Audrey Fraizer

Audrey Fraizer

Best Practices

_A0_8563-2_v2By Audrey Fraizer

Spoken American English doesn’t carry a tune very well.

Unlike other cultures, where the spoken language is often more lyrical to the ear, the English tongue stresses information. Nouns and verbs get all the attention, and if the speaker does not emphasize the important ones, an American audience will have a tough time following the command or conversation.

The Medical Priority Dispatch System (MPDS) provides the emphasis by bolding the words the calltaker needs to stress: What’s the address of the emergency? What’s the phone number you’re calling from?

And that’s exactly the problem Dr. Rafi Kot knew he would have to resolve before offering an emergency *9999 service in concert with Vietnamese and English versions of the medical ProQA through a communication center in Saigon.

“You can’t just read it,” he said. “You can’t talk to someone in a non-native language until you learn how the language is spoken. You have to act within that culture.”

Kot is CEO and owner of the Family Medical Practice (FMP) in Vietnam, which opened its first medical clinic in Hanoi (1994) and has since expanded into Danang and Ho Chi Minh City (HCMC)—with the more familiar name of Saigon generally referring to HCMC urban districts.

FMP is privately owned and operated, although patients seeking assistance at an FMP affiliated emergency center can access public ambulance services by calling the government’s three-digit emergency number 115.

And that was the overriding problem leading to Kot’s developing the alternative *9999.

A majority of Vietnamese are covered by the government’s Universal Health Insurance Program, but the delivery system is overloaded and, consequently, places greater reliance on the private sector to alleviate some of the pressure in providing services.

It’s also a matter of preference, Kot said. Most Vietnamese prefer private clinics, with the number 115 indicative of the larger problem.

“There’s no guarantee the number will result in a response,” Kot said. “Nobody trusts it. Nobody uses it. People prefer going to the hospital by car or motor scooter.”

The *9999 emergency number is exclusive to FMP, and all calls made to that number go to the dedicated Emergency Medical Response Center (EMRC). Calls are answered using the MPDS process not available through the government emergency line.

Similar to the FMP clinics and hospitals, *9999 users pay a nominal annual subscription rate. Non-subscribers can call the hotline number for emergency services, but if and when an emergency ambulance is required, they pay the standard published rate. Subscribers have priority over non-subscribers.

In May, the EMRC went into full operation with certified EMDs using both an English and a Vietnamese version of ProQA. The EMRC controls a fleet of ambulances for the service currently available in Districts D1, D2, and parts of D3 and Binh Thanh District.

The nine EMDs hired were chosen from 1,100 applicants responding to an ad seeking individuals fluent in English and Vietnamese, able to work effectively under stress, and easily adaptable to an environment both hectic and unpredictable.

Hiring was demanding on both sides of the process. Qualifying candidates interviewed twice and took several tests to reflect language proficiency, customer service skills, reasoning, information ordering, and, basically, complete the full battery that well-trained dispatchers and calltakers face internationally. None of the people hired had experience in the health care field, and accepting the position meant taking the Academy’s ETC and EMD courses and certifying as an EMD.

It also meant accepting the guidance of a drama coach.

“They [the EMDs] know English from school and university,” Kot said. “But studying a language and actually conversing in the language is quite different. They had to be coached in the way Americans talk and know the words to stress when in protocol. We had to make sure the dispatcher stayed in control of the situations.”

The structured protocol complements the overall design of the *9999 emergency call plan. Kot wanted software that required calltakers to follow step-by-step, and he wanted a robust international system encompassing the right priorities for Vietnam.

“I looked around and found that MPDS was the answer for proactive engagement,” he said. “At this point, we’re very young at the process and continue to learn.”

Getting a jump-start before going live in May included answering simulated calls on March 4 using ProQA, and modeling calls after the more common types of calls and, also, events requiring PAIs, including childbirth and delivery.

“During the simulation, thanks to ProQA, the calltaker was able to ask a number of questions that allowed her to give advice to the caller on how to deliver the baby,” said Susan Wu, FMP Vice President of Marketing. “The simulation took just a little over six minutes.”

Response time due to the city’s traffic congestion and mix of transportation on the roads—motorbike, taxi, bus, and private vehicle—are persistent challenges and major reasons FMP initially limited the number of districts the EMRC serves. However, that’s an obstacle Kot anticipated, setting in motion a visionary plan to accommodate future growth and demand: He asked for the involvement of Jerry Overton, IAED™ Board of Accreditation Chair. Overton is an acknowledged expert in EMS System Status Management (SSM), which comprises logistical planning to direct EMS resources between calls and prepare the system for the best possible response for subsequent EMS calls.

“He’s (Kot) combining the implementation of MPDS with SSM to optimize patient care and response times in a city with traffic jam after traffic jam,” Overton said. “We’ve already met and discussed what we will need to get started when that growth occurs. He’s very forward thinking in his EMS operation.”

Kot also invested in a system that auto-launches an ambulance and can reject the auto-launch if no ambulance is necessary. The auto-launch cannot be overridden by the operator and gives the dispatcher the opportunity to give instructions by phone until the ambulance arrives.

Kot said the path he’s traveled over the past year was uncharted—at least in Vietnam—and he looks forward to moving ahead. The FMP EMRC is the first of its kind in the country, and, along with being first, he is proud that his work sets the highest standards.

“This is like leading an orchestra,” he said. “I knew where we needed to go, and once I started, there was no stopping.”