many cases, small independent ambulance companies were simply dispatched by a family member or employee, employed part-time in many cases. Ambulance dispatchers required little in the way of qualifications, apart from good telephone manners and a knowledge of the local geography.

In a parallel evolution, the development of 9-1-1

9-1-1

9-1-1 is the emergency telephone number for the North American Numbering Plan .It is one of eight N11 codes.The use of this number is for emergency circumstances only, and to use it for any other purpose can be a crime.-History:In the earliest days of telephone technology, prior to the...

as a national emergency number

Emergency telephone number

Many countries' public telephone networks have a single emergency telephone number, sometimes known as the universal emergency telephone number or occasionally the emergency services number, that allows a caller to contact local emergency services for assistance. The emergency telephone number may...

began, not in the United States

United States

The United States of America is a federal constitutional republic comprising fifty states and a federal district...

, but in Winnipeg

Winnipeg

Winnipeg is the capital and largest city of Manitoba, Canada, and is the primary municipality of the Winnipeg Capital Region, with more than half of Manitoba's population. It is located near the longitudinal centre of North America, at the confluence of the Red and Assiniboine Rivers .The name...

, Manitoba

Manitoba

Manitoba is a Canadian prairie province with an area of . The province has over 110,000 lakes and has a largely continental climate because of its flat topography. Agriculture, mostly concentrated in the fertile southern and western parts of the province, is vital to the province's economy; other...

, Canada

Canada

, in 1959. The concept of a single answering point for emergency calls to public safety

Public Safety

Public safety involves the prevention of and protection from events that could endanger the safety of the general public from significant danger, injury/harm, or damage, such as crimes or disasters .-See also:* By nation...

agencies caught on quickly. In the United States, the decision was made to utilize the Canadian number, for reasons of ease of memory (4-1-1

4-1-1

4-1-1 is the telephone number for local directory assistance in the United States and Canada. One exception is the Pacific Northwest, which used 1-1-3 until the mid-1980s. Until the early 1980s, 4-1-1 calls were free in most states....

and 6-1-1

6-1-1

For customers of some telephone companies in Canada and in the U.S., 611 is the abbreviated dialing telephone number used to report a problem with telephone service, or with a payphone...

were already in use), and ease of dialing. In 1967, the number was established as the national emergency number for the United States, although by 2008, coverage of the service was still not complete, and about 4 percent of the United States did not have 9-1-1 service. Calling this single number provided caller access to police, fire and ambulance services, through what would become known as a common Public-safety answering point

Public-safety answering point

A Public Safety Answering Point , sometimes called "Public Safety Access Point", is a call center responsible for answering calls to an emergency telephone number for police, firefighting, and ambulance services. Trained telephone operators are also usually responsible for dispatching these...

(PSAP). The technology would also continue to evolve, resulting in Enhanced 9-1-1 including the ability to 'lock' telephone lines on emergency calls, preventing accidental disconnection, and Automatic Number Identification/Automatic Location Identification (ANI/ALI), which permits the dispatcher to verify the number originating the call (screening out potential false alarms), and identifying the location of the call, against the possibility of the caller becoming disconnected or unconscious.

As the skill set of those in the ambulance increased, so did the importance of information. Ambulance service moved from 'first come...first served' or giving priority to whoever sounded the most panicked, to trying to figure out what was actually happening, and the assignment of resources by priority of need. This occurred slowly at first, with local initiatives and full-time ambulance dispatchers making best guesses. Priority codes developed for ambulance dispatch, and became commonplace, although they have never been fully standardized. As it became possible for those in the ambulance to actually save lives, the process of sending the closest appropriate resource to the person in the greatest need became very important. Dispatchers needed tools to help them make the correct decisions, and a number of products initially competed to provide that decision-support.

1970s onward

One of the first known examples of call triage

Triage

Triage or ) is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate,...

occurring in the dispatch centre occurred in 1975, when the Phoenix, Arizona

Phoenix, Arizona

Phoenix is the capital, and largest city, of the U.S. state of Arizona, as well as the sixth most populated city in the United States. Phoenix is home to 1,445,632 people according to the official 2010 U.S. Census Bureau data...

