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Concurrence among responders are the goal

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Editor's note: This is one of a series of articles in The Lebanon Voice exploring the use of determinant codes in the dispatch of EMS providers and the challenges as well as benefits it can bring to the people of Maine.

AUGUSTA, Maine - The state of Maine has spent more than $1 million in implementing determinant codes as universal protocols in the delivery of emergency medical services to residents, but its return on investment won't be fully realized until rescue providers at the local level are also fully onboard and actively utilizing the new guidelines, agree officials from the state's Public Utilities Commission.

The state of Maine initially purchased the determinant codes protocols, training and implementation rights in 2009 for $723,219, according to the PUC's Harry Lanphear, who serves as the administrative director of PUC. That covered all the costs for the first three years, after which maintenance of the agreement and continued training and software licensing costs the state an additional $149,000 annually.

Lanphear and Maria Jacques, Director of the Emergency Services Communications Bureau within PUC, said their agency oversees and pays for the contract with the protocols provider, but cannot mandate any local EMS provider to use the codes, however, both she and Lanphear added their hope down the road is the codes would be utilized by everyone from the dispatch centers to local rescue departments.

Drexel White, Maine's Emergency Medical Dispatch project manager, said in a recent Lebanon Voice article he hopes to have education and awareness pave the way for local EMS provides like Lebanon Fire and EMS to ask to use determinant codes.

"We're trying to change the culture; we don't want to go lights and sirens whether it's a hangnail or a heart attack," he said in an interview last month. "But we would like to see it (the impetus to use determinant codes) come from EMS services."

He added that the state EMS board could force the usage of determinant codes, but they haven't in the past.

"Politically, what we try to do is provide the education, and get services to say this is a good thing and a way to make better use of life support and automatic ALS (Advanced Life Support) for high level cases."

Right now Maine is one of a dozen or so states in which all 911 call takers in all 26 state Public Safety Access Points (PSAPs) are licensed in medical dispatch, Lanphear said.

And while most local EMS providers don't use the codes, vital emergency medical access and advanced life care services are being dispatched thanks to their use at regional dispatch centers.

Meanwhile, Lebanon Fire and EMS recently hired a medical services director, a key cog in implementing the use of determinant codes at the local level. And while Chief Dan Meehan told The Lebanon Voice the hiring was not in connection with switching to determinant codes dispatch, it is still seen as a hopeful sign the department will be more ready if and when a switch is made.

The cost of a medical services director, however, is just one reason some local EMS providers aren't interested in determinant codes. Others include the notion of local control and the feeling that determinant codes take longer to dispatch "boots on the ground," though determinant code advocates insist you're talking seconds longer, not minutes.

Meanwhile, all the money to fund the state's protocol system that includes a determinant code component come from the 911 surcharge everyone pays on their phone bill whether it be landline or cell.

The program includes dispatcher training, the cost to recertify some of the dispatchers and follow-up training as well as card sets with protocols listed.

Those card sets are not made available to local providers, however, another added cost, but there are free apps that can be downloaded on any smartphone.

In conclusion, Jacques said the hope is to have concurrence among all providers from PSAPs to local first responders, and while she admits the PUC has little authority to mandate such, it is and will be the end goal.

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