Lights and sirens

[HERBIE1]

So who gets to talk to the caller when the 911 call comes in? Our calls are recieved by the 911 dispatch center, 30 miles away from us, and they page us out by radio. We don't have the option to ask, "Are lights and siren neccessary?"

I've been dispatched to calls that had me bitching about BS only to arrive and have it be Katy bar the door. One particular call comes to mind, woman cut her ankle shaving her legs, 23 miles out from the station. We grumbled about the BS call we were going to, only to arrive and discover she had an abereant artery and she'd sliced it. Blood bath all over the bathroom floor, she was shocky thanks to her coumadin preventing clotting.

Better in my opinion to err on the side of discretion.

Agreed. All it takes is one mistake from dispatch. Not worth the risk.

[emtgrimreaper]

we don't use unless absolutly a must

[Richard B the EMT]

I'll have to review all preceding this, at risk of repeating myself or others, but, do not most 9-1-1 receiving site operators have some sort of set questions to ask callers requesting an ambulance?

FDNY EMS EMD first asks if the patient is breathing, then if the patient is awake (conscious, numerous people calling in wouldn't know or understand the word, sorry to say). Then, they ask what seems to be wrong with the patient, and from there, per the algorithms book (or program, I haven't been to the EMD in a while) get some kind of determination as to what is going on, and enter the call into the CAD (Computer Assisted Dispatch) system, with a pre-assigned caltrop, priority, and if BLS or ALS is the primary responder for the specific allotrope. The call takers have the option, due to age given for the patient, or other factors told them by the callers, to upgrade the priority.

The algorithms book I used to use at the EMD even had the first aid instructions to give the caller, if the caller was wanting, or willing, to assist the patient until either the BLS or ALS ambulance, or even the First Responder Engine company could arrive onscene.

Having stated all that, I realize there are some individuals who call into 9-1-1, and know the "right things to say" to "insure" a rapid response of an ambulance, usually using the word(s) or phrase(s) "Cardiac", "Heart Attack", "Someone is pressing the guy's chest", or other phrases, which all of us have some favorite one.

As has been mentioned and questioned before on the city, "Gee, ya think the callers might be lying, to get an ambulance to them quicker?"

[CBEMT]

I'll have to review all preceding this, at risk of repeating myself or others, but, do not most 9-1-1 receiving site operators have some sort of set questions to ask callers requesting an ambulance?

Nope. Here 911 transfers the caller to whoever dispatches an ambulance for that community (FD, PD, etc). At that point what questions get asked is purely department policy/common practice, and nobody has actual EMD certified dispatchers (in many places the dispatchers are actually the most recently hired firefighters), and none that I know of give pre-arrival instructions.

At my 911 job the PD dispatcher will get a chief complaint, and most of the time if the calling party reports an unresponsive patient, they'll ask the caller if the patient is breathing.

That's pretty much it.

Edited May 23, 2009 by CBEMT

[HarryM]

Personally I still think it is pretty ridiculous to require L & S to every call. Our EMD system over here requires all EMD's to have a basic first aird certificate and then they are trained in Pre-Hospital Emergency Care (PHEC) which is essentially BLS. The call takers use the ProQA system with callers which automatically gives the call a priority between 1 - 4. The dispatcher then gets sent the job details and dispatches the crews via pagers. The call-taker, dispatcher (and in extreme situations) the crew itself can upgrade to L & S.

For example, the other night we did 10 jobs. 2 of those were L & S and 1 of those jobs was to something that definitely didn't warrant lights and sires. A lot of the P1 jobs probably should have been non-L&S, and only very occaisonally do we get a job that comes through as no L&S that should have been L&S.

[tskstorm]

No matter how we look at it ... bottom line dispatch systems and dispatchers aren't always perfect ...

You need to treat every call as an emergency until you can without a doubt justify there not be a reason for lights and sirens, a few weeks ago I responded to a priority 7 which here in NYC is no L&s ... for someone with a "minor injury" The job text read "minor injury in subway" Upon arrival we come to find out the Patient had a seizure and was falling onto the "tracks" as a train was on coming, the moving train struck him in the head and as he fell back on the platform after being struck it spun him around and sure enough hit him in the head again. Certainly if our dispatch system worked a little better and they knew the situation they wouldn't have sent a BLS crew 100+ city blocks away no L&S, they would send the closest BLS and ALS and a supervisor, plus an engine crew.

Upon your arrival and seeing the patient make your determination if you need L&S making that judgment call without seeing the patient is irresponsible at best.

[robert gift]

No matter how we look at it ... bottom line dispatch systems and dispatchers aren't always perfect ...

You need to treat every call as an emergency until you can without a doubt justify there not be a reason for lights and sirens, a few weeks ago I responded to a priority 7 which here in NYC is no L&s ... for someone with a "minor injury" The job text read "minor injury in subway" Upon arrival we come to find out the Patient had a seizure and was falling onto the "tracks" as a train was on coming, the moving train struck him in the head and as he fell back on the platform after being struck it spun him around and sure enough hit him in the head again. Certainly if our dispatch system worked a little better and they knew the situation they wouldn't have sent a BLS crew 100+ city blocks away no L&S, they would send the closest BLS and ALS and a supervisor, plus an engine crew.

