Guideline 1-200 - Ambulance Dispatch

Polk, Hickory, Cedar, & St Clair EMS Protocols


Scope:

LicenseVolunteerCareerCMH
EMDNAYesNA
EMRNoNoNA
EMTNoNoNo
AEMTNoNoNo
RNNoNoNo
MedicNoNoNo

Guideline:

The designated Emergency Medical Services (EMS) Dispatch Center shall seek to ensure dispatch of the appropriate ambulance which has the shortest Estimated Time of Arrival (ETA) to the scene of priority one, two, and three responses. Citizens Memorial Hospital (CMH) ambulances will be dispatched in an efficient manner to each request for service.

Purpose:

The purpose of this guideline is to establish standards and procedures for the dispatch of emergency medical resources to requests for ambulance or medical transport and to ensure ALS ambulance is available for 911 Response in CMH service areas.

Procedure:

  1. Dispatch administration:
    1. It should be a goal for all call takers and ambulance dispatchers to be experienced with EMS and be currently certified Emergency Medical Dispatchers (EMDs).
    2. Communications center directors shall be familiar with and strive to meet NFPA 1221 (Standard for the Installation, Maintenance, and Use of Emergency Services Communications Systems), specifically:
      1. Section 7.2: Telecommunicator Qualifications and Training. This section references NFPA 1061 (Standard for Public Safety Telecommunications Personnel Professional Qualifications) and describes required certifications and training.
      2. Section 7.3: Staffing. This section requires sufficient staffing based on call volume with a minimum of two on duty at all times.
      3. Section 7.4 Operating Procedures. This section sets call answering and processing time requirements. Specifically, 90% of calls answered within 15 seconds and 90% of calls processed within 60 seconds. EMDs are required and CPR instructions shall be provided when a patient is unresponsive and not breathing. Refer to performance data for the four dispatch centers serving CMH EMS:
    3. In each instance when an ambulance is not available to respond to a request for an emergency, an EMS Missed Run Log entry will be made and kept. A report of missed runs will be sent to PHS leadership no later than the 5th day after the beginning of each month. Weekly reporting is preferred.
  2. General dispatching:
    1. If the dispatched ambulance does not acknowledge the call within one minute, a second attempt at dispatch should be made. If no response after another minute, the next closest ambulance should be dispatched and resources deployed to obtain the status of the non-responsive ambulance staff. Additionally, PHS leadership should be advised of the incident.
    2. Primary dispatch should include the ambulance identifier, general location of the call, nature of the call, and priority.
    3. Dispatchers should provide secondary dispatch information within two minutes of the unit calling en route, when possible. Secondary information should include the full address and all pertinent patient and safety information.
    4. The dispatch center shall record the following for every request for an ambulance. This data shall be available to the ambulance crew at the end of the call to complete required documentation.
      1. Call received time
      2. Dispatch time
      3. En route time
      4. On scene time
      5. Transporting time
      6. Transporting mileage
      7. Destination time
      8. Destination mileage
      9. In service time
      10. Run number. A unique run number will be assigned each time an ambulance is dispatched.
    5. The EMS Dispatch Center shall monitor ambulance movement through Automatic Vehicle Locators (AVL). The EMS Dispatch center will dispatch the closest ambulance for Priority One and Two responses.
    6. A form of call rotation will be used where more than one ambulance covers the same geographic location.
    7. If multiple ambulances respond and transport patients, ambulance crews will request additional run numbers. Secondary run numbers will not be auto assigned just because multiple ambulances are responding.
    8. Upon arrival at the destination, the ambulance is automatically in service for another call immediately, unless notified by the crew otherwise.
    9. Within the last 30 minutes of a shift, the crew may otify dispatch of End Of Shift (EOS) and then will move to the back of the response rotation.
  3. 9-1-1 call dispatching:
    1. Refer to Guideline 1-200-24 - Call Natures for specific EMD medical directions.
    2. Refer to Guideline 1-200-48 - Mutual Aid to determine which ambulances to dispatch based on location.
    3. Requests for mutual aid ambulances from neighboring counties will by honored if an ambulance is available. Ambulances will not be held from response unless directed by PHS leadership. Mutual aid requests further than one county away should be approved by PHS leadership.
    4. EMDs will utilize Medical Priority Dispatch System (MPDS) version 13 approved by the International Academy of Emergency Medical Dispatch (IAEMD) to provide emergency medical instructions to 9-1-1 callers. This includes protocols 1 through 33 and associated determinate codes, pre-arrival instructions, and diagnostic tools.
      1. If MPDS recommends a BLS ambulance, utilization of BLS resources should be done first. If no BLS ambulance is available, an ALS ambulance should be used for priority 1, 2, and 3. Priority 4 requests should wait until a BLS ambulance is available.
      2. If MPDS recommends an ALS ambulance, utilization of ALS resources should be done first. If no ALS ambulance is available, a BLS ambulance should be used in addition to the nearest mutual aid ALS ambulance.
    5. All requests for an ambulance where the patient is not located in a hospital, shall be processed as if a 9-1-1 call has been placed. This includes all calls from Long Term Care (LTC) facilities, clinics, and physician offices.
    6. If an ambulance is transporting a patient to a facility within the response area, and a Priority One or Two request is pending, check with ambulance crew for quick turn-around and obtain an estimated time they can be enroute to the call. If the time is within 20 min, dispatch may use this unit for a quick turn-around. In either case, dispatch the closest currently available unit to respond (including mutual aid). The ambulance first arriving to the scene will take the call.
    7. If an aircraft is requested, the dispatch agency where the landing zone is located should make the request. Refer to fire department dispatching policies for establishing the landing zone. Refer to Guideline 1-100 - Air Transport of Patients. If the aircraft refuses the flight due to weather, do not continue to "shop" for another aircraft.
  4. Transfer dispatching:
    1. Refer to Guideline 1-200-72 - Transfer Priority Calculator to determine priority level and dispatch transfers. Reminder, "transfers" are only out of the hospital, all other requests for an ambulance should use MPDS protocols 1 through 32.
    2. The above calculator should be used to triage and prioritize transfers out of the hospital. When patients to be transferred are triaged and prioritized correctly, this allows efficient use of ambulance resources and meets the needs for the condition of the patient.
    3. If multiple transfers are pending with the same priority level, they should be dispatched in order of current locations as follows:
      1. Emergency room
      2. Cath lab
      3. Obstetrics
      4. ICU
      5. Medical/surgical
    4. ModivCare requests (previously LogistiCare): ModivCare requests are automatically approved unless one or more of the following conditions:
      1. Long distance transfer
      2. A CMH facility is neither the patient location nor the destination
    5. Refer to the 9-1-1 dispatching section as it relates to BLS and ALS dispatching.
    6. Long distance transfers (defined as greater than 100 miles) must be approved by CMH Pre-Hospital leadership. Contact order for leadership shall be:
      1. Crew Leader on Duty
      2. Supervisor on Duty
      3. Manager on Duty
      4. Manager on Call

