In one of the opening scenes of the disliked NBC series TRAUMA, the medics responding are wearing their headsets and suddenly begin speaking to the 911 caller.
"Oh, yeah...right..." was my first response too.
But think about it. Imagine being finally able to put the caller in touch with someone other than the call taker. What if the Paramedic or EMT responding was able to apply their education and experience to decide how the system will react to this patient.
It might become more efficient.
The call is received, the unit assigned, then the caller transferred to the practitioner assigned to respond. They begin assembling facts that the little boxes of the priority dispatch and the untrained ears of the call taken can't identify.
"OK, so you have asthma, but this doesn't feel like an asthma attack, you just want some albuterol?" There is no code for that other than an asthma attack, but now we can downgrade the call and possibly save a life and time. Who's life? Not the caller's they're fine. But the responders now travelling with traffic reduces the risk of accident. The call that may come in with CPR in progress can be triaged ahead now that we have a more accurate idea of what's happening at the first call.
We've spent so much time designing systems to categorize, prioritize and automate dispatches we forgot to upgrade the callers and the call takers. Instead of staffing dispatch with practitioners, why not just let me talk to the patient you're about to hang up on anyway to meet your target time.
I can begin to establish if that little code even matches what's going on, gage my response based on what the caller is telling me and save time in patient care for being ready for exactly what's going on.
OR
We could ditch the codes and just dispatch based on their chief complaint.
"Oh, yeah...right..." was my first response too.
But think about it. Imagine being finally able to put the caller in touch with someone other than the call taker. What if the Paramedic or EMT responding was able to apply their education and experience to decide how the system will react to this patient.
It might become more efficient.
The call is received, the unit assigned, then the caller transferred to the practitioner assigned to respond. They begin assembling facts that the little boxes of the priority dispatch and the untrained ears of the call taken can't identify.
"OK, so you have asthma, but this doesn't feel like an asthma attack, you just want some albuterol?" There is no code for that other than an asthma attack, but now we can downgrade the call and possibly save a life and time. Who's life? Not the caller's they're fine. But the responders now travelling with traffic reduces the risk of accident. The call that may come in with CPR in progress can be triaged ahead now that we have a more accurate idea of what's happening at the first call.
We've spent so much time designing systems to categorize, prioritize and automate dispatches we forgot to upgrade the callers and the call takers. Instead of staffing dispatch with practitioners, why not just let me talk to the patient you're about to hang up on anyway to meet your target time.
I can begin to establish if that little code even matches what's going on, gage my response based on what the caller is telling me and save time in patient care for being ready for exactly what's going on.
OR
We could ditch the codes and just dispatch based on their chief complaint.
Comments
I kind of want to be a fly on the wall when you get a caller transfered to you in the abulance and you cell phone cuts out or their phone cuts outs. How about the panicky freaking out person who hangs up repeatedly and just says "send ems" every time you call them back ... oh yeah how are you going to call them back on your cell phone? Sure read the phone number on your little MDT - what you don't have a MDT, how horrible. Oh and lets not even throw in that fact the calls may or may not be recorded for legal purposes.
I am going to shut my mouth now, because you have hurt my one feeling I was issues when I becuase a dispatcher 10 yrs ago. ;(
Then the call takers can go about coding calls in 90 seconds, right or wrong and maintaining their numbers. Then I get on scene to a no merit call that came in as a code 3 diabetic emergency because teh caller made it sound like one and card 41 (This is total BS) isn't finished yet.
I have heard medics talk to callers and it wasn't a pretty site. I was told many years ago that medics make poor call takers because they are always trying to diagnose the patient, when their job is treat the patient's condition in the emergency. Medics don't like the cards, and I know that. Medics like to B(itch) M(oan) & C(omplain) - I am half expecting to hear them complaining about the sun/moon being too bright one day and expect Dispatch to do something about it; they complain because they can.
It sounds to me you have to change the culture in your dispatch centre - it very hard, but can be done. Maybe you need to start looking at industry standards, other centre that are equivalent size to your, and adjust your training methods.
In older days at an old dept we had a call taker who knew zero about EMS and simply dispatched the calls based on what the person told them. we got sent on arm pain, eye trouble and even itchy legs and based our response accordingly because there was no filter, no categorization, no opinions added. And each and every call was exactly what we were told. But was the patient better off? Maybe not. Maybe so.
There certainly needs to be a better relationship between the voices and the knuckle draggers. Would you consider coming on the Crossover Podcast (anonymously or as your real self) to open a dialogue to share with others?
Thanks for reading, HM.
Second, most FD's dispatch everything C3.
Third, other than a general idea of what I'm responding to really dosent help me do my job. I'm still going to approach each incident safely, and determin for myself what is wrong with the patient.
Might as well scrap the whole EMS card
Dispatch system. Not really designed to help patients just reduce how many units driving C3
My 2 cents
Fast forward to me as a Paramedic on the street, EMD centers make everything out to be an emergency and cause me to run lights and sirens to almost all calls when it is rarely needed. Send me to the right address because I will just take all my equipment in to the house because the voice on the other end of the radio is rarely correct to the problem, BECAUSE OF THE EMD. Most calls I am sent on quietly are true emergencies and most calls I am sent on emergently are nothing.
I will give to you the fact that your information is only as good as the caller. I learned that and it did not matter who I was dispatching for. PD calls get one side of the story and when the hysterical female calls and says her significant other is beating her everyone gets sent to find out it happened last night 12 hours ago. She should have gotten a ride into the station to fill out a report. EMS is no different when you go beyond the general question of what is wrong.
I currently have an EMS dispatcher that spends more time looking at the map and making sure I have cross streets than giving me needless medical information. He gets me to the right place so I can assess and find out what the problem is. I could care less that they have had a MI in the past because when you tell me chest pain it is a STEMI until proven otherwise anyways. More information given over the radio is just another distraction to driving.
As far as Medics complaining...You should here the newer police officers complain...
You are right about everything fitting into a check box in MPDS and its tendency to over-code things, but I disagree with your assertion of an "untrained ear". I have been a dispatcher for 12 years and I know just as well as you do what is legit and what is BS based on what the caller says (and what I can hear). We are just as bound as you are by protocols and standards. Just as you know in the field, I know that the callers/patients know just how to game the system and what to say to get what they want. It's a systemic problem in dispatch just as much as it is in the field. I'd love to see a "dispatch 2.0" in parallel with what you are trying to accomplish with EMS 2.0.
With that said, remember that you are trained to provide treatment based on what you can see, feel, smell, etc. and to provide care with your hands. The dispatch side is designed to provide care with only ears and what the caller can verbally identify, and to walk an untrained caller through care until you get there to take over.
~Goose