It was reported this morning in the Cleveland Paper the Plain Dealer that Cleveland EMS will start rejecting minor calls for service unless the system is able to handle it. Writer Mark Puente reports:"This is a huge step for Cleveland," EMS Commissioner Ed Eckart said. "This is a step back from a long-standing culture in this city."
And indeed a long standing culture in America on whole. I have a call into the Commissioner to get more details on the nuts and bolts of this move as I would love to know how we all can enact this kind of common sense in our own EMS systems.
Now before everyone starts wringing their hands about what is going to happen, take the time to read through the comments on the story, many of which claim to be written by local responders.
As you start to write your comment about the referred ankle pain that could be presenting as a silent MI, keep in mind that as you transport that "maybe" call, the actual crushing chest pain that IS an MI is waiting longer for a transport. We need to stop worrying about what might be and focus on what is.
The issue of liability for reducing immediate response is countered by the liability of explaining to the family of a deceased person that their ambulance was delayed because of system abusers. We call it triage. No one thinks twice about ignoring minor injuries in an MCI, why is it suddenly an issue when that decision is moved into the control center? If we let the call taker take the calls and the triage system deems it non-emergent, then let it be non-emergent.
For so long we as an industry have striven for an 8 minute goal only to see the nation expect that 8 minutes for everything. Cleveland says no more. Cleveland. No offense to the system there, I'm learning more about it now, but if you went to a conference and asked which EMS system in the Nation is out ahead of the others, Cleveland is not in my top 3. Until now.
A Tip of the Helmet to Commissioner Eckart and the Cleveland EMS system for breaking free and doing the right thing. I hope to learn more about their research and system savings in the near future. I will most certainly pass that along if I can get it. Do you have a question you'd like me to ask the Commissioner? Post it below and I'll ask him.
Comments
I love the idea of triaging out the calls, however. We'll have to watch how it goes, see how the dispatchers' judgement call matches with the reality the medics find when they get there. Most horrible EMS abuse single call division I can recall: Man got tossed out of a local casino due to talking to the machines and acting weird--turns out he has history of schiz. Man taken to hospital near his home. Man makes total sense, oriented, not having AH or VH, gave the FF/EMS no trouble, etc. etc. Finally says out loud, "Well, I had to get home..." I took several deep breaths, and managed not to ruin the hospital ER's Press-Gainey score or cause injuries that would need the care of a trauma center. He left the ER ambulatory.
Hey, can we triage out the "ambulance=get out of jail free card" calls?
Wal-Mart greeter job. Triage is for mass caualty not the sick lonely old lady whose d-mn cats got tangled in her home O2 again. Be grateful you have a job in this economy and it's not boring as crap stuck on an assembly line or trapped in an office. Do any of you honestly want dispatchers triaging your family members over the phone?
It may take a year or two, but they will stop calling when we stop taking them at the drop of a hat. Keep up the good work and keep those medics honest!
The Europe model, which HM and his British bud have also discussed, has the advantage of putting experienced eyeballs on the patient and making the call about what the patient needs. That's quite a bit different from trying to judge it on the phone, even for a dispatcher who is paramedic trained. That would be the best way.
I respectfully disagree with the "job security" line. I've heard that a number of times, and I do not agree that allowing (and perhaps unknowingly encouraging) abuse helps any of us. Money is tight, and many public safety workers are under attack right now for their modest salaries and their still-intact retirement plans. We are seeing layoffs of police and fire in our area due to no money. So far, EMS has not been affected, but we have been threatened.
As our call volume increases, we aren't getting more trucks and paramedics, we're being forced to do more with the same money or with less. I'm not asking for a huge decrease in calls (and I don't think we'll see that anyway) but we should be active in trying to curb the abuse and at least stay where we are. I'm still a firm believer that spotlighting the abuses of EMS and creating a positive public education campaign would make inroads into some of the problems we face now.
Great discussion. I am watching the Cleveland EMS proposal closely. This will be interesting to follow.
I love the idea of triaging out the calls, however. We'll have to watch how it goes, see how the dispatchers' judgement call matches with the reality the medics find when they get there. Most horrible EMS abuse single call division I can recall: Man got tossed out of a local casino due to talking to the machines and acting weird--turns out he has history of schiz. Man taken to hospital near his home. Man makes total sense, oriented, not having AH or VH, gave the FF/EMS no trouble, etc. etc. Finally says out loud, "Well, I had to get home..." I took several deep breaths, and managed not to ruin the hospital ER's Press-Gainey score or cause injuries that would need the care of a trauma center. He left the ER ambulatory.
