Audrey Fraizer

Audrey Fraizer

Blast From The Past

By Audrey Fraizer

It was a Friday, late in the day, autumn 1989, and Dr. Jeff Clawson was mulling over an issue in protocol when he caught up with Michael Smith in the company elevator.

“Jeff was concerned about the charts used for the Pre-Arrival Instructions,” Smith said. “He thought they were too complicated and hard to read. He asked if there was something I could do.”

Smith said he’d give it a try. He was the company’s graphic designer and, like Dr. Clawson, thought the PAIs in their current configuration were difficult to decipher. The challenge of visually tracking the linear boxes and arrows diagrams could be frustrating to a dispatcher handling an emergency call requiring fast action to help the patient.

“In emergency situations, the high cognitive load of the PAIs as they were formatted was detrimental to the dispatcher’s ability to perform,” he said.

Smith went home and spent the next two days sketching on a yellow legal pad. He wanted to get away from the charts that significantly differed for each PAI and develop a framework—a pattern—compatible with every PAI. He was aware of how the keypad of the touch-tone telephone was designed to replace the old rotary phones and liked the 3-by-3 orientation (essentially three rows by three columns, plus one row for the “0” digit).

This design, he said, tapped into a primitive sense of time and space we all have: top/middle/bottom, left/center/right, before/now/after, and above/here/below. The critical challenge was to preserve the logic encoded in the linear boxes and arrows diagrams.

Smith’s aha moment was a matter of simple association with the 3-by-3 grid concept and a “modular” principle that is common in nature as well as engineering and computer science. He said by embedding the logic of the arrows inside the boxes, orienting them in a grid pattern, and assigning addresses to the instruction “modules,” he could improve the dispatcher’s ability to help in the delivery of complex medical instructions over the phone.

This evolved into the complex non-linear grid pattern introduced in version 12.0 of the Medical Priority Dispatch System (MPDS). Similar to the phone keypad, the grid design for the PAIs used space efficiently, fit neatly into the concept of protocol, and would reduce a “cognitive overload.” The grid pattern also reflected the quality control, universal application, and repeatable results that prompted the invention of protocol.

“Jeff recognized opportunity in my idea,” Smith said.

Turning the idea into a workable framework, however, was not a weekend project. Transitioning the existing CPR, childbirth and delivery, choking, and other PAIs into a grid pattern was more than a matter of spilling instructions into boxes. It took months of effort, reworking, and review before they were ready for prime time.

“This took a medical reworking of the protocol,” Smith said. “Jeff had to break down the instructions. In the long run, this improved the PAIs and made it possible to deliver a higher standard of care with more complex procedures.”

His work was a lasting contribution, and it was one that has earned him a permanent place card in the history of protocol development.

Smith shakes off the compliments. He had a “great time” working for the Academy and, at that time, with the relatively small staff in offices on South Temple. He left after seven years in 1996 to pursue a career “morphing” into computer science and Web development. He is now a technical program manager for Amazon in Seattle, Wash., working to match customer preferences to advertising messaging in mobile apps. His research interests include machine learning systems that can mimic the brain’s abilities to recognize patterns and make decisions.

Smith said his “first career job” at the Academy was an ideal experience and a launching pad for his subsequent interest in technology.

“The constant challenge intrigued me,” he said. “It’s also nice to know that what we developed helps people and has some longevity.”