No mam, the ambulance will not be sent at this time - please hold for the nurse

[JLM]

http://www.raaems.org/html/pr-chap.pdf

This project started just before I left the comm. ctr. and went to medical school.

For the other paramedics (and anyone else) . . . your thoughts?

I have been at both ends of that medical priority dispatch system. And while few and far between, we have all been on low-priority calls that ended up needing some immediate, heavy-duty ALS interventions. These calls sometimes fall through the cracks in the algorithm.

I have also shown up on plenty of toothache calls at 3am waiting on the porch with bags packed . . .

Let me point out that richmond does have good reason behind this program. our resources are heavily taxed. We are NUA (no units available) frequently throughout the day, and an extremely heavy percentage of our call volume is frivolous stupidity - much moreso than any other jurisdiction i have worked in. Mutual aid only goes so far with those types of call volumes, and often calls just get held until somebody is available.

So, I guess the choice came down to throwing more and more money at staffing and equipment . . . or try a program like this.


Your thoughts?? Can it work in this litigious society ?? Is it ethical if they are a taxpayer?? Think it will catch on??

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[pseudoknot]

I think it's a reasonable approach. I don't see any ethical problem whatsoever.

Whether it can work in our society, and whether it will catch on will depend on how much money is saved. Remember that the incremental cost of each EMS response is pretty low until you have to add another unit, so I'm not sure there is a huge incentive not to just go check stuff out.

If we as a society decide that EMS is consuming too much of our resources, another way to attack this is to move away from the model that every response should result in a transport. Either way you are going to make mistakes at some nonzero rate.

 

[emtcsmith]

From what I've studied systems like this haven't worked in the past. I know they are making a return now and in a very different time in EMS, but the reasons it failed haven't changed.

-Uneducated callers
-Scared/Confused/etc callers who can't give an accurate call to 911
-Other Misc failures...third party callers for MVC's, etc

I think in an urban setting you still need to send something (Engine, BLS, or ALS) to every call but priority dispatch is a key aspect of the system. At a bigger level if an ALS unit is 4min away and a BLS is under 10min and the call comes in for a BLS call send the 'B' unit only.

 

[leviathan]

I think a nurse could do a better job at call taking than a call taker. Call takers just follow the AMPDS system and, while objective and consistent, it seems to lead to a lot of false positives, and sometimes even scarier, a lot of false negatives. (+ being an emergency call, - being a routine call). Although I was not around before, so I do not know if things were worse and/or if call takers were better trained before.

 

[BostonEMT]

A good idea but I wonder how successful it will be. As others have stated, it's been tried before. Perhaps dispatching the unit regardless, then fining those who abuse the service, would be a better idea. This would also allow some wiggle room with regard to uneducated bystanders or family calling because they genuinely felt that they were dealing with a life-threatening emergency when in fact the problem was non-emergent. It's usually very easy to distinguish between BS and a well-intentioned caller who perceived an emergency where there was none.

 

[Blahblahologist]

To some extent, a program like Richmond's is dependent on what sort of "alternative health care resources" it can offer. If you give people an alternative way to get seen, they just might take it.

I work for an emergency service that covers about 75,000 residents on the east side of Pittsburgh, which since the loss of the steel mills and Westinghouse Manufacturing has become a high-unemployment, high-crime area. Of the 8000 or so "emergency" calls we run per year, probably 20% are complete bull, 60% are folks with chronic health issues who need treatment of some sort but not emergently (and probably not in the ED), and 20% are having a true emergency. I expect the breakdown is similar for urban EMS elsewhere.

We've often joked about getting a big passenger van and just having it orbit the city so that we could tell our toothaches, and foot-pain-times-two-weeks, and flu like symptoms, "Well, you're not having an emergency, but we can have our van stop by and pick you up in an hour and drop you off at Prebyterian." The problem for many of our patients is they have no PCP, no car, and even if they had the money cabs won't pick up from a lot of the neighborhoods we cover.

So what if the 911 dispatcher/nurse could transfer the non-acute caller over to someone who schedules pickups by paratransit to go to the nearest urgent care? Much as I don't want to make 911 the entry point for public health services in general, for a lot of people it already is. And it's defintely cheaper to staff a wheelchair van than an ALS ambulance.

If our RN-dispatcher could tell our 1am toothache caller to shove it and have Mom drive him to the dentist in the morning, so much the better. I'm all for looking for ways to cut out completely frivolous calls, but reducing the number of people in that middle 60% who go to the ED by ambulance seems like where you'd make the real impact.

 

[deleted87716]

I imagine it wouldn't take long for people to figure out that all they have to do is say "chest pain" instead of "toothache" and their free ride is on the way.

At the ED: "Oh, the chest pain stopped on the way here. But my tooth is killing me!"

 

[leviathan]

I imagine it wouldn't take long for people to figure out that all they have to do is say "chest pain" instead of "toothache" and their free ride is on the way.

At the ED: "Oh, the chest pain stopped on the way here. But my tooth is killing me!"

No worries...I had a 'code 3' call for a toothace this morning, because the person answered 'yes' when the call-taker asked if she was having trouble breathing (her sinuses were congested).

Also had a guy who made up some BS complaint about abdominal pain so we would take him up to the hospital and he could try to get a script for methadone.

Ughh...this is a bit off topic maybe, but I'm venting.