EMT Team Dispatching

The emergency response system, ERIS, assigns grades to response teams based on their qualifications and capabilities. Grade 1 teams are basic life support, Grade 2 are advanced life support, and Grade 3 are critical care teams. The dispatch process involves finding available teams that meet the emergency's priority category, with a preference for teams with lower grades. Response teams work in shifts, and their availability is tracked to ensure only qualified teams are dispatched to emergencies. Upon arrival at an emergency scene, EMTs record patient information and treatment details using field notebooks, which will eventually be replaced by handheld devices. ERIS also generates reports for management, including exception reports for ongoing emergency responses, patient care records, and weekly summaries of emergency responses attended to by each base station.

MURDOCH UNIVERSITY
ICT231 SYSTEMS ANALYSIS AND DESIGN
ASSIGNMENT
Date Due: Sunday 24 July 2016
Assignment Information
You should submit your assignment from the ICT231 LMS site using the Assignment course tool. You
can receive email notification that your assignment has been received. For help on the submission
process, go to: http://www.lms-support.murdoch.edu.au/student/assign_sub.html. Late submissions
will be penalised at the rate of 10 marks per day late or part thereof.
You should submit your assignment as ONE word-processed document containing all of the required
question answers. You must include a completed assignment cover page (see end of this document –
copy and paste this INTO your document). You must keep a copy of the final version of your assignment
as submitted and be prepared to provide it on request.
The University treats plagiarism, collusion, theft of other students’ work and other forms of dishonesty
in assessment seriously. This is an INDIVIDUAL assignment. Any instances of dishonest in this assessment
will be forwarded immediately to the Faculty Dean. For guidelines on honesty in assessment including
avoiding plagiarism, see: http://www.murdoch.edu.au/teach/plagiarism
1

To submit:
1. Domain class diagram.
Produce an analysis class diagram focusing on the problem domain. At this point it is not
required to be fully attributed. However it is important that you attempt to model as many of
the entities as possible, and to ensure the correct multiplicity. A large amount of the required
information is present in the OVERVIEW section of the case. However it is important to study
the whole case as there may be other details or important context that is situated in other
sections. (35)
2. Decision Table.
Draw a decision table to capture the logic of determining the priority category for a call. This is
explained in the interview section on page 6.
You may wish to follow the decision table examples/exercises used in the tutorials as a template
and starting point for this exercise. (25)
3. Activity Diagram.
Draw an activity diagram to show the flow of activity for the process of logging an emergency
call and dispatching a response team. Most of this activity flow is explained in the interview
section of the case on page 8. Two of the most relevant items have been highlighted in the case
as a hint but other useful information may be present elsewhere. End the activity diagram with
“Close Emergency Call” even though this may not explicitly be stated in the interview section
highlighted. (20)
4. Activity Diagram.
Drawan activity diagram to show the flow of activity for the process of supervisor actions on
waiting emergencies. This describes the situation when an operator is attempting to dispatch a
response team but no teams are available. As with previous questions, the most relevant section
of the case has been highlighted as a hint. (20)
2

Rescue911 Case
The following sections provide an overview of Rescue911,providing background to the business,
problems experienced,and requirements for the new system. Additional detailedinformation is
presented in the form of data gathered frominterviews with key stakeholders.
Overview
(Question 1)
Rescue911 is an ambulance and emergency services company. The company operates a single 24-
houremergency operations call center in which all calls toRescue911 are received and processed.
Response teams aredispatched by call center operators. They are all trainedemergency medical
dispatchers. Rescue911 hasapproximately 2000 EMTs (emergency medical technicians)working in these
response teams. Response teams are locatedat 25 base stations that are distributed across the
geographicregion serviced by Rescue911.As a private ambulance and emergency servicescompany, the
assignment of response priorities and thecoordination of the dispatch process are core to
Rescue911’svalue offering. The dispatcher plays a key role in matchingRescue911’s response capability
to emergency situations.Rescue911 knows that the overall effectiveness of the EMS system begins with
the logging of emergency calls and the dispatch of response teams.
People that make use of Rescue911’s services include subscribers and non-subscribers. Direct
subscribers are individuals or families that subscribe directly to Rescue911and pay a monthly fee.
Indirect subscribers are automatically subscribed to the services of Rescue911 as a result of their
medical aid scheme, home insurance or life assurance policies. These medical aid and insurance
companies are called providers. The indirect subscribers do not pay the monthlyfees; instead Rescue911
recovers monies from their providers by billing the providers directly for the services rendered. Non-
subscribers can also make use of Rescue911’sservices i.e. Rescue911 will respond to all emergency calls
received. However, non-subscribers will be billed for any emergency care provided to them.Rescue911
has seen significant growth in operations in recent years. They currently have 2 million subscribed
members (direct and indirect), 2008 revenue was $500million, and in the first 6 months of 2009 they
have responded to 125 000 emergency incidents, an average of 25emergencies per base station per day.
Organization Structure
Rescue911 has a flat organizational structure. Beyond the Chief Executive Officer (CEO) there are only
three senior managers, the Chief Medical Officer, Chief Operating Officer and the Chief Financial Officer.
The responsibility of the Chief Medical Officer is to make sure that Rescue911’sdispatching and medical
procedures adhere to the expectations of the National Association of EMS Physicians. The Chief
Operating Officer is responsible for the day to day business. He is in charge of the call center and all base
stations. The call centers operators are emergency medical dispatchers certified by both national and
3

