The Protocol's Direct-Design 'Attributes'

Upon opening any of the Emergency Priority Dispatch System™ Protocols, you’re immediately met with the striking use of color, bolding, directing symbols, and varied fonts, backgrounds, and clearly laid out panels.¹

Far beyond aesthetics, every protocol element has a function with specific styles to visually guide its use, just as every word of text is consciously chosen for the caller’s understanding in the non-visual environment. This intentional design directs the Emergency Dispatcher clearly and efficiently through the protocol, revealing an intrinsic method to the madness.

Protocol formatting origins
Protocol is an evolving science, and the format designs that present it have been through the refiner’s fire since the first release of the Medical Priority Dispatch System^™ (MPDS^®) in 1979. Today, the research-based IAED^™ Protocols are used in more than 4,307 communication centers across the world, proving adaptability, not only through time and technological advancement, but across countries and continents as well.

Most users are aware that today’s ProQA^® Paramount is a logic-designed software that displays an AI-like, automated version of the protocol based on the original framework of a large (18-inch by 10-inch) flip-through cardset system. However, you may not be aware of the detailed evolution of the cardset versions, proving the protocol, as the Medical Council of Standards states (tongue-in-cheek) each time with each release, is "perfect again" —emphasizing the never-ending evolution of the Academy process.

Occasionally, the protocol’s format has gone through marked bursts of improvement. One such significant release occurred in 1990 (nearly 11 years after its initial release) when the MPDS was renamed the “Advanced MPDS.” In an IAED Dispatch! article, the late Scott Hauert, Director of Training for the then National Academy of Emergency Medical Dispatch^®, detailed the significant design enhancements that took place at that time, proudly promoting the protocol’s “state-of-the-art, safe, and user-friendly interface, focused on consistency in both protocol content and format.”²

Elements of these enhancements remain in the physical cardsets today (used mainly for training and backup purposes), including a larger format to promote ease of use; color and design to help direct the EMD’s eye; sequences and novel formatting of Pre-Arrival Instruction panels (now automated in ProQA), and font specificity showing elemental relationships and actions.³

Of course, some of the enhancements described have evolved since that time. For instance, bold text once indicated a word was “related to a Response Determinant, a Post-Dispatch Instruction, or a prompt to proceed to another protocol,”⁴ where today bolding is used mainly for emphasis unless combined with another stylized element—including color or all caps.

In 1990, italicized words within parentheses meant the phrase was optional (at the discretion of the Emergency Dispatcher).⁵ However, today smaller parenthetical words or phrases (colored maroon in ProQA software) are recognized as clarifiers used only to enhance a caller’s understanding, if needed, after asking the question as written.

Through the decades, countless style choices have been added to the protocol to provide user guidance. For instance, in MPDS v11.3, red framing was added to a specific group of Pre-Arrival Instruction panels pertaining to breathing evaluation.

Later in v12.2, the red-in-yellow question mark symbol was added to indicate mandatory use of the AGONAL BREATHING Diagnostic, the symbol creating a “concrete link” and the red-framing subconsciously reminding the Emergency Medical Dispatcher to “be absolutely sure to get it right.”⁶ Likewise, in ProQA, red-framing in pop-up text boxes is meant to draw extra attention to a warning or special consideration.

Guidance with color and style
Remnants of the cardset design are still incorporated into ProQA, though they appear differently on the screen (often due to different automation capabilities). For instance, fewer symbols are needed for navigation purposes, but there are additional unique icon tools in the ProQA toolbar.

In the cardset, gray font is used for answer choices that shunt to other protocols. These elements are incorporated as drop-down answer choices and panel directors in ProQA. Yet, in all cases, blue is used as operational (or conditional/qualifying) text not meant to be read to the caller—remembered with the phrase “Blue is for you.”

IAED Research Assistant and Translator Anna Shmynets has studied a bit of the psychology behind the use of colors. “Colors hit the brain before we even think about it,” she said. “They slip into the subconscious and set the tone fast. Warm colors push urgency or emotion, while cool colors calm things down or create distance. Our minds sort color into ‘pay attention,’ ‘safe,’ or ‘avoid’ long before we’re aware of it. It’s animal instinct.”

