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13.1V E R S I O N

Emergency Medical DispatchUpdate Guide

The International Academy’s EMD Protocol™

ADVANCED MEDICAL PRIORITY DISPATCH SYSTEM™

© 2017 IAEDNAE, UKE, ANZ 171110

MPDS v13.1 UPDATE

Determinant Code Conversions

Inside

©2017IAED 1

TheInternationalAcademyofEMD110SouthRegentStreet,8thFloorSaltLakeCity,UT84111UnitedStatesofAmericaPhone: 800-960-6236 801-359-6916Fax: 801-359-0996Email: [email protected]: www.emergencydispatch.org

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©2017IAEDThisUpdateGuidefortheAcademy’sMedicalPriorityDispatchSystem™andtheintellectualproperty

describedinitarecopyrighted,withallrightsreserved.SpecialrightstothisbookandtheAdvancedMPDSusedwithinarecontrolledbyJeffJ.Clawson,M.D.,andPriorityDispatchCorp.TheMPDS(PAIs,PDIs,CEIs,TSPs,etc.)isnotinthepublicdomain.Underapplicablenationalandinternationalcopyrightlawsaswellaslawsandconventionscoveringintellectualpropertyrights,thisbookandtheintellectualpropertyitdescribesordemonstratesmaynotbereproduced,distributed,publiclydisplayed,orcopied,noranythingderivedfromit,inwholeorinpart,withoutthepriorexpressandwrittenconsentofPriorityDispatchCorp.Copyrights,patents,andotherintellectualpropertyrightsprotectionswillbeenforcedagainstsuppliersandusersofunlicensedcopiesandderivativeworks.Thisbookcannotbere-usedorre-soldandmaynotbeusedbyunlicensedparties.

Theuseof®representsaregisteredtrademarkofPriorityDispatchCorp.and/ortheInternationalAcademiesofEmergencyDispatch.Trademarksinclude,butarenotlimitedto,EmergencyMedicalDispatch(er),InternationalAcademiesofEmergencyDispatch®,InternationalAcademyofEmergencyMedicalDispatch®,MedicalPriorityDispatchSystem,MPDS®,PriorityDispatchCorp.,PriorityDispatchSystem,ProQA®,thecaduceuslogo,andtheIAEMDcompasslogo,includingthecorrespondingacronymsorspelled-outtermsforanyoftheabove.

Thecontentofthisbookisfurnishedforinformationaluseonlyandissubjecttochangewithoutnotice.Thecopyrightholdersandauthorsassumenoresponsibilityofliabilityforanyerrors,omissions,orinaccuracieswithinthisbook.

ThefollowingU.S.PatentsmayapplytoportionsoftheMPDSorsoftwaredepictedinthisbook:5,857,966;5,989,187;6,004,266;6,010,451;6,053,864;6,076,065;6,106,459;6,607,481;7,106,835;7,428,301;8,066,638;8,103,523;8,294,570;8,335,298;8,355,483;8,488,748;8,494,868;8,712,020;8,971,501;9,319,859.OtherU.S.andinternationalpatentspending.OriginalMPDScopyrightestablishedinSeptember1979.Subsequenteditionsandsupportingmaterialcopyrightedasissued.

©2017IAED 2

DeterminantCodeConversionGuide

Toupdateyourresponseassignments,usethefollowingtabletolocatetheDeterminantCodechangesfromMPDSv13.0tov13.1.YouwillneedtomodifyorassignanappropriateresponseforeachchangedornewDeterminantCodeand/orsuffix.

Column1.Thiscolumnliststhechangingv13.0DeterminantCodesorsuffixes.

Column2.ThiscolumnshowsthechangethathasbeenmadetotheDeterminantDescriptororsuffix.

=TheDeterminantDescriptorisassignedtothesameDeterminantCode,orthesuffixisstillassignedtothesameletter.

!TheDeterminantDescriptorhasbeenassignedtoanewDeterminantCode,orthesuffixhasbeenassignedtoanewletter.

new TheDeterminantDescriptor/suffixisnew.

removed TheDeterminantDescriptor/suffixhasbeenremoved.

split TheDeterminantDescriptorhasbeensplitintomultipleDeterminantCodes.

Column3.Thiscolumnliststhev13.1DeterminantCodetowhichtheDeterminantDescriptorisnowassigned.Newsuffixlettersarealsolistedinthiscolumn.

Column4.Thiscolumnlistsanychanges/modificationstotheDeterminantDescriptor.Neworchangingsuffixesarealsolistedinthiscolumn.

v13.0Code/Suffix

Code/SuffixChanges

v13.1Code/Suffix DeterminantDescriptor/SuffixChanges

PROTOCOL12:Convulsions/Seizures12-C-2 = 12-C-2 Pregnancy!Pregnancy/POSTPARTUMeclampsia

PROTOCOL23:Overdose/Poisoning(Ingestion)— new 23-D-1 Arrest

23-D-1 ! 23-D-2 Unconscious23-D-2 ! 23-D-3 CHANGINGCOLOR— new suffixF Fentanyl— new suffixC Carfentanil— new suffixD AccidentalandFentanyl— new suffixE AccidentalandCarfentanil— new suffixG IntentionalandFentanyl— new suffixH IntentionalandCarfentanil— new suffixQ ViolentorcombativeandFentanyl

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— new suffixR ViolentorcombativeandCarfentanil— new suffixS WeaponsandFentanyl— new suffixT WeaponsandCarfentanil

PROTOCOL24:Pregnancy/Childbirth/Miscarriage

24-C-1 = 24-C-12ndTRIMESTERhemorrhageorMISCARRIAGE!2ndTRIMESTERhemorrhage/MISCARRIAGE

24-A-1 = 24-A-11stTRIMESTERhemorrhageorMISCARRIAGE!1stTRIMESTERhemorrhage/MISCARRIAGE

24-A-1 = 24-A-1

Omegaprotocolonly:1stTRIMESTERhemorrhageorMISCARRIAGEwithout1stpartyverification!1stTRIMESTERhemorrhage/MISCARRIAGEwithout1stpartyverification

— new 24-A-2ConfirmedSTILLBIRTHsituation(≥6months/24weeksandnocomplications)

24-Ω-2 = 24-Ω-2

Omegaprotocolonly:1stTRIMESTERhemorrhageorMISCARRIAGEwith1stpartyverification!1stTRIMESTERhemorrhage/MISCARRIAGEwith1stpartyverification

Sub-ChiefComplaintSelectionTree

WehavecreatedaspecialselectionandsortingfeaturecalledtheSub-ChiefComplaint(Sub-CC)SelectionTree.ThisfacilitatesaquickerandmoredirectwayofenteringtheinformationyouhavedeterminedthroughCaseEntryinterrogationtothispoint,whenselectinganddeterminingtheChiefComplaint(CC),andeliminatestheproblemofselectingCCswithmultipleitemslisted(compoundtitles).Inusingthisfeature,therearefourmethodsofentryintheCCCodefieldthatyoumustknow:

1)Alphabeticalentry:SincemostEmergencyDispatchersbecomeveryfamiliarwiththevarioustypesofincidentsoftencombinedintorelatedCCs(withcompoundtitles),youcannowtypeinaletter,partialword,orfullword,whichthenwillbringup,alreadysorted,allinstancesofyourentryunderneaththefullCCthattheyarefoundin.Theselectioncursor,however,willnotrestonthefullCC,butonthespecificitem(usuallyaSub-CCword)youtypedin.Incasesofmultipleitem/wordfindings,theywillbestackedandsortedalphabeticallyforeasyselection.Youcanarrowupordownthroughthem,andhitting<enter>ordoubleclickingwillselectyourchoice.

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UponselectingoneoftheseSub-CCs,theappropriateCCwillbeautomaticallychosenandthelaterBlueOperatorSub-CCquestionwillbeauto-answered—completelysavingthatstep.

