Guest guest Posted February 21, 2007 Report Share Posted February 21, 2007 The service I worked for would not change anything on the cards for fear of the litigation that may have resulted. That was the fault of my services, not MPDS. But how many EMS services using the MPDS cards don't customize them for that reason. I have seen several posts mention that research shows that MPDS works, where are those studies that proves that system works. Is it like CISM, all the research was conducted by MPDS or someone who has an interest? I found many times that the cards recommended a response that later turned out to be incorrect. I realize that is only my experience and not backed up by research. So let's get some research going. Prove that MPDS works or doesn't. To me this system is " dumbing down " EMS again. Don't think just follow what is written in the cookbook, and I will not get sued. I did not like the system because it did not have any flexibility. At times using MPDS felt like pounding a square peg into a round hole. We need to question, discuss, research, and change things we do in EMS. A majority of procedures that I did 34 years ago when I started in EMS have changed. If we don't change, then EMS will not grow and progress. This just my opinion and .02 for what it is worth. Bernie Stafford LPN EMTP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2007 Report Share Posted February 21, 2007 I will just add a personal observation and get ready for the flames. I find it interesting that so many things in medicine come in cycles. I expect that anyday now we will be hearing that rotating TKs is how we should be treating CHF, Bretylium is coming back, etc. It is also interesting that in emergency medicine, we are expected to BE PERFECT in the areas that no one else wants to touch! Indigent care, lack of resources, overcrowding, etc. Let's just look at MPDS. In any area of medicine except EMS/public service, this is called phone triage. Many physicians just WILL NOT DO IT! Why, too risky. If they send the pt to the hospital and they did not need to be there, they look like a fool to colleuges and the pt. If they have them stay home and they have a bad outcome, they get a call from lawyer. It is " safer and more prudent " to have a policy that says, the pt is not physically in my care, they must decide on their own whether or not to go to the ED. Now, why are we expecting someone who had a week or two of training in the dispatch to make those decisions? Why are we taking a person with training in physical assessment (gotta touch 'em) and asking them to do a phone diagnosis and send proper resources? Is MPDS cookbook? Yes. Have you ever listened to the calls? I have not for a while, but is scares me when I do. We all, myself included, have had pts tell the next provider an important history piece that I did not get and then I look like a fool. That is why I say that EM physicians are always the interns. We get the first and usually the worst history. Not that we are bad at it, just that the patient is prompted to rethink, " I did not have pain in my chest, it just aches. But that is not pain, I guess I should have told about that. " In every system I have been in, everyone complains that dispatch gets it wrong. How much is due to the first history effect I don't know. What I do know is that there is NEVER going to be a perfect system. MPDS is just a system. It beats what I did when I dispatched in 1985; name, address, phone, and what is the problem, OK I'll send someone, click. Quality is a given in MPDS, how do you do good QA on any other system, it is not uniform. Someone want to make the next MPDS, have at it. I would not touch it! If every other doctor is shying away from the phones, it must be hard to do good. Now where have we seen some of the other things coming back, i.e. high doses of NTG for CHF (taught in 1992 on first day of my residency, ridiculed when I started it down here), GIK for ACS, and the list could go on. Newbies, don't totally forget what you are taught is going away, chances are it may come back in 10-20 yrs. Don Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2007 Report Share Posted February 21, 2007 I do not know Dr. Clawson although he and I worked in the same case together once. I have nothing against him, and I assume that he is a well-intentioned, honorable man. He testified in the case and our side won. I expect that we would have won in any event, because the facts were on our side. The fact remains that MPDS is a proprietary, for profit, product. That always makes me suspicious of a number of things. For one thing, I always look at " research " involving such proprietary programs rather closely, just as I have with the CISD program. I would caution those who would be tempted to leap to the assumption that if you buy MPDS you will automatically win every case in court. Many lawyers, even good trial lawyers, do not know much about EMS and all its issues. But they are learning. I expect that under the right kind of cross-examination that MPDS might not stand up as well as some may expect. Therefore it is imperative that each service base its practices on the best available criteria, and that each service examine critically its practices, not in the context of a " package " of services purchased, but in the reality of factual evidence, because it's only the facts that ultimately count. It may well be that MPDS is the best system available; it may be that it's no better than nothing. Gene Gandy, JD, LP > > Thom: > > The differences between the ACLS algorithm and the MPDS algorithm is that > the ACLS algorithms are based upon established science. There are only a > handful of studies on MPDS, They seem to show that MPDS is good at > determining non-serious cases and cardiac arrest. It is not so good in high > acuity cases (as mentioned about the Toronto study). > > Unlike the CISM people, Jeff Clawson and the others are asking for research > and seem