Washington Fire Department (WFD) Must Implement Criteria-Bas ✓ Solved

Washington Fire Department (WFD) must implement criteria-bas

Washington Fire Department (WFD) must implement criteria-based dispatch to address limited ALS resources and reduce unnecessary emergency responses. Background: Emergency medical dispatchers gather information from 911 callers; historically WFD dispatched ALS units with lights and sirens to all medical incidents, including noncritical and frequent users. ALS resources are limited; sending ALS to noncritical incidents delays response to critical patients and frustrates staff. Stakeholders, including elected officials and a retirement community, are concerned that criteria-based dispatch will compromise patient care.

As the new Fire and Emergency Services (FES) administrator, prepare to present at a town hall meeting to address community concerns. Use assumptions and external factors as needed. Answer the following questions: What are the intended goals and objectives of the criteria-based dispatch program? What are the critical areas of concern? What are the desired outcomes? Will this compromise the level of care provided to the patient or cause further injury to patients if responding to a nonemergency?

Paper For Above Instructions

Executive Summary

This paper summarizes the rationale, goals, risks, expected outcomes, and safeguards for implementing a criteria-based dispatch (CBD) system at the Washington Fire Department (WFD). CBD stratifies 911 medical calls by clinical acuity, assigning an evidence-based response level (ALS, BLS, or non-emergency referral) rather than dispatching ALS to all calls. Properly implemented, CBD preserves limited ALS resources for high-acuity incidents, reduces unnecessary emergency driving, improves responder safety and morale, and maintains or improves patient outcomes through focused response and dispatch-assisted care (IAED; Clawson & Dernocoeur, 2016).

Intended Goals and Objectives

Primary goals of the CBD program are:

  • Optimize resource allocation so ALS units are available for true time-sensitive emergencies (e.g., cardiac arrest, severe trauma) (IAED).
  • Reduce unnecessary high-speed responses (lights and sirens) to noncritical calls, improving road safety and reducing responder fatigue (NFPA 1221).
  • Increase operational efficiency and reduce response-time delays to critical patients by minimizing ALS commitments to low-acuity incidents (NHTSA EMS Agenda 2050).
  • Provide consistent, standardized telephonic assessment and pre-arrival instructions to callers to support patient care parity (AHA dispatch-assisted CPR guidance).
  • Enable data-driven continuous quality improvement (CQI) through call auditing, clinical outcome tracking, and stakeholder reporting (IAED; Clawson & Dernocoeur, 2016).

Critical Areas of Concern

Stakeholders rightly focus on potential risks. Key concerns include:

  • Perceived or actual compromise of patient care: community members fear downgraded response may worsen outcomes for vulnerable populations (National Academies, 2007).
  • Legal and political risk: elected officials and the city manager worry about liability if an outcome is poor following non-emergent dispatch (local counsel and IT policies required).
  • Equity and trust: retirement communities and frequent users fear being deprioritized; transparent criteria and outreach are essential to maintain trust (WHO prehospital care guidance).
  • Dispatcher training, consistency, and protocol adherence: incorrect triage due to inconsistent questioning increases risk (IAED training standards).
  • Metrics and QA capacity: insufficient CQI resources can allow errors to persist undetected (Clawson & Dernocoeur, 2016).

Desired Outcomes

A successful CBD implementation should deliver measurable outcomes:

  • Higher availability of ALS resources for high-acuity incidents, evidenced by reduced ALS unit occupation time and fewer delayed ALS responses (NHTSA EMS Agenda 2050).
  • Reduction in noncritical high-speed responses and related roadway incidents (NFPA 1221).
  • Equal or improved clinical outcomes for time-sensitive conditions due to faster ALS arrival and improved dispatcher-guided pre-arrival care (AHA; IAED).
  • Improved firefighter/paramedic job satisfaction and reduced burnout by limiting unnecessary high-stress responses.
  • Community acceptance measured by surveys, town-hall feedback, and complaint trends trending downward over time.

Will CBD Compromise Care or Cause Further Injury?

