Abstract:
An improved method and system for receiving, processing and responding to emergency medical calls by emergency dispatchers is described. A consistent, standard and systematic process is provided which in combination with adequate training, supervision and quality assurance serves to provide a method for gathering emergency medical information, categorizing such information into various determinant levels for appropriate response, and for giving qualified emergency medical information to callers thereby permitting “zero-time” response by those at the scene. By using this invention properly a dispatcher is guided through the interrogation of callers, gathering the critical information, dispatching the appropriate mobile care rapidly when needed and giving the appropriate guidance to the caller. This invention specifically guides the dispatcher through the universal entry protocol, paying particular attention to medical complaints related to respiratory arrest.

Description:
BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     This invention relates to methods and systems for processing and responding to emergency medical inquiries. Specifically, this invention relates to the process or method for receiving and processing critical information regarding emergency medical calls. Also, this invention specifically relates to a system and apparatus for performing the steps of a process for receiving and processing critical emergency medical information. 
     Providing adequate emergency medical care presents several critical challenges to medical care providers. These challenges include: the proximity to the care provider, the time required for help to arrive, the identification of the criticality of the emergency, the appropriate level of care provided, the variances in training of emergency medical dispatcher personnel, and limited nature of emergency care resources. This invention addresses these challenges by providing a consistent and proven system for: First, gathering necessary medical complaint information from emergency medical inquiry callers. Second, prioritizing the complaint to determine the criticality of the emergency. Third, providing emergency verbal instructions to individuals at the scene. Fourth, assisting dispatched responders to be prepared for each emergency situation. And, fifth, advising those on the way to provide care at the scene of specific problems or potential hazards. When used correctly this invention decreases the effective response time, while increasing the professionalism and control of emergency medical dispatchers; increases the accuracy and appropriateness of patient interrogation and well as the quality of gathered information; reduces the number of multiple unit and light-and-siren responses thereby reducing the risk of emergency medical vehicular collisions; improves patient care; reduces burn-out and stress of dispatchers by improving their quality of training and performance; decreases the risk of responder injury or mistake by providing responders with improved knowledge of the situation; and provides a means for continuously improving the quality of emergency medical dispatching and, as a result, emergency patient care. 
     2. Description of Related Art 
     It is desirable to provide a systematic and standardized method for responding to emergency medical requests. Although in the related art some attempt has been made to address the problem of medical care assessment, the related art does not address the specific problems of emergency dispatcher response. Rather related art approaches known to the applicant describe the following. A process of helping patients assess their health, select appropriate health care, and guide such patients to an appropriate level and type of care. An automated medical history taking system and a technique wherein selected branch paths through a question repertory are provided. A method and apparatus for coordinating the actions of two or more medical teams, especially for instructional purposes. An expert system for providing suggested treatments for a patient with physical trauma. A medical payment system that incorporates computer technology in the storage, retrieval and processing of patient data and insurance claims. A knowledge base containing medical/pathological information on various diseases. A hospital computerized system for entering information pertinent to a patient&#39;s stay in the hospital. An expert computer system for processing medical claims. An interactive computerized apparatus and method for presenting medical information for diagnosis and study of disease. An automated and interactive positive motivation system to send a series of motivational messages and/or questions to a client to change or reinforce a specific behavioral problem. An artificial intelligent expert system. A rapid response health care communications system for providing rapid and reliable health services to patients located within or outside a health care facility. Also, several patents issued to the inventor of this invention are directed to several specific issues of an emergency medical dispatch system, but do not describe the specific improvements and entry process steps of this invention. 
     For general background material, the reader is directed to U.S. Pat. Nos. 3,799,147, 4,130,881, 4,237,344, 4,290,114, 4,360,345, 4,489,387, 4,731,725, 4,839,822, 4,858,121, 4,922,514, 4,945,476, 5,063,522, 5,065,315, 5,072,383, 5,086,391, 5,228,449, 5,253,164, 5,255,187, 5,339,351, 5,348,008, 5,404,292, 5,438,996, 5,462,051, 5,471,382, 5,502,726, 5,513,993, 5,516,702, 5,521,812, 5,544,649, 5,554,031, 5,590,269, 5,594,638, 5,596,994, 5,660,176, 5,722,418, 5,724,983, 5,759,044 5,761,493, 5,805,670, 5,809,493, 5,826,077, 5,844,817, 5,857,966, 5,910,987, 5,915,019, 5,926,526, 5,964,700, 5,962,891, 5,989,187, 5,991,751, 6,004,266, 6,010,451, 6,035,187, 6,053,864, 6,074,345, 6,076,065, 6,078,894, 6,106,459, 6,115,646, and 6,117,073. Each of the above references is hereby incorporated by reference in its entirety for the material disclosed therein. 
