Narrative The following information is being provided as a final report of findings and recommendations of the
Advanced Life Support (ALS) Pilot Project. The data provided in this report covers a period
commencing June 18, 2004 and concluding on December 31, 2004. An interim report was produced and
published on November 23, 2004. This document is an extension of that information and provides a
total summary of data collected in table form. Also provided is a medical review of data and patient
Five ALS providers took part in the pilot project: Fitch-Rona EMS, Town of Madison Fire
Department/EMS, City of Madison Fire Department/EMS, City of Middleton EMS, and Sun Prairie
EMS. Sun Prairie EMS began providing paramedic service to their community as of August 9, 2004
and began participating in the pilot project on November 8, 2004 after meeting the requirements for
participation set forth by the Steering Subcommittee. This subcommittee consists of representatives of
Dane County EMS, Fire Fighter Union Local 311, the Public Safety Communications Center, and one
representative from each of the participating ALS providers.
A Memorandum of Understanding was developed by the participating agencies and signed by their
governing bodies. This document provided the guiding principles for the pilot. It specified that the
closest available municipal ALS ambulance would provide ALS care within Dane County. In addition,
BLS service providers would receive the closest available ALS ambulance on those calls determined by
the Medical Priority Dispatch System (MPDS) to be categorized under the currently adopted list of
automatic aid codes or when requested by a BLS provider.
The Medical Priority Dispatch System was fully implemented into the Public Safety Communications
Center on February 18, 2002. The system is intended to assess each 911 call medically to allow
allocation of the proper level and speed of EMS care while identifying pertinent safety and clinical
information for EMS responders. It also identifies certain life threatening conditions that require full
resource allocation while providing life saving instructions to callers. The first automatic dispatch of
ALS began on February 1, 2003 with the first dispatch of the closest ALS unit commenced on June 18,
An additional charge of the steering subcommittee was to study and submit recommendations for the
consolidation of medical direction and collaboration among all ALS providers. To that end, an ad hoc
subcommittee was formed to study the possibility of medical direction consolidation. The subcommittee
will explore potential ways in which this proposal might be accomplished. There are numerous positive
reasons in support of this consolidation initiative. The committee will continue to dialogue on this issue
with the understanding that resolution will take time.
The ALS Pilot Steering Subcommittee concept worked very well. It provided an avenue by which
participating providers could share concerns and request revisions. The subcommittee met monthly
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Data Collection
A Data Collection Subcommittee was formed. They were tasked to review and analyze data on a
biweekly basis. The committee had nine members with representation from each of the following
constituencies: Firefighters Union Local 311, Dane County BLS providers, Dane County EMS, the
Public Safety Communications Center, and a representative from each of the five participating ALS
The Data Collection Subcommittee has met numerous times during the pilot period. Since the
commencement of the pilot 533 calls for ALS service have been made. 187 of those calls were a result
of Automatic Aid or Closest ALS responses as determined by the Medical Priority Dispatch System, and
142 were manual requests for ALS by Basic Life Support services.
The following tables of information show a summary of all calls handled by the ALS providers outside of their primary response jurisdiction. Call Volume Summary for Responses Into Other EMS Districts By Each ALS Provider Participating ALS Agency Mutual Auto BLS Closest Specific Dispatch Total Number Aid Request Request Discrepancies Fitch-Rona EMS City of Madison FD/EMS City of Middleton EMS Sun Prairie EMS Town of Madison FD/EMS
The following definitions are provided for clarification:
Mutual Aid Request – No ambulances were available in the requesting jurisdiction ALS Intercept (Automatic Aid) – Simultaneous dispatch of an ALS unit with a BLS unit based
on the list of high-level Priority Dispatch codes
ALS Intercept (General Request from BLS Services) – Response with a BLS ambulance from
another jurisdiction after the BLS unit has requested ALS support
Closest ALS Unit – Responding ALS unit was closer than an ALS unit from the other Dispatch Discrepancies – Typically, situations where the incident took place near a
jurisdictional border and the official location was changed to reflect the proper
municipality after the ALS unit from the neighboring jurisdiction arrived on scene
Specific Request for ALS – Situations not covered by any of the above examples
Medical Priority Dispatch System – A standardized commercial training program for 911 call
takers with scripted questions and instructions which allows them to:
Consistently and accurately interrogate 911 callers to determine the exact problem and
Identify and provide instructions regarding on-scene safety items.
Allocate the proper level of EMS response and care.
Give medically sound post-dispatch instructions and life-saving pre-arrival instructions to
Provide accurate information to EMS responders.
