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

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. 

On Communication: Words Have Meaning

A standard by which we as a society communicate and function is through a common understanding of language. This is especially important when operating at an emergency scene, in the expenditures of public funds, in matters of employment, and legal issues. How senior managers prepare themselves and their organizations for all of these challenges prior to expected and unexpected events will likely factor into a desireable outcome. 

The words we choose to use in oral and written communication can be used by others when evaluating our inner thoughts, beliefs, and feelings. The effective use of language is important when trying to convey understanding and attempting to influence others. This is illustrated by many of the historic speeches and writings of Prime Minister Winston Churchill, Activist Mahatma Gandhi, President John F. Kennedy, et al during times of crisis. When language is used properly to advance a noble cause good people will follow the leader, whether for an instant emergency incident, a crisis event or a chronic challenge that can only be managed to mitigate damage. 

The media by which modern society gathers, records, and documents our individual communication has changed rapidly in the 21st century and this has proven to be somewhat of a double-edged sword.  Because of the advancement of recording technology, the concept of private communication is no longer assured.  Images and edited recordings of audio and video can be manipulated so as to advance an idea without complete context. The use of advanced monitoring devices such as laser microphones, directional microphones, and highly advanced camera systems can capture information without the knowledge of the subject. This not only eliminates private conversations and actions but leaves out the context of prior understandings between communicators. 

In the business environment individuals should be aware of their communication styles and make every effort to be as effective and respectful as possible while still maintaining fidelity to the mission.  Common words specific to a discipline can sometimes shortened into an acronym, and are commonly seen in military, public safety, and healthcare applications.  Any acronym that may be construed to have an unintended negative meaning should be avoided, as the unintended consequences may prove to be a distraction from the organizational mission. 

Recognizing that people have individual personalities, and that these characteristics may surface in a comfortable work environment is critical for the supervisor or manager of any business. The workplace can be a controlled environment, to some degree, and the people who are authorized to manage that environment are responsible that to the extent possible the workplace is free from many forms of discrimination.  How those in charge care for the individual freedoms, limitations, and corrective actions employed will have significant influence on the morale and productive behavior of the workforce.  

Individual business disciplines involve varying levels of education, and the level of education can influence the size of the commonly used vocabulary. If the intent is to effectively communicate information in a workplace environment, it will be important to use words in the language that will be understood by the receiver. The objective is to achieve a desired result, and when multiple minds develop a common understanding the likely of success is enhanced. 

To add emphasis, foul language may be used in oral communication, most notably in military and public safety environments. This may be due to the inherent nature of timeliness of a needed action so as to prevent injury or death commonly found in those professions. While this may be uncomfortable for someone reviewing a body camera recording involving a subject and a police officer, it can be argued that it is used to achieve a successful outcome in critical use-of-force activities.  The Los Angeles Police Department (LAPD) argues for the use of “tactical language” when dealing with potentially violent subjects as a method to emphasize the seriousness of the officer during critical situations. 

Law enforcement officers operate in an environment where, at virtually anytime, a potential need to report critical information via radio for officer safety exists at virtually all times when on patrol. This speaks to the need to be exceptionally brief when possible.  The use of ten-code radio communication, intended to add brevity and covertness to the verbal communication, is not universal nationwide and can lead to a misunderstanding

Fire departments also routinely operate in in an uncontrolled workplace environment and under stressful conditions. Because most emergency calls for service for a fire service organization are “consequence mitigation/management” in nature a timely, efficient and competent response is mandatory. Much of this involves oral communication on the incident scene is between the individual(s) performing scene management, supervision, tasks and resource dispatchers.  Because this communication can be over portable radio only the most important information is spoken via radio during the emergency phase of an incident. 

In degrees of ascending importance, radio traffic can be described as routine, priority, and emergency, and it is necessary to recognize how to properly and efficiently communicate on the channel/frequency.  “Emergency traffic” via tactical radio channel is reserved for communication limited to information involving the immediate life safety of a firefighter; “priority traffic” is radio communication reserved for important information about the direction of critical tactical activity on the incident scene; and all other radio traffic is designated as “routine traffic.” 

