1.1 IAED, MPDS History & The Role of the EMD

1.1 IAED, MPDS History & The Role of the EMD

Quick Answer: The Medical Priority Dispatch System (MPDS) was created in 1979 in Salt Lake City by Dr. Jeff Clawson, transforming emergency dispatch from an unregulated "send and see" practice into a medically directed triage system. The International Academies of Emergency Dispatch (IAED) establishes the global standard of care, recognizing the Emergency Medical Dispatcher (EMD) as the "First, First Responder." EMDs operate under non-discretionary protocol adherence, meaning scripted questions and instructions must be delivered verbatim. Certification requires a 24-hour course, current CPR certification, an 80% passing score on the 50-question examination, and 24 hours of Continuing Dispatch Education (CDE) every two-year renewal cycle. Certification runs from the day the test is taken and expires on the last day of that month two years later; retests are available online for a $30 fee, and EMD recertification costs $55 with 24 CDE hours.

---

The Pre-1979 Era: The "Send and See" Doctrine

Before the late 1970s, emergency dispatching was treated as an administrative, clerical function rather than a clinical discipline. When a citizen dialed for medical assistance, calltakers operated under an unguided, unstandardized doctrine widely known in emergency medical circles as "send and see."

Under "send and see," calltakers followed a rudimentary process:

1. Ask for the caller's location.
2. Inquire briefly about the nature of the trouble.
3. Dispatch the nearest ambulance running maximum speed with emergency lights and sirens (a "hot" response).
4. Hang up immediately, leaving the caller alone with the patient until field personnel arrived.

Lethal Deficiencies of the "Send and See" Approach

This unstructured approach created severe clinical, operational, and public safety failures:

• The Zero-Minute Resuscitation Gap: In sudden cardiac arrest, asphyxiation, or catastrophic arterial bleeding, irreversible brain damage or circulatory death occurs within 4 to 6 minutes. Because average emergency medical services (EMS) urban response times range from 6 to 10 minutes (and longer in suburban or rural environments), patients frequently died before paramedics crossed the threshold—even though able-bodied bystanders were on scene willing to help.
• Excessive Emergency Vehicle Collisions (EVCs): Dispatching every call "hot" (lights and sirens) subjected field crews, patients, and the motoring public to unnecessary high-speed transit risks. Studies revealed that the vast majority of medical calls were non-life-threatening, yet ambulances ran hot to all of them, leading to disproportionate rates of fatal collisions.
• Severe Resource Misallocation: Advanced Life Support (ALS) paramedic units were depleted handling minor cuts, sprains, or chronic ailments. When true life-threatening emergencies occurred simultaneously, ALS units were unavailable, resulting in fatal system delays.
• Dispatcher Vulnerability and Inconsistent Care: Without written standards, call handling varied wildly depending on the individual dispatcher's mood, intuition, or stress level. A caller might receive compassionate advice on one shift and be abruptly disconnected on the next.

---

Dr. Jeff Clawson and the 1979 Salt Lake City Breakthrough

Recognizing that the 9-1-1 telephone call represented the true clinical starting point of prehospital emergency care, Dr. Jeff Clawson, MD, an emergency physician serving as the medical director for the Salt Lake City Fire Department, designed a revolutionary paradigm shift in 1979.

Dr. Clawson formulated the world's first comprehensive, medically directed dispatch protocol system: the Medical Priority Dispatch System (MPDS). Initially constructed on index cards that dispatchers navigated in physical desktop flip-boxes, the system introduced four revolutionary concepts:

1. Structured, Objective Interrogation: Standardized questions systematically identified clinical priorities without relying on subjective dispatcher guesswork.
2. Triage and Determinant Coding: Every medical incident was classified into a standardized priority tier (from non-urgent to life-threatening), allowing dispatch centers to match the clinical urgency of the patient with the appropriate response configuration (BLS vs. ALS, hot vs. cold transit).
3. Scripted Pre-Arrival Instructions (PAIs): For the first time, dispatchers were given step-by-step, medically authorized scripts to coach untrained bystanders in performing CPR, opening blocked airways, controlling severe hemorrhage, and delivering newborns.
4. Post-Dispatch Instructions (PDIs): Callers received critical scene-safety and patient-preparation instructions (e.g., unlocking the front door, gathering medications, turning on outside lights, securing pets) while units responded.

---

Evolution and Founding of the IAED

What began in Salt Lake City rapidly expanded across North America and internationally. To maintain curriculum integrity, establish scientific standards, and ensure peer-reviewed evolution of dispatch medicine, Dr. Clawson and emergency communications leaders established the National Academy of Emergency Medical Dispatch (NAEMD) in 1988.

As adoption expanded globally across the United Kingdom, Europe, Australasia, Asia, and the Americas, the organization evolved into the International Academies of Emergency Dispatch (IAED). Today, the IAED oversees four related disciplines:

• Medical (EMD)
• Fire (EFD)
• Police (EPD)
• Emergency Communication Nurse System (ECNS)

The IAED's College of Fellows acts as the formal scientific and regulatory body that reviews, amends, and approves all protocol updates based on published medical literature, empirical field data, and continuous quality improvement analysis.

---

Comparative Analysis: Historical vs. Modern Dispatch

---

The EMD as the "First, First Responder"

The foundational doctrine of the IAED is that the Emergency Medical Dispatcher is the "First, First Responder." While field paramedics and EMTs are physically the first units to arrive on scene, the EMD is the first professional to make contact with the patient or caller at minute zero.