international academies of emergency dispatching and have been trained in emergency
telecommunications. Rescue911’sorganizational structure is depicted in Figure 1.
Figure 1 Organizational Structure
Problem Statement
The recent growth of Rescue911 has not come without its problems. Rescue911 has begun to receive
numerous complaints about their services from subscribers and providers. They are also under
increasing pressure from the government, hospitals, doctors, medical aids and insurance companies to
properly account for their services. Typical problems include: spending too much time monitoring and
coordinating response teams instead of focusing on the medical aspects of dispatching, lack of real-time
information on EMT and response team availability, inability to confirm for callers whether a response
to an emergency has been dispatched or to provide details on the response configuration, inability to
determine which emergency calls have been closed / concluded and which are still in progress, under
qualified teams are often dispatched and themes arriving at a scene are not adequately skilled to deal
with the emergency situation, over qualified teams are being dispatched to noncritical incidents leading
to poor utilization of skilled resources, lack of proper documentation of services provided at a scene to
both subscribers and non-subscribers, inaccurate records of shifts worked by EMTs at the various base
stations, incomplete records of EMTs and their qualifications, and lack of metrics for performance
management especially in relation to response turnaround times.
Rescue911 management has determined that many of the problems result from inadequate systems
that have not kept pace with their growth rate. They aim to solve these problems through the
introduction of a new information system. The system is to be called ERIS (emergency response
information system).
4

The new ERIS system is aligned to Rescue911’sobjective to maintain the infrastructural capacity needed
to deliver comprehensive emergency service solutions. Through the implementation of ERIS,
Rescue911management aim to ensure the company can realize its key performance objective to
standardize the process of call logging, ensure accuracy of response team dispatching, and improve pre-
hospital treatment and customer satisfaction with response performance. The system will also provide
for improved internal operational effectiveness, more efficient utilization of response teams, and better
management control over base stations.
There will be three groups of users of ERIS:
1. Call Center Operators, the emergency medicaldispatchers, who will use ERIS to log emergencycall
details, dispatch one or more response teams, and follow up on calls dispatched. Supervisors area type
of operator who are also able to deal with those emergency calls to which operators are unable to
dispatch a response due to response team unavailability, and to authorize the cancellation of an
emergency response
2. EMTs that will report for duty (clock-in) at the beginning of their shift by logging into ERIS and will also
use ERIS to input details about patient care provided at emergency scenes
3. Rescue911 managers who will use ERIS to produce certain reports. These reports included demand
reports, schedule reports as well as exception reports. Managers are also responsible for maintenance
of master file data.
Functional Requirements
ERIS will be implemented using a phased approach. Based on the needs identified, the following
requirements have been defined for inclusion in the first-phase of the ERIS project (see Table 1), while
later phases will incorporate billing, accounting and finance, vehicle and asset management, and a
mobile, PDA based, EMT-patient caresub-system.The above requirements will be met through the
following four sub-systems:
1. Computer aided dispatch sub-system (CAD) –Primary users: Operators and Supervisors.
a. Log emergency calls received.
b. Dispatch, track and manage emergency responses.
c. Reporting and online querying.
2. Base Station management sub-system (BSMS) –Primary users: EMTs and Managers.
a. Base station records management.
b. EMT records management
c. Response team records management
d. EMT shift logging (clocking in and out)
e. Reporting
3. Subscriber management sub-system (SMS) –Primary users: Managers
a. Direct and indirect subscriber recordsmanagement
b. Reporting
5

