Alberta new improved Dispatch System

[tniuqs]

Problems plague EMS dispatch after provincial takeover

17 FEBRUARY 2010 BY DON PATTERSON - STAFF REPORTER NO COMMENTS 1,071 VIEWS

It was a harrowing 45 minutes as MD resident Willy Gannon waited for an ambulance to arrive at her home about six minutes west of Okotoks, because of confusion over directions. She called 911 after her husband began complaining of feeling dizzy, he showed a “scary” high blood pressure and he was vomiting. Her husband has had two heart attacks in the past.Gannon provided directions to her home west of Okotoks, just off Secondary Highway 549 as well as her MD street address and was told they didn’t make sense.

Willy Gannon says the Province should have waited to take over responsibility for dispatching ambulances in October after problems the service has faced since that date. The MD resident waited 45 minutes for an ambulance in December.

“I gave them that number and the lady said to me… “Yeah, but where do you actually live. What’s your exact address?” she said. “She said ‘that doesn’t make sense to me.’”When the ambulance didn’t arrive after 30 minutes she called 911 again, stayed on the line with emergency operators, talked to paramedics and the ambulance arrived about 15 minutes later. Gannon’s husband was taken to Foothills Hospital and was ultimately okay.“It was nothing serious, but it could’ve been. Had it been another heart attack, he wouldn’t be here today,” she said. “It was very frightening and very unsettling.”The incident occurred as problems facing the Foothills Regional Emergency Medical Service (FREMS) have mounted since the Alberta Health Services took over responsibility for dispatching ambulances in the region. Last week Fred Stegmeier, FREMS executive director, gave MD of Foothills council a list of some of the problems the rural ambulance service has faced since a new dispatch centre opened in Calgary in October.

The list of problems Stegmeier presented to council include:

* They handed over the computers from their ambulances in October to be reprogrammed and they haven’t been returned yet.

* Paramedics have had to use paper maps to find where they are to respond.

* They had to switch over to a Mike radio system, for which coverage doesn’t extend west of Highway 22, including the Eden Valley Reserve. He said they have asked to have the coverage area extended. In the mean time, they continue to use their former radio system in some areas to talk to the FREMS dispatch centre, where operators then forward information on to dispatchers in Calgary.

• There have been occasions when firefighters have arrived at a scene before ambulances.

“We were promised a seamless transition of service without any degradation of service and that has not occurred,” said Stegmeier.

As part of plans to hand over responsibility for ambulance services to the provincial government in march, a new ambulance dispatch centre for southern Alberta opened in Calgary on Oct. 29. Prior to this date, the Foothills Regional Emergency Medical Services (FREMS) handled the dispatch for ambulances in its own call centre in Black diamond. Ambulance dispatching call centres are being centralized in Peace River, Edmonton and Calgary with the Calgary location handling calls from southern Alberta.

One of the biggest problems has been with mapping and dispatchers in the city don’t understand rural addresses and legal land descriptions.

Stegmeier said only 10 of the 108 operators have been trained on rural addressing. As well, he said FREMS has been told the computer systems will be upgrades to handle rural addressing, but it won’t be until the fourth quarter of this year.

Jim Garland, director of dispatching for Alberta Health Services, acknowledged there have been problems to date, but they haven’t resulted in a negative impact on patient care. He met with FREMS officials after the MD council meeting and have laid out a plan to address concerns in five areas: Automatic Vehicle Locating (AVL) technology, Mobile Data Terminals (MDTs), addressing, reporting and radio coverage.“I agree that, from the FREMS perspective, the planning around things like the MDTs and the AVL, we ran into issues with that that we hadn’t planned on and as a result there have been delays,” said Garland. He said some of the issues will be addressed by the end of the month. According to Garland, dispatching for FREMS was handed over early because there was some experience sending ambulances to locations in the foothills from Calgary.

He admits there are issues that could have been handled better before hand.“In hindsight, would it have been better to address some of these issues going in – for example the issues around technology – I would rather have done that, yes,” said Garland. He said the consolidation wouldn’t have gone ahead if there was a question of not being able to respond to emergency calls or to get ambulances out. MD Coun. Terry Waddock said the decision was made to transfer dispatch over the MD’s objections.“The fact is since the end of October, we have had 50 to 60 incidents where we haven’t had our preferred standard and that means that in terms of getting an ambulance where it’s supposed to go or on time,” he said. Waddock said they’re fortunate there haven’t been any major incidents to this time. Kevin Taft, Alberta Liberal Party health critic, said it’s life or death issue and the Province should have made certain everything was ready before moving dispatch.“It’s gotta be handled better than this. Frankly, there’s, in my view, no excuse for these kinds of problems,” he said. Taft said the Province should have listened to those who were calling for the process to be slowed down.“There should’ve been a lot more respect for local input and if they haven’t over-centralized control then there would’ve been,” he said. In the end, Gannon wants to make it clear that she doesn’t fault the paramedics and EMS. She said it’s not their fault the system isn’t working properly.Ultimately, she said the Province should’ve waited.“If it’s three months and they still don’t have their act together, this is not a good thing,” she said. “I hope they get it resolved sooner than later.”

