Tag Archives: COVID-19

Modifications to the Medical Priority Dispatch System in the age of COVID-19

Posted on by Standard Reply

The Medical Priority Dispatch System (MPDS), sometimes referred to as the Advanced Medical Priority Dispatch System (AMPDS) is a call taking system used to dispatch appropriate aid to medical emergencies including systematized caller interrogation and pre-arrival instructions. Priority Dispatch Corporation is licensed to design and publish MPDS and its various products, with research supported by the International Academy of Emergency Medical Dispatch (IAEMD). Priority Dispatch Corporation, in conjunction with the International Academies of Emergency Dispatch, have also produced similar systems for Police (Police Priority Dispatch System, PPDS) and Fire (Fire Priority Dispatch System, FPDS).

MPDS was developed by Jeff Clawson from 1976 to 1979 prior to his medical school training. Clawson designed a set of standardized protocols to triage patients via phone and reduce call processing time and create efficiencies in the emergency medical system (EMS) response. Protocols were first alphabetized by chief complaint that included key questions to be asked the call taker, give pre-arrival instructions to the reporting party, and to assign the proper resources to the request for EMS assistance.  

MPDS begins with a call-taker dispatcher asking the reporting party key questions. These questions allow the EMS dispatchers to categorize the call by chief complaint and to establish a determinant level ranging from “A” (minor) to “E” (immediately life-threatening) relating to the severity of the patient’s suspected condition. The phone information is used to accurately assign resources to the incident scene and the proper code of response i.e., red lights and siren. The MPDS also uses the determinant O which may be a referral to another service or other situation that may not actually require an ambulance response.

In 2020 the spread and concern of COVID-19 had caused a dramatic change in the procedures used by pre-hospital personnel in an effort to minimize risk following known, and unknown exposure to a patient with COVID-19. In an effort to minimize exposure on all EMS pre-hospital care patients many delivery systems are limiting the previously standard number of personnel arriving at the scene that physically interact with the patient. Further techniques including moving the patient from a confined space environment to the outdoors, and greater use of a higher level of PPE are practiced in an effort to minimize exposure. 

Each of these efforts, including additional questioning may benefit the hopeful outcome of reduced exposure. However, I believe that technology can provide additional benefit utilizing anonymized cell phone location data (“pings”) based on occupancy types that speak to the number of people per square foot, amount of linger time, and pathway crowding. This data could be used to better understand where people congregate and what methods could be used to leverage this data in an effort to minimize exposure to COVID-19.  

Information on person per square foot, time spent on location, activity during linger time i.e., sweating at a gym, seated at a church, could be used to more clearly identify potential location dangers of biological hazardous previously not well understood. This information will provide dividends in a healthy work environment, potentially higher morale, and overall healthy workforce, potentially saving resource dollars for other preventative needs.  

Locations and occupancies of potential “super-spreader” environments learned prior to arrival at the scene may reduce call to patient contact time as EMS response personnel can be fully and appropriately dressed in personal protective equipment (PPE) upon arrival at the scene. This data could lead to other modifications to EMS response not able to be understood today due to the lack of available data. 

Due to the heavy burden of workers’ compensation claims for federal, state and local government related to COVID-19, and the likelihood of additional biological challenges in the future, the potential benefit of leveraging anonymized cellular phone location data into the MPDS for responder safety and public health is highly valuable. 

My COVID-19 Antibody Testing Experience

Posted on by Standard Reply

The Novel Coronavirus disease has impacted the country at all levels of society, influencing and perhaps exacerbating beliefs about the value of science, importance of government, and the public’s appetite for risk. Because so much of everyday people’s understanding of the science of disease progression, and COVID-19 in particular, is not well understood by the population at large, each day new information is learned that shapes and/or fortifies earlier held feelings. And because of the availability of information that has not been vetted is written and published on an hourly basis, it may be difficult for the everyday American to carefully consider all of the important nuances in each article or news segment.

Like many others I was interested in learning if I had been exposed to COVID-19 earlier this year. I had been sick with a significant respiratory illness about the time of when the virus is reported to have first arrived in California. Because I regularly provide assistance to elderly relatives, I felt motivated to understand what my potential was for contracting and transmitting the disease. Early information indicated that the availability of testing was limited and that available COVID-19 tests would be reserved for those workers whose employment regularly interfaced with infected individuals.