     SUMMARY OF THE INVENTION 
     It is desirable to provide an improved system for emergency medical dispatch of health care services that provides the dispatcher a systematic method of interrogation of callers, where inquiries and instructions are pre-scripted, thus eliminating the variability due to different skills of the individual dispatchers and the need for the dispatcher to attempt to recall the appropriate inquiries and instructions each time a call is received. Furthermore, it is desirable to provide a system for emergency medical care dispatch that improves the accuracy and appropriateness of patient interrogation and resulting response generation. Such a system can formalize the roll of the emergency medical dispatcher as part of the professional chain of patient care. It is also desirable to have a method for communicating with medical response teams such that multiple unit and light-and-siren responses are reduced, thereby reducing the collision risks to emergency vehicles and preserving the limited emergency response resources. It is desirable to provide a medical dispatch system that improves patient care by improving the accuracy and usefulness of gathered information, thereby reserving paramedic teams for the most critical emergencies. It is desirable to have a medical dispatch system that reduces dispatcher burn-out and stress by improving information relayed to field responders while simultaneously providing such. responders with increased safety awareness and knowledge of the field situation. 
     Accordingly, it is the primary object of this invention to provide a medical dispatch system that is designed to programmatically guide the medical dispatcher through the initial interrogation, obtaining all critical patient information. 
     A further object of this invention is to provide a method and system which produces a determinate value, establishing the criticality of the call as well as defining the appropriate response, based, at least partially, on the responses to the programmed initial interrogation, that is upon the critical patient information. 
     Another object of this invention is to provide a cross-referenced scripted set of instructions to be given by the dispatcher to the caller in a medical emergency situation. 
     It is a further object of this invention to provide a method of determining the criticality of a medical emergency and communicating such level of criticality to the response personnel. 
     It is a still further object of this invention to provide a method for gathering and communicating information concerning the situation at the field location to the response personnel and the emergency medical callers. 
     A further object of this invention is to improve the quality, efficiency and usefulness of the information received to and communicated by emergency medical dispatchers thereby improving the quality of emergency medical services provided to patient before, during and after the arrival of emergency medical technicians. 
     A still further object of this invention is to provide a method, system and apparatus for an improved entry protocol for emergency medical dispatchers. 
     These and other objects of this invention, which will be clear to those of ordinary skill in the art upon review of this patent specification and claims, are achieved by an invention which permits a systematic gathering of patient information, with a set of scripted instructions and with guidance for relaying information to the field emergency personnel. The method and system of this invention is currently envisioned in two equally preferred embodiments. First, a set of cross-referenced cards with scripted questions, instructions and categorizations is provided. Second, a computerized process is provided with software controlling the access and reference points to a computerized database of emergency medical inquiries and instructions are provided. Each preferred embodiment incorporates the same essential method of this invention, though each has its own particular advantages. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1 depicts the principle elements of the complete system in which the preferred embodiment of the invention operates and the relationship of the elements of the system to each other and puts into the context of the complete system, the specific claimed invention. 
     FIG. 2 depicts the flip card apparatus showing a preferred embodiment of the invention. 
     FIG. 3 shows a view of the sections of a typical flip card as used in the flip card apparatus embodiment of the invention. 
     FIGS. 4 a  and  4   b  show system components of a typical computer system and telephone communication system used in the preferred embodiment of the invention. 
     FIG. 5 shows a flow chart representation of the preferred top-level steps of the invention. 
     FIG. 6 depicts the detailed steps of the entry protocol steps of the process of the preferred embodiment of the invention. 
     FIGS. 7 a  and  7   b  depict the preferred embodiment of the flip cards showing the steps of the entry protocol of the flip card deck embodiment of the invention. 
     Reference will now be made in detail to the present preferred embodiment of the invention, examples of which are illustrated in the accompanying drawings. 