to be reacting to research by refining their product. But, we must > remember that it is a proprietary product. There is no evidence it is any > better than the APCO model. In fact, there is NO EVIDENCE that any sort of > dispatch screening improves outcomes. It may be, that the best response is > to send a BLS ambulance to every call with ALS provided later if needed. > > BTW I consider Jeff Clawson a friend and an EMS visionary. HE teased me last > Friday about " wanting science " knowing that is what is needed. He is a good > person and has the best of intentions and I am sure his products will react > to changes in the science. His product was, unfortunately, developed at a > time in EMS when there was not much science and things were based upon > rational conjecture. > > EMS is a difficult mistress. If I don't change my textbooks to reflect the > science, I am bashed. But, when somebody gives somebody a certification or > badge in a program such as CISM or MPDS or Tactical Medicine (which are > based on limited or flawed science), they will accept it at face value > despite a paucity of research. > > BEB > > From: texasems-l@yahoogrotexasem [mailto:texasems-l@yahoogrotexasem] On > Behalf Of Thom Seeber > Sent: Wednesday, February 21, 2007 10:45 AM > To: texasems-l@yahoogrotexasem > Subject: RE: Re: MPDS > > So, let me see if I've got this straight. You are saying that an EMS crew > that responds to a call for assistance should make the determination on if > that person " deserves " to go to the hospital to be evaluated, is that right? > Because, there is nothing in the MPDS protocol that determines the patient > should not go for evaluation. Every patient that calls will receive a > response. > > Triage? Absolutely. Based upon a set of questions, the calltaker will > determine the indicated severity of the symptoms the caller describes. The > entire response is based upon the assumption that the information provided > will be honest and complete. > > Is MPDS cookbook? Well, I guess you could say yes inso much as you could say > the same thing about ACLS being cookbook. ACLS follows an establish > algorithm just as MPDS does. > > Thom Seeber, CCEMT-P > American Medical Response > 7509 South Freeway > Houston, Texas 77346 > > > Re: MPDS > > I will just add a personal observation and get ready for the flames. > > I find it interesting that so many things in medicine come in cycles. I > expect that anyday > now we will be hearing that rotating TKs is how we should be treating CHF, > Bretylium is > coming back, etc. It is also interesting that in emergency medicine, we are > expected to BE > PERFECT in the areas that no one else wants to touch! Indigent care, lack > of resources, > overcrowding, etc. > > Let's just look at MPDS. In any area of medicine except EMS/public service, > this is called > phone triage. Many physicians just WILL NOT DO IT! Why, too risky. If > they send the pt to > the hospital and they did not need to be there, they look like a fool to > colleuges and the > pt. If they have them stay home and they have a bad outcome, they get a > call from > lawyer. It is " safer and more prudent " to have a policy that says, the pt > is not physically in > my care, they must decide on their own whether or not to go to the ED. > > Now, why are we expecting someone who had a week or two of training in the > dispatch to > make those decisions? Why are we taking a person with training in physical > assessment > (gotta touch 'em) and asking them to do a phone diagnosis and send proper > resources? Is > MPDS cookbook? Yes. Have you ever listened to the calls? I have not for a > while, but is > scares me when I do. > > We all, myself included, have had pts tell the next provider an important > history piece that > I did not get and then I look like a fool. That is why I say that EM > physicians are always the > interns. We get the first and usually the worst history. Not that we are > bad at it, just that > the patient is prompted to rethink, " I did not have pain in my chest, it > just aches. But that > is not pain, I guess I should have told about that. " > > In every system I have been in, everyone complains that dispatch gets it > wrong. How > much is due to the first history effect I don't know. What I do know is > that there is NEVER > going to be a perfect system. MPDS is just a system. It beats what I did > when I dispatched > in 1985; name, address, phone, and what is the problem, OK I'll send > someone, click. > Quality is a given in MPDS, how do you do good QA on any other system, it is > not uniform. > > Someone want to make the next MPDS, have at it. I would not touch it! If > every other > doctor is shying away from the phones, it must be hard to do good. > > Now where have we seen some of the other things coming back, i.e. high doses > of NTG for > CHF (taught in 1992 on first day of my residency, ridiculed when I started > it down here), > GIK for ACS, and the list could go on. Newbies, don't totally forget what > you are taught is > going away, chances are it may come back in 10-20 yrs. > > Don > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2007 Report Share Posted February 21, 2007 So, let me see if I've got this straight. You are saying that an EMS crew that responds to a call for assistance should make the determination on if that person " deserves " to go to the hospital to be evaluated, is that right? Because, there is nothing in the MPDS protocol that determines the patient should not go for evaluation. Every patient that calls will receive a response. Triage? Absolutely. Based upon a set of questions, the calltaker will determine the indicated severity of the symptoms the caller describes. The entire response is based upon the assumption that the information provided will be honest and complete. Is MPDS cookbook? Well, I guess you could say yes inso much as you could say the same thing about ACLS being cookbook. ACLS follows an establish algorithm