Emergency Medical Services
Emergency Medical Dispatch (EMD) Program
Emergency Medical Dispatch (EMD) Program
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In 1990, the King County Emergency Medical Services Division developed and implemented a new Emergency Medical Dispatch (EMD) program for King County, Washington. This program includes medically approved emergency medical dispatch triage guidelines for telecommunicators, a comprehensive EMD training program, quality improvement measures and ongoing research.
The Criteria Based Dispatch guidelines are an internationally recognized innovative approach to emergency medical dispatching. These guidelines have been implemented in a number of jurisdictions in the United States, Sweden, Norway, and Israel and are available for use by other jurisdictions via a licensing agreement with the King County Emergency Medical Services Division. These EMD guidelines have resulted in a more effective and efficient use of emergency medical services resources, particularly paramedic (ALS) services in King County.
Criteria Based Dispatch Guidelines
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Criteria Based Dispatch (CBD) is based on the recognition that the level of care (ALS vs. BLS) needed by the patient and the urgency of patient care should be the determining factors in the level of response. Critical medical emergencies are those where paramedic intervention within minutes can be crucial to the patient's outcome. Non-critical emergencies are those in which paramedic intervention is not immediately needed and time is not a critical factor in treatment; therefore, a delay of several minutes would make no difference. In other words, we should not be sending a level of care the patient does not need and we should not be sending units Code Red using red lights and siren if time is not critical to patient care.
The Criteria Based Dispatch Guidelines were developed in 1990. The development process included an exhaustive analysis of our EMS dispatch system in King County and a review of other EMD protocols available at that time. Rather than buy existing EMD protocols, King County EMS chose to develop our own program.
The Criteria Based Dispatch Guidelines differ from other approaches to guidelines or protocols for telecommunicators. The CBD Guidelines do not give telecommunicators required questions for use in interrogating the caller, with the exception of an All Callers Interrogation. Instead, the dispatcher uses symptom criteria, i.e. specific signs and symptoms or mechanism of injury to determine which level of response is appropriate. This allows critical medical conditions to receive an ALS response and less critical conditions to receive a BLS response.
The information packet contains some samples of CBD Guidelines, training materials and several publications. It also contains information on how to begin the process of obtaining a licensing agreement to use Criteria Based Dispatch. (The copyright for the Criteria Based Dispatch Guidelines and associated training materials is held by King County Emergency Medical Services Division. We authorize the use of King County's CBD Program via a licensing agreement with Public Health - Seattle and King County EMS Division, Seattle, Washington. A copy of the boilerplate licensing agreement is enclosed in the information packet.)
The copyright for the CBD Guidelines and associated training materials is held by King County EMS Division. We authorize the use of King County's CBD Program via a licensing agreement with Public Health - Seattle and King County, EMS Division, Seattle Washington.
The system is monitored at three levels:
- First, an in house evaluation form is available for individual dispatchers, peer evaluation and supervisor evaluation.
- Second, all dispatchers, EMTs, nurses and paramedics within the EMS system are encouraged to use a Suggestions/Comments/Kudos form (PDF, 8 KB) to provide feedback to communication centers and to the King County EMS Division. Specific problem areas may be reviewed and changes in the guidelines made if necessary.
- Third, each dispatch criteria is given a code, called an Initial Dispatch Code (IDC) This IDC is included on all 911 Medical Incident Report forms, and allow us to compare the criteria for which the call was dispatched with the actual disposition of the patient. In this way we can examine the effectiveness of individual criteria and differences, which may exist among various paramedic or dispatch agencies. We are also able to evaluate oversends and undersends and trends in our system. An oversend is an ALS unit sent when not needed. An undersend is an ALS unit not sent when needed.
Research article abstracts
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Critical Incident Stress Management (CISM) 
It is believed that emergency services workers deal with a stress response similar to that seen in war. The focus of CISM is to minimize the harmful affects of job stress, particularly in crisis or emergency situations.
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| Center for the Evaluation of Emergency Medical Services
The goal of CEEMS is to study pre-hospital emergencies and to develop, evaluate and implement innovative programs to improve survival from medical emergencies.
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