October 12, 2018
You can’t expect someone to get behind the wheel and drive like a pro first time on the road. It takes most people 45 hours of lessons to learn how to drive, plus 22 hours of practicing, according to the UK-based Driver and Vehicle Standards Agency (DVSA).
It’s kind of like learning how to use ProQA® and the Advanced Medical Priority Dispatch System™ (AMPDS®). It takes most EMDs much more than the 24 hours of a certification class plus another four hours in software training to develop mastery.
It’s just a matter of fact. Some people hate hill starts and parallel parking, while others break out in a cold sweat at the thought of giving CPR or baby delivery instructions.
“Using AMPDS is no different than driving a car,” said Martien Boerwinkel, EMD-Q™, Meldkamer Ambulancezorg Noord-Nederland (MkNN). “First, you have to take lessons.”
The MkNN 112 emergency room handles police, security region/fire department, and ambulance care in Fryslân, Groningen, and Drenthe. The center handles all 112 calls in the Northern Netherlands (covering 11,380 km2 and 1.7 million people). The 180 emergency dispatchers answer an average of 400,000 calls a year (fixed line and mobile), of which 125,000 in 2017 required assistance. All EMS calls in the Netherlands are nurse-triaged.
It wasn’t always this way.
A chaotic train incident in 1962 that killed 92 people and injured 52 others led to changes in dispatch and response. Multidisciplinary emergency dispatch centers were established to answer police, fire, and ambulance calls from the same location.
Medical emergencies are handled by a Regional Ambulance Facility, or RAV; a RAV consists of one or more ambulance services and an MKA (such as the MkNN). In addition to deploying ambulances for urgent care, the 10 regional MKAs also direct the deployment of the Mobile Medical Team (MMT), mobile command vehicles, and organized volunteer aid workers.
Each control room uses a dispatch protocol, which is now almost evenly split between the AMPDS/ProQA and the Netherlands Triage System (NTS).
NTS was developed in 2010 from the National Telephone Guide of the Dutch College of General Practitioners and the National Standard for Dispatch Centre Ambulance Care (LSMA), which is important to mention due to its origins.
“The AMPDS met resistance because it’s not Dutch,” Boerwinkel said. “It was not our idea.”
In addition to overcoming the use of a non-Dutch system, the clinically-trained EMDs were not sold on the adherence to the AMPDS script.
“We asked ourselves how can we make AMPDS more natural to the EMDs,” he said. “How could we make it more appealing considering their backgrounds?”
The ED-Qs strategized. They coordinated training topics, emphasizing the give and take of EMD-Q Universal Performance Standards. For example, while Universal Standard 1 requires reading the AMPDS script as written, Universal Standard 4 allows rephrasing of the script if the caller does not understand the scripted questions or instructions. They pointed out the right to interrupt script at any time to provide calming statements, according to Universal Standard 15.
“We went back to the basics,” Boerwinkel said. “We gave everyone driving lessons.”
Finding common ground is vital in a country that thrives on accord, Boerwinkel said.
“If there is a way to reach cooperation, the Dutch will find it,” he said. “We used background and culture to achieve consensus.”
Watch a video about the center at https://www.youtube.com/watch?v=ZL7NN5mXmns.