Dispatch treating CVA with ASA

[katbemeEMT-B]

While I don't know if there have been any impartial studies in regards to EMD dispatching I do know that in recent years there have been law-suits brought for agencies not providing pre-arrival instructions.

I don't think the lawsuits are for not providing pre-arrival instructions rather for failure to provide the proper pre-arrival instructions. I can not see any judge finding a dispatcher at fault for not telling Joe Blow off the street to give some guy ASA or Nitro when there is no true way to get a proper assessment. Any good lawyer could get that case thrown out in a heart beat (no pun intended).

As EMTs and Medics we have to have confidence in our Dispatchers that they will properly dole out pre-arrival instructions so when we arrive on scene the patient hasn't tanked making our job harder. IE: Call comes in for patient with chest pain. While going through the list of questions with the caller who is not trained to properly assess the patient the dispatcher comes to the conclusion that this patient is suffering from a cardiac compromise. He/she advises the caller to administer a dose of Nitro. When EMS arrives on scene the patient has become unresponsive because his blood pressure tanked. Why? It wasn't a cardiac issue, it was a pulled muscle from exertion. The patients BP was low before the Nitro was given resulting in the syncope episode. The dispatcher has no way to look at this patient to assess whether this is a true cardiac or not. He/she is relying on what the caller, who is in a state of panic is telling them. This is why our dispatchers do not advise medication administration over the phone in their pre-arrival instructions. Now if the PD or rescue is on scene and ask the dispatcher that's a different story as they are trained as either first responders or EMTs.

I am not saying that Dispatchers are dumb I am just saying that unless they are there to see the patient or have trained personnel on scene they are not able to get the proper picture of the patient's condition thus resulting in mistakes.

[spenac]

I have been told by another medic of the successful direction of an infant's birth by certified dispatchers.

Child birth happens whether dispatch tells them anything or not. Thats a natural thing not proof of EMD doing anything.

Sorry -10 for giving people credit for natural event.

[ERDoc]

Child birth happens whether dispatch tells them anything or not. Thats a natural thing not proof of EMD doing anything.

Sorry -10 for giving people credit for natural event.

Birth, the one thing that will happen reguardless of how good or bad your crew is.

[copperhead024]

khanek -

A group of lawyers & "expert" witnesses [former "suit types" from the realm of EMS & healthcare in general] were at an industry confernence discussing the rise of malpractice suits in pre-hospital care [which are on the rise; our paramedic program is incorporating an in-depth"legal issues in EMS" as part of our course beginning with the next recruit class]. Some of the lawsuits that they cited involved the lack of pre-arrival instructions being provided. They pointed out that the days of not providing PAI as a way to stay out of a malpractice suit were quickly passing. I can't cite to you the specific cases & in all fairness the cases were way more complex than advising or not advising to take a medication available in a private residence. They were cases within the U.S. & had occurred within approximately the last three to four years. I am not a lawyer & I can't cite the specific cases or case law [for all I know the lawyers degrees came out of a cracker jack box ]. My assumption would be that as more dispatch services provide PAI that it is becoming a comparable "acceptable" standard.

What I do know is that they advised the same four things that they advise to pre-med students & that I advise to my paramedic students.

1. Stay abreast of current & changing trends within our industry & related industries. If there is something you don't know - research it! Don't just form an off-the cuff opinion or take the advice of one individual or group, even if they appear to be knowledgeable of the topic. [This includes my advice on any given topic. ]

2. Document, Document, Document! - You can never cover your butt with enough paper & ink.

3. A pleasant bedside manner will go further towards keeping someone from suing you more than anything else. Although providing competent care does help . I know of various healthcare providers [not just medics; nurses, physicians, etc.] that provide a lack of adequate care but have a great bedside manner. They seem to face very little threat of malpractice from anyone outside of the industry. I know others who can be a royal jerk in the provision of excellent care who are routinely threatened with lawsuits.

4. As a provider ignorance [of the law or acceptable standards - not just locally, but regionally & nationwide] is no excuse. In this day & age relying on "the good samaritan" statutes & laws just aren't good enough.

As to your example of Nitro; I agree that I don't know how dispatch could appropriately assess a patient, for the administration of Nitro, through only questioning them. But, this was not part of the original thread/question. The question was in regards to ASA, which the American Heart Association now states can be given by instruction from a dispatcher, asking the appropriate rule out questions, prior to EMS contact. If you want to know more please check out the AHA link http://www.americanheart.org/presenter.jhtml?identifier=4456 that was previously cited.

