Abstract:
A 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, especially in this embodiment, giving the appropriate guidance to the caller. This invention specifically guides the dispatcher through the universal exit protocol, thereby using determinate criticality values to identifying the most urgent emergencies and give consistent reliable post-dispatch instructions.

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 such a system and apparatus for performing the steps of a process for receiving and processing critical emergency medical information as well as providing programmed consistent instructions for the care of patient. 
   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 and for providing consistent medically qualified instructions for the care of the patient. 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 that includes consistent medical guidance for the patient. 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. Several patents issued to the inventor of this application address some of the process of emergency medical dispatcher, but do not describe the specific improvements of this invention, in particular the exit protocol process. 
   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 a 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. Moreover, it is desirable to have a medical dispatch system that provides programmed instructions for the care of the patient, wherein such programmed instructions are based on determinant data calculated from the responses to pre-programmed inquiries. 
   Accordingly, it is the primary object of this invention to provide a medical dispatch system that is designed to guide the medical dispatcher through the exit interrogation, obtaining essential patient information and providing predefined instructions. 
   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 exit 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 a system diagram showing the components of a typical computer system and telephone device used in the computerized 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 exit protocol steps of the process of the preferred embodiment of the invention. 
       FIG. 7  depicts the preferred embodiment of the flip cards showing the steps of the exit 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. This particular embodiment of the invention makes use of the criticality determinate of the emergency to provide the programmed exit protocol or standardized medical instructions 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 , 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 A2 generally less serious to D1 generally very serious. When the dispatcher identifies a determinant in one of the four levels (Alpha-A, Bravo-B, Charlie-C, and Delta-D) 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 programmed instructions  108  regarding what to do, and what not to do, prior to the arrival of the responders. This part of the process is the heart of the invention of this application. 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 the current embodiment of the flip card apparatus there are five different types of cards, including chief complaint cards, pre-arrival instruction cards, post-dispatch cards, determinant classification card and 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. From the responses to the key questions from the key question section  301 , typically the dispatcher determines the appropriate determinant level. Sections A-Alpha  303 , B-Bravo  304 , C-Charlie  305  and D-Delta  306  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 D-Delta 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 available. 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  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 , 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 telephone  406  communication system preferably used with this invention. 
     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 exit protocol process of the preferred embodiment of the invention, which typically provides the post dispatch instructions. Although the following steps of the process of the invention are describe, the reader should note that each step 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, it is determined  601  whether the caller is the injured person (1 st  party) or another (2 nd  party). If it is a 1 st  party call, general instructions are given  602 . These general instructions  602  include telling the caller that help is on the way and that the caller should not have anything to eat or drink since it might make the patient sick or cause problems for the doctor. An inquiry  603  is made to determine whether the call concerns a medical problem (illness) or a trauma. If it is a medial problem, then a medical instruction is given  604 . The preferred medical instruction  604  is for the patient to rest in the most comfortable position possible. If it is a trauma call, a trauma instruction  605  is given. The preferred trauma instruction  605  is to not move around unless absolutely necessary—to just be still and wait for help to arrive. If  606  it is necessary to disconnect the caller, it is determined whether the disconnection is urgent (such as caused by another call or other emergency) or routine (as might be used when the medical call is not serious and/or help has arrived. If it is an urgent disconnect, then the urgent disconnect instruction  607  is given. The preferred urgent disconnect instruction is to tell the caller that the dispatcher needs to hang up now, that help is on the way and that if anything changes, to call the dispatcher back immediately for further instructions. If it is a routine disconnect, the routine disconnect instruction  608  is given. The preferred routine disconnect instruction  608  is to put away family pets, gather medications, write down the name of the patient&#39;s doctor, unlock the door, and turn on the outside lights. Always the instruction is given to call back immediately, if anything changes, for further instructions. If a call disconnect is not necessary, then a stay on the line instruction  609  is given. The preferred stay on the line instruction  609  is that the dispatcher will stay on the line as long as possible, to tell the dispatcher if anything changes, and to request that the caller tell the dispatcher when the paramedics (or EMTs) arrive. Following the stay on the line instruction  609 , the dispatcher will give specific instructions depending on the previously identified chief complaint and determinant value. 