With the passage of time I learned of a number of locations around Orange County, California that had COVID-19 testing capabilities. It was important that I establish baseline to learn if I had been exposed to COVID-19 to an extent that I had developed antibodies. During one of my limited trips to the supermarket I saw a sign that advertised “Instant COVID-19 antibody testing now available.” I made an appointment for the next day at 0800 when the emergency care facility opened for business that day.

When scheduling an appointment, I was pre-screened online by answering questions about why I wanted the COVID-19 test and if I believed I had been exposed. I was able to obtain the first appointment for the following morning, and upon arrival was surprised to find that I was the only customer at the facility. Because of the prominent sign advertising the availability of such a test, and the limited availability of testing, I had expected greater interest. I walked into the local emergency care facility, followed the written instructions pertaining to disease spread, and made contact with the medical receptionist. The process was efficient and involved a very limited amount of contact. I had worn an N95 face mask that I’ve had for months and the only other potential for transmission was the paper I handed to the receptionist. All of the billing questions and associated HIPPA questions were managed previously via online.

After about ten minutes, I was invited into a treatment room where I was met by a lab technician. The room looked exceptionally clean and the technician was professional. He looked for a site to draw blood and choose to use my left antecubital vein. Using and alcohol swab, proper site preparation and a small needle the technician drew a small sample of blood rapidly. When I asked about the anecdotal figures for those COVID-19 tests he noted that many of the tests were negative, specifically for Orange County. Without elaboration he seemed to indicate that the outcomes were different in other areas.


The testing that was performed was an immunoassay for suspected disease caused by the 2019 novel coronavirus, rapid SARS CoV 2 IgG + IgM Ab, QL IA serum or plasma. To the best of my understanding, this testing process attempts to determine if I have the antibodies following exposure to COVID-19. The test is designed to find antibodies for both near term, such as the last two weeks from the time of the blood draw (IgM), to long term (IgG). The sensitivity and specificity of the assay were not presented.

After about 15 minutes, I was given my result: my test was negative for COVID-19 antibodies, meaning that I was not exposed to the virus if this test proves accurate. The cost was $70.00.

This benefit of this exercise is that it forms a baseline for my exposure moving forward. Assuming I use the same cellular phone I would be able to track my movements and find when/where I am exposed in the future, if that happens. Other technological values that I do not fully understand may be used to follow my movements that could be used in the future to determine a when/where/who of a possible/suspected exposure. My experience illustrates the value of public testing and how this can be used to manage the risk regarding COVID-19 and the reopening timeline specific to state and local government.

Public Safety Officer Response Best Practices in The Age of COVID-19

Posted on by Standard Reply

Due to the highly contagious nature and potentially deadly outcome of exposure to COVID-19, and the need for first responders to adequately serve the public, modifications to the standard emergency response practices need to be designed and implemented by those charged with public protection. The purpose of a streamlined procedure is to ensure that all task and tactical operations achieve the intended benefits of a competent emergency response agency and provide adequate protection for the employees as well as those they serve.  

Because the public safety community has not experienced such a catastrophic event as the COVID-19 pandemic, a model of best practices does not currently exist on the numerous issues relating to the specifics of this disease including contagion, protection and prevention.  Further issues related to the management of labor contracts, treatment guidelines, and psychological issues outside of the normal business of daily emergency management serve to add to the complexity of a workable solution.  

For the purposes of this article I refer to first responders as those whose employment is designated as a safety member by the State of California. Specifically, I will speak to peace officers, police officers, firefighters and ocean lifeguards. These employees constitute the lion’s share of those public safety members who respond to emergencies for service via 911 call or other notification avenue. Privately employed security, emergency medical service (EMS) or other initial emergency responder may benefit from this information as well.  

The understanding and nature of Novel COVID-19 virus is developing rapidly on a daily basis. Each new understanding serves to challenge previously known information and can influence the belief of the public and first response personnel that officials charged with public safety are sufficiently able to meet the demand. The larger legal, economic, and policy issues will be determined over a spectrum of time but the procedures related to emergency response and protection of the public should be focused on all of the safety related components. This includes call taking at the public safety answering point (PSAP), resource assignment, and tactical operations when arriving at the scene as well as patient treatment and transport to a hospital or other care facility.

