The Evolution Of Dispatch

Introduction
When Dr. Jeff Clawson and Kate Dernocoeur sat down in 1985 to write the first edition of “The Principles of Emergency Medical Dispatch,” they were both aiming to transform the world of emergency dispatch. 

A few 911 hubs of the United States—Salt Lake City, Utah; Phoenix, Arizona; Aurora, Colorado; Seattle, Washington; and Stockton, California—were investing in the evolving role of what an emergency dispatcher could be, a growing concept that had only emerged during the prior five or six years.

“I was proud to be a part of that time,” Dernocoeur said. But one voice stood out to her as he questioned the haphazard processing done by an untrained profession with an obvious potential for saving lives: “Why are we doing it this way?” echoed in her mind.

Dr. Clawson’s publications in the “Journal of Emergency Medical Services” (JEMS) had a notable passion for innovation, standardization, and impact on the public. Dernocoeur recognized he had “a whole wealth of knowledge” that no one was talking about—yet—so she volunteered to help him write out the visionary framework for what emergency dispatch should become—and did!

Relying mainly on Dr. Clawson’s JEMS articles, newspaper clippings, hundreds of letters sent by mail, and interactions at professional conferences, the two recorded stories and adages that appealed to the human side of the emerging medical protocols. The resulting textbook introduced a new approach to “calltaking,” which, historically, had been a “just-answer-the phone” dispatch process. Thus, the original “Principles of EMD,” nicknamed the “green book,” launched the new principles of repetitive persistence, caller management, and the redefined role of the emergency dispatcher as the first, first responder.

Some 40 years later, the now global reach of the International Academies of Emergency Dispatch^® (IAED^™) continues to consciously transform the field through conducting research, utilizing technology, and considering the impact on the individual caller. As quoted in the Principles textbook by an unknown futurist, “Change is the way the future reveals itself.” What remains unchanged is that the IAED continues to be at the forefront of that ongoing innovation.

This special issue of the “Journal of Emergency Dispatch” highlights but a handful of the IAED’s pivotal developments that not only influenced this emerging profession as it now appears but will continue to shape emergency dispatch far into the future.

YESTERDAY
 

Aspirin Diagnostic
An Emergency Dispatcher instructing patients who are displaying symptoms of a heart attack to immediately take aspirin doesn’t seem particularly controversial today. However, when the IAED released its official Aspirin Diagnostic and Instruction Tool (ADxT) in August 2007, it was met with significant hesitation and even skepticism from medical professionals and certain Emergency Medical Dispatchers (EMDs). How safe is it to have an EMD instruct a caller to ingest such medication?

Like all updates to the Medical Priority Dispatch System^™ (MPDS^®), the development of this diagnostic Tool was in line with clearly evolving industry standards—particularly those provided by the International Liaison Committee on Resuscitation (ILCOR) and the American Heart Association (AHA). The AHA explains that most heart attacks “occur when the blood supply to a part of your heart muscle […] is blocked.” This causes plaque to build up in your arteries, which in turn restricts the blood flow to the vessels that feed the heart muscle. A heart attack occurs when a clot (comprised of blood, and/or cholesterol, or calcium) blocks a vessel completely. Aspirin thins the blood, which can prevent clots from forming in the first place and, when taken in the early stages of a heart attack, can increase the patient’s chances of survival.¹

At the time of this diagnostic and treatment Tool’s release, Brett Patterson, Chair of the IAED Medical Council of Standards, wrote, “The benefits of early administration [of aspirin] far outweigh the miniscule risk of ingesting what amounts to be one half of the therapeutic, over-the-counter single dose for a headache—even in school-age kids.”²

In an effort to ensure that the Dx Tool was working as intended, the IAED’s research team conducted a study that was later scientifically evaluated and published in 2012. This study involved three dispatch centers from the United States and the United Kingdom and analyzed six months of data involving calls that used the MPDS Chest Pain/Chest Discomfort (Non-Traumatic) and Heart Problems/ A.I.C.D. protocols. Out of the 44,141 cases analyzed, EMDs successfully completed the ADxT on 69.8% of them. In the rest of the cases where the ADxT was not successfully completed, the main barrier was that aspirin wasn’t readily available to the patient.³

During a presentation in 2012, Dr. Clawson shared what was coined “the Clawson Equation.” Using the data available to the IAED, and factoring in elements such as the average time from “send” to EMD administration of aspirin, he found that in its first four years, the ADxT had saved over 114 years of patients’ time waiting for aspirin.⁴ In situations where every second counts, that is a truly remarkable feat, and the sheer amount of time waiting for such a simple and safe treatment must have helped or even saved someone! 

