BACKGROUND

As a premier body of EMS professionals, The National Association of EMS Physicians (NAEMSP) appoints, through its Standards and Practice (S & P) Committee, interested members who are experts, or want to develop expertise in related aspects of EMS.  These members are designated to develop position statements on EMS topics of interest to them and of importance to the field.  These draft position statements are then critiqued by the members of the S & P Committee, and alterations made in response to concerns and subsequent recommendations of the Committee members.  The chair of the S & P Committee then approves the draft for scrutiny and judgment by the Board of Directors (BOD).  The version that is approved by the BOD for publication is the official position statement of the organization, and is its intellectual property.

The members who have developed and amended the NAEMSP position statement that met NAEMSP BOD final approval are invited to author a detailed supporting document that expounds on the position statement.  The NAEMSP “Emergency Medical Dispatch” Position Statement was first approved in 1989 and published in Prehospital Disaster Medicine; Vol. 4(2): 163-166.  It was the first published position statement that was approved by NAEMSP.  The second and most recent position statement was approved and published in 2007, under new rules separating the position statement from the companion supporting document.

The following “Resource Document for the EMD Position Paper” both reviews and updates previously presented concepts, as well as introduces new developments in the field of emergency medical dispatch.  It has been approved by both the S & P Committee and the BOD of NAEMSP.  It also has the endorsement of the International Academy of Emergency Dispatch Board of Trustees.  This document provides EMS and EMD rationale that supports the positions and the published literature that, in turn, supports these views.  Its organization follows the topical sequence in the most recent position statement.

RESOURCE DOCUMENT FOR THE EMD POSITION PAPER

Introduction

Emergency medical dispatch is, sequentially, the first-activated professional link in the vital chain of survival for cardiac arrest 1,2The appropriateness of training, protocols, policies, quality management, and medical oversight of emergency medical dispatchers (EMDs), reflects the quality of the EMS system, of which dispatch is an integral component.  EMDs provide pre-arrival instructions to callers for patient care through scripted protocols. They triage emergency medical calls by level of medical acuity, and they manage their jurisdictions’ EMS response resources efficiently to provide each patient with the most appropriate level of care possible.

With respect to these systems, professional medical service to a patient begins when the telephone is answered in the public safety answering point (PSAP) in response to requests for unscheduled medical assistance.  It is at this point, prior to the scene arrival of EMS personnel, that the first opportunity exists to provide medical care. Thus, involvement of a medical director in emergency medical dispatch programs is crucial to ensure that the questions asked of callers and the information given to them are both appropriate to the out-of-hospital setting and reflective of the highest standards of medical practice available in each community served by EMS.  The following resource document supports the NAEMSP position statement, “Emergency Medical Dispatch.

 

DISCUSSION

It was once stated that “EMD is the jewel upon which the watch movement of EMS turns”.  EMDs can provide expert evaluation, care, and direction before any responding professionals can physically reach and assess the scene and its patients.  They have played a vital role in the ability of the EMS system to respond to perceived medical emergencies since at least 19753. In the majority of cases, the information obtained by them to accomplish this occurs through telephone communications with a caller who is distressed occasionally, and almost always undirected4.  EMDs must have skills that allow them to discover, then match the caller’s needs with the appropriate personnel and equipment designated to address the perceived emergency5,6To accomplish this, they must be able to discern the nature and the urgency of the illness(es) and/or injury(ies) in a manner that allows selection of the most appropriate response configuration and mode7,8

Furthermore, studies indicate that EMDs play a crucial role in providing emergency care by giving pre-arrival instructions that lead a caller to initiate appropriate first aid treatment and life support for a victim prior to the arrival of any EMS personnel9,10. The capable EMD, thereby, provides “first, first responder” care through the surrogate caller. Use of these pre-arrival instruction skills potentially preserves patients’ lives, prevents further injuries to patient(s), provides direct safety advice to the caller and bystanders, guides the arrival and on-scene behavior of responders that preserves their safety, and even assists in childbirth.

Position Statement 1: Tested knowledge and demonstrated skills in the area of basic telecommunications should be requisite for all emergency telecommunicators.  Further training to the level of emergency medical dispatcher should be required for all personnel who receive calls for medical assistance and/or dispatch those resources.  Governments should approve statutes or regulations that require EMDs to be certified/licensed in accordance with nationally accepted standards for emergency medical dispatch.

Certain skills should be requisite for all public safety communicators.  Basic telecommunication skills include the theory and operation of complex communication equipment, troubleshooting of the same, and basic radio and telephone communication skills. The training and certification of EMDs should be built upon this foundation, which is generic for acceptable performance in the role of medical, fire, law enforcement, air medical, military, or park service dispatcher, or any combination thereof.

EMDs need knowledge and skills that are specifically designed to address medical issues in a telecommunications environment10. Instruction should include specific medical information, expressible in lay terminology, that is sufficient to acquire a medical history appropriate to the dispatch environment11. This training should also impart specific knowledge regarding the particular characteristics of a given emergency medical communication center’s dispatch protocol and program that affects the execution of the most appropriate scene response decisions, advice, treatments, and responses11.  Without this special training to transform public safety communication personnel into skilled professional EMDs, there is risk of dispatching inadequate personnel and equipment to major problems while mobilizing unnecessary system resources for minor problems 11,12,13,14,15,16. The latter circumstance may result in depriving others in need of such inappropriately committed services, while the former places patients, the general public, and emergency responders at risk.

The ability to interact with anxious, uncooperative, and, at times, distracted callers rests on the ability of dispatchers to anticipate the actions of the undirected caller, assist the caller in regaining self-control, and then converting the caller into a calmer, more effective first responder17,18. Each of these steps is essential to performing prescribed duties and contributes to the substantial responsibilities delegated to EMDs.  Detailed, targeted, medical dispatch-specific training is required to develop these unique skills, and no more clarifying example of this concept’s importance exists than that of dispatcher intervention in cardiac arrest19. The ultimate goal is to master the skill of applying the correct, compliant, confident use of formal emergency medical dispatch protocols.