just as MPDS does. Thom Seeber, CCEMT-P American Medical Response 7509 South Freeway Houston, Texas 77346 Re: MPDS I will just add a personal observation and get ready for the flames. I find it interesting that so many things in medicine come in cycles. I expect that anyday now we will be hearing that rotating TKs is how we should be treating CHF, Bretylium is coming back, etc. It is also interesting that in emergency medicine, we are expected to BE PERFECT in the areas that no one else wants to touch! Indigent care, lack of resources, overcrowding, etc. Let's just look at MPDS. In any area of medicine except EMS/public service, this is called phone triage. Many physicians just WILL NOT DO IT! Why, too risky. If they send the pt to the hospital and they did not need to be there, they look like a fool to colleuges and the pt. If they have them stay home and they have a bad outcome, they get a call from lawyer. It is " safer and more prudent " to have a policy that says, the pt is not physically in my care, they must decide on their own whether or not to go to the ED. Now, why are we expecting someone who had a week or two of training in the dispatch to make those decisions? Why are we taking a person with training in physical assessment (gotta touch 'em) and asking them to do a phone diagnosis and send proper resources? Is MPDS cookbook? Yes. Have you ever listened to the calls? I have not for a while, but is scares me when I do. We all, myself included, have had pts tell the next provider an important history piece that I did not get and then I look like a fool. That is why I say that EM physicians are always the interns. We get the first and usually the worst history. Not that we are bad at it, just that the patient is prompted to rethink, " I did not have pain in my chest, it just aches. But that is not pain, I guess I should have told about that. " In every system I have been in, everyone complains that dispatch gets it wrong. How much is due to the first history effect I don't know. What I do know is that there is NEVER going to be a perfect system. MPDS is just a system. It beats what I did when I dispatched in 1985; name, address, phone, and what is the problem, OK I'll send someone, click. Quality is a given in MPDS, how do you do good QA on any other system, it is not uniform. Someone want to make the next MPDS, have at it. I would not touch it! If every other doctor is shying away from the phones, it must be hard to do good. Now where have we seen some of the other things coming back, i.e. high doses of NTG for CHF (taught in 1992 on first day of my residency, ridiculed when I started it down here), GIK for ACS, and the list could go on. Newbies, don't totally forget what you are taught is going away, chances are it may come back in 10-20 yrs. Don Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2007 Report Share Posted February 21, 2007 Thom: The differences between the ACLS algorithm and the MPDS algorithm is that the ACLS algorithms are based upon established science. There are only a handful of studies on MPDS, They seem to show that MPDS is good at determining non-serious cases and cardiac arrest. It is not so good in high acuity cases (as mentioned about the Toronto study). Unlike the CISM people, Jeff Clawson and the others are asking for research and seem to be reacting to research by refining their product. But, we must remember that it is a proprietary product. There is no evidence it is any better than the APCO model. In fact, there is NO EVIDENCE that any sort of dispatch screening improves outcomes. It may be, that the best response is to send a BLS ambulance to every call with ALS provided later if needed. BTW I consider Jeff Clawson a friend and an EMS visionary. HE teased me last Friday about " wanting science " knowing that is what is needed. He is a good person and has the best of intentions and I am sure his products will react to changes in the science. His product was, unfortunately, developed at a time in EMS when there was not much science and things were based upon rational conjecture. EMS is a difficult mistress. If I don't change my textbooks to reflect the science, I am bashed. But, when somebody gives somebody a certification or badge in a program such as CISM or MPDS or Tactical Medicine (which are based on limited or flawed science), they will accept it at face value despite a paucity of research. BEB From: texasems-l [mailto:texasems-l ] On Behalf Of Thom Seeber Sent: Wednesday, February 21, 2007 10:45 AM To: texasems-l Subject: RE: Re: MPDS So, let me see if I've got this straight. You are saying that an EMS crew that responds to a call for assistance should make the determination on if that person " deserves " to go to the hospital to be evaluated, is that right? Because, there is nothing in the MPDS protocol that determines the patient should not go for evaluation. Every patient that calls will receive a response. Triage? Absolutely. Based upon a set of questions, the calltaker will determine the indicated severity of the symptoms the caller describes. The entire response is based upon the assumption that the information provided will be honest and complete. Is MPDS cookbook? Well, I guess you could say yes inso much as you could say the same thing about ACLS being cookbook. ACLS follows an establish algorithm just as MPDS does. Thom Seeber, CCEMT-P American Medical Response 7509 South Freeway Houston, Texas 77346 Re: MPDS I will just add a personal observation and get ready for the flames. I find it interesting that so many things in medicine come in cycles. I expect that anyday now we will be hearing that rotating TKs is how we should be treating CHF, Bretylium is coming back, etc. It is also interesting that in emergency medicine, we are expected to BE PERFECT in the areas that no one else wants to touch! Indigent care, lack of resources, overcrowding, etc. Let's just look at MPDS. In any area of medicine except EMS/public