Jeff Clawson, M.D.

Jeff Clawson, M.D.

Ask Doc

By Jeff Clawson, M.D.

Dr. Clawson:

My boss, Council member John Sharp of the City of Kansas City, Mo., is looking into response time issues for our city. Could you provide me with your definition of ECHO calls? Also, would you be able to send me some examples of life-threatening events where time is of the essence for the patient. Thank you in advance for your response.

Araceli B. Gallegos

Assistant, City Council Office

Kansas City, Mo., USA

Dear Ms. Gallegos:

As a member of the Council of Standards for the International Academies of Emergency Dispatch (IAED) and inventor of the Medical Priority Dispatch System (MPDS), I would be very happy to do so. I very much respect the many public safety people from Kansas City I have known and worked with over the past 40 years.

ECHO level is based on the initial EMD recognition of extreme conditions of breathing—especially in those patients whose breathing is INEFFECTIVE. The MPDS defines INEFFECTIVE BREATHING as:

The following descriptions, when volunteered by the caller at any point in the early interrogation period (Case Entry Protocol):

• “Barely breathing”

• “Can’t breathe” or “Can’t breathe at all”

• “Fighting for air”

• “Gasping for air”

• “Just a little”

• “Making funny noises”

• “Not breathing”

• “Turning blue” or “Turning purple”

And/or when the following conditions exist:

• Not breathing at all

• Breathing uncertain (agonal)

• Hanging

• Strangulation

• Suffocation

• Underwater

• Complete airway obstruction in choking

ECHO was differentiated from DELTA to encourage the local assignment of the absolute closest responder of any trained crew (i.e., police with AEDs, fire ladder or snorkel crews, HAZMAT, or other specialty teams not in the usual medical response matrix).

It is important to understand that a patient given an ECHO-level designation does not necessarily require a different response from DELTA, but encourages the “ethical” response of other specialty crews or responders, who otherwise might be sitting close by while someone dies.

Therefore, ECHO creates an earlier point of response for those obviously “dying right now,” as well as sending potentially closer responders that don’t ordinarily go on less urgent medical responses.

In addition to ECHO, there are certain DELTA events that are more serious (timewise) than others. They could basically be defined as what we call “Time/Life Priorities,” such as:

• Critical central trauma

• Uncontrolled arterial bleeding

• Partial obstructed airway (incomplete choking)

• High risk delivery conditions: breech, prolapsed cord, shoulder dystocia, 3rd trimester bleeding

• Electrocution and lightning strikes

• Carbon monoxide poisoning

• Unconscious patient with uncontrolled airway

I am also attaching the section in the textbook, “Principles of Emergency Medical Dispatch” titled “Understanding ECHO Determinant Practice” (pages 3.12–3.16).

Let me add that in the vast majority of 9-1-1 medical cases, time is not a significant factor and these cases should not involve response of multiple vehicles or the use of lights-and-siren (HOT response). The ALPHA- and BRAVO-level calls do not require ALS (paramedic) responders, and ALPHA, and many BRAVO and CHARLIE calls do not require a HOT response.

The MPDS first created 33 years ago was designed to give a medically correct orderliness to EMS response—not just sending everyone to everything, always—and in a big hurry. The MPDS has been proven over time to do what the priority levels were designed to do—send the right thing, to the right patient, at the right time, at the right speed, and do appropriate things over the phone to help the caller and patient, until the troops arrive.

From a city management viewpoint, the MPDS, now in over 2,900 communication centers in 43 countries, has never been involved in a formal lawsuit in those 33 years! It does what it says it will do, if used very compliantly and completely.

I hope this helps you. If you have any more questions, please feel free to contact either the International Academies of Emergency Dispatch or me at any time. I would be happy to talk to you or the councilman if that would help and we would be happy to be involved in further informing the city as to the correct use of the MPDS.

Best regards… Doc

Jeff Clawson, M.D.

Chair, Rules Committee

Council of Standards