APPENDIX 4

APPENDIX 4

Dispatch Protocols

Figure 1: Sample Call Flow for Standard EMD Calls vs. Pandemic Flu Calls

Standard EMD Call Flow		Pandemic Flu Call Flow
Telephone answered at 9-1-1 PSAP		Telephone answered at 9-1-1 PSAP
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EMD call taker obtains address, call back phone number and chief complaint		EMD call taker obtains address, call back phone number and chief complaint (1)
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EMD queries caller with standard questions using existing EMD process		EMD queries caller with standard questions using existing EMD process
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EMD call taker assigns and incident type code to case		For callers meeting predetermined criteria (established with local EMS authorities) EMD call taker queries caller using PAN FLU SPECIFIC PROTOCOL QUESTIONS (developed by State and/or local EMS & public health authorities in advance) then assigns an incident type code to case
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EMS units are selected for response based on pre-determined response schemes for standard EMS operations		EMS or alternative units are selected for response OR call taker transfers caller to alternative call center (1) based on pre-determined PAN FLU EMS DISPATCH PROTOCOLS (see Figure 2 - modified response developed by State and/or local EMS & public health authorities in advance)
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EMS units are alerted and respond to the scene		EMS units are altered and respond to the scene ONLY on designated incident types from PAN FLU EMS DISPATCH PROTOCOLS (see Figure 2)
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EMD call taker provides standard pre-arrivals or post-dispatch instructions while EMS units respond		EMD call taker provides standard pre-arrivals or post-dispatch instructions, or modified PAN FLU POST-DISPATCH INSTRUCTIONS (developed by State and/or local EMS & public health authorities in advance)
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EMS units arrive at scene		EMS units arrive at scene ONLY on designated incident types from PAN FLU EMS DISPATCH PROTOCOLS (see Figure 2)
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Patient is transported to hospital or ED or other appropriate destination via ambulance		Patient is transported ONLY on designated incident types from PAN FLU EMS OPERATING PROTOCOLS (see Figure 3)

(1) At different points in the Pan Flu Call Flow Process, and EMD call taker may transpire a call to an alternative call center (e.g. poison control, nurse advice lines, etc.) based on pre-determined Pan Flu EMS Dispatch Protocols. PSAPs should also plan to accept incoming calls from alternative call centers. A community’s mitigation strategy may include call takers instruction callers on social distancing, home care, or other care options.

Figure 2: Sample Pandemic Influenza EMS Dispatch Protocol

Consider the following when developing Arizona Protocols:

Increased Demand for Services
Reduction of EMS/Dispatch Workforce
Healthcare Facility Bed Availability

Dispatch Priority Level should match vendor or call center based dispatch protocol/tiered algorithm	Response Standard Operating Mode	Pandemic Severity Index Category 1	Pandemic Severity Index Category 2-3	Pandemic Severity Index Category 4-5
Classification 1 Confirmed/suspected cardiac arrest (not breathing, unresponsive per 911 call)	Closest AED unit; closest 1^st responder; closest ALS ambulance (HOT)	Closest AED unit; closest 1^st responder; closest ALS ambulance if available (HOT)	Closest AED unit (HOT); closest 1^st responder if available (HOT)	Closest AED unit if available (HOT)
Classification 2 Life threatening emergency/potentially life threatening/ confirmed unstable patient(s)	Closest 1^st responder; closest ALS ambulance (HOT)	Closest 1^st responder; closest ALS ambulance if available; BLS ambulance if ALS unit is not available (HOT)	Closest 1^st responder; closest ambulance available (ALS or BLS) (HOT)	Closest 1^st responder if available.; closest ambulance available (ALS or BLS) (HOT)
Classification 3 Non-critical/currently stable patient(s) requiring ALS assessment	Closest ALS ambulance (COLD)	Closest available ambulance (ALS or BLS) (COLD)	Closest ambulance available (ALS or BLS) (COLD)	Referral to alternate call center or advise self-transport to alternate care site (ACS)
Classification 4 BLS assessment for unknown/possibly dangerous scenes	Closest 1^st responder (HOT); closest BLS ambulance (COLD)	Closest 1^st responder (HOT); closest BLS ambulance if available (COLD)	Closest 1^st responder (HOT)	Closest 1^st responder if available; or closest stand-in responder unit
Classification 5 BLS treatment	BLS ambulance (COLD)	BLS ambulance (COLD)	Alternate call center (such as poison control, nurse advice line, health care call center, etc.)	Alternate call center (such as poison control, nurse advice line, health care call center, etc.)
Classification 6 Non-ambulance care	Alternate call center (such as poison control, nurse advice line, health care call center, etc.)	Alternate call center (such as poison control, nurse advice line, health care call center, etc.)	Alternate call center (such as poison control, nurse advice line, health care call center, etc.)	Alternate call center (such as poison control, nurse advice line, health care call center, etc.)

