Emergency Medical Dispatcher - History - 1970s Onward

1970s Onward

One of the first known examples of call triage occurring in the dispatch centre occurred in 1975, when the Phoenix, Arizona Fire Department assigned some of its paramedics to their dispatch centre in order to interview callers and prioritize calls. The following year, Dr. Jeff Clawson, a physician employed by the Salt Lake City Fire Department as its Medical Director, developed a series of key questions, pre-arrival instructions, and dispatch priorities to be used in the processing of EMS calls. These ultimately evolved into the Medical Priority Dispatch System (MPDS), APCO (EMD) and PowerPhone's Total Response Computer aided call handling (CACH) system. Such systems were initially technologically quite primitive; in the mid-1970s the use of computers in dispatching was extremely uncommon, and those that used them were dealing with very large mainframe computers. Most such systems were based on either reference cards or simple flip charts, and have been described by lay people on more than one occasion as being like a "recipe file" for ambulance dispatchers. The development of pre-arrival instructions presented an entirely new challenge for those involved in emergency medical dispatch; it might take eight or more minutes for paramedics to arrive at the patient's side, but dispatchers could be there in seconds. Physicians began to see a dramatic new potential for the saving of lives by means of simple scripted telephone instructions from the dispatcher, and the concept of Dispatch Life Support was born. Suddenly dispatchers were providing complex information and instructions to callers, and even providing guidance on performing procedures such as cardiopulmonary resuscitation (CPR) by telephone. The concept became an area of medical research, and even EMS Medical Directors debated on the best approach to such services.

As technology, and particularly computer technology, evolved, the dispatching of EMS resources took on an entirely new dimension, and required completely new skill sets. The process of dispatching was supported by computers, and moved in many locales to a 'paperless' system that required above average computer skills. Computer-assisted dispatch (CAD) systems not only permitted the dispatcher to record the call information, but also automated the call triage process, allowing EMD systems to become algorithm-based decision support tools. Technologies once available only to the military, such as satellite-based Automatic Vehicle Location allowed CAD systems to constantly monitor the location and status of response resources, making response resource assignment recommendations to human dispatchers, allowing human dispatchers to watch the physical movement of their resources across a computerized map, and creating a permanent record of the call for future use.

Emergency medical dispatchers and prioritized dispatching have become a critical and demanding part of EMS service delivery. The PSAP and, in effect the EMD, become the functional link between the public and allocation of emergency resources, including police, fire and EMS. As the system has evolved and become professionalized, control of the Advanced Medical Priority Dispatch System (MPDS), originally developed by Dr. Jeff Clawson, has been turned over to Medical Priority Consultants, Inc. (now known as Priority Dispatch Corporation), while APCO and PowerPhone developed separate systems. The National Academy of Emergency Medical Dispatchers was subsequently established by Dr. Clawson as a non-profit advisory organization to develop products and services provided by PDC. A formal process for the development of emergency medical dispatch protocols and guidelines continues to be developed by National Institutes of Health; the National Association of Emergency Medical Services Physicians (NAEMSP), a professional association of EMS medical directors; and the National Association of State Emergency Medical Services Directors (NASEMSD).