Fire Department assigned some of its paramedics to their dispatch centre in order to interview callers and prioritize calls. The following year, Dr. Jeff Clawson, a physician

Physician

A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

employed by the Salt Lake City Fire Department as its Medical Director

Medical director

As laboratory director,means that you are responsible for the overall operation and administration of the laboratory, including the employment of competentqualified personnel. Even though you have the option to delegate some...

, developed a series of key questions, pre-arrival instructions, and dispatch priorities to be used in the processing of EMS calls. These ultimately evolved into the Medical Priority Dispatch System

Medical Priority Dispatch System

The Medical Priority Dispatch System is a medically-approved, unified system used to dispatch appropriate aid to medical emergencies including systematized caller interrogation and pre-arrival instructions. Priority Dispatch Corporation is licensed to design and publish MPDS and its various...

(MPDS), APCO (EMD) and PowerPhone's Total Response Computer aided call handling

Computer aided call handling

Computer aided call handling is a methodology for managing calls to service providers, such as emergency services, through the use of computer based algorithms in order to make consistent and objective decisions on action to be taken...

(CACH) system. Such systems were initially technologically quite primitive; in the mid 1970s the use of computers in dispatching was extremely uncommon, and those that used them were dealing with very large mainframe computers. Most such systems were based on either reference cards or simple flip charts, and have been described by lay people on more than one occasion as being like a "recipe file" for ambulance dispatchers. The development of pre-arrival instructions presented an entirely new challenge for those involved in emergency medical dispatch; it might take eight or more minutes for paramedics to arrive at the patient's side, but dispatchers could be there in seconds. Physicians began to see a dramatic new potential for the saving of lives by means of simple scripted telephone instructions from the dispatcher, and the concept of Dispatch Life Support was born. Suddenly dispatchers were providing complex information and instructions to callers, and even providing guidance on performing procedures such as cardiopulmonary resuscitation

Cardiopulmonary resuscitation

Cardiopulmonary resuscitation is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive...

(CPR) by telephone. The concept became an area of medical research, and even EMS Medical Directors debated on the best approach to such services.

As technology, and particularly computer technology, evolved, the dispatching of EMS resources took on an entirely new dimension, and required completely new skill sets. The process of dispatching was supported by computers, and moved in many locales to a 'paperless' system that required above average computer skills. Computer-assisted dispatch

Computer-assisted dispatch

Computer-assisted dispatch, also called Computer Aided Dispatch , is a method of dispatching taxicabs, couriers, field service technicians, or emergency services assisted by computer. It can either be used to send messages to the dispatchee via a mobile data terminal and/or used to store and...

(CAD) systems not only permitted the dispatcher to record the call information, but also automated the call triage process, allowing EMD systems to become algorithm-based decision support tools. Technologies once available only to the military, such as satellite

Satellite

In the context of spaceflight, a satellite is an object which has been placed into orbit by human endeavour. Such objects are sometimes called artificial satellites to distinguish them from natural satellites such as the Moon....

-based Automatic Vehicle Location

Automatic vehicle location

Automatic vehicle location is a means for automatically determining the geographic location of a vehicle and transmitting the information to a requester....

allowed CAD systems to constantly monitor the location and status of response resources, making response resource assignment recommendations to human dispatchers, allowing human dispatchers to watch the physical movement of their resources across a computerized map, and creating a permanent record of the call for future use.

Emergency medical dispatchers and prioritized dispatching have become a critical and demanding part of EMS service delivery.Emergency Medical Dispatching The PSAP and, in effect the EMD, become the functional link between the public and allocation of emergency resources, including police

Police

The police is a personification of the state designated to put in practice the enforced law, protect property and reduce civil disorder in civilian matters. Their powers include the legitimized use of force...

, fire

Fire

Fire is the rapid oxidation of a material in the chemical process of combustion, releasing heat, light, and various reaction products. Slower oxidative processes like rusting or digestion are not included by this definition....

and EMS

Emergency medical services

. As the system has evolved and become professionalized, control of the Advanced Medical Priority Dispatch System (MPDS), originally developed by Dr. Jeff Clawson, has been turned over to Medical Priority Consultants, Inc. (now known as Priority Dispatch Corporation), while APCO and PowerPhone developed separate systems. The National Academy of Emergency Medical Dispatchers was subsequently established by Dr. Clawson as a non-profit advisory organization to develop products and services provided by PDC. A formal process for the development of emergency medical dispatch protocols and guidelines continues to be developed by National Institutes of Health

National Institutes of Health

The National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...