Hey, can we triage out the "ambulance=get out of jail free card" calls?
The issue of liability for reducing immediate response is countered by the liability of explaining to the family of a deceased person that their ambulance was delayed because of system abusers. We call it triage. No one thinks twice about ignoring minor injuries in an MCI, why is it suddenly an issue when that decision is moved into the control center? If we let the call taker take the calls and the triage system deems it non-emergent, then let it be non-emergent.
MCI triage and over the phone triage are vastly different things. When you are at an MCI, you are triaging the actual patient that you can look at, touch, and speak with versus over the phone triage where in my experience you are talking to the actual patient only approximately 30-50% of the time. I think that makes a really big difference when attempting to triage a call.
We need to stop worrying about what might be and focus on what is.
I completely agree with this although from a different perspective. I have tried to stress this to a number of dispatchers who would hold units "just in case", and when "just in case" never happened it only created a bigger backlog. I think simply placing low priority calls on hold is a mistake that will see unintended consequences of elongated wait times and the potential for a critical backlog that may very well be blamed for a lost life, whether justified or not. If you have the resources, I say use them for what they are intended for.
Somebody died, and now they don't do it anymore.
Let me know when to start the stopwatch on Cleveland.
(Not saying I hope it fails spectacularly. I just think it will.
Wal-Mart greeter job. Triage is for mass caualty not the sick lonely old lady whose d-mn cats got tangled in her home O2 again. Be grateful you have a job in this economy and it's not boring as crap stuck on an assembly line or trapped in an office. Do any of you honestly want dispatchers triaging your family members over the phone?
Although I have strong feelings on this issue, methinks it best to withhold my views and remain open-minded whilst you attempt to obtain further information. I look forward to your follow up with the Commissioner!
Right now I have to find a warm place for my tootsies.
It may take a year or two, but they will stop calling when we stop taking them at the drop of a hat. Keep up the good work and keep those medics honest!
The Europe model, which HM and his British bud have also discussed, has the advantage of putting experienced eyeballs on the patient and making the call about what the patient needs. That's quite a bit different from trying to judge it on the phone, even for a dispatcher who is paramedic trained. That would be the best way.
I am just a lonely 9-1-1 Dispatcher here, but I have a strong voice.
As Happy mentioned before 9-1-1 dispatcher are mandated to get the calls in the CAD within a certain time frame – every centre in different. In my centre I have 30 seconds to get a fire/medical call put into CAD in a per-alert status for Dispatch uses to dispatch the crews. In that 30 seconds I need to get a verifiable address, phone number, and chief complaint while still talking to the caller in a friendly, compassionate, and controlling manner.
Every time a call comes into a 9-1-1 centre the goal is to correctly triage the call based on what the caller has told us; sometimes the callers lie to use, but we have to assume the caller is giving us the correct information and not trying to abuse the system. I know there is abuse of the 9-1-1 system, and especially EMS.
Sometimes there are errors made when we are triaging the call for help, but with the correct training hopefully we are able to minimize those errors. The medical cards are designed so that non-medically trained personal are able to triage a call correctly – the cards use terms that anyone can understand.
Every centre is different, some centre use medically trained personal while other use non-medically trained to triage the calls. My centre uses primarily non-medically trained personal to triage calls, and we do this for many reason but because years ago we found that the medically trained personal were trying to diagnose the patient while on the phone with them . Now, I have been on the phone with the person who is calling about chest pain, who is alert, breathing normally, no cardiac hx, and no medication used in 12 hrs and triaged the call correctly, and while the medics were responding to the call the caller has gone into cardiac arrest. No one has control of what happens once the phone is hung up, so there is no one to blame.
I won̢۪t comment on the 9-1-1 Dispatchers who may have abandoned their posts, because I don̢۪t know all the facts. However they may lose their jobs, and be prosecuted to the full extent of the law.
--- How many Dispatcher does Cleveland plan to have on duty every day to handle calling back their pending Bravo, Alpha and Omega calls every 10 minutes? [I can tell you from personal experience that in my centre there is no way we would be able to call those pending calls back every 10 minuets - we are just too busy during the day.]
--- How long on average do their ambulance spend in hospital once they arrive at the hospital?
--- The article states Cleveland is decreasing their resources from 18 to 15 units. Will those 15 units be all ALS, or a combination of BLS and ALS units? Also, are those 15 units staffed 24/7 or is that 15 unit at the peak of the day? Will there be any peak unit coming on duty throughout the day to compliment and assist those 15 units?
That is all I have for now .... I may have more.
