Advanced Medical Priority Dispatch System

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Star of Life
Star of Life

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

AMPDS 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)