[emtannie]

Although there are going to be a lot of glitches when the province completely takes over dispatch, the incident quoted above happens in dispatch centres across the province already, even without the regionalization.

In the years I have been working rural (which is *ahem* a long time, because I am old... ) I have responded to more calls than I can count, where dispatch f***ed up directions, locations, and even what the chief complaint is. It has less to do with provincialization, and more to do wsith inadequate training of dispatchers. Patient care has been compromised in many many situations, not due to EMS, but due to dispatch. Too many dispatch centres do not appropriately educate their staff in learning the region that they cover, legal land locations, major landmarks, or even the distances to hospitals from specific areas.

Given that the dispatch centre that covers where I work is an organization of complete incompetence, I am almost afraid to admit that I am looking forward to regionalization of dispatch, because it can't be worse than what we have now.

[tniuqs]

<snip>

So with over runs in "restructuring", then cuts to AHS in dispatch alone. Do you think that training will be the priority ?

Perhaps look to the fine example of centralized dispatch that BCAS when they tried it with Victoria Dispatch ... oddly enough they went back to regions. Just like Druckmans concept of Centralizing Health Care ... FAIL already.

Then the bail out to somehow cut waiting lists for surgery in one blitz campaign when the new Super Board caused this in the First Place.

I smell a very short thinking Stellrat, padding support for an upcoming election then back to status quo.

cheers

Do something fast as a stop gap, it never solves a long term problem.

[rock_shoes]

Perhaps look to the fine example of centralized dispatch that BCAS when they tried it with Victoria Dispatch ... oddly enough they went back to regions. Just like Druckmans concept of Centralizing Health Care ... FAIL already.

I can honestly say the current dispatch system in BC works reasonably well. The problem most of the time is not having enough staff both in dispatch and on the road. Also the chosen CAD heads in the cars are garbage. Occasionally they work, often you still take dispatch information by voice. As to the poor crews having to use paper maps now oh my. We never switched from paper maps. Even in downtown Vancouver.

It's the AMPDS call taking system that's killing us. BCAS dispatch used to allow properly trained call-takers to make call triage decisions. This actually resulted in one of the lowest dispatch call triage error rates in the world. Then, for "liability reasons", the call-taker centered triage was scrapped in favour of MPDS. Now our call-triage error rate has skyrocketed. Scrap the human factor to reduce liability and increase error rates as a result. Makes sense doesn't it?

[Happiness]

Im so glad that I work in a small town. I have in 14 yrs only had one bad dispatch call out were they called us for another town. I did catch it because it was an Avenue and we dont have any. My other solution is to ask for a pt name if it is available, but if I really dont know where Im going i call my husband he worked for public works and knows all the names of the streets. I know this dosnt work for many communities but does work for ours.

[thrutheashes]

Well I was all set to post in here how dispatch can't be blamed on everything, and that the information they supply is only as good as the information they recieve. And I suppose to a certain extent, this is true.

However after being sent out on a call in the fog and icy roads this evening, for an address that doesn't exist, and with a call back number that is disconnected.....You kind of have to wonder. My partner and I were looking for this address for close to 30 mins. I contacted dispatch and told them that our information is not lining up, are you SURE the call is in our town?And the answer was yes. So we looked, and looked, and finally realised that the first 3 digits of the non-functioning phone number may belong to the next town over. In this day and age of cell phones though, nothing is a guarantee. As I called dispatch to check on the posibility of this, when I got to them they told me that they had indeed called out the wrong unit, and that we can stand down, and that the appropriate town service is being called.

Total elapsed time from call recieved until this revelation, 49 minutes..........

It was for a minor call, however had this been someone haveing a cardiac arrest......well that's just frightening.

I have no idea what could have been done dfferently on our end, as I did question the address, I asked for the call-back number (which I believe was copied down wrong by dispatch as I verified it x3 with them, only to find it not in service.) I contacted a local member of our service to see if they had any insight into where our call may be located based on address, , and I even question dispatch as in whether or not they were sure they had the correct town.....as well my partner contacted people they knew in the area to try and narrow down our search area, as of course to top it all off, dispatch reported that there were no bldg numbers on the location in question.

any thoughts, as I've had dispatch screw-up before, but this is definitely a gooder.

[emtannie]

Well I was all set to post in here how dispatch can't be blamed on everything, and that the information they supply is only as good as the information they recieve. And I suppose to a certain extent, this is true.

However after being sent out on a call in the fog and icy roads this evening, for an address that doesn't exist, and with a call back number that is disconnected.....You kind of have to wonder. My partner and I were looking for this address for close to 30 mins. I contacted dispatch and told them that our information is not lining up, are you SURE the call is in our town?And the answer was yes. So we looked, and looked, and finally realised that the first 3 digits of the non-functioning phone number may belong to the next town over. In this day and age of cell phones though, nothing is a guarantee. As I called dispatch to check on the posibility of this, when I got to them they told me that they had indeed called out the wrong unit, and that we can stand down, and that the appropriate town service is being called.

