EMS Best Practices
Key Components of Best Practice Dispatching
Dispatch has historically been the weakest link in the EMS chain. A failure to recognize the vital role that dispatch plays in operational efficiency and the delivery of patient care has relegated it to the status of an inferior step-child. Quality dispatching has often been determined more by the talent of the person sitting in front of the console than by any process that a manager could control. And historically most EMS managers have evaluated the quality of their dispatch based on radio diction, accuracy of addresses, and the number of complaints from street providers. But because of the increasing importance of triage in controlling the cost of health care, dispatch is fast becoming the focal point of EMS systems and a key determiner of best practice operations. With this article, EMS Best Practices begins an ongoing look at EMS dispatch by considering one of the most renowned best practice dispatch centers in the nation.
"One of the best of the best is Clark Regional Communications Agency (CRCA) of Clark County, Washington," said Robert Martin, executive director of the National Academy of Emergency Medical Dispatch. One of the first communication centers to be accredited by the Academy, CRCA operates in southwestern Washington in an area bordered by the Columbia River and including most of the Mount Saint Helens recreation area. Clark County is one of the fastest growing high-tech regions in the country. Its population of 350,000 is spread across a 700-square mile area that includes seven cities, all of which receive emergency services from three ambulance providers, eight fire departments and seven police agencies. CRCA is part of the County Department of Emergency Services and provides complete 911 call-taking and dispatching for all of the public safety agencies, answering 1,100 to 1,400 calls per day and managing 20,000 medical calls per year.
"I would put CRCA up against any dispatch center in the country," said Chief Dennis Mason of Clark County Fire District 11, one of CRCA’s customers. Mason’s confidence comes from the outstanding manner in which CRCA consistently serves all of its customers, especially in dispatching EMS calls. Those customers, according to John Talbot, who directs CRCA’s operations, include not only Clark County citizens, but all of the emergency providers and elected officials. What does it take for CRCA to accomplish its mission of "Excellence in 911 Communications"?
Leadership and Money
When EMS managers consider quality in emergency medical dispatch, they correctly zero in on such specifics as how calls are handled and what information their ambulances receive from the call center. But according to Terry Marsh, vice president of operations for AMR Northwest and another CRCA customer, leadership is what makes CRCA the highest quality call center that he has encountered. "The quality there starts from the top and works down," he said, speaking specifically about CRCA’s Executive Director Thera Bradshaw and how she has marshaled support from elected officials, providers and taxpayers.
Excellence in leadership began well before Bradshaw’s tenure at CRCA, she said, "with some visionary leaders and elected officials who decided they wanted to do the right thing for the citizens." These leaders saw the emerging importance of dispatch and the need to carefully allocate resources to serve a region that was and continues to experience explosive population growth. They acted on their vision by building the infrastructure necessary for political and financial support. That support, according to Bradshaw, is the most important first ingredient in creating a quality dispatch system. "We wouldn’t have the funding if we didn’t have leadership and vision from elected officials and people in this organization," she said.
With adequate funding, CRCA has been able to build a state-of-the-art facility with the latest computer equipment and software. But more importantly, it has hired and trained a highly professional staff of 47 dispatchers, six supervisors and talented managers. CRCA’s proactive leadership also has involved itself in the community to make sure that it is serving all of its customersan effort that makes a good impression on users. "When you see what Bradshaw has done, it’s really incredible," said AMR’s Marsh. "She’s out there more than anyone else, listening, greasing the skids and making sure that users of the system are pleased."
Measure the Product
Fitting hand-in-hand with leadership and vision, a best practice dispatch center understands that the quality of its services and products must be measurable. Few EMS managers would dispute that the product of dispatch should be to receive and triage calls, provide pre-arrival instructions and give responders a clear and accurate picture of what to expect at the scene. What is often debated is how to measure the quality of what comes out of a dispatch center. Jeff Clawson, MD and originator of the Medical Priority dispatching said, "The problem is most dispatch centers are a black hole in space where a lot of information is going in, but little good information is coming out. If you want to improve what comes out, you need to have a quality oversight structure that measures what’s coming out."
CRCA continually measures what’s coming out of its dispatch center through continuous case review. A full-time equivalent is budgeted to review and measure compliance to medical dispatching protocols. Doug Lee-Smith, administrative support manager at CRCA, believes that distinguishing between the use of subjective guidelines and measured compliance to protocols is at the core of CRCA’s success. "In the 1980s, we were using some [dispatch] cards, but we didn’t know if we were following protocols," he said. "A lot of centers are following priority dispatch principles, but the piece that is missing is the quality assurance." He said what matters at the end of the day is whether or not dispatchers have followed protocols. (In a future issue, we will discuss guidelines vs. protocols in depth).
This dedication to quality is what led CRCA to seek Academy accreditation. While accreditation is difficult to attain, Bradshaw said, "It was the right thing to do for the community. We wanted to be able to assure our community that we were doing it correctly."
People Make it Happen
Finally, what makes CRCA shine has been the continuous promotion of professionalism for the front-line dispatcher. According to Clawson, an environment of professionalism through initial training, performance assessment, continuing education, and compensation is key. CRCA takes nine months to one year to fully train new dispatchers. Initial training is followed up by a rigorous QI process that tailors continuing education to needs. In addition, CRCA has created a rewarding work environment in which turnover is minimal. Contract negotiations have just concluded, and a frontline dispatcher will top out in the year 2001 at $23/hour plus benefits.
For more information: A list of National Academy of EMD-accredited dispatch centers and the Academy’s 20 Points of Accreditation are available at http://www.naemd.org A comprehensive resource is the second edition of Principles of EMD by Clawson and Kate Boyd Dernocoeur, which was released in 1998. (third edition now available - 2001)