# Using EMT Skills off-duty



## djarmpit (Jun 28, 2012)

So I've come to the conclusion that although I've learned good amount of BLS through my EMT program, I think I'm pretty useless when I'm off-duty/not around any equipment.

 I witnessed a car accident and stopped to help the driver (who had already gotten out of the car), trying to see if he was injured or had any spinal injuries. Afterwards I was visualizing my "scenario" I was kinda confused because I wanted to grab equipment that I didn't have to further help this guy out. 

I got into EMS because I wanted to know how to handle situations when my friends/family become sick or injured and without things such as oxygen, bag-valve masks, splints, and possibly a blood pressure cuff by my side I don't think theres much I could do except for call 911.


Any thoughts? Does anyone feel that they are able to use a lot of the skills they know when off-duty?


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## mycrofft (Jun 28, 2012)

"With age comes wisdom, young Grasshopper".

First thing is that you were trained NOT to try stuff  which could likely have further injured the victims. (Well, SECOND, after scene safety). Knowing what NOT to do is the second thing after scene safety.

Correct, equipment is needed to DO much beyond basic first aid...except evaluating severity of injuries, making a scene assessment to use when calling 911, and maybe helping take control of the scene before EMS/LE arrives (tell people to shut off their ignitions and take their keys with them,  stop trying to pull their friends out of the wrecks by their heads, etc).

Confusion, especially at first, is most common. "What's goin' on here?" is the first question. But it kicks in, starting with safety safety safety. 
THEN you need to know how to release to LE /FD/EMS when they arrive, or even acknowledge to your self that you do not control the scene and just do your best.

Keep some traffic triangles, a small spiral notebook and pencil, and a safety vest in your trunk, keep your cell phone charged and with you, and you have just taken the first step.


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## Medic Tim (Jun 28, 2012)

djarmpit said:


> So I've come to the conclusion that although I've learned good amount of BLS through my EMT program, I think I'm pretty useless when I'm off-duty/not around any equipment.
> 
> I witnessed a car accident and stopped to help the driver (who had already gotten out of the car), trying to see if he was injured or had any spinal injuries. Afterwards I was visualizing my "scenario" I was kinda confused because I wanted to grab equipment that I didn't have to further help this guy out.
> 
> ...



When off duty you are functioning as a first aider. There is very little you will be able to do. Most times the best and safest thing to do is keep on driving and let the responding crews handle it.


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## JakeEMTP (Jun 28, 2012)

Calling 911 is first.  Sometimes new EMTs who are off duty waste time running into a scene and wanting to do a body count before calling 911. This wastes minutes when all you need to do is say car wreck with x number of cars unless you can see something clearly from your approach. 

Scene safety is next. Sometimes keeping yourself and others away from the scene is all you can do.
Sometimes not stopping at all is what you should do.  If it is unsafe to park you can endanger yourself, your family if they are with you and anyone else driving around you. If you do not have the proper reflective wear to make yourself visible, you put yourself in danger. Causing other injuries or deaths is not helping.  

You can tell others what to do if it could cause harm but don't engage in a physical confrontation if they don't comply.  

The basic ABCs are next. Some newbies rush in to slap on a oxygen mask or jam hard plastic objects into the patient's face but forget about just simply opening the airway which then allows you to assess other problems like foreign body, broken teeth or avulsions obstructing the airway. Remove only what you can see and safely do without losing fingers or having a bite that breaks the skin and could haunt you for the rest of your life.

But again this is only if you can do this safely.

Sometimes compressions only CPR is what you could do.  

Sometimes just a calm reassuring manner informing that help is on the way is all that you can do.


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## EMT91 (Jun 28, 2012)

One of my lab instructors said a lot of callers call then leave and it makes getting further info hard. It might be a good idea to stay and explain to the first responders what you saw. Also if you let the potentially injured know you are an emt they may feel more at ease.


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## JakeEMTP (Jun 28, 2012)

EMT91 said:


> One of my lab instructors said a lot of callers call then leave and it makes getting further info hard. It might be a good idea to stay and explain to the first responders what you saw. Also if you let the potentially injured know you are an emt they may feel more at ease.



A lot of callers don't leave a name or call back number. They wish not to get involved for a number of reasons.  If they stay, chances are they will be told to leave the scene by EMS when they arrive and never get a chance to say anything.  

If you witness a collision and it is not safe to pull over like on an interstate driving 70 mph and having to cross 6 lanes of traffic in your own car, you can give your name and number  when you call to be contacted if more info is needed. 

If you announce you are an EMT but can only do the minimum, some might question why you are not doing more.  If you announce you are an EMT but have no ID on you, expect to be questioned by a Police Officer.  

The problem comes mostly when it involves a crime with bodily injuries or death. Alot of people don't call and will immediately leave. Those who do call may not want to be involved anymore than the phone call reporting a crime with injuries. This could be out of fear of being harmed themselves or legal issues. Unfortunately doing the right thing when it comes to reporting a crime, especially with bodily harm, sometimes penalizes the caller with loss of work days or the fear of harm for themselves or their family.  Their own lives go under a microscope.  But, if it is a bloody MVC with mangled bodies expect everyone to hang around which is why the scene must be secured by EMS, Fire and the Police.