In the prehospital Chain of Survival for sudden cardiac arrest—consisting of early recognition, early CPR, early defibrillation, early ALS intervention, and post-resuscitation care—the EMD controls the first three links:

1. Early Recognition: Rapidly discerning cardiac arrest from agonal breathing within seconds of call connection.
2. Early Telephone CPR (T-CPR): Immediately directing bystanders to begin high-quality chest compressions before chest-wall collapse becomes irreversible.
3. Early Defibrillation: Directing bystanders to retrieve and deploy nearby Public Access Automated External Defibrillators (AEDs).

If the dispatcher fails to identify cardiac arrest or fails to provide confident compression coaching, field paramedics arrive at a biologically deceased patient whose brain has suffered fatal ischemic insult. The EMD's telephone intervention transforms helpless bystanders into functional rescue personnel.

---

Non-Discretionary Protocol Adherence

A central tenet of the MPDS is non-discretionary protocol adherence. In professional emergency communications, protocols are not guidelines or suggestions; they are physician-prescribed medical instructions.

Why Free-Lancing Is Prohibited

Emergency telecommunicators are not licensed physicians. Under the law, an EMD practices prehospital dispatch medicine under the delegated medical license and direct oversight of the agency's EMS Medical Director (an emergency physician). The Medical Director authorizes dispatchers to interrogate patients and provide medical instructions on the explicit condition that the EMD follows the validated, peer-reviewed IAED protocol word-for-word.

When an EMD "free-lances"—omitting scripted questions, inventing custom phrasing, or modifying pre-arrival instructions:

• Diagnostic Validity Fails: Scripted questions are crafted to avoid medical jargon and eliminate ambiguity. Paraphrasing introduces cognitive bias and misinterpretation.
• Crucial Exclusions Are Missed: Subtle signs of life threats (e.g., agonal breathing or atypical chest discomfort) are overlooked when questions are skipped.
• Liability Shields Collapse: The legal doctrine protecting dispatchers relies on proof that the dispatcher operated strictly within the approved standard of care. Deviating from protocol strips away this defense and exposes the EMD and municipality to gross negligence liability.

---

Public Expectations and Telecommunicator Demeanor

The modern 9-1-1 caller expects immediate, calm, and clinically authoritative direction. Callers do not call emergency dispatch on ordinary days; they call during the most terrifying crisis of their lives. When callers encounter uncertainty, hesitation, or argumentative behavior from a calltaker, panic skyrockets.

Professional EMDs project calm authority through structured interrogation. By asking concise, scripted questions with steady vocal inflection, the EMD communicates competence and reassures the caller that help is mobilized and being directed by an expert.

---

Certification Standards, Testing & Lifecycle

To achieve and maintain credentialing as an IAED Certified Emergency Medical Dispatcher, candidates must satisfy rigorous academic and clinical standards:

Initial Certification Requirements

• Course Duration: Completion of the official 24-hour (3-day) IAED EMD certification course led by a certified instructor.
• CPR Prerequisite: Current, valid CPR certification through the National Safety Council, American Heart Association, American Red Cross, European Resuscitation Council, or an equivalent provider. The IAED recommends completing CPR training before the EMD course but accepts CPR certification completed after the course date.
• Written Examination: Achieving a score of at least 80% on the 50-question comprehensive certification exam (requiring a minimum of 40 correct answers).

Recertification & Continuing Education

EMD credentials are not permanent; they require ongoing maintenance to ensure clinical currency:

• Recertification Cycle: Every two years (24 months). Certification begins the day the exam is taken and expires the last day of that month two years later; EMDs may apply for recertification as early as six months before expiration and up to 90 days after it.
• Continuing Dispatch Education (CDE): The dispatcher must complete at least 24 hours of approved CDE during each two-year recertification period.
• CDE Categories: Approved hours include call audit reviews, protocol updates, attending educational seminars, medical dispatch case studies, and participating in scenario-based simulation drills.
• Ongoing CPR Compliance: The EMD must maintain active CPR certification without lapse throughout their operational career.

Career Lifecycle Summary Table

---

Realistic Dispatch Transcript: Historical vs. Modern Protocol

Historical "Send and See" Scenario (Pre-1979)

Dispatcher: Police and Fire, where is your emergency? Caller: (screaming) It's 142 Elm Street! My husband collapsed on the rug! He's turning blue! Please hurry! Dispatcher: Okay, okay, calm down lady! I'm sending an ambulance right now with lights and sirens. Just stay by the front door until they get there. Bye. (Click - disconnects) Outcome: The caller spends 9 agonizing minutes weeping beside her husband. His agonal gasps cease, progressing to irreversible biological death. When paramedics arrive, his heart has deteriorated from a shockable rhythm into refractory asystole.

Modern MPDS Scenario (IAED Standard)

EMD: 9-1-1 Emergency, what's the address of the emergency? Caller: 142 Elm Street! My husband collapsed on the rug! He's turning blue! EMD: What's the phone number you're calling from? Caller: 555-0199! EMD: Okay, tell me exactly what happened. Caller: He was watching TV, made a weird choking noise, and fell out of his chair! EMD: How old is he? Caller: He's 58. EMD: Is he awake? Caller: No, he won't respond to me! EMD: Is he breathing? Caller: He's making a strange snoring sound every few seconds! EMD: (Recognizing agonal respirations - triggers Echo 9-E-1 dispatch) I am sending the paramedics to help you right now. Stay on the line. I'm going to tell you exactly what to do next. Get him flat on his back on the floor. Listen carefully, do not stop...