2)Numericalentry:Asbefore,youcanstillentertheCCnumberandtheCC(fulltitle)willbedisplayed.Simplyclickingonitorhitting<enter>willselectthefullCC.Ifthisisdone,onceonthatCCprotocol,youwillstillhavetoanswertheBlueOperatorQuestionregardingthespecifictypeofproblemorincidentthatyoualreadyknowittobe,atthispoint.

However,youwillnoticethateachSub-CCforthatprotocolisdisplayedunderthefulltitle.Youcanarrowupordownthroughthelist,andhitting<enter>ordoubleclickingwillselectyourchoice.UponselectingoneoftheseSub-CCs,theCCwillbeautomaticallychosenandthelaterBlueOperatorSub-CCquestionwillbeauto-answered—completelysavingthatstep.

3)MultipleConsecutiveAlphabeticalentry:SimilartotheAlphabeticalentryfeatureistheabilitytoentermultiplewordfragmentstodetermineveryspecificSub-CCs.Forexample,typing“FIA”willbringup“Firealarm(unknownsituation)”insteadof“Fire(nopersonsreportedinside).”Typing“HEVI”willbringup“Headvisible(crowning)”insteadof“Headout.”Toaddthesecondandthirdwordselectors,simplyaddaspacebetweenthewordsorstartingfragmentsofthosewords.Aswithothermethodsofentry,hitting<enter>ordoubleclickingwillselectyourchoiceonceyounarrowitdowntothespecificSub-CC.

4)FullCCListselection:OnceintheCCCodefield,byhitting<enter>,<spacebar>,ordoubleclickinginthisblankfield,youcanshow/bringdowntheentirelistofCCswitheachSub-CCunderit.TosimplyseeallCCsinaflatlist,clickintheCCwindownearthetop(underthemenu,butabovetheuppertabline).ThisshowsallCCssortedeitheralphabeticallyornumericallyaspre-setintheViewmenupulldownlist.

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Weareveryexcitedaboutthisfeaturethatshowsgreatpotential—ifitsuseparametersareunderstoodbyallEmergencyDispatchersusingProQA.

Multi-ProtocolChanges

A. INEFFECTIVEBREATHINGDefinitionProtocolsAffected:CaseEntry,9,34,36,38• Thebulletpoint“Can’tbreathe(atall)”hasbeenchangedto“Can’tbreatheatall.”SeeFigure1.

Figure1.ExampleofMulti-ProtocolChangeA.INEFFECTIVEBREATHINGdefinition.CaseEntryProtocol.MPDSv13.1.©1979–2017PDC.

Rationale:Theparentheseswereremovedduetohighover-triageratesassociatedwiththephrase“Can’tbreathe”alone.

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B. 1stPartyCallersBreathingRuleProtocolsAffected:CaseEntry,6,9• AnewRulehasbeenaddedtoCaseEntry,Protocol6,andProtocol9:“1stpartycallersusing

phraseslike“Ican’tbreathe”or“Icanbarelybreathe”maybefurtherassessedbytheirabilitytospeaknormallyorincompletesentences,theirlevelofapparentdistressoragitation,andthepresenceofairwaynoises(i.e.,stridor,wheezing,gasping,etc.).BreathingeffectivenessrangesfromnormalbreathingtomildshortnessofbreathtoDIFFICULTYSPEAKINGBETWEENBREATHStofightingforair(INEFFECTIVEBREATHING).Whenindoubt,theEMDshoulderronthesideofpatientsafety.”SeeFigure2.

Figure2.ExampleofMulti-ProtocolChangeB.Rule4.CaseEntryProtocol.MPDSv13.1.©1979–2017PDC.

Rationale:ThisnewRuleprovidesEMDswithmorelatitudewhenassessing1stpartycallerswherebreathingeffectivenessanddistressismoreobviousthanwhenpresentedthrough2ndpartycallers.

C. PregnancyandtheAspirinDiagnostic&InstructionToolProtocolsAffected:6,10,19• TheCEIforutilizingtheAspirinDiagnostic&InstructionToolhasbeenmodifiedtoincludethe

text“notpregnant.”ThemodifiedCEInowreads“UtilizetheAspirinDiagnostic&InstructionTool–ifauthorizedbylocalMedicalControlandthechestpain/discomfort(HeartAttackSymptoms)patientisalert,≥16yearsold,notpregnant,andhasnoreportedSTROKEsymptoms.”The“notpregnant”additionwillnotbeshowninProQA®formalepatients.SeeFigure3.

Figure3.ExampleofMulti-ProtocolChangeC.CriticalEMDInformation.Protocol10.MPDSv13.1.©1979–2017PDC.

Rationale:Thereisasmallwindowoftimeduringtheearlystagesofpregnancywhenthereisariskofbirthdefectsassociatedwithaspirinadministration.Whilethisriskisrelativelylow,soistheriskofheartattackduringpregnancy.Therefore,thedecisiontoadministeraspirinduringpregnancyisbestmadeafterfurtherdiagnostics.

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D. VolatileorCriminalSituationsProtocolsAffected:4,23,25,27• TheCEI“Involatile/criminalsituations,refertoapplicablelawenforcementprotocol”hasbeen

modifiedtoremovetheslash.Itnowreads“Involatileorcriminalsituations,refertoapplicablelawenforcementprotocol.”SeeFigure4.

Figure4.ExampleofMulti-ProtocolChangeD.CriticalEMDInformation.Protocol4.MPDSv13.1.©1979–2017PDC.

Rationale:RemovingtheslashemphasizesthatbothsituationsapplytothisCEI.

E. Unconscious,PregnantPatientsRuleProtocolsAffected:23,24,31• TheRuleforpositioninganunconscious,pregnantpatienthasbeenmodifiedtochange“left

side”to“back”andtochange“objectwedgedbehindherlowerback”to“objectimmediatelywedgedunderherrightbuttock.”TheRulenowreads“Anunconscious,pregnantpatientinher3rdTRIMESTERshouldbeplacedonherbackwithapilloworlikeobjectimmediatelywedgedunderherrightbuttock.AirwayandCPRinstructionsshouldthenbecompletedinthisposition.”SeeFigure5.

Figure5.ExampleofMulti-ProtocolChangeE.Rule5.Protocol23.MPDSv13.1.©1979–2017PDC.

Rationale:Thischangeinwordingbetterdescribesthemaneuverandensuresthatthepatientisnotleftonherbackforanextendedperiodoftime.

F. NON-TRAUMATICChestPain/HeartAttackSymptomsandBreathingProblemsRuleProtocolsAffected:CaseEntry,6,10

• TheRuleforchoosingaChiefComplaintwhenapatientisreportingbothchestpain/heartattacksymptomsandbreathingproblemshasbeenmodifiedtoinclude“notpregnant.”TheRulenowreads,“WhenthecomplaintdescriptioninvolvesbothNON-TRAUMATICchestpain/heartattacksymptomsandbreathingproblems,choosetheChiefComplaintProtocolthatbestfitsthepatient’sforemostsymptom,withECHO-levelconditionstakingprecedence.(≥16,alert,notpregnant,noreportedSTROKEsymptoms)UsetheAspirinDiagnostic&InstructionTooloneitherprotocolasappropriate.”The“notpregnant”additionwillnotbeshownonProtocol6andProtocol10formalepatients.SeeFigure6.

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Figure6.ExampleofMulti-ProtocolChangeF.ModifiedNON-TRAUMATICchestpain/heartattacksymptomsandbreathingproblemsrule.CaseEntry.MPDSv13.1.©1979–2017PDC.

Rationale:Thischangereflectsthenewpregnancycontraindicationforaspirinadministrationinstructions.

G. BreathingVerificationDiagnosticProtocolsAffected:CaseEntry,9,12,31,N,A,B,C,YA,YB,YC• TheAGONALBREATHINGDetectorhasbeenrenamedtheBreathingVerificationDiagnostic.