Color is used to indicate answer choice elements in the cardset, using green for affirmative “YES” responses and red for “NO” answer choices. Colors are also used to indicate Determinant Response Levels: ECHO (purple), DELTA (red), CHARLIE (orange), BRAVO (yellow), ALPHA (green), and OMEGA (light blue), demonstrating varying degrees of priority and response “triage.”

Understandably, safety questions appear in red text throughout the cardset and ProQA to indicate danger or caution.

Font styles can have a similar effect in guiding the caller. “Typography ends up shaping mood and attention just as much as the content itself,” Shmynets said. “Sharp, strict fonts feel strong but can make people tense, while softer, rounded fonts feel friendly but can be taken less seriously. Interestingly, the brain reacts to the shape of the letters before the meaning of the words.”

Protocol stylization in translation
The Priority Dispatch Corp.^™ (PDC^™) Protocol, Translation, Curriculum & Instructional Design Department includes 17 employees: native-speaking translators, team leads, and supervisors who are solely responsible for producing protocols in 31 languages and regional dialects.⁷

Using multiple translation platforms, translators not only have to consider consistent language and preferred phrasing in the unique Emergency Dispatch environment, but they also aim to preserve protocol conventions in translated products (both cardsets and software).

However, there are a few exceptions that require localization such as numeric values for temperature, length, and weight; number formats; and acronyms that have to be converted to full terms for understanding. Each language has its own unique elements as well, such as reversing arrows in Arabic (read right to left) and replacing first-aid cross symbols with crescent moons for better understandable and acceptable cultural adaptation.

While working on the Ukrainian language translation of the protocol, Shmynets has learned how to apply the articulate detail of specific styles to each element she translates.

“Working with protocols forces a translator to think like a designer, not just a linguist,” Shmynets said. “Every arrow, symbol, number format, and phrasing pattern affects how an Emergency Dispatcher reads and reacts under often time-restricted pressure. Maintaining consistency becomes a kind of discipline. Even tiny deviations can shift the meaning or the flow.”^8,9

Shmynets has learned that the stylization isn’t decorative — it’s functional accuracy. The style guides the Emergency Dispatcher, and respecting that style is just as critical as choosing the right words.

Conclusion
Understanding the intentional design of the protocol gives the user the added advantage of following its guidance with swift recognition. Keeping a keen perception of conventions, cautions, and connections allows the protocol to guide your actions while you multitask and prioritize communicating quickly and accurately with the caller. This historically designed usability shows yet another way the protocol thrives in these essential details—when they matter most.

Sources
1. Smith, M. “Birth of the Pre-Arrival Instruction Grid.” Principles of EMD. Sixth Edition. Fig. 13-8, pgs 13.16–17. Priority Press. 2015.

2. Hauert, S. “Conventions of the new Advanced MPDS.” Emergency Medical Dispatch! The official Journal of the National Academy of EMD. 1990; Autumn Vol I.(No. III): 3–5. cdn.emergencydispatch.org/IAED-JOURNAL/HistoricalEditions/autumn90.pdf (accessed Dec. 22, 2025).

3. See note 2.

4. See note 2.

5. See note 2.

6. Patterson, B., Weight, I. “Why Do I See Red?” Journal of Emergency Dispatch. International Academies of Emergency Dispatch. 2014; Feb. 24. iaedjournal.org/why-do-i-see-red (accessed Nov. 1, 2025).

7. Fraizer, A. “Language is No Barrier.” Journal of Emergency Dispatch. International Academies of Emergency Dispatch. 2024; July 5. iaedjournal.org/language-is-no-barrier (accessed Nov. 1, 2025).

8. Meischke, H.W., Calhoun, R.E., Yip, M-P., Tu, S-P., Painter, I.S. “The Effect of Language Barriers on Dispatching EMS Response.” Prehospital Emergency Care. 2013; Aug. 16. stacks.cdc.gov/view/cdc/214457 (accessed Nov. 6, 2025).

9. Li, H., Ali, S., Hartling, L., Dennett, L., Lopatina, E., Ganeshamoorthy, K., Khangura, J. “Language interpretation and translation in emergency care: A scoping review protocol.” PLOS ONE. 2024; Nov. 19. doi.org/10.1371/journal.pone.0314049 (accessed Nov. 6, 2025).