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     This invention provides a method, system and an apparatus for receiving, processing and communicating emergency medical information, enabling an assessment of the critical or “key” information by trained emergency medical dispatch personnel. When the invention is properly employed the initial interrogation of the caller or patient will provide critical patient information, such as the patient&#39;s location, the caller&#39;s phone number, a description of what happened, the number of people hurt, injured or sick, the patient&#39;s age, and the patient&#39;s status as to consciousness and breathing. This information is then immediately put to use identifying the criticality of the emergency and the appropriate medical response, as well as leading to a series of established medical instructions for the dispatcher to give to the caller. 
     FIG. 1 shows the complete system in which the invention operates in its best mode. The process of managing emergency medical dispatchers, the information they require and the information they give is detailed in FIG.  1 . The case entry protocol  101 , the heart of this invention, provides the initial steps through which the all emergency callers or patients are taken to provide symptom information and to access medical information. The purpose of the case entry protocol  101  is to receive sufficient information to permit the dispatcher to identify the caller&#39;s chief complaint. This critical information received during the primary interrogation  101  includes a description of the problem (or the patient&#39;s complaint), the patient&#39;s age and the status of consciousness and breathing. This information is also referred to as “the four commandments of emergency medical dispatching.” If the dispatcher receives information that the patient is unconscious and not breathing (or unconscious and breathing is uncertain or conscious but not breathing where the failure to breath has been verified), for whatever reason, a maximal response  102  is sent immediately, before continuing with any further interrogation or instructions, and the caller is told to stay on the line for further instructions. The life threat is then verified  103  and pre-arrival instructions are given  104 . These pre-arrival instructions  104  include six treatment sequence algorithmic scripts covering Arrest, Choking, and Childbirth. Instructions  104  are given to guide the caller through CPR, the Heimlich Maneuver, or emergency childbirth procedures. In many cases, the result of properly conveyed instructions is a more viable patient by the time field personnel arrive. Should the dispatcher learn that the patient is breathing, but the dispatcher lacks sufficient information to directly go to the Key Questions of the Dispatch Protocol  106 , the dispatcher is shunted  105  to additional interrogations whose purpose is to give the dispatcher the necessary information to ascertain the caller&#39;s chief complaint while focusing on heart problems, industrial/machinery accidents and/or general sick person issues. Once the dispatcher has enough information to have identified the caller&#39;s chief complaint, the dispatcher is taken to the Dispatch Protocol  106  where additional interrogations are performed to complete “key questions.” This secondary interrogation  106  typically takes approximately 30 seconds and tends to focus on the specific or chief complaint of the caller. This secondary interrogation, or Dispatch Protocol  106 , provides a more orderly and closer view of the patient so that the pre-hospital care provided is appropriate and in keeping with the severity of the injury or illness. During this step  106  the dispatcher will match the symptoms, or combination of symptoms, discovered through interrogation and send the appropriate response  107 . The appropriate response  107  is determined through a system of assigning determinant levels and numbers, from A 2  generally less serious to D 1  generally very serious. When the dispatcher identifies a determinant in one of the five levels (Alpha—A, Bravo—B, Charlie—C, Delta—D, Echo—E) the response configuration (emergency vehicles and the mode of response) is dispatched as indicated by the response protocol. After the responders (field emergency medical care-givers) has been sent, the dispatcher remains on the telephone with the caller to give instructions  108  regarding what to do, and what not to do, prior to the arrival of the responders. This information is taken from the “Post-Dispatch Instructions” section of the protocols and provided whenever possible and appropriate. A main purpose of these “Post-Dispatch Instructions”  108  is to prepare the patient for and to expedite the field personnel&#39;s work at the scene. “Post-Dispatch Instructions” include such instructions as to collect the patient&#39;s medications, write down the name of the family doctor and put away pets. Each caller is also instructed to ensure  109  that the patient has an open airway, is breathing, is given nothing to eat or drink before responders arrive and, if necessary, how to treat for shock using the procedure given in the reference script for Airway, Breathing, and Circulation. Callers are routinely advised to “call back if the patient&#39;s condition worsens for further instructions.” 
