Dispatch sending doctors instead of ambulances

[JPINFV]

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.

Maybe in my young age I'm just being a tad nieve and ignorant (won't be the first time, to be honest), but aren't x-ray machines starting to get small enough so that you could probably set up a boom arm on a track in the ceiling of an ambulance? Done with the x-ray, secure the boom arm and slide the carriage forward out of the way? With ultrasound machines becoming smaller and the introduction of hand held blood testing machines (I-Stat, for example), we are starting to be able to take diagnostic tests to the patient instead of taking the patient to the tests. I don't think it would be too long (decades, sure, but that's short in the long run) till we see the "medical center in a glove" that they had on the TV show Earth 2.

To be honest, I think economics might be a bigger problem. A healthcare provider in the ER sees several patients at the same time. A mobile fast track/urgent care center can only see 1 patient at a time. You lose the economy of scale that the ER has when you go 1 on 1 with the patient.

[MadMod]

Actually, there are mobile X-ray machines. There are companies that provide this service to nursing homes and what-not. Unfortunately, the equipment takes up the back of a Ford E-350 van.

Years from now we will look back and wonder how we ever got by without all the small sized equipment. We still have an old Data-Scope monitor we hang onto as a collectors piece and to show new Paramedics so they'll quit whining about the weight of the LP-12.

Dispatch diagnosisng over the phone will always have one major variable: the caller. Either the caller doesn't understand the urgency or lack of during a call, or they "don't want to be a bother." They will get confused or led by the call taker. Those of you who use a priority dispatch type system: think about how many times you get dispatched to a resp distress or chest pain call only to find something completely different. I think it's mainly because the question is asked if the patient is having trouble breathing. "Why come to think of it, I am breathing a bit fast" or "you know, mother does look like she is". "Are you having chest pain?" "Holy crap, I am!" People in a time of "crisis" can be easily led. And even though WE know it's not a crisis, the caller doesn't. No matter how minor the emergency is, to the caller it's the single greatest focused moment of their life to date.

Systems based on statistics mean someone will make a mistake one day. If 95% of the time the system correctly identifies the problem, 5% are going to have a day that's just getting worse.

Ask yourself this: does your dispatch center "grade" their calls? Now, do they "grade" on if what was dispatched what was really found? I'll go on a limb and say no. I suggested this in a staff meeting one day. You would think I also suggested giving the employees a 100% raise and that they no longer had to wear uniforms. We place all our faith in we're right, we don't want to know the ugly truth.

One thing that bothers me about the original idea of this thread, some private company will be competing with the EMS provider for revenue. We generate by transporting, they by assessing and refering. Any guesses who will be cheaper up front? Somebody is still going to get charged. This may hurt the local EMS in the long run. If you start "reserving" the EMS for the "real" calls only and turf everything else to this company and a contracted private transportation company, you just gave the local city or government good excuse to hire a couple of more FD guys and some really cool ambulances. After all, an EMS company would be seen as a waste or a duplication of services since the firefighters are just waiting for a call.

[UMSTUDENT]

I think imaging technology will be relatively small within the decade. I wouldn't be surprised if it reaches hand-held size within fifteen years.

I remember reading in a magazine recently that mentioned a UK company who is developing a handheld devise that can identify common infectious agents from small blood samples. It uses holographic technology to compare the image of the microbe with those stored in a database. It was specifically being marketed for use in EMS...

Imagine being able to hold a small device the size of a radio that tells you blood gases, CBC, Chem-7, and whether or not your patient definitively has pneumonia. We write a script for an antibiotic and go on our way with a relatively high level of confidence that our diagnosis is correct. Think about a device that could compare patient blood chemistry with a list of possible syndromes and determine a list of differentials.

I recently heard about a company developing a vest that can deliver an 80-lead ECG. The technology is being developed; EMS just needs to push for higher education so these devices can be properly used. All of the technology in the world doesn’t replace a properly educated provider.

[everyminutesucks.com]

Hello everyone.

