Priority Dispatching

[kevkei]

Dust,

I generally agree but that isn't what I was suggesting. You still need to do your initial critical interventions to cover off the ABS's and use an acceptable method to identify the critical threats. After you have done that, invest some time (maybe 2-3 more minutes to get additional and specific information. (This will account for 5-10% of most systems call volume).

The telehealth part can cover an additional 15-20%. This is why I suggested talking to the other services above. AMPDS itself even allows for this, anyone familiar with the 'Omega' protocol?

If we as practitioners think that everyone that calls 911 should have a Paramedic at their door within the industry standard, are fooling ourselves. We don't walk into the ER and expect an ICU intensivist to see each patient within 5 minutes of arrival. We should change out method of thinking.

As for a recipe for disaster, I'd say the Dallas system was doomed to fail. There are many places around the U.S and the world doing these things, doing it well and with little to no liability or negative outcomes. Looking at their evidence changed my perspective as I had thought, how can this be done? Well, it seems that it can be and their is significant cost avoidance and resource allocation to respond to those cardiac arrests, FBAO and major trauma even faster.

[tniuqs]

Kev:

For ground dispatch in this province things are sitting on the edge of a cliff right now with all the restructuring, one can garrentee that AHS will be hiring "lay people" to lower costs. Very unlike the London system that staffs with real experianced Paramedics, you should have heard Steven Hines from NHS lecture at EMStock ... eye opening when a slow day in London is 4000 calls.

Yes agreed I sure wish we would look across the street let alone the Big Pond, that said a bit off topic nevertheless we spend more ca$h on studies than we put into the systems in a vast majority of cases when we already know the outcomes.

Running L+S on every return to ER is positively assine, and "media reporting "The Patient was rushed to Hospital" honestly if I ever hear "Paramedics rushed to the Scene, stabilised the Patient and Pt is in stable Condition in Hospital" then I know we are advancing our profession, I can only hope before I die ...

btw got a link to Omega project ?

For Air Ambulance the current policy is 30 minutes to "wheels in the wells" and absolutely stupid when pilots and medics are responding in their personal viehicles (no matter what the call triaged as) I can tell you from personal experiance some one is going to die responding to a "needs open reduction for # tib/fib" besides there is no L+S on a KA 200 or BK 117.

Oh and the "senario" dust presented .... I too can relate after calling 911 in a couple of Industrial remote situations (after clearly identifying myself as a Registered Paramedic, had the a 5 minute 911 Q + A period !

Me: I am calling in an intubated poly trauma from industial accident.

Operator: Is the person awake and breathing

ME: wtf a GCS of 3 you fool, intubated.

Operator: Sir just doing my job, please dont use abusive language.

This when I needed assistance and knowing that the local ambulance was staffed by BLS only anyway, and get their asses out of bed I need help stat /

Me: or "no rush" I will meet the ambulance @ km 55 on the Willow Creek road, (they showed up L+S anyway gravel spitting everywhere and causing a traffic hazard themselves for a stuck fart abdo pain)

Just saying strict dispatch protocol is just not a replacement for common sence.

(I know, I know just anicdotal)

I agree the more protocol dispatch introduced the more fatal errors will occur, just in response alone.

cheers

Edited March 27, 2009 by tniuqs

[emtannie]

I have worked in a dispatch centre that used ProQA (and still does).

There are several issues with this system...

- to be a fully certified dispatcher, you take 3 weekend courses (a total of not quite 60 hours) to be certified in Fire, Ambulance, and Police dispatching. This isn't education - this is training.

- ProQA is like IKEA furniture - put tab A in slot B, and you will have success..... there is no room for variation, and no room for discretion.

- QA is based on the caller/dispatcher conversation only - when I worked dispatch, we were audited on our calls.... we had to score 84% or higher on our audits - which meant that we asked the questions in the order that the software requires, we coded the call properly, and we confirmed both address and telephone number back to the caller..... NOWHERE were we monitored on our communication with the responding units, and that is part of the problem. Some of the dispatchers I worked with could answer all the questions in the order we were supposed to, could type it all in in the time frames we were were supposed to, but when it came to sending out units, and getting the information to the responding units, they SUCKED.

- this program does nothing to address whether the dispatchers know their region, what units are to respond where and to what kind of calls, and what units are to be backup on those calls.

- this program does nothing to address whether your caller is someone other than a layperson (tniuqs addressed this a little bit) - even if you are a medically trained person calling dispatch, they are still required to ask the questions in order, even though the caller might be requesting "send unit 5B1 to this address as I am already on scene with a 60yo male complainig of chest pain, and is pale, cool, and diaphoretic, and has a hx of MI'... They will still go through the "what is the address of the emergency.... what is the telephone number you are calling from.... what is your name.... what is the emergency, tell me exactly what happened.... are they conscious, are they breathing....."

- the dispatch centre I worked for, and which still dispatches for the region I work in, has dispatched my unit to calls that are 3 hours away, because they don't know the region. They have dispatched me to mvc's, giving "the intersection of highway X and Y" as the location, when X and Y don't intersect. They have argued with me on who to send for backup when I have specifically requested the fire department closest to me.

