Post-Dispatch Instructions

My director has raised a good question regarding Post-Dispatch Instructions (PDIs). Can PDIs be made optional after discussion by the DRC and approved by the DSC and the Local Medical Director?

Michael Cochran
Quality Improvement Coordinator
Monroe County Central Dispatch
Michigan (USA)

Michael,
Thank you for the question. 

Standard PDIs cannot be made optional as they are part of the protocol, and the end user is expected to use them as designed. The current PDIs are considered the most relevant to most situations, as shown by decades of real-time testing and evaluation of the protocols. We also continually assess the Smart (focused) PDIs by identifying specific instructions that can be safely eliminated (grayed-out but still technically available) based on the information gained during Key Questions.

The International Academies of Emergency Dispatch^® (IAED^™) does recognize the need for a few instructions to be more specific to the user-agency and, therefore, made optional, with individual agency review and approval. As a result, in the last few years the IAED Fire Council of Standards and Police Council of Standards have approved certain jurisdictionally-approved PDIs and Critical ED Information (CEIs) to be added to the FPDS^® and PPDS^®, respectively.

These instructions can be turned on or off using the ProQA^® Admin Utility. The local need for their use must be officially discussed and approved individually through each agency’s Dispatch Review and/or Steering Committees and their administration. 

The ED-Q performance standards allow for this approved degree of flexibility with PDIs for different situations and scene conditions. For example, an agency-approved PDI-a “I’m sending the paramedics (ambulance) to help you now” will be stated to the caller between asking for the phone number and asking the Case Entry question, “Okay, tell me exactly what happened.” This change may be appropriate for this agency because they dispatch (pre-alert) off the address without waiting for a Determinant Code. With a pre-alert system in place at this agency, the medical director and agency administration felt that it made sense to move this PDI up to inform the caller that help is being sent at this point in the calltaking process. (The IAED does not support "pre-alerting" per se.)

Perhaps a better way to address this is by using the ED-Q performance standards. DLS Standard 1 (Possible and Appropriate) addresses any instruction that, in certain circumstances, would not be possible and/or appropriate to give. Emergency Dispatchers with a bit of time under the headset know there are situations in which an instruction clearly is irrelevant. A good example in the Medical Protocol appears during Case Entry with the Chief Complaint of a hanging. PDIs inform the caller to “cut the patient down.” If the caller has already done so and stated that to the Emergency Dispatcher, then the instruction does not need to be given, and the Emergency
Dispatcher can now focus directly on the patient and the resuscitation attempt.

The key to ensuring the correct instructions are given, when possible and appropriate, comes from a strong quality management system within the agency. The ED-Q, or Quality Assurance Unit, when there is more than one ED-Q, must deliver a consistent message to the entire staff on what the expectations are for the most common caller circumstances.

When a caller is in a residence, what instructions should be given, and which situations exclude a specific instruction? In most cases using the MPDS^®, Exit panel 2 instructions would be appropriate. But what if the caller is the patient and has fallen, but is still on the floor? Instructions regarding pets, unlocking the door, and turning on the outside lights cannot be reasonably given. Instead, the Emergency Dispatcher must make an attempt to ensure responders will have direct access into the home. Another consistent message to your staff is the First Law of Medical Dispatch: “First, do no harm.” In other words, have a clear expectation for Emergency Dispatchers to reasonably and consistently provide the correct DLS Instructions—including all PDIs.

Lastly, the Emergency Dispatcher and the ED-Q must consider situations where the caller cannot comprehend or deal with multiple instructions simultaneously. The Emergency Dispatcher must consider all factors and do what is best for every caller given the current scene situation.

Bryon Schultz
Subject Matter Expert—Medical
IAED