Pre-arrival pt. contact

[unknown]

spenac -

Here is the answer to your question about seizures - Here in Dane County (WI) we use the National Academy of Emergency Dispatch, Medical Priority Dispatch System;

We ask EVERY caller the same CASE ENTRY QUESTIONS;

What is the address of the THE emergency?

What is the phone number you are calling from?

What's the problem, tell me what happened?

Are you with the patient now?

How old is he/she?

Is S/he conscious?

Is s/he breathing?

Then, depending on the answer to 'whats the problem...', the EMD will choose one of 34 CHIEF COMPLAINTS, in the case of a seizure I would go to CC 12 & ask the following;

1. Has s/he had more than 1 seizure in a row?

2. (female) Is she pregnant?

3. Is s/he a diabetic?

4. Does s/he have a history of heart problems?

5. Is s/he an epileptic or ever had a seizure before?

6. Has the jerking stopped yet? (You go check and tell me what you find?)

6A - If Yes - Is s/he breathing now?

6B - Is s/he breathing regularly?

Now, depending on the answers to these questions this call would be coded somewhere between;

DELTA -

1 - NOT breathing

2 - continuous or mulitple seizures

3 - irregular breathing

4 - breathing regularly NOT verified pt is >35YO

CHARLIE -

1 - pregnant

2 - diabetic

3 - cardiac history

BRAVO -

1 - breathing regularly NOT verified, pt is <35YO

ALPHA

1 - NOT seizing now AND breathing regularly verified

In our system, EMS units run COLD (no L&S) to ALPHA and some BRAVO calls - alternately, we send AUTOMATIC ALS to ALL ECHO LEVEL (the most serious) and some DELTA level calls.

I know it's not as easy to explain, but I'd be happy to go into more detail with anyone who is interested. Email me at madwis911@gmail.com.

Paul

Dear Paul

As an EMD with this aformentioned company I have this exact set of protocals (flip chart) sitting at my emediate left when I take a call. It does not flow with our call taking process however it is there ready to be used at a moments notice should I need it----- But we still manage to get the job done-- CORRECTLY. As a NREMTB I find the flip charts to be slow when I can just pull off the top of my head.

[spenac]

YOU @$$!!!!!

Your welcome.

[madwis911@yahoo.com]

spenac,

Maybe my remarks related to being accurate 95% of the time need some clarification -

our system, working towards strict protocol compliance, means that our CHIEF COMAPLAINTS & ACCUITY LEVELS (priorities) match what the EMTs/Medics find upon arrival between 90-95% of the time.

The 5-10% of the times where the responders find something TOTALY different mean the caller either lied completely or the EMD failed to follow the protocol, skipped questions, made a data entry error (our system is PC based) otherwise 'screwed up', yes, it happens!

As a point of reference, this year my center will answer in excess of 700,000 calls and dispatch in the neighborhood of 40,000 EMS calls.

Having been on your side of the radio for nearly 20 years, I underastand that not every call is as it would appear!!

[madwis911@yahoo.com]

OK! Good luck!

[spenac]

spenac,

Maybe my remarks related to being accurate 95% of the time need some clarification -

our system, working towards strict protocol compliance, means that our CHIEF COMAPLAINTS & ACCUITY LEVELS (priorities) match what the EMTs/Medics find upon arrival between 90-95% of the time.

The 5-10% of the times where the responders find something TOTALY different mean the caller either lied completely or the EMD failed to follow the protocol, skipped questions, made a data entry error (our system is PC based) otherwise 'screwed up', yes, it happens!

As a point of reference, this year my center will answer in excess of 700,000 calls and dispatch in the neighborhood of 40,000 EMS calls.

Having been on your side of the radio for nearly 20 years, I underastand that not every call is as it would appear!!

I am not trying to argue just no way in hell that 90% of how you dispatch is what is found. You dispatch as broken leg we find stubbed toe, you dispatch as heart attack we find bad gas, you dispatch as stroke we find diabetic emergency, etc. That means information was wrong, not dispatchers fault very often but callers fault. Your little flip book does not stop the errors it builds on the error. Also do you actually have access to what the paramedics find on arrival? So you sent me out for a seizure do you follow up and record that I found a person that was sneezing not seizing? That or actually matching each run report to it's dispatch record would be only way to prove correct dispatch. Or are your stats actually for getting us to correct location?