; the National Association of Emergency Medical Services Physicians (NAEMSP), a professional association of EMS medical directors; and the National Association of State Emergency Medical Services Directors (NASEMSD).

The role of the EMD

In most modern EMS systems, the Emergency Medical Dispatcher will fill a number of critical functions. The first of these is the identification of basic call information, including the location and telephone number of the caller, the location of the patient, the general nature of the problem, and any special circumstances. In most EMS systems, the telephone remains almost a singular point of access for those needing assistance.

There are general exceptions to this rule. Most of them still involve 9-1-1 calls, but using new alerting mechanisms upstream from the 9-1-1 call. While these new applications are not directly monitored by the EMD, the EMD nevertheless remains the primary point of contact into the dispatch system. The three most common new applications are:

Some public access defibrillators have an alarm
Alarm
An alarm device or system of alarm devices gives an audible or visual alarm signal about a problem or condition.Alarm devices include:* burglar alarms, designed to warn of burglaries; this is often a silent alarm: the police or guards are warned without indication to the burglar, which increases...

built in that triggers an automated 9-1-1 call, on removal, on the assumption that an AED
Automated external defibrillator
An automated external defibrillator or AED is a portable electronic device that automatically diagnoses the potentially life threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient, and is able to treat them through defibrillation, the application of...

is usually removed for emergency medical reasons; maintenance removal will use an alarm override.
Personal safety alarms, designed for use by the old or infirm, such as Philips LifeLine. They usually take the form of a bracelet
Bracelet
A bracelet is an article of jewelry which is worn around the wrist. Bracelets can be manufactured from metal, leather, cloth, plastic or other materials and sometimes contain jewels, rocks, wood, and/or shells...

or pendant
Pendant
A pendant is a loose-hanging piece of jewellery, generally attached by a small loop to a necklace, when the ensemble may be known as a "pendant necklace". A pendant earring is an earring with a piece hanging down. In modern French "pendant" is the gerund form of “hanging”...

. The device will have a push-button-activated alarm, and possibly a motion sensor for automatic alarms, which are relayed through a base unit attached to a telephone landline. Most such systems inform a monitoring company, which will has a protocol for informing 9-1-1 about the potential emergency of the subscriber. Sophisticated versions of these systems may even allow two-way voice communucation among the subscriber, the monitoring company, and emergency dispatch.
Vehicle monitoring systems (such as GM
General Motors
General Motors Company , commonly known as GM, formerly incorporated as General Motors Corporation, is an American multinational automotive corporation headquartered in Detroit, Michigan and the world's second-largest automaker in 2010...

OnStar
OnStar
OnStar Corporation is a subsidiary of General Motors that provides subscription-based communications, in-vehicle security, hands free calling, turn-by-turn navigation, and remote diagnostics systems throughout the United States, Canada and China. A similar service is known as ChevyStar in Latin...

). Such systems have sensors to monitor for vehicle crashes, mobile or satellite telephony to call the monitoring company, and GPS to identify the vehicle's location. In the event that the system detects a possible crash situation, the system will call the monitoring center and submit the crash and location information. If the operator cannot verify with the car's occupants that emergency services are unnecessary, then the operator will call the PSAP appropriate to the vehicle's location. This is becoming increasingly common in North America.

The next area of responsibility involves the triage

Triage

of incoming calls, providing expert interrogation

Interrogation

Interrogation is interviewing as commonly employed by officers of the police, military, and Intelligence agencies with the goal of extracting a confession or obtaining information. Subjects of interrogation are often the suspects, victims, or witnesses of a crime...

of the caller, using the script provided by the Emergency medical dispatch

Emergency medical dispatch

Emergency Medical Dispatch refers to a system that enhances services provided by Public Safety Answering Point call takers, such as municipal emergency services dispatchers...

algorithm

Algorithm

In mathematics and computer science, an algorithm is an effective method expressed as a finite list of well-defined instructions for calculating a function. Algorithms are used for calculation, data processing, and automated reasoning...

