September 28, 2023
*To take the corresponding CDE quiz, visit the College of Emergency Dispatch.*
"True 2 Q" explores a wide range of questions revolving around the QA quest to resolve the deepest, thorniest, and most nuanced issues associated with maintaining the highest standards of protocol.
It’s powered by members submitting questions and commenting on the puzzlers generated within the Q community. It’s a fun place to hang out, as reflected by the numbers: 2,940 members (which seems to grow by the day) and more than 100 contributors. Four moderators and an admin oversee the process.
There is an important caveat: The comments are not protocol bible.
As stated by Brian Dale, former IAED™ Associate Director of Medical Control & Quality Processes, in a post soon after the inception of True 2 Q, “These are NOT Position Statements from the IAED.” They are opinions, ideas, and concerns within the Q setting. With that said, Dale is a devoted fan of True 2 Q and what it offers to protect the high standards of protocol.
“The collective knowledge on this site and on the ED-Q Forum is immeasurable and impressive, to say the least,” he said. “Every day as I peruse the site, I am so astonished at how we as a community do this job of measuring the performance of those under pressure and how we can manage performance expectations and dispatcher advocacy as well as we do.”
The following are samples of questions posted in True 2 Q accompanied by expert opinions provided by Kim Rigden, IAED Associate Director of Accreditation, and Jayme Tidwell, PDC™ Director of
Quality Performance Review (QPR). We hope this helps you in your Q journey!
Clarifying incorrect information
Example: The caller volunteers in CE3 that the patient is 47 years old. When it comes to the age question, the EMD asks, “You said he’s 42?” offering the wrong age. I understand that had the EMD offered the correct age, this would be evaluated as an inappropriate clarifier as they aren’t asking a complete question. However, what’s the correct way of evaluating a question such as this where the wrong information is being “clarified.”
There are two separate behaviors that are in error here.
1. It is an incorrect clarifier: scored as # of inappropriate clarifiers in the Questions/Instructions area of Case Entry.
2. It is an answer recorded incorrectly: scored by unchecking the tick box beside the age question.
Don’t forget to use Strengths-Based Feedback to educate: Next time you hear an age offered but are not sure what was said, ask the age again by saying “Tell me again, how old is the patient?” This will ensure you get the correct age. You could ask, “You said he is 42? Is that correct?” as the correct way to clarify. Asking the caller, “Is that correct?” will ensure they either confirm it’s correct or offer the correct age.
Another example: The caller offers that they hurt their head in a fall in CE3. When asking about injuries the EMD asks, “Other than your leg, what part of the body was injured?” with no mention on the caller's behalf that their leg was ever injured.
Again, this is clarified “correctly” but the wrong information is being offered to the caller.
Someone needs to put their listening ears on! This should be scored as a question asked incorrectly as they provided incorrect information in the body of the question. I understand how confusing it is; had they said the correct body part, then it is scored differently. This is where the “art of Q” comes into place and understanding that the details and dynamics of each call can alter how standards can be applied and why Q is not a one size fits all.
Developing the confident Q
I am trying to create a presentation for newly certified Qs to help bridge the gap from certification to feeling competent in job performance. Looking back, what advice, resources, training, articles, etc., would you recommend to yourself or others that helped you? Anything and everything you can think of would be helpful.
This is a BIG question.
• Review the Strengths-Based Feedback Formulas. Take the course on the College if you haven’t yet.
• Discuss the philosophy of “reasonableness.” Use education over deviation where appropriate.
• Create a QIU scoring guide for all things that could have variation between ED-Qs due to interpretation or that have more than one way to score them in AQUA®.
• Review how to score PDIs in AQUA: iaedjournal.org/pdis-in-aqua
• Use Sequences on every review to see exactly what the Emergency Dispatcher did.
• Use ProQA® for every PAI case to see exactly what the Emergency Dispatcher did.
• It is not about being right. It is about supporting the Emergency Dispatcher to do it right.
• There is no place for ego in ED-Q.
• Develop a QIU library of books, podcasts, and TedTalks. Here is an example: Books (and more) list.docx
• Hold calibration sessions for the ED-Qs.
