Dispatch


OPERATION PROTOCOL OF THE INTEGRATED EMERGENCY DISPATCH


         The Integrated Dispatch of the Mures County is an independent structure within the Tirgu Mures Mayor's Office, having the following obligations:

  1. To take the incoming calls on the emergency numbers 961, 981, 982, 955, 956.
  2. To make recordings in digital format and to transmit the data to the subdispatches, for the Firemen, the Police, the Gendarmerie, the Public Guard and the Civil Protection.
  3. To make the selection for the emergencies and to sent the data to the subdispatches belonging to the County Ambulance Service and SMURD, specifying the unit(s) to respond.

  1. The coordination of the activity of medical services in pre-hospital, keeping contact with the intervention units, receiving reports on the intervention's status and assisting the respondents or the emergency units operating without a physician by indicating the modality of correct proceeding based on the report.
  2. The transmission of data using a data terminal to the mobile units having such terminals.
  3. Where is necessary, alerting the respondants directly by phone, radio or pager.
  4. The satellite positioning of the mobile units endowed with a GPS system.
  5. The transfer of phone calls, where is asked for, directly to the subdispatch the caller requires.
  6. The recording of phone calls and radio transmissions and the storage of the recordings for at least 15 days.
  7. The updating of commanding officers and service coordinators on the interventions and incoming calls of the dispatch. (Only directly related data will be updated, otherwise, a special approval will have to be issued by the coordinator of the related service, respecting the secret of the patient, according to the law, in cases for which the needed data implicates medical interventions)
  8. Maintaining the database for the entire dispatch activity.

         The services that the Mures Integrated Dispatch takes calls for are:

  1. The County Ambulance Service (County Level)
  2. SMURD (County Level)
  3. The "HOREA" Fire Department of the Mures County (County Level)
  4. The Mures County Police Department (City Level)
  5. The Mures Gendarmerie Command
  6. The Public Guard Corps (City Level)
  7. The County Civil Protection (County Level)


         The transmission of data by direct phone line and by computer terminals will be made, if required, to:
  1. The County Ambulance Service
  2. SMURD
  3. The "HOREA" Fire Department of the Mures County
  4. The Mures County Police Department
  5. The Mures Gendarmerie Command
  6. The Public Guard Corps
  7. The County Civil Protection (The Tirgu Mures Mayor's Office)

         Permanent personnel:
  1. Dispatcher / phone operator (15 positions):
    • 5 positions employed by the Tg. Mures Mayor's Office
    • 5 positions employed by other Mayor's Offices in the county
    • 5 positions employed by the Mures Gendarmerie Command.
  2. Shift Coordinator Physician (shift line from the County Hospital).
  3. System Engineer (from the Mayor's Office).
  4. Genitors (from the Mayor's Office).
         Activity Coordination:
         The activity coordination will be made under the direct management of the Targu Mures MAyor, who will prezide a coordinating comission made of:
  1. Coordinating Physician of the Ambulance Service or his representantive.
  2. Coordinating Physician of UPU / SMURD or his representantive.
  3. Commanding Officer of the County Firefighter Group or his representantive.
  4. Commanding Officer of the Mures Police or his representantive.
  5. Commanding Officer of the Mures County Gendarmerie or his representantive.
  6. Commanding Officer of the Public Guard or his representantive.
  7. Commanding Officer of the Civil Protection or his representantive.
  8. Director of the Direction for Public Health Mures or his representantive.
Direction for Public Health Mures will assign a person in charge of the quality of the medical activities within the integrated dispatch and of the following the operating protocol from the medical point of vue. The comission will assign a person in charge of the permanent supervision of the dispatch and of reporting the problems to the comission, the Mayor's Office or the institution directly implicated. The person assigned will be one of the coordonating comission members.


         The functioning and the incoming calls handling for non-medical cases:
  1. The dispatch will answer the incoming calls on the numbers 981, 982, 955, 956 simultaneously with the new number 112.
  2. When taking a call, the telephone number and the address of the caller will automatically be shown on the screen; if not, the dispatcher will fill out trhe data regarding the phone number and address of the caller.
  3. The dispatcher will fill in the 112 form for every call, also filling in the specific information for the Fire Department and/or Police.
  4. Once the form is filled, the dispatcher will send it right away to the terminal of the institution(s) to intervene.
  5. In case of such necessity or in case the call does not meet the emergency protocol requirements, the dispatcher will transfer the call directly to the institution(s) connected to the phone switch.
  6. The dispatcher will follow the development of the case and will make sure that the call was answered by the alerted institution(s).
  7. The decision to intervene and to send various crews is the responsibility of the alerted institution.