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## EMT91 (Jun 28, 2012)

JakeEMTP said:


> A lot of callers don't leave a name or call back number. They wish not to get involved for a number of reasons.  If they stay, chances are they will be told to leave the scene by EMS when they arrive and never get a chance to say anything.
> 
> If you witness a collision and it is not safe to pull over like on an interstate driving 70 mph and having to cross 6 lanes of traffic in your own car, you can give your name and number  when you call to be contacted if more info is needed.
> 
> ...


Of course prudence is needed. . I was more thinking of just in regular city streets. And of course scene safety is a needed thing. I was merely thinking that if you are able to safely provide some info, whether it be to the dispatcher or to the arriving crew. I would say something like this to the people involved "Hi, my name is EMT91; I am a certified EMT, but I am not on duty so I do not have my gear to help much, however I have called 911 and they are on the way. If  you would like, I will stay here if it will make you feel better or calmer, for whatever reason." I do not recommend being a Ricky Rescue or Hubert Hero; I do recommend doing what you can if you can provide assistance, even just emotional support as long as it is safe.  The point about callers is from what my instructor in lab told me was that they will call and say "There was an accident on 123 street." and the dispatcher may ask "how many cars were involved or was anyone walking around or anything?" and the caller will say "Oh, I don't know- I am ten blocks away." Again, perhaps my lab instructor is mistaken, and if so, I apologize for passing on the info.
You summed it up very well- "Sometimes just a calm reassuring manner informing that help is on the way is all that you can do." I apologize if I seemed to suggest unsafe or otherwise foolish things.


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## djarmpit (Jun 28, 2012)

Thanks for all the replies! Now in cases other than a car accident (medial emergencies) what would you guys do? Obviously call 911 if you want to get involved and scene size-up but is that pretty much all there is until the on duty guys come?


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## Medic Tim (Jun 28, 2012)

djarmpit said:


> Thanks for all the replies! Now in cases other than a car accident (medial emergencies) what would you guys do? Obviously call 911 if you want to get involved and scene size-up but is that pretty much all there is until the on duty guys come?



There still isn't much you are going to be able to do. Don't call 911 unless the pt wants you to*. 

*feel free to call if they are not breathing or anything like that.


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## Handsome Robb (Jun 28, 2012)

Medic Tim said:


> Don't call 911 unless the pt wants you to*.



This. 

If you want to help go for it but I'll guarantee most crews will be pretty agitated with you if you call for someone and that person didn't want you to. Makes more paperwork for us and runs like this generally happen while we are waiting for our food, which we have already paid for, to be finished.


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## Veneficus (Jun 28, 2012)

Make a reasonable guess if my getting involved would change anything.

If yes, if it is safe perhaps some basic interventions.

If no, call 911 as I move on.


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## the_negro_puppy (Jun 28, 2012)

Ahhh this is nothing new.

Person joins the world of EMS etc and suddenly has fantasies about using their skills off duty to save the world.

Let me say that if you are driving past an MVA, it seems to be relatively minor with the occupants out, walking around with no major injuries then there is no reason to stop. By stopping at a crash you are putting yourself at unnecessary risk/danger. You are not at work and will not be covered if you are hit by another rubber necking idiot. Try explaining to your family that you are a paraplegic because you topped to play EMS super hero at a minor nose-tail MVA.

Not only is it dangerous but what exactly are you going to do with no gear or equipment? take a radial pulse and GCS?

The only time I would ever stop to help in a trauma or medical call is if the person was unconscious, bleeding severly or had an immediate life threat such as airway, cardiac arrest.

As you move on in your career, you will be less and less inclined to stop and play EMS superhero while you are off duty. Once you have been in the job a while you will realise there is very little you can do other than CPR and call 911


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## djarmpit (Jun 28, 2012)

the_negro_puppy said:


> Ahhh this is nothing new.
> 
> Person joins the world of EMS etc and suddenly has fantasies about using their skills off duty to save the world.
> 
> ...






Obviously I am still new to all of this and have much to learn, but it's only natural for me to offer my hand to someone when I feel like I can help (regardless of whether or not I was an EMT) . The reason why I started this thread was just to see learn how others approached situations whether medical or trauma during their non-working hours. 

I appreciate all of your responses and do know better now that it's always best to go back to the basics and start by protecting the most important person, yourself.


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## DrParasite (Jun 28, 2012)

as a 911 operator, I say this: CALL 911!!!!  I would rather get a dozen calls about an MVA than 0.  If I send a cop, great.  If I send an ambulance, great.  if I send a fire truck, helicopter, SWAT team, great.  you give e the information, let me do my job as I am trained to

The reason I want everyone to call is to make sure I know where the crash is.  

if you want to play Ricky Rescuer (and yes, i have, turnout gear and all), go for it.  just do it after you call 911, so I, the dispatcher, can get the appropriate resources started to the scene while you are doing your thing.  Holding c-spine, basic assessment, even telling the cop to start a chopper (or not in my case) when he asks,  you won't be able to do much without the proper assistance.

and of course, once the local authorities say they got it, give them a quick report, and let them do their job, and get out of their way (unless they ask you to stay).

The other thing that would benefit the 911 operator is saying what is going on (2 car mva, 1 entrapped, 4 injured, 1 overturned, bus involved, etc), after identifying yourself an off duty EMT.  it might not change my response, but there are times where I would upgrade a response based on a callers information.


