A Suddenly Discovered OBVIOUS Or EXPECTED Death

Jeff Clawson, M.D.

Jeff Clawson, M.D.

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Jeff Clawson, M.D.

Western Jeff,

After consolidation of our PSAP in New Orleans, Louisiana (USA), we have been working closely with the new PSAP leadership as non-medical telecommunicators work through ProQA®/EMD. A question came up today, and I would like it if you could point me in the right direction.

In the case of a cardiac arrest—initially thought to be a 9-E-1 resulting in a quick push to the dispatcher and multiple unit response: If the calltaker later during the call processing realizes that the call really fits into the obvious or expected death category, does ProQA allow for the “downgrade” of the call?

I’m getting conflicting info, and I wanted to check with the experts.


… a more southern Jeff

Jeffrey M. Elder, M.D., FAAEM, FAEMS

Director | Medical Director

Emergency Medical Services

City of New Orleans, Louisiana, USA

Southern Jeff,

Okay, I finally got my act together … so again, great to hear from you. Okay, so now you have to go and remind a former LSU’er of the fair city of New Orleans just as the first snow flies here in SLC?! Not fair … but happy to answer your questions, while still grinding my teeth.

ProQA (the automated MPDS®) has several processes and features that your EMDs should know about, but might not. These apply in the following situations (all caps for OBVIOUS DEATH and EXPECTED DEATH means that they are both defined situations per the protocol). I will, for simplicity’s sake, refer only to OBVIOUS DEATH, although both function in nearly the same way:

  1. EMD finds an OBVIOUS DEATH condition before or right at the Case Entry coding point

  2. EMD finds an OBVIOUS DEATH condition after an ECHO code is recommended but actually not sent yet—the “Delay Send and Continue” button use

  3. EMD finds an OBVIOUS DEATH condition after an ECHO code is initiated: in KQs or PAIs

By referring to the attached ProQA screenshots, you can follow along with the explanations below:

Regarding Item 1, please see the attached screenshot #1, wherein, by using the new Sub-Chief Complaint Selection Tree feature (in the new v13.1 release), the EMD can easily, at this point, directly pick the sub-Chief Complaint of OBVIOUS or EXPECTED DEATH option, not just initially “Cardiac Arrest” in Protocol 9. This bypasses the need for any delay and send process activation to follow the desired OBVIOUS DEATH pathway.

Regarding Item 2, through this process, the EMD finds out information clearly indicating that a situation now involves an apparent “defined” OBVIOUS DEATH. This delays the send action and allows the further interrogation, if needed, and the entry of Key Questions now suggesting a presenting OBVIOUS DEATH. This then resets the send code of 9-E-1 to a 9-B-1.

Regarding Item 3, depending on which KQ in Protocol 9 the EMD is on, they should use the back “red” arrow to return to KQ1 and then re-answer it as OBVIOUS DEATH, which will reconfigure the response code to 9-B-1.

If the EMD has already reached PAIs (CPR beginnings) and then determines, usually upon advising CPR, that the patient is beyond help, PAI C-2 has an OBVIOUS DEATH answer choice button that can take you back to KQs where the EMD simply clicks on KQ1 and re-answers as OBVIOUS DEATH.

At any other time, the EMD can then return to the KQs to do the same thing by selecting the KQ Answers section tab and clicking on the desired KQ answer.

I hope this gives you a good starting point to answer this question with your dispatch staff.

If you would like we could do a “Go To” session to demonstrate this stuff live …

Best regards, always … Western Jeff