You all know I am not a fan of little boxes.

I dislike the little boxes we have to cram our patients into to treat them based on chief complaint.

Also on my list is the little boxes we take them to the hospital in.  Bolting a box onto a van isn’t enough.  More on that another time.

On the top of this list in big red letters are the little boxes our call takers are required to fit their callers into.

They must meet criteria in order to be coded, qualified, weighted, and then sent out to the trauma hungry troops on standby all over the City.

Problem is, it doesn’t work.

I do not know Dr Clawson, but I do know his system and that, if a system can correctly act on the information gathered and coded, it works most of the time.

What really gets me going these days is the purposeful miscategorization or non categorization used to move calls out of the call center faster than they need to be.  I am not alone in this experience, getting messages, tweets and emails from folks all over the USA asking me what they can do to improve dispatch.

You can’t improve dispatch.  Not until you improve the callers themselves.

One of my readers described it as GIGO (Garbage In, Garbage Out) meaning, in the most respectful of terms, that dispatch should not be changing anything the caller says and that if the caller is wrong, then I do hope my dispatcher is wrong as well.  If a person calls and tells the dispatcher that the space shuttle has crashed on main street and thousands are dead, maybe it did.  But the problem lies in sending that call out before it is coded.

The two most inexperienced people in the system are the ones guiding the system.  The caller and the call taker.

I have never been to a call that was reported, coded and turned out to be the same thing, mainly for the same reason my patients’ chief complaints never seem to jive with my treatment per protocol:

They don’t fit into your pre-determined boxes.

Many systems run a BLS tier, or perhaps a single paramedic resource to handle Omega, Alpha or even Bravo calls.  Here in mine, there seems to be no rhyme or reason to the assigning of resources on some calls.

A call coded by the system, based on information provided by the caller, to the call taker has been declared a 26A1, a sick call.  Yet in the call classification next to the code is the term BLEED-SEVERE.  And now the call becomes a code 3 and 6 or more lives are at risk.

“Better safe than sorry, right?”  Good thought.  Who is in more danger?  The person who bit their lip and called 911 or the 6 responders using red lights and sirens to respond to the call now thought to be more than it is.

“Then what’s the answer, smart guy?”

Ditch the codes.  Stop the tiny box requirement.

If they call and say “I bit my lip,” Dispatch it as such.  Let the responders apply calculated risk to the situation without being blinded by administrative tricks used to ring the bells faster, improving your call center stats.

If you can send a call out in 30 seconds without gathering all the information, that is not a success.

I am not blaming dispatchers.  That voices that tell me where the sick people are are not the ones in control of the dispatch system, but the ones required to work within it, not unlike me not liking aspects of my treatment protocols.


They relay what they are told and code the call.

It is the trick of changing the code or description that I don’t like.  That is how the cut fingers, bit lips and sleeping people send out a full ALS response and drain the system of resources at a time when we are getting stretched thin.

By changing from a criteria based system to a “plain text” system, two distinct things will happen.

Firstly, crews can use their judgment, ETA and experience to determine their response priority based on what the caller actually said, not what the system thinks they might be saying.

“My back hurts again” is not coded as “Non-Traumatic Pain-Code 3” so the crews can apply their expert training to audit the dispatches in real time.  I worked in a system like this and it worked.

Secondly, it will become very complicated and difficult to classify and track types of calls for analysis after the fact.

“We don’t know how many CPR calls went out last quarter because we have to go back through each call instead of just pulling the codes.”

A recent study by UCSF and SFFD Medical Director Karl Sporer celebrates the finding that 1 out of 7 reports of a rescusitation in San Francisco turned out to be just that.  You can’t find stats like that celebrated outside of baseball.  1 in 7 was a success.  I see the 6/7 mis-reported or mis-coded calls as room for improvement indeed.

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