Evidence and protocol design indicate that properly implemented CBD does not inherently compromise care. Key points:

  • CBD is built on structured, validated question sets and decision trees developed by organizations such as the International Academies of Emergency Dispatch (IAED). When used correctly, CBD reliably identifies high-acuity presentations and triggers appropriate ALS dispatch (IAED; Clawson & Dernocoeur, 2016).
  • Dispatch-assisted care (e.g., CPR instruction) has been shown to improve survival and outcomes for cardiac arrest; CBD protocols emphasize immediate telephonic interventions when indicated (AHA).
  • Risks are real when training, QA, or governance are insufficient. Therefore CBD must be accompanied by robust dispatcher certification, continuous medical oversight, and retrospective case review to identify and correct under-triage events (IAED; NFPA 1221).
  • Clinical safety nets (automatic ALS dispatch triggers) should be embedded for ambiguous or high-risk caller descriptions, and protocols must err on the side of patient safety (National Academies, 2007).

Implementation Recommendations and Risk Mitigation

To address community fears and reduce risk, the following phased plan and safeguards are recommended:

  1. Stakeholder engagement and education: Hold town halls, informational materials, and targeted outreach to retirement communities explaining CBD logic, safety measures, and how dispatch provides immediate care instructions (WHO; local public information campaigns).
  2. Phased pilot with data collection: Start with a controlled pilot in selected precincts and run CBD concurrently with the current response model for audit comparison (NHTSA EMS Agenda 2050).
  3. Dispatcher training and certification: Implement IAED-certified EMD training, continuing education, and simulation-based competency checks (IAED).
  4. Medical oversight and CQI: Appoint a medical director responsible for protocol approval, regular case review, and real-time feedback to dispatch staff (Clawson & Dernocoeur; NFPA standards).
  5. Transparent performance metrics: Publish outcome metrics (response times for high-acuity calls, ALS availability, patient outcomes, complaint rates) to the public monthly or quarterly to build trust.
  6. Safety-first protocol design: Ensure automatic ALS dispatch criteria for high-risk keywords, and pathways for callers to request escalation if symptoms change.
  7. Alternative response pathways: Partner with BLS transport, community paramedic programs, and non-emergent social services for frequent users to reduce repetitive emergency dispatches while maintaining care continuity.

Communication Strategy for the Town Hall

At the town hall, present clear, non-technical explanations with visuals: a flowchart that shows caller interrogation, decision nodes, safety nets, and post-dispatch QA steps. Emphasize evidence-based benefits, legal and medical oversight, and community safeguards. Offer concrete examples where CBD shortens time to life-saving ALS care by freeing resources, and provide a commitment to transparent reporting and an independent review board for adverse outcomes.

Conclusion

Criteria-based dispatch is a clinically supported, safety-enhancing approach that, if implemented with rigorous training, medical oversight, community engagement, and transparent metrics, will not compromise patient care and will improve system capacity for true emergencies. Addressing retirement community concerns requires intentional outreach, robust safety nets, pilot data, and open reporting to demonstrate that CBD enhances overall public safety and preserves the highest level of care for those who need it most (IAED; NFPA; AHA; NHTSA).

References

  • International Academies of Emergency Dispatch (IAED). Emergency Medical Dispatch (EMD) protocols and standards. IAED. https://www.emergencydispatch.org
  • NFPA. NFPA 1221: Standard for the Installation, Maintenance, and Use of Emergency Services Communications Systems. National Fire Protection Association. https://www.nfpa.org
  • American Heart Association. Dispatch-Assisted CPR and Emergency Dispatch guidance. AHA Guidelines (2020). https://www.heart.org
  • Clawson, J. J., & Dernocoeur, K. (2016). Principles of Emergency Medical Dispatch. Jones & Bartlett Learning.
  • National Highway Traffic Safety Administration (NHTSA). EMS Agenda 2050. U.S. Department of Transportation. https://www.nhtsa.gov
  • National Academies of Sciences, Engineering, and Medicine. Emergency Medical Services: At the Crossroads. The National Academies Press (2007). https://www.nap.edu
  • World Health Organization. Prehospital emergency care systems. WHO guidance on ambulance services and systems. https://www.who.int
  • Centers for Disease Control and Prevention (CDC). Emergency Medical Services—Trauma and Prehospital Care resources. https://www.cdc.gov
  • National Association of Emergency Medical Technicians (NAEMT). Position statements and guidance on EMS response and community paramedicine. https://www.naemt.org
  • Journal of Emergency Medical Services (JEMS). Articles on dispatch protocols, field triage, and system efficiency. https://www.jems.com

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