     FIG. 2 depicts an embodiment of the flip card apparatus showing a preferred system for the use of the invention. One preferred embodiment of the invention involves the use of a flip card apparatus  201 . The flip card apparatus  201  has the advantage of organizing the cards  202  so that the top or bottom, label edge of each card can be seen by the user. Each card  202  is separately fastened into the apparatus with one or more fasteners  204 . The steps embodying the elements of this invention, the entry protocol, are displayed on a top flap  203  and the first card  202   a . Alternative embodiments of the card apparatus can be a deck of cards bound in a manner well known to those skilled in the art. In a present embodiment of the flip card apparatus there are sixty-four chief complaint cards, twelve pre-arrival instruction cards, two post-dispatch cards, one determinant classification card and two entry protocol cards. The cards are generally organized in pairs, with the top card providing the protocol questions, instructions, jump directions and determinant assignments. The bottom card provides information the dispatcher uses to improve the dispatcher&#39;s decision-making process. 
     FIG. 3 shows a view of the sections of a typical flip card, as used in the flip card apparatus embodiment of the invention. The typical flip card  202  is divided into logical sections for ease of use and consistency. A key question section  301  is provided as a script to the dispatchers to ensure that all key questions are asked in a calm, consistent, systematic manner. After all key questions are asked from the key question section  301 , typically the dispatcher determines the appropriate determinant level. Sections A—Alpha  303 , B—Bravo  304 , C—Charlie  305 , D—Delta  306   a  or E—Echo  306   b  are provided to aid the dispatcher in making the determinant designation. Each determinant level may have one or more sublevels. Generally, the most critical call is given a determinant level of E—Echo, with D—Delta nearly as critical, and the least critical call is given a determinant level of A—Alpha. The more critical the determinant level assigned to a call, the more medical resources and urgency may be applied to provide help. For example, an A—Alpha call will typically be responded to by emergency medical technicians and an ambulance proceeding to the patient under the safest method reasonably possible, while a D—Delta call will typically be responded to by the closest emergency medical technicians, an ambulance, paramedics, all who will proceed under the most urgent method possible. Sublevels may not indicate the criticality of the call; rather sublevel designations indicate the type of call, information often especially important to the dispatched medical team. After the determinant code is determined  303 - 306   a,b  the dispatcher is referred to the post-dispatch instructions section  302 . The purpose of the post-dispatch instructions is to systematically prepare for and expedite the field personnel&#39;s job at the scene, and prevent further harm to the patient or others at the scene. The post-dispatch instruction section  302  includes such instructions as collecting the patient&#39;s medications, writing down the name of the family doctor and securing animals in the area. Each caller is also instructed, from the post-dispatch instruction section  302 , to ensure that the patient has an open airway, is breathing, is given nothing to eat or drink before responders arrive, and, if needed, how to treat for shock using a reference script. Callers are also routinely advised to “call back if the patient&#39;s condition worsens for further instructions.” Pre-arrival instructions  106  are provided on alternative cards  314 , subsectioned as shown in FIG. 3 as  314   a-r . These pre-arrival instruction sections  314  provide scripted treatment sequences for arrest, choking and childbirth. These procedures, provided through sections  314 , guide the caller through CPR, the Heimlich Maneuver or emergency childbirth procedures. Sections  307  to  314  provide important information to the dispatcher for the dispatcher&#39;s use in providing more educated responses. This information includes such information as categorizations of dangerous areas or injuries; types of injuries; symptoms; rules and axioms. Such information as is systematically provided to place the key questions of section  301 , the determinant classifications of sections  303 - 306   a,b , and the post-dispatch instructions of section  302  into context for the dispatcher. 
     FIG. 4 a  shows a system diagram of the components of a typical computer system used in the computerized embodiment of the invention. A second preferred embodiment of the invention is designed to operate in combination with a computer system using specially designed computer software incorporating the procedure of the invention. A typical computer system used in combination with software incorporating the invention includes a processing unit  401  to execute the instructions of the software; a display unit  402  to provide the means for providing the dispatcher with the prompts and information necessary to practice the invention; an input device  403  to provide the means for the dispatcher to interact with the software version of the invention; a storage device  405  for storage of the software and the files associated with the invention; and an output device  404  for printing reports and other information. FIG. 4 b  shows the typical telephone communication device as used with this invention to communicate between the dispatcher and emergency medical callers and/or paramedics (or EMTs). 
     FIG. 5 shows a process flow chart representation of the preferred top-level steps of the invention. The software embodiment of the procedure of the invention is accomplished by performance of a number of procedural steps. First, the software is initialized  501 . Data is received  502  following the request for information from the caller. As data is received  502 , the determinant level is determined  503 . Intermediate determinant levels are produced as information is received and processed, the final determinant level is only achieved after all necessary information is received and processed. A database is accessed  504  to produce the appropriate instructions for communication with the caller. Records of the calls and queries are stored  505 , for historical reports, for review of the dispatchers and for continued quality assurance control. 
