Emergency Medical Service (EMS) is an important component of any community's health care system. 911 dispatchers, EMTs (Emergency Medical Technicians) and paramedics, extrication teams, etc. are the individuals who, paid or otherwise, are responsible for ensuring that your medical "emergency" is taken care of.
Why the quotes? Because "emergency" is a euphemism for whatever a 911-caller says is an emergency. It is also whatever the dispatcher thinks is an emergency. Tremendous variation exists.
It begins with the interaction between caller and "dispatch," a group of EMS individuals with limited or no medical training who answer 911 calls--usually answering with the phrase "Police and fire." Dispatchers use latitude in interpreting the emergency nature of any particular call.
In our community there are five response levels for medical emergencies based upon the nature and/or severity of the emergency. These levels indicate to EMTs, etc., what sort of problem the caller is experiencing or witnessing, how serious it may be, and what sort of personnel and equipment might be necessary for a successful intervention.
An "alpha" response is a non-immediate transport of a patient for a minor problem or illness, or the transfer of a stable patient from one medical facility (e.g., nursing home, hospital, etc.) to another.
A "bravo" response is more serious and emergent. It is used for motor vehicle accidents in which unknown injuries may have occurred or for patients with undisclosed medical emergencies, whether injury or illness.
"Charlie" designates a serious emergent illness that is potentially life-threatening (e.g., chest pain, shortness of breath, severe allergic reaction).
A "delta" response may indicate a serious accident in which there are known injuries, a serious traffic accident requiring extrication of patients from vehicles, and/or a serious medical problem like uncontrolled bleeding, etc. EMT and/or paramedic assistance is necessary as soon as possible.
"Echo" response is reserved for problems requiring near-instantaneous attention, like an on-going resuscitation attempt by by-standers or the need for CPR. This response usually means someone is as close to being dead, either because of illness or injury, either this side or that side of death, as they can possibly be. Needless to say, echo responses don't usually result in successful interventions.
However, the amount of interpretation dispatchers employ in translating 911 calls into responses varies.
Some examples. Recently, four patients were brought to the ER by an out-of-area ambulance after it had been dispatched to a rollover accident. Initially, all of the individuals were assessed by EMTs and refused transport. After the ambulance had returned to its station, however, a second call went out for EMS response to the the same accident. Apparently, the "victims" realized they didn't have a ride home!
A woman calls 911 because her husband is bleeding. The woman, an ICU nurse, says to dispatch, "We need an ambulance quick! My husband's cut his arm and is bleeding from an artery." Serious? Perhaps...probably. But here is how it got called out:
"EMT Ambulance, Echo response for a hemorrhage, 41 year male, attempted suicide!"
Where that last part came from, who knows? The man had been working with a metal range hood that fell on him. Clearly, what is interpreted as an emergency, and what are the circumstances of the emergency, are as much affected by who makes the 911 call as they are by the 911 dispatcher who answers.
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5 comments:
That's not correct.
Apha = non-emergent
Bravo = unknown, with no mechanism no breathing difficulty
Charlie = known medical problem non-respiratory
Delta = known medical problem, breathing difficulty, or *uncontrolled* bleeding
Echo = no breathing or subjects trapped in a burning building/vehicle
How a call is prioritized is based on a pre-determined algorithm laid out on "run cards" which determine response levels based on a standard list of questions. They are not intended to provide a dispatcher with opportunities to exercise their judgment or try to figure out what is taking place at the other end of the line. There are only a short list of appropriate dispatches (breathing difficulty, unknown injury, sick person, and yes, attempted suicide). Which one depends on a short set of questions designed to get the right category of resources moving. What the dispatcher says the call "is" is not necessarily what the EMT's could find. It is a representation of the category of the response that is likely to be appropriate.
And the clincher? Those run cards are designed, surprise, surprise, under the expertise of people like the physician in *your* emergency department. If you think you know a better way, bring it up with them.
There are lots and lots of ways the EMS system in your area is nonsensical, but I strongly doubt one of them.
eer, I meant to say I doubt that THIS is one of them.
The issue might be that from your armchair seat by the ER scanner you expect too fine a grain on the information that comes across the radio. Dispatchers should NOT be going with their gut, or trying to ask probing questions that really get to the precise nature of the problem. As you point out yourself, that is a job for the professionals.
For a nice example of why the way your system is set up (and by the way, the alpha/bravo/charlie/delta/echo system is called a "tiered response" and is the system used in 911 dispatch centers almost nation wide) is favorable, look to the recent San Francisco zoo tiger attack. The 911 caller asserted that by the level of agitation she was witnessing, she though the person reporting a tiger on the lose was "on something." Which do you think is more common in San Francisco? Loose tigers wandering through cafes, or high/crazy people acting agitated in public?
The run card protocol, and not the dispatcher's assessment, is what guided the proper response. In fact, criticisms of the response being "slow" (look to the news) all point to places where the tiered response system was deviated from by individuals trying to exercise their own judgment.
This is all a long way of saying that the function of the 911 system is not to provide you, in the ER, with a picture perfect assessment of the events on scene. Nor, in fact, should it be. The purpose of the tiered response system is to quickly (e.g., in far less than a minute) provide responding resources with a category of response (Alpha, Charlie, etc.) and a protocol to follow to ensure they are likely to be able to handle whatever they find. That's all. To do a good job, across time, a short amount of time, the most times, the dispatchers need to interpret LESS, not more, as your post suggests.
And I humbly suggest that the tiered system works very, very well, given what it is supposed to do. EMS systems across the country, and your very own ER doctors, agree with me.
My, my, my, Mr. Patrick, such a lucid articulation of logical positivism. This is how the system is designed, ergo, this is how the system works.
Despite my ER arm chair, my point is not that the system is not useful, or widely accepted, or even (perhaps) the best. My point is that the system is susceptible to inaccuracies based upon the ability of dispatchers to interpret or filter what they hear on one end (i.e., what the 911 caller says) before it comes out the other end (i.e., the tone out reponse category).
Your points are clarifications, not arguments. I appreciate them but sense you've arisen to a debate that doesn't exist. I can no more deny what you've written about the way the system is supposed to work than you can deny the truthfulness of the examples I provided that demonstrate my point: good, bad, or indifferent, the system is not infallible.
Well, if that's all you are saying, then there is no disagreement.
But if you are suggesting the dispatchers are incompetent or making fun of them because they sometimes do things like call arm lacs suicide attempts, and allow people to leech off the EMS system, then I call "cheap shot." I see both of those examples as results of the way a desirable system is set up, and I (personally) would be extremely challenged to produce a better way of doing things.
I provided those clarifications because I don't think you understand the way the system is supposed to work. And how can a person say "this acts broken sometimes" when they don't know what "this" is for?
The dispatcher's job is NOT to interpret what the caller is telling them, nor is it to produce "infallible" descriptions of what is taking place on scene. Nor is it to coordinate the response category with what they personally believe to be taking place on scene. Their job is to match the response category with whatever keywords the caller produces. The dispatcher who says, "I interpret this caller's statement X to mean Y" is called a bad dispatcher-who-gets-fired. That's simply not what they do, nor is it what they should do. What they do is ask yes or no questions, work though an algorithm of questions (designed by the responding units) and assist in coordinating the response.
That's all I meant to get across.
(And you don't really think I think that the way a systems is designed is necessarily the way it actually functions do you? I politely call cheap shot on that one, too.)
Interestingly, a story "on point" from today's AP stream:
http://us.rd.yahoo.com/dailynews/rss/us/*http://news.yahoo.com/s/ap/20080118/ap_on_re_us/911_call_death
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