, in order to determine the likely severity of the patient's illness

Illness

Illness is a state of poor health. Illness is sometimes considered another word for disease. Others maintain that fine distinctions exist...

or injury

Injury

-By cause:*Traumatic injury, a body wound or shock produced by sudden physical injury, as from violence or accident*Other injuries from external physical causes, such as radiation injury, burn injury or frostbite*Injury from infection...

condition, so that the most appropriate type of response resources may be sent, with all calls sorted by medical acuity. This process may be further complicated by panic-stricken callers who scream, cry or make unreasonable demands; the EMD must use interpersonal and crisis management skills to sort through these distractions, taking control of the dialogue, calming the caller, and extracting the required information. This interrogation begins with obvious questions, such as 'Is the patient conscious?' and 'Is the patient breathing?' This interrogation will continue until the point when the EMD is able to identify a potentially life-threatening condition, at which time the closest appropriate response resource (such as a paramedic-staffed ambulance) may be notified and begin to move towards the call location. When this occurs, the EMD will continue the interrogation, attempting to gather relevant additional information, which will be passed to responding paramedics, and may influence the speed of the response, the type of resources sent, or the type of equipment that the paramedics will initially take to the patient's side when they arrive. In most cases, this 'pre-alert' function will not be required, and the resource will simply be dispatched when all of the required information has been gathered. The manner in which this interrogation proceeds is often governed by protocols, or by decision-support software, but ultimately, the decision as to how to proceed, or when to interrupt the established process, requires the judgment of the EMD handling the call.

The third function is the selection and assignment of the most appropriate type of response resource, such as an ambulance, from the closest or the most appropriate location, depending on the nature of the problem, and ensuring that the crew of the response resource receive all of the appropriate information. The EMD is responsible for the management and work assignment (physicians and supervisors provide work direction) for all of the response resources in the EMS system. In many cases, the EMD is responsible for multiple response resources simultaneously, and these may include ALS

ALS

ALS refers to amyotrophic lateral sclerosis, also known as Lou Gehrig's diseaseIt may also refer to:-Medicine:* Advanced life support, a level of medical training* Anterolateral system, part of the nervous system...

, BLS

Basic life support

Basic life support is the level of medical care which is used for patients with life-threatening illnesses or injuries until the patient can be given full medical care at a hospital. It can be provided by trained medical personnel, including emergency medical technicians, paramedics, and by...

, or some mix of skills, ambulances, 'fly-cars', and other types of resources. In a quiet, rural

Rural

Rural areas or the country or countryside are areas that are not urbanized, though when large areas are described, country towns and smaller cities will be included. They have a low population density, and typically much of the land is devoted to agriculture...

setting, such resources may be at a fixed point, in quarters, most of the time, while in other cases, such as urban

Urban area

An urban area is characterized by higher population density and vast human features in comparison to areas surrounding it. Urban areas may be cities, towns or conurbations, but the term is not commonly extended to rural settlements such as villages and hamlets.Urban areas are created and further...

settings, all or many of the resources may be mobile. It is not uncommon, in a large urban centre, for an EMD to manage and direct as many as 20 response resources simultaneously. It is the job of the EMD to analyze the information and ensure that it leads to the right resource being sent to the patient in the shortest appropriate time. This requires a constant level of awareness of the location and status of each resource, so that the closest available and appropriate resource may be sent to each call. Particularly in larger, urban settings, the mental demands and stress level may be comparable to those of an air traffic controller

Air traffic controller

Air traffic controllers are the people who expedite and maintain a safe and orderly flow of air traffic in the global air traffic control system. The position of the air traffic controller is one that requires highly specialized skills...

, and 'burn-out

Burnout (psychology)

Burnout is a psychological term for the experience of long-term exhaustion and diminished interest. Research indicates general practitioners have the highest proportion of burnout cases; according to a recent Dutch study in Psychological Reports, no less than 40% of these experienced high levels of...

' rates may be quite high. This has been eased somewhat in recent years through the use of Automatic Vehicle Locating (AVL

Automatic vehicle location

Automatic vehicle location is a means for automatically determining the geographic location of a vehicle and transmitting the information to a requester....

), permitting the EMD to monitor the location and status of all assigned resources using a computer screen instead of by memory

Memory

In psychology, memory is an organism's ability to store, retain, and recall information and experiences. Traditional studies of memory began in the fields of philosophy, including techniques of artificially enhancing memory....

.

