In the early days of 9-1-1, dispatchers were on their own without a protocol system to accurately and consistently dispatch needed support or assign the necessary resources to the variety of calls coming in to their centers. There were no key questions to narrow and focus calls or pre-arrival instructions such as CPR to help the caller until the needed help arrived. For the most part, dispatchers told callers that help was on its way and after that, the dispatcher would disconnect the line to move on to the next caller. The quick and often hasty response ultimately wasted time and resources. Without sufficient information about the situation, the agency risked sending the wrong emergency vehicles and the caller was left without the benefit of further, life-saving instructions while waiting for whatever was sent to help. The response system was lacking at its most critical period, and call centers throughout the country were providing varied levels of care to a public in crisis. Response teams were stretched to the limits, responding to simple problems while across the city someone was in need of critical care. Something had to be done.

For five years prior to graduation from medical school, Dr. Jeff Clawson had worked as a certified emergency medical technician (EMT) and erstwhile dispatcher for Gold Cross Ambulance Service, an emergency medical transport company operating in Utah since 1968. The years at the ambulance company confirmed his notion that the use of lights-and-siren runs was not always the most appropriate response. Not only did the lights-and-siren runs increase wear and tear on vehicles, but the runs also were dangerous to the public. Gold Cross policy restricted lights-and-siren runs to cases when the response time made a difference and, according to Clawson, the policy made a significant difference: 50 percent of the runs could be handled appropriately without lights-and-sirens.

What could be done to standardize response like Gold Cross was doing by policy but at the onset - from the moment the call comes into the communication center?

Clawson designed a set of protocols that would standardize the way dispatchers communicated with callers and, in turn, improve the emergency response system. The original set of protocols published in 1978 contained 29 sets of two 8-inch-by-5-inch cards. Each caller complaint was listed in alphabetical order, as they are today, and reflected either a symptom (e.g., abdominal pain, burns, cardiac/respiratory arrest) or an incident (e.g., electrocutions, drowning, or traffic injury accident). The core card contained three color-coded areas: key questions, pre-arrival instructions, and dispatch priorities, and they were distributed on for the good of dispatch. "We gave away the cards just so they [the public safety agencies] would do something about their dispatch," Clawson said. The doctor believed in the protocol system, and he wanted others to share in the success of a well-coordinated response team that included dispatchers as the "first, first responders" - a phrase he coined in 1981 for the first national meeting that included emergency medical dispatch (Source: Jim Page's "EMD in the Fire Service: Born of Necessity)

The manual protocol system - dispatch cards - became the core of a 25-hour training course used to educate and certify dispatchers as Emergency Medical Dispatchers (EMD); the 25th hour was for taking the final examination. The first courses, taught in Utah, basically followed what happens now in the classroom. NAED-certified instructors teach the trainee how to coordinate and prioritize the dispatch process and actions. Students practiced calls using the card system and listened to tape recordings of actual emergency calls. The final exam - then 25 questions - was given on the last day. Those passing became certified EMDs.

In 1981, about 100 public safety and private agency dispatchers (all in Utah) had been trained and certified as EMDs using what was to become known as the Medical Priority Dispatch System® (MPDS). Clawson called use of the system "far reaching," a claim that holds today as the number of public safety agencies has grown to more than 3,000 centers and in 23 countries worldwide; the electronic and hard copy card set reaches communication centers in each state and province and many centers outside of the United States and Canada. The medical protocol has gone through 18 revisions to reflect advances in medicine, such as the addition of compressions first cardiopulmonary resuscitation (CPR), and it shares the stage with protocol designed for police and fire dispatch centers. The NAED, established in 1988, has more than 35,000 members and the IAED oversees the use of protocol in nearly two dozen countries, including Great Britain, Ireland, Germany, Italy, Azerbaijan, New Zealand, and Australia. In July 2007, the IAED opened a major office in Bristol, England, to serve the communication centers and trusts using the MPDS, according to the National Enterprise Maintenance Agreement (NEMA) between the National Health Service and the NAED.

The system's growth over the years only emphasizes the reason Clawson created the protocol-based training system: it saves paramedic teams for true advanced life support emergencies. The system also provides a plus around the communication center that Clawson finds particularly gratifying. "Emergency dispatchers are a respected part of the emergency response team," he said. "They are the first of the first responders, an important first link in the chain of emergency medical care. They are the helping hands when you need it the most - now!"

Priority Dispatch Corp. (PDC) is licensed to design and publish the Medical Priority Dispatch System® (MPDS), Fire Priority Dispatch System™ (FPDS), and the Police Priority Dispatch System™ (PPDS) and their associated support products. In addition, PDC provides technical support for ProQA and AQUA software, and schedules the training courses necessary to become an Academy-certified user of these protocols. For more information about the MPDS, FPDS, PPDS, ProQA, AQUA, or other support products and consulting services available, please visit their website at www.prioritydispatch.net.

The MPDS is in part based on published standards by the National Association of EMS Physicians (NAEMSP), the American Society for Testing and Materials (ASTM), the American College of Emergency Physicians (ACEP), the U.S. Department of Transportation (USDOT), the National Institutes of Health (NIH), the American Medical Association (AMA), and more than 20 years of research, development, and field testing throughout the world. The protocol contains 34 Chief Complaint Protocols, Case Entry and Exit information, call termination scripts, and additional verbatim instruction protocols for AED support, cardiopulmonary resuscitation (CPR), childbirth assistance, tracheostomy airway and breathing, and the Heimlich maneuver. Special protocols for stroke identification, aspirin administration, pandemic flu triage, and lost person locating are coming out this year.

The FPDS combines the latest technology in systematic call interrogation with the ability to logically prioritize dispatch responses and give lifesaving pre-arrival instructions immediately to the caller at the scene, saving precious time while first responders arrive. The protocol has been designed to protect against liability while increasing call processing effectiveness and assuring measurable standards of equalized care to the public. In addition, your center will benefit from over 20 years of experience in the emergency dispatching field and will have the opportunity to learn from other centers experience as the protocol grows. Special protocols exist for escaping from burning buildings and sinking vehicles.

The Police Priority Dispatch System (PPDS) has been created to effectively deliver the best possible level of public care while protecting dispatchers and their centers from liability. The 35 PPDS Chief Complaint Protocols cover most if not all of the possible scenarios encountered in law enforcement call centers and provide a measurable and equalized standard of law enforcement practice for the public for each call taken. Scripted Case Entry Questions are designed to collect as much information about the scene as possible for first responders, and additional sections provide information to the caller for scene safety and preservation, sinking vehicles, suspicious packages, and hostage situations.

In addition to the protocols that may be delivered as a flip-file cardset or ProQA software, the medical, fire, and police systems also contain products for quality improvement including the Quality Assurance (QA) Guide, case entry and case evaluation pads, and AQUA quality assurance and report software. Other products available help field responders with their understanding of the protocols, the "Medical Miranda" or Secondary Emergency Notification of Dispatch (SEND) card, and the field responder pocket response code guide (FRG).