The Wheel Reinvented
Introducing Version Eleven
By Brett Patterson, Council of Standards Reader & Curriculum Board Editor:Robert Martin, Executive Director
The Medical Priority Dispatch System (MPDS) is always a work-in-progress. Indeed, the Academy has been entrusted to continually reinvent the MPDS. It is the world's most widely used 9-1-1-type Pre-Arrival Instruction and Dispatch Life Support protocol system and has been credited with helping save thousands of lives. Version 11 represents the single most comprehensive upgrade in the history of the protocol. It is easier to use and full of exciting new features designed to ensure safety and take better care of patients.
In the immortal words of pseudo-rocker Nigel Tufnel, "The numbers all go to eleven...it's one louder, isn't it?" Indeed, version 11 is one step louder, and one step clearer, and one step closer to being perfect...again!
The MPDS is truly a worldwide protocol. The Academy has established several International Standards Committees which are responsible for translating, evaluating, approving, and adopting changes approved by the Council of Standards.
There are currently nine different MPDS Version 10.3 language variants available for online use which are now being updated to reflect Version 11: North American English, U.K./European English, N.Z./Australian English, French Canadian, North American Spanish, European Spanish, German, Italian, and Finnish.
The Academy's College of Fellows, through the various International Standards Committees and ultimately the Council of Standards, has the exclusive right to modify the core protocol content; however, licensed users are individually responsible for establishing, maintaining, and reviewing local response assignments, which necessarily vary from agency to agency.
MPDS Version 11 contains nearly 300 "Determinant Descriptors," which are designed to categorize and prioritize emergency situations based upon caller interrogation and the presence or likelihood of priority symptoms and threat to life. It is important to note that scene circumstances may change at any time.
The MPDS is not meant to replace a thinking calltaker and cannot reasonably be expected to predict outcomes or assure EMD compliance in all cases. EMDs always have the option of overriding a recommended choice for patient safety, or of reconfiguring a determinant code based on new information. There are also times when the EMD may have to choose the most appropriate telephone treatment options from several possibilities. These are issues for consideration on a case-by-case basis, through local continuing dispatch education, quality improvement, and medical control.
This article introduces and highlights the significant changes apparent in MPDS Version 11. Anyone interested in better understanding how the MPDS update process works is encouraged to attend an Academy-approved EMD Certification Course or Version 11 Update Course, purchase the Version 11 Update Video and Workbook, as well as participate in the annual Navigator EMD Conference.
For each of the 33 Chief Complaint pairs, one of the cards is referred to as the Dispatch card and the other as the Additional Information card, together comprising a protocol card pair. Each dispatch card consists of Key Questions, Determinant Descriptors, Post-Dispatch Instructions, Critical EMD Information, and Dispatch Life Support (DLS) Links. There is extra space in the determinant area for listing each local response assignment alongside its corresponding MPDS code. Each Additional Information card consists of classifications, definitions, axioms, rules, and laws, pertaining to that specific chief complaint.
Choosing a Chief Complaint Protocol
(1) more conversational,
(2) more directive,
(3) more clearly organized, and
(4) more medically correct and current.
All the changes apparent with Version 11 integrate to form a new product that is fundamentally safer, more user-friendly, and easier to learn and apply than previous versions—which quite simply equates to better patient care and outcome.
First, terms and sentence structure throughout the protocol have been changed to make questions and instructions more "conversational" and easier for the layperson to understand (e.g., using "completely awake" rather than "alert" when inquiring about a patient's level of consciousness). In addition, the format of the Pre-Arrival Instruction scripts has changed to break up sentences into logical, more conversational segments. These changes make the instructions easier and more natural to read, which fosters consistency and compliance to protocol. This restructuring goes a long way toward improving specifically "how" to ask potentially delicate questions and in what order.
