Localized Approach

Audrey Fraizer

Audrey Fraizer

CDE Universal

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

The Priority Dispatch System (PDS) forms a global community. 

From its beginning in Utah nearly 45 years ago, the protocols of the PDS affect thousands of lives every day internationally by assessing emergencies through their standardized set of Key Questions and Determinant Codes; sending the appropriate medical, police, and fire response; and giving step-by-step Pre-Arrival Instructions that guide callers through lifesaving measures such as CPR, emergency childbirth, the Heimlich Maneuver, tourniquet application, escaping a sinking vehicle, and more.

Available in 29 languages or dialects, the PDS has spread to 2,025 centers across 59 countries. With this growth, the International Academies of Emergency Dispatch® (IAED) recognized the importance of keeping the protocols consistent, regardless of language. Equally important, to create a truly international system, the protocols must be adapted to match the culture, language rules, norms, and requirements of various countries and regions. Professional translators call this “localization.”

“A language barrier can be an enormous problem, preventing accurate assessment and high-quality care. Linguistic variations in the EMD Protocol have a crucial impact on the efficiency of the calltakers’ process in emergency calls,” said Anna Shmynets, member of the IAED Academics, Research & Communication team.1 Shmynets holds a master’s degree in Ukrainian Linguistics from Ivan Franko National University in Lviv, Ukraine.

Localizing the Medical Priority Dispatch System (MPDS®), Fire Priority Dispatch System (FPDS®), Police Priority Dispatch System (PPDS®), and Emergency Communication Nurse System (ECNS) begins with the core protocols—those written in North American English (NAE).

What matters
Proper wording is significant. The language must address the needs of the callers. Linguistic changes include the deletion or adaptation of words. For example, Dutch, Vietnamese, and German do not use “Okay” at the beginning of a sentence. Instead of saying “Okay, tell me exactly what happened,” those versions simply use “Tell me exactly what happened.”2

French-speaking people of Quebec, Canada, use various expressions that differ from the French spoken in France. Emergency Dispatchers must be aware of these locally used expressions and how to respond to them in their conversations with callers. Protocols translated into French must also include expressions that are commonly used and understood by the public that are not necessarily found in the core NAE protocols.

For example, in the NAE version of the MPDS, Protocol 9: Cardiac or Respiratory Arrest/Death, there are certain keywords and phrases listed in the Additional Information section that North American callers use to describe the conditions of ineffective breathing and not breathing. IAED-certified EMDs are trained to recognize these terms so they can more quickly identify and enter ECHO-level cases and readily begin Pre-Arrival Instructions for resuscitation.

Other languages can have different keywords and phrases that describe the same conditions and, therefore, are not direct translations from the NAE version. One such statement French-speaking dispatchers should look for is “Court après son souffle,” which directly translated into English means “Running after my breath.” Such an expression is nonsensical to English speakers, but it makes perfect sense to a French Canadian. The English equivalent in the protocol is “Barely breathing,” which, directly translated, would be “Respirant à peine,” but the French protocol uses the expression that is familiar to the local population.3

Another example is “Is anyone trapped?” The word “trapped” is all-encompassing in English; however, in German and Dutch, three different words are used to fully express “trapped.” In German, these are “eingeklemmt, eingeschlossen, verschüttet,“ and in Dutch, “bedolven, bekneld, ingesloten.”4

Protocol localization also includes recognizing differences in English language usage between the North American, United Kingdom, and Australia/New Zealand dialects. For example, the Australian Cultural Committee members helped modify the U.K. English that was the basis of the Australian protocols to include words and phrases that were more common among Australians. This included changing “Alert,” “Seizures,” “Lorry,” and “Articulated Lorry” to the more Australian-standard “Completely Awake,” “Convulsions/Convulsing,” “Truck,” and “Semitrailer.” Also, patients in the U.K. say they are “feeling poorly,” while in Australia, they say “feeling crook.”5 These changes are all reflected in the protocols.

A country’s geography and flora and fauna are also considered. For example, Australia has more venomous snakes than any other continent on Earth. Australians must also contend with other potentially dangerous animals such as jellyfish, stonefish, the highly venomous blue-ringed octopus, and a host of poisonous spiders. These potential medical hazards require more detailed instructions about snake bite response or a jellyfish sting than are necessary in the core NAE protocols, where these animals are far less likely to be encountered.

