The Medical Priority Dispatch System (MPDS) is an emergency medical dispatch system widely used to prioritize 9-1-1 calls and optimize resource allocation. This study evaluates whether the assigned priority predicts a Delphi process-derived level of prehospital intervention in each emergency medical dispatch category.

All patients given a MPDS priority in a suburban California county from 2004–2006 were included. A Delphi process of emergency medical services (EMS) professionals in another system developed the following categories of prehospital treatment representing increasing acuity, which were adapted for this study: advanced life support (ALS) intervention, ALS–Stat, and ALS–Critical. The sensitivities and specificities of MPDS priority for level of prehospital intervention were determined for each MPDS category.

A total of 65,268 patients met inclusion criteria, representing 61% of EMS calls during the study period. The overall sensitivities of high-priority dispatch codes for ALS, ALS-Stat, and ALS-Critical interventions were 83% (95% confidence interval 83–84%), 83% (82–84%), and 94% (92–96%). Overall specificities were: ALS, 32% (31–32%); ALS-Stat, 31% (30–31%); and ALS-Critical 28% (28–29%). Compared to calls assigned to a low priority, calls with high-priority dispatch codes were more likely to receive ALS interventions by 22%, ALS-Stat by 20%, and ALS-Critical by 32%. A low priority dispatch code decreased the likelihood of ALS interventions by 48%, ALS-Stat by 45%, and ALS-Critical by 80%. Among high-priority dispatch codes, the rates of interventions were: ALS 26%, ALS-Stat 22%, and ALS-Critical 1.5%, all of which were significantly greater than low-priority calls (p <0.05) [ALS 13%, ALS-Stat 11%, and ALS-Critical 0.2%]. Major MPDS were categories with high sensitivities (>95%) for ALS interventions included breathing problems, cardiac or respiratory arrest/death, chest pain, stroke, and unconscious/fainting; these categories had an average specificity of 3%. Medical Priority Dispatch System categories such as back pain, unknown problem, and traumatic injury had sensitivities for ALS interventions <15%.

The MPDS is moderately sensitive for the Delphi process derived ALS, ALS-Stat, and ALS-Critical intervention levels, but non-specific. A low MPDS priority is predictive of no prehospital intervention. A high priority, however, is of little predictive value for ALS, ALS-Stat, or ALSCritical interventions.

Medical Miranda, also called Secondary Emergency Notification of Dispatch (Secondary Emergency Notification of Dispatch), is a low cost, effective, and welcome addition to emergency medical dispatching systems. The benefits are recognized by emergency medical dispatchers who receive feeder calls from associated public safety agencies that have trained both their field staff and call-takers in the Medical Miranda protocol.

The dispatchers would be more satisfied with feeder agencies that used the Secondary Emergency Notification of Dispatch protocol.

A survey was conducted and analyzed, taking advantage of a situation in which two agencies (one used Secondary Emergency Notifi-cation of Dispatch) fed calls to the same communication center.

Dispatchers were more satisfied with the information gained from the feeder agency that used the Secondary Emergency Notification of Dispatch protocol and believed that the officers and dispatchers of that agency had afar better understanding of the emergency medical dispatcher's needs.

When the emergency medical dispatcher does not talk directly with the reporting scene personnel or caller, Medical Miranda increases the usefulness of the information the dispatcher receives, helps the dispatcher better understand the reported medical emergency, and improves response appropriateness in emergency medical service (Emergency Medical Service) systems where responses routinely are prioritized.