Priority Dispatching

[Chief1C]

We're dispatched by three different counties. One of them uses a priority system.

The dispatchers never get a 100% fact story from the callers, who are stricken with panic, fear, never having had this happen to them before. There is no fool proof system. So, why not get the message to us a little more quickly, by leaving out "Alpha Priority Response"? (Which is how ours sounds, if it's a medical call. MVA's and Fires don't get a priority.)

Edited March 29, 2009 by 4cmk6

[WolfmanHarris]

CTAS stands for Canadian Triage and Actuity Scale.

CAEP (Canadian Association of Emergency Physicians) CTAS Info

You're absolutely right and I knew better too. Blame it on poor editing and a plethora of acronyms in my day to day life.

[Kiwiology]

We use AMPDS in BC and speaking from my own experience it is a complete failure. The number of unneccesary "hot" runs to scene has increased dramatically with no relatable increase to positive patient care outcomes.

I would have to agree. Another problem we have here from what I've seen is the call detriments (A/B/C/D/E) are also tied into our KPIs of response times and Government funding; high levels of over-proritization is just not a good thing.

[Richard B the EMT]

... if it's a medical call. MVA's and Fires don't get a priority.

MVAs don't get priority? A potential major trauma from being ejected doesn't rate a priority, if the caller cannot phrase it beyond "2 cars ran into each other"? Or am I misreading the way the statement was written here?

As for fire calls, are you referring to "Stand-by" at the scene (FDNY EMS Command level 7 priority- no L&S to respond to the scene), an injury/trauma from burns and falling debris, or the medical call of smoke inhalation?

[HERBIE1]

There is no perfect solution here. While I am not familiar with the various types of programs and/or systems that triage calls, I AM familiar with the people who call 911. The general public is the weak link in the chain here and why we have such difficulty in getting accurate info. Some are excited or nervous, some are 3rd party calls, some are pranks, and far too many are people who are intimately familiar with what to say in order to get the quickest response. In some areas, local "activists"/ministers actually coach their congregations as to what to say. Tell them you have chest pain or trouble breathing- regardless of what your complaint actually is- to get EMS. If you need the police, tell them you think you see a shiny object in someone's hand. Our system cannot track cell phone calls, they simply do not answer if the dispatcher calls them back, thus it's a purely anonymous act with no consequences.

Yes, questions need to be asked, but my point is, don't take too much of the information you get prearrival to heart. Too often it has nothing to do with the current problem, so you deal with whatever you see. A call for a diabetic problem turns out to be someone who has had diabetes all their life but their current complaint is back pain. A call for left sided chest pain turns out to be 3 38 caliber bullets to the left chest. No matter how good a system is, there is always the "unknown" factor you simply cannot avoid. It's the fun part of the business- you never know what will happen.

I do like the idea of EXPERIENCED medics or EMT's doing the dispatching- they know what questions to ask above and beyond any protocol. Nothing is perfect, but relying too much on a "system" or protocol is a dangerous road to take.

[Chief1C]

MVAs don't get priority?

That's not what I'm saying.. They don't get a priority, because it only applies to lights and siren use in response to medical criteria calls for BLS and ALS units. MVA's and Fires still get the same response, individual agency SOG on response. We follow our own SOG/OP, for response, as a stipulation of us providing coverage.

Edited March 31, 2009 by 4cmk6

[Richard B the EMT]

Perhaps it is a case of similar words for different things.

At FDNY EMS, EVERYTHING has a priority, from an Arrest (Priority one, L&S response over most other calls then in the system for the nearest appropriate ALS, BLS, or both, to respond to), to an EDP (priority 7, with BLS response, no L&S, to be reassigned if a higher priority assignment comes in for that ambulance if not yet to the scene), to a unit down mechanical (priority 8 for administrative purposes).

Perhaps I should refer to it as a "Prioritization System"?

Edited April 2, 2009 by Richard B the EMT

[Dustdevil]

Anyone ever seen a fire department prioritising their fire responses? Maybe they ought to be leaving the lights and sirens off for all those "smoke in the area", automatic fire alarm, stove fires, and "fire reported out" runs that they go screaming down the road on, en masse, and saving it for only those calls that are true inhabited structure fires. I dunno. If it makes sense for us, it makes sense for them. Even police departments prioritise their responses. Why not firemonkeys? Is the concept too complicated for them?

[HERBIE1]

Anyone ever seen a fire department prioritising their fire responses? Maybe they ought to be leaving the lights and sirens off for all those "smoke in the area", automatic fire alarm, stove fires, and "fire reported out" runs that they go screaming down the road on, en masse, and saving it for only those calls that are true inhabited structure fires. I dunno. If it makes sense for us, it makes sense for them. Even police departments prioritise their responses. Why not firemonkeys? Is the concept too complicated for them?

Obviously many of the calls that fire, police and EMS respond to do not turn out to be what we would call "emergencies". Problem is, what happens when one of those calls really turns out to be true emergency? Things like priority dispatching are supposed to sort out the nonemergency from the real thing and assign the proper resources to mitigate the problem, but what happens when one slips through the cracks? Who will be left holding the bag?

It's NOT the crew responding, but the municipality or company who will be responsible for those responses. This is a huge liability that could easily result in a multimillion dollar judgment, and it makes no sense from a fiscal/management perspective to take that chance.

Problem is, because of budget/ personnel/resource limitations, things like priority dispatching are merely a calculated risk and necessary evil. In a perfect world, we would have all the resources we need, people would not give false information when requesting help, budget restrictions would not exist, and pay would be equitable for all for the type of service we deliver.

[Donavan]

Anyone ever seen a fire department prioritising their fire responses? Maybe they ought to be leaving the lights and sirens off for all those "smoke in the area", automatic fire alarm, stove fires, and "fire reported out" runs that they go screaming down the road on, en masse, and saving it for only those calls that are true inhabited structure fires. I dunno. If it makes sense for us, it makes sense for them. Even police departments prioritise their responses. Why not firemonkeys? Is the concept too complicated for them?

The Fire Monkeys in one of my service's response towns does respond cold to all automatic alarms, unless someone calls 911 and lets them know it's an actual emergency.

As for EMS, I started working in a volunteer system where we responded lights and siren to all calls. That changed when the PD dispatchers were trained and started using an Emergency Medical Dispatch system, I don't know which one. The number of L+S responses dropped by about 30%, only to calls that were definitely not emergencies, ie bad labs, misplaced g-tubes, distal extremity injuries with minor mechanisms. Any unknowns, and we still responded L+S. It decreased the number of hot responses without endangering anyone who had a real emergency on their hands.

I don't think this would benefit any systems that already have an effective method of over-the-phone triage and priority assignment.