What Is ProQA™?

ProQA™ is the premier Emergency Medical Dispatcher (EMD) software package. It offers you the automated tools you need to provide the very best in pre-hospital patient care. During the course of an emergency medical call, ProQA guides you through the process of collecting the vital information from the caller, obtaining the patient's status, choosing an appropriate dispatch level, and instructing the caller with medically approved protocols until the dispatched units arrive at the scene.

ProQA is an expert system designed to help you provide the very best in service and speed. Correct dispatch levels are usually determined in less than one minute. ProQA additionally provides you with Dispatch Life Support (DLS) protocols which meet or exceed the international standards for emergency medical dispatching. ProQA is built on a foundation of empirical literature and medical experience relevant to medical dispatching.

It purposely takes into account the unique, non-visual nature of the medical dispatch environment, where patients must be assessed and treated by remote control.

ProQA is based on the Medical Priority Dispatch System™ (MPDS) and provides a standardized format for carrying out the practice of priority dispatching. It is an automated system which operates by evaluating incoming information according to logical rules built on expert medical knowledge. Those using this system must have the very best in EMD training, must have a firm understanding of the MPDS system, and must operate within a quality assurance and improvement environment.

The use of ProQA software by EMDs trained and certified by the National Academy of Emergency Medical Dispatch SM (NAEMD SM ) results in state-of-the-art emergency medical dispatching. Training is also available for communication center supervisors, medical directors, and EMS administrators in the form of a Management Seminar. This seminar provides training on medical management and dispatcher supervision issues related to this software.

ProQA, along with its companion software package AQUA™ (Advanced Quality Assurance), provides a superb quality assurance platform designed specifically for the needs of medical directors, quality improvement coordinators, and dispatch supervisors.

 

What is MPDS™?

At the core of ProQA is the Medical Priority Dispatch System (MPDS). The MPDS has been developed and refined over the last two decades under the direction of Jeff J. Clawson, M.D. The MPDS EMD protocols are supported and continually validated by a scientific, international body of medical experts.

The MPDS is simple, yet complete. It includes Chief Complaint/incident type protocols which help EMDs quickly obtain vital information about patient status and scene conditions. The EMD then uses this information to send the appropriate response configuration as determined by local medical and EMS control. The MPDS also includes DLS treatment sequence protocols covering arrest, choking, and childbirth. These protocols enable a trained and certified EMD to assist the caller in immediately helping the patient.

The MPDS protocols ensure that trained and certified EMDs properly carry out the following four important activities.

1. Structured and rapid caller interrogation and patient evaluation.

2. Accurate selection of the appropriate EMS unit response.

3. Relay of important patient and scene information to field responders.

4. Provision of essential Dispatch Life Support.

In order for EMDs to be patient advocates, they must also be system advocates. EMS agencies must maintain a reasonable level of staffing and unit availability, so when calls come in, EMDs can make the most efficient use of available resources.

Emergency Medical Dispatch
For many years the EMS dispatcher was without a system to ensure accurate decision making based on sound medical principles. Historically, the interrogations conducted by these ill-equipped medical dispatchers resulted in subjective evaluations of the pre-hospital responses required for each call. Inconsistencies in medical dispatch policies, procedures, and practices have led to major legal disasters that could easily have been avoided if the dispatchers had been provided with the training and protocol tools necessary to perform their job properly.

One of the primary purposes of the MPDS protocols is to enable EMDs to determine the appropriate response to send to a given emergency. The protocols help EMDs quickly obtain the patient status and scene information necessary to determine the appropriate dispatch determinant code. The EMD then sends the response configuration that has been assigned to the code by local medical and EMS control. In short, the MPDS helps dispatchers send the right thing, at the right time, in the right way.

In several implementation studies of agencies with both BLS and ALS capabilities, the MPDS reduced the number of ALS responses by 30 percent. The MPDS also produced commensurate decreases in emergency medical vehicle accidents and unit maintenance costs. This happens because the MPDS protocols enable EMDs to make safe response choice decisions based on well-established medical principles, as opposed to making dangerous decisions based on subjective, unstructured interrogations.

Another primary purpose of the MPDS is to enable EMDs to assist callers in aiding the patient prior to on-scene arrival of field personnel. This is accomplished through uniform, medically approved, DLS protocols. All of the MPDS DLS protocols meet or exceed the international standards for emergency medical dispatching.

It has long been believed that emergency medical care begins when the pre-hospital care providers arrive at the scene. However, when EMDs are properly trained and equipped, emergency medical care can begin the moment the dispatcher answers the phone. This makes properly trained and equipped EMDs a critical link in the EMS chain of patient care.

The National Academy Of Emergency Medical Dispatch
One of the most important functions of the National Academy of Emergency Medical Dispatch (NAEMD) is the consideration, research, and adoption (or rejection) of proposed revisions to the MPDS protocols. The NAEMD College of Fellows consists of internationally recognized experts in EMS, public safety telecommunications, and emergency medical dispatching. Just as the American Heart Association establishes the standards for CPR, BLS, and ACLS, the College of Fellows maintains the standards and integrity of all aspects of DLS including MPDS protocols and curriculum.

This orderly process provides a legally-defensible national medical standard in addition to maintaining a unified protocol and curriculum. The MPDS uniform coding system is similar to the U. S. National Fire Protection Administration's Uniform Fire Incident Reporting System (UFIRS) or the ICDM-9 Medical Coding System. Only through the use of a unified coding system can national and international standards be maintained and comparative research be carried out.

EMS responders should be able to expect a reasonable correlation between response level and scene findings. Significant problems, discovered through the use of your agency's designated Medical Dispatch Feedback Report (or equivalent), should be reported through the prescribed channels. This field responder feedback assists in the developing science of EMD by helping to improve the MPDS.

Field responder observations should be carefully and systematically researched and reported. These reports should not attack the MPDS or accuse the EMD, but should include all of the relevant facts. A thorough case review should be completed regarding any seemingly problematic dispatch case. Judgement on these cases should be reserved until the case review has been completed.

Significant findings or trends observed by field personnel and verified by protocol compliance case reviews should be forwarded to the NAEMD College of Fellows. The College of Fellows will evaluate the information and take the necessary action.

 

How ProQA and the MPDS Work

As an EMD using ProQA and the MPDS, your first step with every incoming call is Case Entry (equivalent to the field responder's primary survey). In Case Entry you verify the location and callback number for the incident, and then determine the patient's age, status of consciousness, status of breathing, and Chief Complaint (the Four Commandments of emergency medical dispatching). If you receive information that the patient is unconscious and not breathing (for any reason), before continuing with any further interrogation or instructions, you immediately send a maximal response.

After Case Entry, your next task is to complete the Key Questions from the appropriate protocol (determined from the Chief Complaint). The Key Questions are equivalent to the field responder's secondary survey. They provide you with a more orderly and much closer view of the patient so the pre-hospital care provided is appropriate and in keeping with the severity of the injury or illness.

ProQA then takes the information obtained through Case Entry and the Key Questions and automatically determines the appropriate dispatch determinant code. Your task is to dispatch the response configuration (emergency vehicles and mode of response) assigned to the code.

 

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