Emergency Medical Dispatch applies triage to emergencies

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Riverside County has taken the next step with its use of Emergency Medical Dispatch. Since EMD’s initial implementation in 2012, trained dispatchers on 911 emergency medical calls question the caller about the symptoms of the victim whose life may be in jeopardy.

The questions follow a very thoroughly tested and studied protocol. “Is this a high-priority or a lower-priority call?” is what the dispatcher must assess within a minute or two. Dispatchers may ask the caller to take interim steps, such as giving a heart patient an aspirin or beginning CPR, before the emergency responders arrive.

The patient’s condition and any instructions given to the caller are quickly transmitted to the responding unit so it knows what to expect upon arrival.

Last month, the county took the next step. Based on the severity or immediacy of the situation, the dispatched responders may only be an ambulance responding code 2, without lights and sirens.

Greater EMD use and implementation was goal two the county’s Emergency Medical Service Plan, said Bruce Barton, director of Riverside County’s Emergency Medical Service, which is overseeing the EMD protocol. EMS, Cal Fire, American Medical Response, the county’s ambulance contractor, and the cities and jurisdictions using the dispatch center have had numerous meetings and discussion before this step.

“Implementation of full emergency medical dispatch is in the spirit of Riverside County’s EMS Plan,” said county Fire Chief John Hawkins. “Citizens will be better served. The response will be based on need.”

Idyllwild Fire Chief Patrick Reitz, who is a long-time supporter of EMD, has said the new response procedures will have less effect in Idyllwild.

“It won’t affect Idyllwild’s dispatch as much as it affects other entities,” he said. “It doesn’t change a lot for us. We have too many ups and downs.”

With the mountainous terrain, homes below street level or entrances one or two levels up, getting patients from the house to the ambulance with a gurney is more often a difficult maneuver here than for responders in flatter areas.

Nevertheless, he acknowledges the benefits this procedure will ultimately produce. He believes that with telephonic triage assessments, his crews also will be able to respond to some calls without the lights and sirens.

All the emergency medical officials identified the improved safety to the public and crews if they do not have to race through populated areas with sirens blaring. Through the middle of July, Riverside County Fire Department responded to nearly 88,000 emergencies since Jan. 1. Nearly 75 percent were medical emergencies.

The Idyllwild Fire Department has been responding to about 600 emergency medical incidents, or almost two per day, for the past five years.

Both Chief Phil Rawlings, of the county Fire Department, who is responsible for EMD’s implementation at the Dispatch Center, and Barton stressed these safety issues.

“So far, the numbers look very good,” Rawlings said. “It is consistent with our expectations.”

But paramount is the ability for triage to identify an incident where the response can be without lights and sirens. Nobody wants to risk an inappropriate response, which is why so much effort and detail goes into its use and evaluation.

“These are the lowest acuity calls,” Barton said. The dispatcher effectively interrogates the caller with a set of proven questions to assess the severity of the situation.

The county evaluates all medical 911 calls and responses to determine whether they were handled appropriately or if changes to the protocol may be needed, according to Rawlings. The county’s EMS quality assurance program is thoroughly staffed and applied.

Medical situations are designated a label, alpha to echo and omega. The alpha and omega responses will not trigger a blaring ambulance and loud sirens. There is no change to responses labeled beta to echo.

Doug Key, AMR vice president, is very supportive of the changes. He believes it will improve safety for all involved, from patients to crews. In his opinion, this may affect about a quarter of AMRs responses.

Sometime in the future, these agencies will discuss whether to modify responses based on whether the call is advanced or basic life support, Barton acknowledged. Are both an engine and ambulance necessary for all of these responses, he asked.

Ultimately, the evolution of EMD will benefit the pubic, responders and patients because its purpose, according to Hawkins, is “… do the right thing for the right reason.”

 

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