Protocol Triage with AMPDS and NHS Pathways

Overview#

A call-taker runs a structured chief-complaint flow that determines dispatch priority deterministically, pre-flags time-critical conditions, and writes every step to the audit trail without manual transcription.

The Protocol Triage module guides PSAP medical call-taking through structured chief-complaint question cards drawn from the IAED Advanced Medical Priority Dispatch System (AMPDS / ProQA) v13.3 or NHS Pathways v23 logic. Each card produces a deterministic dispatch determinant code, for example 10D-04 for confirmed cardiac arrest, 28C-01 for stroke, or 09E for cardiac arrest, which then drives priority assignment, clinical pre-flagging, and the correct resource type at dispatch. AMPDS and NHS Pathways are proprietary protocols that each require a commercial licence from Priority Dispatch Corp and NHS Digital respectively; Argus supplies the protocol engine and tenant-configurable card scaffolding, while the licensed card content itself is procured separately by the operating agency.

Key Features#

• Deterministic Determinant Resolution: Each completed card produces a single dispatch determinant code that drives priority and resource type, removing call-taker ambiguity at the dispatch decision point.

• Agency-Configurable Card Library: Each agency can adapt question wording, local terminology, and bilingual prompts within the constraints of their licensed protocol, without touching shared platform logic.

• Time-Critical Pre-Flagging: STEMI, stroke, and cardiac arrest determinants automatically raise clinical alerts on the encounter the moment the determinant is resolved, no second step required.

• Full Q-and-A Audit Trail: Every question asked, every answer captured, and every branch taken is written to the timeline for clinical governance review and post-incident quality assurance.

• Dual-Protocol Support: A single engine runs either AMPDS chief-complaint cards or NHS Pathways v23 logic, letting multi-region deployments standardise on one platform.

• Event-Driven Step Emission: Every protocol step publishes a structured CloudEvents 1.0 event for downstream analytics, supervisor monitoring, and replay.

• FHIR Clinical Findings: At the end of triage the engine emits HL7 FHIR R4 Observation and Condition resources so clinical findings travel cleanly into the ePCR and the receiving hospital.

Use Cases#

Emergency Ambulance Services#

• Cardiac Arrest Recognition: A call-taker reaches the breathing-and-consciousness branch on the AMPDS chief-complaint card, the engine resolves a cardiac arrest determinant, and an arrest pre-flag is raised on the encounter immediately.

• Stroke Time-Critical Routing: A stroke determinant triggers a stroke pre-flag, allowing dispatch to send the nearest stroke-capable resource and pre-notify the receiving stroke unit simultaneously.

• STEMI Activation Pathway: A STEMI determinant pre-flags the encounter so the cath-lab activation pathway can be initiated in parallel with response, not after crew arrival.

Quality Assurance and Clinical Governance#

• Protocol Adherence Review: A QA reviewer can replay the exact sequence of questions and answers a call-taker followed, comparing protocol adherence against clinical outcome.

Multi-Region Deployments#

• NHS Pathways Region: A UK-aligned agency runs Pathways v23 logic instead of AMPDS while continuing to feed the same dispatcher console, ePCR, and hospital handoff workflows.

• PHECC-Aligned Services: Irish pre-hospital services link determinant outcomes directly to PHECC Clinical Practice Guidelines, giving crews protocol-aligned guidance from the moment of dispatch.

Integration#

The Protocol Triage module integrates with the broader platform through standard events and data contracts:

• Dispatcher Console and CAD: The resolved determinant is published to the active incident so the dispatcher sees the priority and resource recommendation without re-keying anything. CAD connectors conforming to NENA EIDO carry the determinant in the incident snapshot from the first message.

• Clinical Alerts: Determinants for time-critical conditions are translated into clinical alerts on the active encounter, surfacing critical context to the responding crew and the receiving facility at the same moment they appear on the dispatcher screen.

• ePCR Encounter: The chief complaint and triage outcome pre-populate the electronic patient care record so the responding crew does not start from a blank form at scene. FHIR R4 Observation and Condition resources carry clinical findings forward into the ePCR and onward hospital systems via the standard handoff payload.

• Scene Triage: PSAP protocol triage is distinct from on-scene mass-casualty triage (START / JumpSTART); both pathways feed the same encounter record without overlap, and the pre-hospital dataset export conforms to NEMSIS v3 for national reporting.

• Call-Taker Interface: The question-card flow is designed for progressive disclosure and keyboard-first navigation, minimising cognitive load during high-stress calls. Each card supports bilingual prompts for multilingual dispatch centres.

Open Standards#

• IAED AMPDS v13.3 (Medical Priority Dispatch System): Structured chief-complaint cards and determinant code vocabulary used for priority and resource-type selection; proprietary protocol, commercial licence required from Priority Dispatch Corp.

• NHS Pathways v23: Alternative triage logic licensed via NHS Digital for UK-aligned deployments; same licensing model as AMPDS, same engine underneath.

• PHECC Clinical Practice Guidelines (CPGs): Irish pre-hospital clinical guidelines linked to individual card outcomes, ensuring determinant-to-protocol alignment for PHECC-regulated services.

• NENA EIDO (NENA-STA-010.3): Emergency Incident Data Object standard used to carry determinant codes, incident priority, and clinical pre-flags in CAD connector payloads.

• APCO ANS 1.102.1: APCO incident type and call-taker QA standards referenced for dispatcher console integration and call quality measurement.

• NEMSIS v3: National EMS Information System data standard for pre-hospital care datasets; triage determinants and outcomes are mapped to NEMSIS v3 fields for national registry reporting.

• SNOMED CT (Dispatch refset): Coded chief complaints captured at triage so downstream clinical systems share a common vocabulary for clinical decision support and outcome analysis.

• ICD-10-AM / ICD-10: Outcome coding cross-reference for post-incident clinical reconciliation, reporting, and PHECC dataset submission.

• HL7 FHIR R4: Observation and Condition resources are emitted at end of triage for clinical findings, carrying triage outputs into the wider clinical record and hospital EHR systems.

• CloudEvents 1.0: Every protocol step and completion publishes a CloudEvents 1.0 envelope, enabling portable downstream consumption by analytics, supervisor monitoring, and replay tools.

• HTTPS / TLS: All determinant, clinical alert, and FHIR payload traffic is carried over standard secure web transport.

Security and Compliance#

All protocol session data is scoped to the operating agency's tenant and is never shared across tenants. The full question-and-answer audit trail is written in an append-only manner to support clinical governance obligations, regulatory inspection, and legal disclosure. Access to triage session data and determinant history is controlled through the platform's role-based access model.

FHIR payloads and clinical alert messages are encrypted in transit. PHECC dataset exports are pseudonymised before transmission, with patient identifiers replaced by non-reversible tokens as required by data protection obligations.

Last Reviewed: 2026-05-05 / Last Updated: 2026-05-05