EMERGENCY MEDICAL DISPATCHERS' ABILITY TO DETERMINE OBVIOUS OR EXPECTED DEATH OUTCOMES USING A MEDICAL PRIORITY DISPATCH PROTOCOL.

Introduction: Emergency Medical Dispatchers (EMDs), at emergency communication centers that have implemented the Medical Priority Dispatch System® (MPDS) protocols, use scripted questions to interrogate people calling 9-1-1. Based on this interrogation, case determinant codes are assigned– to identify the specific patient condition and enable optimal allocation and deployment of resources to ensure appropriate field responses. MPDS determinant codes for both OBVIOUS and EXPECTED DEATH exist for patients that are clearly and irreversibly dead, or have a terminal illness accompanied by written “Do Not Resuscitate” (DNR) legal orders to forgo lifesaving measures. The ability of EMDs to effectively determine these OBVIOUS and EXPECTED DEATH outcomes has not previously been studied. Objective: The study objective was to assess the EMD’s ability to use emergency dispatch protocol’s OBVIOUS or EXPECTED DEATH recommendations to effec tively classify these cases as intermediate- or low-acuity priority level calls. Methods: This was a retrospective, descriptive cohort study involving analysis of 12 months de-identified emergency dispatch datasets, paramedic care reports, and computer-aided dispatch (CAD) data from three agencies in the United States. Descriptive statistics were used to determine outcome measures: OBVIOUS or EXPECTED DEATH cases transported to hospital, and reasons for transport percentages. Results: Overall, unquestionable death in the priority response classifications of BRAVOand OMEGA-level codes were coded correctly by the EMD in 98.5% of all cases, as indicated by the paramedics’ decision not to transport upon arrival. The reasons for transport included: local protocols, inability to locate DNR and paramedic intuition. Conclusion: Low transport frequency for determinant descriptors OBVIOUS and EXPECTED DEATH cases demonstrates the ability of EMD’s to correctly classify cases of irreversible death. A substantial number of the transports were due to the inability of the responders to locate a DNR.