Advanced Medical Priority Dispatch System
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The Advanced Medical Priority Dispatch System (AMPDS), is a medically approved, unified system used to dispatch appropriate aid to medical emergencies including systematized caller interrogation and pre-arrival instructions. AMPDS is developed and marketed by Priority Dispatch Corporation which also has similar products for police and fire.
The output gives a main response category - A (Immediately Life Threatening), B (Urgent Call), C (Routine Call). This may well be linked to a performance targeting system such as ORCON where calls must be responded to within a given time period. For example, in the United Kingdom, calls rated as 'A' on AMPDS are targeted with getting a responder on scene within 8 minutes.
Each call is then assigned a sub-category or code, often used as a means of gathering statistics about performance. It also helps when analysing the calls for how the call was described by the informant, compared to the injury or illness found when the crew attend. This can then be used to help improve the questioning system which gives the AMPDS classification.
It should be noted that each category is also referred to by a number from 1 (abdominal pain) through 32 (unknown). This is usually used for brevity and privacy over the radio. In some areas instead of the A, B, C categories, A (alpha) through E (echo) are used.
The software is used widely but its validity is constantly questioned by first reponders in the pre hospital care environment. It is often accused of responding emergency vehicles under fast lights and siren situations for no good reason. The cause of this falling on questions asked to callers that are deliberately kept simple to avoid confusion. For example, call takers ask callers if the "patient is breathing normally" rather than is "the patient is having difficulty breathing" which is considered too technical. Consequently, a patient who is nauseated and vomiting may be considered to be having difficulty breathing as the caller notices that the patient is breathing differently from normal when vomiting. Breathing whilst vomiting does often appear different from normal breathing. This does not mean the patient is having difficulty breathing. The result is an ambulance dispatced under emergency driving conditions that creates an increased risk of accident and potential harm to responding paramedics and the community alike regardless of the care taken whilst driving. An experienced paramedic taking a call would be able to differentiate between the breathing differences of someone vomiting and someone who truly is having trouble breathing. For cost effectivness AMPDS does not generally use medically qualified and experienced call takers. It uses call takers trained to use the software rather than those experienced in the pre hospital care environment. This is a major and on going criticism of the AMPDS software.
[edit] Call categorisation
| Problem | Category A | Category B | Category C |
|---|---|---|---|
| Abdominal Pain/Problems | Not Alert | Abdominal Pain | |
| Fainting or near fainting | |||
| Females with fainting 12-50 | |||
| Males with pain above the navel > 35 | |||
| Females with pain above the navel > 45 | |||
| Allergies/Envenomations | Difficulty breathing or swallowing | Special medications or injections used | Spider bite |
| Severe respiratory distress | Unknown status (3rd party caller) | ||
| Not Alert | No difficulty breathing or swallowing | ||
| Condition worsening | |||
| Swarming attack (bee, wasp, hornet) | |||
| Snakebite | |||
| Ineffective breathing | |||
| Animal bites/attacks | Unconscious or arrest | Dangerous body area | Non-dangerous body area |
| Not Alert | Large Animal | Not recent injury | |
| Exotic animal | Superficial bites | ||
| Attack or multiple animals | |||
