Emergency Medical Dispatch Protocols: MPDS, Codes, Training

Emergency medical dispatch (EMD) protocols are standardized, scripted pathways that guide 911 call-takers through high-stakes medical calls from the first question to the last instruction. The Medical Priority Dispatch System (MPDS) is the most widely adopted framework: it structures case entry, chief-complaint selection, key questions, determinant codes (Alpha–Echo), a matching dispatch response, and pre-arrival instructions such as CPR and bleeding control—delivering consistent, evidence-based care while responders are on the way.

This article gives you a practical, authoritative tour of EMD protocols. You’ll learn the building blocks of call processing, how MPDS determinant codes work (with examples like 9-E-1), and the scope of dispatcher-directed instructions for cardiac arrest, hemorrhage, choking, and childbirth. We’ll cover diagnostic tools and high-risk scenarios (stroke, active assailant, drowning, overdose), the Medical Transfer Protocol Suite for interfacility moves, how to obtain and maintain protocols (guidecards vs. ProQA), training and CDE, QA and ACE accreditation, documentation and defensibility, integrations with CAD/EHR and automation, plus an implementation roadmap and FAQs to help you operationalize best practices.

The building blocks of EMD call processing

Emergency medical dispatch protocols translate chaos into a consistent, defensible workflow. In MPDS, every call runs through a scripted algorithm that applies the same questions, safety cues, and dispatch priorities from start to finish. Calls begin with a standardized entry, route into one of 36 chief-complaint protocols, and conclude with instructions and closure while responders are en route—augmented by diagnostic tools where appropriate.

• Case Entry: The universal start point that initiates the structured pathway for all calls.
• Chief Complaint Selection: Routes the call into one of MPDS’s 36 protocols.
• Key Questions: Structured interrogation tailored to the complaint.
• Determinant Assignment: Produces a priority code that aligns with the response plan.
• Pre-Arrival Instructions (PAIs): Evidence-based guidance (e.g., dispatcher-directed CPR, bleeding control, choking, childbirth).
• Diagnostic Tools: Targeted aids such as the Stroke Diagnostic Tool.
• Case Exit: Safe wrap-up and ongoing monitoring until responders arrive.

MPDS determinant codes explained (Alpha–Echo, examples like 9-E-1)

MPDS converts a caller’s answers into a determinant code that ties assessment to the right response. Each code has three parts: the protocol number (chief complaint), the determinant level (A–E), and a sub-determinant digit describing the specific finding. For example, 9-E-1 reads as “Protocol 9, Echo level, sub-determinant 1”—a highest-urgency scenario defined by that protocol’s rules.

• Alpha (A): Lower-acuity situations suitable for a non-urgent response.
• Bravo (B): Moderate priority conditions with some time sensitivity.
• Charlie (C): Potentially life-threatening; prompt response is indicated.
• Delta (D): Life-threatening emergency requiring the highest standard response.
• Echo (E): The most time-critical level used in specific protocols for immediate action.

Determinants are produced by structured key questions and validated diagnostic tools, then mapped to local response plans (who goes, how fast, and in what mode). This keeps dispatch consistent across hundreds of call types while enabling pre-arrival instructions to start immediately and continue as the situation evolves.

Life-saving instructions: dispatcher-directed CPR, bleeding control, choking, childbirth

Pre-arrival instructions are the heartbeat of emergency medical dispatch protocols—actionable, word-for-word steps that turn callers into immediate helpers while units are en route. MPDS standardizes these instructions so call-takers can move fast, stay calm, and deliver evidence-based care that buys critical minutes in high-threat conditions.

• Dispatcher-directed CPR: Scripted recognition and compressions with AED prompts, ensuring resuscitation begins immediately and continues safely until responders arrive.
• Bleeding control: Stepwise hemorrhage control—including direct pressure, wound packing, and the dispatcher-instructed tourniquet protocol, which research shows can reduce mortality in critically injured patients by up to 60%.
• Choking relief: Clear, age-appropriate sequences for conscious and unconscious patients, with transitions to CPR when indicated.
• Childbirth—Delivery: Comprehensive delivery support covering normal birth and complications; these protocols are so robust that even experienced providers seek guidance for difficult scenarios.

Diagnostic tools and high-risk scenarios in MPDS (stroke, active assailant, drowning, overdose)

MPDS pairs scripted questioning with targeted diagnostic tools to surface time‑critical conditions and manage complex threats. These emergency medical dispatch protocols help call-takers recognize strokes sooner, stabilize dangerous scenes, and deliver precise pre-arrival instructions for high-risk events like drowning and suspected overdose, all while aligning the case to a defensible determinant code and keeping callers and responders safe.