Panelsthatwereoriginallytitled“DeterminingAGONALBREATHING”nowread“BreathingVerificationDiagnostic.”SeeFigure7.

• ThecalltakerinstructionsfortheBreathingVerificationDiagnostichavebeenclarifiedonCaseEntry,Protocol9,Protocol12,andProtocol31.Thefirstsentencenowreads,“Usewhenthepatientisunconsciousandsomebreathingreportedbythecallerisquestionabletoyou(theEMD),orwhenmandatedbytheprotocol.”Theseinstructionshavebeenmovedaftertheinstructionsforthecaller.SeeFigure7.

Figure7.ExampleofMulti-ProtocolChangeG.Protocol12.MPDSv13.1.©1979–2017PDC.

Rationale:Thenewnameforthisdiagnostictoolbetterdescribeswhenitshouldbeused.TheBreathingVerificationDiagnosticshouldbeusedwhenreportedbreathingisquestionable(i.e.,itisusedtoverifyeffectivebreathing,notUNCERTAINorAGONALbreathing).TheinstructionshavebeenclarifiedtobetterdescribewhentheBreathingVerificationDiagnosticshouldbeused.

H. BreathingVerificationDiagnosticCEI

ProtocolsAffected:N,A,B,C,YA,YB,YC• TheCEI“Determinenowifthepatientisbreathingeffectively.Ifanyquestionexists,usethe

AGONALBREATHINGDetectorDiagnostic”hasbeenupdatedwiththenewnamefortheBreathingVerificationDiagnostic.SeeFigure8.

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Figure8.ExampleofMulti-ProtocolChangeH.ProtocolC.MPDSv13.1.©1979–2017PDC.

Rationale:Thenewnameforthisdiagnostictoolbetterdescribeswhenitshouldbeused.

I. NarcoticsAxiomProtocolsAffected:23,31

• AreferencetothenewProtocolS:NaloxoneInjectionInstructionshasbeenaddedtotheAxiomthatinformsthecalltakerthatnaloxonecanbeusedtotreattheeffectsofanarcoticOVERDOSE.SeeFigure9.

Figure9.ExampleofMulti-ProtocolChangeI.Axiom6.Protocol23.MPDSv13.1.©1979–2017PDC.

Rationale:ThenewProtocolSwasaddedtoinstructcallersregardingtheuseofgenericNarcan/Naloxonekits.

J. NexttoPatientInstructionsProtocolsAffected:Q,R

• Theinstruction“Tellmewhenthey’rerightwithher/him”hasbeenchangedto“Tellmewhenthey’rerightnexttoher/him.”SeeFigure10.

Figure10.ExampleofMulti-ProtocolChangeJ.ProtocolQ.MPDSv13.1.©1979–2017PDC.

Rationale:ThemodificationofthisinstructionreducescallerconfusionandensuresthattheEMDwillbeinformedwhentheparamedicsarerightnexttothepatient.

K. Infant/NeonateLogicforObviouslyNotBreathingfasttrackProtocolsAffected:9,12,35(UKE)

• Ifthe“ObviouslyNOTBREATHING&Unconscious(non-traum)”answerchoiceisselectedonCaseEntry,anewPre-QuestionQualifier“(Obviously≥1yearold)”andanewanswerchoice“N/A(<1yearold)”areaddedtotheKeyQuestion“Ifthereisadefibrillator(AED)available,sendsomeonetogetitnow,andtellmewhenyouhaveit.”Selectingthe“N/A(<1yearold)”answerchoicewilldirectthecalltakertoobtainthepatient’sageandthentoN-1/A-1/Ya-1asappropriate.SeeFigure11.

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Figure11.ExampleofMulti-ProtocolChangeK.Protocol9.MPDSv13.1.©1979–2017PDC.

Rationale:Thischangeensuresthatadefibrillatorwillnotbeusedifapatientisunderoneyearinage.

ChangestoIndividualProtocolsCaseEntryProtocolMulti-ProtocolChangesaffectingthisprotocol:A,B,F,GChangesaffectingonlythisprotocol:

• CaseEntryRule3hasbeenmodifiedtousethenewnamefortheBreathingVerificationDiagnostic.SeeFigure12.

Figure12.ModifiedCaseEntryRule3.CaseEntryProtocol.MPDSv13.1.©1979–2017PDC.

Rationale:SeeMulti-ProtocolChangeG.

• CaseEntryAxiom4hasbeenmodifiedtousethenewnamefortheBreathingVerificationDiagnostic.SeeFigure13.

Figure13.ModifiedCaseEntryAxiom4.CaseEntryProtocol.MPDSv13.1.©1979–2017PDC.

Rationale:SeeMulti-ProtocolChangeG.PROTOCOL4:Assault/SexualAssault/StunGunMulti-ProtocolChangesaffectingthisprotocol:DChangesaffectingonlythisprotocol:NonePROTOCOL6:BreathingProblemsMulti-ProtocolChangesaffectingthisprotocol:B,C,FChangesaffectingonlythisprotocol:NonePROTOCOL9:CardiacorRespiratoryArrest/DeathMulti-ProtocolChangesaffectingthisprotocol:A,B,G,KChangesaffectingonlythisprotocol:None

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PROTOCOL10:ChestPain/ChestDiscomfort(Non-Traumatic)Multi-ProtocolChangesaffectingthisprotocol:C,FChangesaffectingonlythisprotocol:NoneAspirinDiagnosticandInstructionsMulti-ProtocolChangesaffectingthisprotocol:NoneChangesaffectingonlythisprotocol:

• “Notpregnant”hasbeenaddedtothetoplineoftheAspirinDiagnostic&InstructionToolinProQA.Itnowreads,“Selectoneforachestpain/discomfortpatientwhoisalert,≥16,notpregnant,andhasnoreportedSTROKEsymptoms.”The“notpregnant”additionwillnotbeshowninProQAformalepatients.SeeFigure14.

Figure14.AspirinDiagnostic&InstructionTool.MPDSv13.1.©1979–2017PDC.

Rationale:SeeMulti-ProtocolChangeF.

• “Pregnant”hasbeenaddedtoRule1ontheAspirinDiagnostic&InstructionTool.Itnowreads,“Aspirin-containingmedicationsshouldnotbeadministeredtopatientswhoarenotalert,underage16,pregnant,orhavereportedSTROKEsymptoms.”SeeFigure15.

Figure15.ModifiedRule1.AspirinDiagnostic&InstructionTool.MPDSv13.1.©1979–2017PDC.

Rationale:SeeMulti-ProtocolChangeF.PROTOCOL12:Convulsions/SeizuresMulti-ProtocolChangesaffectingthisprotocol:G,KChangesaffectingonlythisprotocol:

• Anew“Prolongedseizure≥10minutes”answerchoicehasbeenaddedtotheKeyQuestion“Hass/hehadmorethanoneseizureinarow?”Selectingthisanswerwillresultina12-D-2“CONTINUOUSorMULTIPLEseizures”DeterminantCode.SeeFigure16.

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Figure16.Newanswerchoice.Protocol12.MPDSv13.1.©1979–2017PDC.

Rationale:ProlongedseizuresmayindicateaCONTINUOUSseizureoraseizurewithalife-threateningcause.Thischangeisdesignedtobetteridentifyseizureswithaserious,underlyingcause.• The“SlowRate”answerchoiceontheoperatorquestion“Ø Selectanswerbasedonthe

BreathingVerificationDiagnosticfindings”hasbeensplitintotwonewanswers:“SlowRate(abnormalbreathing)”and“SlowRate(INEFFECTIVEBREATHING).”Selecting“SlowRate(abnormalbreathing)”willqualifythe12-D-4“Effectivebreathingnotverified≥35”or12-B-1“Effectivebreathingnotverified<35”DeterminantCodes,dependingonthepatient’sage.Selecting“SlowRate(INEFFECTIVEBREATHING)”willqualifythe12-D-3“AGONAL/INEFFECTIVEBREATHING”DeterminantCode.SeeFigure17.