Second, more specific directives are included regarding protocol navigation and specific instructions for the caller. Through text, symbols, and formatting changes, all Post-Dispatch Instructions are now more specific to the Chief Complaint Protocol on which they are found, and more generic instructions, i.e. "Ensure ABCs", have been enhanced and placed within the new Case Exit protocol (the "X" card) or redesigned Pre-Arrival protocols. The EMD is now linked to these instructions, depending on the patient's condition, via a new DLS Links section provided just below the Post-Dispatch Instruction area of each protocol. Cautions about potentially dangerous situations and scene safety are also incorporated directly within each protocol and linked whenever relevant.
Third, a comprehensive protocol overhaul afforded the Council of Standards the opportunity to reorganize and re-order all the questions, determinants, instructions, definitions, classifications, and other additional information. The order of these components relates to priority, acuity, or protocol navigation requirements. For example, Key Questions involving safety issues are now all listed first, and questions involving priority symptoms or those containing DELTA-level drivers follow. The clinical Determinant Descriptors have been reorganized to list high priority levels first, and, when possible, individual descriptors are ordered to correspond with the order of the Key Questions. At times, specific questions not related to priority or acuity are asked first to determine if a SHUNT is appropriate, (i.e. Protocol 5, Key Questions 1 and 2).
Finally, MPDS Version 11 is more medically correct and current. Indeed, it represents a new standard of care for emergency medical dispatching and call processing. As part of our systematic update and improvement program, the Academy continues to work closely with other associations and organizations to ensure that the MPDS embodies all generally accepted medical and telecommunications industry practice standards.
Recognition of EMD standards have been promulgated by the American Society for Testing and Materials (ASTM), the U.S. Dept. of Transportation, the National Institutes of Health, the American Heart Association, the Canadian Heart and Stroke Foundation, and the European Resuscitation Council, among others. Incorporating all the appropriate international industry standards, the MPDS represents the very core of vital and standardized knowledge for the practicing EMD. Furthermore, the Academy has specifically dedicated itself to continuing to support the MPDS protocol and to maintaining minimum requirements and guidelines to accompany the EMD training, certification, and accreditation processes.
Expanding and detailing these descriptors in Version 11 has afforded EMS agencies opportunities to further customize their pre-planned assignments and gather the information necessary to conduct related studies. Protocol 29 provides an excellent example of this Determinant Descriptor enhancement. With Version 11, agencies now have the option of assigning a response with "one unit" or "additional units" in situations affecting multiple victims. Also, individual responses can now be assigned to subdescriptors within the definitions of MAJOR INCIDENT and HIGH MECHANISM.
DLS Links and Case Exit (X)
Y & Z Protocols
Making the Change
To accomplish this, all EMDs must successfully complete an Update Course taught by a Version 11-qualified EMD Instructor, or complete the Update Course Video Training program. All EMDs must be provided with an Update Course Workbook and submit the included Qualification Application to the Academy. The purchase of the Workbook contains the processing fee, and each qualifying EMD will receive an official document substantiating their Version 11 qualification status. The Academy also recommends that each EMD review every protocol in its entirety, several times, and continue to study its contents until well understood.
In order to better accommodate transitions from previous versions of the MPDS, Medical Priority Consultants, Inc. [now Priority Dispatch Corporation] has developed several training programs and options. For more information, please call toll-free: (800) 363-9127, or (801) 363-9127, fax (801) 363-9144, or send email to: email@example.com
Brett Patterson: Brett is an Academics and Standards Associate for Medical Priority Consultants, Inc. He is also the Editor of the Academy's Curriculum Board and he serves as a member of the College of Fellows and the Council of Standards. He is a 20-year paramedic with 13 years of experience in the communications industry and is an accomplished speaker, educator, and researcher and can be reached at firstname.lastname@example.org.
Robert L. Martin: Rob is Executive Director of the Academy and has been involved with publishing and coordinating Academy activities since 1988. He is a district board member for the International Association of Business Communicators. He can be reached at email@example.com.