April 10, 2020
Is an Emergency Medical Dispatcher a professional?
The short answer is, YES! The more complicated answer is … yes, but it is an unrecognized profession.
The state of Qatar, a small but influential nation in the Middle East that will soon host the World Cup in 2022, has brought distinction and respect to the field of emergency dispatch by reclassifying and professionalizing Emergency Medical Dispatchers (EMDs). The Hamad Medical Corporation Ambulance Service (HMCAS), the national ambulance service in Qatar, sought support from the Qatar Council for Healthcare Practitioners (QCHP) to register and license EMDs alongside their ambulance paramedic brothers and sisters.
A journey that started nearly two years ago was achieved in August 2019 under my stewardship. The foundation of this achievement was years of practice using the internationally recognized Medical Priority Dispatch System™ (MPDS®) at accreditation levels.
As you know, EMDs ensure that the right ambulance resources are sent to the right person, at the right time, in the right way, and provide the right instructions for the care of the patient until help arrives. Starting a career as an EMD traditionally requires a high school education or equivalent. This is because it is an entry-level position where classroom and on-the-job training prepare the EMD for the role.
HMCAS EMDs fell under the job description of Ambulance Service Medical Dispatcher, which had moved from an allied health position to a clinical support position in 2017. The reason for this change had to do with the minimal education requirements as well as the overall nature of the job duties as described. This is similar to what U.S. emergency dispatchers are facing in trying to move the occupation of public safety telecommunications from administrative support occupations to protective service occupations. At issue is the job classification and how it impacts staff benefits including basic salary, leave, promotions, and allowances.
At HMCAS, the answer was not in making the EMD a first responder. The way to assure that EMDs could be moved from an unprotected post to a protected post was to get the job licensed as a health care practitioner under QCHP.
QCHP was established to regulate and accredit health care practitioners like physicians, nurses, dentists, pharmacists, and other allied health care providers. HMCAS submitted a scope of practice document as well as licensure requirements to describe the competency framework comprising of professional ethics, clinical practice, and learning and professional development intrinsic to the role of the EMD as well as the qualifications of the EMD’s professional roles, activities, and practice settings.
However, before HMCAS could go before QCHP, an internal audit of the job description was performed with the Job Evaluation Panel of HMCAS. They were on board with the idea that the EMD uses an algorithmic and rapid clinical patient evaluation questioning process to analyze information provided by the caller to triage the request and identify appropriate resources to be prioritized and allocated at the earliest possible opportunity. They could not fathom how someone just out of high school could do this. I am inclined to believe that some of the issues with the panel’s lack of confidence was not with the role of the EMD, but the inherent education system that would produce said EMDs.
HMCAS provided evidence-based research, giving examples of best practices internationally, and allowed the panel to listen to some of the cases. The panel was of the firm opinion that based on the associated job grade, a diploma in a clinical degree was more appropriate.
HMCAS EMDs now require a three-year diploma in a clinical discipline and two years’ experience in a clinical discipline. If recruited, the EMD must complete the IAED™ EMD and ETC courses within six months and maintain EMD certification including BLS and completion of continuing dispatch education to achieve licensure.
Internationally, EMDs are drawn from both trained health care professionals and non-health care professionals. In the United States, United Kingdom, Canada, Czech Republic, Estonia, and Ireland, EMDs are typically recruited from non-health care backgrounds but are then subsequently trained using an EMD syllabus. It is noteworthy, however, that Australia, the U.K., and Canada have also developed a “clinical desk” to inject additional clinical experience and knowledge to support the emergency dispatch systems because of the lack of clinical knowledge and experience present in their EMDs.
However, in Belgium, Croatia, Lithuania, the Netherlands, Norway, and Turkey, qualified nurses are typically recruited as calltakers/dispatchers. In Germany, South Africa, and Hungary, ambulance paramedics are used in the EMD role. Interestingly, Denmark and Sweden use a combination of specially trained registered nurses and/or paramedics for this role. Additionally, it was identified that the use of clinicians in a dispatch environment helps to minimize the risk of underestimating the clinical seriousness of a situation and therefore avoid assigning a lower EMS response priority.
This is to say that the combination of nurses and/or paramedic knowledge with the specialist emergency operators' training, at an EMD center, may potentially improve the prehospital care for those requiring emergency medical care. The combination of the health care professional with additional specialist training as an EMD offers increasing resilience and room to grow the profession. To this end, HMCAS built, strengthened, and developed its dispatch/calltaking process supported by the added professionalization of the service provided.