The IAED’s Aspirin Diagnostic Tool opened the door for EMDs to be able to instruct callers on the administration of aspirin, which later led to guiding callers through epinephrine and Narcan administration, enabling patients to survive life-threatening situations long enough for first responders to care for them at the scene and/or transport them to the hospital for further treatment.

Invention of ProQA and AQUA
When Richard Saalsaa, Product Development and Protocol Engine Specialist, met Dr. Clawson in 1988, the MPDS we know today was a metal cardex file of protocol cards already emerging from its early version infancy. Though portable and convenient at the console, there was no electronic connection between the cardset and their computer-aided dispatch (CAD) system, which required a manually typed entry into CAD.

At the time, Saalsaa, a manager of his own CAD company (Systems Plus), got into a bit of copyright trouble when he began the creation of a computerized cardset version of the MPDS. 

“I was on the radar,” Saalsaa said. “But it was just as well because that set the stage for showing Dr. Clawson the efficiency of an MPDS model that directly fed a CAD system.” The streamlined process worked beautifully, but it would be impossible to cater to each of the then dozens of CAD systems in use at that time. So, the idea of ProQA^® was naturally conceived.

Dr. Clawson hired a two-man independent company of satellite programmers to create the first software version of the MPDS, which was previously built to run on early Macintosh 512K computers at the console. This early program called “Priority M.E.D.I.C” was initially used only to guide the EMD through Pre-Arrival Instructions followed by Case Entry and Key Questions and was later rebuilt as the Windows-based ProQA application.

In 1990, Saalsaa agreed to merge his company with Medical Priority Consultants (today known as Priority Dispatch Corp.^™ (PDC^™)) and began working with an expanding team of software developers to create an interface between ProQA and the mostly DOS- and UNIX-based CAD systems of that time.

“At first, ProQA wasn’t graphically Windows-based on those UNIX CAD systems,” Saalsaa said. “The interface between them was often clunky. But at least we were talking to CAD and the responders.” The MPDS-CAD interface shared information back and forth seamlessly, earning Saalsaa and PDC a critical patent award.

Not many years later, the Academy began to examine their quality improvement mechanisms, which were initially (1983) all paper-based data collections. The feedback could help clarify questions and instructions to improve the evolving MPDS Protocol, which was invaluable but manually intensive.

While sitting over cocktails in a lounge area of the Anchorage, Alaska (USA) airport, Dr. Clawson and Saalsaa used a napkin to scrawl out the roots of a computerized method, based on Dr. Clawson’s paper checkbox evaluation form, to better perform quality assurance (QA), score cases, and formulate compliance reports. Agencies could monitor their own compliance, and the Academy could analyze instances of over- and under-triage. Saalsaa wrote the first iteration of the independent program internally nicknamed “PDQA (an acronym for Pretty Damn Quick Quality Assurance!),” which turned into the first version of the AQUA^® program that we know eight versions later today. 

Next came the idea that would allow ProQA to dump its data into this new QA system. With an extraordinary amount of data shared from the Metropolitan Ambulance Service (Melbourne, Victoria, Australia), the team was able to test the development of the interface. With that, another patent was awarded for the unique process of evaluating the performance of Emergency Dispatchers.

From these pieces came the computer processes that enhanced the delivery of the protocol, enabled detailed interaction with CADs, and allowed recording data for QA review and compliance improvement. 

“The ripple effect of all of this is evident in the people being impacted by the systems,” Saalsaa said. “It’s mindblowing. It’s not just the patient, but the Emergency Dispatcher and responder in between—these streamlined processes for collecting, sending, and then analyzing performance data empowers them.”

For Saalsaa, it is clear to see how the Priority Dispatch Systems evolved, not only through software advancements that were ahead of their time, but by the IAED defining itself early on as a protocol creator, evolver, and perpetual improver. 

“Other agencies had their own homegrown guidelines, but they left compliance up to the operator, who was rarely highly skilled enough or prepared for that freedom,” Saalsaa said. “The Academy’s presence and vision remained the focus, building software applications to better run the protocol and clearly providing the essential groundwork to give rise to everything we know now.”

TODAY
 

Evolving efforts in Fire 

Unlike the oft-quoted quip that “the fire service is 200+ years of tradition, unimpeded by progress,” the IAED’s evolving Fire Priority Dispatch System^™ (FPDS^®) has proven otherwise during its past 25 years.