EMDs need knowledge and skills that are specifically designed to address medical issues in a telecommunications environment.  It follows that a curriculum for their training differs substantially from that used in the training of EMTs or paramedics20. Training as an EMT or paramedic does not adequately prepare a person for the role of an EMDs. Much of the required emergency medical dispatch curriculum cannot be found in standard EMS training curricula. Because the environment, content, and emphasis differs significantly from that used for the training of all other health professionals, and even other public safety dispatchers, instructor requirements should include training and certification as EMDs, subsequent dispatch-related experience, and a minimum of advanced life support (ALS) training and EMS experience in the field, since the emergency medical dispatch instructor is responsible for teaching core course materials, and explaining to students their medical practice basis, of which at least some are dispatch priorities of an expertise-sensitive, ALS-level medical nature21. An instructor requirement of EMS experience in the field at the advanced life support level is thought to be invaluable for the correlation of emergency medical responder safety and critical care rendered in the field to the medical dispatch knowledge upon which crucial decisions transmitted to responders and instructions to callers are based22.  All instructors, after successfully completing a recognized emergency medical dispatch course, should complete an instructor course prior to assuming this teaching role23.  They should be expected to be responsible for conducting initial certification training to the level of EMD, continuing dispatch education, and periodic recertifications that should be required of all dispatchers functioning in medical dispatch agencies in order to stay abreast of relevant medical practice developments24.

Recognition of the important role of EMDs in the delivery of prehospital EMS by responsible governmental agencies, and by the public in general, is important for the public’s health and protection11, 25  Without such recognition, and its enactment in the form of licensure26 or certification, it is unlikely that the crucial training of these professionals will be mandated.  An increasing number of states, regions, counties, and municipalities certify, or at least, require both standard training of EMDs and their formal use of structured protocols27.  Minimum standards have been developed and promulgated for the selection, training, certification, and/or licensure of all public safety telecommunicators, and specifically, EMDs 28,29.

Position Statement 2: The use of formal, medically approved emergency medical dispatch protocols should be required for the practice of emergency medical dispatching. In all EMS systems, prioritization of calls to be dispatched should be an essential element. 

Since emergency medical dispatching responds largely to the emergency needs of particular jurisdictional populations that contain, to variable degrees, a mobile, national, transient subpopulation, the policies, procedures, and protocols utilized by trained EMDs should be structured and standardized, based upon national standards, both in response to a national public’s expectations, as well as for the public’s optimal safety and health, and the integrity of the system that protects it30American Society for Testing and Materials. Standard Practice for Emergency Medical Dispatch. In Annual book of ASTM standards. Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1258-00. 2000[/note].  While the resources dispatched vary according to the type and level of medical care possible to provide by specific local EMS systems serving unique communities and coverage commitments, the histories of symptoms and signs that EMDs obtain by telephone and the on-line medical care rendered by them can and should conform to national standards for equitable care across the country’s communities31.

EMDs’ use of standardized, structured protocols is as crucial as for any medical practitioners who are required to operate at maximal efficiency in a time-restricted environment32. Similar to a pilot’s use of a pre-flight checklist, use of standardized, structured protocols are meant to assure the attainment of all clinical, operational, and safety objectives on-scene that are required in an unregulated, time-sensitive environment characterized by enormous case variation. Protocols reduce practice variations that can be introduced otherwise by individual dispatchers, work shifts, and 9-1-1 centers33,34. By the unique nature of the 9-1-1 environment, omissions and errors born of arbitrary decisions made on dispatch prioritization may have dire consequences35,36,37. Haphazard dispatch decisions by dispatchers have been shown to place victims of serious illness or injury at unnecessary risk and have resulted in significant liability to systems lacking the protocols, procedures, and policies essential to prioritizing calls38,39,40,41,42. With the use of unified, standard protocols, dispatchers’ conduct will be less vulnerable to charges of careless or reckless judgment 43,44,45,46,47.

The content of these protocols must be reviewed by expertly staffed standards groups that contain public safety and health experts and physicians with medical dispatch expertise.  Local and untested modification of protocols should be discouraged, as the complexity of such protocols is often significantly underestimated48. Compliance to these protocols should be enforced according to emergency medical dispatch operations and quality assurance policies49.

The appropriate prioritization of the type, number, and manner of response resources is essential in all EMS systems to reduce the number of responding vehicles traveling lights-and-siren, and therefore, the attendant risk of unnecessary emergency vehicle and “wake effect” crashes50.  Prioritization is meant to assure that emergency crews will not be committed inappropriately to emergency cases that are non-life-, brain-, heart-, or limb threatening, and that the right care will be sent in the right way, to the right patient, and at the right time.  In order to prioritize calls properly, EMDs should be well versed in the dispatch-specific understanding of medical conditions and incident types facing them routinely. For it to function appropriately, the levels of call-prioritization must correspond to well-defined parameters of appropriate response, including the expertise level of personnel (ALS vs. BLS vs. first responder), response configuration (numbers and types of vehicles responding), and time sensitivity of the patient medical condition, which translates into mode of response (light-and-siren vs. routine)51.  The development of standardized responses based on these dispatch parameters for an agency or locality should be carefully thought out by dispatchers, their managers, supervisors, and medical director, and then ultimately, approved by the medical director10, 31. Mounting data regarding the issues of both time-to-dispatch and response times continue to suggest that “doing it right” is more important than “doing it fast,” time-life critical emergencies excepted52,53,54. Appropriate dispatch prioritization supports risk management and reduces legal liability in an arena in which human error and its dire consequences are clearly foreseeable55,56

Position Statement 3: The provision of pre-arrival instructions should be a mandatory function of every EMD in a center that interrogates callers and prioritizes medical calls.  Pre-arrival instructions should take into account the dispatch-specific (i.e., non-pretrained caller, non-visual environment) circumstances of providing standard basic life support and/or advanced life support procedures and care to callers, known as dispatch life support.

Since EMDs first demonstrated successful provision of pre-arrival instructions to callers attending victims of drowning and cardiopulmonary arrest in 1974, pre-arrival instructions studies have supported their value as a mandatory function of the EMD8, 9, 3557,58. Provision of such instructions is considered safe, and, it is an ethical imperative, where applicable. Telephone instructions are given to the caller, empowering him/her to treat the patient, protect both the patient(s) and the caller from further harm or injury, and to initiate life-impacting treatments by transforming undirected, helpless callers into calmer on-scene “rescuers”59,60American Society for Testing and Materials. Standard Practice for Training Instructor Qualification and Certification Eligibility of Emergency Medical Dispatchers. In Annual Book of ASTM Standards, Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1552-94. October, 1994[/note],62. The lay public today has very high expectations of receiving pre-arrival instructions63,64.  In essence, pre-arrival instructions remotely transform EMDs into the “first” first-responders who, through immediate action, can effectively eliminate the often-deadly time gaps that occur between receipt of a call for a life-threatening condition and the beginning of onscene treatment by responding EMS personnel.