• Stroke: The MPDS Stroke Diagnostic Tool has been shown to identify more than twice as many strokes as medics on scene—accelerating recognition and response.
• Active Assailant: Purpose-built protocol feeds the most appropriate information to inbound officers and provides lifesaving instructions to citizens.
• Drowning: Structured assessment prioritizes airway/breathing status and scene safety, initiating critical guidance while units are en route.
• Overdose: Scripted pathways for suspected overdose/poisoning support swift risk identification, safety screening, and pre-arrival care until responders arrive.

The Medical Transfer Protocol Suite (MTPS) and interfacility transfers

Interfacility transfers demand coordination beyond lights-and-sirens. Within MPDS, the Medical Transfer Protocol Suite (MTPS) standardizes these calls so emergency medical dispatch protocols consistently match a patient’s condition to the right transport vehicle, equipment, personnel, and destination facility. By guiding call‑takers to ask the right questions and send the right team, MTPS streamlines the transfer process, shortens time-to-dispatch, and improves continuity between sending and receiving facilities—building confidence and trust with community providers while keeping responses rational, repeatable, and documented.

Getting protocols: guidecards vs ProQA software, updates, and versioning

Agencies can deploy emergency medical dispatch protocols either as physical/digital guidecards or via ProQA software. Guidecards are structured, scripted algorithms that mirror MPDS content—case entry, chief complaints, key questions, determinant logic, and pre‑arrival instructions. ProQA delivers the same standards in software, streamlining the call flow and determinant selection with on‑screen prompts and maintenance releases that apply protocol updates as they’re issued.

• Guidecards: Low-tech, resilient, excellent for training and continuity during outages.
• ProQA software: Dynamic logic and prompts that keep call-takers on path; updates delivered through scheduled maintenance releases.
• Updates and versioning: MPDS is continually updated; the current medical content release is v14.0.467 (9/12/2025) paired with a ProQA v5.1.1.53 maintenance release. Align local response plans, document update receipt, brief staff on changes, and verify QA uses the current version for scoring and review.

Training, certification, and continuing dispatch education (CDE)

People—not software—ultimately deliver the benefits of emergency medical dispatch protocols. Agencies typically adopt the International Academies of Emergency Dispatch (IAED) certification pathway for MPDS, validating call-taker competency in case entry, chief-complaint selection, determinant coding, pre‑arrival instructions (including dispatcher-directed CPR), and scene safety. Many jurisdictions also require recognized EMD certification and the use of standard protocols, reinforcing defensibility and consistency.

• Initial EMD certification: Formal IAED training on MPDS call processing, PAIs, legal/ethical practice, and version-aware use (guidecards and/or ProQA).
• Recertification & CDE: Ongoing Continuing Dispatch Education tied to protocol updates, with refreshers on high-risk, low-frequency events (e.g., stroke, childbirth).
• Update adoption: Document update receipts, brief staff on new MPDS releases, and align local response plans.
• DD‑CPR emphasis: Dedicated instruction ensures rapid identification and hands-on coaching quality.
• Instructor development: Train‑the‑trainer options support sustainable onboarding and scenario‑based drills.

Quality assurance, performance standards, and ACE accreditation

High-reliability EMD programs live or die by quality management. IAED performance standards and QA/QI practices verify that emergency medical dispatch protocols are followed exactly, that determinant coding is accurate, and that lifesaving instructions are delivered fast and clearly—every call, every shift. Structured case review, coaching, and data-driven improvement make protocol use consistent and defensible.

• Protocol compliance review: Adherence to Case Entry, correct Chief Complaint, Key Questions, determinant selection, PAIs, and Case Exit.
• Critical time intervals: Measure time-to-dispatch and time-to-critical instructions (e.g., CPR) to track system performance.
• Coaching quality: Evaluate dispatcher-directed CPR tone, pacing, and verification prompts.
• High-risk audits: Target stroke, childbirth, drowning, and active assailant cases for deeper review.
• Data-informed QI: Use analytics to spot trends and prioritize training and staffing adjustments.
• ACE accreditation: IAED’s Accredited Center of Excellence recognizes agencies that sustain protocol compliance, robust QA/QI, version control, and dispatcher certification—establishing an internationally recognized standard of care.

Keep QA tools and scoring aligned to the current MPDS and ProQA release to ensure fair reviews and reliable metrics.

