A Dispatch Thought Experiment

Matthew Miko, J.D.

Matthew Miko, J.D.

Blast From The Past
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IMAGINE presenting this scenario to the typical, everyday person on the street who knows nothing about Emergency Medical Dispatch:

Someone you care deeply for is going to experience a medical issue, and a nearby bystander is going to call 911. I can’t tell you anything about the patient including: age or medical history, the medical issue (minor, severe, or life-ending), the surrounding circumstances, the locality or its EMS resources, or the  experience, commitment, training, or general abilities of the emergency dispatcher who will answer the call.

However, you get to decide which tool (protocol or process) the emergency dispatcher will use when handling this call to potentially help you. 

In this type of scenario, where a person knows absolutely nothing about the situation, would he or she want the emergency dispatcher answering the call to be certified in the use of an evidence-based, structured calltaking protocol? Or would that person want the emergency dispatcher to use criteria-based dispatch guidelines or a homegrown (one-off) call-processing system?

This thought experiment is modeled after the one originally proposed by the philosopher John Rawls exactly 50 years earlier in his book, A Theory of Justice. The genius of this approach, which Rawls termed the “veil of ignorance,” is that it insulates the question of what is fair, ethical, or just from the biases and assumptions embedded in each of us through our own lived experiences. If, for example, you didn’t know your economic status, what would you view as a just and fair tax structure? If you didn’t know whether you would ever be inflicted with any serious health conditions, what role would you want government to have in your health care system? For Rawls, the best way to get to the right answer was to have you consider the question without knowledge of your  present circumstances (basically un-biasing your decision-making).

I think that this same rationale applies to any discussion about the value of the IAED protocols. While some may voice support for guidelines in a general sense, would that be the emergency call-processing system they would choose for themselves in a true state of situational ignorance? Probably not.

The following article, published in 1992, takes on the question of whether the MPDS® protocols are an “unnecessary” burden. In it, Dr. Jeff Clawson explains why the protocols—far from being unnecessary or burdensome—are a necessity to provide callers with the standard of care socially expected and legally required. 

As you read this article, keep in mind the thought experiment I started with, and ask yourself whether a reasonable person, completely ignorant of the circumstances surrounding their coming medical issue, would choose anything other than the IAED evidence-based protocols.