Pre-arrival pt. contact

[PatrickW]

What else do you do on your trip out? Me, I am usually thinking about the senario ahead, lookin at my protocols if it is something I haven't dealt with in a while. Watching for traffic, navigating, operating the radio....

How would it be more useful, I don't understand. There is nothing relevant a caller tells me I won't tell you. If you want your dispatchers to tell you they are talking to a 78 year old woman on the phone who just didnt know what to do so she called you. Ask your dispatcher that.

Do you want me to relay to you every minute detail in the call? Do you want me to tell you all 50 medications he is on and all 45 times he was in the hospital the last 20 years; using air time that could be needed for you or any other unit to call for help, or do you want me to filter out what is appropriate to this paticular call. If he is bleeding profusely from a cut to the arm, do you want to know all 15 medications he is on, or does it just matter he is on blood thinners? Think about it. It is a waste of resources. If you have a problem with dispatchers, ask to pull tapes and sit down with your supervisor and ask to do a QA with them. Don't ask to do their jobs for them.

Oh, dear lord.

I don't know how I can say this more clearly. I'm not asking to try to do dispatch's job. I don't want dispatch to tell me every minute detail they get. Hell, one of the benefits to being able to listen to the 911 call on the computer en route would be so you DIDN'T have to tie up radio traffic with every single detail from the call. Apparently your system divulges more info to the crews than ours does, because our dispatchers don't tell us if a patient who is bleeding is on blood thinners. It changes the priority in their dispatch protocols, but we don't get that information. That would be one way listening to the calls can be beneficial.

Of course I'm thinking and doing the same things you are on the way to a call. But I don't see how you can argue that listening to the 911 call to the call you are headed to is not helpful in preparing you for the call, just like looking at your protocols is.

It would just be an added resource. More information at our disposal. It's not a bad thing, no one is trying to take anyone else's job, it is just potentially useful info.

If nothing else, it would allow us the hear how much misinformation dispatch gets told on a day to day basis, right?

[brentoli]

Apparently your system divulges more info to the crews than ours does, because our dispatchers don't tell us if a patient who is bleeding is on blood thinners. It changes the priority in their dispatch protocols, but we don't get that information. That would be one way listening to the calls can be beneficial.

This is where you have to get involved. You need to step up to the plate, and make documentation of what your dispatch has screwed up on or not told you. Pull tapes, copy run narratives, show where it has or potentially could have harmed patient care. Show it to your supervisors. Make sure it gets passed on.

What do you want more, a better dispatch center, or another toy you can use to wreck the ambulance responding emergent to pick grandma off the potty.

[unknown]

The last thing I want from a ground unit running L&S in route to a scene is for the crew to be paying attention to whats coming over a computer in the line of a 911 call-- When instead they should be concentrating on traffic and radio calls.....SAFETY first. You can't possibley tell me you can successfully glean anything more from listening on your own while paying attention to the Radio and the cars/traffic around you; nothing more than your dispatch can provide!

[PatrickW]

This is where you have to get involved. You need to step up to the plate, and make documentation of what your dispatch has screwed up on or not told you. Pull tapes, copy run narratives, show where it has or potentially could have harmed patient care. Show it to your supervisors. Make sure it gets passed on.

What do you want more, a better dispatch center, or another toy you can use to wreck the ambulance responding emergent to pick grandma off the potty.

I guess I don't really feel like I have a right to complain about not getting every bit of info from dispatch for a few reasons.

1: I don't want to be "telling dispatch how to do their jobs".

B: I've been on ride-alongs in neighboring counties, and the only info they get is age, whether the pt is conscious and alert, whether they are breathing "ok", and the address. What we have is far better than that.

3: I'm very new to EMS.

The last thing I want from a ground unit running L&S in route to a scene is for the crew to be paying attention to whats coming over a computer in the line of a 911 call-- When instead they should be concentrating on traffic and radio calls.....SAFETY first. You can't possibley tell me you can successfully glean anything more from listening on your own while paying attention to the Radio and the cars/traffic around you; nothing more than your dispatch can provide!

I guess we should take away GPSs and radio/stereos too, then.

One of the best parts about being able to listen instead of actually being on the line is that you don't have to be paying 100% attention. No one is counting on you to respond to everything they say. It's just another tool.

And as I said in my first post in this thread, it could be just the passenger that listens. I'm pretty sure I'm qualified to look to my right at intersections and say "clear" while listening to something else. At least in my area, navigation isn't really an issue.

[brentoli]

One of the best parts about being able to listen instead of actually being on the line is that you don't have to be paying 100% attention. No one is counting on you to respond to everything they say. It's just another tool.

So then you only hear half of what they say, not knowing you missed something, and then blame dispatch for their screw up, even though it wasnt theirs to begin with, and even possibly harming the paitent because you are convinced on what you thought they said.

[PatrickW]

So then you only hear half of what they say, not knowing you missed something, and then blame dispatch for their screw up, even though it wasnt theirs to begin with, and even possibly harming the paitent because you are convinced on what you thought they said.

Right, because the fact that someone could improperly use a tool causing a minor inconvenience is a good reason to withhold it.

I really can't think of an example of how you could mishear a 911 call causing poor pt care that would be any more likely than mishearing dispatch info. At least if you got to listen to the 911 call you would probably catch your mistake if you do mishear dispatch. But I think that's such an improbability that it doesn't really need to be worried about. We wouldn't be relying on the 911 call 100% either, it is just an extra tool. More info. It would be a good thing. We'd still listen to dispatch. Nothing would change except for a little extra info at our disposal.