The EMDs next priority is to provide and assist the layperson/caller with pre-arrival instructions to help the victim, using standardized protocols developed in co-operation with local medical directors. Such instructions may consist of simple advice to keep the patient calm and comfortable or to gather additional background information for responding paramedics. The instructions can also frequently become more complex, providing directions over the telephone for an untrained person to perform CPR, for example. Examples of EMDs guiding family members through assisting a loved one with the process of childbirth

Childbirth

Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...

prior to the arrival of the ambulance are also quite common. The challenge for the EMD is often the knowledge level of the caller. In some cases, the caller may have prior first-aid and/or CPR training, but it is often just as likely that the caller has no prior training or experience at all. This process may still consist of a symptom-based flip-card system, but is increasing automated into the CAD software.

The EMD is generally also responsible for providing information support to the responding resources. This may include callbacks to the call originator to clarify information. It may involve clarifying the exact location of the patient, or sending a bystander to meet the ambulance and direct paramedics to the patient. It may also include requests from the EMS crew to provide support resources, such as additional ambulances, rescue

Rescue

Rescue refers to responsive operations that usually involve the saving of life, or prevention of injury during an incident or dangerous situation....

equipment, or a helicopter

Helicopter

A helicopter is a type of rotorcraft in which lift and thrust are supplied by one or more engine-driven rotors. This allows the helicopter to take off and land vertically, to hover, and to fly forwards, backwards, and laterally...

. The EMD also plays a key role in the safety of EMS staff. They are the first with the opportunity to assess the situation that the crew is responding to, will maintain contact on the scene in order to monitor crew safety

Safety

Safety is the state of being "safe" , the condition of being protected against physical, social, spiritual, financial, political, emotional, occupational, psychological, educational or other types or consequences of failure, damage, error, accidents, harm or any other event which could be...

, and are frequently responsible for requesting emergency police response to 'back up' paramedics when they encounter a violent situation. EMDs are often responsible for monitoring the status of local hospitals, advising paramedics on which hospitals are accepting ambulance patients, and which are on 're-direct' or 'divert'. In many cases, the EMD may be responsible for notifying the hospital of incoming patients on behalf of the response resource crew. Paramedics who are working on patients or driving an ambulance are rarely able to make a detailed telephone call. As a result, the EMD will relay any advance notification regarding patient situation or status, once in transit.

Finally, the EMD ensures that the information regarding each call is collected in a consistent manner, for both legal and quality assurance

Quality Assurance

Quality assurance, or QA for short, is the systematic monitoring and evaluation of the various aspects of a project, service or facility to maximize the probability that minimum standards of quality are being attained by the production process...

purposes. In most jurisdictions, all EMS records, including both patient care and dispatch records, and also recordings of dispatch radio and telephone conversations, are considered to be legal documents. Dispatch records are often a subject of interest in legal proceedings

Legal process

Legal process , are the proceedings in any civil lawsuit or criminal prosecution and, particularly, describes the formal notice or writ used by a court to exercise jurisdiction over a person or property...

, particularly with respect to initial information obtained, statements made by the caller, and response times for resources. Any or all may be demanded by a criminal court or civil court, a public inquiry

Public inquiry

A Tribunal of Inquiry is an official review of events or actions ordered by a government body in Common Law countries such as the United Kingdom, Ireland or Canada. Such a public inquiry differs from a Royal Commission in that a public inquiry accepts evidence and conducts its hearings in a more...

, or a Coroner

Coroner

A coroner is a government official who* Investigates human deaths* Determines cause of death* Issues death certificates* Maintains death records* Responds to deaths in mass disasters* Identifies unknown dead* Other functions depending on local laws...

's Inquest, and may have to be produced as evidence

Evidence

Evidence in its broadest sense includes everything that is used to determine or demonstrate the truth of an assertion. Giving or procuring evidence is the process of using those things that are either presumed to be true, or were themselves proven via evidence, to demonstrate an assertion's truth...

. It is not uncommon in some jurisdictions for EMDs to be summoned to court, in order to provide evidence regarding their activities. As a result, there is frequently a legal requirement for the long-term storage of such information, and the specific requirements are likely to vary by both country and jurisdiction. Additionally, medical directors will frequently rely on information provided by EMDs for the purpose of medical quality assurance

Quality Assurance

for paramedics; in particular analyzing conversations between paramedics and dispatchers or physicians, analyzing the paramedic's actions and judgments in the light of the information that they were provided with. As a direct result of these two factors, there is a requirement for all call information to be collected and stored in a regular, consistent, and professional manner, and this too, will often fall to the EMD, at least in the initial stages.