• For medical, have the Principles of EMD book handy and reference it where necessary.
• Have Performance Standards open and double-check there is a standard but don’t quote standards. Instead, refer the Emergency Dispatcher to the place they have been trained in (i.e., the course manual, Principles book, Rules and Axioms in protocol, etc.).
• Welcome being challenged as it means your staff is engaged in the process.
• Admit when you are wrong and correct yourself! This is a strength not a weakness.
• Create a commendation wall for recognition of high performers and create fun calltaker competitions to increase compliance. This will challenge ED-Q creativity.
Fill in the gaps
I am looking for gap fillers in calltaking. Does anyone have anything they can provide to help me with it?
One thing you can always do is explain your actions. “I am recording this information for the responders; it isn’t delaying help.”
Reassurance or calming statements are always great gap fillers. When training, I print out a list so that the calltaker has an easy reference for something to say when they have a gap.
• I am going to help you.
• We are going to help you.
• This information helps me send you the right help.
• I'm updating the responders with this information.
• My name is ____________. What is your name?
• You are doing a great job. Stay with me while I enter this info.
• Hang in there.
• How are you doing?
Total time report
Is there a report to run that shows the average time in PDIs/PAIs to add on to the total time in ProQA? All I'm finding is the time analysis, but that's not showing what I need. Thanks!
The “Emergency Dispatcher Comparative Performance” in ProQA Reports provides average, longest, and shortest times in PDIs and PAIs per Emergency Dispatcher.
Hey folks, would the following be deemed as freelance instructions: telling the patient who was having a panic attack to take deep breaths and advising them “in through the nose and out through the mouth” and “in for 5 then breathe out slowly.”
For someone described as having a panic attack, I would view this as a calming statement. Counting breaths is a common technique for helping panic and anxiety. Be aware that this answer only applies to this specific scenario. It could be a freelance instruction in another case where it would be inappropriate to tell someone how to breathe. Reasonableness must be applied as well as critical thinking skills.
Clarifier for medical bleeding
Does anyone have an example of a good clarifier for MEDICAL bleeding when the caller seems to be misunderstanding the question "Is the bleeding serious?" I keep hearing responses like “I would assume it's serious” or “Well of course it's serious . . . it's internal!”
Axiom 4 has some descriptors that can be used to clarify. It says, “Vomiting blood, coughing up blood, and vaginal or rectal bleeding are considered SERIOUS when bleeding is copious, profuse, flowing, or presenting in large clots.”
So, in response to "Well of course it's serious . . . it's internal!" the EMD could say, “I understand it is internal. Is it copious, profuse, or flowing out, or do you see any large clots?”
Standards of Practice
Good morning. Can someone explain to me when it's appropriate to take off for not meeting the Standards of Practice under DLS Links? Would that be used if an EMD did PAIs when not needed?
First, if an EMD provided PAIs when they were not needed, this should be scored as an incorrect DLS Link.
DLS Standard 1 provides an explanation of Failure to Meet the Minimum Standard of Practice.
Some instructions are viewed more critically than others and may include things like:
• Failure to control bleeding or provide burn care
• Safety Instructions
• Instruction to call back when using the Urgent Disconnect pathway.
Now, here is where clear expectations within your QIU are important. There could be more than one way to measure this in AQUA, and you want to make sure everyone in your QIU scores it the same way. A failure to provide bleeding control for a SERIOUS Hemorrhage can be measured as a DLS Link error or Failure to Meet Minimum Standard of Practice.
Both give a critical deviation, yet I am sure you can understand that it might be confusing to have one ED-Q score it as a DLS Link error and then another scores it as a Failure to Meet Minimum Standards. You need to have QIU agreement on how everyone will score this. A nice rule of thumb is: If there is a specific way to apply the critical deviation in AQUA use that and if there isn’t, use Failure to Meet Minimum Standards.
Here is an example of when to use Failure to Meet. A caller clearly tells the EFD that they are going to pour water on the grease fire on their stove top. The EFD does not tell the caller not to do this. This is a failure to intervene in a safety situation, and there is no other way to score this as it isn’t a scripted instruction.