Analyst: Determinant codes streamline dispatch

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.

An analyst for one of the leading providers of determinant code protocols nationwide says that the benefits of dispatch centers and EMS providers using the codes far outweigh any negatives and said fears that they might be hard to learn or time-consuming are overblown.

Greg Scott, an operations research analyst for the International Academy of Emergency Dispatch in Salt Lake City, Utah, told The Lebanon Voice that the determinant codes are a "core asset of protocols."

In the world of EMS and emergency dispatch centers, protocols are formalized processes that dictate what level of response is appropriate for a medical emergency call.

"The codes give responders a good initial understanding of what they are responding to," Scott said on Monday.

Bill Tower, the director of Sanford Regional Dispatch which dispatches for Lebanon and surrounding Maine towns, said last week he felt that determinant codes could be time consuming because they have more question and response prior to dispatch. He said he could have boots on the ground in 30 seconds, but that determinant codes could take longer.

Scott, however, said not by much. He said the average time from call received to dispatch using determinant codes on a Charlie level call, a mid-level response with advanced life support, is 57 seconds.

Determinant codes rate emergency response from A-E, or Alpha to Echo, with Echo being the most acute.

Scott said the average time for a Delta response is 47 seconds and an Echo, 33.

From determinant code response protocols

Another barrier to use of the codes is that some doubt volunteers in small community ambulance services like Lebanon could learn all the codes, but Scott said there are solutions to that problem as well.

He said they range from pocket-size field response flip charts to mobile apps you can load onto a smartphone.

Maine is among several states that are seeking to implement the Medical Priority Dispatch System as developed by Scott's organization.

With the codes in use, Scott was confident that the symptoms suffered by Lebanon Voice President Martha Soto-Galicia during her ruptured brain aneurysm would've drawn an expedited response.

He said the specific responses that would draw the quick response were the "sudden onset of severe pain" and "paralysis" due to no feeling in the neck (or stiff neck), both suffered by Soto-Galicia when she suffered the ruptured brain aneurysm on Feb. 12.

In an earlier story in The Lebanon Voice in its series on determinant codes last week, Maine Emergency Medical Dispatch Program Manager Drexel White also stated that the "sudden onset of severe pain" would've drawn the same "Charlie" level response.

A "Charlie" level response normally calls for advanced life support going "hot" to the scene, which can mean sirens and lights.

With any kind of suspected stroke, whether it be the more common Ischemic or Subarachnoid (hemorrhagic), a swift response is needed, Scott said.

Even a mini-stroke, or transient ischemic attack (TIA) has to be treated as a stroke, because the condition can change quickly, Scott added.

Scott said he's heard some of the grumbles when it comes to determinant code dispatching, but adds, "I don't understand why you wouldn't want to take advantage of it."

He said the codes are also useful in analyzing dispatch trends and helping to build efficiencies into an EMS provider's operation.

The determinant codes developed by the International Academy of Emergency Dispatch are the most widely used in the country, with about 3,000 dispatch agencies onboard, Scott said.

Lebanon Fire and Rescue Chief Dan Meehan has said Lebanon and Milton do not use determinant codes.

"Sanford Regional Communications Center is generating a determinant code on medical 911 calls, but is not (yet) broadcasting determinant codes as part of its dispatch to EMS services," Meehan told The Lebanon Voice in an email today.