HomeMy WebLinkAbout6000_02 Emergency Medical Dispatch Emergency Rule 202201136000.02 Emergency Medical Dispatch Emergency Rule
Standard Operating Procedure
Implemented: January 2022 Revised: N/A Next Review: January 2024
This procedure is for internal use only and does not enlarge an employee’s civil liability in any way. The procedure
should not be construed as creating a higher duty of care, in an evidentiary sense, with respect to third party civil claims
against employees. A violation of this procedure, if proven, can only form the basis of a complaint by this department
for non-judicial administrative action in accordance with the laws governing employee discipline.
Related Policies:
Applicable HI Statutes:
I. PURPOSE
The purpose of this standard operating procedure (SOP) is to establish procedures for Fire
Communications Control Center (FCCC) operations in situations of over-capacity in the
communications center. Over-capacity from a dispatch perspective is defined as a period of
high call volume and/or radio operations that exceeds the dispatcher’s ability to maintain
effective operations at a given level of staffing. Refer to section IV for examples of over-
capacity.
II. APPLICABILITY
The Emergency Medical Dispatch Emergency Rule SOP applies to all Hawai‘i Fire
Department (HFD) FCCC employees.
III. DEFINITIONS - As defined by Principles of Emergency Medical Dispatch, 6th Edition:
Emergency Rule-From a medical-legal perspective, when one is faced with an extraordinary
emergency situation, one is not held to the same standard of conduct as when not faced with
such a situation.
Pre Arrival Instructions (PAI) - Medically approved, scripted instructions given by trained
EMDs to callers, which help provide necessary assistance to the victim and control of the
situation prior to the arrival of EMS personnel. Pre-Arrival Instructions are read word for
word by the EMD to the fullest extent possible.
Key Questions (KQ) - Systemized interrogation questions constituting the secondary survey
of the EMD. Must be written in full sentence form and address the four objectives of pre-
arrival evaluation.
Post-Dispatch Instructions (PDI) - PDIs are specific to each chief complaint and are
designed to ensure the safety of the caller and responders and increase the overall
effectiveness of the response.
IV. PROCEDURE
In a situation of over-capacity, FCCC personnel shall make every effort to provide Emergency
Medical Dispatch (EMD) instructions to callers. FCCC personnel may suspend EMD using
the Emergency Rule clause.
6000.02 Emergency Medical Dispatch Emergency Rule
Standard Operating Procedure
Implemented: January 2022 Revised: N/A Next Review: January 2024
In times of over-capacity, HFD recognizes the need may arise to suspend Emergency Medical
Dispatch (EMD) protocols. HFD FCCC personnel may suspend or discontinue Post-Dispatch
Instructions (PDI) once case entry questions and key questions are completed. Pre-Arrival
Instructions (PAI) may also be suspend in situations where lifesaving instructions are not
provided (Refer to section C below).
The following are acceptable examples of when FCCC personnel may suspend EMD:
1. Staffing levels are not at a point where EMD-PAI can be consistently sustained.
2. Multiple additional 9-1-1 calls are being received, and waiting to be answered.
3. Extended and complex incidents requiring multiple radio communications and/or
notification functions.
4. Mass casualty incident.
5. Natural disaster.
6. Fire fighter safety is in jeopardy.
V. EMERGENCY RULE SHALL NOT APPLY
Every attempt should be made to complete the EMD interrogation sequence. The Emergency
Rule shall not apply to situations where life-saving EMD instructions are necessary. In these
types of situations, the dispatcher shall stay on the line and continue to provide EMD-PAI to
the caller, to the extent possible, until units arrive. These situations are:
1. Cardiac/Respiratory Arrest
2. Choking
3. Childbirth
When the Emergency Rule is used by FCCC personnel, a notation will be made in the call
comments of the call. The notation shall give the reason the Emergency Rule was enacted.
VI. RELEASING THE CALLER
When releasing a 9-1-1 call and enacting the Emergency Rule, the dispatcher will end the call
by saying “I need to hang up now to take another call. If the patient gets worse in any way,
call back to 9-1-1 and ask for medical for further instructions. Help is on the way.” This
allows the caller to understand why the dispatcher is disconnecting the call while reassuring
the caller that the appropriate help is on the way.