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## CANDawg (Jun 28, 2012)

Medic Tim said:


> There still isn't much you are going to be able to do. Don't call 911 unless the pt wants you to*.
> 
> *feel free to call if they are not breathing or anything like that.



I don't agree with this. I think it is best if you use your discretion, rather than blindly follow the directions of someone that just went through a physically and mentally stressful incident.

Remember that calling 911 doesn't necessarily mean the calvary will come. Let the 911 operator know what you see, and let them make the call. In most cases there should definitely be LE on the scene to help manage the incident and direct traffic. (Except in maybe a minor fender bender as long as the vehicles can move off the road.) If an EMS crew gets dispatched, c'est la vie. They'll blame the dispatcher, not you, and maybe even see something you missed.


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## Medic Tim (Jun 28, 2012)

dbo789 said:


> I don't agree with this. I think it is best if you use your discretion, rather than blindly follow the directions of someone that just went through a physically and mentally stressful incident.
> 
> Remember that calling 911 doesn't necessarily mean the calvary will come. Let the 911 operator know what you see, and let them make the call. In most cases there should definitely be LE on the scene to help manage the incident and direct traffic. (Except in maybe a minor fender bender as long as the vehicles can move off the road.) If an EMS crew gets dispatched, c'est la vie. They'll blame the dispatcher, not you, and maybe even see something you missed.



My quote above was in regard to a medical call. For a mvc 911 should be called.


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## emtCstock (Jul 22, 2012)

There is really not much anyone can do without proper equipment. I've been in this situation, and unfortunately had nothing at my disposal. It sucks, especially if you know what to do and what you need for the particular scenario.


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## NYMedic828 (Jul 22, 2012)

If I pull up alone on an MVA, I will hold C-Spine until an ambulance arrives. Even if that means for 25 minutes!







not serious.


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## mycrofft (Jul 22, 2012)

Remember : "check-call-care"!


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## EMDispatch (Jul 22, 2012)

DrParasite said:


> *The reason I want everyone to call is to make sure I know where the crash is.  *



I cannot emphasize that point enough...Working dispatch in an area with heavy tourism traffic, and lots of long empty stretches of road it's a total nightmare. We often get locations for accidents 5-10 miles away from the actual location. 

Pt info is also great, in our system it can allow us some discretion on pre-alerts for helicopters,etc. I tend to take reports from first responders more seriously, but the caller may also be lying (normally easy to tell by the jargon used). Also when we're flooded with calls for the same incident I may have to be less courteous than I like, just know that it's nothing personal.

When it comes to stopping... listen to your gut.  In portions of our county it can take hours for accidents to be discovered. Whenever I come across an accident or a car in a ditch I stop (when safe) just to make sure everyone is ok.


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## cusadiz (Jul 24, 2012)

You can still work w/o equipment. Patients walking around != all-ok. Some could be going into shock, some could have a neck injury that's only sore now but has the potential to become worse with aggravation. Stress of the accident may trigger a seizure or cardiac event. If nothing else, it's a great skills review for patient assessment purposes.


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## NYMedic828 (Jul 24, 2012)

Some of you guys think wayyyyy too far into your capabilities as a rescue-randy passerby...

Stop, ask if everyone is alright, call 911, sit back and watch the show.


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## cusadiz (Jul 24, 2012)

Some of us enjoy what we do.


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## NYMedic828 (Jul 24, 2012)

There's nothing wrong with that, but many people need to learn to slow down and take a step back.

Sometimes doing nothing is better than doing everything.

The best thing you can do is to ensure the response of the appropriate resources to the correct location.

If someone has chest pain, neck pain, ouchies and boo boos what life saving heroics are you going to perform out of your personal vehicle?


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## Tigger (Jul 24, 2012)

cusadiz said:


> You can still work w/o equipment. Patients walking around != all-ok. Some could be going into shock, some could have a neck injury that's only sore now but has the potential to become worse with aggravation. Stress of the accident may trigger a seizure or cardiac event. If nothing else, it's a great skills review for patient assessment purposes.



It's also rather bothersome for the non-serious patient to receive multiple assessments, especially considering that a passing bystander can't really do much with the results of such an assessment.


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## Christopher (Jul 24, 2012)

cusadiz said:


> You can still work w/o equipment. Patients walking around != all-ok. Some could be going into shock, some could have a neck injury that's only sore now but has the potential to become worse with aggravation. Stress of the accident may trigger a seizure or cardiac event. If nothing else, it's a great skills review for patient assessment purposes.



Ambulatory patients, without extremes of age, vital changes, focal neurological deficits, or pain to palpation are fine. F. I. N. E. Even then, patients with whom you have a low index of suspicion and who don't quite meet criteria that end up having an unstable injury are also going to be fine! Occult, unstable spinal injuries which go unimmobilized and end up with deficit are rare! Even less likely is immobilization HELPING.

