Pre-Arrival Instruction

[brentoli]

For the 911 people. Does your dispatch do pre-arrival EMD? (Emergency Medical Dispatch)

Aside from CPR, do you see it making much of a difference?

I have noticed, since I work on both sides of the radio, when I pull up on a call sometimes it seems like there is nothing that has been done. And when I hang up the phone with a 911 caller, sometimes I feel like I didn't make any difference in the outcome.

Opinions?

[Dustdevil]

Ah, controversy! I love it!

It has been awhile since I visited this one, so I concede that some valid and definitive research may have occurred in the last two years that I am unaware of. That said, you can spend the rest of the week searching the literature and you won't find a single paper that validates the efficacy of the EMD concept. Yes, you will find a lot of anecdotal stories. And yes, you will find a lot of "scientific" papers on it. Interestingly enough, they are all written by Dr. Jeff Clawson or one of his financially vested associates, offering a lot of hyperbole and obfuscation without really giving us any compelling evidence. Nothing independent that uses valid technique and reaches any positive conclusion.

My admittedly un-scientific observation is that EMD is a wonderful and logical theory on paper, but falls short in actual practice. It's CISD all over again. All bark and no bite. It simply never realised its enormous potential. And, just like CISD, those who have a financial interest in its perpetuation refuse to let it go.

EMD is the 1980s version of having the expectant dad go boil water during the delivery. It keeps people busy and makes them feel like they are doing something useful, but in reality, it doesn't really accomplish anything.

[AZCEP]

Is there really anything that the non-medically trained bystander can do to help?

I'd venture probably not. CPR is big and dramatic, but it doesn't happen all that often, statistically. Holding someone's hand, keeping them warm, staying by their side is just as important, but not as impressive.

[brentoli]

Is Dr. Jeff Clawson the Powerphone guru? It seems like they are all about the money. $100 flip charts, $300 8 hour classes.

My 3 day EMD class cost about $100 less then my 6month EMT course.

Indiana is going to actually having A&R and Medical Direction for EMD, but it keeps on getting pushed back. Most EMD is minimalist as it is.

There isnt anything in the book that could potentially cause a problem.

Bleeding? Put a towel and pressure. No elevation, no pressure points.

Broken leg? Don't move. No splinting, no bleeding control with pressure.

Overdose? I will ask you for the next 5 min if they are still breathing.

There isn't much accomplished with these too expensive books.

But, it creates the 911 hero's right?

Don't get me wrong, there are plently of times that we can control whats going on through the phone, but this EMD system is not the best. Most agencies don't implement it with the responding companies. You could talk to half of the responders in the county and they wouldn't have an idea we do any instructions.

What about a system where the responders and the dispatchers are in sync with each other? A more in depth medical course. I feel like EMD needs to be more focused on getting the true complaint of a person and less on treating anything but life threatening conditions.

[Dustdevil]

Is Dr. Jeff Clawson the Powerphone guru? It seems like they are all about the money. $100 flip charts, $300 8 hour classes.

My 3 day EMD class cost about $100 less then my 6month EMT course.

There it is. I do have to say though, Clawson is a great guy. I have had the pleasure of his company on multiple occasions. I met him when he first introduced EMD in the mid 1980s and found him to be an intelligent and kind guy. I thought EMD was the greatest thing since sliced bread at that time. I watched as it swept the country by storm and became a "standard of care" nationwide. It was so widely accepted as the state-of-the-art based upon the empirical evidence that you were deemed negligent if you didn't have it. Rescue 911 only solidified that image and belief into the public's mind. Rescue 911 made Jeff Clawson a very wealthy man. But now, over twenty years later, we have yet to see a pay-off, and it is time to either put up or shut up.

What about a system where the responders and the dispatchers are in sync with each other? A more in depth medical course.

For what? What can be achieved by this? First, it is completely impractical to believe that you can train dispatchers, who never see, examine, or treat an actual patient, to learn and maintain medical assessment skills. Second, even if this were possible, it accomplishes nothing. Would you take this dispatcher's word for the patient's condition? I sure hope not.