Figure17.Newanswerchoices.Protocol12.MPDSv13.1.©1979–2017PDC.

Rationale:ApatientwhosebreathingisslowbutINEFFECTIVEwillnowqualifyforahigherDeterminantCode.

• TheDeterminantDescriptorfor12-C-2“Pregnancy”hasbeenchangedto“Pregnancy/POSTPARTUMeclampsia.”SeeFigure18.

• KeyQuestion2hasbeenchangedfrom“(Female12–50)Isshepregnant?”to“(Female12–50)Isshepregnantorhasshebeenpregnantinthepast4weeks?”SeeFigure18.

• AdefinitionhasbeenaddedforPOSTPARTUMEclampsia:“Seizureactivitywithin4weeksofendofpregnancy.”SeeFigure18.

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Rationale:ThisnewdefinitiondefinesPOSTPARTUMeclampsiaintheDLSenvironment.TheaugmentedquestionhelpsidentifythepotentialconditionofPOSTPARTUMeclampsiaasacauseofthepatient’sseizure,andtheaugmentedDeterminantDescriptorprovidesaresponseoptionforthecondition.

• PDIsd,e,f,andghavebeenremoved.• AnewPDI-dhasbeenadded:“(Stillseizing)Tellmeimmediatelywhens/hestopsseizing.”See

Figure19.• AnewPDI-ehasbeenadded:“(Notseizing&Notawake)Let’scheckher/hisbreathing(again).”

SeeFigure19.• AnewPDI-fhasbeenadded:“(Effectivebreathing)Turnher/himgentlyonher/hisside(left

sideifpregnant).Ass/hewakesup,reassureher/himandtellher/himnottogetuporwalkaround.”SeeFigure19.

Rationale:ThenewPDIsequenceforseizuresmoreclearlyprovidesinstructionsbasedonthepatient’scurrentcondition.

Figure19.NewPost-DispatchInstructions.Protocol12.MPDSv13.1.©1979–2017PDC.

Figure18.Pregnancy/POSTPARTUMeclampsiaadditions.Protocol12.MPDSv13.1.©1979–2017PDC.

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• TheATYPICALSeizuredefinitionhasbeenmodified.Thephrase“(ornottypicalof)”hasbeen

replacedwith“ornotnormalascomparedto.”SeeFigure20.

Figure20.ATYPICALSeizuredefinition.Protocol12.MPDSv13.1.©1979–2017PDC.

Rationale:Thisrevisedtextandformattingbetterdescribesthemeaningof“ATYPICAL.”• TheSeizuredescriptionhasbeenremoved.• AnewformaldefinitionforGENERALIZEDSeizurehasbeenadded:“Anabnormalfiringofbrain

cells,usuallyresultinginaperiodofunconsciousnessandfull-bodyjerkingmovements.Alsoknownasconvulsions,epilepsy,orfits.”SeeFigure21.

• Theword“Generalized”isnowformattedinalluppercaselettersinanswerchoicestoreflectthenewdefinition.

Figure21.GENERALIZEDSeizuredefinition.Protocol12.MPDSv13.1.©1979–2017PDC.

Rationale:ThisformaldefinitionbetterseparatesanddefinestheGENERALIZEDSeizurefromothertypesofseizures,whichisimportanttotheuseofthisprotocol.• ThesecondsentenceintheRecurrentSeizuresdefinitionhasbeenmodified:“Theseare

consideredrecurrentseizuresifthepatientregainsconsciousnessbetweenepisodes.”SeeFigure22.

Figure22.ModifiedRecurrentSeizuresdefinition.Protocol12.MPDSv13.1.©1979–2017PDC.

Rationale:Theremovalofthephrase“isableto”moreaccuratelydescribesthistypeofseizure.

• Rule1hasbeenmodifiedtousethenewnamefortheBreathingVerificationDiagnostic.Italsoupdatedtheformatfor“GENERALIZED”toreflectthenewdefinition.SeeFigure23.

Rationale:ThesechangesapplyMulti-ProtocolChangeGandthenewGENERALIZEDSeizuredefinition.• AnewclarifyingsentencehasbeenaddedtotheendofRule1:“Useofthistoolisnotnecessary

whenitisobviousthatthepost-seizurepatientisalert,talking,oractivelywakingup(notjusteyesopen).”SeeFigure23.

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Figure23.ModifiedRule1.Protocol12.MPDSv13.1.©1979–2017PDC.

Rationale:ThisnewdirectiveeliminatesthemandatoryuseoftheBreathingVerificationDiagnosticwhenitisobviouslynotnecessary.

• AnewRule6hasbeenadded:“WhentheBreathingVerificationDiagnosticToolresultsina

SlowRate(6–7secondinterval)foranunconsciouspatient,theEMDshouldrepeatthediagnosticwithin60secondstoconfirmeffectivebreathing.TheEMDshoulderronthesideofpatientsafetyandupgrade(Override)theresponserecommendationifconsecutivebreathingevaluationsproduceSlowRatedeterminations.”SeeFigure24.

Figure24.NewRule6.Protocol12.MPDSv13.1.©1979–2017PDC.

Rationale:PatientswhoreceiveaSlowRatedeterminationfromtheBreathingVerificationDiagnosticToolneedfurtherevaluationtoensureeffectivebreathing.IfpatientsrepeatedlyreceiveSlowRatedeterminations,theresponseshouldbeupgraded.

• Axiom5hasbeenmodifiedtoreflectthenewGENERALIZEDSeizuredefinition:“GENERALIZED(tonic-clonic/grandmal)seizuresgenerallylastabout60seconds.”SeeFigure25.

Figure25.ModifiedAxiom5.Protocol12.MPDSv13.1.©1979–2017PDC.

Rationale:ThischangeappliesthenewGENERALIZEDSeizuredefinitiontothisAxiom.

• AnewAxiom8hasbeenadded:“Someseizurepatients,especiallychildren,haveprescribedtreatmentplanstodealwithfrequentseizures.Treatmentsforactiveseizuresincluderectal,nasal,andliquidoralmedications.Whenasked,caregiversshouldbeencouragedtofollowthepatient’sprescribedtreatmentplanforactiveseizures.However,pills,capsules,orothersolidmedicationsshouldnotbeadministeredtonotalertpatients.”SeeFigure26.

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Figure26.NewAxiom8.Protocol12.MPDSv13.1.©1979–2017PDC.

Rationale:ThisnewAxiomguidestheEMDwhenthecallerrelatesthataprescribedtreatmentplanisinplacefortheseizurepatient.

PROTOCOL13:DiabeticProblemsMulti-ProtocolChangesaffectingthisprotocol:NoneChangesaffectingonlythisprotocol:

• Foranunconsciouspatient,the“No”answerchoicefortheKeyQuestion“Iss/hebreathingnormally?”hasbeensplitintotwo:“No,butobviouslyeffective”and“No–launchBreathingVerificationDx.”Nochangehasbeenmadeforconsciouspatients.SeeFigure27.

o The“No–launchBreathingVerificationDx”answerchoicewilllaunchtheBreathingVerificationDiagnosticTool.

Figure27.Newanswerchoices.Protocol13.MPDSv13.1.©1979–2017PDC.

Rationale:ThischangebetteridentifiesandrespondstoAGONALorINEFFECTIVEBreathingintheunconsciousdiabeticpatient.

• AnewoperatorquestionhasbeenaddediftheBreathingVerificationDiagnosticToolislaunchedonProtocol13:“Ø SelectanswerbasedontheBreathingVerificationDiagnosticfindings.”If“AGONALRate(INEFFECTIVEBREATHING)”or“NotBreathing”isselected,thepatientwillbeconsideredtohavehadasuddenarrest,andthecasewillbedispatchedas9-D-1“INEFFECTIVEBREATHING.”SeeFigure28.

Figure28.Newoperatorquestion.Protocol13.MPDSv13.1.©1979–2017PDC.

