Protocol 25

Brett Patterson

Brett Patterson

Best Practices

Hi Brett,

The revised Protocol 25: Psychiatric/MENTAL HEALTH CONDITIONS/Suicide Attempt/Abnormal Behavior has a new dispatch definition for MENTAL HEALTH CONDITIONS that contains the term “Anxiety.” Does this addition imply that a complaint of “anxiety attack” should be handled here or should the EMD still seek symptoms, rather than this offered diagnosis, to select an appropriate Chief Complaint Protocol?

Kim Rigden

IAED Associate Director of Accreditation 



Great question, Kim. In fact, I have been asked this question several times since the release of the revamped Protocol 25.

I spoke with Dr. Jeff Clawson recently to verify my thoughts as he was the one who drafted this definition, and he confirmed my understanding.

The use of the term “Anxiety” in the MENTAL HEALTH CONDITIONS list was only meant to inform the EMD that anxiety disorder is a mental health condition; its inclusion was not meant to imply that the complaint of anxiety attack should be handled here. In retrospect, we did not make this as clear as possible.

As we have long been taught, the complaint of anxiety attack is a caller diagnosis that may involve several different presentations including, but not limited to, extreme nervousness, restlessness or paranoia, a sense of impending doom, rapid or difficulty breathing, rapid heart rate or palpitations, sweating, or trembling.

This variance is why we have always encouraged EMDs to seek presenting symptoms rather than relying on a caller’s more general diagnosis. The other potential danger of accepting such a diagnosis is the historic tendency to ask the patient to breathe into a paper bag, which has been a notorious remedy in the minds of the general public. In reality, such treatment without a confirmed diagnosis may be deadly. In this regard, nothing has changed. We want to teach EMDs to seek symptoms, not a diagnosis, and base the Chief Complaint Protocol selection on those symptoms.

We are past our deadline to make changes to the Spring 2023 release of both ProQA® and our printed materials, but this issue has inspired ideas for improvement in our next release. It is likely we will qualify the term “anxiety” in the MENTAL HEALTH CONDITIONS list and provide some written direction for a complaint of anxiety attack. Until that time, please encourage EMDs to retain the previous best practice of seeking specific symptoms and basing Chief Complaint Protocol on that information, rather than the caller’s diagnosis.

Preemptively, I want to acknowledge that we do base Chief Complaint Protocol selection on a specific diagnosis with regard to two other complaints, and I would encourage our readers to pause and think about where. The reason we do this is because of the historical accuracy of caller diagnosis in the diagnostic complaints of Stroke and Diabetic Problems. While we still need to know “exactly what happened” to help us verify these conditions, EMDs may accept these diagnoses at face value simply because we know they are very accurate, and we have the data to back this up.

Thanks for bringing up this important issue and we will do everything we can in protocol to educate our EMDs in the next version of the MPDS®.

Brett A. Patterson
Academics & Standards Associate
Chair, Medical Council of Standards
International Academies of Emergency Dispatch®