At the time 9-1-1 was established as the universal emergency number throughout the United States (1968), most emergency dispatch centers were located in fire department buildings and manned by officers, secretaries, and clerks with little or no medical training. Then, in 1974, the parents of a child who had fallen into a swimming pool called the Phoenix Fire Department and were transferred to a paramedic, who gave them instructions on how to perform CPR until an ambulance arrived.
The child survived; and, as the news of the successful intervention spread, several other emergency dispatch centers set up their response systems so either a medically-trained person was on-site or at the end of a phone to provide pre-arrival instructions to callers. Within a couple of years, scripted pre-arrival instructions became the norm; and, due to the medical terminology used in some scripts confusing already distraught callers, the Medical Priority Dispatching System (MPDS) was developed in 1978.
Medical Priority Dispatching System Used for Weeding Out Non-Emergency Calls
The Medical Priority Dispatching System originally consisted of a flip tray that gave call dispatchers lists of medically-vetted questions to ask depending on the information provided to them by 9-1-1 callers. Depending on the answers to the questions, dispatchers were able to calm callers and provide clear instructions on what they should do while waiting for an ambulance to arrive. The system still exists, but is now computerized and integrated into computer-aided dispatch systems all over the world.
In addition to being a vehicle through which call dispatchers could provide pre-arrival instructions, the Medical Priority Dispatching System was also used to prioritize emergency resources depending on the severity of the patient's condition. In many cases, 9-1-1 callers were found not to need emergency medical services at all, and paramedics were being requested for non-emergency events such as changing a dressing or providing an evaluation on whether a patient needed to see a doctor.
To address “patient abuse” of emergency medical services, Dallas was one of the first cities to set up a Nurse Hotline in 1981. Medically-related 9-1-1 calls were screened by a qualified nurse to determine whether an ambulance was necessary. In its first year of operation, the Hotline identified 6,579 (of 10,059 screened calls) in which emergency services were not necessary. Unfortunately the Hotline folded in 1983 when a nurse failed to send an ambulance to a caller who subsequently died.
The Development of PSAPs See a Decline in Pre-Arrival Instructions
In the early 1980s, the 9-1-1 emergency service was nothing like it is today. At the start of the decade, 9-1-1 coverage only reached 26% of the population. By 1987, even though the service was growing at the rate of seventy new 9-1-1 systems per year, only 50% of the population could call 9-1-1 in an emergency from a landline. Now the 9-1-1 emergency service reaches 98% of the population, with the E9-1-1 service for mobile users covering 95% of the country.
The almost-nationwide coverage is mostly due to the development of Public Safety Answering Points (PSAPs) - centralized call centers responsible for answering calls to 9-1-1 and dispatching the appropriate emergency service. As these call centers have become more technologically advanced, the need for human personnel to run them has declined; and, due to fewer personnel being available, there is not always the time to provide pre-arrival instructions or medical advice to 9-1-1 callers.
This is not the only adverse effect of advanced technology. PSAP operators with little time are also unable to determine whether a medically-related 9-1-1 call is a real emergency. In March this year, the Washington Post reported as many as 70% of calls to 9-1-1 are not genuine life-threatening emergencies. The city's response to the problem has been to set up a program whereby triage nurses are employed to sit alongside 9-1-1 call dispatchers - much like in 1974!
How Technology Can Help Triage Nurses Make Better Informed Decisions
Washington D.C. is not the only jurisdiction to employ triage nurses or provide a Nurse Hotline to determine the severity of an injury and, if an ambulance is dispatched, provide pre-arrival instructions. Many public and private medical organizations around the country have implemented similar programs to reduce patient abuse of emergency medical services and to save money. However, the risk still exists that a delayed or incorrect decision could result in the loss of a life.
The risk exists because triage nurses and Nurse Hotlines rarely have access to patients' medical histories. Similar to what happened in 1983 - when a 65-year-old woman called Dallas' Nurse Hotline to complain of breathing difficulties - the medical personnel speaking with 9-1-1 callers have no idea of existing medical conditions, the medication callers are already taking, or the potential complications of prescribing a specific course of treatment if an emergency service is not necessary.
Technology may have contributed to the reason Nurse Hotlines are now necessary, but it can also be a solution to help triage nurses make better-informed decisions. Services such as Smart911 can be implemented at PSAPs to alert call dispatchers, triage nurses, and personnel manning Nurse Hotlines to callers' existing medical complications, medications, and potential complications. With this information at their fingertips, decisions about whether an ambulance is necessary can be made quicker, and pre-arrival instructions - or non-emergency medical advice - can be provided with greater accuracy.
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