Patch me through to the patient please

In one of the opening scenes of the disliked NBC series TRAUMA, the medics responding are wearing their headsets and suddenly begin speaking to the 911 caller.

“Oh, yeah…right…” was my first response too.

But think about it.  Imagine being finally able to put the caller in touch with someone other than the call taker.  What if the Paramedic or EMT responding was able to apply their education and experience to decide how the system will react to this patient.

It might become more efficient.

The call is received, the unit assigned, then the caller transferred to the practitioner assigned to respond.  They begin assembling facts that the little boxes of the priority dispatch and the untrained ears of the call taken can’t identify.

“OK, so you have asthma, but this doesn’t feel like an asthma attack, you just want some albuterol?” There is no code for that other than an asthma attack, but now we can downgrade the call and possibly save a life and time.  Who’s life?  Not the caller’s they’re fine.  But the responders now travelling with traffic reduces the risk of accident.  The call that may come in with CPR in progress can be triaged ahead now that we have a more accurate idea of what’s happening at the first call.

We’ve spent so much time designing systems to categorize, prioritize and automate dispatches we forgot to upgrade the callers and the call takers.  Instead of staffing dispatch with practitioners, why not just let me talk to the patient you’re about to hang up on anyway to meet your target time.

I can begin to establish if that little code even matches what’s going on, gage my response based on what the caller is telling me and save time in patient care for being ready for exactly what’s going on.

OR

We could ditch the codes and just dispatch based on their chief complaint.

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12 thoughts on “Patch me through to the patient please”

  1. Bahahah! Yea sure a training monkey can use those cards, lets just automate the whole system and let a computer send out the calls – who need a human to do the job a computer can do.

    I kind of want to be a fly on the wall when you get a caller transfered to you in the abulance and you cell phone cuts out or their phone cuts outs. How about the panicky freaking out person who hangs up repeatedly and just says “send ems” every time you call them back … oh yeah how are you going to call them back on your cell phone? Sure read the phone number on your little MDT – what you don’t have a MDT, how horrible. Oh and lets not even throw in that fact the calls may or may not be recorded for legal purposes.

    I am going to shut my mouth now, because you have hurt my one feeling I was issues when I becuase a dispatcher 10 yrs ago. ;(

  2. Come on now Little Girl, imagine not having to do call backs, deal with cranky medics complaining you and the caller didn’t know what was actually happening!  You get the call, code it, dispatch it and transfer it…DONE!  The cards are useless, let’s just agree to that.  This isn’t a dispatch problem, it’s a caller problem.  Since I’m on the way to help them anyways, why not give me the call?  That’s all.
    Then the call takers can go about coding calls in 90 seconds, right or wrong and maintaining their numbers.  Then I get on scene to a no merit call that came in as a code 3 diabetic emergency because teh caller made it sound like one and card 41 (This is total BS) isn’t finished yet.

  3. Call backs are a necessary evil and part of the job. I enjoy my job do it very well. See, I don’t think the cards are useless. I do agree the average caller can be difficult to work with at times, but once we can shock them over the phone there will no longer be any problems – they provide a wrong answer or don’t answer the question and SHOCK – they will learn soon enough.

    I have heard medics talk to callers and it wasn’t a pretty site. I was told many years ago that medics make poor call takers because they are always trying to diagnose the patient, when their job is treat the patient’s condition in the emergency. Medics don’t like the cards, and I know that. Medics like to  B(itch) M(oan) & C(omplain) – I am half expecting to hear them complaining about the sun/moon being too bright one day and expect Dispatch to do something about it; they complain because they can.

    It sounds to me you have to change the culture in your dispatch centre – it very hard, but can be done. Maybe you need to start looking at industry standards, other centre that are equivalent size to your, and adjust your training methods.  

    1. I am a Paramedic and have been a Dispatcher for a Sheriff Dept. where we dispatched everything for the county: Police, Fire, and Medical.  I have no problem saying Medical and Fire could be dispatched by that pleasant, compter generated, Verizon lady that asks you questions.  We did not do EMD, transferred them to the hospital dispatchers for that and it worked fine.  10-30 seconds to find out the chief complaint and dispatch the closest fire department with the actual chief complaint of the patient.  I feel it is more important to have the correct address than anything else.

      Fast forward to me as a Paramedic on the street, EMD centers make everything out to be an emergency and cause me to run lights and sirens to almost all calls when it is rarely needed.  Send me to the right address because I will just take all my equipment in to the house because the voice on the other end of the radio is rarely correct to the problem, BECAUSE OF THE EMD.  Most calls I am sent on quietly are true emergencies and most calls I am sent on emergently are nothing.

      I will give to you the fact that your information is only as good as the caller.  I learned that and it did not matter who I was dispatching for.  PD calls get one side of the story and when the hysterical female calls and says her significant other is beating her everyone gets sent to find out it happened last night 12 hours ago.  She should have gotten a ride into the station to fill out a report.  EMS is no different when you go beyond the general question of what is wrong.