Recent events, including widespread wildfires and modern advances like electric vehicles, have changed the way the public is now impacted by fire, clearly requiring new, more effective methods for this discipline of dispatch and response, with the IAED inventing the structured processes required and remaining at the forefront of fire suppression combat.

The California wildfires in 2017 and 2018 revealed a relatively new occurrence of large-scale evacuations and entrapments from wildland fires in the United States. “Wildfires blew hot embers ahead into urban and suburban neighborhoods, burning homes as fuel to the growing flames,” said Mike Thompson, IAED Fire Protocol, Academics, and Standards Expert. “In many cases, these neighborhoods were some distance away from any forested areas.”

More than a million acres burned across California in 2017, damaging or destroying more than 10,000 structures, exceeding the previous nine years combined. The next year suffered increased fire damage—with over 7,500 fires burning an area of over 1.6 million acres; of these, the Camp Fire in Butte County caused 85 fatalities, the deadliest wildland fire on record.⁵ In 2020, nearly 10,000 fires burned over 4.2 million acres, making it the largest wildfire season recorded in California's modern history.⁶

“We hadn’t commonly seen this type of fire behavior before,” Thompson said. In California, specifically, firefighters face annual wildland fire seasons where the wind breathes life into the flames, then, as a result, the following winter rains cause hillsides stripped of vegetation to slide downhill, and this process builds on itself as the scope grows.

Every year, the problem is made worse by the building of more homes in the Wildland/Urban Interface. “Unfortunately, we expect to see more of this as an extended yearslong drought dries up increasing wildland fuels in the West; it’s just waiting for a spark from lightning, a fallen tree-downed powerline, or a careless camper to start another fire,” he said.

In response to these large-scale events, the IAED has made substantial improvements to the FPDS to accommodate the evolving wildland threat, including advising callers to follow recommended evacuation routes and to move away from the fire’s path, if safely possible. When lacking official orders, callers can follow the Emergency Fire Dispatcher’s (EFD’s) instruction to “leave the area immediately and take others with you,” if they feel they are in danger. This may be especially applicable if the advancing fire outpaces resources to warn, evacuate, and then safely rescue victims.

“Telling people to get out, without waiting for a response, can save lives,” Thompson said. “We’re willing to have people take an identifiable risk for a potentially bigger life-preserving gain.”⁷

Another growing issue addressed in the FPDS is how to handle electric vehicle (EV) fires. Though the current statistics show EV fires only comprise about 0.2% of the U.S. fire total, the consumer growth of electric vehicles is expected to account for what could be more than half of all new car sales by 2030,⁸ creating a new, increasing dynamic on the road.

This projection is sure to influence the National Fire Protection Association’s statistics showing on average 215,096 vehicle fires per year in the United States—currently causing an estimated annual 643 civilian deaths, 1,532 civilian injuries, and $2.8 billion in direct property damage.⁹

The extreme difference in handling EV vs. standard-fueled vehicle fires is their specific difficulty to extinguish, which may require up to 10 times as much water (3,000 to 8,000 gallons) as internal combustion engines. This key distinction poses difficulty when a typical fire engine only carries 500–800 gallons of water.¹⁰

The IAED Fire Council of Standards has researched the tactical response and resource requirements of EV fires since 2018. Because high-voltage, lithium-ion batteries are susceptible to what’s known as “thermal runaway,” they create uncontrollable self-heating that can then, after apparent extinguishing, be a source of potential reignition.¹¹

With the release of FPDS v8.0, both Protocol 71: Vehicle Fires and Protocol 77: Traffic Collision/Transportation Incident now ask whether the involved vehicle is electric powered and then provide EV information to clearly enable agencies to assign additional response resources while identifying potential hydrant locations.¹²

Though the goals of prioritizing life and property remain the same, the IAED has improved the specific FPDS instructions for guiding callers in danger and has added essential considerations for response assignments to address evolving fire events. As a leading voice in such impacted communities, the IAED recognizes that the protocol must continue to adapt to meet these new dynamics.

Flexibility for Emergency Police Dispatchers
The nature of police emergency calls truly sets the IAED’s Police Priority Dispatch System^™ (PPDS^®) apart from the MPDS and FPDS. During high-acuity police events, time spent reporting can be frustrating for both Emergency Police Dispatchers (EPDs) and responding law enforcement officers who fear losing a lead or miss apprehending the suspect. Asking for the address of the emergency and phone number, when an active crime is being reported, can appear to get in the way of giving police first responders the information they need now.