         The functioning and incoming calls handling for medical cases:
  1. The dispatch will answer the incoming calls on the numbers 981, 982, 955, 956 simultaneously with the new number 112.
  2. When taking a call, the telephone number and the address of the caller will automatically be shown on the screen; if not, the dispatcher will fill out trhe data regarding the phone number and address of the caller.
  3. In case the call is of medical nature, following the filling of the 112 form, the dispatcher will fill the medical form, asking the specific questions and chosing the most appropiate protocol.
  4. After evaluating the degree of the emergency (code red, yelow, green), the dispatcher will transfer the medical form to the coordinating physician.
  5. In medical cases in which the dispatcher cannot evaluate the degree of the emergency, he will transfer the call to the coordonating physician.
  6. Upon receiving the dispatcher's form, the coordonating physician will confirm the degree of the emergency and will decide which unit(s) are to intervene.
  7. Upon arrival at the scene, the team-leader will send a brief assessment on the situation and of the state of the patient(s), to the coordonating physician, who, on his turn, will decide to send more units if necessary or will indicate to the team-leader the procedure to be followed, case being he is an assistant or a paramedic from an emergency crew or a first respondant unit.
  8. In serious cases and situations, at distances which require a long duration ambulance transportation, the coordonating physician will alert the SMURD helicopter.
  9. In cases of massive accidents, serious accidents or special cases, SMURD's coordonating physician will be informed immediately.
  10. The coordonating physician will folllow alongside the radio-telephone operator all ambulances tracked by satelite and their status (in intervention, available, etc.) in order to send the nearest ambulance possible.
  11. In cases with threat to vital signs and in critical conditions the coordonating physician will send the nearest emergency unit or first respondant followed shortly by the mobile resuscitation unit or by the helicopter. The first unit to arrive will send in an assessment to confirm the gravity of the case.
  12. Once the physician confirms the dispatcher's decision or changes it and assigns the intervening unit, he will send the form to the radio-telephone operator who will alert the Tg. Mures Ambulance Service subdispatch, the Fire Department subdispatch and the hospital's subdispatch if the case is assigned to SMURD, or another subdispatch in the county, or will alert the allocated unit by radio-telephone or by data terminal from the ambulance.

        The emergency triage by protocol:
         The medical emergencies will be triaged according to the dispatch protocol, entering them into 3 categories, as followes:
  1. Code Red Emergencies:
    • Are vital emergencies or critical situation which require the fast intervention of a MIC resuscitation unit or if not available of an emergency unit with a AIC physician.
    • Until the arrival of the resuscitation or emergency unit, the dispatcher can simultaneously send a first respondant unit from near by, in order to start the first aid while waiting for the resuscitation unit.
    • Moving to these cases will be made using the alarm system (emergency lights and sirens) choosing the fastest/shortest way, breaking traffic rules if necessary and avoiding the endangerment of the lives of traffic partners or the unit's crew.
    • Upon the arrival of the unit at the scene, an assessment of the patient(s)'s condition will be sent to the coordinating physician.
    • Upon the arrival of the resuscitation unit, the physician from it's crew will take over at the scene and will decide on the therapeutical measures informing the dispatch on the patient(s)'s condition, the treatment and the destination of the patient(s)'s transportation.
    • In case an emergency unit is sent to a case which later proves to be code red, the crew at the scene will inform the dispatch in order to send a resuscitation unit.
    • On code red emergencies the alert and departure of the units will be made in no more than one minute and the arrival at the scene will be in less than 8 minutes in Tg. Mures and in rural areas the helicopter will be sent if necessary in order not to be at the scene in more than 15 minutes since the incoming call.
    • In smaller towns of the county where the interventions are made with emergency units from the Ambulance Service, the same time frame will aplly as for the resuscitation unit of SMURD in Tg. Mures. These crews are to inform the dispatcher on the assessment in order to send appropiate support if necessary.
  2. Code Yellow Emergencies:
    • These are emergencies with no immediate vital threat but which can become so in time if not properly attended with medical assistance and transportation to an adequate sanitary facility.
    • These emergencies can be covered by the emergency crews of the Ambulance Service and by the SMURD First Respondand Units.
    • If applicable, the coordinating physician will send a first respondant from nearby followed by the closest emergency unit available.
    • Moving to these cases will be made using the alarm system (emergency lights and sirens) intermittently, breaking as little of traffic rules as possible. While returning to the sanitary facility transporting the patient, the transport will be made using only visual alarm signalling (lights) and respecting traffic regulations. If it should be considered to have an emergency transportation of the patient, the authorization of the dispatch will be demanded.
    • The first unit to arrive as well as the emergency unit will send assessments on the patient(s)'s condition to the integrated dispatch.
    • In case the emergency unit sent has no physician on board, the crew will act within the limits of it's competence and the unit is supposed to transport the patient to an Emergency Department or to a medical facility following the instructions of the coordinating physician.
    • In case the situation is code red or turns into code red the crew at the scene will inform the dispatcher in order to send in a resuscitation unit.
  3. Code Green Emergencies:
    • These are cases requiring medical assistance or medicalized transportation but can be delayed due to not being emergencies.
    • These cases will be covered by emergency units, ambulance physicians, transportation units, etc. according to the patient(s)'s condition and the service required by the caller.
    • In these cases no alert will be used for making the intervention (lights, siren) unless the patient(s)'s condition evolves to critical.
    • Upon arrival at the scene, an assessment of the case will be sent to the central dispatch and in case it is proven to be a code yellow or code red, the crew will alert the dispatch to send in adequate units.