Dispatch life support (DLS) refers to the overall body and science of pre-arrival telephone instructions provided by trained EMDs functioning from standard, scripted, medically approved protocols1, 65,66. Training, including certification, and recertification processes, should include those portions of ALS and BLS appropriate to application by medical dispatchers.  This  maintains and continually upgrades these unique, and, at times, life-saving, non-visual skills67,68. To strengthen these skills, it is important for EMDs to understand the underlying philosophy of medical interrogation and the psychology associated with the provision of pre-arrival instructions69,70,71. This knowledge and its associated skills result from appropriate teaching and training, direction, and management of EMDs72,73.

Position Statement 4:  The “medical service” in EMS begins when a public call is received at a public safety answering point or other agency that provides prehospital emergency care in response to requests for unscheduled medical assistance.  All centers servicing requests for medical assistance should have medical oversight by a physician medical director, with knowledge at least to the level of a certified EMD, who is responsible for all medical aspects of the EMD program by which these calls are processed.

The quality of all the medical care delivered by any EMS system is the ultimate responsibility of the medical director(s) of that system74,75,76,77. Therefore, all of the policies and procedures regarding medical care rendered from the emergency medical dispatch center are the responsibility of the EMS medical director and hence, must be approved by the medical director of the system and/or the designated dispatch center medical director.  Key to the medical director’s role in the management of medical dispatch function is his or her understanding of the concepts of emergency medical dispatch and its physical operation, accountability for the protocols, policies, and procedures relevant to emergency medical dispatch activities, and the quality management process that monitors and improves them78,79,80.  In terms of the practice of these responsibilities, as the newly board-certified specialty of EMS and its component emergency medical dispatch medical direction matures, a commensurate maturing level of accountability will be expected of the medical director by other EMS professionals as well as those patients cared for through emergency medical dispatch.  This credibility can be achieved by acquiring knowledge and skills, at least to the level of certified EMD, for all physicians providing medical oversight. One pathway through which to accomplish this is for physicians responsible for medical dispatch oversight to take a complete, recognized EMD certification course. In summary, the medical aspects of emergency medical dispatching and communications are an integral part of the responsibilities of the medical director of each EMS system and/or medical dispatch program medical director. Recent developments resulting from new challenges that are described in the following position statement sections (see Position Statements 6 and 7) have expanded these responsibilities.

Position Statement 5: Quality improvement and risk management activities should include oversight of calltaker compliance with protocols, including levels of protocol use reliability and consistency.  These are essential for effective, safe, and risk-averse medical dispatch operations. 

Quality assurance, risk management, and their medical oversight are essential elements for the acceptable performance of all medical dispatch centers and EMS systems81,82,83,84. Routine, data-based medical reviews of the performance of individual EMDs, as well as medical dispatch center shifts, and centers as a whole, coupled with performance feedback, produces constant improvement in protocol compliance85,86. Dispatch review committees constitute one method of providing quality assurance for emergency medical dispatch activities and the medical aspects of dispatch center operations. Such committees should be composed of prehospital EMS physicians, the physician responsible for the provision of dispatch medical oversight and quality improvement, dispatch supervisors, management personnel, field EMTs and/or paramedics, dispatchers, as well as other associated 9-1-1 and public safety personnel87. Every member should be familiar with all relevant aspects of EMS communications, most specifically, the medical dispatch process, and should be involved continuously with its function relative to medical care developments, 9-1-1 operations, and patient care88.

Position Statement 6: EMD medical directors should participate in the design, operation, and data analysis of medical dispatch, data-based programs for community injury and disease surveillance, wherever these programs are possible to implement. 

Emerging, naturally occurring, infectious diseases (i.e., SARS, West Nile fever, avian and swine flu) and those associated with biological terrorism (i.e., anthrax, smallpox, etc.) threaten EMS providers, as well as the general public, with the possibility that the former may unwittingly become vectors of these diseases, further endangering the latter.  One of the earliest points, in both time and space, to detect such outbreaks occurs when victims call 9-1-1 for emergency medical care.  While not possessing the clinical specificity of emergency department-based surveillance programs, dispatch protocol-based, interrogation-generated, medical data offer valuable and broad population coverage (“footprint”) geographically, through geographic information system (GIS) mapping, and temporally, through electronic syndromic incidence plotting89. This advantage enhances the possibility of detecting symptom-delayed and population-defused events (both characteristics of bioterrorism) earlier than through traditional epidemiological investigation methods. This possibility has led to development of automated emergency medical dispatch protocol/computer aided dispatch (CAD)-based surveillance programs in coordination with jurisdictional public health departments90,91,92.

Similarly, geographic distribution patterns of injury mechanisms, severity, and their frequencies have been mapped based on medical dispatch-generated CAD data93. Discovery of high-frequency injury environments can lead to alteration in law enforcement and EMS geographic deployment as well as investigation of the risk factors involved, prompting injury prevention initiatives94,95. As a public health responsibility, medical dispatch program medical directors should participate in the design and implementation of emergency medical dispatch-based disease and injury surveillance programs, and are primarily responsible for the analysis of the resultant data.  As an occupational health responsibility to EMS care providers, dispatch program medical directors should participate in the evolution of standards and implementation of protocols consisting of questions to callers that are targeted to discovering on-scene risks prior to providers’ arrival.  The standards for such protocols should be maintained by national emergency medical dispatch standard-setting organizations with contributions and evaluations by medical dispatch industry experts and public health officials.

Position Statement 7: Investigation of the need for, and the safety and potential effectiveness of expanded service options as an alternative to dispatching resources to the scene in response to emergency medical calls, should be a medical director responsibility.

Increasing demands on limited EMS resources have stimulated the search for non-EMS, “on-line” referral services to better address the emergency medical caller’s specific healthcare needs, while achieving efficiencies for EMS by conserving ambulance expertise and resources for those callers whose EMD assessments show will most benefit from them96,97,98. Examples of these professional services include medical examiner resources to respond to expected and obvious deaths, emergency mental health services to handle psychiatric/behavioral/suicide calls, rape crisis centers to address non-physically injured sexual abuse calls, poison control (toxicology) centers to address overdose/poisoning calls, and dispatch center-directed telephone advice nurse programs to address stable patients in need of primary care resources outside the EMS system50, 5199,100. In regard to such liaison programs, the dispatch program medical director must investigate their potential patient value and safety (protection features), develop the policies by which the liaison and interface to these programs will function, implement protocols, then monitor dispatcher compliance with them, and the quality of resultant service and outcomes101.

Position Statement 8:  Research designed to improve emergency medical dispatch should focus on the specific components of the process (e.g., interrogation questions, dispatch prioritization descriptors, post-dispatch instructions, pre-arrival instructions, and safety element advisories) and/or their relationships.  