Total elapsed time from call recieved until this revelation, 49 minutes..........

It was for a minor call, however had this been someone haveing a cardiac arrest......well that's just frightening.

I have no idea what could have been done dfferently on our end, as I did question the address, I asked for the call-back number (which I believe was copied down wrong by dispatch as I verified it x3 with them, only to find it not in service.) I contacted a local member of our service to see if they had any insight into where our call may be located based on address, , and I even question dispatch as in whether or not they were sure they had the correct town.....as well my partner contacted people they knew in the area to try and narrow down our search area, as of course to top it all off, dispatch reported that there were no bldg numbers on the location in question.

any thoughts, as I've had dispatch screw-up before, but this is definitely a gooder.

Ashes, not sure where you are located, but this could have been solved by your dispatch centre using the ANI-ALI system (I can't remember what that stands for, but I am sure someone will remind me)... what that does, is any call that comes into dispatch shows up on the screen of the dispatcher's computer. The phone number, address, and name of the person whose number it is shows up, if it is a land line. If it is a cell phone, the phone number and the carrier (Telus, Bell, Rogers, etc) shows up, and the tower location they are bouncing off of. At least if that cell phone caller doesn't know where they are, it is a starting point. There is nothing more you could do in the situation you had. You used all the resources you could.

If your dispatch uses this, the call you described should have never happened. The dispatcher would have been able to tell if it was a cell phone or not, and they would have had access to the number called through the entire incident, as it would have stayed on their screen. If it was a land line, the exact address would have shown up too, and they could have referred back to it. This gives no chance of human error by copying down a wrong address or phone number, or the caller giving completely wrong information that is unable to be verified.

Now, having said that, there are so many other ways that dispatch can mishandle a call - paging out the wrong crew is a big one. I have had many calls where I have argued with dispatch that the call is not in my area, and they have argued with me. Since I have worked in the dispatch centre here, I tend to tell them to turn around, pull the big wall map down from the ceiling, and look at a certain area, which I describe to them... within a few seconds, I get the "your unit can stand down, and we will page unit XYZ."

One of the biggest problems our dispatch centre has is staff turnover - they have almost a 50% staff turnover every 3 months... this has been going on for at least 5 years, and the powers that be haven't done a thing about it. Obviously, with that kind of staff turnover, there are administrative issues. Having worked there, I can tell you what they are, but that would take a whole other thread. With that kind of turnover, and shortened orientation times, staff do not know the region, they do not know how to read maps, and they end up on a desk before they are ready. Add to that the politics that goes on in that department, and it is a recipe for disaster.

The provincial dispatch centre is going to have a number of wrinkles to iron out, but that does happen with any change. I am hoping that it will be better than what I have in my area right now... because my head is starting to bleed from banging it against the wall...

[Siffaliss]

ANI / ALI = Automatic Name Indicator / Automatic Location Indicator

[Kiwiology]

New Zealand made the switch to nationwide AMPDS use in ... 2007 I think, with AVL and MDTs being completed last year but we've been using ANIALI for years.

Now this might be a bit of a generalisation but call takers are trained in AMPDS compliance so they can get stuck in a cricle going round-and-round getting an "exact address" that will verify in VisiCAD or w/e it's called these days and if that doesn't happen AFAIK no resource gets deployed because "we cannot send somebody to somewhere we can't find [in CAD]". In the old days when we had ambos on the phone in regional centres there was a bunch more local knowledge and less reliance on making the software happy.

This has happened here with Ambulance, and Police too.

[a_shane2_go]

Do you know what I think of this new dispatch system? *GAG ORDER* .....

"Joe McWilliams Lakeside Leader

According to Slave Lake town councillor Rob Irwin, the level of ambulance service being provided in Slave Lake has taken a big hit since the province took over the management of the service last year. Irwin vented his dismay for the record at

council’s Jan. 19 meeting.“The province promised the service would not decline,” he said.“I’m hearing we’ve gone from eight paramedics to two.”The result of that,

Irwin asserted, is that 90 per cent of the calls the ambulance service responds

to do not have the ALS (advanced life support) rating, but are of the basic life support (BLS) category. The percentage had been the reverse previously,he said.

Irwin said he’s also hearing that response times are slower than previously. The circumstance has arisen, he said, in which the nearest

ambulance to Slave Lake was an hour-and-a-half away in High Prairie!

“Not only that,” Irwin continued. “Equipment,some of which was locally fundraised for, including ambulances,has left town.“It’s a shocking and horrible situation,”

Irwin said, not mincing words in the least. “The service has been decimated

since the takeover by the province.”The impression is apparently not an isolated

one. Mayor Karina Pillay-Kinnee said it was brought up by other communities at an Alberta Urban Municipalities meeting, with provincial health officials in attendance.

Please see Page 3"

http://www.lakesideleader.com/2010/100127/week4.pdf

Edited March 4, 2010 by a_shane2_go