Dispatch sending doctors instead of ambulances

[DwayneEMTP]

I was just wondering about this. It seems like a no-brainer good idea...but then I started wondering about dispatch based triage.

Many medics/Docs/nurses here seem to think that basics, on site, deciding level of care (ALS v BLS) is often not a good idea. It would seem that dispatch (outside looking in, I have no idea of their qualifications) would be less capable to make this decision. Particularly in geriatric patients. This is not my judgment, just my train of thought...

They mention the sprained ankle. Can they reliably determine if the sprain caused a fall, additional injuries from the fall, level of conscienceness, if the sprain was casued by a fall, that was possibly caused by a medical, medication, mentation issue, etc?

If this really caught fire, would there be ramifications for the EMS job market? Can you see this moving outside of the geriatric population and becoming main stream?

One of the many things you all have taught me is that things are seldom what they seem...I look forward to your thoughts.

Dwayne

http://www.emsresponder.com/article/articl...p;siteSection=1

New Tampa Dispatch System Reduces ER Trips

TAMPA - Each day, emergency dispatchers field dozens of calls from people needing medical care, but not all of those calls require an ambulance ride and a trip to an emergency room.

A twisted ankle, a minor spider bite or a backache don't have to be treated as quickly as, say, a heart attack or a gunshot wound.

Now, a pilot program between Tampa Fire Rescue and a private home care company promises to send a doctor or nurse practitioner out to certain patients' homes to treat nonemergency medical troubles.

"It's just such a wonderful concept," said Dr. Catherine Carrubba , a Tampa General Hospital emergency room doctor and the medical director for the Fire Rescue. "It will work well for patients."

The two-year pilot program is the first in the state and will treat patients 65 and older, she said.

It comes at no cost to the city, and there is no contract. AllianceCare , a for-profit company based in Boynton Beach, will send a medical team out to private homes. Because of the age restriction, most of the patients will be covered by Medicare. If a patient doesn't have insurance and is not covered by Medicare, they will be treated at no cost, said Greg Bellware , AllianceCare's senior vice president.

"This is a very simple and a very small service but a very important one," Bellware said.

Here's how it works: When someone calls 911, dispatch sorts the calls according to priority. If an elderly person calls in with a nonemergency problem, dispatch will contact AllianceCare. A company employee will call the patient within 10 minutes to set up a home visit appointment.

Within two hours, a doctor or nurse practitioner and a paramedic will come to the patient's home. Once there, the team can prescribe medications, perform X-rays and handle other medical needs.

The AllianceCare team works from 8 a.m. to 8 p.m., seven days a week. The company has started small, handling only three or four calls a day.

"Taking care of patients' needs that can be best met in the home is not only better care but it's more economical for the entire health care community," Bellware said.

Hillsborough Fire Rescue has no plans to get involved in the program, said spokesman Ray Yeakley.

[whit72]

Dwayne wrote:

Here's how it works: When someone calls 911, dispatch sorts the calls according to priority. If an elderly person calls in with a nonemergency problem, dispatch will contact AllianceCare. A company employee will call the patient within 10 minutes to set up a home visit appointment.

Like a broken toe that the elderly woman refuses to admit she received while falling down a flight of stairs, because she is nervous her children will put her in a nursing home, cause she cant take of herself anymore.

Sounds like a slippery slope.

[Dustdevil]

I agree, Dwayne. Although it sounds like a solid concept on the surface, the dispatcher is ultimately going to be the weak link in this system. And elderly people will suffer for all these good intentions.

If I were a senior citizen (which actually isn't that far off), I would be raising hell about this plan. If I've paid taxes for over 65 years, I expect the same consideration and emergency response as every other taxpayer, not some bimbo pawning me off on a rent-a-nurse because she doesn't want to wake up her precious firemonkeys.

[BushyFromOz]

If I were a senior citizen (which actually isn't that far off), I would be raising hell about this plan. If I've paid taxes for over 65 years, I expect the same consideration and emergency response as every other taxpayer, not some bimbo pawning me off on a rent-a-nurse because she doesn't want to wake up her precious firemonkeys.