Research targeted on components of the emergency medical dispatch process will strengthen the overall emergency medical dispatch programs’ validity, and is expected to lead to improved patient outcomes102. Such research evaluations can then be correlated with patient outcomes and scene conditions, where possible, to safely and credibly improve system response103.  The predominance of emergency medical dispatch research has focused on the effectiveness of pre-arrival instructions in resuscitating cardiac arrest victims, although other research has focused specifically on identification of cardiac arrest by EMDs 104,105.  It has demonstrated that dispatch-assisted CPR instructions significantly increase bystander CPR rates106.  A majority of this research has been designed to measure the effectiveness of the traditional verbal-only instruction dimension, with plans to measure its effect on survival to hospital discharge107.  However, with the rapid development of telecommunications modalities into the video realm, one study has delineated the current deficiencies in audio-only dispatcher-assisted, non-scripted CPR instructions with plans for video integration and the possible need for subsequent enhancements to dispatcher training and protocols108.

Research aimed at system efficiencies and service response effectiveness has been addressed.  A 2005-2006 study based on London Ambulance Service data (1,137,873 calls over one year) concluded that response resource choices were both more accurate and consistent when based on protocol rather than on subjective experiencebased determinations109.

Research aimed at very specific aspects of dispatcher interrogation has resulted in significant improvements in protocol design110.  Another study based on London Ambulance Service data showed a significant improvement in the identification of cardiac arrests within the patient group of seizure calls that otherwise receive lower acuity codes111.

On the other end of the patient acuity spectrum, another robust body of research has focused on  dispatcher accuracy in identifying patient low acuity61, 62, 63112,113,114.  Several critical issues challenging EMS have brought this subpopulation into research focus.  From a population perspective, the low acuity patients present EMS with most of its demand for service.  This presents a public health challenge of how to most safely and efficiently meet their needs, while preserving the EMS system resources, expertise, and timely responsiveness for patients at the high acuity end of the spectrum.  Their need for access to primary care settings has already come into political focus nationally, and this focus will likely grow.  Key to resolving this debate within EMS operations will be the accuracy in defining this population telephonically.  The responsibility for that lays clearly within emergency medical dispatch.  Defining this subpopulation accurately also affects the need for lights-and-siren responses and the risks therein115.  The issue also brings into focus the response expertise issue (ALS vs. BLS), with its attendant economic implications for any given EMS service116,117.

Research based on specific predictability aspects of dispatch clinical findings based on compliant protocol use64 has the ability to confirm or modify individual aspects of dispatch protocol design 118,119,120,121.

CONCLUSION

EMDs provide the important, first professional link in the overall EMS chain of care. In order to assure high quality professional performance in this key aspect of prehospital emergency medical care, the EMS medical director must provide commensurate high quality medical oversight for EMDs.  This should be mandatory for the development of their training, the quality management of their performance, and the communication center’s safe, effective patient care.

REFERENCES

Citation: Yancey A, Clawson J. EMD position paper resource document. Annals of Emergency Dispatch & Response 2014;2(2):32-39.