HOT and COLD as defined in Appendix 3 – Glossary:

Hot	An EMS vehicle involved in an emergency response or transport while using appropriate audible and visual emergency signaling equipment (i.e., lights and siren) in accordance with statutes.
Cold	An EMS vehicle involved in a non-emergency response or transport while not using emergency signaling equipment (i.e., no lights and siren).

Figure 3: Sample Pandemic Influenza EMS Operating Protocol

Consider the following when developing Arizona Protocols:

Increased Demand for Services
Reduction of EMS/Dispatch Workforce
Healthcare Facility Bed Availability

Sample Protocol	Pandemic Severity Index Category 1	Pandemic Severity Index Category 2-3	Pandemic Severity Index Category 4-5
Triage to occur at 9-1-1 call center & on scene	Determine whether to implement triage and treatment protocols that differentiate between non-infected and potentially infected patients based on CDC or ADHS case definition*	Triage would focus on identifying and reserving immediate treatment for individuals who have a critical need for treatment and are likely to survive. The goal would be to allocate resources in order to maximize the number of lives saved	Using screening algorithm to ensure only severe get response
Treatment	Ambulatory patients will be redirected to alternate care sites within or outside of the hospital	Treatment protocols may be modified to enable and encourage patients to receive care at home Consider provision of antiviral prophylaxis if effective, feasible, and quantities sufficient	Certain lifesaving efforts may have to be discontinued Provision of antiviral prophylaxis if effective, feasible, and quantities sufficient
Equipment	Prudent use of equipment Implementation of strict PPE/infection control protocols for patents meeting case definition during response phase of 9-1-1 call	Selective criteria in place for priority use Some scarce and valuable equipment, such as ventilators, may not be used without staff available who are trained to operate them	Strict criteria in place for equipment use Some scare and valuable equipment, such as ventilators, may not be used without staff available who are trained to operate them
Transportation	Non-urgent and ambulatory victims may have to walk or self-transport to the nearest facility or hospital	Emergency medical services may transport victims to specific quarantine or isolation locations and other alternate care sites	Only severe cases transported via ambulance
Destination	Alternate care sites will be used for triage and distribution of vaccines or other prophylactic measures, as well as for quarantine, minimum care, and hospice care	Ambulatory and some non-ambulatory patients may be diverted to alternate care sites 9including non-medical space, such as cafeterias within hospitals, or other non-medical facilities)	Emergency department access may be reserved for immediate-need patients

*Case definition for presumptive/definitive diagnosis includes fever of at least 101^o F along with either cough or sore throat. A specific clinical case definition for pandemic influenza will be developed when more is known about the circulating pandemic flu virus (any unique symptoms or epidemiological links such as geographic or contact with chickens, etc.).

Figure 4: Pandemic Influenza Specific Protocol Questionnaire

To be used for surveillance and early outbreak detection and situational awareness (who-where is data sent-state lab? How is it collected-database, fax paper, etc.?

Please save and forward this form to your local County Health Department
Figure 5: Sample Pandemic Influenza EMS Pre-Arrival Guidance