service, this is called phone triage. Many physicians just WILL NOT DO IT! Why, too risky. If they send the pt to the hospital and they did not need to be there, they look like a fool to colleuges and the pt. If they have them stay home and they have a bad outcome, they get a call from lawyer. It is " safer and more prudent " to have a policy that says, the pt is not physically in my care, they must decide on their own whether or not to go to the ED. Now, why are we expecting someone who had a week or two of training in the dispatch to make those decisions? Why are we taking a person with training in physical assessment (gotta touch 'em) and asking them to do a phone diagnosis and send proper resources? Is MPDS cookbook? Yes. Have you ever listened to the calls? I have not for a while, but is scares me when I do. We all, myself included, have had pts tell the next provider an important history piece that I did not get and then I look like a fool. That is why I say that EM physicians are always the interns. We get the first and usually the worst history. Not that we are bad at it, just that the patient is prompted to rethink, " I did not have pain in my chest, it just aches. But that is not pain, I guess I should have told about that. " In every system I have been in, everyone complains that dispatch gets it wrong. How much is due to the first history effect I don't know. What I do know is that there is NEVER going to be a perfect system. MPDS is just a system. It beats what I did when I dispatched in 1985; name, address, phone, and what is the problem, OK I'll send someone, click. Quality is a given in MPDS, how do you do good QA on any other system, it is not uniform. Someone want to make the next MPDS, have at it. I would not touch it! If every other doctor is shying away from the phones, it must be hard to do good. Now where have we seen some of the other things coming back, i.e. high doses of NTG for CHF (taught in 1992 on first day of my residency, ridiculed when I started it down here), GIK for ACS, and the list could go on. Newbies, don't totally forget what you are taught is going away, chances are it may come back in 10-20 yrs. Don Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2007 Report Share Posted February 21, 2007 In working on the admin level with services using MPDS, our patient surveys always slammed it. Most said they were afraid if they didn't answer the questions the right way, no ambulance would be dispatched. Customer service issues as well as everyone asking - is this really doing any good prompted ceasing the program. -MH >>> " Thom Seeber " 2/21/2007 10:44 am >>> So, let me see if I've got this straight. You are saying that an EMS crew that responds to a call for assistance should make the determination on if that person " deserves " to go to the hospital to be evaluated, is that right? Because, there is nothing in the MPDS protocol that determines the patient should not go for evaluation. Every patient that calls will receive a response. Triage? Absolutely. Based upon a set of questions, the calltaker will determine the indicated severity of the symptoms the caller describes. The entire response is based upon the assumption that the information provided will be honest and complete. Is MPDS cookbook? Well, I guess you could say yes inso much as you could say the same thing about ACLS being cookbook. ACLS follows an establish algorithm just as MPDS does. Thom Seeber, CCEMT-P American Medical Response 7509 South Freeway Houston, Texas 77346 Re: MPDS I will just add a personal observation and get ready for the flames. I find it interesting that so many things in medicine come in cycles. I expect that anyday now we will be hearing that rotating TKs is how we should be treating CHF, Bretylium is coming back, etc. It is also interesting that in emergency medicine, we are expected to BE PERFECT in the areas that no one else wants to touch! Indigent care, lack of resources, overcrowding, etc. Let's just look at MPDS. In any area of medicine except EMS/public service, this is called phone triage. Many physicians just WILL NOT DO IT! Why, too risky. If they send the pt to the hospital and they did not need to be there, they look like a fool to colleuges and the pt. If they have them stay home and they have a bad outcome, they get a call from lawyer. It is " safer and more prudent " to have a policy that says, the pt is not physically in my care, they must decide on their own whether or not to go to the ED. Now, why are we expecting someone who had a week or two of training in the dispatch to make those decisions? Why are we taking a person with training in physical assessment (gotta touch 'em) and asking them to do a phone diagnosis and send proper resources? Is MPDS cookbook? Yes. Have you ever listened to the calls? I have not for a while, but is scares me when I do. We all, myself included, have had pts tell the next provider an important history piece that I did not get and then I look like a fool. That is why I say that EM physicians are always the interns. We get the first and usually the worst history. Not that we are bad at it, just that the patient is prompted to rethink, " I did not have pain in my chest, it just aches. But that is not pain, I guess I should have told about that. " In every system I have been in, everyone complains that dispatch gets it wrong. How much is due to the first history effect I don't know. What I do know is that there is NEVER going to be a perfect system. MPDS is just a system. It beats what I did when I dispatched in 1985; name, address, phone, and what is the problem, OK I'll send someone, click. Quality is a given in MPDS, how do you do good QA on any other system, it is not uniform. Someone want to make the next MPDS, have at it. I would not touch it! If every other doctor is shying away from the phones, it must be hard to do good. Now where have we seen some of the other things coming back, i.e. high doses of NTG for