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References

  1. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute. Emergency Medical Dispatching: Rapid Identification and Treatment of Acute Myocardial Infarction. Washington, D.C. NIH Publication No. 94-3287. July, 1994
  2. Clawson JJ. Dispatch Priority Training—Strengthening the Weak Link. Journal of Emergency Medical Services. 1981; Vol. 6, No 2: 32-36
  3. Zachariah BS, Pepe PE. The Development of Emergency Medical Dispatch in the USA: A Historical Perspective. European Journal of Emergency Medicine. 1995; 2:109-112
  4. Clawson JJ, Sinclair R. The Emotional Content and Cooperation Score in Emergency Medical Dispatching. Prehospital Emergency Care. 2000; 5:1
  5. Stratton SJ. Triage by Emergency Medical Dispatchers. Prehospital and Disaster Medicine. 1992; Vol. 7, No. 3: 263-268
  6. Cone DC, Galante N, MacMillan DS. Can Emergency Medical Dispatch Systems Safely Reduce First Responder Call Volume? Prehospital Emergency Care. 2008; 12: 479-485
  7. Cone DC, Galante N, MacMillan DS. Can Emergency Medical Dispatch Systems Safely Reduce First Responder Call Volume? Prehospital Emergency Care. 2008; 12: 479-485
  8. Bailey E, O’Connor R, Ross, R. The Use of Emergency Medical Dispatch Protocols to Reduce the Number of Inappropriate Scene Responses Made by Advanced Life Support Personnel. Prehospital Emergency Care. 2000; 4:2
  9. Carter WB, Eisenberg MS, Hallstrom AP, et al. Development and Implementation of Emergency CPR Instruction Via Telephone. Annals of Emergency Medicine. 1984; Vol. 13: 695-700
  10. Kellermann AL, Hackman BB, Somes G. Dispatcher-assisted Cardiopulmonary Resuscitation: Validation of Efficacy. Circulation. 1989; Vol. 80: 1231-1239
  11. Clawson JJ. Dispatch Priority Training—Strengthening the Weak Link. Journal of Emergency Medical Services. 1981; Vol. 6, No 2: 32-36
  12. Cone DC, Galante N, MacMillan DS. Can Emergency Medical Dispatch Systems Safely Reduce First Responder Call Volume? Prehospital Emergency Care. 2008; 12: 479-485
  13. Bailey E, O’Connor R, Ross, R. The Use of Emergency Medical Dispatch Protocols to Reduce the Number of Inappropriate Scene Responses Made by Advanced Life Support Personnel. Prehospital Emergency Care. 2000; 4:2
  14. American Society for Testing and Materials. Standard Practice for Emergency Medical Dispatch. In Annual book of ASTM standards. Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1258-00. 2000
  15. Kennedy JD, Sweeney TA, Roberts D, O’Connor RE. Effectiveness of a Medical Priority Dispatch Protocol for Abdominal Pain. Prehospital Emergency Care. 2003; 7:7
  16. Feldman MJ, Verbeek PR, Lyons DG, Chad SJ, Craig AM, Schwartz B. Comparison of the Medical Priority Dispatch System to an Out-ofhospital Patient Acuity Score. Academic Emergency Medicine. 2006; 13: 954-960
  17. Clawson JJ, Sinclair R. The Emotional Content and Cooperation Score in Emergency Medical Dispatching. Prehospital Emergency Care. 2000; 5:1
  18. Clawson J. The Hysteria Threshold: Gaining Control of the Emergency Caller. Journal of Emergency Medical Services. 1986; Vol. 11, No. 8: 40
  19. Hauff SR, Rea TD, Culley LL, Kerry F, Becker L, Eisenberg MS. Factors Impeding Dispatcher-Assisted Telephone Cardiopulmonary Resuscitation. Annals of Emergency Medicine. 2003; 42:731-737
  20. American Society for Testing and Materials. Standard Practice for Training Instructor Qualification and Certification Eligibility of Emergency Medical Dispatchers. In Annual Book of ASTM Standards, Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1552-94. October, 1994
  21. American Society for Testing and Materials. Standard Practice for Training Instructor Qualification and Certification Eligibility of Emergency Medical Dispatchers. In Annual Book of ASTM Standards, Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1552-94. October, 1994
  22. American Society for Testing and Materials. Standard Practice for Training Instructor Qualification and Certification Eligibility of Emergency Medical Dispatchers. In Annual Book of ASTM Standards, Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1552-94. October, 1994
  23. American Society for Testing and Materials. Standard Practice for Training Instructor Qualification and Certification Eligibility of Emergency Medical Dispatchers. In Annual Book of ASTM Standards, Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1552-94. October, 1994
  24. American Society for Testing and Materials. Standard Practice for Emergency Medical Dispatch Management. In Annual Book of ASTM Standards, Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1560-94. December, 1994
  25. .Clawson J. Regulations and Standards for Emergency Medical Dispatchers: A Model for State or Region. Emergency Medical Services. 1984; Vol. 13, No. 4: 25-29
  26. Bailey E, O’Connor R, Ross, R. The Use of Emergency Medical Dispatch Protocols to Reduce the Number of Inappropriate Scene Responses Made by Advanced Life Support Personnel. Prehospital Emergency Care. 2000; 4:2
  27. National Association of State EMD Directors State EMD Legislation and Regulations Survey, NAED Government Affairs Division, 1999
  28. National Academy of Emergency Medical Dispatch. Model EMD Legislation (Model Statute for Regulation of EMD Agencies and Emergency Medical Dispatchers). NAED Standards Publication. 2001
  29. National Academy of Emergency Medical Dispatch. Model EMD Rules and Regulations (Model Statute for Regulation of EMD Agencies and Emergency Medical Dispatchers). NAED Standards Publication. 2001
  30. American Society for Testing and Materials. Standard Practice for Emergency Medical Dispatch Management. In Annual Book of ASTM Standards, Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1560-94. December, 1994
  31. Hauff SR, Rea TD, Culley LL, Kerry F, Becker L, Eisenberg MS. Factors Impeding Dispatcher-Assisted Telephone Cardiopulmonary Resuscitation. Annals of Emergency Medicine. 2003; 42:731-737
  32. Clawson J. The EMD as a Medical Professional. Journal of Emergency Medical Services. 1996; 21: 69-72
  33. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute. Emergency Medical Dispatching: Rapid Identification and Treatment of Acute Myocardial Infarction. Washington, D.C. NIH Publication No. 94-3287. July, 1994
  34. Hauert S. The MPDS and Medical-Legal Danger Zones. Journal of the National Academy of EMD. 1990; 1
  35. Hurtado F. EMD Risky Business?: The Risks Associated with the Failure to Correctly Implement A Formal Emergency Medical Dispatch Program. 9-1-1 Magazine. 2001; 11.1-11.40 a. Gant vs. City of Chicago (97-L-3579, Nov. 30, 200, Cir. Ct., Cook Co., Ill.) b. Cooper vs. City of Chicago (1997, Cook County, Ill., 331 Ill. App. 3d 1123 (Ill. App. Ct. 1st District 2002)
