Dispatch treating CVA with ASA

[spenac]

Actually here my EMT-B can do that. Radio, cell phone, or sat phone and we get what we need directly, but I'm rural and we keep numbers with us to call. And as I've mentioned at other times what works here would not work everywhere else.

Bren again I have not said dispatch is not needed, I just do not feel they can replace the person in the field helping me. Thank you and other dispatchers for your help.

[Copperhead24]

Spenac - You're correct in a nerve being struck, but it wasn't necessarily struck by you . The educator in me was frustrated with the topic moving, in my opinion, off course from the original & valid question. That being the administration of ASA, on the advice of dispatch, prior to EMS contact. My desire was to answer the original question as factually as possible.

As to my medical control allowing dispatchers to administer ASA, this is not the case. We are two seperate entities. It would be their [the dispatch agency] medical director allowing it if he chose to follow the AHA guidelines. This [ASA administration prior to EMS contact] is not necessarily my opinion [or the opinion of this station & it's staff ]; it is something that the AHA is now recommending on a national level.

Again, for everyone, I was just trying to answer the original question. And I myself am guilty of getting pulled off task.

As previously mentioned the new AHA/ACLS course demonstrates this [ASA administration prior to EMS contact] during the ACS portion of their video presentation. I have provided the link twice, but to quote from that link;

"Should I take aspirin during a heart attack or stroke?

The more important thing to do if any heart attack warning signs occur is to call 9-1-1 immediately. Don't do anything before calling 9-1-1. In particular, don't take an aspirin, then wait for it to relieve your pain. Don't postpone calling 9-1-1. Aspirin won't treat your heart attack by itself.

After you call 9-1-1, the 9-1-1 operator may recommend that you take an aspirin. He or she can make sure that you don't have an allergy to aspirin or a condition that makes using it too risky. If the 9-1-1 operator doesn't talk to you about taking an aspirin, the emergency medical technicians or the physician in the Emergency Department will give you an aspirin if it's right for you. Research shows that getting an aspirin early in the treatment of a heart attack, along with other treatments EMTs and Emergency Department physicians provide, can significantly improve your chances of survival."

This is directly from the American Heart Association website & is part of their new recommendations. Whether they choose to follow those recommendations is up to the individual dispatch agency & their medical director. This is just as it is up to EMS agencies & their medical directors what, if any portion, of AHA/ACLS guidelines they choose to utilize. Ultimately it is a physician's choice; in this case the medical director.

Khanek - As to dispatch being held responsible, I would certainly hope that an individual dispatcher would not be held responsible for the action or mis-action of their employer. If a lawsuit were to be brought for an action, or lack of action, that was written [or not written] in a dispatcher's protocol that should not be their fault. That should be the responsibility of their employer & their medical director. And you are right, in that, if an individual decides to go off the reservation & treat or give advice outside of their"prompts" they should be held accountable.

[katbemeEMT-B]

I know this is not a universal thing, due to the time honored "Local Protocols", but all my dispatchers, as well as the call takers, are minimally EMT-Bs.

I'm not trying to start an argument so please don't take it that way. I am trying to understand why you feel that because your dispatchers are EMT-B trained they should be allowed to advise callers to administer meds to a patient. I realize that yes they may have the assessment skills necessary but you have to remember, they are not on scene. They are talking to an unskilled individual who is emotionally involved in the situation. The caller is unable to give a proper picture of the patient regardless of the questions asked by the dispatcher. From my personal experience some people don't even have a clue what clammy means. This is what makes a dispatchers job so difficult and why I would never want to do it.

I appreciate our dispatchers and that is why I made the decision to spend some time with them. I felt I needed to know what it was like to be on their end.

[spenac]

Spenac - You're correct in a nerve being struck, but it wasn't necessarily struck by you . The educator in me was frustrated with the topic moving, in my opinion, off course from the original & valid question. That being the administration of ASA, on the advice of dispatch, prior to EMS contact. My desire was to answer the original question as factually as possible.

Hey I get you now. Definitly this post has took many a turn. I don't like the new AHA guidelines to tell an unseen person to take a med. But as AHA is considered standard of care, if dispatchs medical control follows it's guidelines they would be protected in lawsuits. I still don't think it's right. Don't know if you guessed yet but I don't agree with sight unseen treatment. Next I'll be able to deny transport w/o even leaving the station, ah my dream is closer now than ever.

I agree lets get back to the original post. To any I offended I apologize again.

Guess this posts twists is what was discussed in the post "WHY" a week or to ago.

[katbemeEMT-B]

So now that it seems we are all on the same rail, we can get this thread on the same track. I agree that the AHA guidelines are opening up a can of worms and that is why as a dispatcher, EMT, or Medic we have to look out for each other.

And spenac is getting closer to the almighty dream of not having to transport.. ;)/

Stay safe all!

[Dustdevil]

Don't just form an off-the cuff opinion or take the advice of one individual or group, even if they appear to be knowledgeable of the topic.

It appears to me that this is exactly what you have done. You listened to some guys at a conference and decided that their word was gospel. Who were they? What were their names? What was their background? Do they have any connection to Dr. Clawson and the EMD bureaucracy? Did they cite references for their statistics? Are they published? Are they scientifically valid? Are they peer reviewed and verified? Did you bother to ask them any of these questions? If not, don't you think you are being more than a little hypocritical with your advice?

[Copperhead24]

Dust;

Whoa! If you look I pointed out that I didn't know the lawyer's exact credentials [ "don't know if they got there degrees from a cracker jack box"] & if you had taken the quote, that you stated, further I advised to not even take my opinion as the final word. I later pointed out that I myself had gotten off track from the original topic, which was the administration of ASA on the advice of dispatch prior to EMS contact.

My point was to research the topic & not just accept an opinion or opinions on it. In my view the best way to learn about a topic, especially a controversial one is to research the subject & "see" it from several different sides. If there are questions in my class on a topic without a finite answer I have my students "Google" it. If it's a big enough topic I have them create a presentation for the class. They won't learn that our industry is always evolving & changing from just taking someone else's word. What was appropriate treatment 10 or 15 years ago can now be considered harmful [someone discussed MAST; Bretylium; etc. earlier] in many circumstances. Remember the days when the emphasis was on the admin of bicarb & calcium ?

As to the "guys" at the conference; it was a large conference that was not presented in a Q & A format. To be fair, while they did have material to support their discussion, it was information that they had produced. As to their background, that I do remember because it was unique. One was a lawyer / paramedic from the Chicago area; another a lawyer / paramedic-student from Missouri. The third was a former paramedic & EMS administrator from New York. Their discussion on dispatch was an example of many examples surronding liability & malpractice in EMS. Their emphasis was that "the good samaritan" laws & the days of "gunslinger" EMS with people looking at us like we were "Johnny & Roy" with William Shatner "narrating" were long passed.

I would love to discuss legal issues in EMS further, but believe that it either belongs in another thread, or you could PM me & we could talk more. Don't know if I would enjoy discussing your dis-taste for EMD-type systems; or if I'm qualified to discuss it, but I would be willing to, I think

By the way; enjoyed your photo gallery

[Dustdevil]

That's cool, Bro. Your philosophy and advice are good. I like your style and admire your outlook. This is probably a great asset to your students. I just wasn't sure where you were coming from on the EMD thing, as I am so used to the mindless idolatry of EMD that has taken root over the last two decades without any real supporting evidence. This is just definitely one of those things we have to seriously re-think.

Thanks for the intelligent discussion.