Compliance, documentation, and legal defensibility

Legal defensibility in 911 hinges on disciplined compliance and documentation. Follow recognized emergency medical dispatch protocols (e.g., MPDS) as your adopted standard of care, keep version control tight, and prove that trained, certified EMDs executed scripts as designed. Your record should make the call reproducible: who decided what, when, and why—supported by timestamps, determinant logic, pre‑arrival instructions, and QA oversight aligned to IAED performance standards and any jurisdictional requirements.

• Adopt and version-control: Formal policy adopting MPDS; record current version and update receipts.
• Create a full audit trail: Timestamps, chief complaint, determinant code, and caller answers.
• Document PAIs and outcomes: Verbatim instructions delivered and what occurred (CPR, tourniquet).
• Capture justified deviations: Rationale plus supervisor review; retain audio and call artifacts.

Integrations and technology: CAD/EHR, analytics, and automated dispatching

Emergency medical dispatch protocols deliver greater value when connected to CAD, EHR, and analytics. Determinant codes, timestamps, and pre‑arrival instruction notes should flow automatically to dispatch, clinical, and billing systems, eliminating re‑entry and preserving an auditable record. Tight integrations also enable data‑driven unit recommendations, faster handoffs, and accurate documentation—while analytics surfaces bottlenecks, compliance gaps, and staffing needs. Layering automation on top allows systems to act on those insights in real time.

• CAD integration: Auto-create events, recommend units/mode, and update unit statuses.
• EHR/billing: Send determinants, narrative/PAIs, and signatures to prefill run sheets and handoffs.
• Analytics/BI: Dashboards for time‑to‑dispatch/CPR, determinant distribution, and protocol compliance.
• Automated dispatching: AI agents schedule/assign, negotiate rates, reroute, push updates, and trigger billing.
• Governance: Store MPDS version IDs and audit logs so QA and legal reviews align.

Implementation roadmap for agencies adopting EMD protocols

A disciplined rollout turns emergency medical dispatch protocols from paper policy into daily practice. Use this lean roadmap to stand up MPDS with clarity, accountability, and speed—so your team can code accurately, deliver lifesaving instructions confidently, and prove compliance on every call.

• Adopt policy and standard: Formally adopt MPDS; record current version and update receipts.
• Choose platform: Procure guidecards and/or ProQA; plan for resilience during outages.
• Map response plans: Align determinant codes to local unit types, modes, and notifications.
• Integrate systems: Connect CAD/EHR/billing; enable timestamps, determinants, and PAI narratives.
• Train and certify: IAED EMD certification with DD‑CPR emphasis; schedule recertification/CDE.
• Define QA/QI: Build reviews against IAED performance standards and critical time intervals.
• Prepare go‑live: Scenario drills, active assailant/stroke/childbirth simulations, supervisor coverage.
• Launch and monitor: Track determinant accuracy, time‑to‑dispatch/CPR, and coaching quality.
• Tighten governance: Enforce version control, document deviations, maintain complete audit trails.
• Elevate program: Pursue ACE accreditation to validate sustained compliance and outcomes.

Frequently asked questions about EMD protocols and codes

Here are quick answers to common questions agencies ask when adopting emergency medical dispatch protocols. Treat these as a primer and align final decisions with your local policy, MPDS release notes, and QA standards.

• What do Alpha–Echo letters mean? Priority tiers from lower-acuity (Alpha) to most time‑critical (Echo).
• What does 9‑E‑1 indicate? Protocol 9, Echo level, sub‑determinant 1—as defined within that protocol.
• Do I need software to use MPDS? No. Centers use guidecards or ProQA; both contain the same protocols.
• Who maintains MPDS? IAED maintains and updates MPDS; current medical release is v14.0.467 (9/12/2025).
• Is EMD training required? Many jurisdictions require recognized EMD certification with ongoing CDE/recertification.

Key takeaways

EMD protocols give call‑takers a reproducible, defensible path that turns chaotic moments into coordinated action. Paired with certification, QA, and current content, they speed recognition, deliver lifesaving instructions, and match the right response—while integrations create the data backbone for improvement and legal defensibility.

• Standardized workflow: Case Entry to Case Exit across 36 chief complaints.
• Determinant codes: Alpha–Echo tiers map assessment to response; e.g., 9‑E‑1.
• PAIs: DD‑CPR, bleeding control (tourniquets up to 60%), choking, childbirth.
• Diagnostics: Stroke Tool (>2× identification) and Active Assailant guidance.
• Governance: IAED certification/CDE, QA/ACE, version control (v14.0.467; ProQA v5.1.1.53).

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