Rationale:ThisKeyQuestionhelpsthecalltakertoidentifypatientswhohavesufferedsuddenarrest.

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PROTOCOL19:HeartProblems/A.I.C.D.Multi-ProtocolChangesaffectingthisprotocol:CChangesaffectingonlythisprotocol:None

PROTOCOL23:Overdose/Poisoning(Ingestion)Multi-ProtocolChangesaffectingthisprotocol:D,E,IChangesaffectingonlythisprotocol:

• Selecting“Narcotics(heroin,morphine,methadone,OxyContin,etc.),”“Other(unlisted):,”or“Unknown”inresponsetoKeyQuestion7“Whatdids/hetake?”willpromptafollow-upoperatorquestion:“Ø AnymentionofFentanyl,Carfentanil,orU4(PinkorPinky)?”SeeFigure29.


Rationale:Thischangeisdesignedtopromptspecificcodingwhennarcoticswithpotentialscenehazardsareidentified.

• AnewKeyQuestion9hasbeenadded:“(Unconscious/Notalert)IsthereanyNarcan

(naloxone)available?”ThisKeyQuestionisonlyavailableifthecallerreportsthatnarcoticsoranunknownsubstancewastakeninresponsetoKeyQuestion7“Whatdids/hetake?”SeeFigure30.

• If“Unknown”isselectedinresponsetothenewKeyQuestion9,twofollow-upquestionsareasked:“Askeveryonethere,‘DoesanybodyknowwhereanyNarcan(naloxone)is?’”and“Whatdidtheysay?”

• AnewKeyQuestion9ahasbeenadded:“(Yes)Good,Iwantyoutogiveittoher/himnow.”SeeFigure30.

Rationale:ThesenewquestionsaredesignedtoestablishtheavailabilityofNarcan/Naloxonewhennarcoticsareinvolved.ThenewinstructionhelpstoensureNarcan/Naloxoneusewhenavailable.

Figure30.NewKeyQuestions9and9a.Protocol23.MPDSv13.1.©1979–2017PDC.

©2017IAED 18

• Ifthepatientisunconscious,Carfentanilismentioned/identified,andNarcanisavailable,KeyQuestion9achangesto“Okay,ifit’ssafetodoso,andwithouttouchingher/himwithyourhands,Iwantyoutogiveittoher/himnow.”SeeFigure31.

Figure31.AlternateKeyQuestion9a.Protocol23.MPDSv13.1.©1979–2017PDC.

Rationale:ThisnewinstructionprovidesadditionalsafetymeasureswhenCarfentanilisinvolved.

• If“Onedosegivenalready”or“Twodosesgivenalready”areselectedinresponsetothenewKeyQuestion9,afollow-upquestionisasked:“Iss/hegettingbetternow?”If“Yes”or“Unknown”isselected,thatistheendoftheKeyQuestions,andthecalltakergoestoPDIs.SeeFigure32.

o If“No”isselected,afollow-upquestionisasked:“ArethereanymoreNarcan(naloxone)dosesavailable?”If“No”or“Unknown”isselected,thatistheendoftheKeyQuestions,andthecalltakergoestoPDIs.SeeFigure32.

o If“Yes”isselected,thenewKeyQuestion9aisasked:“Good,Iwantyoutogiveittoher/himnow”or“Okay,ifit’ssafetodoso,andwithouttouchingher/himwithyourhands,Iwantyoutogiveittoher/himnow,”ifCarfentanilismentioned/identified.SeeFigure30andFigure31.

Figure32.NewKeyQuestions.Protocol23.MPDSv13.1.©1979–2017PDC.

Rationale:PatientsshouldbegivenadditionaldosesofNarcan/naloxoneiftheydonotimproveandadditionaldosesareavailable.

• AnewDeterminantCodehasbeenadded:23-D-1“Arrest.”TheremainingDELTA-levelDeterminantCodeshavebeenrenumbered.SeeFigure33.

Figure33.NewandreassignedDeterminantCodes.Protocol23.MPDSv13.1.©1979–2017PDC.

©2017IAED 19

Rationale:ThisnewDeterminantCodeanditsassociatedDLSLinkaccommodateArrestcausedbyOVERDOSE/POISONING,thusaddressingscenesafetyandNarcan/Naloxoneadministration.

• Tennewsuffixeshavebeenadded:F=Fentanyl,C=Carfentanil,D=AccidentalandFentanyl,E

=AccidentalandCarfentanil,G=IntentionalandFentanyl,H=IntentionalandCarfentanil,Q=ViolentorcombativeandFentanyl,R=ViolentorcombativeandCarfentanil,S=WeaponsandFentanyl,andT=WeaponsandCarfentanil.SeeFigure34.

• AsteriskshavebeenaddedtosuffixesF,D,G,Q,andS.Anotehasbeenaddedinreferencetothosesuffixes:“*Note:TherarebutdangerousopioidknownasU4(Pink,Pinky,U-47700)islogicallysimilartoFentanyl.”SeeFigure34.

• TheProblemSuffixestexthasbeenmodifiedtoinclude“andsituation.”Itnowreads“Thesuffixcodeshelptodelineatethetypeofproblemandsituationforspecificresponseandsafetypurposes.”SeeFigure34.

Figure34.NewProblemSuffixesandNote.Protocol23.MPDSv13.1.©1979–2017PDC.

Rationale:Thesenewsuffixeswereaddedtoprovidelocalresponseoptionsandscenesafetyinformationwhenthesenarcoticsareassociatedwithvariousscenecircumstances.TheasterisksnotethesimilarityofU4withFentanyl,guidingtheEMDtousetheFentanylsuffixwhenU4isinvolved.

• The“Unconscious(perCaseEntry)”sendpointhasbeenchangedto“ArrestorUnconscious

(perCaseEntry).”Insteadofdirectingthecalltakertosend23-D-1andgodirectlytoPDIs,thesendpointnowdirectsthecalltakertosendandreturntoquestioning.ThecalltakerwillthenskiptoKeyQuestion7.

©2017IAED 20

Rationale:ThenewsendpointaccommodatesarrestcausedbyOVERDOSE/POISONING,andthenewdirectorensuresthattheavailabilityNarcan/Naloxoneisdetermined.

• AnewCEIhasbeenadded:“Ifthecallerexpressesreluctancetoapproachorphysicallyassist

thepatientduetosceneorpatientcircumstances,theEMDshouldnotencouragethecallertodoso,butratherassurethemthathelpisontheway.”SeeFigure35.

Figure35.NewCEI.Protocol23.MPDSv13.1.©1979–2017PDC.

Rationale:ThisnewCEIprovidesforscenesafetywhenthecallerexpressesscenesafetyconcerns.• The“Unconscious”DLSLinktoNABC-1hasbeenchangedto“UnconsciousorArrest.”See

Figure36.

Figure36.DLSLinks.Protocol23.MPDSv13.1.©1979–2017PDC.

Rationale:ThisnewDLSLinkanditsassociatedDeterminantDescriptoraccommodateArrestcausedbyOVERDOSE/POISONING,thusaddressingscenesafetyandNarcan/Naloxoneadministration.• Rule1hasbeenmodifiedtoinclude“immediately.”TheRulenowreads“Whenapprovedand

arrangedbythelocalMedicalControl,mostasymptomaticingestions(notincludingantidepressants,cocaine,narcotics,acids,oralkalis)shouldbeimmediatelyreferredtotheregionalPoisonControlCenter.IfPoisonControl’sevaluationindicatesthenecessityofamobileresponse,theywillinformMedicalDispatch.”SeeFigure37.

©2017IAED 21

Figure37.ModifiedRules1and2.Protocol23.MPDSv13.1.©1979–2017PDC.

• Rule2hasbeenmodifiedtoinclude“immediate.”TheRulenowreads“IfanimmediateOMEGA(Ω)referraltoaPoisonControlCenterisnotlocallyapproved,theappropriateresponseislocallydetermined.“Homecare,”whichhasbeenusedbyregionalPoisonControlCenterswithgreatsuccess,isanOMEGA(notanALPHA)codebecauseanEMSresponsemaynotbenecessary.”SeeFigure37.