  36. George JE. EMS Triage. EMT Legal Bulletin. 1981; 5:2-
  37. Lazar R. Dispatch and the Law: How to Avoid the 9-1-1 Litigation Blues. Journal of Emergency Medical Services. 1989; 14:35-40 a. DeLong vs. Erie County (89 A.D.2d 376, 455 N.Y.S.2d 887 (New York 1982)) b. Brooks vs. Herndon Ambulance Service, Inc (475 So.2d 1319; Fla. App. 5 Dist. 1985) c. Archie vs. City of Racine (847 F.2d 1211; Wis. 7th Cir. 1988) d. Trezzi vs. City of Detroit (120 Mich. App. 506, 328 NW2d 70 1982)
  38. Hauert S. The MPDS and Medical-Legal Danger Zones. Journal of the National Academy of EMD. 1990; 1
  39. George JE. EMS Triage. EMT Legal Bulletin. 1981; 5:2-4
  40. Lazar R. Dispatch and the Law: How to Avoid the 9-1-1 Litigation Blues. Journal of Emergency Medical Services. 1989; 14:35-40 a. DeLong vs. Erie County (89 A.D.2d 376, 455 N.Y.S.2d 887 (New York 1982)) b. Brooks vs. Herndon Ambulance Service, Inc (475 So.2d 1319; Fla. App. 5 Dist. 1985) c. Archie vs. City of Racine (847 F.2d 1211; Wis. 7th Cir. 1988) d. Trezzi vs. City of Detroit (120 Mich. App. 506, 328 NW2d 70 1982)
  41. Verdicts Spotlight Dispatch Problems: Legislative Remedies Sought. EMS Insider. 2001; Vol. 28 No. 1:1-2 a. Gant vs. City of Chicago (97-L-3579, Nov. 30, 200, Cir. Ct., Cook Co., Ill.) b. Cooper vs. City of Chicago (1997, Cook County, Ill., 331 Ill. App. 3d 1123; Ill. App. Ct. 1st District 2002) c. American National Bank & Trust Co. (for Estate of Renee Kazmierowski) vs. City of Chicago (177 Ill. 2d R. 315(a); 192 Ill. 2d 274, 735 N.E. 2d 551 2000)
  42. Principles of Emergency Medical Dispatch, 4th Edition, Chapt. 11: Legal Issues: a. Dale vs. City of Chicago; call transcript – pgs 11.17-11.18; case settled out of court b. Lam vs. City of Los Angeles; call transcript – pgs 11.13-11.15 (LASC NVC 01788) c. Hauser vs. City of Boca Raton; call transcript – pgs 11.25-11.26; case settled out of court d. Hendon vs. DeKalb County (GA) 203 Ga. App. 750 [417 S.E.2d 705] (1992) e. Myrick vs. City of Dallas (TX) No 85-1721 US Court of Appeals – 5th Circuit, and 810 F2d 1382 (1987) – call transcript of Boff vs. City of Dallas – pgs 11.27-11.28 (settled out of court) f. Tina Ellis case; pgs 11.26 (Loomis, Placer County, CA 1991)
  43. Hurtado F. EMD Risky Business?: The Risks Associated with the Failure to Correctly Implement A Formal Emergency Medical Dispatch Program. 9-1-1 Magazine. 2001; 11.1-11.40 a. Gant vs. City of Chicago (97-L-3579, Nov. 30, 200, Cir. Ct., Cook Co., Ill.) b. Cooper vs. City of Chicago (1997, Cook County, Ill., 331 Ill. App. 3d 1123 (Ill. App. Ct. 1st District 2002)
  44. George JE. EMS Triage. EMT Legal Bulletin. 1981; 5:2-4
  45. Lazar R. Dispatch and the Law: How to Avoid the 9-1-1 Litigation Blues. Journal of Emergency Medical Services. 1989; 14:35-40 a. DeLong vs. Erie County (89 A.D.2d 376, 455 N.Y.S.2d 887 (New York 1982)) b. Brooks vs. Herndon Ambulance Service, Inc (475 So.2d 1319; Fla. App. 5 Dist. 1985) c. Archie vs. City of Racine (847 F.2d 1211; Wis. 7th Cir. 1988) d. Trezzi vs. City of Detroit (120 Mich. App. 506, 328 NW2d 70 1982)
  46. Principles of Emergency Medical Dispatch, 4th Edition, Chapt. 11: Legal Issues: a. Dale vs. City of Chicago; call transcript – pgs 11.17-11.18; case settled out of court b. Lam vs. City of Los Angeles; call transcript – pgs 11.13-11.15 (LASC NVC 01788) c. Hauser vs. City of Boca Raton; call transcript – pgs 11.25-11.26; case settled out of court d. Hendon vs. DeKalb County (GA) 203 Ga. App. 750 [417 S.E.2d 705] (1992) e. Myrick vs. City of Dallas (TX) No 85-1721 US Court of Appeals – 5th Circuit, and 810 F2d 1382 (1987) – call transcript of Boff vs. City of Dallas – pgs 11.27-11.28 (settled out of court) f. Tina Ellis case; pgs 11.26 (Loomis, Placer County, CA 1991)
  47. Maggiore WA. Priority Medical Dispatch Is the Standard of Care. Journal of Emergency Medical Services. 2004; 29: 160-161 a. Gant vs. City of Chicago (97-L-3579, Nov. 30, 200, Cir. Ct., Cook Co., Ill.) b. Cooper vs. City of Chicago (1997, Cook County, Ill., 331 Ill. App. 3d 1123; Ill. App. Ct. 1st District 2002) c. Ma vs. City & County of San Francisco (City & County of S.F. Super. Ct. No. 998809)
  48. Emergency Medical Services for Children Program of Health Resources and Services Administration (USA). Emergency Medical Dispatch for Children: Consensus Statement (funded by National EMS for Children and National Highway Traffic Safety Administration grant), Dailey E, Chair, Georgia EMSC Chapter, 1998
  49. Emergency Medical Services for Children Program of Health Resources and Services Administration (USA). Emergency Medical Dispatch for Children: Consensus Statement (funded by National EMS for Children and National Highway Traffic Safety Administration grant), Dailey E, Chair, Georgia EMSC Chapter, 1998
  50. Clawson J, Martin RL, Cady GA, Maio RF. The Wake Effect – Emergency Vehicle-Related Collisions. Prehospital and Disaster Medicine. 1997; 12:274-77
  51. Principles of Emergency Medical Dispatch, 4th Edition, Chapt. 11: Legal Issues: a. Dale vs. City of Chicago; call transcript – pgs 11.17-11.18; case settled out of court b. Lam vs. City of Los Angeles; call transcript – pgs 11.13-11.15 (LASC NVC 01788) c. Hauser vs. City of Boca Raton; call transcript – pgs 11.25-11.26; case settled out of court d. Hendon vs. DeKalb County (GA) 203 Ga. App. 750 [417 S.E.2d 705] (1992) e. Myrick vs. City of Dallas (TX) No 85-1721 US Court of Appeals – 5th Circuit, and 810 F2d 1382 (1987) – call transcript of Boff vs. City of Dallas – pgs 11.27-11.28 (settled out of court) f. Tina Ellis case; pgs 11.26 (Loomis, Placer County, CA 1991)
  52. Kupas DF, Jula DJ, Pino BJ. Patient Outcome Using Medical Protocol to Limit “Red Lights and Siren” Transport. Prehospital and Disaster Medicine. 1994; Vol. 9, No. 4: 226-229
  53. Salvucci A, Kuehl A, Clawson JJ, Martin RL. The Response Time Myth Does Time Matter in Responding to Emergencies? Topics in Emergency Medicine. 2004; Vol. 26, No. 2: 86-92
  54. Auerbach PS, Morris JA Jr, Phillips JB, et al. An Analysis of Ambulance Accidents in Tennessee. Journal of The American Medical Association. 1987; Vol. 258: 1487-1490
  55. Hauert S. The MPDS and Medical-Legal Danger Zones. Journal of the National Academy of EMD. 1990; 1
  56. . George JE. EMS Triage. EMT Legal Bulletin. 1981; 5:2-4
  57. Kellermann AL, Hackman BB, Somes G. Dispatcher-assisted Cardiopulmonary Resuscitation: Validation of Efficacy. Circulation. 1989; Vol. 80: 1231-1239
  58. Rea TD, Eisenberg MS, Culley LL, et al. Dispatcher-Assisted Cardiopulmonary Resuscitation and Survival in Cardiac Arrest. Circulation. 2001; Vol. 104: 2513-2516