The IAED has responded to these concerns, evaluated the pros and cons, and then created a more reasonably flexible approach by entering information into the novel Critical Apprehension Description Essentials (CADE) Tool. Based on feedback from countless EPDs, communication center directors, and police chiefs, the CADE Tool was first made available in PPDS v6.2 in February 2020. It was designed to capture descriptions for high-acuity events where the caller is spontaneously reporting needed event information as soon as the EPD picks up the phone. This Tool enables EPDs to easily record this information in the ProQA CADE pop-up box as the information is being given without neglecting other Key Questions such as the location of the emergency.

The essential descriptions referenced in “Critical Apprehension Description Essentials Tool” include any information that would help law enforcement officers to more easily and accurately flag potential suspects while in the earliest response phase possible. This information includes the reported physical attributes of the suspect(s), involved vehicle descriptions, and any other important information the caller spontaneously gives right up front, such as the direction the suspect went when leaving the scene.

Although the CADE Tool doesn’t specifically prompt EPDs to ask about weapons, anything that impacts scene safety for the caller, bystanders, and first responders qualifies as essential and can also be captured. If a caller spontaneously mentions that weapons were used, the EPD can easily put it in the CADE Additional Information section so police or sheriff’s officers will be notified and can respond more safely and appropriately.

Jurisdictionally Approved Questions (JAQs) and Jurisdictionally Approved Instructions (JAIs) also provide the PPDS with appropriate local flexibility. When a center is in the process of implementing the PPDS, the local authority (usually the police or deputy chief) can decide which PPDS questions or instructions are appropriate based on the resources and methods specifically available within their service area. JAQs and JAIs can only be disabled for situations that do not have an element of scene, caller, or responder safety.

For example, in Protocol 119: Harassment/Stalking/Threat there are six JAIs that can be enabled and given depending on that department’s capabilities and legal processes. They involve having the caller make a list of all the dates, times, and details of previous incidents, not deleting their phone’s call log history or messages, having any court orders available for responding officers, and/or taking a screenshot of any harassment posts. Instructing the caller to stay quiet and out of sight, if the suspect is nearby, is NOT a JAI because it is paramount to the caller’s safety.

The IAED recognizes that police calls are dynamic, tactical, time-critical, and dependent upon human behavior in volatile situations; therefore, the CADE Tool provides a new mechanism to gather information while keeping pace with the caller and enabling a prepared, effective response. In valuing these differences, the IAED continually assesses and updates the PPDS to prioritize the public’s safety, ensuring that all parties receive the right information, to send the right help, to the right place, at the right time.

TOMORROW
 

AI SkillLab
Using Priority Dispatch's AI SkillLab feels like stepping into the future. With just an email address to log in, you can enter a simulated environment and explore scenarios for each EMD Protocol. You'll interact with a realistic, albeit simulated, caller in the same way you’d chat with familiar household “friends” like Alexa or Siri.

But the real mind behind the scenes is that of Amanda Beal, IAED AI SkillLab Script Administrator, who writes a vast library of simulations that may sound familiar—some are derived from the role-playing scenarios found in the EMD certification course manuals. Beal also creatively crafts scenarios inspired by her 15 years of dispatch experience, her former co-workers’ experiences, and a few scenarios from popular emergency and first responder television series.

The new version of AI SkillLab has incorporated the actual ProQA v5.0 Paramount, giving you seamless transitions between practice and application—starting at Case Entry and continuing through Pre-Arrival and Case Exit Instructions, all at your fingertips.

Just like a real call, you can listen to the details the caller provides, ask appropriate questions, provide instructions, and focus on delivering professional care. The AI-generated caller responds based on preprogrammed text-to-voice data for each scenario. This creates a safe place to learn and experiment with the potential to build confidence and familiarity with IAED protocols and exact ProQA functions and its graphical user interface.

“I try to make sure each voice sounds realistic and develop various personalities,” Beal said. “We use the best that is available right now, but I’m limited with adding emotion, which is mainly controlled by punctuation. I can program the voice to mimic yelling, but I can’t implement the caller’s sadness, excitement, confusion, anxiety, or hysteria (like when a child is choking)—yet!”

In the future, Beal hopes AI SkillLab can potentially be programmed to detect the Emergency Dispatcher’s emotional responses as well, determining whether they can deal with the caller’s emotion or if they control the call by speaking clearly, calmly, and professionally. “Before you get on the dispatch floor, you want to learn to exercise compassion and control, which is not always instinctual,” Beal said.