   If a 2nd party makes the call, then the 2 nd  party general instructions  610  are given. The preferred 2 nd  party general instructions include reassuring him/her that help is on the way, telling him/her not to give the patient anything to eat, as it may make him/her sick and/or cause problems for the doctor. An inquiry  611  is made to determine if it is a medial (illness) call or a trauma call. If it is a medical call, then the medical instruction  612  is given. The preferred 2 nd  party medical instruction  612  is to just let the patient rest in the most comfortable position available and to wait for help to arrive. If it is a trauma call, then the trauma instruction  613  is given. The preferred trauma instruction  613  is to not move the patient unless it is absolutely necessary and to tell him/her to have the patient keep still and wait for help to arrive. If  614  it is necessary to disconnect the caller, it is determined whether the disconnection is urgent (such as caused by another call or other emergency) or routine (as might be used when the medical call is not serious and/or help has arrived. If it is an urgent disconnect, then the 2 nd  party urgent disconnect instruction  615  is given. The preferred 2 nd  party urgent disconnect instruction is to tell the caller that the dispatcher needs to hang up now, that help is on the way and that if the patient gets worse in any way to call back for further instructions. If appropriate, the instruction is given to quickly turn the patient on his/her side if he/she becomes less awake and vomits. If it is a routine disconnect, the 2 nd  party routine disconnect instruction  616  is given. The preferred 2 nd  party routine disconnect instruction  616  is to put away family pets, gather medications, write down the name of the patient&#39;s doctor, unlock the door, turn on the outside lights and have some meet the paramedics. Always the instruction is given to call back immediately, if patient gets worse in any way, for further instructions. If a call disconnect is not necessary, then a stay on the line instruction  617  is given. The preferred stay on the line instruction  617  is that the dispatcher will stay on the line as long as possible, that the caller should watch the patient very closely and look for any changes, to tell the dispatcher if the patient becomes less awake or starts getting worse, and to request that the caller tell the dispatcher when the paramedics (or EMTs) arrive. Following the stay on the line instruction  617 , the dispatcher will give specific instructions depending on the previously identified chief complaint and determinant value. 
   The specific instructions depend on the previously identified chief complaint and determinant value assigned. If  618  the patient is hemorrhaging severely, the hemorrhage instruction is given  619 . The preferred hemorrhage instruction  619  is: don&#39;t use a tourniquet, rather to listen carefully to the instructions for stopping the bleeding; to get a clean, dry cloth or towel and place it right on the wound; press down firmly and don&#39;t lift it up to look. If it keeps bleeding, the caller is told that he/she is probably not pressing hard enough. The caller is told to keep firm, steady pressure on the wound. If  620  the patient has suffered amputation, the amputation instruction is given  621 . The preferred amputation instruction  621  is for the caller to locate all amputated parts or skin and place them in a clean plastic bag. The caller is instructed not to place any amputated parts on ice or in water as these may damage the part. If  622  the patient is in a hazardous material contaminated area, the hazardous material instruction is given  623 . The preferred hazardous material instruction  623  is to inform the caller that this could be a very dangerous situation. The 2 nd  party caller should not approach or touch the patient at all. They should let the paramedics handle the situation. The caller is instructed to call back from a safe place, f possible. Depending on the criticality, the caller may be told to leave immediately. If  623  the patient is violent, the violent patent instruction is given  624 . The preferred violent patent instruction  624  is to avoid any contact with the patient, to tell the dispatcher if he/she leaves the scene or passes out and not to disturb the scene or move any thing. Depending on the criticality determinant the caller may be told that there is danger and to leave now. If  625  an assailant or dangerous animal is nearby, the assailant/animal instruction is given  626 . The preferred assailant/animal instruction  626  is to keep very quiet and to stay out of sight, to tell the dispatcher if the assailant or animal leaves the scene and not to disturb the scene or move any thing. Depending on the criticality determinant the caller may be told that there is danger and to leave now. If  627  the caller is uncertain whether the danger is gone, then the danger-gone instruction is given  628 . The preferred danger gone instruction  628  is to listen carefully, this could still be a very dangerous situation, but if the caller is sure the danger is gone they can help the patient. If  629  the caller is still uncertain whether the danger has passed, the uncertainty instruction is given  630 . The preferred uncertainty instruction  630  is that the dispatcher will stay on the line to be sure the caller is safe. If the assailant/animal comes back, the caller is to tell the dispatcher right away. The caller is also instructed to let the dispatcher know when the paramedics (EMTs) arrive. If  631  danger remains present, the danger instruction is given  632 . The preferred danger instruction  632  is “if it&#39;s too dangerous to stay where you are, and you think you can leave safely, get away and call” the dispatcher from somewhere safe. If  633  the patient is suffering from a burn, the burn instruction is given  634 . The preferred burn instruction  634  is to cool the burn for up to 10 minutes with water, if it is a heat or fire burn, or flush area of the burn with water until help arrives if it is a chemical burn. The dispatcher, preferably stays on the line until the paramedics (EMTs) arrive  635 , at which point the process ends  636 . 
     FIG. 7  depicts the preferred embodiment of the flip cards showing the steps of the exit protocol invention. The 1 st  party caller section and the general instructions are shown  701 . The 1 st  party routine disconnect with instructions is shown in section  702 . The 1 st  party stays on line and instructions are shown in section  703 . The 1 st  party urgent disconnect and instruction is shown in section  704 . The 2 nd  party caller section and general instructions are shown in section  708 . The 2 nd  party routine disconnect and instruction are shown in section  709 . The 2 nd  party stay on the line and instructions are shown in section  712 . The 2 nd  party urgent disconnect and instruction is shown in section  713 . Universal instructions  706 , airway instructions  707 , stay on the line  710  and direct pressure instructions  711  are also provided. The specific instruction sets control bleeding  705 , hazardous material  714 , violent patient  715 , assailant/animal nearby  716 , danger gone verification  717 , danger uncertainty  718 , danger present  719  and cooling and flushing  720  and associated instructions are provided. A danger awareness section  721  is also provided to give guidance to the dispatcher. 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.