Resolution 27(17) 9-1-1 Number Access and Prearrival Instructions
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Resolution 27(17) 9-1-1 Number Access and Prearrival Instructions
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RESOLUTION: 27(17)
SUBMITTED BY: Alaska Chapter
EMS-Prehospital Care Section
Illinois College of Emergency Physicians
Missouri College of Emergency Physicians
Oklahoma College of Emergency Physicians
West Virginia Chapter
SUBJECT: 9-1-1 Number Access and Prearrival Instructions
PURPOSE: Develop a policy statement to support and advocate to achieve 100% coverage of the U.S. population with 9-1-1 next generation level service and every Public Safety Answering Point or EMS dispatch center provides appropriate medical pre-arrival instructions with EMS physician oversight. Work with appropriate stakeholders to collect information on 9-1-1 and PSAP funding models and engage in development of model legislation incorporating enduring funding for 9-1-1 and PSAPs that includes EMS physician involvement.
FISCAL IMPACT: Budgeted committee and staff resources. Additional staff resources to inventory PSAP funding models and working with stakeholders to develop model 9-1-1 funding legislation.
Resolution 27(17) 9-1-1 Number Access and Prearrival Instructions
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WHEREAS, 9-1-1 number access to Public Safety Answering Points (PSAP) is not uniformly available nationwide; and
WHEREAS, 240 million calls are made to 9-1-1 annually in the US, of which >70% of calls were through wireless carriers (2011 data); and
WHEREAS, 29.7% of U.S. households relied on wireless communication as their primary service (2011) and it is expected that number is considerably higher now, therefore, maximizing benefit of wireless communication by capitalizing on the ability to determine exact call location, and using this location determination to route calls to the responsible call center, are critical capabilities for PSAPs; and
WHEREAS, A call to 9-1-1 is not necessarily routed to a local PSAP, as some areas do not provide access to their PSAP through the 9-1-1 number and this results in delays (which may be considerable) to appropriate resource deployment as calls are routed to the PSAP that serves that emergency call location; and
WHEREAS, PSAPs, regardless of 9-1-1 or 10 digit dial access number, have different capabilities with regard to being able to verify emergency call location using wireless technology and those with basic or enhanced 9-1-1 service do not have the ability to use GPS location to pinpoint call location and must rely on the caller’s knowledge and ability to describe the location accurately, which can be significantly problematic if the caller is in distress, or in an unfamiliar location (i.e. Interstate, rural road); and
WHEREAS, PSAP and EMS dispatch point ability to provide any (or appropriate) medical prearrival instruction is inconsistent; and
WHEREAS, Medical prearrival instructions for bystander aid in life threatening medical emergencies are a critical element for survival in some time critical diagnoses (TCD) and in cardiac arrest; therefore be it
RESOLVED, That ACEP create a policy statement supporting 9-1-1 number access to a Public Safety Answering Points for 100% of the U.S. population at next generation 9-1-1 level; and be it further
RESOLVED, That ACEP create and advocate for broad recognition of a policy statement supporting every Public Safety Answering Point or EMS dispatch point be able to give appropriate medical prearrival instruction for bystander aid, including CPR and hemorrhage control, and include EMS physician involvement in their creation, implementation, and quality improvement activities; and be it further
RESOLVED, That ACEP work with appropriate stakeholders to inventory and summarize models for 9-1-1 and Public Safety Answering Point funding as a resource for areas in need of increased service levels; and be it further
RESOLVED, That ACEP work with appropriate stakeholders to engage in development of model legislation incorporating enduring funding stream for 9-1-1 call centers/Public Safety Answering Points incorporating key elements including: bringing systems to at least the next generation 9-1-1 level, providing medically appropriate prearrival instructions, and incorporating EMS physician involvement in quality oversight, response profiles, and prearrival instructions.
Resolution 27(17) 9-1-1 Number Access and Prearrival Instructions
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Background
This resolution directs ACEP to advocate and promote efforts that support achieving 100% coverage of the U.S. population with 9-1-1 next generation level service and every Public Safety Answering Point (PSAP) or EMS dispatch center provides appropriate medical pre-arrival instructions with EMS physician oversight. It also directs the College to work with appropriate stakeholders to collect information on 9-1-1 and PSAP funding models and engage in development of model legislation incorporating enduring funding for 9-1-1 and PSAPs that incorporates EMS physician involvement.
Currently, more than 99% of the U.S. is covered by 9-1-1 service and many communities are working to implement the Next Generation 9-1-1 (NG911) level. The current 9-1-1 system includes a single number to access emergency services for a given area that provides caller location, name, and telephone number. Some of the limitations of the current system include the inability to transfer calls and data between PSAPs and the lack of routing to the appropriate PSAP based on actual caller location versus the cell phone tower location that was accessed.
The NG911 system will greatly enhance and upgrade the 9-1-1 infrastructure and includes enhanced coverage for wireless calls, more accurate caller location detection for wireless callers, receiving text messages, and data images and videos. It will be able to receive electronic data directly from programs such as Advanced Automatic Collision Notification (AACN) systems, medical alert systems, and safety sensors of various types. NG911 will also allow the PSAP to issue emergency alerts to wireless devices in a specific area via voice or text messages and to highway alert systems.
The type and detail of medical pre-arrival instructions provided to callers varies greatly across the country. While there are only a few standardized medical pre-arrival systems in use today, there is a lack of uniformity on how they are used and the kind of information provided to the caller by individual PSAPs or EMS services. There is also a lack of uniformity in the involvement of an EMS physician in the medical directions provided and in quality oversight.
ACEP’s policy statement “Physician Medical Direction of EMS Dispatch Programs” partially addresses both the NG911 and medical pre-arrival instructions.
ACEP Strategic Plan Reference
Goal 1 – Reform and Improve the Delivery System for Acute Care
Objective A – Develop and promote delivery models that provide effective and efficient emergency medical care in different environments across the acute care continuum.
Fiscal Impact
Budgeted committee and staff resources. Additional staff resources to inventory PSAP funding models and working with stakeholders to develop model 9-1-1 funding legislation
Prior Council Action
None
Prior Board Action
June 2017, revised and approved the policy statement “Physician Medical Direction of EMS Dispatch Programs;” reaffirmed June 2010; revised and approved September 2003; and originally approved October 1998.
Background Information Prepared by: Rick Murray, EMT-P
EMS & Disaster Preparedness Director
Deanna Harper, EMT-I
Coordinator, EMS & Disaster Preparedness
Reviewed by: James Cusick, MD, FACEP, Speaker
John McManus, MD, FACEP, Vice Speaker
Dean Wilkerson, JD, MBA, CAE, Council Secretary and Executive Director