Though emotional connection cannot be analyzed yet, the process of providing instant feedback is a helpful start. To review the simulated call, you can immediately go to the Analytics page to review a color-coded transcript, enable playback features, and analyze statistics of your simplified score.

There is no limit to the hours you could spend proving your protocol prowess within AI SkillLab (earning up to 4 CDE credits each year), and the applications are widely varied. It is a great way for providing the Emergency Dispatcher with the hands-on tools to gain confidence in protocol compliance and develop muscle memory navigating ProQA.

Some agencies have used AI SkillLab to test potential trainees for the right fit. A few high school career academies have also included AI SkillLab as part of their student curriculum to attract interest in the dispatch profession. 

The veteran Emergency Dispatcher can also brush up on some high-acuity, low-frequency scenarios to feel prepared. Within the scenario library, you can search for specific call types by Determinant Codes or keywords to review (e.g., CPR instructions, childbirth, choking). 

“Remarkably, in the 15 years I dispatched, I never delivered a baby over the phone,” Beal said. “Looking back, I would have felt a lot more comfortable if I’d had a chance to practice that in a realistic setting, just in case.”

As AI SkillLab continues to grow a userbase, integrates feedback, and looks to the future, developers review the impact of the Tool on Emergency Dispatchers and callers alike. “We hear about increased QA scores, trainee confidence, and the benefit of administration having an opportunity in the hot seat,” Beal said. At the base of these virtual tools is a human impact that remains the focus. “Just remember to never stop learning,” she said.

Although the future role and application of evolving technology is uncertain, one thing is for sure—as demonstrated time and again, the IAED will weigh the data and continue to produce the best, most evidence-based protocols to help support you, your center, and your callers as this technology is more widely implemented and its AI abilities more evolved.

Artificial Intelligence
We’ve all heard that the only constant in life is change, and the future of emergency dispatch definitely embodies this. AI SkillLab and its increasingly life-like simulation training is just one example of the growing presence of Artificial Intelligence (AI) in the modern emergency communication center.

While still in its earliest stages, AI is a powerful tool that holds tremendous promise in the dispatch world. There are a number of efforts already underway to integrate AI into the emergency communication center workflow. We’ve seen speech-to-text, translation, and video streaming services made available to us through our personal computers and smart phones already being incorporated into our centers. Generative AI has also proven capable of providing call summaries and determining whether specified tasks or actions were completed but not so much how well they have been done—the gold standard of protocol compliance.

But the real challenge isn’t whether Artificial Intelligence can handle certain functions related to the spectrum of emergency operations. Experimental use shows AI will try to do anything it is asked to do, regardless of the context; however, mechanical processing sometimes delivers funny and not-so-funny results, which in our line of work could mean serious injury or death.

The real challenge of Artificial Intelligence is whether our collective industry has the commitment, fortitude, and patience to ensure AI is used in the right way and for the right reasons and not simply used to “check off” governmental boxes to say, “We’re doing QA,” and thereby only providing the “illusion” of doing life-critical dispatch evaluations and pre-arrival actions extremely well.

Conclusion
When you examine the shaping influence of the IAED’s protocols over nearly 45 years, it’s clear to recognize the revolutionizing role of evidence-based research, technical advancements, evolving environmental factors, user feedback, and built-in limited but appropriate flexibility within an important standardized structure.

These stepping stones of progress have continued, decade after decade, to build the Academy as the leading voice focused on the impact of innovation, and one not easily impressed by the glitz and glam of the latest technological trend promising to “revolutionize the 911 industry.” Meeting the demands of a changing world requires consideration, research, and refinement. It’s not justifiable to employ advancing technologies in the name of progress without a thorough understanding of existing capabilities, current limitations, and future possible outcomes. While preparing and implementing future advancements, the IAED does not foolishly seek to “do it first” but is far more focused on “doing it best.”

As Thera Bradshaw, former President of NENA, was quoted in the Principles textbook, “It’s time we start doing it right, not just fast.” Evolving as both a profession and a service to the world around us, we cannot hope to retain the public’s trust if we choose to blithely experiment with their lives.

Confidently utilizing advancing technology, while uniformly using the age-old principles of the scientific method, the IAED continues to look forward and evolve while relying on an evidence-based protocol that proves we are only as good as our united efforts. We forge the way together and move “Onward through the fog,” as Dr. Clawson likes to say, emphasizing that “change is the way the future reveals itself!”

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10. See note 8.
11. See note 8.
12. See note 8.