I am a dispatcher in Minnesota and we DO use a priority dispatch system. I don't care for it at all myself because it was designed to be used by dispatchmonkeys with no ems trainging at all. I understand the need since most dispatch centers have a severe problem getting qualified applicants and often have to resort to the undesirables to fill a seat.

This is the first that I have heard of this program and if it were used properly it could help. BUT that would mean fixing the problems that are already abundant in the system. Undertrained employees, undisiplined employees. The same things that you are worrying about with the different system are already a problem. We have other services in the area that will determine that a 911 rig is not necessary and will a) set up another service with scheduled units to pick up the pt when they can get to it they will tell them to call themselves.

This does not reduce the transports to the hospital but it does lighten the load on the 911 rigs. I think that it is a MAJOR problem because they will often tell them to call us to see if we have an interfacility bls rig available and we will pre-arrival the call again and determine that it should have gone with the original service via a 911 unit. Since we can't send one of our ALS rigs due to PSAs we have to tell them to call 911 again. It sucks, it is terrible pt care and these other services (which are state/county services not private) should be sued or held accountable in some other way.

The only way that I would endorse a system in which they were sending non emergent MD/RN/NP to the scene was if it was still in the same timely manner that you would send a rig to the call routine. It would still have to be an immediate response and they would have to have the ability to transport themselves if they needed to. While there are a couple of dispatchers that I work with that I trust to properly triage a call because they have street experience and have shown to be competent and they do not trust the software we use either and will happily override it and send a rig lights and sirens instead of routine, most of the rest have probably contributed to the death of a pt at one time or another already. (sorry for all of the ranting.... can you tell I love my co-workers :wink: )

Anyways as I was saying the program could help to reduce some of the unneeded costs but it should not cause a delay in the response of whatever type of unit being sent. The pt should always come first. While I do think you can triage some calls over the phone it should mainly be to give additional help WHILE someone is on the way. Not be used to delay care. There are just too many calls that I would be stumped if I were on scene myself, let alone over the phone. There would be too many mistakes made.

You call. We haul.

[DwayneEMTP]

I think imaging technology will be relatively small within the decade. I wouldn't be surprised if it reaches hand-held size within fifteen years.

Asside from being able to point and say "Hey, look, it's an xray!", I really know nothing of xrays.

I do know however that Vets have used a portable xray for quite a while (I've seen them perhaps for the last 10 years or so, though they are far from standard on most trucks). It's maybe 18" x 18", and they are able to carry it easily. It's set up on whatever is handy at the level needed, and then xraying seems to occur, and the Vet tells you his/her findings in a few minutes. I'm not sure of the quality, and I've only seen it used on the legs of horses...but I thought I'd mention it in case anyone found the info useful.

Have a great day all!

Dwayne

[Chrisclark]

Yeah, everything is smaller now, and it is only going to get smaller. However, ion our current system the average medic does not have the training to operate an x-ray.

[mediccjh]

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

Someone's gotta drive the bus.

[kristo]

Asside from being able to point and say "Hey, look, it's an xray!", I really know nothing of xrays.

Pretty simple technology, just place something that emits a known dose of radiation that can penetrate a human (x- or gamma rays) on one end, a radiation meter (probably a simple Geiger-Muller counter) on the other end and see how much gets through at different places - then you get the density of the specimen (patient) in between. Where a lot gets through, it's just air. If a little less goes through, it's soft tissue. Where very little goes through, it's a bone. If a bone looks non-continous or malformed where it shouldn't be, it's broken.

On the topic, ultrasound would probably be easiest, not to mention safest, imaging technique for use in EMS. That just means sending sound (in a higher frequency than the human ear can detect) through tissues and assessing what's in it's way by the frequency and latency of the echo (simplified). When the frequency of the echo is taken into account, it can also assess things like blood flow, which is pretty cool. This is the only imaging technique that's not using ionizing radiation, that I see fit for EMS use (MRI uses magnet fields and radiowaves, but we won't ever see that or even need it in EMS). I can totally see a small screen next to the cardiac monitor in an ambulance with a small pad attached, which can be used to take a peak into someone's lungs or whatever. It's not perfect, but it would probably give us something to go by.