Scope Of Response Care

Question: Is there any movement toward recognizing the Advanced Emergency Medical Technician (AEMT) scope of care in dispatch protocols? 
Jeffrey D. Ferguson, M.D. 
EMS Physician I Medical Director 
Henrico County Fire Department 
Virginia, USA 

Dr. Ferguson, 
Thanks for your insightful question.

The AEMT is an important response type consideration for agencies with this specific level of staff expertise. The AEMT can be integrated into an existing Medical Priority Dispatch System^™ (MPDS^®) Determinant Code Response Plan list at dispatch. In particular, I can see it being an important response type for certain BRAVO- and CHARLIE-level responses. The good thing about a system that uses the MPDS, is that an agency can assign a unique response (such as an AEMT unit) to any of the hundreds of available MPDS Determinant Codes. So it doesn't change anything from our end of the ledger in terms of MPDS codes—however, it does give agencies another special response-type to use.

Regards, 
Greg Scott 
Associate Director of Protocol Evolution 
International Academies of Emergency Dispatch^® 

Hi Greg, 
Thank you for your reply. I was hoping that you guys had something in the works to identify call types within the CHARLIE-level recommendations where an AEMT would be sufficient—rather than sending true ALS. I know there are a number of agencies moving toward a more tiered-response model that this would be beneficial for, but don't have the power of the IAED^™ to identify those calls on a local level. 
Jeff 
 
Hello Dr. Ferguson, 
I think this is worth a more detailed discussion. While currently we don’t have any specific recommendations for the use of an AEMT response on specific MPDS codes, we do have some internal data—as well as published study data that could give us a good look at how it could be done.

I’m including a few of my Academy colleagues to see if they have other comments or suggestions. 

Regards, 
Greg 

All, 
Thank you. Happy to engage with anyone to discuss further. 
Jeff 

Hi Dr. Ferguson: 
I would add that while the MPDS was originally conceived to accommodate standard ALS and BLS transport as well as other 1st responder resources, this is not a limitation with regard to other responder capabilities including, but not limited to, AEMTs, Advanced and Critical Care Paramedics, specialist medics such as HAZMAT or mental health responders, and even specially trained clinicians qualified for secondary telephone triage.

What is key is aligning the locally available resources to the various codes in the MPDS. Very important to this conversation is that varied resources can, and should, be made at the Determinant Descriptor level, and not be limited to the basic ALPHA/BRAVO/CHARLIE/DELTA/ECHO levels of the MPDS. This alone opens opportunities for AEMT assignment based on your (the Medical Director’s) clinical judgment.

For example, one may consider a monitor and epinephrine-capable AEMT response for an alert, allergic reaction patient with trouble breathing or swallowing, and reserve often more limited numbers of available paramedics for not alert patients, or patients with difficulty speaking between breaths, with these specific complaints. Or perhaps a stable versus potentially unstable stroke patient.

One might also consider AEMTs for some CHARLIE-level Sick Person complaints while reserving paramedics for patients that may require more advanced pain medication or steroid therapy. 

Happy to discuss further. Just let me know. 
Brett A. Patterson 
Chair, Medical Council of Standards 
International Academies of Emergency Dispatch 

Dr. Clawson adds: 
Doc-to-Doc, 
Jeff, not sure you, or many out there know, but seeking correct, more specific, and appropriate use of our DIY country’s varied EMS system’s types of response crews and units, was actually the original basis for beginning the creation of the Medical Protocol Dispatch System (MPDS).

While in the late 1970s, Salt Lake City Fire Dept. (Utah, USA) was essentially sending everyone (paramedics, BLS fire crews, and transport-cable EMT ambulances—and at times, even police cars) to every single medical case. As Medical Director, my parallel work experience in the emergency room was dramatically different from this process. If a patient checking into the ER did not have priority symptoms, or an apparent life-threatening condition, they essentially “took a number,” and on a Friday night got what we somewhat comically called “two hours of television therapy” while waiting their appropriate turn for further evaluation and/or care!

Medical care, and other public safety help, was meant to always be based on doing the right thing, for the right reasons, in the right way, at the right time for those soliciting often scarce public services for help—not simply first come, first served. Hence, emerged a structured, prioritized process—which works extremely well when done within high compliance to now, widely known standards—not simply a clinical technician (previously, phone clerk) reinventing the interrogation/evaluation wheel every time the phone rang! 

As we say at the Academy, “Onward thru the (evolutionary) fog” … Doc