A review of a fairly liberal clearance protocol found 5 patients (n=504) who "should" have been boarded/collared but were not. Only 1 patient suffered any negative sequelae:


> Patient 5 was a 76-year-old man who complained of back pain from the neck through the lumbar region several hours after chiropractic manipulation. He had a past history of a neck fracture 50 years previously. He reported progressive worsening of his pain over weeks, recently requiring the use of a walker. He had been ambulatory before his chiropractic visit that day, but shortly after returning home, he had increased pain and was no longer ambulatory. He was diagnosed with cervical cord dysfunction from a combination of cervical spondylosis, stenosis, degenerative disease, and displacement of an old nonfused unstable C2 fracture. He was treated with laminectomy, dens removal, and fusion from occiput to C4 and was discharged to a nursing home with residual quadriparesis.
> ...
> Patient 5 presents a dilemma because he clearly complained of pain and neurologic dysfunction; however, the question remains whether chiropractic manipulation qualifies as trauma. If considered trauma, this remains a protocol violation. If not, this would become an injury missed by the protocol. We believe that the paramedic should have known to immobilize this patient because he documented an acute inability to ambulate after manipulation. This patient is also concerning because he represents the only patient who had an adverse outcome with residual quadriparesis. However, the extent of neurologic dysfunction did not change between the initial paramedic evaluation and the ED evaluation. Consequently, it seems unlikely that spinal immobilization would have changed the outcome in this situation.
> ...
> Three patients with cervical injuries met none of the protocol criteria for immobilization (patients 2, 3, and 4)...[They] had no neurological deficits.


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## cusadiz (Jul 24, 2012)

NYMedic828 said:


> If someone has chest pain, neck pain, ouchies and boo boos what life saving heroics are you going to perform out of your personal vehicle?



Chest pain: on-hand to do cpr if necessary. 

Neck pain: convince the pt to not move and/or hold c-spine if required. 

Ouchies & boo-boos: Tell mommy to kiss it.

No, you're not gonna have the benefit of a full box, but that doesn't mean you can't help if you feel so inclined. 



			
				Tigger said:
			
		

> It's also rather bothersome for the non-serious patient to receive multiple assessments, especially considering that a passing bystander can't really do much with the results of such an assessment.



Some people hate attention, some are comforted by it. I don't mean to start a flame war, but OP was asking what he could do to help; telling him to just keep driving by - while certainly an option - wasn't what he was looking for, if I read the original post correctly.


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## emtCstock (Jul 24, 2012)

cusadiz said:


> You can still work w/o equipment. Patients walking around != all-ok. Some could be going into shock, some could have a neck injury that's only sore now but has the potential to become worse with aggravation. Stress of the accident may trigger a seizure or cardiac event. If nothing else, it's a great skills review for patient assessment purposes.



I wasn't implying you can't do anything without equipment, just not much without equipment.


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## NYMedic828 (Jul 24, 2012)

Sometimes my friend, the answers you seek may not necessarily be those which you desire.

No one is telling anyone not to do the righteous thing and help if the situation presents itself. We are stating that the harsh truth is that more often than not there is nothing you can do, and that which you can do may not be beneficial.


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## usalsfyre (Jul 24, 2012)

I'm going to guess your fairly new at this. 



cusadiz said:


> You can still work w/o equipment.


In a very, very limited way 



cusadiz said:


> Patients walking around != all-ok.


Generally yes.



cusadiz said:


> Some could be going into shock,


Even on an ambulance I don't have blood and surgical control of internal hemorrhage so what is the off-duty responder going to do?



cusadiz said:


> some could have a neck injury that's only sore now but has the potential to become worse with aggravation.


Conscious people generally do a VERY good job of protecting a true neck injury. Look up self-splinting 



cusadiz said:


> Stress of the accident may trigger a seizure


The DEA frowns on carrying benzos around...



cusadiz said:


> or cardiac event.


I guess you could hand them some aspirin 



cusadiz said:


> If nothing else, it's a great skills review for patient assessment purposes.


They may not appreciate being skills practice.

Sometimes the best thing to do is let the people who are empowered handle the situation. We have a very limited tool box as it is, further limited when off duty. The honest truth is doing things off-duty is often more about making you feel good than true help to the situation.


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## usalsfyre (Jul 24, 2012)

cusadiz said:


> Some people hate attention, some are comforted by it. I don't mean to start a flame war, but OP was asking what he could do to help; telling him to just keep driving by - while certainly an option - wasn't what he was looking for, if I read the original post correctly.


Just because it's not what he was looking for doesn't mean its not the right answer


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## Veneficus (Jul 24, 2012)

usalsfyre said:


> The DEA frowns on carrying benzos around...



Not to mention state medical boards.

There is also that pesky little caviat about practicing medicine without a license being a felony.


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## cusadiz (Jul 24, 2012)

You guys take the fun out of everything!


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## NYMedic828 (Jul 24, 2012)

Sorry :blush:


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## nocoderob (Jul 24, 2012)

If you really feel the pressing need to stop, I suggest walking up, if the scene is safe which they generally never are, and advising that you have called 911. I wouldn't want some stranger claiming to be an EMT pawing my family members in an attempt to assess them and surely others feel the same way. 

More than likely this desire will pass, young Padawan


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## CANDawg (Jul 24, 2012)

Veneficus said:


> There is also that pesky little caviat about practicing medicine without a license being a felony.



Even further reason medics should be a self regulated profession rather than operating under a doctor's medical license. Some jurisdictions are moving this way, but alas. 

