Common Sense and Case Review

*To take the corresponding CDE quiz, visit the College of Emergency Dispatch.*

Most Emergency Dispatch Quality Assurance Specialists (ED-Qs) would agree that common sense guides the daily work in the world of case review, especially when providing feedback to our teams. Webster's Dictionary defines common sense as “sound and prudent judgment based on a simple perception of the situation or fact.”

The use of the word fact in this definition is particularly meaningful in case review. For ED-Qs, the fundamental facts we rely on are locally defined policies and procedures, the Performance Standards, and the guiding components of the protocol (Priority Dispatch System^™) Additional Information sections, definitions, Rules, and Axioms).

Like lines drawn in the sand, these facts are critical tools for providing clear, impactful feedback to Emergency Dispatchers, helping them gain insight to refine future performance.

However, when evaluating an Emergency Dispatcher’s performance, there must also be room for grace in the face of complexity, understanding how immediate decisions made in the moment can be too easily criticized upon thorough review. Ultimately, the ED-Q’s role is not to find every deviation, but to arm Emergency Dispatchers with tools, support, and preparation to be the voice on the front line.

Fully understand the facts
Protocol
ED-Qs must have an advanced understanding of protocol intent and function to demonstrate how an Emergency Dispatcher’s deviation could impact the protocol logic pathway, altering the appropriate interrogation and response for an incident.

Though there is no need to memorize every Rule, Axiom, and pathway, each ED-Q should confidently utilize ProQA^® as a reference to run through alternate selections as a useful background comparison. In fact, if a question arises with the Emergency Dispatcher, ED-Qs can be prepared to demonstrate this impact by running cases to illustrate how each entry determines the protocol options that follow. Often, the quality assurance (QA) questions addressed to the International Academies of Emergency Dispatch^® (IAED^™) could be answered simply by testing alternative selections in the protocol and reviewing differences.

When in doubt, remember to use every ED-Q tool available, including the most valuable: case sequence and ProQA playback. Case sequence gives a detailed timeline—keystrokes, selections, and buttons pressed. By reviewing this sequence early in the call evaluation process, you will be better prepared to give thoughtful, effective communication to the Emergency Dispatcher, pinpointing what went awry.

If something seems odd in a sequence, you may find yourself questioning, “Why did ProQA do that?” Create a test case in ProQA and try replicating the sequence. You may answer your own questions before seeking external support. This is especially helpful for rare protocols or complex call types.

ED-Qs must also review and understand each change that occurs in protocol updates (twice a year). You cannot evaluate or train on what you do not fully understand, so build your own knowledge base so you can confidently offer feedback and/or education on these changes.

Policies
Compliance to the protocol is important—but so is adaptability. There are times when the local policies of a communication center are critical for guidance. For instance, some of the most difficult calls Emergency Dispatchers face involve working through communication barriers with callers who are young or elderly, have language differences, or have medical/neurological conditions that make comprehension difficult. A clear local policy can guide Emergency Dispatchers and ED-Qs on handling these calls while prioritizing the caller’s understanding.

Grace and real time
When it comes to addressing the gray areas in call review, a commonly underutilized concept is “If it’s not wrong, it’s right.” This compass phrase is especially relevant in Chief Complaint Protocol Selection.

Often, an Emergency Dispatcher has only seconds to categorize a caller’s complaint description into a specific Chief Complaint Protocol. While most complaints are straightforward, there are some exceptions with complex layers and unclear implications, which the Emergency Dispatcher must interpret immediately.

The sports term “armchair quarterback” applies to evaluating these quick decisions. Unlike the ED-Q, the Emergency Dispatcher cannot pause and analyze, researching the implications of the various choices before them. Their actions rely on training, continued education, personal experience, and prior feedback, all culminating in an instant decision. An ED-Q should strive to align their experience during case review in real time—within the same time frame.

ED-Qs often question complex calls where the Emergency Dispatcher must weigh multiple symptoms or choose a course of action from a “laundry list” of complaints. In these situations, Chief Complaint Selection Standard 5 becomes key.

Unless the Chief Complaint Protocol Selection is clearly incorrect (e.g., selecting Protocol 26 for a trauma case), the ED-Q’s role is not to overrule but to assess whether the selected Chief Complaint Protocol collected the appropriate responder information, indicated the appropriate response, and provided necessary DLS Instructions.

While providing feedback, you may guide the Emergency Dispatcher for future calls without penalizing a well-reasoned decision made under pressure. Personal bias has no place in QA, so avoid using phrases like “I think …” or “I would have …” unless those statements are rooted in the facts: policies and procedures, Performance Standards, and protocol Rules, Axioms, and definitions.

Also keep in mind that not every mistake warrants a deviation. “Fatfinger” entries—errors quickly corrected by the Emergency Dispatcher—can be acknowledged as a minor correction in your feedback. However, positive reinforcement should be the overarching goal, encouraging best practices going forward.

Education over deviation
The ED-Q’s philosophy of education over deviation can build a culture of learning and trust. The goal is a teamwork approach to improving compliance and building confidence to handle each call.

When an Emergency Dispatcher navigates a difficult call with mostly correct actions, contemplate whether it may be more beneficial to offer coaching instead of issuing a deviation for small infractions.

Consider the following factors as you perform case review:
• the complexity of the call
• the Emergency Dispatcher’s personal tenure and experience
• teaching opportunities that might benefit the whole team

The goal isn’t perfection; it’s growth.

Polish your own performance 
Your professionalism is an indication of the effort you put into your own performance. If you present yourself as a prepared, fair, invested, and knowledgeable resource, you’re more likely to inspire trust in your teammates and greater success in your compliance goals.

Work to employ the following tools to polish the presentation of your call review feedback: • Use spellcheck or writing tools. Grammarly works well.
• Own your mistakes. Fix them in the review and model accountability.
• Be a lifelong learner. Read journals, take classes, and practice calls.
• Be humble. It’s OK not to know—just find the answer before sharing one.
• Don’t use the Protocol Pilot Guide to review live cases. It’s great for learning and practicing, but it’s not accurate enough for formal QA.

Finally, remember that quality assurance and improvement is about supporting—not controlling—the front line. As Dr. Jeff Clawson famously said, “Catch them doing it right.”