         Types of medical crews which will handle emergencies in Mures County:
  1. Mobile Resuscitation Unit (MRU)
    • Within SMURD / Mures County Clinical Hospital.
    • Works in cooperation with the Mures County Fire Department.
    • At least one unit / county 24 hours a day.
    • The physician can be part of the crew on board or separately in the emergency physician unit.
    • Crew consisting of at least one driver + 2 medical assistants/paramedics + 1 physician specilly trained in UPU/SMURD.
  2. Mobile Emergency Unit (MEU)
    • Within the County Ambulance Service.
    • At least 3 units in Tg. Mures during day time.
    • At least 2 units in Tg. Mures during night time.
    • At least one 24 hours a day unit in each of the following cities in the county: Sighisoara, Tirnaveni, Reghin.
    • Minimal crew consisting of driver + medical assistant + physician of SAJ Mures.
    • If no physician is available, the crew will consist of one driver and two medical assistants.
    • The crew will act at the team-leader's competency limit, according to protocol for units with no physician present.
    • If there isn't a physician in the crew, the crew is supposed to transport the patient(s) to the Emergency Department or to another sanitary facility according to the dispatch's coordinating physician.
  3. Emergency / Intervention Helicopter (EIS)
    • Within SMURD.
    • Location at the Mures County Clinical Hospital.
    • Minimal crew consisting of pilot + medical assistant + physician of SMURD.
    • The helicopter can function alternatively with the resuscitation unit for cases which have a duration of no more than one hour, otherwise another physician being necessary.
    • In case the resuscitation crew's physician is not present, the unit becomes equal to a first respondant unit or goes to the hospital to pick one of SMURD's physicians in case of necessity.
  4. First Respondant Unit (FRU)
    • Within SMURD/The Fire Department and within SAJ.
    • Are placed in towns and villages in the county, especially there where emergency units are missing.
    • Minimal crew consisting of driver + medical assistant / paramedic.
    • It will take action according to protocols and according to the level of the team leader's competence.
  5. First Respondant / Extrication Unit (FREU)
    • Within SMURD/The Civillian and Millitary Fire Departments.
    • Will be placed in Fire Department locations on national roads with high traffic accident risc.
    • Will intervene as first respondant on medical cases.
    • Will intervene as first respondant and extrication on road accidents cases.
    • Minimal crew consisting of driver + 2 medical assistants / paramedics specially trained for extrication.
    • The driver must be a fireman.
    • At least one other member of the crew is also a fireman besides being an assistant or paramedic.
  6. Medical Transport Unit (MTU)
    • Within SAJ or the hospitals.
    • Is located at SAJ or at the hospitals.
    • The minimal crew consists of one driver instructed in basic first-aid (it is preferred another medical assistant or paramedic, according to necessities).
  7. Ambulance House Calls Physician (AHCP)
    • Within SAJ.
    • The minimal crew consists of one physician or one driver and one physician.
  8. Emergency Physician (EP)
    • Within SMURD/UPU.
    • Is located at the hospital/UPU or at the integrated dispatch.
    • The minimal crew consists of one physician + one assistant /paramedic or a physician + one driver / paramedic.
    • Is a part of the mobile resuscitation unit or is a support for the emergency units and for the first respondant units.

