We have been using AMPDS for for about 10 years in Melbourne AUST. Have experienced similar issues with despatch to jobs. We are able to have jobs refered to a Clinical Support Officer (senior intensive care paramedic) at the dispath centre who can upgrade or downgrade a job. This decision may be based on the available information or the CSO may talk to the requester We also reserve the right for crews to upgrade to a Signal 1 ( lights and bells ) if they believe the case warrants such a response. However, this option is not exercised often. We are unable to change the AMPDS questioning as it a propriety program but we can change "the Grid" , which determines the ambulance response, ie Chest Pain SOB and changing colour, will recieve a response an Ambulance Paramedic crew and a MICA crew both on a sig 1, whereas Chest Pain , no SOB, will get a AP crew or a MICA crew travelling sig 1 with backup (if available) on a sig 2 (normal aapproach). The grid is reviewed approx 3 times a year, with additional reviews occuring when any particular issue arises Initially the establishment of AMPDS through an outside contractor was a painful experience, but it has improved dramatically.