Pre-arrival pt. contact

[mrmeaner]

I thought of this while reading the pet ambulance thread of all things, but, do any of you contact the pt. directly either via patch through the dispatcher's office or by calling the pt's home? I haven't because, well, I didn't think of it. If we could make contact with the caller directly it would give us a greater chance to make educated decisions about: response (upgrade to L&S or downgrade to no L&S), additional support (ALS, flight or cancel services) and a decent idea of what's going on (called in as flu-like symptoms but now sounds like a stroke). I'm not implying that the person in the passnger's seat isn't without tasks like playing navigator or spiking a bag. But, if you use GPS (and it works for you) and you make a habit of preparing IV's, the time taken to talk to the caller ahead of time would be invauable, even if all you get out of it is a short history.

Maybe all the other services are doing this and I missed the boat. If this is a practice, how well does it work? Do you get good information? Is it better information than you would get from dispatch?

I'm not picking on dispatchers, but my BS meter doesn't work as well in the third person. That and the idea of using EMD's sounds like a good idea, but wouldn't it be better to have the person talk directly to the medical response? No offense, but once we have the destination and the call info, I don't think the dispatchers need to be playing interpreter.

[kristo]

What you're basically asking is if dispatchers should be downgraded to switchboard operators?

Never having been a dispatcher myself, I can't really say I speak from experience, but it seems to me that apart from the process of taking the call, extracting basic information from the caller, deciding an appropriate response and dispatching it, the dispatcher has a vital role in calming the (often very upset) caller down just using his/her voice over the phone, extracting more information, giving instructions (like chest compressions or whatever), etc.

I think you may be overestimating the bullshit (for lack of a better term) filter dispatchers provide between the caller and the responder.

[brentoli]

From now on, we will develop a system to route all 911 calls to the closest ambulance by GPS, and allow the paramedic to talk to the hysterical caller while trying to get an idea of where the call is and any associated hazards or responses theyby cutting the dispatcher out of the equasion. Good idea.

[AnthonyM83]

Well, it wouldn't be downgrading the dispatcher, because the dispatcher would have done the same thing s/he always does...just in addition, the crew would make a phone call en-route. I guess if you have a long response time, why not?

You guys spike bags en-route?

[brentoli]

If you want to know something ask me on the radio. More often then not we are still online with the caller, and if we arent we have their call back number. Why do you want the added responsiblity, because everything you talk about on the phone needs to be documented anyways.

[jjones1418]

I think your motives are good, such as better preparation before arriving at a call, but at what cost?

I'm not talking on a phone en route to a call, because I'm too busy watching for idiots trying to hit the target on the side of my ambulance. I'm an extra set of eyes for the driver. Also, I understand the need for preparation, but I've never spiked a bag on the way to a call. Can't say that I see a need for this, ever. I'm not sure that I've ever known anyone to do this either. How does this work for you guys?

I'm all for the EMD portion of asking questions, I guess. It's what accepted as a national standard. Where I used to work, call-take and dispatch were separate. Someone answered 911, EMD'd the call, and put it into the computer. Then, it popped up on the computer screen in a different room, and the dispatcher then dispatched the appropriate unit. Our system was busy enough that even with 2 dispatchers, they didn't have time to answer all of the calls and dispatch units simultaneously. We had 2 dispatchers, sometimes 3 for EMS and 2, sometimes 3 for Fire. I don't have a clue how many call-takers we had, but they answered all the calls for Fire, Police, EMS in the entire city. I'm sure it was a few.

Anyways, to answer your question, I think it's a bad idea for paramedics to be calling people on the way to the call. I think it would only add to the accidents we had responding, providing more of a distraction than it's worth. I personally am thankful I don't have to deal with some idiot on the phone quoting shit he's seen on Rescue 911.

As an example... "Um yeah, I think Billy Fred here had one of them thar colonary arrests."

That's the shit I wanna try to decipher while clearing intersections and watching for morons.

[EMDP2081]

What happened to interviewing the patient while on scene?

[mrmeaner]

Thanks for the responses.

It's not that I want to get rid of or demean the dispatchers, my thought was that being able to better understand the call, respond appropriately, and get a history ahead of time would be a benifit and free up the dispatcher to take other calls and communicate with fire or police regarding other calls.

I've never been in a dispatch center so I don't know what information they process during a call. Maybe that's part of the problem. I just assumed that they are usually multitasking when they may not need to be.

I can see where this wouldn't work in urban areas as well regarding traffic. Good point.

Half the time we will have a bag spiked and ready already in the ambulance. If I think I'll need a second line or the previous shift didn't put one together, I will enroute.

[FireGuard69]

It's not that I want to get rid of or demean the dispatchers, my thought was that being able to better understand the call, respond appropriately, and get a history ahead of time would be a benifit and free up the dispatcher to take other calls and communicate with fire or police regarding other calls.

I've never been in a dispatch center so I don't know what information they process during a call. Maybe that's part of the problem. I just assumed that they are usually multitasking when they may not need to be.

As it was explained before I got here, there is a call taker, an EMD, and then the dispatcher.

Call taker (depending on area), is a PD/SO employee, who asks, 911, what is your emergency. After telling him/her that you "need da bambulaance", they forward the call to the EMD. The EMD then collects info, location, nature of emergency, and makes the determination (at least in Jersey) if it is an ALS, or BLS call. If it is hopping, and a BLS call of low priority, they will then give pre arrival instructions, (put pets away, go outside to flag down), and hang up. If it is an ALS call of high priority, then the EMD will be collecting info, and forwarding it to the Dispatcher on the fly. That is often the reason we, as street crews will not be getting the whole picture. In small cities and towns, often there will be just on person for all three services, but don't get me started in regionalization of emergency services...

I can see where this wouldn't work in urban areas as well regarding traffic. Good point.

Half the time we will have a bag spiked and ready already in the ambulance. If I think I'll need a second line or the previous shift didn't put one together, I will enroute.

If my partner is on the phone while I am responding, he better be getting directions, or getting me a date for that night!

He needs to be working the siren, horn, and assisting me in clearing the intersection.

As for spiking the bag, if the previous shift didnt do it, shouldn't you find that in the AM check?

[mrmeaner]

As it was explained before I got here, there is a call taker, an EMD, and then the dispatcher.

Call taker (depending on area), is a PD/SO employee, who asks, 911, what is your emergency. After telling him/her that you "need da bambulaance", they forward the call to the EMD. The EMD then collects info, location, nature of emergency, and makes the determination (at least in Jersey) if it is an ALS, or BLS call. If it is hopping, and a BLS call of low priority, they will then give pre arrival instructions, (put pets away, go outside to flag down), and hang up. If it is an ALS call of high priority, then the EMD will be collecting info, and forwarding it to the Dispatcher on the fly. That is often the reason we, as street crews will not be getting the whole picture. In small cities and towns, often there will be just on person for all three services, but don't get me started in regionalization of emergency services...

From what I understand, we have two dispatchers per shift that take care of: Police, county and 1 city; EMS, two services; First Responders, about 5 services; Fire, about 8 services. I should stop by there to see how they request and process information.

As for spiking the bag, if the previous shift didnt do it, shouldn't you find that in the AM check?

They don't make it a requirement. So, realisticly, if I wan't to have a bag spiked and ready, I should do it myself.

What happened to interviewing the patient while on scene?

The intent wasn't to take that away, but to get more information before arriving on scene. I don't think that every response needs to be emergent, but I'd like to make the decision for each call with the most information available. Also, if I can eliminate some time on scene, even better.

Nice avitar, btw.