Spenac- You are correct - childbirth is a natural process that has been occurring since life was first created. Death of the newborn & the mother has also been occurring since that time. Having a calm voice to talk a layperson through an event that they are not use to dealing with every day can be very valuable, especially when something less-than-natural occurs. [prolapsed cords; cords around a newborn's neck; post-partum hemorrhage all come to mind as examples with this scenario]. And I do give credit to dispatchers. Not only for getting their job done, but for remaining calm & getting the job done even when they know the brevity & seriousness of any given situation. If you want to continue this conversation you can PM me.

[BushyFromOz]

Birth, the one thing that will happen reguardless of how good or bad your crew is.

And taxes...

[BushyFromOz]

Sorry -10 for giving people credit for natural event.

Aww comon now dude, surely there are some natural "events" that deserve giving your mates some credit

Then again, there are some natural events that should just not be natural at all :shock:

I know, i know, off topic..... :spam2:

[spenac]

Spenac- You are correct - childbirth is a natural process that has been occurring since life was first created. Death of the newborn & the mother has also been occurring since that time. Having a calm voice to talk a layperson through an event that they are not use to dealing with every day can be very valuable, especially when something less-than-natural occurs. [prolapsed cords; cords around a newborn's neck; post-partum hemorrhage all come to mind as examples with this scenario]. And I do give credit to dispatchers. Not only for getting their job done, but for remaining calm & getting the job done even when they know the brevity & seriousness of any given situation. If you want to continue this conversation you can PM me.

No need to private message. If things do go wrong the guy on the phone is of limited use to the untrained person assisting. The untrained person is not going to change the outcome. I have assisted to many woman delivering in my ambulance, including dealing with the worst case scenarios.

I respect dispatchers that stay calm and would not want a job where I could do basically nothing to help.

The EMD bashing began when Brentoli said " Dispatch will save your ass better then any EMT-B will." Can not agree with that statement. And as others have clearly stated w/o seeing the patients and getting vitals advising use of meds is not a good thing. In the field we find often something completely different than what is called in. IN MY OPINION DISPATCHERS SHOULD NOT ADVISE USE OF MEDS. MY OPINION ONLY. IF YOUR MED CONTROL WANTS THEM TO LET THEM THEY ASSUME THE RISK. JUST MY HALF PENNY WORTH OF THOUGHT.

Copper welcome as a poster even though not new to the site by the way. Guess this discussion struck a nerve.

[katbemeEMT-B]

So Copper, I have a question;

If a dispatcher is not qualified and educated to a level that allows them to advise callers to give ASA or any other med (which most are not), how is it that they can be held liable? They are required by law to work within their scope of practice. I think, as I stated before that it is not the lack of advising meds in pre-arrival instruction that is getting them sued but rather giving bad instruction or none at all. I know I would not want to be a dispatcher as it would definitely have to be a high stress job. You sit on a phone talking to some person who is out of control that you would like to just reach out and slap. This is why in most cities, everything is recorded.

As I stated previously, I have spent time with our dispatchers and it was pretty amazing. Everything said and typed is recorded for each call. They are able to bring those calls back up and replay any part or the entire call. As long as the dispatcher follows their flow chart and asks the questions that are prompted their butts are covered should some schmuck decide he/she wants to sue. We do live in a sue happy world. What gets them in trouble is when they start moving outside of those little prompts and try to treat the patient themselves.

If a Medical Director feels comfortable enough to allow his dispatchers to advise giving meds via the phone without ever seeing the patient I guess that's his choice. I'm not sure there's very many that will. As has been stated already, many times a call comes in for one thing and turns out to be another. While in most cases ASA can be harmless, what about the rare times it isn't?

I guess we can argue this point for days. What it comes down to is I have my opinion and you have yours. Who is right? I guess only God knows. What I do know is that I hope that I don't ever come upon a call where one of my dispatchers decided he/she could diagnose from the phone and opted to advise the administration of a drug that ended up having an adverse affect on the patient. I think our dispatchers are great but I wouldn't cover for one of them either. If they were at fault, then they should accept the responsibility for their actions.

Stay safe and cover your butt out there.

[brentoli]

It is true, dispatch is here to send you the cops, the bird and what ever else you need. Your EMT-B cant do that.

[Richard B the EMT]

I know this is not a universal thing, due to the time honored "Local Protocols", but all my dispatchers, as well as the call takers, are minimally EMT-Bs.