Upon your arrival and seeing the patient make your determination if you need L&S making that judgment call without seeing the patient is irresponsible at best.

WE ASKED the caller.

"Is this an emergency needing red lights and siren?"

If unsure, we asked a few more questions, having already alerted the crew.

My fire department had a great system!

Every fire station had a speaker connected to the incoming emergency telephone line.

We could hear the circuit connect and we could answer the telephone BEFORE it rang!

We could hear the caller talking to our dispatcher.

From what we learned, we.re often on the way to our apparatus before being dispatched.

This is BS - sending a crew AND SUPERVIOSR.

What's da supervisor going to do other than get in the way?

And an Engine crew?

Three vehicles for a bumped head or seizure?

People are sick and tired of all the sirens and emergency vehicles for nothing.

And this waste is what is costing taxpayers so much.

That is the nonsense.

[tskstorm]

This is BS - sending a crew AND SUPERVIOSR.

What's da supervisor going to do other than get in the way?

And an Engine crew?

Three vehicles for a bumped head or seizure?

People are sick and tired of all the sirens and emergency vehicles for nothing.

And this waste is what is costing taxpayers so much.

That is the nonsense

Getting hit in the head by a moving train is considered a bumped head to you ?

Obviously you never worked in a system with a subway as the vertical challenge(multiple flights of stairs where pedestrians are still walking) alone requires a minimum of 4 people to successfully and safely remove a patient on a long board.

Other thing is you must not be thinking about response times, 100 city blocks takes a good 30 min. with medium to light traffic and no L&S. An engine crew can be on scene in under 5 min. Supervisors are sent on jobs like this for many reasons I wont pretend to know them all I do know is If the supervisor is there with the Engine company they can initiate patient care while the ALS and BLS get to the scene. Here none of the firefighters are EMT's or Paramedics or even if they are they are not working in that capacity and usually equipment is limited to an oxygen bag.

By people who are you referring to? Are you referring to the people who complain about our 6-8 minute average response time not being quick enough ?

Edited May 24, 2009 by tskstorm

[HERBIE1]

Getting hit in the head by a moving train is considered a bumped head to you ?

Obviously you never worked in a system with a subway as the vertical challenge(multiple flights of stairs where pedestrians are still walking) alone requires a minimum of 4 people to successfully and safely remove a patient on a long board.

Other thing is you must not be thinking about response times, 100 city blocks takes a good 30 min. with medium to light traffic and no L&S. An engine crew can be on scene in under 5 min. Supervisors are sent on jobs like this for many reasons I wont pretend to know them all I do know is If the supervisor is there with the Engine company they can initiate patient care while the ALS and BLS get to the scene. Here none of the firefighters are EMT's or Paramedics or even if they are they are not working in that capacity and usually equipment is limited to an oxygen bag.

By people who are you referring to? Are you referring to the people who complain about our 6-8 minute average response time not being quick enough ?

This is all about show. It is a given that there are NEVER enough ambulances- especially in a busy urban system, so the powers that be make a show of force and send fire apparatus with varying levels of medical training to provide initial care until an ambulance arrives. Administration can say they are doing the best they can with their resources, but in the end, as we all know, you still need a transport vehicle. When EMS is fire based, it will ALWAYS be second on the list of their priorities, despite being the vast majority of the call volume and that is the age old problem.

As for supervisors, it depends on their role. Is it strictly supervisory, or are they actually equipped to provide care? Here, our supervisors are only to handle administrative issues, conflicts, or coordinate large numbers of patients- they do NOT provide patient care.

Yes, in an urban setting with 4th floor walk ups, subways or elevated train platforms, difficult access situations, providing protection on a highway scene, CPR- more bodies are needed, but I agree it looks silly when 10 people show up for a little old lady with a tummy ache.

[Richard B the EMT]

No matter how we look at it ... bottom line dispatch systems and dispatchers aren't always perfect ...

... a few weeks ago I responded to a priority 7 which here in NYC is no L&s ... for someone with a "minor injury" The job text read "minor injury in subway" Upon arrival we come to find out the Patient had a seizure and was falling onto the "tracks" as a train was on coming, the moving train struck him in the head and as he fell back on the platform after being struck it spun him around and sure enough hit him in the head again...

1) Correct, no matter how good a dispatch center and it's crew are, there is always going to be room for improvement

2) Transit just has a link to send the assignment to the "Relay" position in the EMD. They rarely if at all talk to anyone in the EMD.

3) Even with me being a former call taker in the FDNY EMD, I thought a minor injury was at least a priority 5, which still has a L&S response.

4) That person, while starting out as a seizure call, was hit by a train! Someone dropped the ball, and badly so, as I'd think a person hit by a train would be a Major Trauma, at Pri ONE! BLS, ALS CFR Engine, EMS supervisor, hell, add a truck company. That was a big time call.

4A) Tskstorm, if available, could you provide a link to any newspaper stories on that job?