- Priority Dispatching is not the complete answer. It is a tool, and only ONE tool in dispatching. There are so many more areas that need to be covered in dispatching, and from what I have seen, some centres feel that if they use Priority Dispatching, they have done enough, and that is not the case.

[Richard B the EMT]

I forgot to mention, in my last posting, that the personnel in the FDNY EMS EMD are, at minimum, EMTs, with a few Paramedics on extended light duty.

[NOMedic119]

I dont support priority dispatching having worked for one service that does priority dispatching in rural louisiana and one that doesn't in Urban louisiana for the following reasons. (1) for the most part the person is calling 911 because they are in an emergency although our definition of emergency and theirs may differ they non the less want our help. (2) Dispatchers dont always have the best information and i say dont always respectfully (i would like to say most of the time) so the dispatcher may take information from the patient and interpret it incorrectly causing a delayed response to a serious situation. (3) usually seriously ill patients will try to downplay their illness in an attempt to cope with the situation causing for delayed response. (4) Large Call volumes spending all day responding to a low priority call turning a 30 minute call into an hour call ties us up for a high priority call. (5) we sometimes get diagnoses of patients wrong and were looking right at them how can you expect dispatch to get it right over the phone. All in all i think priority dispatching is dependent on situation an EMS service should decide which one works best for them.

[WolfmanHarris]

Maybe they voted without reading the thread and understanding what was meant. I didn't vote until I'd read the whole thread and it turns out I thought you guys were talking about something else.

Now I learned something disturbing in this thread. I had no idea that there were services out there that not only ran L&S to all calls, but transported all calls L&S. I don't understand why this is happening? Could someone in this sort of system enlighten me as to why you're dispatched this way?

If priority dispatching is not used, does that mean that all responses are L&S or is another system in use that I'm not aware of? Crotch is right that we shouldn't be using dispatch CAD software to patch over not having enough resources. I still think we need something to determine how we respond to these calls. I doubt the public would accept an abandonment of L&S entirely, regardless of the evidence, heck I doubt many services would get behind it, so how can we best limit dangerous and unecessary L&S responses, if not by priority dispatch?

And for FYI:

We use a priority code dispatching system who name escaped me. Something with cards in the title. Technically it has four codes, but the lowest two are never used with 911 calls as far as I can tell.

Code 4- Emergent (Lights with sirens as necessary to clear traffic, intersections)

Code 3 - Prompt (No L&S)

Code 2- Scheduled (IFT's. Some services rarely if ever do these no due to private IFT companies)

Code 1 - Deferrable (Like urban legends. I've never heard of anyone actually get dispatched priority 1 outside of a disaster)

Once we've made patient contact and are transporting, we assign a code for dispatch and a CTAS level (Canadian Trauma Accuity Scale) for the receiving facility. They're coded in reverse with 1 being the most severe. Usually only CTAS 1&2 will warrant L&S and I've had some CTAS 2's that did not.

CTAS 1 - Resuscitation (arrest, pre-arrest, post-arrest)

CTAS 2 - Emergency

CTAS 3 - Urgent

CTAS 4 - less urgent

CTAS 5 - Non-urgent

[celticcare]

LOL@tears

I'm a little surprised that we haven't heard from any of the twelve people -- a significant majority -- who voted that they are for priority dispatch systems. Why don't they have anything to say? Is there something overwhelmingly positive about it that the rest of us are missing? Or is this yet another case of an uneducated majority simply parroting what they've always heard or always done, but not having any intelligent insight into why they do it?

I was one of the 12 who posted Dust, please read my post on the first page and please remember that in 7 weeks I will be an EMD using ProQa and so will be reporting back to you all.

[kevkei]

... CTAS level (Canadian Trauma Accuity Scale) for the receiving facility.

CTAS stands for Canadian Triage and Actuity Scale.

CAEP (Canadian Association of Emergency Physicians) CTAS Info

[RatPack]

I voted yes, I'm not sold on the priority dispatching, I think the general public are poor predictors of whats a true emergency.

I do like the pre-arrival instruction and emergency medical dispatcher portion thats usually included with these programs.

[Dustdevil]

I do like the pre-arrival instruction and emergency medical dispatcher portion thats usually included with these programs.

I do too, in theory. Sounds like a great idea. And it looked great on Rescue 911 in the 1980s. Unfortunately, in twenty-five years of use, not a single analysis has shown any *evidence that it reduces mortality or morbidity, or otherwise improves patient outcomes. Not once. Meanwhile, it's making a tonne of cash for Jeff Clawson, and cost a lot of communities a lot of money on materials, training, certification, and extra personnel that are making zero difference.

* You cand find anecdotal stories of it making a difference. You can also find a lot of dubious pseudo-evidence supporting Priority Dispatch and EMD on the Google, but none that is independent and cannot be traced back to Clawson and his minions.