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Post by 911guy on Sept 23, 2003 18:29:18 GMT -5
Well, we have been doing some of the Alpha/Bravo/Charlie/Delta/Echo responses for some time now. What is everyone's opinion of it? First of all, I KNOW that not EVERY dispatch has a response level - there are several reasons for that. Some of it is internal quality assurance, some of the calls come from other counties or from people who refuse to cooperate, and still others are from care facilities, which we are currently not doing EMD for. We hope to add these soon.
Aside from the ones that FAIL to get a response level, has anyone seen where announcing the level makes a difference in responses? Less lights and sirens for low-prioirty calls? As you should know, this is about trying to give the most appropriate response to a given incident when certain criteria and questions are known. Now I know, as a paramedic, that some really stupid calls have gone out as Delta, and perhaps some that turned out to be a more serious patient upon arrival have started as a low priority. One of the main reasons for that is that EMD instantly escalates the response for virtually ANYONE with a cardiac history, even if there are no priority symptoms. Conversely, there are times when I KNOW we are "thinking" that it should be a higher level because it smells funny..... The National Academy of EMD is always researching and reviewing these to fine-tune them. Nothing will ever be 100%, but I am interested in hearing whether you think they are beneficial to the EMS community?
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Valley2
Junior Member
DUTY...Above Everything Else But HONOR
Posts: 15
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Post by Valley2 on Sept 23, 2003 20:41:43 GMT -5
I feel that it has made a difference. This has raised the bar for services and the EOC. It allows all of us to be on the same page. Yes, there will always be the Monday morning quarterback who will say it should be done this way or you should not have made the change. Comming from out of the area, and seeing several county 911 sysysrems, I feel the EOC has made big steps in the past 2 years. Keep up the GREAT work and continue doing what you all do!!
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Post by paramedicpam on Sept 24, 2003 6:43:46 GMT -5
As we talked at the Council meeting, I think it helps our ALS service, with staffing. We generally send a medic on all calls, but with the EMD we are more assured that what sounds like a BLS call really is when it is dispatched, and we can hold the medic back for the call where he/she may really be needed. It also allows our EMT's to get more experience without the medic always being there. They really appreciate that! And there are those cardiac and respiratory calls that are alpha-even though they are chest pain or difficulty breathing, so when they are dispatched that way, we can send a BLS crew on those also. Keep up the good work!
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3unit2
Junior Member
Posts: 24
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Post by 3unit2 on Sept 26, 2003 14:58:33 GMT -5
After giving this subject some thought, since the time of original post,this is MY story and I'm sticking to it ..I pay little attention to the response level given for a call. I feel there are just to many variables,problems and or faults with EMD to be of much value to the EMS world at this time. I know it well never be 100%,but with more time and fine-tuning, an Alpha call for ankle pain will be just that.. the pt. saying(It hurts and I don't know why) . Not getting on scene and finding the pt. saying(I haven't been feeling good for 3 day's, I must have passed out and fell down the stairs and now my ankle hurts)
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Post by 911wacker on Sept 27, 2003 16:18:13 GMT -5
Although the end result has been less than desirable on a few occasions, the EMD protocol and the way we are dispatched is improving in my opinion. Yes there have been some cases when you get there and it's not what you were expecting, however there were many cases of this before EMD dispatch codes. Many factors play key roles in the EMD protocol, and any variable can change what would or should have been the end result. Personaly as a dispatcher I have found that it takes some getting used too and have just recently reached a REAL comfort level with it (not that I was not OK with using it in the past). Then you always have to factor in caller information, what we percieve to be an emergency and what they percieve to be an emergency are not always close to the same thing.
I have faith that with a little input and QA/QI the EMD dispatch process will excell to great levels with a little more time. It has been used for YEARS with great sucess in many other places across the country.
Change is never easy!!
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3unit2
Junior Member
Posts: 24
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Post by 3unit2 on Sept 28, 2003 17:13:27 GMT -5
Ok,I will agree,that the EMD program as a whole has some very good areas and is lacking badly in others.. The original post asked this question.. "Aside from the ones that FAIL to get a response level, has anyone seen where announcing the level makes a difference in responses?" My answer is still the same.. NO.
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Post by redlight on Sept 29, 2003 12:49:46 GMT -5
I think that overall the system is working however, it does need improvement and further training for dispatching and EMS. As a field provider I see what most of the ambulances are doing with the priority dispatching. Red lights and sirens are being run on almost every dispatch. Now I know we can't have the redlight police out there watching everyone but we all need to respond to each situation in a responsible manner and not terrorize our communities with lights and sirens pushing people off the highway for a minor incident or continue in full response mode when units already on a scene report to come in at a reduced rate. Respond appropriately for your safety and the safety of the residents in your community.
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Medic21
Junior Member
Saving the world, One life at a time
Posts: 16
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Post by Medic21 on Sept 30, 2003 16:41:09 GMT -5
It is my understanding that the response level assigned to a call is determined by the responses to specific questions given to the dispatchers by the 911 caller, This being the case I think that the system works well, we know that a hystarical caller does not always give ALL the info needed but in most cases the level assigned is appropriate, The dispatchers do the best they can with the info the get, However can we change Alpha to mean ALS and Delta to mean dumb? ?
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911Mom
Full Member
Welcome to the real world!
Posts: 60
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Post by 911Mom on Sept 30, 2003 18:53:32 GMT -5
Ah, that it should be so simple.....I agree that we are getting more comfortable with it, but there are still those calls that the priority level is totally out of whack. But it will get better!
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Post by canton1 on Oct 1, 2003 0:34:23 GMT -5
I only can say. That all should do the same thing. Not just do what you want. BLS goes this mode---ALS goes another mode.