I like the basic idea of not dispatching lower priority calls when the city is busy. I would like to know more before I make my final decision.
I respectfully disagree with the "job security" line. I've heard that a number of times, and I do not agree that allowing (and perhaps unknowingly encouraging) abuse helps any of us. Money is tight, and many public safety workers are under attack right now for their modest salaries and their still-intact retirement plans. We are seeing layoffs of police and fire in our area due to no money. So far, EMS has not been affected, but we have been threatened.
As our call volume increases, we aren't getting more trucks and paramedics, we're being forced to do more with the same money or with less. I'm not asking for a huge decrease in calls (and I don't think we'll see that anyway) but we should be active in trying to curb the abuse and at least stay where we are. I'm still a firm believer that spotlighting the abuses of EMS and creating a positive public education campaign would make inroads into some of the problems we face now.
Great discussion. I am watching the Cleveland EMS proposal closely. This will be interesting to follow.
The issue of liability for reducing immediate response is countered by the liability of explaining to the family of a deceased person that their ambulance was delayed because of system abusers. We call it triage. No one thinks twice about ignoring minor injuries in an MCI, why is it suddenly an issue when that decision is moved into the control center? If we let the call taker take the calls and the triage system deems it non-emergent, then let it be non-emergent.
MCI triage and over the phone triage are vastly different things. When you are at an MCI, you are triaging the actual patient that you can look at, touch, and speak with versus over the phone triage where in my experience you are talking to the actual patient only approximately 30-50% of the time. I think that makes a really big difference when attempting to triage a call.
We need to stop worrying about what might be and focus on what is.
I completely agree with this although from a different perspective. I have tried to stress this to a number of dispatchers who would hold units "just in case", and when "just in case" never happened it only created a bigger backlog. I think simply placing low priority calls on hold is a mistake that will see unintended consequences of elongated wait times and the potential for a critical backlog that may very well be blamed for a lost life, whether justified or not. If you have the resources, I say use them for what they are intended for.
Somebody died, and now they don't do it anymore.
Let me know when to start the stopwatch on Cleveland.
(Not saying I hope it fails spectacularly. I just think it will.
Although I have strong feelings on this issue, methinks it best to withhold my views and remain open-minded whilst you attempt to obtain further information. I look forward to your follow up with the Commissioner!
Right now I have to find a warm place for my tootsies.
I am just a lonely 9-1-1 Dispatcher here, but I have a strong voice.
As Happy mentioned before 9-1-1 dispatcher are mandated to get the calls in the CAD within a certain time frame – every centre in different. In my centre I have 30 seconds to get a fire/medical call put into CAD in a per-alert status for Dispatch uses to dispatch the crews. In that 30 seconds I need to get a verifiable address, phone number, and chief complaint while still talking to the caller in a friendly, compassionate, and controlling manner.
Every time a call comes into a 9-1-1 centre the goal is to correctly triage the call based on what the caller has told us; sometimes the callers lie to use, but we have to assume the caller is giving us the correct information and not trying to abuse the system. I know there is abuse of the 9-1-1 system, and especially EMS.
Sometimes there are errors made when we are triaging the call for help, but with the correct training hopefully we are able to minimize those errors. The medical cards are designed so that non-medically trained personal are able to triage a call correctly – the cards use terms that anyone can understand.
Every centre is different, some centre use medically trained personal while other use non-medically trained to triage the calls. My centre uses primarily non-medically trained personal to triage calls, and we do this for many reason but because years ago we found that the medically trained personal were trying to diagnose the patient while on the phone with them . Now, I have been on the phone with the person who is calling about chest pain, who is alert, breathing normally, no cardiac hx, and no medication used in 12 hrs and triaged the call correctly, and while the medics were responding to the call the caller has gone into cardiac arrest. No one has control of what happens once the phone is hung up, so there is no one to blame.
I won̢۪t comment on the 9-1-1 Dispatchers who may have abandoned their posts, because I don̢۪t know all the facts. However they may lose their jobs, and be prosecuted to the full extent of the law.
--- How many Dispatcher does Cleveland plan to have on duty every day to handle calling back their pending Bravo, Alpha and Omega calls every 10 minutes? [I can tell you from personal experience that in my centre there is no way we would be able to call those pending calls back every 10 minuets - we are just too busy during the day.]
--- How long on average do their ambulance spend in hospital once they arrive at the hospital?
--- The article states Cleveland is decreasing their resources from 18 to 15 units. Will those 15 units be all ALS, or a combination of BLS and ALS units? Also, are those 15 units staffed 24/7 or is that 15 unit at the peak of the day? Will there be any peak unit coming on duty throughout the day to compliment and assist those 15 units?
