Dispatch sending doctors instead of ambulances

[BEorP]

^ My grandmother is much more likely too call me if she is having chest pain than to call 911. If 911 would send a doctor, she would still probably call my cell phone.

Honestly, I would rather have her call me than anyone else.

Do you keep drugs with you while you're off duty?

[Chrisclark]

Course not

She has problems calling 911. When I was in high school she would call my cousin, who is a nurse in Louisiana. And if she can't get ahold of anyone, she just sits there and says "I wonder what I am going to do."

At least if she calls me I can tell her to call 911, call 911 for her, tell her to take her nitro, drive over there, calm her down. That kind of stuff.

Her of her husband do not trust doctors. Her husband died on the side of the road sitting on a curb because he would not have a valve replacement.

[JPINFV]

I wounder if this would work better if ran though a hospital based program. If the ambulance is already leaving from the hospital then why not load it with a NP/PA/MD/DO and a EMT-P instead of 2 P's. You should still have the same response time, but more could be done on scene, including definitive treatment. If the patient needs to be admited or is more serious, then you still have a paramedic and a NP/PA/MD/DO on scene to treat and transport.

[Dustdevil]

Their concept though is to eliminate EMS involvement altogether, beyond call taking. And you wouldn't have room to transport after you stick in the x-ray machine and other diagnostics they are bringing.

Yeah, one of two things is going to creep its ugly head into this situation. If they're lucky, it will be NPs arriving two hours after the initial call, finding a really sick patient, and calling EMS back to send medics. If they're unlucky, it will be either NPs arriving to find dead people, or finding really sick people but not calling EMS for them. Either way, the patient is getting screwed.

[zippyRN]

look at some of the emergency care practitioner schemes in place in the UK ...

there is also the aspect of making sure that EMS staff have the training and education to identify patients who

a. may be better served by this kind of service

b. are fit to be left at scene to be followed up

c. are happy to do this

some times this may be identifiable from the original call, especially if there is secondary triage by a Health professional clinical advisor with appropriate skills, knowledge and experience once MAPDS has identified it as a lower priority call.

in other cases it may be appropriate to send the closest provider to make a face to face assessment and then confirm the priority and organise follow up at home, or organise Middle tier or Patient transport service transport to the approrpaite recieving facility ( not necessarily an major ED - minor injuries unit / urgent care centre / ealk-in centre etc as appropriate ...

EMS are already finding dead people at home becasue of system failures such as the family doctors who diagnose over the phone and book admission and transport 'within 4 hours' .. middle tier crews turn up withinthe 4 hours and find the patient has deteriorated and end up calling for A+E vehicle or transporting and coming to the resus room rather than the booked inpatient unit

- do we really need to haul grandad across town if it;s clear he slipped on the frosty path and is an isolated ankle injury? ( needs a trip to the closest X ray machine and a POP if he has broken it , as well as a mobility assesment to check what if any walking aids are needed )

- do we really need to haul grandma across town when it's clear she got the pre-tibial laceration on the nail sticking out the corner of the table ? ( needs someoen to come and sort the pre tibial lac, do a brief mobility assessment and organise follow up to make sure the wound is healing nicely and change dressing etc.)

[DwayneEMTP]

I found the make-up of the team interesting...What is the thinking behind having an MD,NP, and medic? Wouldn't the medic be redundant?

Dwayne

[Dustdevil]

- do we really need to haul grandma across town when it's clear she got the pre-tibial laceration on the nail sticking out the corner of the table ?

Ahhh... but you miss the point.

The question is, can we really determine that is the case on the telephone? Case after case tells us the answer is 'no.'

[zippyRN]

Ahhh... but you miss the point.

The question is, can we really determine that is the case on the telephone? Case after case tells us the answer is 'no.'

this issue arises with telephone triage - but the system issues other than telephone vs face to face traige are ery valid - however this also means transforming 'ambulance' care ...

[BushyFromOz]

Telephone v face to face triage is a mute point as in the end only 1 will be efficient (and even that is/can be sketchy)

[BEorP]

Ahhh... but you miss the point.

The question is, can we really determine that is the case on the telephone? Case after case tells us the answer is 'no.'

I would also add that, IMHO, if grandma wants to go to the hospital then we should not hesitate to haul her across town.