Rationale:Theadditionofthewords“immediately”and“immediate”isdesignedtopreventdelayedOMEGAreferralsintheinterestofpatientsafety.

PROTOCOLQ:Narcan/NaloxoneNasalInstructionsMulti-ProtocolChangesaffectingthisprotocol:JChangesaffectingonlythisprotocol:

• AnewCEIhasbeenaddedtoPanelQ-5:“Provideanadditionaldoseifthereisnoimprovementinher/hisbreathing(respiratoryfunction)in2–3minutesorifher/hissymptomsreturnafterthefirstdose.”SeeFigure38.

• AnewpaneldirectorhasbeenaddedtoPanelQ-5:“SymptomsRecurring/NotImproving.”SeeFigure38.

©2017IAED 22

Figure38.PanelQ-5.ProtocolQ.MPDSv13.1.©1979–2017PDC.


• PanelsQ-6,Q-6a,andQ-6bhavebeenaddedforSymptomsRecurring/NotImproving.SeeFigure

39.

Figure39.NewPanelsQ-6,Q-6a,andQ-6b.ProtocolQ.MPDSv13.1.©1979–2017PDC.

©2017IAED 23


PROTOCOLR:NaloxoneAuto-Injector(Evzio)InstructionsMulti-ProtocolChangesaffectingthisprotocol:JChangesaffectingonlythisprotocol:

• OnPanelR-3,theword“no”hasbeenunderlinedintheCEI.Rationale:ThischangemakestheCEIonProtocolRidenticaltotheCEIonProtocolQ.

• OnPanelR-4a,thetext“Now,wewillinjecttheseconddose,”hasbeenchangedto“Good,let’sinjectanotherdosenow.”SeeFigure40.

Figure40.Newinstruction.ProtocolR.MPDSv13.1.©1979–2017PDC.

Rationale:Thenewwordingisgenericandcanbeusedforrepeateddoses,notjustaseconddose.

PROTOCOLS:NaloxoneInjectionInstructionsMulti-ProtocolChangesaffectingthisprotocol:NoneChangesaffectingonlythisprotocol:

• AnewProtocolShasbeenaddedforadministrationofnaloxonethroughsyringes/needles.Panels1through7includeinstructionsfordeterminingthetypeofsyringe,fillingasyringe(ifnecessary),administeringdosesofmedication,andmonitoringthepatienttoassurerecovery.SeeFigure41.

• ToaccommodatetheadditionofProtocolS,twonewpaneldirectorshavebeenaddedforthequestion“Whattypeofdevicedoyouhave?”Selecting“SyringeandNeedle(s)”or“UnopenedKitorBox”willtakeyoutothecorrectpathwayonProtocolS.

©2017IAED 24

Figure41.ListofpanelnamesinthePAITargetTool.ProtocolS.MPDSv13.1.©1979–2017PDC.

Rationale:ThenewProtocolSwasaddedtoinstructcallersregardingtheuseofgenericNarcan/Naloxonekits,includingprefilledsyringes,ampules,andvials.

PROTOCOL24:Pregnancy/Childbirth/MiscarriageMulti-ProtocolChangesaffectingthisprotocol:EChangesaffectingonlythisprotocol:

• Theoperatorquestion“Ø Apparentmiscarriage?”hasbeenchangedto“Ø ApparentMISCARRIAGEorSTILLBIRTH?”Ananswerchoicehasbeenaddedfor“STILLBIRTH(non-viablebabyborn).”SeeFigure42.

Figure42.ModifiedKeyQuestionandanswerchoice.Protocol24.MPDSv13.1.©1979–2017PDC.

Rationale:ThisanswerchoicehasbeenaddedtoaccommodatethenewconditionofSTILLBIRTH,whichishandledusingtheMISCARRIAGEPAIpathway.

• TheDeterminantDescriptorfor24-C-1“2ndTRIMESTERhemorrhageorMISCARRIAGE”hasbeenchangedto“2ndTRIMESTERhemorrhage/MISCARRIAGE.”SeeFigure43.

• Standardprotocolonly:TheDeterminantDescriptorfor24-A-1“1stTRIMESTERhemorrhageorMISCARRIAGE”hasbeenchangedto“1stTRIMESTERhemorrhage/MISCARRIAGE.”SeeFigure43.

©2017IAED 25

Figure43.NewDeterminantDescriptorsandDeterminantCodes.Protocol24.MPDSv13.1.©1979–2017PDC.

Rationale:ThisformattingchangewasmadetobetterseparatethetwoconditionsandeliminateanyconfusionregardingMISCARRIAGEbeingassociatedwithTRIMESTER.

• Anew24-A-2DeterminantCodehasbeenadded:“ConfirmedSTILLBIRTHsituation(≥6

months/24weeksandnocomplications).”SeeFigure43.Rationale:ThisnewDeterminantCodeaccommodatesthenewconditionofSTILLBIRTH.

• Omegaprotocolonly:TheDeterminantDescriptorfor24-A-1“1stTRIMESTERhemorrhageor

MISCARRIAGEwithout1stpartyverification”hasbeenchangedto“1stTRIMESTERhemorrhage/MISCARRIAGEwithout1stpartyverification.”SeeFigure44.

• Omegaprotocolonly:TheDeterminantDescriptorfor24-Ω-2“1stTRIMESTERhemorrhageorMISCARRIAGEwith1stpartyverification”hasbeenchangedto“1stTRIMESTERhemorrhage/MISCARRIAGEwith1stpartyverification.”SeeFigure44.

Figure44.NewOmegaProtocolDeterminantDescriptors.Protocol24.MPDSv13.1.©1979–2017PDC.

Rationale:ThisformattingchangewasmadetobetterseparatethetwoconditionsandeliminateanyconfusionregardingMISCARRIAGEbeingassociatedwithTRIMESTER.

• TheCEI“FollowtheBREECHPositioningpathwaywhencervicalcerclage(stitch)isassociatedwithlabor”hasbeenmodifiedtoinclude“orFGM.”Itnowreads“FollowtheBREECH

©2017IAED 26

Positioningpathwaywhencervicalcerclage(stitch)orFGMisassociatedwithlabor.”SeeFigure45.

Figure45.ModifiedCEI.Protocol24.MPDSv13.1.©1979–2017PDC.

Rationale:TheadditionofFEMALEGENITALMUTILATION(FGM)tothisCEIdirectstheEMDtousetheBREECHPositioningPathwaywhenFGMisassociatedwithlabor.

• The“MISCARRIAGE”DLSLinkhasbeenchangedto“MISCARRIAGE(<6months/24weeks).”SeeFigure46.

Rationale:ThischangeclarifiesthedefinitionofMISCARRIAGE.• The“Cervicalcerclage(laborIMMINENTornotimminent)”DLSLinkhasbeenchangedto

“Cervicalcerclage/FGM(laborIMMINENTornotimminent).”SeeFigure46.

Rationale:FEMALEGENITALMUTILATIONfollowsthesameDLSLinkascervicalcerclage(F-25).

• Anew“ConfirmedSTILLBIRTHsituation(non-viablebabyborn)”DLSLinktoPanelG-2hasbeenadded.SeeFigure46.

©2017IAED 27

Figure46.NewandmodifiedDLSLinks.Protocol24.MPDSv13.1.©1979–2017PDC.

Rationale:ThisnewDLSLinkdirectstheEMDtoPanelG-2whenpresentedwithaconfirmedSTILLBIRTHsituation.

• TheMISCARRIAGEdefinitionhasbeenmodifiedtoinclude“(noSIGNSOFLIFE).”Itnowreads

“Thepost-deliveryofafetusorproductsofconception(tissue)priorto6monthsor24weeksofgestation(noSIGNSOFLIFE).”SeeFigure47.