Varying technical standards also demand attention from localization specialists. Fire departments in the U.S. and Canada have accepted nationally recognized vehicle standards (e.g., NFPA 1901: Standard on Automotive Fire Apparatus) as opposed to the country-by-country standards often seen in Europe. Not only are the distinctions visual, but they also affect the deployment and configuration of hoses and  equipment.6 Strategies and tactics can differ substantially in Europe, where municipalities both large and small can be up to 2,000 years old and have marginal water supplies and narrow streets in addition to centuries-old buildings.7

As the ECNS grows, so does the need for internationally sensitive revisions. At present, the ECNS is available in eight languages and dialects, including protocol sets that reflect differences in the three English dialects for Australia, the U.K., and North America. According to Conrad Fivaz, Medical Director, Priority Solutions, Inc.:

“All our international ECNS protocols prompt the same questions in the international protocol set unless an agency asks for a specific custom-made protocol to be developed just for them. These custom-made protocols are the exception, and there are only a handful of them. We work closely with the medical directorate and management of the agency when drafting a custom-made protocol for an agency. The custom protocol follows the same rigorous quality assurance controls as our regular protocols before it is released in the next software release.

“We accommodate international nuances to protocols by adding additional information to our clinical rationale sections that is available to the nurses on each question. An example would include various poisonous snakes. Snakes specific to the country are listed in the clinical rationale of questions relating to symptoms experienced when bitten by a specific type of poisonous snake.

“We also add Pre-Question Qualifiers or Pre-Instruction Qualifiers (in parentheses) to some questions and interim care instructions to guide nurses.

“We designed our system so that the Recommended Care Levels (the equivalent of the Determinant Codes in MPDS) stay consistent but the Point of Care settings (response configurations equivalent) are customer modifiable. This allows each international agency to set their own Point of Care settings to what is available in their local community as alternative responses.”

Cultural influence
Cultural Committees are key to international success. When the Academy releases a full NAE version, the Cultural Committees convene to confirm that all changes and updates fit the language and culture. The ultimate approval rests with the IAED Councils of Standards. Today, 24 Cultural Committees exist to address the need to consider cultural differences between places across the world when updating. As more  countries adopt the protocols, the number of Cultural Committees will increase to address the needs of the local population.

The impact of international expertise through cultural committees and PFCs cannot be understated.8 Here are only a few of the many  examples of international influence: 
• The German Weather Protocol led to the development and implementation of Fire Protocol 83: Weather/Disaster Situations in FPDS v7.0. 
• Description Essentials for bicycles were requested by the German Cultural Committee.
• The European Italian (EUI) experience with tunnel fires far exceeds the NAE experience. The same goes for avalanche danger and, once again, the EUI experience influenced these instructions in the FPDS.

“International Cultural Committee meetings and PFCs submitted by international customers have had a fairly significant influence on the FPDS over the years,” said Mike Thompson, IAED Fire Protocol, Academics, and Standards Expert. “Our point of view has always been that if a change requested by an international customer CAN work in the NAE version, we will put it in.”9 

1. Hoagland K. “Linguistic and Cultural Adaptations in Emergency Dispatch: A Localized Approach in a Global Village.” EURO NAVIGATOR  2023.
2. See note 1.
3. McFadden J. “Cultural Shift.” The Journal of Emergency Dispatch. IAED. 2015; July 29. iaedjournal.org/cultural-shift (accessed Oct. 3, 2023).
4. See note 1.
5. See note 3.
6. Avsec R. “North American vs. European fire apparatus: Breaking down the differences.” FireRescue1. 2022; April 8. firerescue1.com/fire-products/fire-apparatus/articles/north-american-vs-european-fire-apparatus-breaking-down-the-differences-zsiTPu2O7PZokQVp (accessed Oct. 3, 2023).
7. Potter G. “Fire Commentary: European Firefighting Operations.” Fire Engineering. 2008; Dec. 6. fireengineering.com/leadership/fire-commentary-european-firefighting-operations/#gref (accessed Oct. 3, 2023).
8. See note 1.
9. See note 1.