     FIG. 6 depicts the detailed steps of the entry protocol process of the preferred embodiment of the invention. The following steps of the process of the invention need not be accomplished in this specific order, alternative ordering of the steps of the invention are possible. This order of the steps of the process has been determined by the inventor to be the best mode of the invention. First, the address of the emergency is determined  601 . This address or location is clearly essential if the dispatch of a response team is necessary. Next, the phone number where the caller is calling from is learned  602 . Having the caller&#39;s phone number permits the dispatcher to call back if the call is prematurely disconnected, or if there is difficulty locating the scene or the patient. A description of the chief complaint or problem is then acquired  603  from the caller. The chief complaint, which is the reason the patient is seeking medical care, must contain sufficient information to allow the categorization of the problem into one of thirty-two defined, chief complaints. Such categorization permits the dispatcher to branch to a protocol designed specifically to respond to the patient&#39;s specific problem. If the description of the problem learned in step  603  involves a person who is hanging or was found underwater  604 , whether hanging or underwater is determined  605  and the determinate is set to E- 6   606 ,  607  and the dispatcher immediately proceeds to the Arrest Protocol. The Arrest Protocol is critical in these situations because a person suffering from respiratory arrest almost certainly requires the most immediate medical care possible. If the patient was not hanging or found underwater, the inquiry is made as to whether the caller is with the patient now  608 . Next, the dispatcher learns the number of people involved or injured  609 . An inquiry  610  is made as to whether the injury was caused by a traffic accident, or if a multiple number of victims are involved. If the injury was caused by a traffic accident  611 , the dispatcher is immediately branched to the traffic accident protocol  612 . If it is not a traffic accident, but multiple victims are involved, the dispatcher goes to the Chief Complaint  613  for additional information. If the injury involves only one person and was not caused by a traffic accident, then the dispatcher learns if the patient is choking  614 . If the patient is choking, then the determinate is set to E- 1  and the dispatcher immediately proceeds to the choking protocol  615 . If the patient is not choking, the dispatcher learns the patient&#39;s age  616 . Next, an inquiry is made as to whether the patient is conscious  617 . If the patient is not conscious then the dispatcher immediately dispatches emergency medical assistance. If the caller is uncertain if the patient is conscious, the dispatcher further inquires as to whether the patient is breathing  618 . If the caller is uncertain or believes the patient is not breathing, the dispatcher immediately dispatches emergency medical assistance. If the patient is conscious, the dispatcher continues with the interrogation based on the protocol associated with the Chief Complaint  620 . 
     FIGS. 7 a  and  7   b  depict the preferred embodiment of the flip cards showing the steps of the entry protocol invention. The entry questions  701  (numbered  1 - 6 ) are shown in the Entry Questions section  702 . Specific critical answers are shown  703 , including “Hanging,” “Underwater,” “Traffic Accident,” “Multiple Victims”, as well as responses to the consciousness and breathing inquiries. The determinate and protocol assignments based on the critical answers  703  are provided in column  704 . Critical information for the dispatcher is provided  705 , as are post dispatch instructions  706  for the dispatcher to give is specific shown circumstances. Identification of Non Breathing Situations is provided in section  707  along with the protocol and criticality determinate assigned. For example, if the response to the question “What is the problem?” involves choking, the dispatcher assigns a criticality determinate of E- 1  and jumps to the choking protocol. Section  708  provides a list of responses related to Ineffective Breathing, which if received, assigns a criticality of E—Echo. The Echo Determinate practice is described in section  709 . An Obvious Death section  710  is provided to assist the dispatcher in situations where death of one or more patients is reported. An Axiom list  711  is provided to remind the dispatcher about considerations regarding uncertain or unknown breathing status, and to complete case entry process and the Chief Complaint protocol after an E—Echo determination even after dispatching an emergency medical response. This information is relayed to the paramedics or EMTs to assist them in performing their duties in the most efficient manner possible. 
     It is to be understood that the above-described embodiments are merely illustrative of numerous and varied other embodiments which may constitute applications of the principles of the invention. Such other embodiments may be readily devised by those skilled in the art without departing from the spirit or scope of this invention and it is our intent that they be deemed within the scope of our invention.