Echo should get lights------Not Medic or EMT dependent (or what ever you want it to be)
I have followed, well went around, a ALS unit going to a reported MVA with Entrapment and possible fire that had no lights or anything on.
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Larry
Junior Member
Posts: 24
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Post by Larry on Oct 1, 2003 11:35:54 GMT -5
I have seen the same thing that Kim has, no red lights! What happens when a BLS or ALS is going to a call with out red lights maybe just over the speed limit goes through radar and gets pulled over or is involed in a MVA with out lights and siren? What does the insurance co. have to offer???
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Post by Matt Russell on Oct 1, 2003 22:19:05 GMT -5
Ok you 2 Whackers (Canton1....Smithfield 1) first of all if you passed or witness this ALS or BLS unit going to an incident without lights / siren how much sooner did YOU arrive at the incident ahead of them?
And What if the ambulance is returning from the hospital without lights / siren because we aren't Squad 51 here and just say MAybe they are going a little over the speed limit and get caught in radar OR involved in an MVA what is the insurance going to say? (Don't get mad boys you both left yourselves wide open for this)
My opinion is that you are talking about 2 different issues here. (1) is Priority Dispatch which gives a priority level to the nature of a call from caller information. (2) is the use of audible / visual warning devices when responding to an incident. Now Here is where I'm gonna goof because I haven't read the system you have and I don't know it inside and out and if it dictates what the use of lights and sirens should be then I would use it right after I got done with the sears catalog. There have been many studies that have shown the use of red lightls and sirens DOES NOT REDUCE the amount of time it takes to reach the scene of an emergency by a great deal. Usually this is 1-2 minutes at best. However studies have shown that the use of lights and/or siren DOES INCREASE the likelyhood of becoming involved in some type of accident. Therefore I believe that use of these devices should be left of to the responders not dictated by a bunch of cards because there are other factors you need to put into play here......rural vs metropolitan, summer vs winter and lets not forget the experience of the driver.
Now to make Larry and Kim feel better I too am a whacker (not as big as them) and everyone of us in this crazy fire / EMS world is...at least to some extent.
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Post by canton1 on Oct 2, 2003 5:50:28 GMT -5
I arrived several minutes before. I am not really sure how long it was.
Yes, It is kinda 2 different things but, Priority is priority no matter how you look at it. Is a Cardiac Arrest (Echo Priority) any different than a MVA with Entrapment (Should be sn ECHO priority). My guess is they are both pretty serious and we should get there as FAST and SAFELY as we can. I dont think we need to go 100 and drive like a idiot but should get there as quick as Possible.
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Medic21
Junior Member
Saving the world, One life at a time
Posts: 16
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Post by Medic21 on Oct 2, 2003 17:28:49 GMT -5
I feel that we have an obligation to our patients to arrive quickly and safely but if the likleyhood of an accident is increased by the use of lights I feel that we may better serve our patients by increasing the likelyhood that we will arrive by not using them on every call. The priority system gives us a feel for what the dispatcher is hearing from the other end of the line but we all have had Echo calls that were Alpha on arrival, The dispatch phase is the first phase of Pt. assessment for the field providers and the descision on wether or not to use lights should be dictated by the responding crew based on Dispatch info, Time of day, Traffic conditions, weather conditions Etc... Please note this is only my opinion and it is likely to disagreed with but hey that is why we are here!!! ;D
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Post by 911guy on Oct 2, 2003 20:54:59 GMT -5
Larry- Regarding your question on what if an EMS unit gets pulled over for just over the speed limit without lights/sirens------although there is no 100% absolutes, I would say 90% or more of the time, if they ain't running lights and sirens, they ain't going fast either. If the crew thinks they should be hurrying, they will almost always run lights/sirens. As a previous command-level medic, I know in my mind the mentality of paid services in this area. As a volunteer, there was some deep part of me that wanted to bust butt and get there pronto, but little by little, that "drive" starts fading away (usually). A lot of it is because the paid services, in staff meetings and so on, emphasize what has been said here already - lights and sirens save SO little time, as mentioned by Matt Russell. In fact, I can distinctly remember while rising to a paramedic being told by several "veteran" medics that ALS RARELY makes a life-and-death difference. Maybe 5% of the time at best. Not to pick on or belittle any one or any service, but a "hasty" response is not always present in the aeromedical arena either. Dr. Clawson, who is the father of Emergency Medical Dispatch recognizes from a 100% medical aspect that an EXTREMELY small percentage of EMS "emergencies" are truly a seconds-count situation. It is extremely rare that a patient's condition or outcome will deteriorate within minutes. In other words, whether you take 3 minutes or 6 minutes to begin treatment of the patient will rarely make any difference one way or the other. Remember, I did NOT say it NEVER makes a difference, just RARELY (according to studies, much less than 5% of the time). Conversely, Dr. Clawson also recognized that FIRE is NOT the same - a fire's spread and damage increases exponentially in minutes, so an efficient response by fire apparatus CAN make a true difference. I will NEVER forget one time while on duty on the ambulance we were paged with the fire department (not going to say which one because it doesnt matter) to a vehicle fire. We happened to be less than 1/4 mile from the scene and arrived first. We stayed back to leave room, gave our on-scene report (vehicle fully involved). Shortly afterwards, an officer came screaming by us with the full array of lights and sirens, screached to a halt near the car, got out and stood there. What was the benefit of a screaming response in that scenario? It also happened to be on a narrow street with lots of kids around...... My point is, when a pager goes off, the gas pedal should not become an on/off switch (full bore or nothing), but tempered to the type of incident, ever-mindful of the potential disaster waiting to happen if - God forbid - we would be in or CAUSE more injury in the effort to arrive quickly under the guise of "saving lives." This, by the way, is MY opinion, not necessarily the official position of Bradford County
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