Question 1 · Law, Ethics & Human Factors · Moderate
An enhanced care team reviews a month of activations and finds a high stand-down rate, with most tasks turning out not to need critical care intervention. Dispatch is currently made by a non-clinical dispatcher applying the standard priority dispatch system used for all ambulance calls. Which single change is most likely to improve the accuracy of tasking?
- AAdd more dispatch codes that trigger the team automatically, without clinical review
- BSend the team automatically to every call categorised as immediately life-threatening
- CStop accepting crew requests from scene and task the team only from the initial call
- DPlace a critical care practitioner on the dispatch desk to screen and interrogate calls
- EReplace priority dispatch with clinician telephone triage of every 999 call in the region
Show answer
Answer: D
Place a critical care practitioner on the dispatch desk to screen and interrogate calls
The ABC explains that systematised caller interrogation of the kind used for ambulance dispatch (the Advanced Medical Priority Dispatch System, AMPDS) is effective in prioritising an ambulance response but lacks the sensitivity and specificity needed to select the calls that would benefit from enhanced pre-hospital intervention. The remedy is an additional tier of enhanced caller interrogation and dispatch criteria, best delivered by active pre-hospital emergency medicine (PHEM) practitioners such as critical care paramedics or doctors, because they are best placed to judge the likely need for advanced interventions; using non-clinical dispatchers in this role is associated with high rates of over-triage. The London helicopter emergency medical service (HEMS) model has a dispatch desk within the ambulance control centre staffed by an operational HEMS paramedic, who scans all incoming cases, dispatches immediately against evidence-based criteria and interrogates callers directly for other categories before a delayed dispatch. More automatic triggers, or sending the team to every call in the highest ambulance category, keeps the non-clinical selection that is causing the stand-downs. The crew request is the third form of dispatch and is treated as an immediate dispatch, so discouraging it removes the one route from someone who has seen the patient. Replacing ambulance prioritisation for every 999 call does not address the enhanced-care selection problem.
Where this comes from
- ABC of Prehospital Emergency Medicine
- Ch. 2 Activation and Deployment · Call prioritisation: AMPDS and enhanced interrogation · p. 4“lack the sensitivity and specificity required to select calls”
- Ch. 2 Activation and Deployment · Call prioritisation: enhanced interrogation · p. 4“should be delivered by active PHEM practitioners (e.g. critical care paramedics or doctors)”
- Ch. 2 Activation and Deployment · Call prioritisation: enhanced interrogation · p. 4“non-clinical dispatchers in this role is associated with high rates of over-triage”
- Ch. 2 Activation and Deployment · London HEMS dispatch model · p. 4“dispatch desk within the Ambulance Control Centre is manned by an operational HEMS paramedic”
- Ch. 2 Activation and Deployment · Crew request · p. 4“the crew request, which is treated as an immediate dispatch”