That said, the amount of apathy in this thread is astounding. Yes, off duty w/o complex supplies, you can't do much. But not being able to do much does not equal not being able to do anything. If so, there would be no such thing as basic first aid. 

If you want to call 911 and keep driving, that's your call. But telling someone that wants to help that they should do the same is rude and immature. Yes, you're limited in what you can do, but that alone is not excuse enough not to help someone.


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## bahnrokt (Jul 24, 2012)

usalsfyre said:


> Even on an ambulance I don't have blood and surgical control of internal hemorrhage so what is the off-duty responder going to do?



Triage.  Figuring out that somone is going down hill fast gives Ricky Rescuer the chance to relay this information to dispatch and get appropriate resources moving faster.  Maybe they only had a BLS responding as an aplha and now know to upgrate to delta and get als or life flight en route. Getting that pt into a trauma er 10,15,20 min sooner makes a big difference.


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## Aidey (Jul 24, 2012)

Since when was Ricky Rescue able to accurately triage a group of people without grossly over-triaging them? The last thing we need are more people landing helicopters on interstates because someone has pain from the seat belt.


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## EMDispatch (Jul 24, 2012)

*As a refresher for some, and an FYI for others:*

*In 911 dispatch, we ideally would like answers about:*
1. *Exact Location*
2. *Number of Patients*
3. *Entrapment*
4. *Hazards*

Generally I can't get even a quarter of that from callers.

Obviosuly scene safety is the top priority, but if you can stop and get that information, you are doing about the best service possible for responders and victims. If you can't stop, do a scene size-up as you drive by. While doing that size-up try to think about the answers for those 4 areas.


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## usalsfyre (Jul 24, 2012)

dbo789 said:


> Even further reason medics should be a self regulated profession rather than operating under a doctor's medical license. Some jurisdictions are moving this way, but alas.


Nurses are a self regulated profession, yet they don't have the authority to practice medicine either (leaving aside the advanced practice debate for now) 



dbo789 said:


> That said, the amount of apathy in this thread is astounding. Yes, off duty w/o complex supplies, you can't do much. But not being able to do much does not equal not being able to do anything. If so, there would be no such thing as basic first aid.


It's not apathy. Its just the realization the returns are not worth the investment. There is quite literally nothing I can do in the majority of cases except stand there and look like a jackwagon while making myself a gigantic target for Suzy Cellphone and her minivan.   



dbo789 said:


> If you want to call 911 and keep driving, that's your call. But telling someone that wants to help that they should do the same is rude and immature. Yes, you're limited in what you can do, but that alone is not excuse enough not to help someone.


Except you represent me in some form or fashion (professionally) and I may be the one who has to deal with the fact that you have now convinced a totally uninjured party to be transported "just in case" and that not doing "x" intervention is malpractice (and yes, I've had this happen on multiple occasions).


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## Veneficus (Jul 25, 2012)

dbo789 said:


> Even further reason medics should be a self regulated profession rather than operating under a doctor's medical license.



Sure, right after they go to skule for longer than a few months.

Just what the world needs... a bunch of vocational education medic mill Rickey rescues wandering around with drugs in their car randomly "helping people."


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## Tigger (Jul 25, 2012)

dbo789 said:


> Even further reason medics should be a self regulated profession rather than operating under a doctor's medical license. Some jurisdictions are moving this way, but alas.
> 
> That said, the amount of apathy in this thread is astounding. Yes, off duty w/o complex supplies, you can't do much. But not being able to do much does not equal not being able to do anything. If so, there would be no such thing as basic first aid.
> 
> If you want to call 911 and keep driving, that's your call. But telling someone that wants to help that they should do the same is rude and immature. Yes, you're limited in what you can do, but that alone is not excuse enough not to help someone.



It's not apathy, it's a desire to not get splattered on the side of a highway while rendering "care" that will make no difference in the long or short run for the patient. Out and about the town is a different story I suppose but at the end of the day giving 911 the info they need is the best thing you can do to actually make a difference.


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## DrParasite (Jul 25, 2012)

bahnrokt said:


> Triage.  Figuring out that somone is going down hill fast gives Ricky Rescuer the chance to relay this information to dispatch and get appropriate resources moving faster.  Maybe they only had a BLS responding as an aplha and now know to upgrate to delta and get als or life flight en route. Getting that pt into a trauma er 10,15,20 min sooner makes a big difference.


Sure, I'll buy that argument.  Give the answers I am looking for can make me modify my dispatch.  When I used to play Ricky Rescuer (I still do once in a while), I have requested ALS, or told the cop that no helicopter was needed, and told him I hope he had a rescue crew enroute, because this guy needed to be cut out of the car.


Aidey said:


> Since when was Ricky Rescue able to accurately triage a group of people without grossly over-triaging them? The last thing we need are more people landing helicopters on interstates because someone has pain from the seat belt.


why not?  cops do it ALL THE TIME.  Usually it involves a bad crash, the helicopter being put on standby or requested to fly, and when EMS gets there and actually assesses the patient, they cancel it.





MCERT1 said:


> *As a refresher for some, and an FYI for others:*
> 
> *In 911 dispatch, we ideally would like answers about:*
> 1. *Exact Location*
> ...


Someone has taken a PriorityDispatch class!!!! 