  59. Clawson JJ, Sinclair R. The Emotional Content and Cooperation Score in Emergency Medical Dispatching. Prehospital Emergency Care. 2000; 5:1
  60. Clawson J. The Hysteria Threshold: Gaining Control of the Emergency Caller. Journal of Emergency Medical Services. 1986; Vol. 11, No. 8: 40
  61. .  While a second-party caller has the right to decline instructions on his or her own, the dispatcher’s role should always be to proactively offer pre-arrival instructions whenever possible and appropriate to the case. Attempting to obtain the caller’s permission to help is not necessary, may plant doubt in the caller, and wastes vital time61Clawson J. Please—Don’t Ask Permission. Journal of the National Academy of Emergency Medical Dispatch. 1991; 2
  62. Billettier A, Lerner EB, Tucker W, Lee J. The Lay Public’s Expectations of Pre-Arrival Instructions When Dialing 9-1-1. Prehospital Emergency Care. 2000; 4:3
  63. Clawson A, Stewart P, Olola C, Freitag S, Clawson J. Public Expectations of Receiving Telephone Pre-Arrival Instructions from Emergency Medical Dispatchers at 30 years Post Origination. Journal of Emergency Dispatch. 2011 May/June; 13(3): 34-39.
  64. American Society for Testing and Materials. Standard Practice for Emergency Medical Dispatch Management. In Annual Book of ASTM Standards, Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1560-94. December, 1994
  65. Clawson JJ, Hauert SA. Dispatch Life Support: Establishing Standards that Work. Journal of Emergency Medical Services. 1990; Vol. 15: 82-86
  66. American Society for Testing and Materials. Standard Practice for Emergency Medical Dispatch. In Annual book of ASTM standards. Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1258-00. 2000
  67. American Society for Testing and Materials. Standard Practice for Training Instructor Qualification and Certification Eligibility of Emergency Medical Dispatchers. In Annual Book of ASTM Standards, Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1552-94. October, 1994
  68. American Society for Testing and Materials. Standard Practice for Training Instructor Qualification and Certification Eligibility of Emergency Medical Dispatchers. In Annual Book of ASTM Standards, Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1552-94. October, 1994
  69. Clawson J. The Hysteria Threshold: Gaining Control of the Emergency Caller. Journal of Emergency Medical Services. 1986; Vol. 11, No. 8: 40
  70. Principles of Emergency Medical Dispatch, 4th Edition, Chapt. 11: Legal Issues: a. Dale vs. City of Chicago; call transcript – pgs 11.17-11.18; case settled out of court b. Lam vs. City of Los Angeles; call transcript – pgs 11.13-11.15 (LASC NVC 01788) c. Hauser vs. City of Boca Raton; call transcript – pgs 11.25-11.26; case settled out of court d. Hendon vs. DeKalb County (GA) 203 Ga. App. 750 [417 S.E.2d 705] (1992) e. Myrick vs. City of Dallas (TX) No 85-1721 US Court of Appeals – 5th Circuit, and 810 F2d 1382 (1987) – call transcript of Boff vs. City of Dallas – pgs 11.27-11.28 (settled out of court) f. Tina Ellis case; pgs 11.26 (Loomis, Placer County, CA 1991)
  71. American Society for Testing and Materials. Standard Practice for Emergency Medical Dispatch Management. In Annual Book of ASTM Standards, Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1560-94. December, 1994
  72. Clawson J. Regulations and Standards for Emergency Medical Dispatchers: A Model for State or Region. Emergency Medical Services. 1984; Vol. 13, No. 4: 25-29
  73. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute. Emergency Medical Dispatching: Rapid Identification and Treatment of Acute Myocardial Infarction. Washington, D.C. NIH Publication No. 94-3287. July, 1994
  74. American Society for Testing and Materials. Standard Practice for Emergency Medical Dispatch. In Annual book of ASTM standards. Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1258-00. 2000
  75. American Society for Testing and Materials. Standard Practice for Emergency Medical Dispatch Management. In Annual Book of ASTM Standards, Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1560-94. December, 1994
  76. Clawson J. Regulations and Standards for Emergency Medical Dispatchers: A Model for State or Region. Emergency Medical Services. 1984; Vol. 13, No. 4: 25-29
  77. American Society for Testing and Materials. Standard Practice for Emergency Medical Dispatch. In Annual book of ASTM standards. Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1258-00. 2000
  78. Bailey E, O’Connor R, Ross, R. The Use of Emergency Medical Dispatch Protocols to Reduce the Number of Inappropriate Scene Responses Made by Advanced Life Support Personnel. Prehospital Emergency Care. 2000; 4:2
  79. American Society for Testing and Materials. Standard Practice for Emergency Medical Dispatch Management. In Annual Book of ASTM Standards, Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1560-94. December, 1994
  80. Cone DC, Galante N, MacMillan DS. Can Emergency Medical Dispatch Systems Safely Reduce First Responder Call Volume? Prehospital Emergency Care. 2008; 12: 479-485
  81. American Society for Testing and Materials. Standard Practice for Emergency Medical Dispatch Management. In Annual Book of ASTM Standards, Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1560-94. December, 1994
  82. Auerbach PS, Morris JA Jr, Phillips JB, et al. An Analysis of Ambulance
    Accidents in Tennessee. Journal of The American Medical Association. 1987; Vol. 258: 1487-1490
  83. Clawson J. Quality Assurance: A Priority for Medical Dispatch. Emergency Medical Services. 1989; Vol. 18, No. 7: 53-62
  84. Clawson JJ, Cady GA, Martin RL, et al. Effect of a Comprehensive Quality Management Process on Compliance with Protocol in an Emergency Medical Dispatch Center. Annals of Emergency Medicine. 1998; Vol. 32, No. 5: 578-584
  85. Clawson J. Medical Dispatch: “Run” Review for the EMD. Journal of Emergency Medical Services. 1986; Vol. 11: 40-41
  86. American Society for Testing and Materials. Standard Practice for Emergency Medical Dispatch Management. In Annual Book of ASTM Standards, Vol. 13.01, Medical Devices. Philadelphia. ASTM Designation F 1560-94. December, 1994
  87. National Academy of Emergency Medical Dispatch. Model EMD Rules and Regulations (Model Statute for Regulation of EMD Agencies and Emergency Medical Dispatchers). NAED Standards Publication. 2001
  88. Pertgen R, Gresh F, Baker M. Early Warning of Flu Epidemic by RealTime Monitoring of 9-1-1 Call Data, Richmond (Va), Oklahoma City and Tulsa (OK). 2005 http://www.firstwatch.net/wp-content/themes/firstwatch/files/CS-FluWarning_RichmondVA.pdf (last accessed 8-6-12)