CHF (taught in 1992 on first day of my residency, ridiculed when I started it down here), GIK for ACS, and the list could go on. Newbies, don't totally forget what you are taught is going away, chances are it may come back in 10-20 yrs. Don Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2007 Report Share Posted February 22, 2007 NO, you did misunderstand. Clawson does want science. The problem is how to get it. I am for something like MPDS, be it MPDS, APCO, or something else, just make the information gathering uniform. BTW, you are apparently unaware of the " Omega " response in MPDS. This is not specific, but imagine you call 911 for you child found wearing a bottle of tylenol liquid or something else. 911 MAY, with medical directors' specific instruction, forward the call to poison center and NOT send an ambulance. Some omega response may be to connect caller to a clinic to get a next day appt, etc. Personally, I feel is dangerous WITHOUT hard science. So, how do we get the evidence? Taken to the extreme, look at the back issues of www.qfever.com for the heart transplant studies with real hearts vs styrofoam placebos. (I was laughing out loud) but it shows how hard someof this could be. I think we all do many things cookbook, but the cook has to think and interpret! Don > > So, let me see if I've got this straight. You are saying that an EMS crew > that responds to a call for assistance should make the determination on if > that person " deserves " to go to the hospital to be evaluated, is that right? > Because, there is nothing in the MPDS protocol that determines the patient > should not go for evaluation. Every patient that calls will receive a > response. > > Triage? Absolutely. Based upon a set of questions, the calltaker will > determine the indicated severity of the symptoms the caller describes. The > entire response is based upon the assumption that the information provided > will be honest and complete. > > Is MPDS cookbook? Well, I guess you could say yes inso much as you could say > the same thing about ACLS being cookbook. ACLS follows an establish > algorithm just as MPDS does. > > > Thom Seeber, CCEMT-P > American Medical Response > 7509 South Freeway > Houston, Texas 77346 > > > Re: MPDS > > I will just add a personal observation and get ready for the flames. > > I find it interesting that so many things in medicine come in cycles. I > expect that anyday > now we will be hearing that rotating TKs is how we should be treating CHF, > Bretylium is > coming back, etc. It is also interesting that in emergency medicine, we are > expected to BE > PERFECT in the areas that no one else wants to touch! Indigent care, lack > of resources, > overcrowding, etc. > > Let's just look at MPDS. In any area of medicine except EMS/public service, > this is called > phone triage. Many physicians just WILL NOT DO IT! Why, too risky. If > they send the pt to > the hospital and they did not need to be there, they look like a fool to > colleuges and the > pt. If they have them stay home and they have a bad outcome, they get a > call from > lawyer. It is " safer and more prudent " to have a policy that says, the pt > is not physically in > my care, they must decide on their own whether or not to go to the ED. > > Now, why are we expecting someone who had a week or two of training in the > dispatch to > make those decisions? Why are we taking a person with training in physical > assessment > (gotta touch 'em) and asking them to do a phone diagnosis and send proper > resources? Is > MPDS cookbook? Yes. Have you ever listened to the calls? I have not for a > while, but is > scares me when I do. > > We all, myself included, have had pts tell the next provider an important > history piece that > I did not get and then I look like a fool. That is why I say that EM > physicians are always the > interns. We get the first and usually the worst history. Not that we are > bad at it, just that > the patient is prompted to rethink, " I did not have pain in my chest, it > just aches. But that > is not pain, I guess I should have told about that. " > > In every system I have been in, everyone complains that dispatch gets it > wrong. How > much is due to the first history effect I don't know. What I do know is > that there is NEVER > going to be a perfect system. MPDS is just a system. It beats what I did > when I dispatched > in 1985; name, address, phone, and what is the problem, OK I'll send > someone, click. > Quality is a given in MPDS, how do you do good QA on any other system, it is > not uniform. > > Someone want to make the next MPDS, have at it. I would not touch it! If > every other > doctor is shying away from the phones, it must be hard to do good. > > Now where have we seen some of the other things coming back, i.e. high doses > of NTG for > CHF (taught in 1992 on first day of my residency, ridiculed when I started > it down here), > GIK for ACS, and the list could go on. Newbies, don't totally forget what > you are taught is > going away, chances are it may come back in 10-20 yrs. > > Don > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2007 Report Share Posted February 22, 2007 In a message dated 2/22/2007 5:15:21 P.M. Central Standard Time, curtismcdonald@... writes: Does anyone know where to find the UTMB study about regional call centers? I have heard that the study concludes that MPDS (the pre-arrival component specifically) does indeed make a difference in patient outcomes. I believe that (don’t quote me here) something like 6 people are alive now that would not have been if it had not been for the pre arrival instructions. (choking, drowning, CPR) It might be interesting reading. Not familiar with that study but I KNOW of SEVERAL cases where pre-arrival instructions done by dispatch (either in a formal EMD system or on the fly) have saved lives and I am sure that all one need to do is ask around some folks at any dispatch related convention to get anecdotal proof that they can and do make a difference. The rest of the " systems " are the issue as I see them. