Protocol 33 Or Protocol 37— Handling Calls From Medical Facilities And Personnel

When receiving calls from facilities, one of the most common questions is which protocol to use—and even what qualifies as a facility. As we discuss the options with agencies and demonstrate the differences, it often opens their eyes to the possibilities. Is Protocol 33: Transfer/Interfacility/Palliative Care better than Protocol 37: Interfacility Evaluation/Transfer, or vice versa? That is for each agency to decide based on what works best for them.

Protocol 33 was the first generation of interfacility protocols, and Protocol 37 was developed several years after. One major difference is that Protocol 33 handles all transfer and interfacility requests through a single pathway, while Protocol 37 separates them into Evaluation–Interfacility and Transfer–Interfacility pathways. Another key difference appears in the early questions: Protocol 33 asks, “Is this call the result of an evaluation by a nurse or doctor?”

Protocol 33 also includes a dedicated Palliative Care pathway, though that does not mean Protocol 37 cannot accommodate palliative care patients. In general, Protocol 33 asks facilities specific questions to gather details about the patient’s current response needs and identify potential concerns. Protocol 37, by contrast, is designed to ask fewer questions and quickly establish a clear understanding of what happened. These Protocols are specifically designed to be used when interacting directly with Health Care Professionals in nursing homes, urgent care centers, doctors’ offices, etc. Since the patient is already under this level of care, only asking the exact questions needed, in the right way, will facilitate better relationships and not ask questions that HCPs would think unnecessary or repetitive—wherever possible and appropriate.

Protocol 33 was introduced over 25 years ago and became the first protocol for Emergency Medical Dispatchers (EMD) using the Medical Priority Dispatch System^™ (MPDS^®) to manage calls from medical professionals who are in a facility where a doctor or nurse has already evaluated the patient. This gave the EMD a more streamlined and user-friendly method to capture needed patient information without having to ask exactly the same questions one would ask a layperson with no medical training. It was made available in both cardset and software (ProQA^®).

Protocol 33 contains some of the same assessment Key Questions as a layperson interrogation does (when using other protocols), such as “Is s/he responding normally (completely alert)?” and “Is s/ he breathing normally?”, but the Key Questions also include clinician-level questions (not asked to the layperson), such as “Does s/he have any shock symptoms?”, “Could this be an MI (heart attack)?”, and “Will any special equipment be necessary?”. This blended interrogation approach provides Protocol 33 with the broadest possible range for different medical facilities and professional settings. Also, ALPHA-level acuity can be locally defined by the user-agency with up to three unique Determinant Codes.

Protocol 37, introduced in March 2010, was the first software-only protocol (available only in ProQA). Aside from being software-only, another difference from Protocol 33 is that Protocol 37 relies almost exclusively on the medical expertise of the clinician reporting the patient’s condition and the EMD receiving the information. Using this protocol not only requires that the patient information comes from a nurse or doctor’s evaluation (same as Protocol 33), but that the evaluation occurred in the last two hours—to ensure high clinical accuracy and timeliness.

After establishing a recent clinical evaluation (by a nurse or doctor), Protocol 37 allows for a “Transfer” Key Question sequence, similar to Protocol 33. It also has a unique “Evaluation” Key Question sequence that relies on the reporting clinician to mention any high-acuity conditions (suspected heart attack, stroke, respiratory distress, sudden change in mentation, severe hemorrhage) early in the interrogation sequence. This protocol also gives the EMD a degree of clinical judgment in allowing them to select a higher DELTA or CHARLIE Determinant Level, in certain cases.

Agencies that either operate with a tiered system or handle a large number of Interfacility type requests should look into our Medical Transfer Protocol Suite (MTPS), which allows agencies to customize lists and has a multitude of Optional Logistic Questions that agencies have the ability to ask or not.

Whether or not you use either, or both, of these protocols is an important decision made by your agency’s Dispatch Steering Committee, with approval from your medical director. The following articles, previously published in the Journal by some of our most experienced protocol experts, will give you valuable insight into making that decision. Be sure to now read the excellent articles written by Brett Patterson and Cynthia Murray about Protocols 33 and 37, respectively.