      I currently have an EMS dispatcher that spends more time looking at the map and making sure I have cross streets than giving me needless medical information.  He gets me to the right place so I can assess and find out what the problem is.  I could care less that they have had a MI in the past because when you tell me chest pain it is a STEMI until proven otherwise anyways.  More information given over the radio is just another distraction to driving.

      As far as Medics complaining…You should here the newer police officers complain…

  4. I agree training is important, and we all complain. I ask for a call back on the first party code 3 head ache and am told there is no answer, then I call on my phone and the person asks me if anyone was going to call them back.  Anecdotal, sure.  I’m not looking to eliminate call takers, but take the patient one step closer to definitive care by starting my interaction with them sooner.  I can ask questions the cards don’t know about and take my time.  There is no response standard, no time goal hovering over me to get the call coded and dispatched.  we can work as a team to benefit the patient.  Imagine our roles reversed for a minute.  I get as much info from the caller as I can and get it to you as fast and as accurately as I can based on what they told me.  You arrive to a wrong address.  I call back and find out it was 3rd avenue, not third street and prepare to re-dispatch the call.  In the meantime you’re wondering where this caller is and why I got it wrong.  The system relies on the caller above all to be accurate in a panicked state, somethign I think we rely too heavily on.  All I want to do is take your work and build on it by talking to the caller after you’re done, not replacing you.

    In older days at an old dept we had a call taker who knew zero about EMS and simply dispatched the calls based on what the person told them.  we got sent on arm pain, eye trouble and even itchy legs and based our response accordingly because there was no filter, no categorization, no opinions added.  And each and every call was exactly what we were told.  But was the patient better off?  Maybe not. Maybe so.

    There certainly needs to be a better relationship between the voices and the knuckle draggers.  Would you consider coming on the Crossover Podcast (anonymously or as your real self) to open a dialogue to share with others?
    Thanks for reading, HM.

  5. In our fair City, HM, retirement age medics were our call-takers and boy, that experience makes for some accurate dispatching, not like the junk we have now….

  6. Well first most call takers receive some sort of EMS dispatch training, and how to get info needed to dispatch units. They really don’t need to be fully trained EMT’s paramedics or nurses!

    Second, most FD’s dispatch everything C3.

    Third, other than a general idea of what I’m responding to really dosent help me do my job. I’m still going to approach each incident safely, and determin for myself what is wrong with the patient.

    Might as well scrap the whole EMS card
    Dispatch system. Not really designed to help patients just reduce how many units driving C3

    My 2 cents

  7. presently here in the east of england while the AMPS triage is done a paramedic in control can listen in on the call and take over once initial triage is done. Using their clinical training and experience the call is re triaged and the response can be down graded in response type. Cynics believe more to manipulate the 8 minute response time we are obliged to make for  cat “A”s the chest pains and SOB’s as ones that get downgraded are always calls with long distances to attend but of course these are ones that the time can be spent on getting a accurate phone consultation. new information for the call from the secondary triage is passed on to the crew by the computer in the cab. Such info for downgraded calls i have had on jobs i have attended are patient making call says SOB but able to talk full sentences to paramedic on phone with tingling in lips and hands had prior panic attacks so response downgraded to a 19 min response time.Or the time we were attending an unconscious male, caller is the patient who is answering questions call thus downgraded  AMPS would have given this a 8min response with RRV ( rapid response car like the one you rode on with Mark) and a DSA (double staffed ambulance)

    1. Problem is recalls, IE when you start responding and another unit is exchanged with yours. I feel the idea can be done with extra call takers or Paramedic/ rn types screening it.

  8. While you are responding I picture you putting on your gloves, checking the map, helping your driver get through traffic, speaking with other units on the radio, and I don’t know what else.  Do you want to add to that trying to calm a caller, let alone give effective CPR instructions without distraction?  Sometimes the callers are hard enough to hear and understand in a dispatch center with a headset on, I can’t imagine adding siren and traffic noise to the equation.  What if you get diverted to another call?  What if you come up on something and have to abandon your dispatched call for a still alarm? 

    You are right about everything fitting into a check box in MPDS and its tendency to over-code things, but I disagree with your assertion of an “untrained ear”.  I have been a dispatcher for 12 years and I know just as well as you do what is legit and what is BS based on what the caller says (and what I can hear).  We are just as bound as you are by protocols and standards.  Just as you know in the field, I know that the callers/patients know just how to game the system and what to say to get what they want.  It’s a systemic problem in dispatch just as much as it is in the field.  I’d love to see a “dispatch 2.0″ in parallel with what you are trying to accomplish with EMS 2.0.  
    With that said, remember that you are trained to provide treatment based on what you can see, feel, smell, etc. and to provide care with your hands.  The dispatch side is designed to provide care with only ears and what the caller can verbally identify, and to walk an untrained caller through care until you get there to take over.

  9. in my county we do dispatch based on chief complaint and it works great for us. From the little bit I understand about medical priority dispatch, it sounds like a bunch of unnecessary BS. but then again, I am a Volunteer EMT-B in a small rural county. My primary service that transports only does about 1000 calls a year.
    ~Goose  

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