         In case of mass accidents, calamities, etc. the transport units and the resources used for code yellow and code green are to be mobilized for code red, being used in first aid and transportation.

         The command and coordination of an intervention is made by the highest in rank crew leader, so the physician within the MIC will coordinate the intervention from the moment of his arrival at the scene. In cases of multiple victims accidents, a commanding medical officer will be assigned from SMURD, the person being the SMURD coordinating physician or an assigned replacement with graduated catastrophy medicine training.

The Shift Coordinator Physician's tasks:
  1. Taking and supervising the calls answered by the dispatchers.
  2. The verification and confirmation of modification of dispatchers' decisions.
  3. Monitoring the interventions derouling in pre-hospital.
  4. Maintaining the connection with different crews and modification of their destinations depending on case occurance, circumstances and available units.
  5. The coordination of medical interventions of the first respondant units or emergency units without a physician on board.
  6. Reporting to the coordinators of SAJ and SMURD on his shift's events.

The dispatcher's tasks:
  1. Taking incoming calls following protocol.
  2. Transmission of the alert forms towards the sudispatches or to the coordinating physician.
  3. Keeping the caller connected on the line in serious cases until the finasl physician's decision and sending of an unit.
  4. Transmission of first aid information to the caller, where applicable, until the arrival of the unit, using the pre-established protocol.
  5. Transferring the call towards the required subdispatch or to the coordinating physician where applicable.

The radio-telephone operator's tasks:
  1. Alerting the subdispatches electronically, by phone or by radio.
  2. Keeping a radio-telephone contact to units in action.
  3. Traking the units having JPS on board.
  4. Keeping track of crews, resources, supplies and personnel, including the way to alert each one of them.

The working clothes in the dispatch:
  1. The dispatchers will wear an uniform while working hours.
  2. The dispatchers will wear professional ranks showing the training level and dispatch experience.
  3. The personnel from the Gendarmerie will wear uniforms provided by the Gendarmerie.
  4. The physician on dispatch duty will wear the uniform of the service he belongs to or a vest having the mark "COORDINATING PHYSICIAN".

Data Access:
         Access to recorded data and listening to magnetic or video tapes will be granted only to coordinators of the services or their second in command in possession of a written authorization.
         The dispatchers, shift coordinating physicians and the system engineer have access to information stored in the computers in the dispatch being signed to confidentiality by contract agreement.

Access In Central Dispatch:
         Access in the central dispatch is allowed only to working personnel, chief dispatcher, system engineer and to the comission members or their assigned representatives. The official visits to the dispatch can be made on a previous notice of at least one hour and with the approval of the Mayor or of one of the coordinating comission members.

Operative financing:


The Tirgu Mures City Hall:
  • Headquarters plus expenses.
  • Telephone lines.
  • 5 dispatchers.
  • System engineer, 2-3 hours / day.
SAJ:
  • The Tg Mures. subdispatch personnel.
  • The County subdispatches personnel.
UPU/SMURD (The Mures Clinical Hospital):
  • Physician on-call.
The Mures Fire Department:
  • The Tg Mures. subdispatch personnel.
  • The County subdispatches personnel.
The County Police Commandment:
  • The Tg Mures. subdispatch personnel.
The Mures Gendarmerie:
  • 5 dispatchers at the central dispatch.
  • The Tg Mures. subdispatch personnel.
The Sighisoara City Hall based on protocol with the Tg. Mures City Hall:
  • One dispatcher.
The Reghin City Hall based on protocol with the Tg. Mures City Hall:
  • One dispatcher.
The Sovata and Iernut City Halls based on protocol with the Tg. Mures City Hall:
  • One dispatcher.
The Ludus City Hall based on protocol with the Tg. Mures City Hall:
  • One dispatcher.
The Tarnaveni City Hall based on protocol with the Tg. Mures City Hall:
  • One dispatcher.

The Internal Activity Regulation

The latest in 3 months from the beginning of the activity, an internal activity regulation will be ellaborated and approved by the coordinating comission of the dispatch. The regulation will describe in detail the functioning from all points of vue.