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant Buddhist philosopher at-large LNMolino@... (Cell Phone) (Home Phone) (IFW/TFW/FSS Office) (IFW/TFW/FSS Fax) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) The comments contained in this E-mail are the opinions of the author and the author alone. I in no way ever intend to speak for any person or organization that I am in any way whatsoever involved or associated with unless I specifically state that I am doing so. Further this E-mail is intended only for its stated recipient and may contain private and or confidential materials retransmission is strictly prohibited unless placed in the public domain by the original author. <BR><BR><BR>**************************************<BR> AOL now offers free email to everyone. Find out more about what's free from AOL at http://www.aol.com. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2007 Report Share Posted February 22, 2007 Any study that s the most recent to be released is also considered to be the " deciding factor " in the success or failure of any issue in the industry. I think that before anyone goes throwing absolute statements should first wait for more than one study that may cast doubt upon all the previous studies conducted. BTW, there is no such thing as an " Omega Response " . The proper term is " Omega Referral " , and it is not the dispatch agency/EMS that is refusing to the response/transport. It is the referring agency that accepts the responsibility for such actions, and then only after a signed agreement is in place. Without such an agreement, the proper response would be an Alpha-level (non-emergency) response. But then again, I am apparently aware of this. Thom Seeber, CCEMT-P Re: MPDS > > I will just add a personal observation and get ready for the flames. > > I find it interesting that so many things in medicine come in cycles. I > expect that anyday > now we will be hearing that rotating TKs is how we should be treating CHF, > Bretylium is > coming back, etc. It is also interesting that in emergency medicine, we are > expected to BE > PERFECT in the areas that no one else wants to touch! Indigent care, lack > of resources, > overcrowding, etc. > > Let's just look at MPDS. In any area of medicine except EMS/public service, > this is called > phone triage. Many physicians just WILL NOT DO IT! Why, too risky. If > they send the pt to > the hospital and they did not need to be there, they look like a fool to > colleuges and the > pt. If they have them stay home and they have a bad outcome, they get a > call from > lawyer. It is " safer and more prudent " to have a policy that says, the pt > is not physically in > my care, they must decide on their own whether or not to go to the ED. > > Now, why are we expecting someone who had a week or two of training in the > dispatch to > make those decisions? Why are we taking a person with training in physical > assessment > (gotta touch 'em) and asking them to do a phone diagnosis and send proper > resources? Is > MPDS cookbook? Yes. Have you ever listened to the calls? I have not for a > while, but is > scares me when I do. > > We all, myself included, have had pts tell the next provider an important > history piece that > I did not get and then I look like a fool. That is why I say that EM > physicians are always the > interns. We get the first and usually the worst history. Not that we are > bad at it, just that > the patient is prompted to rethink, " I did not have pain in my chest, it > just aches. But that > is not pain, I guess I should have told about that. " > > In every system I have been in, everyone complains that dispatch gets it > wrong. How > much is due to the first history effect I don't know. What I do know is > that there is NEVER > going to be a perfect system. MPDS is just a system. It beats what I did > when I dispatched > in 1985; name, address, phone, and what is the problem, OK I'll send > someone, click. > Quality is a given in MPDS, how do you do good QA on any other system, it is > not uniform. > > Someone want to make the next MPDS, have at it. I would not touch it! If > every other > doctor is shying away from the phones, it must be hard to do good. > > Now where have we seen some of the other things coming back, i.e. high doses > of NTG for > CHF (taught in 1992 on first day of my residency, ridiculed when I started > it down here), > GIK for ACS, and the list could go on. Newbies, don't totally forget what > you are taught is > going away, chances are it may come back in 10-20 yrs. > > Don > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2007 Report Share Posted February 22, 2007 Does anyone know where to find the UTMB study about regional call centers? I have heard that the study concludes that MPDS (the pre-arrival component specifically) does indeed make a difference in patient outcomes. I believe that (don’t quote me here) something like 6 people are alive now that would not have been if it had not been for the pre arrival instructions. (choking, drowning, CPR) It might be interesting reading. Curtis Mc, EMT-P, Etc. Montgomery County Hospital District EMS The message above does not reflect the views of my employer, or maybe even myself. I should not be held responsible for anything that I say, do or think. Thank you. _____ From: texasems-l [mailto:texasems-l ] On Behalf Of Thom Seeber Sent: Thursday, February 22, 2007 2:52 PM To: texasems-l Subject: RE: Re: MPDS Any study that s the most recent to be released is also considered to be the " deciding factor " in the success or failure of any issue in the industry. I think that before anyone goes throwing absolute statements should first wait for more than one study that may cast doubt upon all the previous studies conducted. BTW, there is no such thing as an " Omega Response " . The proper term is " Omega Referral " , and it is not the