When writing in the business environment on a work computer or device, it is important to limit the communication to that which is accurate, proper, fair and fact based.  Any electronic communications involving specific subject matter may be open to discovery in a claim and the employee/supervisor/manager will want to be seen as professional as possible.  Interpersonal communication between employees and the proper supervision of the healthiness of the workplace communication is a supervisory and management priority. How the supervisor handles her/his subordinates and understanding when to engage and at what level to engage will determine the success of those charged with this duty.  The volume and tenor of your voice, the environment chosen to have a discussion, and the perceived fairness and adherence to stated policy are important factors in these critical discussions. Modeling proper communication techniques is very important, as the standard is established by the supervisor. Giving license to subordinates by behaving contrary to the established organizational policy can lead to failure

Why Marine Fire Fighting in California Matters

Historically, the incidence of fires aboard vessels near the coastline in California has been low, comparatively, to the total call for service volume of local fire service delivery. The irregular level of activity may have contributed to this false sense of security for firefighters charged with marine firefighting responsibility. Many local jurisdictions outside of California in the US have taken significant action to develop sophisticated program for the training of land-based firefighters in marine firefighting following the withdrawal of active mission support by the US Coast Guard in the 1980s. The failure of State Fire Training (SFT) to design and develop a modern curriculum for land-based firefighters to properly fight fires in the marine environment, and the implications of such following the seminal event involving the Santa Cruz/Conception dive boat fire suggest this can no longer be tolerated.

The fire service has historically accepted many duties involving disciplines outside of firefighting, perhaps due to the geographical distribution of fire stations across the landscape. This distribution permits a reduces travel time of trained people to the scene of an emergency following notification. Some of these duties are more recognizable such as emergency medical service (EMS), hazardous materials response (Haz-Mat) and perhaps Urban Search & Rescue (US&R). Other response activities are less known to the public, such as rope rescue, ice rescue, et al. Other duties such as Search & Rescue are a primary duty of law enforcement. Each of these common emergency activities are often accomplished by the fire service but are sometimes done by agencies, both public and private, outside of the fire service. This is understandable given that when a member of the public makes a request for emergency service a timely response from the authority having jurisdiction (AHJ) is expected.

The development of firefighting training in California is the express duty of SFT, a division of the Office of the State Fire Marshal. Nature abhors a vacuum, and due to the failure of SFT to develop a comprehensive program for firefighting in the marine environment other disciplines have filled the gap with a marine firefighting program not approved by SFT and not developed by firefighters in what is one of the most dangerous of firefighting activities.

The US Constitution provides the states police power that enables each state the authority to provide for the health and safety of the public. In California the AHJ is given the explicit control of how this is accomplished in emergency situations under the Emergency Services Act. Further, each jurisdiction along the coastline in California extends a three mile boundary beyond the mean high tide line into the ocean or other open water such as a bay. This authority cannot be abdicated unless expressly done so by the AHJ. The duty and responsibility of a fire service agency along the California coast extends into the open water for three miles from the shore.

California law under the Harbors & Navigations code mandates that the local sheriff’s department maintain capability to provide aid and assistance to persons in the coastal waters, but does not provide for firefighting. This suggests that each local government agency along the coastline in California has a responsibility to the public to maintain some plan for marine firefighting within the three mile coastal zone.

California Occupational Health and Safety (Cal OSHA) stipulates that, in the workplace, workers must be provided with proper training and protective equipment for dangerous duties. The marine environment and vessel firefighting are unique as compared to land structural firefighting activities as there are numerous challenges found in the marine environment not found on land, i.e., confined space, redundant electrical systems, rotating mass below the waterline, large quantities of fuel, limited fire prevention regulations, et al. Taken in total is it clear that firefighting fire on a vessel away from the shore provides many challenges not found on land. Because land-based firefighters will provide the workers to fight a fire in the marine environment, and the lack of a SFT approved plan to train these firefighters currently exists, it is foreseeable that a Santa Cruz/Conception dive boat incident proximal to the coast would be devastating for the fire service as well as any victims.

I have been championing the idea that SFT develop a curriculum for firefighting in the marine environment for land-based firefighters for ten years. I ask that you schedule this idea for discussion at the Statewide Training Education and Advisory Committee (STEAC) as soon as reasonably possible so as to properly address this gap in the training of firefighters in the protection of the public.