Priority Dispatching

[CBEMT]

We only have one type of response- lights and siren, and only one type of transport- same.

Same here, though sometimes we can respond without if we're going to be waiting for PD to secure the scene- usually talking down a suicidal person.

[2wheelinemt]

The problem with using it is that we leave too much open to the dispatchers. If they miss understand what the patient is saying then the

out come can be devastating. Some people just aren't good at explaining whats wrong with them while others have learned how to be

very good at it. This puts a lot on the dispatchers to make the right call when they already have enough resp on them and then you have

the dispatchers that are like some in the ems, not for the right reasons and is playing with fire.

This is just my opinion from years of experience in the ems field and human nature.

[crotchitymedic1986]

Here is a novel idea: Instead of trying to figure out how you can delay an ambulance to some patients, why not staff enough ambulances or first responders to give everyone a good response time ? Imagine the Pizza Hut employee who takes your order over the phone, and asks:

1. Sir when was the last time you ate ? You: 3 hours ago

2. When was the last time you ate Pizza ? You: 2 days ago

3. How much do you weigh ? You: 275lbs

4. Could you rate your hunger on the 1-10 scale for me, with "1" being equal to just finishing a buffet meal, and "10" being an ethiopian child ? You: I would say about a "3"

Pizza Hut: Okay sir, I am making you a priority 4 response, your pizza will be there in 6 hours, and it will be delivered by our lowest trained personnel. We are saving our best employees for customers who really need a pizza.

[RatPack]

Here is a novel idea: Instead of trying to figure out how you can delay an ambulance to some patients, why not staff enough ambulances or first responders to give everyone a good response time ? Imagine the Pizza Hut employee who takes your order over the phone, and asks:

Cause money doesn't grow on trees. A city budget is a balancing act, sometimes difficult decisions need to be made, they are not always the most popular ones.

In the land of rainbows and gumdrops we would have an ambulance on every corner, a police department with enough manpower that people wouldn't have to wait, a fire truck around every corner just in case. Enough teachers etc,etc.

We dont live there, at least I dont. Things cost money and the cost is always rising.

[FL_Medic]

Because running lights and sirens is dangerous. Should I be running code to a cut finger? Jellyfish sting? Domestic (where I have to wait for cops anyway)?

Because I may have an ambulance closer to the stroke that just got called in that was initially responding to "abnormal lab values" at a local nursing home.

There are reasons for priority dispatching, let's not make rash judgements and opinions. I would prefer evidence. Thanks Devil for the references, by the way.

Edited March 25, 2009 by FL_Medic

[crotchitymedic1986]

Cause money doesn't grow on trees. A city budget is a balancing act, sometimes difficult decisions need to be made, they are not always the most popular ones.

In the land of rainbows and gumdrops we would have an ambulance on every corner, a police department with enough manpower that people wouldn't have to wait, a fire truck around every corner just in case. Enough teachers etc,etc.

We dont live there, at least I dont. Things cost money and the cost is always rising.

Dddduuuuuuhhhhhhhh. But funny how they always have enough fire trucks, and usually enough cops. But you will note that I said "ambulance or first responder". First responders can handle your non-acute 911 calls.

[Dustdevil]

Here is a novel idea: Instead of trying to figure out how you can delay an ambulance to some patients, why not staff enough ambulances or first responders to give everyone a good response time ? Imagine the Pizza Hut employee who takes your order over the phone, and asks:

Quite possibly your best post ever!

Because running lights and sirens is dangerous. Should I be running code to a cut finger? Jellyfish sting? Domestic (where I have to wait for cops anyway)?

Who said anything about running code? Priority dispatch means more than simply deciding whether to run the siren or not. It is a system of queuing resources.

[kevkei]

A lot of systems are using it. I have never seen anything bad come from it. It does cut down of the number of L&S responses, so that is always a good thing. You still get the low level calls that slip through, due to "Just being careful" with the response.

But , I see no cons to it.

I don't know what you did or used before, but using AMPDS typically increases L&S responses to the average of 75% of all incidents.

IT is an okay product if you want to try to mitigate the risk of call evaluation and dispatch but you have to accept risk of L&S responses. A 01C1 (Abdominal pain) is a medium priority L&S response because of a 1-3% chance it is a AAA (lacks specificity by 97-99%)

If you want to provide the best service and most appropriate resources, and if you are comfortable accepting some risk, there are other alternatives that would be better. I agree with Dust that what’s nice is it is a pretty prepackaged product that the masses are using, but not a great product. AMPDS, ProQA and SSM are the ‘be all end all’ for ‘best practice sites’ (Fitch anyone?).

If you would like some good contacts to review, try looking at:

- any of the NHS ambulance trust services in the U.K London Ambulance Trust

- Metropolitan Ambulance Service in Melbourne Australia MAS

- or a contact closer to home Mecklenburg EMS Agency in Charlotte MEDIC 911

[HERBIE1]

You transport everyone light and sirens?

What is the reasoning behind that?

We do use the Emergency medical dispatching, however we dont base response on it. Every call we respond to. Transport priority is based on pt condition. The majority are without lights and sirens.

As far as the dispatchng our system is geared more towards pre-arrival instructions then triaging calls. Bleeding control, CPR, Pt positioning, things of that nature. In my opinion it does work for us and would state that it has benefited more then one pt.

There is no logic to it that I am aware of. As far as we can tell, it's merely to get the rig back in service quicker for the next run. Depending on time of day, location, and traffic, it could save a lot of time. Apparently this "need" outweighs the risk for running hot all the time.

Dispatch triages AND gives pre arrival instructions, but everyone also knows what to say to make dispatch "triage" essentially pointless.

[RatPack]

There is no logic to it that I am aware of. As far as we can tell, it's merely to get the rig back in service quicker for the next run. Depending on time of day, location, and traffic, it could save a lot of time. Apparently this "need" outweighs the risk for running hot all the time.

Dispatch triages AND gives pre arrival instructions, but everyone also knows what to say to make dispatch "triage" essentially pointless.

Our policy states every ambulance summoned will use light and sirens to the scene. Transport priority is based on presentation of the patient and ultimately the crews decision.

I dont know where you get that notion that its about getting a unit back in service. A service requiring lights and sirens to and from the scene is a policy geared towards getting a unit back in service.

In my area extensive CQI usually curbs the enthusiasm to respond to the hospital when not warranted.