[madwis911@yahoo.com]

No, it's like I said. We have a close working relationship with our field users, all of the medical directors compare notes, we have quartly 'grand rounds' where medics, EMTs, dispatchers, medical directors, ER staff get together and review cases, even the minor ones... ...yes, we have a dedicated 9-1-1 center medcial director (yes, he is an MD!) and trust me, when things DON't match up we hear about it. Our user agenices call us for times or they complete a 'field feedback' report in the ER when they are doing their run reports and they get a special review.

Obviuosly I'm not going to win you over, I know every system is just a little different...what can I say, our system works well for us! So, if you ever find yourself in the land of beer, brats and cheese, give me a call and you can come see for yourself!

[PatrickW]

I am not trying to argue just no way in hell that 90% of how you dispatch is what is found. You dispatch as broken leg we find stubbed toe, you dispatch as heart attack we find bad gas, you dispatch as stroke we find diabetic emergency, etc. That means information was wrong, not dispatchers fault very often but callers fault. Your little flip book does not stop the errors it builds on the error. Also do you actually have access to what the paramedics find on arrival? So you sent me out for a seizure do you follow up and record that I found a person that was sneezing not seizing? That or actually matching each run report to it's dispatch record would be only way to prove correct dispatch. Or are your stats actually for getting us to correct location?

I don't know about how your dispatch works, but we never get dispatched to a "broken leg" or "heart attack". We may get dispatched to a traumatic injury/leg injury, or chest pain. 90% accuracy seems about right to me with that system in place. Maybe a little high, but not unheard of.

[spenac]

No, it's like I said. We have a close working relationship with our field users, all of the medical directors compare notes, we have quartly 'grand rounds' where medics, EMTs, dispatchers, medical directors, ER staff get together and review cases, even the minor ones... ...yes, we have a dedicated 9-1-1 center medcial director (yes, he is an MD!) and trust me, when things DON't match up we hear about it. Our user agenices call us for times or they complete a 'field feedback' report in the ER when they are doing their run reports and they get a special review.

Obviuosly I'm not going to win you over, I know every system is just a little different...what can I say, our system works well for us! So, if you ever find yourself in the land of beer, brats and cheese, give me a call and you can come see for yourself!

I will have to take you up on that because I can not see that ever happening based on how the callers give information. IF I am wrong then I say the entire world needs your type of dispatch. But I will give you it sounds like your system has lots of checks and balances. Maybe some of the medics from your system are on here and can give me there input.

We got brats here to. The neighbors little brats have been bugging me all day.

[spenac]

I don't know about how your dispatch works, but we never get dispatched to a "broken leg" or "heart attack". We may get dispatched to a traumatic injury/leg injury, or chest pain. 90% accuracy seems about right to me with that system in place. Maybe a little high, but not unheard of.

Now I could see it being higher than I have experienced with a broad statement like you give. My dispatch calls in like the caller does. If caller says fell and broke toe that is what we get told. In your system bad gas could still count as chest pain. Stubbed toe traumatic injury. So with that broad based dispatch I could see it matching. Does dispatch still say what caller said was the problem in other words - EMS XZ you are being dispatched to traumatic injury caller states they have a broken leg?

[madwis911@yahoo.com]

Thats why we ask the CASE ENTRY question - "What's the problem, tell me what happened?" - This allows the EMD to ask clarifying questions;

EMD = whats the problem, tell me what happened?

caller - "I think I brok my leg"

EMD - "tell me what happened?"

caller - "it was dark, i was going to the bathroom and hit my little toe on the bedframe"

EMD - "ok, so you stubbed your toe?"

caller - 'yes'

a call like this would likely code out as a 30A1 - Traumaitc Inury - NOT DANGEROUS BODY AREA - all of the ambulances in our county have MDC's so the crew can read exactly what comments the dispatcher see's...

Make sense?