I feel like EMD needs to be more focused on getting the true complaint of a person and less on treating anything but life threatening conditions.

The only possible reason for this would be to screen calls and triage them for priority of responses. This too is a really bad idea. The worst case must be assumed and the response geared towards this scenario. Otherwise, you end up on the wall of shame with the likes of the Dallas Fire Department, DCFD, Miami-Dade County Fire, and Detroit EMS, who kill people regularly with such nonsense.

[brentoli]

Quote:

What about a system where the responders and the dispatchers are in sync with each other? A more in depth medical course.

For what? What can be achieved by this? First, it is completely impractical to believe that you can train dispatchers, who never see, examine, or treat an actual patient, to learn and maintain medical assessment skills. Second, even if this were possible, it accomplishes nothing. Would you take this dispatcher's word for the patient's condition? I sure hope not.

Quote:

I feel like EMD needs to be more focused on getting the true complaint of a person and less on treating anything but life threatening conditions.

The only possible reason for this would be to screen calls and triage them for priority of responses. This too is a really bad idea. The worst case must be assumed and the response geared towards this scenario. Otherwise, you end up on the wall of shame with the likes of the Dallas Fire Department, DCFD, Miami-Dade County Fire, and Detroit EMS, who kill people regularly with such nonsense.

Require dispatch to work in the field, and require the field personnel to work in dispatch.

I know it is not practical.

I know not every caller is telling you what you need to know, and you are blind on the telephone. I should have clarified my point a little more. We need to focus on the interrogation skills of dispatch more and the treatment less. I hate the "person ill" dispatch. You are never just ill, there is always a reason you called 911. Is it the vomit, the fever, or the dehydration? Even if dispatchers don't work in the field, they still need to be out there on ride alongs. And not just one shift a year. What if we required 40 hours of ride alongs in the year? Would that improve the quality of dispatching? I have explained some things to my co-workers that amazes them. They have no idea about many ambulance and fire operations.

That is where the break down is in EMD. There is no connection between the two ends. We talk about the chain of survival for CPR or what the buzz word may be this week. We have to work on the link between the caller and the responder. I have seen it happen here, dispatched on a person ill, turns out to be a butt breather. Injured in a fall? Massive stroke. I know you can't trust the information dispatch tells you. If we can get dispatch the experience to know what to look for, maybe that will help us out though.

[AZCEP]

With the system you suggest brentoli, you end up with two bastardized systems instead of one.

A field provider uses an entirely different set of processes to gather information than dispatchers do. You can't expect a dispatcher to magically understand which questions not to ask when confronted with a situation, and you can't expect a field provider to ask the right ones when you take away 80% of their observational ability.

There are select few that are capable of doing both jobs well, and you should not spend time trying to find them. I would actually prefer the dispatcher not gather extraneous information. The more information I have before arriving on scene, the more errors I tend to make because I use the bad information to plan what I'm going to do. Send me an "unknown medical" every time. I know it's medical, and I know that the dispatcher honestly didn't know what the problem was.

When this happens I am able to determine what is actually happening by experiencing the scene instead of forcing the situation to fit the information that was received in error.

[brentoli]

With the system you suggest brentoli, you end up with two bastardized systems instead of one.

touché

[Niftymedi911]

[brentoli]

Forgive me for I am young and not as experienced.

I do see the point about trust and the dispatcher. The more I think about it the more sense it makes.

Still, that leaves open the question, should we even be doing EMD? Can a dispatcher even have that big of a difference in the outcome?

And still how much can it hurt to have them ride out with us for some real experience? Make them see we really don't just "load and go." I know our county doesn't see why we would want status checks every 10 min. on a call. Obviously they haven't been with a violent diabetic, or psych patient. The police get 4 min. status checks on calls much more "routine" (I hate that word) then ours. Is 10 min. too much to ask for?

/rant

What do other agencies offer. Besides the feel good cases, is there anyone out there who thinks their EMD is making a difference?