dispatch agency/EMS that is refusing to the response/transport. It is the referring agency that accepts the responsibility for such actions, and then only after a signed agreement is in place. Without such an agreement, the proper response would be an Alpha-level (non-emergency) response. But then again, I am apparently aware of this. Thom Seeber, CCEMT-P Re: MPDS > > I will just add a personal observation and get ready for the flames. > > I find it interesting that so many things in medicine come in cycles. I > expect that anyday > now we will be hearing that rotating TKs is how we should be treating CHF, > Bretylium is > coming back, etc. It is also interesting that in emergency medicine, we are > expected to BE > PERFECT in the areas that no one else wants to touch! Indigent care, lack > of resources, > overcrowding, etc. > > Let's just look at MPDS. In any area of medicine except EMS/public service, > this is called > phone triage. Many physicians just WILL NOT DO IT! Why, too risky. If > they send the pt to > the hospital and they did not need to be there, they look like a fool to > colleuges and the > pt. If they have them stay home and they have a bad outcome, they get a > call from > lawyer. It is " safer and more prudent " to have a policy that says, the pt > is not physically in > my care, they must decide on their own whether or not to go to the ED. > > Now, why are we expecting someone who had a week or two of training in the > dispatch to > make those decisions? Why are we taking a person with training in physical > assessment > (gotta touch 'em) and asking them to do a phone diagnosis and send proper > resources? Is > MPDS cookbook? Yes. Have you ever listened to the calls? I have not for a > while, but is > scares me when I do. > > We all, myself included, have had pts tell the next provider an important > history piece that > I did not get and then I look like a fool. That is why I say that EM > physicians are always the > interns. We get the first and usually the worst history. Not that we are > bad at it, just that > the patient is prompted to rethink, " I did not have pain in my chest, it > just aches. But that > is not pain, I guess I should have told about that. " > > In every system I have been in, everyone complains that dispatch gets it > wrong. How > much is due to the first history effect I don't know. What I do know is > that there is NEVER > going to be a perfect system. MPDS is just a system. It beats what I did > when I dispatched > in 1985; name, address, phone, and what is the problem, OK I'll send > someone, click. > Quality is a given in MPDS, how do you do good QA on any other system, it is > not uniform. > > Someone want to make the next MPDS, have at it. I would not touch it! If > every other > doctor is shying away from the phones, it must be hard to do good. > > Now where have we seen some of the other things coming back, i.e. high doses > of NTG for > CHF (taught in 1992 on first day of my residency, ridiculed when I started > it down here), > GIK for ACS, and the list could go on. Newbies, don't totally forget what > you are taught is > going away, chances are it may come back in 10-20 yrs. > > Don > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2007 Report Share Posted February 22, 2007 I would not go that far. If what you are saying is true, then lidocaine would have been thrown out when " the chemical defibrillator " came along. That being Bretylium in the 80's, instead, studies have shown that the latest and greatest is not always the best. MPDS is not a new concept. I will repeat it, I think that all dispatch centers need some form of uniform data collection and QI. Is MPDS the end all and be all, not in my book. No more than a single dose of any drug is the only dose for that drug for ALL indications. This is where the medical director, EMS director, and communications have to arrive at the best solution for their situation. May be MPDS, might not be. I am unaware of any study from UTMB about PAI's. Sounds anectdotal, but I can't argue with it. I know of one cardiac arrest in Ft. Worth where PAI's were given and a pulse returned before EMS and fire arrived. Don > > > > So, let me see if I've got this straight. You are saying that an EMS crew > > that responds to a call for assistance should make the determination on if > > that person " deserves " to go to the hospital to be evaluated, is that > right? > > Because, there is nothing in the MPDS protocol that determines the patient > > should not go for evaluation. Every patient that calls will receive a > > response. > > > > Triage? Absolutely. Based upon a set of questions, the calltaker will > > determine the indicated severity of the symptoms the caller describes. The > > entire response is based upon the assumption that the information provided > > will be honest and complete. > > > > Is MPDS cookbook? Well, I guess you could say yes inso much as you could > say > > the same thing about ACLS being cookbook. ACLS follows an establish > > algorithm just as MPDS does. > > > > > > Thom Seeber, CCEMT-P > > American Medical Response > > 7509 South Freeway > > Houston, Texas 77346 > > > > > > Re: MPDS > > > > I will just add a personal observation and get ready for the flames. > > > > I find it interesting that so many things in medicine come in cycles. I > > expect that anyday > > now we will be hearing that rotating TKs is how we should be treating CHF, > > Bretylium is > > coming back, etc. It is also interesting that in emergency medicine, we > are > > expected to BE > > PERFECT in the areas that no one else wants to touch! Indigent care, lack > > of resources, > > overcrowding, etc. > > > > Let's just look at MPDS. In any area of medicine except EMS/public > service, > > this is called > > phone triage. Many physicians just WILL NOT DO IT! Why, too risky. If > > they send the pt to > > the hospital and they did not need to be there, they look like a fool to > > colleuges and