9/11/2023 0 Comments Dispatch itsWhen fully implemented in 1979, this system became known as the Medical Priority Dispatch System® (MPDS). 1 In 1977, development of a protocol-based calltaking and processing system comprised of three essential components (interrogation questions, telephone help, and determinant coding for level of EMS resource deployment) was started. However, the funding emphasis was on hardware, radio frequencies, and vehicle communications rather than dispatcher qualifications, dispatcher training, and protocols. The Emergency Medical Services Systems Act of 1973 designated "Communications" as one of its fifteen components. Prior to 1973, only a few Emergency Medical Service agencies had employed even rudimentary communication technologies. However, as EMS researchers make progress in identifying new methods for outcome-based studies to determine the true effectiveness of EMS deployment decisions and treatments (beyond traditional cardiac arrest resuscitation, i.e., "yes or no" survival) certain elements of the EMS system remain poorly defined, especially emergency dispatch. The study of Emergency Medical Services (EMS) effectiveness continues to evolve as scientific-based research matures in the dynamic environments of EMS field response and EMS communication center operations. This process will enhance the ability to study correctly the critical decisions made by EMDs using prioritization protocols used in optimal deployment of the limited resources of emergency medical systems. In addition, in order for dispatch decisions to be clinically accurate, there must be an understanding of the composite clinical make-up of each dispatch code as they relate to outcome findings. The detection of such hidden, specific information can only be accomplished by electronically mining the actual answers (clinical and/or situational specifics) to key questions captured by automated dispatch protocol systems. When these combinations and choices are made, they may result in Code Hierarchy Bias during EMD protocol-based evaluation. The solution to correctly link dispatch decisions to patient outcomes for scientific and operational use rests in the ability to detect all relevant clinical information contained in any singular "code". The databases search yielded no results for the Code Hierarchy Bias. An examination was conducted to clearly describe it and determine its implications for outcome-based, clinical studies. The investigators searched known scientific databases (including PubMed, MEDLINE, and GoogleScholar) of previously published outcome studies for a description and impact of this problem. The objective of this study was to describe the concept of hierarchy bias in emergency medical dispatch coding and its implications for affecting accuracy in outcome-based studies and dispatch-based and EMS system design and response deployment. In this study, the phenomenon is termed as "Code Hierarchy Bias". This phenomenon can be identified in both automated and manual protocol systems. When two or more signs, symptoms, or situational conditions are encountered in a calltaker evaluation, but are assigned and reported as a single, dispatch-defined code descriptor during the call-taking process by an EMD, a data hiding "bias," can occur. Response is based on EMD-assigned dispatch codes upon completion of caller-interrogation questions in a dispatch protocol system. Among many other roles, an Emergency Medical Dispatcher (EMD) is responsible for accurate response selection. The value of dispatch in modern Emergency Medical Services (EMS) systems cannot be understated.
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