Once I have the exact location, the rest is all fluff.  I can send a response with just a location.  if I know more, I can send an upgraded response (multiple EMS units, ALS, Rescue, FD, etc), and the sooner I hear something might be needed, the sooner they arrive.  As a general rule, once I start a response, they don't get cancelled until a member of the AHJ arrives on scene.





usalsfyre said:


> Except you represent me in some form or fashion (professionally) and I may be the one who has to deal with the fact that you have now convinced a totally uninjured party to be transported "just in case" and that not doing "x" intervention is malpractice (and yes, I've had this happen on multiple occasions).


So what do you do?  take the person to the hospital, which is your job!!!  Who cares why they want to go, just take them to the hospital.

I've both been Ricky Rescue and dealt with Ricky Rescue's on scenes.  When I was Ricky Rescue, I did my thing until the AHJ took over.  Than I left the scene, and let them do their work.  When I deal with Ricky Rescues, I expect a quick report on what is going on, then want them off my scene (unless for some reason I want them to stay, which is very very rare, and usually only if I know them).  

I don't always stop at MVAs, and if is a minor fender bender, I usually call 911 and make sure the AHJ is on the way.  if it looks like a major incident (over turned car, ejection, or just look really cool), and ITS SAFE TO DO SO, than I might stop.  first question I ask "has someone called 911?"  In most of the cases, once the cop shows up, and I show him my ID and look like I know what I am doing, they are typically appreciative of the help, and they go back to doing traffic and such.

You don't want to stop?  that's ok.  I won't hold it against you, nor call you an apathetic person.    I don't recommend you stop at EVERY MVA, or at any MVA.  

and in case you still want to stop at every MVA, please read this article from my home county:


> Old Bridge crashes leave 2 dead
> 
> 
> Published in the Home News Tribune 3/16/04
> ...


on a minor 3 car crash, in his own jurisdiction, and the mentor of a good friend of mine was killed.  Don't think it can't happen to you.


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## NYMedic828 (Jul 25, 2012)

I volunteer on long island and while we have a great working relationship with law enforcement most times, they don't want you stopping in the middle of the highway in your private vehicle to help them out. If you aren't operating under an agency, they don't want you there.

Long island simply has way too many buffmobiles that are dying to drive up on something. They even sit and listen to the scanners and claim they were passing by when they show up.

In NYC its a different story. If I am passing an MVA, and I stop and identify myself as an FDNY employee and render actual care, I can get overtime for it. In 3.5 years, I never once had to stop at an MVA in the city limits. I know people who have though.


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## CANDawg (Jul 25, 2012)

Veneficus said:


> Just what the world needs... *a bunch of vocational education medic mill Rickey rescues* wandering around with drugs in their car randomly "helping people."



:blink:

Yes. That's a great way to refer to your profession, and all the other members on this board who take pride in their skills and what they do. Self regulation is A) not new, B) works very well, C) solves a number of problems that our American counterparts complain about quite often. I see constant posts from American EMS professionals bemoaning that EMS in the US doesn't get the same respect as fire and police, but then I see comments like this. I don't know, seems like one kind of explains the other.

As well, good luck finding a self regulating system that allows people to carry a drug box in their car's first aid kit. That's not even close to the point of self regulation, and implying otherwise shows a vast misunderstanding of the issue.



usalsfyre said:


> Except you represent me in some form or fashion (professionally) and I may be the one who has to deal with the fact that you have now convinced a totally uninjured party to be transported "just in case" and that not doing "x" intervention is malpractice (and yes, I've had this happen on multiple occasions).



What makes you think that the professional stopping to assist doesn't know the difference between severe injury and uninjured? Its not like they're going to be walking around begging uninjured people to demand transport and a morphine push. You're assuming that the person stopping doesn't know how to do their job, which is insulting. Maybe they're upset that someone with such attitudes is representing _them_.


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## Veneficus (Jul 25, 2012)

dbo789 said:


> :blink:
> 
> Yes. That's a great way to refer to your profession, and all the other members on this board who take pride in their skills and what they do. Self regulation is A) not new, B) works very well, C) solves a number of problems that our American counterparts complain about quite often. I see constant posts from American EMS professionals bemoaning that EMS in the US doesn't get the same respect as fire and police, but then I see comments like this. I don't know, seems like one kind of explains the other.




I don't think you understand the issue very well actually. 

The US has volunteer ALS providers. That means things like intubation, drugs, electrical therapy, etc. 

There are more than a few threads on how to light up your personal vehicle, what do you carry in your personal jump kit, etc. 

I don't hear any of these topics being discussed in countries where paramedics are a self regulating body. 

I will point out in those countries as well, becomming a paramedic requires years of education, in the state of Ohio, a barber has more training than a paramedic by more than double.

You can graduate as a paramedic in 750 clock hours, with basic A&P included. 

Self regulation is not a right. It is earned. US EMS is and has done nothing for the last 2 decades to earn self regulation. SOme groups like the fire service representatives and volunteers have actively capaigned against what is required for such.

It is not a question of being proud of skills or training, etc. It is a question of responsibility and accountability. Which a vast majority of US EMS providers want absolutely nothing to do with.

