Until Proven Otherwise?

Brett Patterson

Brett Patterson

Best Practices

Brett Patterson

Hi there, just a quick question regarding one of our protocols.

On Protocol 1: Abdominal Pain/Problems, Rule 1 states that pain above the navel should be considered a heart attack until proven otherwise. We also have a CHARLIE-level coding for patients that answer “Yes” to KQ 4 [“Is her/his pain above the belly button (navel)?”]. I noticed that ProQA® does not prompt us to initiate the Aspirin Diagnostic at all regardless of the coding. My question: is there a reason that we should not be administering aspirin in these circumstances?

Katie McAran

OnStar Emergency Advisor

CSD OnStar


You ask an insightful question!

Rule 1 of Protocol 1 was written with response assignment in mind, to ensure that an ALS evaluation is performed for epigastric pain in patients of cardiac age range. Essentially, it means that these patients are assumed to be at risk of heart attack until a complete, face-to-face evaluation rules that possibility out. However, the Rule was not meant to encourage more definitive therapy PRIOR to that evaluation, such as aspirin administration.

In the Medical Priority Dispatch System (MPDS®), aspirin administration is advised when patients complain of Heart Attack Symptoms, as listed in the Additional Information sections of Protocol 10: Chest Pain/Chest Discomfort (Non-Traumatic) and Protocol 19: Heart Problems/A.I.C.D., when the exclusion criteria of the related CEI and the Aspirin Diagnostic and Instruction Tool are ruled out. If these symptoms are present, Protocol 10, rather than Protocol 1, is indicated.

With that said, I’m now more interested in the frequency of heart attack in the 1-C-5 and 1-C-6 codes. Now that we have better outcome data, we can have a look.

Thanks for the question. If the numbers are higher than I expect, we may want to consider ASA administration aligned with these codes.

Brett Patterson

Academics & Standards Associate

Chair, Medical Council of Standards

International Academies of Emergency Dispatch®

Hi Brett:

How does the AMPDS (or FPDS® for that matter) deal with the specific hazards of electric cars after a crash?

This was a question from the regional fire brigade of one of my centers, as more and more people drive fully electric cars over here (Tesla, for instance). Local firefighters tend not to know how to deal with these incidents...

Kind regards,

Harm van de Pas

Medical Manager

RAV Brabant Midden-West-Noord


Hi Harm:

There are no specific provisions for electric cars in the MPDS and I have seen no specific suggestions proposed. I have seen demonstrations at fire conferences to educate firefighters about batteries and extrications, but I am not aware of any specific instructions for bystanders other than what is currently in the MPDS.

I am forwarding your question to Jay Dornseif for comment on the FPDS.



Brett is correct in that we do not have any special or specific instructions for electrical cars whether involved in a fire or in a crash.

The only specifics that we (FPDS) are aware of is when extrication exercises are carried out on an electric vehicle. Since this does not involve call processing, we leave this to the field responders to identify and address on the scene of the event. We (FPDS) keep our eyes and ears open to what changes the Automobile Manufactures Association make as new makes and models are sold to the public.

If a needed change was to occur with alternative fuel vehicles, we would adopt them into the FPDS and share those changes with our EMD and EPD Council of Standards.

Thanks for you question.

Jay Dornseif

Program Administrator – Fire

Priority Dispatch Systems