November 21, 2012
By Jeff Clawson, M.D. and Brett Patterson, EMD-I
We are told that it is always appropriate and necessary to say from the Case Exit, Panel 2 Post-Dispatch Instruction (PDI): “If he/she becomes less awake and vomits, quickly turn him/her on their side.” Is this so?
Jo Anne Fleming EMR, EMD-Q
Alberta Health Services Alberta, Canada
As chairman of the Academy’s Council of Standards, Dr. Clawson has asked me to respond to your question.
In the current version of the Medical Priority Dispatch System (MPDSR) (v.12.2), the PDI you are referring to is qualified with (Appropriate), which makes the instruction optional and dependent upon the EMD’s judgment of the patient’s clinical condition.
When this instruction was added to the MPDS, the Council of Standards debated this very question and there was sufficient consensus to make the question optional. The argument in favor of doing this was based on patients who are obviously stable and, therefore, not likely to pass out and vomit; in these types of situations, it was felt that EMDs should have the option not to read this instruction. The discussion was lengthy, however, and there were members who thought it should be mandatory.
Your question happens to be most timely. The Council of Standards revisited the topic when meeting to consider Proposals for Change (PFCs) regarding MPDS v13. After several years of experience with this instruction, consensus has changed. Many agencies encourage the use of this instruction for all patients (2nd party callers), citing that the instruction does no harm to stable patients and, if it is not given and the patient passes out and vomits, the caller needs to know what to do BEFORE calling back.
So technically, and according to ED-Q scoring standards, the instruction is currently optional, although as I mentioned many agencies are encouraging its use for all 2nd party callers. However, in v13 of the MPDS, due to be released next year, the (Appropriate) qualifier will likely be removed, making the instruction mandatory for 2nd party callers. I use the term “likely” because v13 has yet to be formally ratified by the Council of Standards and the College of Fellows.
Thank you for your interest in the MPDS.
IAED Academics & Standards Associate
Medical Council of Standards Chair