[unknown]

I guess I don't really feel like I have a right to complain about not getting every bit of info from dispatch for a few reasons.

1: I don't want to be "telling dispatch how to do their jobs". BINGO!

B: I've been on ride-alongs in neighboring counties, and the only info they get is age, whether the pt is conscious and alert, whether they are breathing "ok", and the address. What we have is far better than that. COUNT YOUR BLESSING!!!

3: I'm very new to EMS. DING DING DING Give the Boy a Cookie--By George I think He's finally GOT it!

[Richard B the EMT]

I was a call-taker for the pre-merger NYC EMS from 1985 to 1996, so let me take you through a call to the 9-1-1 system in NYC from back then.

The caller calls 9-1-1, and is connected to an "Automatic Call Distribution" operator at 1 Police Plaza's communications office. On recognizing that it is a request for EMS, the ACD puts the call down a trunk line to the EMS Communications Bureau, Maspeth, where the next available operator gets the call.

(This is 1985 to 1996 for me, the information style and protocols used probably had changed by now in 2007. The ACD is an NYPD civilian communications technician, and the Call Receiving Operator at EMS is either a Uniformed Member of the EMS EMT or Paramedic)

CRO- "EMS 8643"

ACD- "ACD 1234, going to Queens, 8643. Caller on"

CRO- "This is EMS, caller, is the patient breathing?"

Caller- "Uh, donno."

CRO- "Is the patient awake?"

Caller- "No idea"

CRO-" What is going on needs an ambulance?"

Caller- "I was asked to call. There's a car accident on the Eastbound LIE (Long Island Expressway) at the 108th Street Exit."

ACD- "Sending."

At this time, the ACD sends a "linking" to CRO 8643s computer screen, 8643 taps the keyboard key to put the ACDs information into the mask, clicks another to have the computer verify the address as existing, while still talking with the caller.

CRO- "Please confirm, that's LIE at 108th, for the car accident?"

Caller- "Yes."

CRO- "If you can, let somebody at the scene know not to move anybody out of the vehicles, unless they are in imminent danger. We'll be there as soon as possible."

While talking, 8643 entered the call type into the Computer Assisted Dispatch (CAD) system, as an MVAInj, and the CAD sends the call to the Queens West dispatcher. The dispatcher might have already alerted the nearest ambulance, which would be on the way to the LIE at 108, before the caller, CRO, and ACD hang up the phones.

For space, continued next posting.

[Richard B the EMT]

Now, let's do a medical call.

CRO- "EMS 8643."

ACD- "8643, this is 1234, and we're going to Queens. Caller is on".

CRO- "Hello, Caller. This is EMS. Is the person you're calling about breathing?"

Caller- "I don't think so"

CRO- "Is the caller awake?"

Caller- "No"

ACD- "Sending" (as mentioned in previous posting)

CRO- "This is at the train station at Beach 116 Street?"

Caller- "Yeah."

CRO- "The phone there is 718-555-9999?"

Caller- "Yes"

ACD- "I have some first aid instructions for you to do until the ambulance gets there"

The caller hangs up. The CRO routes the call into the CAD system as a call type "ARREST", which will place it as a priority one on the dispatcher's screen for dual ALS/BLS response. The CRO then sends the job through the CAD to the Screening Nurse, asking for a callback. The Screening nurse, an RN, calls the number back, tries to get more information, and give instructions.

If the responding crew(s) cannot locate the patient, they will ask the dispatcher to call back the number, making sure they are at the correct location, or get an apartment number in a multiple dwelling.

Sometimes, if a CRO felt the caller was hiding something, or holding information back, they would have the Nurse call back, again, for more information. CROs had no authority to cancel calls, except when a subsequent call stated the patient had left the scene by alternate means, but the RNs did.

We usually operated with 18 CROs on the phone lines, another one on the "Relay position" for jobs sent by the NYPD without callers on line, like a Cop putting "over the air", a request for "a bus" to respond, or one where the caller told the ACD the basic information and hung up before the ACD could connect with the CROs.

After the merger, the FDNY did away with the positions of "Screening Nurses". Sometimes, some of us long-timers miss that.

In my posting, I used the CRO number of 8643. Yes, that was my number, and has been reassigned a couple of times after I was reassigned street-side in the fall of 1996.

[MSDeltaFlt]

I can see where both sides are coming from on this thread. I work fulltime with incognitogirl, and feel safe hearing her voice on the other end of the radio. If there is not much info, it's not because she isn't trying. The CIA calls her for help on interrogation techniques. She can get blood from a rock.

I used to think the same as the original poster when I first started in EMS. I work part time on a rural ground service in a very impoverished area of the country. 60,000+ city, majority of it is hood with few street signs or house numbers, very bad streets, over worked and under staffed PD, you get the picture. EMS also runs >1000 calls/mo in this county. That's when I started to really learn things.

Dispatchers are very trained in what they do. They are a very integral part of the EMS system. They get more information than you will ever realize. Let's just say they didn't. Let's just say, for the sake of arguement, that all they gave you was the location. There isn't a call out there that you shouldn't be able to handle. I've been called for "sweating". They were dead. I've been called to a dead person. Got a refusal on them. It happens. We've all had calls like these. Dispatched for a vaginal itching. Met us on the side of the road doing the PEE PEE dance. Late 3rd trimester OB constipated >1mo. A naked Schyzophrenic 8 yo - WTF?!?!?! But you handle it. Just like every other call, with or without information, you just handle it.

A true patient advocate can.

Skids up