Work locations

The overwhelming majority of EMDs will perform their work in an EMS dispatch centre. Occasionally this may involve some 'site work', such as on-site dispatching for large special events, but this is somewhat rare. EMS dispatching may be a single, independent process, or it may be a mixed function with one or more of the other emergency services. In some smaller jurisdictions, the EMS, fire and police dispatch functions, and even the 9-1-1 system may be physically co-located, but with different specialist staff performing each function. Such decisions are frequently made based on the sizes of the services involved, and their call volumes. While some jurisdictions are required, generally through economics

Economics

Economics is the social science that analyzes the production, distribution, and consumption of goods and services. The term economics comes from the Ancient Greek from + , hence "rules of the house"...

or size, to provide a single public safety dispatch system, the three emergency services have requirements and procedure

Procedure (term)

A procedure is a sequence of actions or operations which have to be executed in the same manner in order to always obtain the same result under the same circumstances ....

s that are sufficiently different that wherever possible, independent dispatching is preferred. Even in truly large, mixed (fire and EMS) services, such as the New York City Fire Department

New York City Fire Department

The New York City Fire Department or the Fire Department of the City of New York has the responsibility for protecting the citizens and property of New York City's five boroughs from fires and fire hazards, providing emergency medical services, technical rescue as well as providing first response...

, the functions and requirements are seen as sufficiently different that an independent dispatch function is maintained for each. The emergency services in question all have their own priorities, and while they are extremely important to each, those priorities often simply conflict too greatly to allow reasonable joint dispatch functions. To illustrate, in a scenario with a single dispatcher for both fire and EMS: the truck officer on a fire apparatus is requesting additional resources for a working fire with a possibility of trapped people, and two paramedics are attempting to resuscitate a dying child, but require medical direction, which request gets priority? Another important consideration is workload; in many jurisdictions the call volume of the EMS system is 5-6 times as great as that of the Fire Department. Asking fire service dispatchers to also dispatch EMS resources, or vice versa, may exceed the capabilities of the dispatchers. Even when joint dispatching is pursued by a community, the various types of dispatch functions to support EMS, fire and police are so different that the dispatchers involved will require separate training and certification in each.

Increasingly, such public safety dispatch locations are becoming community owned and operated resources. As such, they tend to be co-located with other emergency service resources, as in a headquarters

Headquarters

Headquarters denotes the location where most, if not all, of the important functions of an organization are coordinated. In the United States, the corporate headquarters represents the entity at the center or the top of a corporation taking full responsibility managing all business activities...

-type complex. Such environments must strike a 'balance' between the high-tech requirements of the work, including large numbers of computers, telephone

Telephone

lines, and radios, and the psychological needs of the human beings operating them. The environment is frequently both high-performance and high-stress, and every measure must be taken to ensure as little ambient stress in the environment as possible. Such issues are often the subject of careful design

Design

Design as a noun informally refers to a plan or convention for the construction of an object or a system while “to design” refers to making this plan...

and also ergonomics

Ergonomics

Ergonomics is the study of designing equipment and devices that fit the human body, its movements, and its cognitive abilities.The International Ergonomics Association defines ergonomics as follows:...

. Environmental colour choices, the reduction of ambient noise (and therefore stress) and the physical design of the seating and consoles used by the EMD are all intended to reduce stress levels. Supervisory staff also typically monitor staff carefully, particularly in high-performance environments, ensuring that rest and meal breaks are taken, and occasionally providing a 'time out' after a particularly difficult call. Despite all of these measures, occupational stress is a significant factor for many EMDs, and the 'burnout' rate for those in these positions tends to be higher than other occupations.

It should be pointed out that while the role and certification of Emergency Medical Dispatcher has its origins in the United States

United States

The United States of America is a federal constitutional republic comprising fifty states and a federal district...

, it is gradually gaining acceptance in many other countries. The position and credential

Credential

A credential is an attestation of qualification, competence, or authority issued to an individual by a third party with a relevant or de facto authority or assumed competence to do so....

are in widespread use in Canada

Canada

and the U.K.. The acceptance and use of this position and credential are growing in the European Union

European Union

The European Union is an economic and political union of 27 independent member states which are located primarily in Europe. The EU traces its origins from the European Coal and Steel Community and the European Economic Community , formed by six countries in 1958...