A person could be the best damn paramedic in the world, but that in no way represents the vocation as a whole in the US.  



dbo789 said:


> As well, good luck finding a self regulating system that allows people to carry a drug box in their car's first aid kit. That's not even close to the point of self regulation, and implying otherwise shows a vast misunderstanding of the issue.



I don't think so. I have seen US EMS providers who actually have purchased defibrilators for thier "personal jump kit." Things like BP cuffs, pulse oximeters, and bottles of aspirin seem almost tame in comparison. 

What other self regulating systems allow a person to equip their personal vehicles with warning lights, sirens, and scanners "waiting for the call"?

In the many US systems you can't stop people from putting backboards on every patient who falls from standing. How could it possibly be suggested by a responsible party that these people are ready or should self regulate?





dbo789 said:


> What makes you think that the professional stopping to assist doesn't know the difference between severe injury and uninjured?].



experience.



dbo789 said:


> Its not like they're going to be walking around begging uninjured people to demand transport and a morphine push. You're assuming that the person stopping doesn't know how to do their job, which is insulting. Maybe they're upset that someone with such attitudes is representing _them_.



:rofl:

Transport and a morphine push would be rather benign compared to the $20K helo ride.

The US can't stop full time professional agencies from over treatment/over triage, how do you plan to include all of the volunteers into this self regulating fold?


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## NYMedic828 (Jul 25, 2012)

dbo789 said:


> :blink:
> 
> Yes. That's a great way to refer to your profession, and all the other members on this board who take pride in their skills and what they do. Self regulation is A) not new, B) works very well, C) solves a number of problems that our American counterparts complain about quite often. I see constant posts from American EMS professionals bemoaning that EMS in the US doesn't get the same respect as fire and police, but then I see comments like this. I don't know, seems like one kind of explains the other.



Ven. is one of the most beneficial and highest contributing members of this forum. I'm sure he can and will stand up for his statement on his own but considering the fact that he had the opportunity, as a respected medical doctor, to leave EMS behind many years ago that he does in fact have a great level of pride for the service.

That said, I hate to break it to you but sometimes the truth hurts. What people sometimes fail to realize is, the people on this forum are not the problem. The people on this forum are here because they seek answers and means of self education through discussion with others of greater/differing experience. Ven. is not literally referring to the entire service as an incompetent bunch of drones but quite frankly, a good enough portion of them are. The harsh reality is that most of EMS has never set foot in an educational institution past a high school. They barely payed attention in their class and the testing procedure was so easy that they are permitted to practice. The last thing that we need is these people being permitted to practice medicine on their own. The Ricky rescues as we call them may act in good faith but often times they aren't doing things in an educated manor. If you want the PRIVELEDGE to practice under your own license, make the strides to reach that level, as Ven. did.




dbo789 said:


> What makes you think that the professional stopping to assist doesn't know the difference between severe injury and uninjured? Its not like they're going to be walking around begging uninjured people to demand transport and a morphine push. You're assuming that the person stopping doesn't know how to do their job, which is insulting. Maybe they're upset that someone with such attitudes is representing _them_.



Again, because quite frequently, they don't. Most of the people I volly with are ready to throw every patient involved in an MVA on a board and collar when they have been walking around for 10 minutes already.

These people are the reason I get called an ambulance driver and not a paramedic. When you take the time to explain things to the patient in an intellectual manor, they will look at you in a brighter light than just a taxi service. 

The same goes when operating with police officers. Half the time we have people running around like monkies rushing about when the situation is nowhere near life threatening.

Here's some comedy for you, that while a bit exaggerated, holds pretty true in many places.


http://www.youtube.com/watch?v=YzYxz_uvtSI&feature=youtube_gdata_player


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## NYMedic828 (Jul 25, 2012)

Dammit Ven. Always gets the upperhand! You suck!

Little side note, I have jump bag in my vehicle with all the fun stuff in it (full ALS bag) but you can bet your *** it will NEVER come out of my vehicle unless I am operating in the township which issued it to me. NEVER.

Personally I would feel comfortable having to take responsibility for my own actions but I can't maintain that feeling of comfort when the other medic next to me stabs my patient in the arm with glucagon unexpectedly AS IM ALREADY PUSHING D50!

Also, most volunteer ALS providers, not all, but most, have almost no experience. The majority of the Critical Care providers in my department have never intubated a real human being.


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## Handsome Robb (Jul 25, 2012)

dbo789 said:


> Remember that calling 911 doesn't necessarily mean the calvary will come. Let the 911 operator know what you see, and let them make the call.



I don't know about other systems but if you call 911 here stating you drove past a car accident "the cavalry" will come. At minimum you will get 1-2 LEOs, an Engine crew and an ALS ambulance crew (we only run ALS so take that with a grain of salt, other systems may dispatch BLS and only run an ALS unit if certain parameters are met)



dbo789 said:


> That said, the amount of apathy in this thread is astounding.



It's not apathy, it's self preservation. I don't have a wife or kids or even a girlfriend but I do have a mom, dad and brother along with extended family and friends. Me stopping while off duty and getting hurt or killed at the scene of an MVA isn't going to do them any good. 

What am I going to do at a medical call outside of CPR that is going to help? A bad breather doesn't need an off duty or *unemployed* EMT asking a million questions and demanding answers causing them to exert even more effort than they already are on their respiratory effort. A cardiac patient doesn't need an amped up ricky rescue stressing them out and boosting their BP and pulse. An abdominal pain patient doesn't need someone asking a bunch of questions that are going to be repeated by EMS personnel while they are in pain. 