LMAO....... I just had this mental image of the dispatcher leaner out the window screaming "go my pretties, kill, kill" and some of those flying monkeys in little bunker suits go flapping off into the night to deal with the elderly patients............ :?

Does this mental image prove that i should not be awake at 4am? :shock:

[Chrisclark]

Ya'll are so mean to firemonkeys!

We have feelings too

[BEorP]

In my relatively small time riding out in Toronto I have already come to hate BS calls. That being said, I don't see almost any complaint an elderly person can come up with as being BS and do enjoy most of those calls. If you have the flu, a toothache, or menstrual cramps then it's no reason to call an ambulance. But is it really that much of a pain to take an old person to the hospital because they feel weak or fell out of bed? I don't think so. If that is becoming too taxing on an ambulance service then maybe they need to get more trucks on the road or try to educate the members of the public who are actually using ambulances for BS (see above).

As has already been pointed out, it sounds like a good idea on the surface, but when people call 911 they expect an ambulance that will bring them to the hospital. If they just wanted an appointment with a doctor they could have made that themselves.

Although I am just a student so I haven't been on the road as much as those of you who are employed as medics, my classmates and I have done a few calls for elderly falls when all the pt wants is some help getting back into bed or up off the ground (I don't know if this is standard or just something we happen to have come across). They really have no medical complaint of injury. Will the MD or NP come and pick them up off the ground?

[Dustdevil]

Great point, BEorP. Once you really consider this proposal in context, it almost seems back asswards. The elderly are the ones most likely to actually need hospital diagnostics, not the young people. Writing them off as non-emergent on the telephone is just a disaster waiting to happen. Just ask the Dallas Fire Department and the Detroit Fire Department, and the many other crappy EMS services who tried this and lost their arses in court when somebody died.

[Ridryder 911]

Hmmm... me remembers a certain dispatch problem in priority dispatch (Dust you remember the Dallas incident).

Actually, this is not a new concept. Many trial physician or physician extenders (NP/PA) has been placed in Pseudo EMS units under HMO contracts for non-emergency. This was not to decrease the ER visits, rather it has been proven to reduce the number of tests, procedures and definitely admissions.

Many argue that this would be costly but in reality, it would save millions daily for insurance providers. Think about the mild pneumonia, that could be prescribed antibiotics without all the tests, without the potential admission, back pains, general malaise, etc... again no costs for EMS, no ER charges, and no admission charges.. thousands saved. Enough saved that one to trip has paid that persons salary alone...

EMS had the chance, but rather increase our educational values and system we much rather water and dilute it down to see how fast we train and process through a program to pass a test to get a patch.

R/r 911

[chazmedic]

Another way to think about it: how would YOU want YOUR grandmother treated?

Most elderly call us because they honestly don't know what to do and Fire and EMS has sold itself to the public as "the problem-solvers". Granted I have had my share of the BS where the person is only calling for attention or because they've fallen again and really should be in a nursing home. But most of them really think they're having an emergency and "those nice boys and girls from the Fire Department and the nice Ambulance Drivers came over and helped."

If you want to put in a program like this, staff more field units and put in ALS response/assessment cars with a Paramedic. The res/assess could go and determine more what is needed (call their doctor, order in a transport, begin the code).

The Priority Dispatch system is good, but not perfect. You're trying to assess over the phone. The caller probably doesn't understand. I used to dispatch this system and discovered you could lead the caller in the questioning. Plus, the dispatcher is taught that they can in a two day course assess over the phone better than you can in person after going to a class for 1200 hours.

BTW, our dispatchers are paid more than the paramedics. I love a fair and just world.

Just my rant.

[Chrisclark]

^ My grandmother is much more likely too call me if she is having chest pain than to call 911. If 911 would send a doctor, she would still probably call my cell phone.

Honestly, I would rather have her call me than anyone else.