, in Australia

Australia

Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...

, and elsewhere. In many respects, the development of this position is a logical sequel to the incorporation of the Emergency medical dispatch

Emergency medical dispatch

Emergency Medical Dispatch refers to a system that enhances services provided by Public Safety Answering Point call takers, such as municipal emergency services dispatchers...

system by EMS. Together, NAED and PDC often present themselves as the de facto standard in EMD systems. However, the continued recognition given to alternative providers suggests that this approach is not universally accepted. And not all EMS dispatch worldwide is conducted by EMDs. In some jurisdictions using the Franco-German model of EMS service delivery (SAMU

Samu

Samu may refer to:* Samu, nickname for a Homo erectus man found in Vértesszőlős, Hungary* SAMU - Service d'Aide Médicale d'Urgence, an emergency medical service in France.* Servicio de Atencion Medica Urgente, also an emergency medical service...

in France

France

The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...

, for example), a call for a medical emergency will not be processed by an EMD, but generally by a physician, who will decide whether or not an ambulance will even be sent.

Training

Training for EMDs is required to meet a National Standard Curriculum

Curriculum

See also Syllabus.In formal education, a curriculum is the set of courses, and their content, offered at a school or university. As an idea, curriculum stems from the Latin word for race course, referring to the course of deeds and experiences through which children grow to become mature adults...

, as outlined by the National Highway Traffic Safety Administration

National Highway Traffic Safety Administration

The National Highway Traffic Safety Administration is an agency of the Executive Branch of the U.S. government, part of the Department of Transportation...

of the U.S. government. This training program may be offered by private companies, by community colleges, or by some large EMS systems which are self-dispatching. The minimum length of such training is 32 classroom hours, covering such topics as EMD Roles and Responsibilities, Legal and Liability Issues in EMD, National and State Standards for EMD, Resource Allocation, Layout and Structure of EMD Guidecards, Obtaining Information from Callers, Anatomy

Anatomy

Anatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy , and plant anatomy...

and Physiology

Physiology

Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...

, Chief Complaint Types, Quality Assurance

Quality Assurance

& Recertification and Stress Management. Certification in CPR is not mandatory, but upon completion of the training, students are required to sit a certification examination. Upon completion of the training and certification, Emergency Medical Dispatchers are required to complete 24 hours of Continuing Dispatch Education every two years, in order to maintain certification. This level of training and certification only satisfies the national curriculum, and in most cases, additional training will be required. Additional training will have a local focus, and will deal with local geographical knowledge, dispatch procedures, local laws and service policy. Additional training may be required to orient new emergency medical dispatchers to different forms of 9-1-1

9-1-1

telecommunication

Telecommunication

Telecommunication is the transmission of information over significant distances to communicate. In earlier times, telecommunications involved the use of visual signals, such as beacons, smoke signals, semaphore telegraphs, signal flags, and optical heliographs, or audio messages via coded...

(if this will be a part of their job function). This may also include (depending on the jurisdiction) EFD (Emergency Fire Dispatching), EPD (Emergency Police Dispatching), ETC (emergency telecommunication), ECE (Executive Certification Course), CMC (Communication Center Manager), when such services are jointly operated. Similar courses are also generally available in Law Enforcement Dispatch (LED), Fire Service Dispatch (FSD), and Public Safety Dispatch (PSD), designed for those working in a multi-agency 9-1-1 call center that handles police, fire and EMS dispatching.

Additional local training is likely to be required for the actual skill of dispatching. This may involve extensive 'drilling

Drilling

Drilling is a cutting process that uses a drill bit to cut or enlarge a hole in solid materials. The drill bit is a multipoint, end cutting tool...

' on local geography

Geography

Geography is the science that studies the lands, features, inhabitants, and phenomena of Earth. A literal translation would be "to describe or write about the Earth". The first person to use the word "geography" was Eratosthenes...

