THE GOOD FIGHT
October 17, 2016
By Jeff Clawson, M.D.
The memo, composed nearly 35 years ago, supported a hard-fought concept we now take for granted in the state of Utah but have yet to realize across the country and world.
Historically, the process in Utah began with the development of the Medical Priority Dispatch Card System at the Salt Lake City Fire Department, followed by the state-level Emergency Medical Dispatcher training course. While the courses became quite popular at the individual dispatcher level, required training for all dispatchers was adopted initially by only the Salt Lake City Fire Department, Davis County Sheriff’s Office, and Gold Cross Ambulance.
In 1981, we approached the Utah Paramedic Association with a rough plan for statewide standards. With the initial blessing and expertise of Richard L. Warburton, Director, Utah State EMS Bureau, and Jan Buttrey, the Associate Director, a draft of EMD regulations was prepared.
In an early Paramedic Advisory Committee meeting, it was decided that the standards should include all medical dispatchers in Utah, in both ALS and BLS agencies. While only modest resistance came from municipal departments providing ALS, rural law enforcement agencies were incensed. The need was questioned, the economics decried, and the safety of Pre-Arrival Instructions doubted. Dr. Clawson was quickly flown by the EMS Bureau to St. George, Utah, to address the Utah Chiefs of Police Association in a very tense meeting, in which the tide was swayed based on the obvious need to provide pre-arrival instructions statewide.The State Bureau of EMS held two public hearings, and after a number of administrative delays and political meetings, a compromise version was reached. The regulations then read, “Dispatchers serving medical providers are not required to be certified as EMDs, but are encouraged to voluntarily seek training and certification through a department-approved course” (effective July 1, 1983).
The EMS Regulatory Committee also established an Emergency Medical Dispatch Advisory Board to make recommendations concerning dispatch protocols, training, curriculum, instructor programs, as well as to review all new selective dispatch protocols now required by the regulations.
Over the past three decades, the regulation has gone through several modifications and now (as of July 1, 2016) requires certification, provision of Pre-Arrival Instructions, and ongoing continuing medical education programs and appropriate review and evaluation (Rule R426-2. Emergency Medical Services Provider Designations for Pre-Hospital Providers, Critical Incident Stress Management and Quality Assurance Reviews).
The early phase of the process was one of the most taxing and political struggles that has ever occurred in Utah EMS, and we are grateful for the support of the Utah State EMS Bureau, the Utah Paramedic Association, and prime public service figures at the time such as forward-thinking Salt Lake City Fire Department Chief Peter O. Pederson.
The process is obviously not yet over. The Academy continues to put up the good fight in states, provinces, regions, and entire countries that lack requirements essential to an effective (Academy-worthy) Emergency Medical Dispatch program. Join us in making training, certification, continuing dispatch education, and quality assurance an international reality as we approach the 40th anniversary of Protocol.