Figure47.ModifiedMISCARRIAGEdefinition.Protocol24.MPDSv13.1.©1979–2017PDC.

Rationale:ThisadditionhelpstoensurethattheMISCARRIAGEpathwayisnotusedwhenSIGNSOFLIFEarepresent.

• AnewSIGNSOFLIFEWarninghasbeenadded:“IntheveryrareeventthataconfirmedSTILLBIRTHsituationorMISCARRIAGEproducesaninfantwithanySIGNSOFLIFE(moving,crying,orbreathing),theEMDshouldusetheTargetToolandlinktothemostappropriatePAIpathwayforchildbirthand/orresuscitation(F-7).”SeeFigure48.

©2017IAED 28

Figure48.SIGNSOFLIFEWarning.Protocol24.MPDSv13.1.©1979–2017PDC.

Rationale:Thiswarningwascreatedtoprovideforappropriatechildbirthand/orresuscitationinstructions,regardlessofgestation,whenSIGNSOFLIFEarepresent.

• AnewdefinitionhasbeenaddedforConfirmedSTILLBIRTHSituation:“Amedicallypreconfirmedandexpectedfetaldeath(≥6months/24weeksofgestation)atanystageoflaborordelivery.”SeeFigure49.

Figure49.ConfirmedSTILLBIRTHSituation.Protocol24.MPDSv13.1.©1979–2017PDC.

Rationale:ThisdefinitiondefinesSTILLBIRTHintheDLSenvironment,settingthestageforappropriateinstruction.

• AnewRule7hasbeenadded:“AconfirmedSTILLBIRTHsituationpriortodeliveryshouldbehandledusingProtocol24andPAIF.Oncethebabyisborn,PAIG-2isappropriate.”SeeFigure50.

Figure50.NewRule7.Protocol24.MPDSv13.1.©1979–2017PDC.

Rationale:ThisnewRuledirectstheEMDregardingconfirmedSTILLBIRTHsituationspriortoandafterdelivery.

• AnewdefinitionhasbeenaddedforFEMALEGENITALMUTILATION(FGM):“Anyprocedurethatinvolvespartialortotalremovaloftheexternalfemalegenitalia,orotherintentionalalterationorinjurytothefemalegenitalorgansfornon-medicalreasons.FGMismostcommonlydonetopreventsexualintercourseorpleasure.”SeeFigure51.

Figure51.FEMALEGENITALMUTILATION(FGM)definition.Protocol24.MPDSv13.1.©1979–2017PDC.

©2017IAED 29

Rationale:ThisdefinitiondefinesFGMintheDLSenvironment,settingthestageforappropriateinstruction.

• “FEMALEGENITALMUTILATION”hasbeenaddedtotheHIGHRISKComplicationslistandasananswerchoicetotheKeyQuestion“DoesshehaveanyHIGHRISKcomplications?”SelectingthisanswerchoicewillqualifytheDeterminantCode24-D-5“HIGHRISKcomplications.”SeeFigure52.

Figure52.HIGHRISKComplicationslist.Protocol24.MPDSv13.1.©1979–2017PDC.

Rationale:ThisadditionallowsforlocalresponseoptionsforFGM.

• Rule5hasbeenmodifiedtoincludeareferencetoFEMALEGENITALMUTILATION.Itnowreads,“LaborwiththeHIGHRISKcomplicationsofcervicalcerclage(stitch)orFGMshouldbehandledusingtheBREECHPositioningpathway.”SeeFigure53.

Figure53.ModifiedRule5.Protocol24.MPDSv13.1.©1979–2017PDC.

Rationale:ThisRuledirectstheEMDtousetheBREECHPositioningPathwaywhenFGMisassociatedwithlabor.

• AnewAxiom6hasbeenadded:“VictimsofFGMareverylikelytoexperienceseriouschildbirthcomplications,includingfetaland/ormaternaldeath,severepain,theneedtohaveacaesareansection,dangerouslyheavybleedingafterthebirth,andprolongedhospitalizationfollowingthebirth.VictimsmaynotmentionormayevendenytheyhavesufferedFGM.”SeeFigure54.

©2017IAED 30

Figure54.NewAxiom6.Protocol24.MPDSv13.1.©1979–2017PDC.

Rationale:ThisnewAxiomeducatestheEMDregardingFGM.

• TheTrimesterCalculatorDiagnosticToolhasbeenadded.ThisToolusesthereportedduedatetodeterminethegestationaltrimesterofapregnantfemaleorhowmanyweeksormonthsalongsheis.ItcanbelaunchediftheEMDselects“Knowsduedate”ontheKeyQuestion“Howmanyweeks(ormonths)pregnantisshe?”SeeFigure55.

Figure55.TrimesterCalculatorDiagnosticTool.MPDSv13.1.©1979–2017PDC.

Rationale:ThenewTrimesterCalculatorDiagnosticToolallowsforquickassessmentofTRIMESTERbasedonduedate.

©2017IAED 31

• AnewtabhasbeenaddedfortheTrimesterCalculatorDiagnosticToolwithintheContractionsTimerTool.ClickingonthistabwilllaunchtheTrimesterCalculatorDiagnosticTool.SeeFigure56.

Figure56.NewtabforTrimesterCalculatorDiagnosticTool.ContractionsTimerTool.MPDSv13.1.©1979–2017PDC.

Rationale:ThisgivestheEMDquickaccesstotheTrimesterCalculatorDiagnosticToolshoulditbecomenecessary.

©2017IAED 32

PROTOCOLG:MiscarriageMulti-ProtocolChangesaffectingthisprotocol:NoneChangesaffectingonlythisprotocol:

• OnPanelG-1,twonewPanelDirectorshavebeenaddedafterthequestion“Istheafterbirth(placenta)outyet?”The“Yes–Tissueonly”directorguidesthecalltakertoPanelG-2,andthe“Yes–SIGNSOFLIFE”directorguidesthecalltakertoPanelF-7.SeeFigure57.

Figure57.NewPanelDirectors.ProtocolG.MPDSv13.1.©1979–2017PDC.

Rationale:ThenewPanelDirectorsprovideappropriateinstructionlinksbasedongestationandpresentation,thusavoidinginappropriateinstructionfortissuepresentationorSIGNSOFLIFEinMISCARRIAGEorSTILLBIRTHsituations.

• OnPanelG-2,thetext“I’mverysorry.There’snothingwecandoforthebaby”isnowinparenthesestoindicatethatitiscircumstantialtext.ThetextwillnotbedisplayedatallinProQAifthecallerisreportingaConfirmedSTILLBIRTHSituation.SeeFigure58.

Rationale:Thisformattingmakestheinstructioncircumstantialsothatitisnotreadinappropriately.

• OnPanelG-2,thequestion“Isthemotherallright?”hasbeenremoved.Ithasbeenreplacedwiththeinstruction,“Let’scheckonthemothernow”andthequestion“IsshehavinganySERIOUSbleedingorcramping?”ThePanelDirector“Yes->X-1”hasbeenchangedto“No->X-1.”SeeFigure58.

o For1stpartycallers,theinstruction“Let’scheckonthemothernow”hasbeenomitted.

©2017IAED 33

Figure58.ModificationstoPanelG-2.ProtocolG.MPDSv13.1.©1979–2017PDC.

Rationale:Thesechangesprovidemoreappropriatewordingandinquiremoredirectlyregardingthemother’scondition.

• OnPanelG-3,theinstruction“Nowmakeafistandplaceitjustaboveherpubichair,butbelowherbellybutton”hasbeenmodified.Itnowreads,“Nowmakeafistandplaceitjustaboveherpubichair,rightnearherbellybutton.”SeeFigure59.

Figure59.ModifiedinstructiononPanelG-3.ProtocolG.MPDSv13.1.©1979–2017PDC.

Rationale:Thischangeclarifieshandplacementforsuprapubicpressure.