| Possible dangerous body area | |||
| Serious Haemorrhage | |||
| Unknown status (3rd party caller) | |||
| Assault, Sexual Assault | Unconscious or Arrest | Multiple Injuries | Not dangerous body area |
| Not Alert | Possible dangerous body area | Not recent (>6 hours) | |
| Abnormal breathing | Serious Haemorrhage | ||
| Dangerous Body Area | Unknown status (3rd party caller) | ||
| Back Pain | Not Alert | Non-traumatic | |
| Fainting or near >50 | Not recent traumatic (>6hrs) | ||
| Breathing Problems | Severe Respiratory distress | Clammy | |
| Not Alert | Abnormal Breathing | ||
| Ineffective Breathing | Cardiac History | ||
| Burns, Scalds, Explosion | Unconscious or Arrest | Explosion | Sunburn or minor (< hand size) |
| Severe respiratory distress | Multiple victims | ||
| Not Alert | Building fire - persons reported | ||
| Difficulty breathing | |||
| Burns > 18% | |||
| Unknown status (3rd party caller) | |||
| Burns < 18% | |||
| Fire alarm (unknown status) | |||
| Carbon Monoxide, Hazchem | Unconscious or Arrest | Multiple victims | |
| Severe respiratory distress | Alert with difficulty breathing | ||
| Not Alert | Alert without difficulty breathing | ||
| Unknown status (3rd party caller) | Carbon monoxide detector alarm | ||
| Cardiac or Respiratory arrest, Death | Ineffective breathing | Obvious death unquestionable | |
| Not breathing at all | Expected Death | ||
| Breathing Uncertain (Agonal) | |||
| Hanging | |||
| Strangulation | |||
| Suffocation | |||
| Underwater | |||
| Chest Pain | Abnormal breathing | Breathing normally <35 | |
| Cardiac history | |||
| Cocaine | |||
| Breathing normally > 35 | |||
| Severe respiratory distress | |||
| Not Alert | |||
| Clammy | |||
| Nausea or vomiting | |||
| Choking | Not alert | Abnormal breathing | Not choking now |
| Verified/ineffective breathing | |||
| Convulsions, Fitting | Pregnancy | Diabetic | |
| Not breathing | Cardiac History | ||
| Continuous or multiple fitting | Breathing regularly not verified < 35 | ||
| Irregular breathing | Not seizing now and breathing regularly | ||
| Breathing regularly not verified > 35 | |||
| Diabetic Problems | Unconscious | Not Alert | Alert |
| Abnormal Behaviour | |||
| Abnormal breathing | |||
| Drowning, Diving,SCUBA accident | Unknown status (3rd party call) | SCUBA accident | |
| Unconscious | Alert with abnormal breathing | ||
| Not Alert | Alert and breathing normally (injuries or in water) | ||
| Diving or suspected neck injury | Alert and breathing normally (No injuries) | ||
| Electrocution, Lightning | Unconscious | Alert and breathing normally | |
| Not disconnected from the power | |||
| Power not off - hazard present | |||
| Long fall > 6ft | |||
| Not Alert | |||
| Abnormal breathing | |||
| Unknown status (3rd party caller) | |||
| Not Breathing/Ineffective breathing | |||
| Eye Problems | Not Alert | Medical Eye Problem | |
| Severe eye injuries | Minor eye injuries | ||
| Moderate eye injuries | |||
| Falls | Dangerous Injuries | Long fall > 6ft | Not dangerous injuries |
| Not Alert | Possible dangerous body area | Not recent (>6 hours) | |
| Abnormal breathing | Serious Haemorrhage | ||
| Unknown status(3rd party caller) | |||
| Headache | Not alert | Normal breathing | |
| Abnormal breathing | |||
| Speech problems | |||
| Sudden on set of pain <3hrs | |||
| Numbness or paralysis | |||
| Change in behaviour >3hrs | |||
| Unknown status (3rd party caller) | |||
| Heart Problems | Chest Pains > 35 | Firing of AICD | Chest Pain < 35 |
| Severe respiratory distress | Abnormal breathing | Heart rate > 50 and < 130 | |
| Not Alert | Cardiac History | ||
| Clammy | Cocaine | ||
| Heart rate <50 or >130bpm | |||
| Unknown status (3rd party caller) | |||
| Heat/Cold Exposure | Not Alert | Alert | |
| Cardiac History | |||
| Change in skin colour | |||
| Unknown status (3rd party caller) | |||