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List of Predetermined Automatic Aid Codes and ALS Call Activity Code Description
Ineffective Breathing – Cardiac or respiratory arrest
Chest Pain – Severe respiratory distress
Heart Problem - Severe respiratory distress
Stabbing/Gun Shot – Unconscious or arrest
Interfacility Transfer - Suspected cardiac/respiratory arrest
Total Delta Code Description
Ineffective Breathing (Allergic Reaction)
Ineffective Breathing (Breathing Problems)
Cardiac or Respiratory Arrest (Not Breathing)
Cardiac or Respiratory Arrest (Breathing Uncertain)
Cardiac or Respiratory Arrest (Strangulation)
Cardiac or Respiratory Arrest (Suffocation)
Cardiac or Respiratory Arrest (Underwater)
Ineffective Breathing (Electrocution/Lightening)
Ineffective Breathing (Unconscious/Fainting)
Total Echo
Prior to the inception of the ALS Pilot Project, the above list of high priority call types was established
in which 911 dispatchers were to send the closest available ALS ambulance. This chart illustrates the
frequency that ALS ambulances were dispatched to each of the specific high priority call types. This
data can be used to evaluate the ways in which ALS resources are being used and if this list of codes
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Reasons For ALS Support and/or Mutual Aid Received by All Providers District Receiving ALS Services Specific Dispatch Request Discrepancy Total Belleville EMS Blooming Grove, Burke, Maple Bluff EMS Brooklyn EMS Cambridge Area EMS Cross Plains Area EMS Deer-Grove EMS De Forest FD/EMS District 1 EMS Fitch-Rona EMS City of Madison FD/EMS Marshall EMS McFarland EMS Middleton EMS Monona FD/EMS Mount Horeb FD/EMS New Glarus EMS Oregon Area FD/EMS Sauk Prairie EMS Shorewood Hills EMS Stoughton Area EMS Sun Prairie EMS Town of Madison FD/EMS Waunakee Area EMS
*Albany EMS
*Arena EMS
*Arlington EMS
*Barneveld EMS
*Blanchardville EMS
*Curtis Ambulance (Edgerton)
*Curtis Ambulance (Madison)
*Evansville EMS
*Heartline-Medix EMS (Columbus)
*Lake Mills EMS
*Lodi Area EMS
*Plain EMS
*Poynette-Dekorra EMS
*Ryan Brothers Ambulance
*Spring Green EMS
*Waterloo EMS
* Indicates an Out-of-County or Private EMS Provider. The definitions shown on page 2 should be used when reviewing this
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ALS Support and/or Mutual Aid Supplied by Each ALS Provider ALS Agency Providing Services District Receiving ALS Services Belleville EMS Blooming Grove, Burke, Maple Bluff EMS Brooklyn EMS Cambridge Area EMS Cross Plains Area EMS Deer-Grove EMS De Forest FD/EMS District 1 EMS Fitch-Rona EMS City of Madison FD/EMS Marshall EMS McFarland EMS Middleton EMS Monona FD/EMS Mount Horeb FD/EMS New Glarus EMS Oregon Area FD/EMS Sauk Prairie EMS Shorewood Hills EMS Stoughton Area EMS Sun Prairie EMS Town of Madison FD/EMS Waunakee Area EMS *Albany EMS *Arena EMS *Arlington EMS *Barneveld EMS *Blanchardville EMS *Curtis Ambulance (Edgerton) *Curtis Ambulance (Madison) *Evansville EMS *Heartline-Medix EMS (Columbus) *Lake Mills EMS *Lodi Area EMS *Plain EMS *Poynette-Dekorra EMS *Ryan Brothers Ambulance *Spring Green EMS *Waterloo EMS
This table illustrates the number of times that each of the participating ALS providers supplied ALS
support or mutual aid responses in support of another EMS district. As expected, this data reveals the
relationships and interactions between all EMS providers and helps to define the regiona
STUDENT NAME ________________________________________________________________ BIRTH DATE _____/_____/_________ I, the undersigned, being the parent, legal next-of-kin, or legal guardian of _____________________________________, hereby authorize any necessary medical treatment for this person while participating in any South-Doyle High School Band functions during the 2011-2012 school year. I also
The Way Forward in Package Insert User Tests Introduction: A significant increase in the ty to locate information, thus putting people off amount of text in package inserts has been ob- from reading the contents (P ≤ 0.021). served over the last years. This study investigat- Discussion: The results suggest that decreasing ed the consequences of this increase. Method: the amoun