  89. Mostashari F, Fine A, Debjani D, et al. Use of Ambulance Dispatch Data as an Early Warning System for Community-wide Influenza-like Illness, New York City. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2003; Vol. 80, No. 2, Supplement 1: 143-149
  90. Greenko J, Mostashari F, Fine A, et al. Clinical Evaluation of the Emergency Medical Services (EMS) Ambulance Dispatch-based Syndromic Surveillance System, New York City. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2003; Vol. 80, No. 2, Supplement 1: 150-156
  91. Buehler J. Point Taken: The Promise of Syndromic Surveillance. Homeland First Response. 2004; Vol. 2, No. 3: 42
  92. Pepe PE, Mattox KL, Fischer RP, et al. Geographic Patterns of Urban Trauma According to Mechanism and Severity of Injury. Journal of Trauma. 1990; Vol. 30, No. 9: 1125-1131
  93. Datner EM, Shofer FS, Parmele K, et al. Utilization of the 911 System as an Identifier of Domestic Violence. American Journal of Emergency Medicine. 1999; Vol. 17:560-565
  94. Snooks H, Williams S, Crouch R, et al. NHS Emergency Response to 999 Calls: Alternatives for Cases that are Neither Life Threatening Nor Serious. British Medical Journal. 2002; Vol. 325: 330-333
  95. Snooks H, Williams S, Crouch R, et al. NHS Emergency Response to 999 Calls: Alternatives for Cases that are Neither Life Threatening Nor Serious. British Medical Journal. 2002; Vol. 325: 330-333
  96. Studnek J, Thestrup L, Blackwell T, Bagwell B, et al. Utilization Of Prehospital Protocols To Identify Low-Acuity Patients. Prehospital Emergency Care. 2012; Vol. 16 No. 2: 116-122
  97. Smith WR, Culley L, Plorde M, et al. Emergency Medical Services Telephone Referral Program: An Alternative Approach to Nonurgent 911 Calls. Prehospital Emergency Care. 2001; Vol. 5, No. 2: 174-180
  98. Studnek J, Thestrup L, Blackwell T, Bagwell B, et al. Utilization Of Prehospital Protocols To Identify Low-Acuity Patients. Prehospital Emergency Care. 2012; Vol. 16 No. 2: 116-122
  99. Smith WR, Culley L, Plorde M, et al. Emergency Medical Services Telephone Referral Program: An Alternative Approach to Nonurgent 911 Calls. Prehospital Emergency Care. 2001; Vol. 5, No. 2: 174-180
  100. Studnek J, Thestrup L, Blackwell T, Bagwell B, et al. Utilization Of Prehospital Protocols To Identify Low-Acuity Patients. Prehospital Emergency Care. 2012; Vol. 16 No. 2: 116-122
  101. Clawson J, Olola C, Scott G, Patterson B. Predictive ability of emergency medical priority dispatch system protocols should be assessed at the atomic level of the determinant code. Prehosp Disas Med. 2010 Jul-Aug; 35(4): 318-9.
  102. Clawson J, Olola C, Heward A, Patterson B. Cardiac Arrest Predictability in Seizure based on Emergency Medical Dispatcher Identification of Previous Seizure or Epilepsy. Resuscitation. 2007 Nov; 75(2): 298-304
  103. Heward A, Damiani M, Hartley-Sharpe C. Does the Advanced Medical Priority Dispatch System Affect Cardiac Arrest Detection? Emerg Med J. 2004; 21:115-118.
  104. Roppolo L, Westfall A, Pepe P, Nobel L, Cowan J, Kay J, Idris. Dispatcher Assessment for Agonal Breathing Detection of Cardiac Arrest. Resuscitation. 2009; 80(7):769-772.
  105. Vaillancourt C, Verma A, Trickett J, et al. Evaluating the Effectiveness of Dispatch-assisted Cardiopulmonary Resuscitation Instructions. Academic Emergency Medicine. 2007; Vol. 14, No. 10: 877-883
  106. Vaillancourt C, Charette M, Stiell I, et al. An Evaluation of 9-1-1 Calls to Assess the Effectiveness of Dispatch-assisted Cardiopulmonary Resuscitation (CPR) Instructions: Design and Methodology. BMC Emergency Medicine. 2008; Vol. 8, No. 12: 1-9
  107. Bolle SR, Scholl J, Gilbert M. Can Video Mobile Phones Improve CPR Quality when Used for Dispatcher Assistance During Simulated Cardiac Arrest? ACTA Anaesthesiologica Scandinavica. 2009; Vol. 53: 116-120
  108. Clawson J, Olola C, Heward A, Scott G, Patterson B. Accuracy of Emergency Medical Dispatchers’ Subjective Ability to Identify When Higher Dispatch Levels Are Warranted over a Medical Priority Dispatch System Automated Protocol’s Recommended Coding Based on Paramedic Outcome Data. Emerg Med J. 2007; Vol. 24: 560-563
  109. Clawson J, Olola C, Heward A, Patterson B. Cardiac Arrest Predictability in Seizure based on Emergency Medical Dispatcher Identification of Previous Seizure or Epilepsy. Resuscitation. 2007 Nov; 75(2): 298-304.
  110. Clawson J, Olola C, Scott G, Heward A, Patterson B. Effect of a Medical Priority Dispatch System Key Question Addition in the Seizure/ Convulsion/Fitting Protocol to Improve Recognition of Ineffective (Agonal) Breathing. Resuscitation. 2008 Jul; 79:257-264.
  111. Shah M, Bishop P, Lerner E, et al. Derivation of Emergency Medical Services Dispatch Codes Associated with Low-Acuity Patients. Prehospital Emergency Care. 2003; Vol. 7, No. 4: 434-439
  112. Garza A, Gratton M, McElroy J, et al.: The Association of Dispatch Prioritization and Patient Acuity. Prehospital Emergency Care. 2007; Vol. 12, No. 1: 24-29
  113. Hinchey P, Myers B, Zalkin J, et al. Low Acuity EMS Dispatch Criteria Can Reliably Identify Patients without High Acuity Illness or Injury. Prehospital Emergency Care. 2006; Vol. 11, No. 1: 42-47
  114. Clawson J. The Maximal Response Disease: “Red Lights and Siren” Syndrome in Priority Dispatching. Journal of Emergency Medical Services. 1987; Vol. 12, No. 1: 28-31
  115. Cone DC, Galante N, MacMillan DS. Can Emergency Medical Dispatch Systems Safely Reduce First Responder Call Volume? Prehospital Emergency Care. 2008; 12: 479-485
  116. Bailey E, O’Connor R, Ross, R. The Use of Emergency Medical Dispatch Protocols to Reduce the Number of Inappropriate Scene Responses Made by Advanced Life Support Personnel. Prehospital Emergency Care. 2000; 4:2
  117. Clawson J, Olola C, Scott G, Heward A, Patterson B. Ability of the Medical Priority Dispatch System Protocol to Predict Acuity of “Unknown Problem” Dispatch Response Levels. Prehosp Disas Med. 2008 Jul-Sep; 12(3): 290-6.
  118. Clawson J, Olola C, Scott G, Heward A, Patterson B. The Medical Priority Dispatch System’s Ability to Predict Cardiac Arrest Outcomes and High Acuity Pre-Hospital Alerts in Chest Pain Patients Presenting to 9-9-9. Resuscitation. 2008 Sep; 78(3):298-306.
  119. Ramanujam P, Gluma K, Castillo E, Chacon M, Jensen M, Patel E, Linnick W, Dunford J. Accuracy of Stroke Recognition by Emergency Medical Dispatchers and Paramedics – San Diego Experience. Prehospital Emergency Care. 2008; 12:307-313.
  120. Clawson J, Olola C, Scott G, Schultz B, Pertgen R, Robinson D, Bagwell B, Patterson B. Association between patient unconscious or not alert conditions and cardiac arrest or high-acuity outcomes within the Medical Priority Dispatch System “Falls” protocol. Prehosp Disas Med. 2010 Jul-Aug; 25(4): 302-8.