| Haemorrhage/Laceration | Haemorrhage through tubes | Possible Dangerous Haemorrhage | Minor Haemorrhage |
| Dangerous Haemorrhage | Serious Haemorrhage | Not dangerous Haemorrhage | |
| Not Alert | Bleeding disorder or thinners | ||
| Abnormal Breathing | |||
| Industrial or Machinery Accident | Life Status Questionable | Multiple Victims | |
| Caught in Machinery (Unknown Status) | Unknown situation (not caught in machinery) | ||
| Overdose, Poisoning, Ingestion | Unconscious | Violent (Police must secure) | |
| Severe Respiratory Distress | Not Alert | ||
| Abnormal Breathing | |||
| Antidepressants | |||
| Cocaine (or derivative) | |||
| Narcotics (heroin) | |||
| Acid or Alkali (lye) | |||
| Unknown status (3rd Party Caller) | |||
| Poison control request response | |||
| Pregnancy, Childbirth, Miscarriage | Breech or Cord | Head visible/out | 1st trimester or miscarriage |
| Imminent Delivery (>5 months/20weeks) | 2nd Trimester haemorrhage or miscarriage | ||
| Baby Born | 1st trimester serious haemorrhage | ||
| 3rd trimester haemorrhage | Labour (delivery not imminent. >5 months | ||
| High risk of complications | Unknown status (3rd party caller) | ||
| Psychiatric, Suicide attempt | Not Alert | Non-violent and non-suicidal | |
| Violent (police must secure) | |||
| Threatening Suicide | |||
| Near hanging, strangulation or suffocation (alert) | |||
| Unknown status | |||
| Sick Person | Not Alert | No priority symptoms | |
| Cardiac History | Deafness | ||
| Unknown status (3rd party caller) | Defecation | ||
| Earache | |||
| Enema | |||
| Gout | |||
| Haemorrhoids | |||
| Hepatitis | |||
| Hiccups | |||
| Hungry | |||
| Nervous | |||
| Boils | |||
| Object stuck (nose, ear, vagina, rectum, penis) | |||
| Object swallowed (not choking) | |||
| Penis problem or pain | |||
| Rash or skin disorder | |||
| Sore Throat | |||
| Toothache | |||
| Transportation only | |||
| Venereal disease | |||
| Wound infected | |||
| Bumps (non traumatic) | |||
| Can't sleep | |||
| Can't urinate | |||
| Catheter problem | |||
| Constipation | |||
| Cramps or spasms | |||
| Cut off ring request | |||
| Stabbing, Gunshot, Penetrating Trauma | Unconscious or Arrest | Multiple victims | Not recent (>6 hours) single peripheral wound |
| Not Alert | Not Recent (>6 hours) single central wound | ||
| Central wounds | Known single peripheral wound | ||
| Multiple Wounds | Serious Haemorrhage | ||
| Unknown status (3rd party caller) | |||
| Stroke, CVA | Not Alert | ||
| Abnormal breathing | |||
| Speech or movement problems | |||
| Numbness or tingling | |||
| Stroke history | |||
| Breathing normally > 35 | |||
| Unknown status (3rd party caller) | |||
| Breathing Normally <35 | |||
| Traffic & transportation accidents | High Mechanism - Ejection | Major Incident | |
| Not Alert | High Mechanism | ||
| High Mechanism | |||
| HAZMAT | |||
| Pinned or trapped victim | |||
| Injuries | |||
| Multiple victims (one unit) | |||
| Multiple victims (additional units) | |||
| Serious Haemorrhage | |||
| Unknown status (3rd party caller) | |||
| 1st party caller with non-dangerous injury | |||
| Traumatic Injuries (specific) | Dangerous body area | Serious Haemorrhage | Not Dangerous Injury |
| Not Alert | Possibly dangerous body area | Not recent (>6 hours) | |
| Abnormal breathing | |||
| Unconscious or fainting (near) | Multiple fainting episodes | Alert with abnormal breathing | Single fainting episode (age <35) |
| Unconscious | Cardiac history | ||
| Severe respiratory distress | Single or near fainting. Alert >35 | ||
| Not Alert | Females 12-50 with abdominal pain | ||
| Ineffective breathing | |||
| Unknown problem or 3rd party report | Life status questionable | Standing, sitting, moving or talking | |
| Medical Alert notification | |||
| Unknown status (3rd party caller) |
[edit] References
- Department of Health - AMPDS Call Categorisation Vers 11 (April 2005)