the > > pt. If they have them stay home and they have a bad outcome, they get a > > call from > > lawyer. It is " safer and more prudent " to have a policy that says, the pt > > is not physically in > > my care, they must decide on their own whether or not to go to the ED. > > > > Now, why are we expecting someone who had a week or two of training in the > > dispatch to > > make those decisions? Why are we taking a person with training in > physical > > assessment > > (gotta touch 'em) and asking them to do a phone diagnosis and send proper > > resources? Is > > MPDS cookbook? Yes. Have you ever listened to the calls? I have not for > a > > while, but is > > scares me when I do. > > > > We all, myself included, have had pts tell the next provider an important > > history piece that > > I did not get and then I look like a fool. That is why I say that EM > > physicians are always the > > interns. We get the first and usually the worst history. Not that we are > > bad at it, just that > > the patient is prompted to rethink, " I did not have pain in my chest, it > > just aches. But that > > is not pain, I guess I should have told about that. " > > > > In every system I have been in, everyone complains that dispatch gets it > > wrong. How > > much is due to the first history effect I don't know. What I do know is > > that there is NEVER > > going to be a perfect system. MPDS is just a system. It beats what I did > > when I dispatched > > in 1985; name, address, phone, and what is the problem, OK I'll send > > someone, click. > > Quality is a given in MPDS, how do you do good QA on any other system, it > is > > not uniform. > > > > Someone want to make the next MPDS, have at it. I would not touch it! If > > every other > > doctor is shying away from the phones, it must be hard to do good. > > > > Now where have we seen some of the other things coming back, i.e. high > doses > > of NTG for > > CHF (taught in 1992 on first day of my residency, ridiculed when I started > > it down here), > > GIK for ACS, and the list could go on. Newbies, don't totally forget what > > you are taught is > > going away, chances are it may come back in 10-20 yrs. > > > > Don > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2007 Report Share Posted February 23, 2007 Here is a link to the UTMB study based on S.B.523 from the 79th session. www.etxahec.org/reports/EMS%20Dispatch%20REPORT%20final.pdf ________________________________________________________________________________\ ____ Now that's room service! Choose from over 150,000 hotels in 45,000 destinations on Yahoo! Travel to find your fit. http://farechase.yahoo.com/promo-generic-14795097 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2007 Report Share Posted February 23, 2007 as a side note to this, an omega response/referral is only allowed in Accredited Centers of Excellence (ACE) which is the accrediting agency for NAEMD. NOT everyone who uses MPDS is authorized Omega. And to date there are only 79 ACE's Internationally. Mike Re: MPDS > > I will just add a personal observation and get ready for the flames. > > I find it interesting that so many things in medicine come in cycles. I > expect that anyday > now we will be hearing that rotating TKs is how we should be treating CHF, > Bretylium is > coming back, etc. It is also interesting that in emergency medicine, we are > expected to BE > PERFECT in the areas that no one else wants to touch! Indigent care, lack > of resources, > overcrowding, etc. > > Let's just look at MPDS. In any area of medicine except EMS/public service, > this is called > phone triage. Many physicians just WILL NOT DO IT! Why, too risky. If > they send the pt to > the hospital and they did not need to be there, they look like a fool to > colleuges and the > pt. If they have them stay home and they have a bad outcome, they get a > call from > lawyer. It is " safer and more prudent " to have a policy that says, the pt > is not physically in > my care, they must decide on their own whether or not to go to the ED. > > Now, why are we expecting someone who had a week or two of training in the > dispatch to > make those decisions? Why are we taking a person with training in physical > assessment > (gotta touch 'em) and asking them to do a phone diagnosis and send proper > resources? Is > MPDS cookbook? Yes. Have you ever listened to the calls? I have not for a > while, but is > scares me when I do. > > We all, myself included, have had pts tell the next provider an important > history piece that > I did not get and then I look like a fool. That is why I say that EM > physicians are always the > interns. We get the first and usually the worst history. Not that we are > bad at it, just that > the patient is prompted to rethink, " I did not have pain in my chest, it > just aches. But that > is not pain, I guess I should have told about that. " > > In every system I have been in, everyone complains that dispatch gets it > wrong. How > much is due to the first history effect I don't know. What I do know is > that there is NEVER > going to be a perfect system. MPDS is just a system. It beats what I did > when I dispatched > in 1985; name, address, phone, and what is the problem, OK I'll send > someone, click. > Quality is a given in MPDS, how do you do good QA on any other system, it is > not uniform. > > Someone want to make the next MPDS, have at it. I would not touch it! If > every other > doctor is shying away from the phones, it must be hard to do good. > > Now where have we seen some of the other things coming back, i.e. high doses > of NTG for > CHF (taught in 1992 on first day of my residency, ridiculed when I started > it down here), > GIK for ACS, and the list could go on. Newbies, don't totally forget what > you are taught is > going away, chances are it may come back in 10-20 yrs. > > Don > > > > > Quote Link to comment Share on other sites More sharing options...
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