Dispatch Dictators

[carolinagrl]

My partner and I responded to an unresponsive woman--massive CVA. He needed to use RSI on her and asked me to call for another paramedic, per protocol, for backup. When I call, dispatch asks me what is RSI--as in why am I calling for another medic. The other night during snow storm she argued with a unit about sending fire dept, when they requested them--they didn't get any help. In fact they were told to leave the scene and return to their call area with two people trapped at the bottom of a ditch for 45 minutes. I'm assuming they weren't injured but.... Anyway since when does dispatch dictate what resources I receive?? My partner and I sent in a formal complaint and they were "exonerated" so I guess someone with little or no training and zero field experience can tell me what I need on a scene. This is a county EMS system and I come from a combined system-fire/ems. If they don't understand what I've asked for and need clarification that's one thing but DO NOT sit in the bat cave and tell me you know better than I do what I need!!! Typically the only reason we ask for help is if we are up to our as- in alligators. I don't have time to explain to you what a RSI is and you do not need to know. We don't have any first responders ems or otherwise. This is a rural area and the next closest help may be 15+ miles away. I haven't gone and jumped up and down in the office yet and probably won't cause I like a paycheck. Anyway has anybody else run into this? Can anybody think of a logical professional sounding arguement to make to management? I seriously can't believe I need to say that but... I want to say ARE YOU INSANE?!!!

[MS Medic]

I have experienced this problem. I worked for a large corporate service (insert appropriate letters) Management only imposes the controls that were required when dispatch alsmost caused them to fail their last CAAS inspection. I have had dispatchers do everything from refuse to send fire for lift assist on bariatic pts to telling me that I did not need LEO on a psych pt and that they were not going to call and I was not to stage. When you logged a written complait with managment, it was filed in the shred box but only after the dispatch center learned you complained. When you coupled this with the fact that they ran modified system status management and you can imagine the fun of working there.

(I am sorry for any misspelled words or typos. I am at work and the company firewall will not let me download the spell check.)

Edited February 21, 2010 by MS Medic

[HellsBells]

Wow! I can't imagine a system where dispatch dictates what type of assistance you need on a call. We have some problems with dispatch, but I could not even concieve of a situation where they would refuse to send help that was requested by the crew. Its a safety issue for both crew and patient.

My advice, if you are looking for a logical argument (although it doesnt sound like logic is your managements strong suit) is to fall back on the RSI protocol. It states that you are to have medical back-up for all RSI's. So if you are denied back up, then you are technically in violation of company policy. In that case either the protocol needs to be changed or dispatch has to be educated about what an RSI requires, in terms of manpower. If this argument fails to impress them, I would seriously think about leaving, as these ignorant dispatchers put both you and your patients at risk.

[JPINFV]

RSI protocol = addition paramedic.

Medical director writes medical protocol.

Dispatch failing to dispatch additional paramedics without reason (was there any paramedics within a reasonable distance available to be dispatched?) means that medical care was compromised.

Go up chain of command, terminating at medical director if need be.

[DwayneEMTP]

RSI protocol = addition paramedic.

Medical director writes medical protocol.

Dispatch failing to dispatch additional paramedics without reason (was there any paramedics within a reasonable distance available to be dispatched?) means that medical care was compromised.

Go up chain of command, terminating at medical director if need be.

Nod..what Jp said..

[fiznat]

I work for the big bad 3-letter corporation as well and we never have trouble getting the resources we ask for. Sometimes the dispatcher will try and play games, say something like "it's going to be a little while" or "can you try to manage it on your own," but if we really need the resources than the reply from us is always the same. I've found that at least part of the responsibility for maintaining this standard falls in the hands of the crews. If a crew folds when a dispatcher gives them trouble, than that dispatcher will think he/she can do it again next time. We have some issues with solidarity in our rank and file, but not when it comes to this. If someone asks for resources, they won't allow themselves to be unreasonably denied.

I understand the environment is different everywhere you go, but if you need help then you need the help, and I don't see anything wrong with getting a little short with dispatch over the radio if they are going to start messing around with you.

[Richard B the EMT]

FDNY EMS Command doesn't want us dictating what assistance we need, so we have what are seemingly reasonable wordings.

The bariatric patient? Don't request an engine company, request "additional manpower". You'll probably get the engine anyway, or a BLS ambulance (even if you ARE a BLS).

The engine is automatically dispatched for a cardiac call (actually getting the assignment first).

If a call goes south, and my BLS requests Paramedics, dispatch might ask the condition, but unless there is no Paramedic team available, we usually get one.

On that last, if the wait for Paramedics to arrive at the scene is longer than L&S transport, or enroute intercept, BLS has authority to "Load and Go". Just keep dispatch advised.

I have heard one BLS unit ask for the Paramedics, when asked for condition, answered, "Need the medics, because I don't have a clue what is going on with this patient!"

[JPINFV]

I have heard one BLS unit ask for the Paramedics, when asked for condition, answered, "Need the medics, because I don't have a clue what is going on with this patient!"

Valid reason. Sometimes spidey sense goes off and you just can't place why. I don't know if I'd have worded it that way though...

[Richard B the EMT]

I requested LEO backup for the same reason, "Something seems 'off", I am not making entry without them". NYPD understood my concern, but it turned out to not be a problem needing them.

Rather safe than sorry!

[KCH11]

As both an EMT, FF, and dispatcher for fire, ems, and law enforcment, I can tell you that thing are not always as they appear which is something that I did not really know till I started working in the bat cave myself, I would love to send everything that anyone asked for but sometimes I just dont have it, or sending it will take away something from my system that I need to get something else done, Its kind of like playing a game of chess, and sadly we never have enough pieces. I know that sound cold, but I can tell you a couple of things If you are in trouble I will always send help, If I have to leave the bat cave come out there and throw a radio at them I will, If I have it and you ask for it, and I dont send it to you there is a reason, it could be that I am watching one of the call takers take a call for there area, I may have them staged in there station because pd is down the road on a high risk warrant, and Instead of paging them out and waking them up I decided that they could sleep, because I trusted them that when I hit that tone they would be out of that station in less than a minute. When you go to an assault and I dont send first responders, It may be because I have already talked to the deputies and Its just b.s. and there is no reason to put additional units on the road that have the potential to run into one another, (yes it happens alot) or cause a wake related accident, In its best form a system status controler, aka dispatcher (or as I prefer to be called radio) has the duty to look after the system, balancing the risk vs rewards of everything that happens in the system, I can not tell you how well it works in your area, sometimes I can not tell you how well it works in my area, I can only speak for the ideal and the ideal is good, it involves protocals, balanced by discretion. It depends on the medical director, control center, management, and the field crews all working together to take what has historcally been a system of a single ambulance going to help a single pt to an operation that is multi faceted, working to service an area with a well balanced responsive system that looks at the needs of a whole community.