Citations:


Change Log:

DateLink to
previous
version
Description of change
02/03/16Created Section 6-125 - Transfer Out of Hospital.
07/22/16pdfAdded OB patient to Priority One transfer criteria.
08/24/17pdfAdded priority 2 with comment that it is used as low acuity community requests.
09/25/17Added comment that when physician requests ALS transfer, paramedic will attend the patient in the back.
11/11/17pdfUpdated according to new CMH policy.
07/23/19pdfAdded link to performance graph.
11/27/19pdfAdded reference to stroke protocol if tPA drip.
04/04/20pdfAdded content (without substantive modification) from old Section 6-125 - Transfer Out of Hospital.
04/04/20pdfAdded content (without substantive modification) from old Section 6-095 - Mutual Aid Maps.
04/04/20Moved dispatch center instructions (without substantive modification) from Section 0-020 - Standing Orders by Agency Type.
05/28/20pdfMoved Call Natures section to its own protocol (1-200-01). Moved Mutual Aid section to its own protocol (1-200-02). Moved Transfer Priority Calculator section to its own protocol (1-200-03).
10/07/20Renamed all policies to guidelines.
11/10/20pdfAdded part B & G of CMH Policy PHS01-10 (Basic Life Support Ambulance). Added part C, E, & F from CMH Policy PHS01-35 (Ambulance Communications). Added part B from CMH Policy PHS01-02 (Emergency Response Requested Outside of the Primary Service Area). Added entire memo n.d.-Newell (EMS Policy Cheat Sheet). Added entire memo 2016-10-26-Newell (Ambulances). Added entire memo 2017-10-06-Newell (EMS Psych TransferPriority 4 Transfers). Added entire memo 2017-10-19-Newell (EMS Dispatch PHS01-35). Added entire memo 2018-06-19-Newell (Multiple Run Numbers for CMH). Added entire memo 2018-11-05-Newell (Logisticare Calls). Added entire memo 2020-02-25-Newell (St Clair EMS).
06/05/21pdfMoved to emsprotocols.online

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