4. Electronic patient care reporting sub-system(EPCR) – Primary users: EMTs
a. Capture patient care data
b. Reporting
Table 1 Selected user requirements
Interviews with Stakeholders
Interview with Mr.Tye Red, Chief Operating Officer, to understand details related to handling of
emergency calls and dispatching of response teams
Q. Please explain the concept of an emergency
A. There are many types of emergencies to which Rescue911responds. Typical emergencies include:
vehicle collisions, heart attacks, strokes, shootings, stabbings, child birth,drownings, allergic
reactions, choking, broken bones, and numerous other household accidents and incidents.
Q. What are the responsibilities of operators when answering an emergency call?
A. Rescue911’s call center operators are Emergency Medical Dispatchers that possess special
knowledge and skills. Dispatchers not only log calls and dispatch response teams, they are also
responsible for the medical aspects of dispatching, providing direction and pre-arrival instructions to
callers. Through caller interrogation, dispatchers are able to evaluate the severity of the injury or
illness, allocate the call to a priority category, and ensure that they dispatch an appropriate
response configuration.
Q. How exactly is the priority category determined? And what role would you like the system to
play?
(Question 2)
A. Operators are highly trained to determine the severity of an emergency and assign the call to a
priority category. This function is not required to be automated by the system. The priority category
of an emergency is determined by the dispatcher at the time of the call based on information
6

provided by the caller. Criteria based dispatch guidelines provide a series of well-structured
questions that operators have been trained to ask of callers. The priority category, and the
estimated number of patients involved, determines the response configuration i.e. the number and
skills levels of response teams that need to be dispatched. The priority categories are:
1. Minor incident cases where treatment can be delayed. These are mostly minor single victim
/patient accidents requiring basic care levels.
2. Stable cases where single or multiple victims /patients are reported but all are conscious and
considered stable. Prompt but basic treatment levels are required.
3. Serious cases when a single or multiple victims /patients are reported and one or more are
unconscious or considered unstable due to possible injury to vital points. Prompt and advanced
treatment is desirable.
4. Critical trauma cases when a single or multiple victims / patients are reported and one or more
are unconscious, not breathing, or have lost a great deal of blood. Prompt and advanced treatment
is necessary for patient survival.
Prioritization is core to the effectiveness of the dispatch process to ensure that appropriately
qualified teams are dispatched to provide the appropriate level of care. The dispatching operator
needs to input the priority category of an emergency as well as the number of response teams that
are required. Operators also need to capture the address, nearest landmark to the emergency, the
phone number and name of the caller, and a brief description of the emergency. Once these details
of an emergency are captured, we consider the emergency call as being in a ‘logged’ state. The
operator should then proceed to dispatch a new response, or link the call to an existing emergency
response.
Q. What do you mean by dispatching a response and linking the call?
A. An emergency call should result in what we term an emergency response. This is the actual
dispatching of one or more teams of particular skill that proceed to the emergency location in a
certain response mode (e.g. red lights and sirens versus routine driving).Sometimes Rescue911 will
receive more than one call for the same emergency situation. Operators will determine if any new
calls received are related to existing calls and can then link the call to an existing emergency
response. This will ensure that the operator does not dispatch a response to an emergency which is
already being dealt with. The operator will inform the caller that Rescue911 is already aware of that
emergency situation and that a response team has already been dispatched to that scene. Obviously
this is not a faultless process and we have had situations before where two different emergencies
have occurred in close proximity. Operators have incorrectly assumed that callers have been
referring to the same emergency situation. Therefore, we would like an operator tube able to refer
the details of any emergency situation already recorded so that they can clearly determine from the
caller whether the emergency being reported is indeed a new one.
7