, for example. Large dispatch centres also tend to train staff in a graduated manner. Some of the more sophisticated EMS systems might actually have a teaching 'lab' complete with dispatch consoles, where the trainees can practice dealing with simulated calls, using exactly the same technologies that would be present in a real call centre. In other cases, or in addition to this 'lab' work in many cases, a graduated process of introduction and mentoring

Mentoring

Mentorship refers to a personal developmental relationship in which a more experienced or more knowledgeable person helps a less experienced or less knowledgeable person....

is used to develop an EMD. This generally involves supervised introduction of tasks, from the lowest priority and least stressful, to the highest priority and most stressful. A typical pattern might begin with the candidate performing call reception, then progressing to the actual dispatching of non-emergency transfers, dispatching emergency calls during periods of low volume, dispatching emergency calls at periods of high volume, and so on. In high performance systems, the path to being left alone to run an emergency dispatch console during high volume periods may take months to travel. Some EMS dispatch centres also have designated Communications Training Officers, who are the only people permitted to train or mentor new EMD candidates.

Following the murder of Denise Amber Lee

Murder of Denise Amber Lee

Denise Amber Lee was murdered by Michael King on January 17, 2008; the crime followed his kidnapping and raping her earlier in the day. Lee and several others had attempted to call for help through the 9-1-1 system but there was a lack of communication and the police and other emergency services...

in 2008, new laws are being considered in the State of Florida regarding the training of all public safety telecommunicators including EMDs. One of the 9-1-1 calls relating to her abduction was allegedly mishandled.

Dispatchers Career paths in English Speaking Countries

EMDs come to their jobs from a variety of backgrounds. These might involve no prior experience

Experience

Experience as a general concept comprises knowledge of or skill in or observation of some thing or some event gained through involvement in or exposure to that thing or event....

at all, but are more likely to involve some other previous form of dispatching experience (taxis

Taxis

A taxis is an innate behavioral response by an organism to a directional stimulus or gradient of stimulus intensity. A taxis differs from a tropism in that the organism has motility and demonstrates guided movement towards or away from the stimulus source ...

and tow trucks are common). In some cases, prior dispatch experience might involve one of the other emergency services. In some cases, although not a great many, trained paramedics may become EMDs. This may happen as the result of a work-related injury resulting in disability

Disability

A disability may be physical, cognitive, mental, sensory, emotional, developmental or some combination of these.Many people would rather be referred to as a person with a disability instead of handicapped...

, or it may simply be that a paramedic completes training and then finds that field work is not to their taste, or that they lack the ability to perform the physical aspects of being a paramedic (e.g. heavy lifting) without fear of injury. There is some debate, particularly between paramedics and EMDs, as to whether prior training as a paramedic actually constitutes an advantage or an unnecessary distraction from the EMD job function. Valid perspectives exist on both sides of the debate.

In large EMS systems, EMDs may follow a progressive career path. Actual dispatching may lead to training

Training

The term training refers to the acquisition of knowledge, skills, and competencies as a result of the teaching of vocational or practical skills and knowledge that relate to specific useful competencies. It forms the core of apprenticeships and provides the backbone of content at institutes of...

positions, and from there to supervisor

Supervisor

A supervisor, foreperson, team leader, overseer, cell coach, facilitator, or area coordinator is a manager in a position of trust in business...

y or even managerial positions within the dispatch centre. EMDs may move from smaller systems to larger systems, just as paramedics sometimes do, in search of advancement opportunities, or economic improvements. In some cases, EMDs may choose to retrain and move to fire dispatch (EFD), to police dispatch (EPD), or to the 9-1-1 call centre. The inequities in the sheer amount of training required for certification

Certification

make advancement of EMDs to paramedic status an extremely infrequent event. The required additional training, depending on the jurisdiction, might take two years or more, part-time, in addition to regular full-time employment, putting this option beyond the reach of all but the most determined. Typically, EMDs who are also certified paramedics tend to have been paramedics first.

French SAMU Professional Medical Regulation Assistants

In France there is a SAMU SAMU

Samu

in each capital town hospital that is the Regulator Medical Center of the French county (Département) EMS. This central hub "regulates" all the Emergency care resources of the area from Fire men First Aid EMT vehicles to Hospital Medicalized ground or helicoptered MICUs , but also Hospital Emergency Wards, Intensive care Units , GP and Private basic Ambulances on call. This is more than anglosaxon EMS and could be called IEMS (Integrated Emergency Medical System). The Medical Doctor Regulator has a team of assistants called PARM and recently defined by French Public Health Ministry as medical care paraprofessionals .