How a dispatcher's visual perception improves patient outcomes
Technology to photograph, video and broadcast from an emergency incident to a dispatcher shortens EMS response, improves bystander care and ensures better patient treatment at hospitals
By Eli Jaffe, Oren Blustein, Ido Rosenblat, Roman Sonkin
The decisions of an EMS dispatcher are based on the receipt of verbal phone calls and are often made under tremendous stress. During the call, it is imperative that the dispatcher understands the event’s location, what caused the event, the status of the casualties and the supposed diagnosis. Dispatchers also must provide first aid instructions. All of these steps hinge on the cooperation of the caller.
In face, the dispatcher can only interpret the situation based on his imagination of the occurrences on site based on the auditory description. Oftentimes, the dispatcher may act on her first impressions with some form of uncertainty.
In Hebrew, we have a term "Tmoonat Matzav" for the assessment of a situation which translated literally means, "creating a situational image." Dispatchers are taught to create a situational image of the many pieces of information that are obtained from the scene.
Until recently, this input was all auditory. In recent years, due to the addition of the real-time visual dimension to the dispatcher's work, there has been a major shift in the decision-making processes of the EMS dispatch center. Today's technology enables the receipt of files from a cell phone, along with accurate GPS location, receipt of texts, image and video files and real-time video broadcast.
This ability enables the dispatcher to make decisions on a visual basis and not to merely rely on auditory perception, as has been done up to now. Thus considerably decreasing the uncertainty about the incident, that has been such an integral portion of a dispatcher's activities.
Israel's Magen David Adom implemented new technological systems that make the expression "Situational Image" literally an image. MDA operates these systems to support the decisions made by medical dispatchers. Over recent months, a number of technological systems have been introduced, significantly reducing the time from the initiation of the emergency call to exact geographical location of the patient, estimated diagnosis of the event and its urgency, the medical response that is dispatched to the site, preliminary instruction for assistance and contact with the designated hospital.
Accurate pinpointing of a patient's location requires a time period ranging from a few seconds, in some cases, to a few minutes in others. The technological systems in today's emergency centers usually enable a general location pinpoint within a range of hundreds of meters.
The integration of location sharing technology directly into command and control software enables an accurate determination of the caller's location. The dispatcher receives the accurate location directly into the command and control screen and consequently saves the time of asking questions and keying in responses. This information is particularly essential in open spaces, on roads and highways where the caller cannot explain specify an exact location.
Making urgent decisions
The dispatcher is required to determine the sick or injured individual's medical problem and the urgency required for a response. In the traditional manner, the receipt of the caller's report and a decision on urgency is based on questions and answers between the caller and the dispatcher.
The dispatcher is completely dependent on the feedback received from the typically non-medical professional caller and the caller's ability to cooperate and answer the dispatcher's questions clearly while operating under stress. The receipt of visual data can cut time in the dispatcher's decision-making regarding the patient's situation and considerably reduce dependence on the caller.
Through the implementation of a designated application the caller is able to contact the emergency medical center. Subsequently, a video broadcast can be initiated in real time and be associated to the event in the command and control software, all during the actual call.
The dispatcher only has to ask the caller to aim the cell phone camera at the injured person in order to receive the same view as the caller. In more dramatic events, such as multiple trauma or loss of consciousness, identification shall, of course, be immediate.
If the patient is conscious, the dispatcher can ask the patient questions and obtain a response while gaining a better first impression of the situation and determining the appropriate response. A lesser, but still efficient technological option is the forwarding of image, video and audio files by cellular phone, not in real time.
To connect, the dispatcher keys in the caller's cell number in the relevant location in the call screen. After the caller's phone number is keyed in, the dispatcher will ask the caller to film a clip or still pictures with his phone's camera. The film is saved on the caller's cellphone and it can then be forwarded by SMS or WhatsApp to the designated cell number of the command and control system. The dispatcher sees the event-related file in the software and can then make a decision on the urgency of the event.
Instructions for first aid
In many cases, the dispatcher can instruct the caller or a bystander on basic lifesaving assistance until the ambulance arrives. Without this technology, the dispatcher can provide the instructions, but cannot know if they are carried out and if so how effectively. With the broadcasting of a video in real time, during the call, the dispatcher can easily provide the caller them step-by-step procedures required in a more efficient manner.
Forwarding of visual information to hospital
The ability to receive image and video files from the event location into the command and control system can also contribute in continued medical treatment. These technological resources enable the overall medical system to participate in the decision-making process.
For example, the receipt of an image from an event where fingers have been severed can be forwarded to hand surgeons while the ambulance is still en route to the actual event. The surgeon can prepare for surgery and even be helicoptered to the designated receiving hospital during the initial moments of the event.
Magen David Adom command and control software screenshot with a real call with an amputation of the hand in a remote rural area, The images allowed the dispatch of the medical helicopter even before the ambulance got to the scene. The images were then sent to the surgeon who operated on the patient in order to prepare to the operation before the patient's arrival to the hospital.
These images and films can also assist in interpreting ECG's and enable direction of the patient directly to the catheterization lab or operating room.
The visual dimension that has entered EMS can considerably reduce the uncertainty that is so rampant in the dispatch center's activities. The expression "a picture is worth a thousand words" becomes real when human lives depend on the speed at which the medical dispatcher can determine that the situation is a true emergency.
In the very near future, the visual world will change the activities of the prehospital emergency medical dispatcher, shortening response times, making first aid provided by bystanders more efficient and ensuring continued advanced medical treatment at hospitals.
About the authors
Dr. Eli Jaffe, Ph.D., EMT-P, is the Director of Training, PR, Volunteer Activities, Marketing and International Relations Division, of the Israeli national EMS organization – Magen David Adom. He has published books and articles and is an authority in the fields of Emergency Medicine and Medical Management and is also one of the leading researchers in Israel in the field of volunteers and the prevention of PTSD. Dr. Jaffe is a well-known lecturer in the Israeli universities. Email: EliY@mda.org.il
Mr. Oren Blustein, Adv., LL.B., L.L.M, M.A, B.A., MHA, EMT-P is the deputy director of Magen David Adom in Israel and the manager of the IT arrays. Email: OrenB@mda.org.il
Mr. Ido Rosenblat, B.A, MHA, EMT-P is the national director of the EMS dispatching centers of Magen David Adom in Israel. Ido is a senior and airborne paramedic. He orchestrated the implementations of innovative technologic solutions at the various dispatch centers to improve dispatches response times and service quality. He also created professional qualification standards and trainings programs. Email: IdoR@mda.org.il
Mr. Roman Sonkin, EMT-P, B.EMS is an instructor at the Magen David Adom national paramedics school, a certified ACLS instructor and an active paramedic in the MICU array. Roman finished his bachelor's degree in EMS at Ben-Gurion University and is responsible for academic research and publishing at Magen David Adom. Email: RomanS@mda.org.il