• OnPanelG-5,theinstruction“Iwantyoutofirmlyanddeeplymassageherbelly,justbelowthebellybutton”hasbeenmodified.Itnowreads,“Iwantyoutofirmlyanddeeplymassageherbelly,rightnearthebellybutton.”SeeFigure60.


Rationale:Thischangeclarifies/simplifieshandplacementforfundalmassage.

©2017IAED 34

• OnPanelG-7,theinstruction“Youneedtomassageherbellyagain,justbelowthebellybutton”hasbeenmodified.Itnowreads,“Youneedtomassageherbellyagain,rightnearthebellybutton.”SeeFigure61.


Rationale:Thischangeclarifies/simplifieshandplacementforrepeatfundalmassage.

PROTOCOL25:Psychiatric/AbnormalBehavior/SuicideAttemptMulti-ProtocolChangesaffectingthisprotocol:DChangesaffectingonlythisprotocol:NonePROTOCOL27:Stab/Gunshot/PenetratingTraumaMulti-ProtocolChangesaffectingthisprotocol:DChangesaffectingonlythisprotocol:None

PROTOCOL31:Unconscious/Fainting(Near)Multi-ProtocolChangesaffectingthisprotocol:E,G,IChangesaffectingonlythisprotocol:

• Anew“SlowRate(INEFFECTIVEBREATHING)”answerchoicehasbeenaddedtotheoperatorquestion“Ø SelectanswerbasedontheBreathingVerificationDiagnosticfindings.”Ifthisanswerchoiceisselected,the31-D-1“Unconscious–AGONAL/INEFFECTIVEBREATHING”DeterminantCodewillbedispatched.SeeFigure62.

Figure62.Newanswerchoice.Protocol31.MPDSv13.1.©1979–2017PDC.

Rationale:ApatientwhosebreathingisslowbutINEFFECTIVEnowqualifiesforahigherDeterminantCode.

• AnewKeyQuestionhasbeenadded:“Ifthereisadefibrillator(AED)available,sendsomeonetogetitnow,andtellmewhenyouhaveit.”ThisKeyQuestionwillonlybeshownifthepatientisoneyearorolderandeitherofthe31-E-1or31-D-1DeterminantCodeshasbeensent.SeeFigure63.

©2017IAED 35

Figure63.NewKeyQuestion.Protocol31.MPDSv13.1.©1979–2017PDC.

Rationale:ThisKeyQuestionensuresthatinformationabouttheavailabilityandpresenceofadefibrillatorisnotedcorrectlyinProQA.

PROTOCOL32:UnknownProblem(PersonDown)Multi-ProtocolChangesaffectingthisprotocol:NoneChangesaffectingonlythisprotocol:

• Anewoperatorquestionhasbeenaddedfor3rd-and4th-partycallers:“Ø Callermentionofanyinformationsuggestingthefollowingconditions?”Selectingthe“Abnormalbreathing,”“Cardiacarrest,”“Majorinjury,”“Unconsciousness,”or“Uncontrollablebleeding”answerchoiceswillenabletheDeterminantCode32-D-1“LIFESTATUSQUESTIONABLE.”SeeFigure64.


Rationale:ThisquestionandansweroptionsensurestheselectionoftheLIFESTATUSQUESTIONABLEDeterminantCodewhenanyoftheconditionsaremet.

PROTOCOL34:ACN(AutomaticCrashNotification)Multi-ProtocolChangesaffectingthisprotocol:AChangesaffectingonlythisprotocol:NonePROTOCOL35:HealthCareProfessionalAdmission(UKEonly)Multi-ProtocolChangesaffectingthisprotocol:KChangesaffectingonlythisprotocol:NonePROTOCOL36:Pandemic/Epidemic/Outbreak(SurveillanceorTriage)Multi-ProtocolChangesaffectingthisprotocol:AChangesaffectingonlythisprotocol:None

©2017IAED 36

PROTOCOL38:AdvancedSEND(MedicalMiranda)Multi-ProtocolChangesaffectingthisprotocol:AChangesaffectingonlythisprotocol:None

PROTOCOLN:Airway/Arrest/Choking(Unconscious)–Newborn/Neonate<30daysMulti-ProtocolChangesaffectingthisprotocol:G,HChangesaffectingonlythisprotocol:None

PROTOCOLA:Airway/Arrest/Choking(Unconscious)–Infant<1yrMulti-ProtocolChangesaffectingthisprotocol:G,HChangesaffectingonlythisprotocol:NonePROTOCOLB:Airway/Arrest/Choking(Unconscious)–Child1–7yrsMulti-ProtocolChangesaffectingthisprotocol:G,HChangesaffectingonlythisprotocol:None

PROTOCOLC:Airway/Arrest/Choking(Unconscious)–Adult≥8yrsMulti-ProtocolChangesaffectingthisprotocol:G,HChangesaffectingonlythisprotocol:NonePROTOCOLF:Childbirth–DeliveryMulti-ProtocolChangesaffectingthisprotocol:NoneChangesaffectingonlythisprotocol:

• APAIpathwayforFEMALEGENITALMUTILATIONhasbeenaddedtoProtocolF.SeeFigure65.o “FEMALEGENITALMUTILATION”hasbeenaddedto“Cervicalcerclage(stitch)”onthe

BREECHPositioninglistonPanelF-20.Itnowreads“Cervicalcerclage(stitch)/FEMALEGENITALMUTILATION.”

o “FGM”hasbeenaddedtothe“Yes–Cerclage”PanelDirectoronPanelF-25.Itnowreads“Yes–Cerclage/FGM.”SeeFigure65.

o “FGM”hasbeenaddedtothe“Cerclage”PanelDirectoronPanelF-26.Itnowreads“Cerclage/FGM.”

©2017IAED 37

Figure65.NewFGMpathway.ProtocolF.MPDSv13.1.©1979–2017PDC.

Rationale:ThesePAImodificationsprovideapathwayforthenewFGMcondition.

• OnPanelF-33,theinstruction“Iwantyoutofirmlyanddeeplymassageherbelly,justbelowthebellybutton”hasbeenmodified.Itnowreads,“Iwantyoutofirmlyanddeeplymassageherbelly,rightnearthebellybutton.”SeeFigure66.

Figure66.ModifiedinstructiononPanelF-33.ProtocolF.MPDSv13.1.©1979–2017PDC.

Rationale:Thischangeclarifies/simplifieshandplacementforfundalmassage.

• OnPanelF-35,theinstruction“Youneedtomassageherbellyagain,justbelowthebellybutton”hasbeenmodified.Itnowreads,“Youneedtomassageherbellyagain,rightnearthebellybutton.”SeeFigure67.

Figure67.ModifiedinstructiononPanelF-35.ProtocolF.MPDSv13.1.©1979–2017PDC.

Rationale:Thischangeclarifies/simplifieshandplacementforrepeatfundalmassage.

©2017IAED 38

PROTOCOLYA:Tracheostomy(Stoma)Airway/Arrest/Choking(Unconscious)–Infant<1yrMulti-ProtocolChangesaffectingthisprotocol:G,HChangesaffectingonlythisprotocol:NonePROTOCOLYB:Tracheostomy(Stoma)Airway/Arrest/Choking(Unconscious)–Child1–7yrsMulti-ProtocolChangesaffectingthisprotocol:G,HChangesaffectingonlythisprotocol:NonePROTOCOLYC:Tracheostomy(Stoma)Airway/Arrest/Choking(Unconscious)–Adult≥8yrsMulti-ProtocolChangesaffectingthisprotocol:G,HChangesaffectingonlythisprotocol:None

NAE, UKE, ANZ version 13.1

13.1V E R S I O N

Emergency Medical DispatchUpdate Guide

The International Academy’s EMD Protocol™

ADVANCED MEDICAL PRIORITY DISPATCH SYSTEM™

© 2017 IAEDNAE, UKE, ANZ 171110

MPDS v13.1 UPDATE

Determinant Code Conversions

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