That is all I have for now .... I may have more.
I like the basic idea of not dispatching lower priority calls when the city is busy. I would like to know more before I make my final decision.
Cleveland Police And Firefighters Laid Off
More than 100 Cleveland firefighters, patrolmen and EMS workers are on the unemployment line after layoffs took effect Monday.
http://www.fox8.com/news/wjw-layoffs-txt,0,1562...
This is a very bad circumstance under which to implement dispatch-level triage and expect success, as it indeed seems that it is being implemented for the wrong reasons, to compensate for a resource shortage instead of establishing intelligent resource management for the betterment of the taxpayers. Ugh.
"We need to stop worrying about what might be and focus on what is."
Perfect! Couldn't have said it better myself!
I am not in your system so I make general observations from my own rural experiences of being an hour from the nearest ER so abusers with 3 hour round trip times were standard.
But don't feel like the system is against you, you ARE the system. If you stand up for your patient by getting him the treatment or support he needs, instead of an automatic transport, he gets healthier and doesn't call anymore. Problem solved. It really is that easy.
In SF we had a person who specialized in Social Care who wandered the City looking for our regular 911 abusers and when we found them he came and put them into the system. It worked so well the folks who make money on all the homeless in SF got him shut down. now all our regulars are back on the streets and calling us day in and day out.
Watch for the premiere of Chronicles of EMS where one of our regulars gave permission to talk on camera about how she abuses 911 using our code words to get her ride across town coded as an ALS 6D3. In Cleveland she would still get a response, but we need to stand up and find solutions to our respective problems.
Remember, you ARE the system. We have the power to change things, and we will. Thanks for reading.
Cleveland Police And Firefighters Laid Off
More than 100 Cleveland firefighters, patrolmen and EMS workers are on the unemployment line after layoffs took effect Monday.
http://www.fox8.com/news/wjw-layoffs-txt,0,1562158.story
This is a very bad circumstance under which to implement dispatch-level triage and expect success, as it indeed seems that it is being implemented for the wrong reasons, to compensate for a resource shortage instead of establishing intelligent resource management for the betterment of the taxpayers. Ugh.
Hope is out there, believe me. Things will always seem to get better right before a new policy comes down the pipeline to ruin your day. That's just the way it is.
From what you have written on this message board, there is nothing they could fire you for, we don't know where you are, who you are or what days you worked, aside from your last comment about a "cluster" "last night.' Don't let them frighten you. Carry a copy of the HIPAA rules with you and if they press you, ask them to show you where in the laws you are wrong.
Supervisors HATE it when you also ask them specifics about protocols. Learn yours backwards and forwards, then follow them. If you do what is right, you'll never be wrong.
nothing in the laws says you can't get your patient help outside of the EMS system.
Hang in there.
"We need to stop worrying about what might be and focus on what is."
Perfect! Couldn't have said it better myself!
I am not in your system so I make general observations from my own rural experiences of being an hour from the nearest ER so abusers with 3 hour round trip times were standard.
But don't feel like the system is against you, you ARE the system. If you stand up for your patient by getting him the treatment or support he needs, instead of an automatic transport, he gets healthier and doesn't call anymore. Problem solved. It really is that easy.
In SF we had a person who specialized in Social Care who wandered the City looking for our regular 911 abusers and when we found them he came and put them into the system. It worked so well the folks who make money on all the homeless in SF got him shut down. now all our regulars are back on the streets and calling us day in and day out.
Watch for the premiere of Chronicles of EMS where one of our regulars gave permission to talk on camera about how she abuses 911 using our code words to get her ride across town coded as an ALS 6D3. In Cleveland she would still get a response, but we need to stand up and find solutions to our respective problems.
Remember, you ARE the system. We have the power to change things, and we will. Thanks for reading.
Hope is out there, believe me. Things will always seem to get better right before a new policy comes down the pipeline to ruin your day. That's just the way it is.
From what you have written on this message board, there is nothing they could fire you for, we don't know where you are, who you are or what days you worked, aside from your last comment about a "cluster" "last night.' Don't let them frighten you. Carry a copy of the HIPAA rules with you and if they press you, ask them to show you where in the laws you are wrong.
Supervisors HATE it when you also ask them specifics about protocols. Learn yours backwards and forwards, then follow them. If you do what is right, you'll never be wrong.
nothing in the laws says you can't get your patient help outside of the EMS system.
Hang in there.