Time, Distance, Shielding 

The primary consideration of public safety operations is force protection. This is consistent with the need to have a functional force capable of performing their sworn duty to protect the public. It does not suggest that first responders will not enter into harm’s way to take a calculated risk to protect a victim from harm. There is a tenet in the hazardous materials response discipline that applies to virtually all aspects of emergency response management. Time, distance, and shielding speaks to the three components of protection to be employed when dealing with a substance, or situation of known/unknown nature that could pose a health hazard to the public or responders. 

The concept of time seeks to address the influence of time of exposure to activities that are, or could be, hazardous to human health. The more time a first responder is exposed to the hazard the greater the chances of harm to that rescuer.  

For firefighters the concept of time is intended to limit how long of an exposure to toxic hazardous chemical substances, or poisonous biological agents in the immediately dangerous to life & health (IDLH) environment. For a lifeguard it could include operating a water rescue in open water at night, subsurface activities, or high surf rescue operations. In law enforcement it may include a felony car stop, high risk felony search warrant, or domestic violence response for service.  

Distance refers to the distance between the hazard and the rescuer. A firefighter may increase the distance from a hazardous chemical fire liberating toxic smoke, or simply increase the distance from the radiant heat from a structure fire to limit injury. A lifeguard may modify open water rescue tactics away from the surf line and choose to place a victim into a rescue boat off-shore to avoid the challenge of dragging a victim through heavy surf.  A police officer, when faced with overwhelming human force may add distance between criminal subjects to buy time to consider alternative solutions.  

Shielding speaks to the personal protective equipment (PPE) used and provided by an employer for the purpose of protecting the wearer from the damaging effects of a specific insult. This can be as simple as a helmet to provide some form of protection to the head, gloves providing protecting to the hand(s), boots to protect the feet, etc… Firefighters wear structural protective coats and pants for thermal protection from fire, law enforcement officers don ballistic vests to provide protection from bullets projectiles, and knife attacks, and lifeguards use a personal flotation device (PFD) to help them stay afloat in open water. 

Whatever the discipline it is likely that all first responders will come into contact with people during the course and scope of their work. It is also believed that some degree of these people will be carriers of COVID-19, and some will be symptomatic and others asymptomatic. Because we believe this disease to be highly contagious significant procedures, behaviors, and policies will need to be trained, practiced, and enforced for the safety of the public and first responders. 

Recent information indicates that a significant number of people are silent carriers of COVID-19 and because of this all patients will need to be treated as a potential carrier. Further, awareness on how to disinfect the protein involved in the virus should be understood by all first responders so that efficient and effective measures are developed and learned properly by those who are expected to have public contact. Additionally, the life expectancy of the virus in all mediums that first responders are expected to operate should be known and understood so that the confidence of the health & safety of the force is well established. 

Standard behaviors when operating in a confined space should recognize that the COVID-19 virus can stay atomized in an unventilated environment for hours.  Because of this EMS care providers should take measures that would either minimize exposure time in that environment or remove the patient to a more controlled environment such as the outdoors or inside an ambulance where the air is constantly changed. 

The treatment of a patient often involves intimate contact that enhances the potential for human-to-human transmission. Because of this distance becomes impossible for the patient woman/man. However, other EMS care providers can support the person providing treatment and still maintain six feet of distance. The use of a single EMS care provider entering a home so that the entire pre-hospital medical crew is not potentially exposed may hold promise, but fails to account for the realities of where all emergency medical calls occur and a stair-step approach should be considered so as to ensure adequate scene safety for responders.  

Providing proper PPE, and the consistent use of adequate protective equipment on each EMS call will be necessary to prevent the transfer of the COVID-19 virus from a known, or unknown patient. This is the only shield that we currently have to prevent human-to-human transfer via personal contact. Because the protection of the force of first responders is paramount to the safety employee these measures are necessary in the near term until effective anti-viral, vaccines, and other solutions are developed for common use.