I can only assume everyone played this game as a kid, but as rescuers, we play it everyday.
For those not familiar, you and your friends sit in a circle and one person whispers a sentence to the person to their right and so on and so on. The gist of the game is to see how much the sentence changes from person to person either by forgetting the exact words, or rewording it for whatever reason.
Funny thing is, I get to see each step of the game as it goes. This was brought to mind one morning when I got another one of my blog starting runs when I asked, "You called 911...for this?"
The game started when the client (See Glossary of Terms) had a sore throat and went to the doctor yesterday. Our story should end there, but this is managed care, so of course there is more.
This morning, 10 hours after starting the course of antibiotics, our citizen phones the expensive private health care nursing advice line. According to her, she told the nurse, "My throat still hurts, can I use a throat spray to eat? It hurts to swallow."
The nurse told her to "...hang up, call 911 and tell them you need an ambulance."
Our client calls 911 and, in clear words, tells the call taker she needs an ambulance for a sore throat.
Call taker follows instructions coding the call as a 26A25, Non-emergent sore throat. It worries me the 911 system even recognizes this, but...
The dispatcher changed the call to a 11D2, choking with difficulty breathing.
The notes on the MDT state she is unable to swallow.
As we arrive code 3 as instructed, we are met by a young woman with a diagnosed and medicated case of strep throat.
"Did you call your doctor today?" I ask after checking all vitals without disturbing findings.
"No, the office said he was too busy, they had me call the nurse line." She hands me the card.
"What did the nurse say?" I can't wait to hear this.
"To call 911 for an ambulance." She says with a small laugh.
After a small conversation I discovered she didn't feel different, just wanted advice on a throat spray so she could have breakfast. Her throat hurt, but no more than yesterday.
We went full circle in the telephone game this time, where the sentence was the same at the beginning and end, but it was all the junk in the middle that got messed up.
Maybe folks should be able to call us directly in the ambulance for advice since the dial-a-nurse seems to default to us most of the time anyways.
For those not familiar, you and your friends sit in a circle and one person whispers a sentence to the person to their right and so on and so on. The gist of the game is to see how much the sentence changes from person to person either by forgetting the exact words, or rewording it for whatever reason.
Funny thing is, I get to see each step of the game as it goes. This was brought to mind one morning when I got another one of my blog starting runs when I asked, "You called 911...for this?"
The game started when the client (See Glossary of Terms) had a sore throat and went to the doctor yesterday. Our story should end there, but this is managed care, so of course there is more.
This morning, 10 hours after starting the course of antibiotics, our citizen phones the expensive private health care nursing advice line. According to her, she told the nurse, "My throat still hurts, can I use a throat spray to eat? It hurts to swallow."
The nurse told her to "...hang up, call 911 and tell them you need an ambulance."
Our client calls 911 and, in clear words, tells the call taker she needs an ambulance for a sore throat.
Call taker follows instructions coding the call as a 26A25, Non-emergent sore throat. It worries me the 911 system even recognizes this, but...
The dispatcher changed the call to a 11D2, choking with difficulty breathing.
The notes on the MDT state she is unable to swallow.
As we arrive code 3 as instructed, we are met by a young woman with a diagnosed and medicated case of strep throat.
"Did you call your doctor today?" I ask after checking all vitals without disturbing findings.
"No, the office said he was too busy, they had me call the nurse line." She hands me the card.
"What did the nurse say?" I can't wait to hear this.
"To call 911 for an ambulance." She says with a small laugh.
After a small conversation I discovered she didn't feel different, just wanted advice on a throat spray so she could have breakfast. Her throat hurt, but no more than yesterday.
We went full circle in the telephone game this time, where the sentence was the same at the beginning and end, but it was all the junk in the middle that got messed up.
Maybe folks should be able to call us directly in the ambulance for advice since the dial-a-nurse seems to default to us most of the time anyways.
Comments
EMS is constantly becoming the stop gap for many situations like this. We NEED a way to meet this need without responding with undue haste to a situation that could be solved by having a simple conversation, with all the facts in hand, about the right throat spray to use to make it easier to swallow food. The healthcare system FAILED this person miserably!!
It seems that we have taken the ability to think out of the hands of people that should be doing some thinking. There is legalistic thinking that is rigidly contained inside the box and then there is the ability to take the facts...all of the facts...and making a decision or initiating a response that is truly appropriate for the situation.
Ryan, we don't need a way to meet this need, we need a way to stop doctors, nurses, and other so called health care professionals from dumping their problems and lack of resources on us. Civil or criminal penalties would be my solution, but I also know that the politicians won't do that.
You and I both know why this non emergent call got bumped up, the magical time target was likely approaching and to keep he bar graph from changing colors this week, it was upgraded and "flushed" out of the call center with a "successful" call to dispatch time.
If the pt was having trouble breathing it should have been determined earlier in the call interrogation, and coded as an 06C or 26C - card 11 should only be used for CHOKING calls, that is why it is called the CHOKING card, not the 'I have a sore throat, and can't swallow without it hurts' card.
(Okay, I sound a little b!tchy here, but this is the prime reason why EMS responding crews dislike Dispatch and think we do a horrible job.)
EMS is constantly becoming the stop gap for many situations like this. We NEED a way to meet this need without responding with undue haste to a situation that could be solved by having a simple conversation, with all the facts in hand, about the right throat spray to use to make it easier to swallow food. The healthcare system FAILED this person miserably!!
It seems that we have taken the ability to think out of the hands of people that should be doing some thinking. There is legalistic thinking that is rigidly contained inside the box and then there is the ability to take the facts...all of the facts...and making a decision or initiating a response that is truly appropriate for the situation.
Don't be too hard on telephone nurses. They are trying to make a decision based on limited and possibly corrupted data.
Ryan, we don't need a way to meet this need, we need a way to stop doctors, nurses, and other so called health care professionals from dumping their problems and lack of resources on us. Civil or criminal penalties would be my solution, but I also know that the politicians won't do that.
You and I both know why this non emergent call got bumped up, the magical time target was likely approaching and to keep he bar graph from changing colors this week, it was upgraded and "flushed" out of the call center with a "successful" call to dispatch time.
If the pt was having trouble breathing it should have been determined earlier in the call interrogation, and coded as an 06C or 26C - card 11 should only be used for CHOKING calls, that is why it is called the CHOKING card, not the 'I have a sore throat, and can't swallow without it hurts' card.
(Okay, I sound a little b!tchy here, but this is the prime reason why EMS responding crews dislike Dispatch and think we do a horrible job.)
Don't be too hard on telephone nurses. They are trying to make a decision based on limited and possibly corrupted data.