Q. Can you please explain more about the process of dispatching a response team?
(Question 3)
A. Response teams are dispatched from one of 25 base stations. Response teams are dispatched
based on availability, proximity to the emergency location, and the response team’s grade. The new
ERIS system does not need to determine which base station is closest to the emergency. Instead,
operators already have access to a sophisticated GIS/ GPS (geographic information system and
global positioning system) that is used to map emergency locations to base stations. When initiating
a dispatch for a new emergency response, we’d like for the operator to simply be required to input
into ERIS the base station ID of the nearest base stations determined from the GIS / GPS system. Our
GIS/GPS system shows our base station locations, and emergency response flags. Operators use this
system to find base stations closest to reported emergency locations. Some of our very experienced
operators often know the different areas so well that they can recall by heart the closest base
station. We’d like for the new ERIS system tallow operators to use the base station ID in order to
begin the process of searching for an available response team. The operator dispatches a response
team by radioing the relevant base station “Control to Base Station AA.Response Team XXX Proceed
to Location XXXXXX.Over”.
Once a response team is dispatched, the operator waits for the response team to respond over the
radio system with “Roger Control. Response Team XXX Proceeding to Location. Over”.
If no response is received within 15 seconds, the operator radios the team again. If no response is
received within further 10 seconds, the operator is required to dispatch another team. The system
should enforce this confirmation process i.e. the operator must confirm that a response team has
acknowledged the call and that they are precedingtithe scene. Once confirmed, we consider the
Emergency Callas having changed from a ‘logged’ to ‘actioned’ state, and the system should record
that a responding team has been dispatched.
Q. What happens next?
(Question 3)
A. The operator will radio a description of the emergency tithe responding team. The operator will
also request thatresponding team radio in to the control center upon arrival at the scene. The
response team will typically call in upon arrival with “Response Team XXX to Operator. Response
Team XXX on Location. Respond. Over” Any operator at the control room can then respond “Roger
Response TeamXXX”. This is important step in the process as it allows us to know that a responding
team is actually ‘on-scene’ and the time of team’s arrival.
Q. Does the process always run as smoothly as you’ve described it? Are there any exceptions?
(Question 4)
A. Yes, of course there will always be some exceptions. For example, if an operator is attempting to
dispatch a response team to an emergency but no teams are available from an appropriate base
station, the Emergency Call is flagged as ‘waiting’. Dispatch supervisors are responsible for dealing
8

with all calls that are ‘waiting’. Usually, the supervisor will attempt to dispatch a team currently in
the field by radioing teams close to the scene and determining their availability. Supervisors are able
to do this by checking their AVL(automatic vehicle location) and GIS/GPS systems to find teams in
the field close to another emergency scene. Oralsystem, lets us know where each responding team
is at any point in time. If a supervisor is able to dispatch a team in the field, then they should do
that. If they can’t, the supervisor contacts another emergency services company e.g. County
EMS.Once the other service provider confirms they are attending to the call, the supervisor closes
the call on our side.
Q. What is your expectation with regards to the integration of ERIS with the existing GIS/GPS and
the existing AVL system?
A. We don’t want you to make any changes to the existing AVL or GIS / GPS system. Their developers
(Live TrackInc) will be responsible for integrating them with our new ERIS once it is completed. They
will ensure that the AVL system and the GIS/GPS system read data from ERIS in order to update the
maps. It is not within your brief to worry about those systems. I only mentioned them so you could
understand that those systems also play a role in the overall process.
Interview with Ms Sue P. Phizer, Base Station Supervisor, to understand and clarify the roles of EMTs
and response teams
Q. Can you explain to us what an EMT does, and what is response team?
A.An EMT is a trained emergency medical professional. Within our company, EMTs can be one of
three EMT Grades. These are: basic EMT, paramedic, and critical care paramedic. EMTs never work
alone. They each belong to what we call a “response team”. Each response team will have 3 to 4
EMTs. Each response team is assigned a team grade. The team’s grade is determined by the grades
of themes that make up the team. The team will be categorized as grade 1 (basic life support team),
2 (advanced life support team) or 3 (critical care team).
Q. Of what importance are these grades?
A. Grades come into play during the dispatch process. I’m sure our COO explained that process to
you. I used to working the control room as a dispatch supervisor before I was promoted to the base
station supervisor, so I have a very good idea about how all the pieces fit together. Let me explain:
Grade 1, basic life support teams, can respond to emergency priority categories 1 and 2. Grade 2,
advanced life support teams, can respond to categories 1, 2 and 3.Grade 3, critical care teams, can
respond to categories 1, 2, 3and 4. Grade 1 teams ride in basic life support ambulances, while grade
2 and 3 teams ride in advanced life supportambulances.Rescue911’s priority dispatch rule is always
to configure response with a team whose grade meets the emergency’s priority category rather than
exceeds it e.g. for a category 2emergency, dispatch operators should first try dispatch team with
grade 1, if none are available then try a grade 2team, if none available then only try a grade 3 team.
This is done to ensure that advanced and critical care response teams are reserved for the most
serious of emergency priorities.
9

