Effect of a comprehensive quality management process on compliance with protocol in an emergency medical dispatch center.

STUDY OBJECTIVE: Modern emergency medical dispatch provides appropriate resource responses with the use of an emergency medical dispatch priority reference system (EMDPRS). The EMDPRS is a systematic protocol for all aspects of the dispatch process, including interrogating the caller, matching responses with severity, and providing pre-arrival care. We tested the hypothesis that appropriate performance feedback would increase dispatcher compliance with the protocol. METHODS: We examined how emergency medical dispatchers complied with the protocols contained in the Advanced Medical Priority Dispatch System, a commercially available EMDPRS. Six key areas and overall compliance were studied. Dispatchers performed for 2 months without feedback and for a further 2 months with performance feedback. We used statistical methods to compare the dispatchers' compliance with the protocols each month. RESULTS: The mean overall compliance score improved from 76.4%+/-10.2% (mean+/-SD) in the absence of performance feedback to 96.2%+/-4.0% (n=217; P <.001) when performance feedback was provided. Five of 6 key areas showed similar improvements. CONCLUSION: Providing emergency medical dispatchers with regular and objective feedback regarding their performance dramatically improves how rigorously they follow a systematized dispatch protocol.

The wake-effect--emergency vehicle-related collisions.

INTRODUCTION: Emergency medical vehicle collisions (EMVCs) occurring during initial response and with patient transport have been a long-standing problem for emergency medical services (EMS) systems. Experience suggests "wake-effect" collisions occur as a result of an EMS vehicle's transit, but do not involve the emergency medical vehicle (EMV). Substantiating the existence and magnitude of wake-effect collisions may have major implications regarding the manner of EMV response. HYPOTHESIS: Paramedics will report that wake-effect collisions do occur and that they occur more frequently than do EMVCs. DESIGN: Survey analysis. PARTICIPANTS: Thirty paramedics employed by the Salt Lake City (Utah) Fire Department and 45 paramedics employed by Salt Lake County Fire Department. Geographic Area: Service area has population of 650,000 and is urban, suburban, and rural. MEASUREMENTS: The survey consisted of three open-ended questions concerning years on the job, EMVCs, and wake-effect collisions. ANALYSIS: The mean value for the number of EMVCs and wake-effect EMVCs, along with the 0.95 confidence intervals (0.95 CI) were determined. RESULTS: Seventy-three surveys were analyzed. Sixty EMVCs and 255 wake-effect collisions were reported. Overall, the mean value for the number EMVCs per respondent was 0.82 (0.60-1.05) and for wake-effect collisions 3.49 (2.42-4.55). The mean values for EMVC's for each service were 0.86 (0.50-1.38); 0.80 (0.50-11.0). For wake-effect collisions the mean values were 4.59 (2.83-6.35); and 2.76 (1.46-4.06) respectively. CONCLUSIONS: This study suggests that the wake-effect collision is real and may occur with greater frequency than do EMVCs. Significant limitations of this study are recall bias and misclassification bias. Future studies are needed to define more precisely wake-effect collision prevalence and the resulting "cost" in regards to injury and vehicle/property damage.

1991 ambulance manufacturers directory.

In order to fit form to function, ambulance design should be a democratic process that involves the participation of all providers within a service. Our annual updated list of ambulance manufacturers can provide the tools to ensure that custom-built rigs meet specific functional needs.