Q. Can you please explain more about how the shifts work?
A. Response teams work on 1 of 3 shifts. There is a 12am to8am shift, and 8am to 4pm shift and a
4pm to 12am shift. When EMTs arrive for work, at their shift time, they need to “clock in”. Response
teams usually have three to four EMTs assigned. If a response team has only 1 team member that
has reported for duty on their allocated shift, then that response team cannot be dispatched to any
emergency scenes.
Q. It seems that some checks need to be performed when dispatching a team from a base station
such as yours to an emergency. Can you clarify?
A. Yes, the procedure from the control room’s point of view is to find from the nearest base station,
those response teams that are 1) on shift, 2) available for dispatch and 3) are qualified to handle an
emergency of the specified priority. But remember what I said earlier, our business rule is to
dispatch teams with just the right qualifications, so the operator must dispatch a team with the
lowest acceptable grade.
Q. Can you please go back to the concept of a shift so that I understand its implications for team
availability?
A. A response team begins and ends a shift in what we call an ‘invalid’ state. Once two or more
members of a response team have checked-in and reported for duty, the team then becomes
‘available’. These on-shift teams will change state from ‘available’ to ‘away’ multiple times in a single
shift. When a response team gets dispatched to a scene and acknowledges their acceptance of the
dispatch to the operator, their state changes to ‘away’. When the response team leaves a scene, the
state changes back to ‘available’. There is a further state called ‘double-dispatch’. If a team is in the
away state and asked to respond to an emergency by supervisor, their state will change from ‘away’
to ‘doubledispatch’ upon their acceptance of the supervisor’s order. Only control room supervisors
are able to double-dispatch teams in the away state.When an on-shift response team becomes
‘available’, at the beginning of a shift, they are assigned a shift grade equal to the value of their team
grade. However, in the case of team whose default is critical care (grade 3), that grade will only be
assigned when at least one critical care paramedic has reported for duty. If no members on duty are
critical care paramedics then the team will be assigned a shift grade of 2(advanced life support). Oh,
I must clarify! It is the shift grade rather than default team grade that should be used when
determining a team’s eligibility to respond to an emergency. Please remember that.
Q. OK, so when deciding on which teams to dispatch, the operator should decide based on the grade
assigned to an on shift team, which might be different to their default team grade.
A. Yes. You’ve got it.
Interview with Dr Warren Piece, Chief Medical Officer, to better understand emergency response
procedures
Q. Can you please explain what happens at an emergency scene?
10

A. With pleasure. Insurance companies and doctors treating patients often require Rescue911 to
provide a report on the qualifications of EMTs responding to an emergency call as well as the
specific details of emergency care provided to patients at the scene. This information together with
information on their average response times may also be requested by various national
accreditation bodies when reviewing Rescue911’s license to operate as an emergency
servicesprovider. Therefore, at the scene of an emergency, responding EMTs need to record
information on emergency care provided including details of procedures as well as medicines
administered. Patient vital signs (heart rate and blood pressure) also need to be recorded at the
time the EMT leaves the scene or hands the patient over to medical staff ate hospital. Details of the
hospital or clinic to which a patient was transported must also be recorded. Currently, we use field
notebooks to record all details about procedures and care given to patients. When we arrive or
leave an emergency scene, we always radio in to the operators at the call center to ensure that our
movements are recorded. By telling them we’re returning to base, they also know that we’re
available again to respond to other emergency calls.
Q. I’m beginning to get a good picture. As you probably know, in version 1 of ERIS, all data to be
recorded by EMTs will be done at the base station. So your field note books will still be necessary for
now, and you’d need to transcribe from those field note books to the ERIS system upon arrival back
at base.
A. Yes, we do understand. In fact I brought along a copy of the field note book to show you.
Q. But we are very excited about Version 2 of ERIS which will enhance the EPCR sub-system by
rolling out handheld devices that will replace the field note books. Is there anything else at this stage
that you would like to tell us?
A. I think we’re done. I’m hoping for a smooth implementation.
Interview with Mrs. Ima Cranky, Chief Executive Officer, to understand managerial reporting
requirements
Q. What types of reports does management need from the new ERIS?
A. The first thing that is very important to us, is that an exception report should be printed at the
end of each shift of all emergency responses that are not yet closed and the details of the
emergency calls to which they have been linked. The manager requesting this report is the call
center supervisor. He/she will follow up and radio response teams, if necessary, to determine the
situation before handing the call center over to the next supervisor. Another exception report is
needed by base station supervisors of zxfpatient care records not yet captured by the
respondingMesta scheduled report must be produced each week. There port will indicate for each
base station and for each shift, which EMTs had reported for duty. Our accountant will use this
report to prepare the weekly EMT paychecks. Our COO will need a weekly summary report of the
number of emergency responses attended to by each base station that week. This report allows us
to make important decisions about our capacity to handle emergencies in the differentlocations.
11

Medical aid and government regulation requires thatRescue911 is able to report on our emergency
responses. If necessary, on demand, our CMO will need to be able to produce a report on the details
of an emergency response, including: the time the call was logged, details of response configuration
dispatched from base stations, the response mode, the time of arrival on scene, the treatment given
to patients, the hospital to which they were transported, and the time, and by whom, the response
was finally closed on our side.
12