I'm new at this, about a year of experience in a busy 911 system, but I along with most if not all of my coworkers will take whatever a ricky rescue tells us with a grain of salt. If it's one of my coworkers or a firefighter that I know that's off duty it's a different situation but outside of those two situations I'm going to repeat everything you already asked because, frankly, I don't know you are trust you. 

Like others have said, if you want to stop that's your prerogative but don't get offended if responders disregard everything you have to say.

Outside of life threatening hemorrhage control, opening an airway or CPR you aren't going to do a whole lot of good for the patient. Some patients may appreciate your caring nature but plenty will just be annoyed that some random human being is trying to get involved in their business.


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## EMDispatch (Jul 25, 2012)

dbo789 said:


> Remember that calling 911 doesn't necessarily mean the calvary will come. Let the 911 operator know what you see, and let them make the call.



I'd be appalled to find an agency that didn't send out a response fora reported mvc, or anything else. It isn't my "call" to make, I'm bound by strict protocols, regulations, and the traditional fear of negligence lawsuits. We live by the mantra: *"When in doubt, send them out."*Since I can't see what you told me, I'm in doubt on a good 99% of calls. Now, if I actually had the power of omni-presence... I just might feel comfortable not sending a full response on an mvc where I receive minimal info. 



NVRob said:


> I don't know about other systems but if you call 911 here stating you drove past a car accident "the cavalry" will come. At minimum you will get 1-2 LEOs, an Engine crew and an ALS ambulance crew (we only run ALS so take that with a grain of salt, other systems may dispatch BLS and only run an ALS unit if certain parameters are met)



All agencies in our area will run a similar response. We'll modify it if we have additional info. It doesn't even have to be great info. If the caller saw 12 people in a van involved in the crash...You can bet we'll add a few more ambulances.


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## bahnrokt (Jul 25, 2012)

MCERT1 said:


> All agencies in our area will run a similar response. We'll modify it if we have additional info. It doesn't even have to be great info. If the caller saw 12 people in a van involved in the crash...You can bet we'll add a few more ambulances.



How much does a callers attitude and tone of voice play into how you dispatch a call? Maybe not on an official level but just a basic human reaction?  I've noticed a pattern over the years that everytime a call is grossly over dispatched there is always a nervous nelly with her (sorry, but its almost always a woman) hands shaking and barely able to talk.  It's not her fault.  In her mind, a minor roll over might as well be a passenger jet hitting a football stadium during a sold out game.

You pull up and see a couple bored leos directing traffic and this wreck comes running up with her hands in the air like she is trying to fly. Before you even open the door she  tries to tell you her husbands entire hx in four syllables, you have no idea what she said, but all you can find wrong with him is some airbag burns and the chest pain is from the seatbelt.  He says he is fine and does not want transport, but
as your getting the RMA form out she is now babbling that he needs to go to some hospital 3 hours away because his doctor is there.


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## CANDawg (Jul 25, 2012)

Veneficus said:


> I don't think you understand the issue very well actually.



I think it is a bit of a misunderstanding and an admitted lack of knowledge on my part about the US EMS system. Whenever I look at things, I look at them through the eyes of the way EMS operates in Canada. When I see EMT, I think an EMT here in Alberta, not an EMT-B in the US. 

Most EMS professionals here aren't going into EMS as a jumping point into another health care profession, they're making EMS a conscious career choice. The educational requirements are stricter and longer, and as a result the scopes are bigger. (Medics here even have things like pericardiocentesis in their scopes.) Experience is a major requirement to move on to the next level, as you generally need at least 2-3 years (recommended)  of active experience as an EMT to move on to medic. (Which generally is a 2 year program on its own.) Alberta arguably has the strictest training and largest scopes in Canada as well, so that only exacerbates the differences.

Alberta is self-regulated at the moment (Alberta College of Paramedics), and is moving to a system of legislation where Paramedics (and later EMTs and EMRs) operate under their own license rather than under a doctor's. (Health Professions Act.) There is still an MD in each agency to provide QA, system review and develop protocols, but this is on a agency (or even system) wide basis instead. Generally, the profession, MDs, legislators, and the public see this as a positive change and one that is long overdue. 

In the situation you described, I admit that self regulation isn't the best option at the point, as it is the last step in a long line of improvements. That said, I think that all it will take is some initial heavy pressure on state and federal governments to improve the system before the ball starts to roll toward a point where self regulation is a viable option. Its disappointing to see experienced, talented and passionate practitioners be held back by a system that places them alongside these "ricky rescuers" as you call them. (People that are only in EMS because it looks good on a resume, or because they want to drive the truck with the lights and sirens.) 

Getting a little bit back to topic, I still believe that if there is no emergency crew on scene and someone wants to stop to make sure everyone is okay and provide basic first aid, they shouldn't be discouraged. I don't approve of impeding on-duty emergency crews once they arrive, or stopping at a scene that looks well controlled to try and jump in and work on a patient. But if I was in an injury accident or had a significant medical emergency in a public place, I would appreciate even the moral support of someone stopping and trying to help as opposed to just calling 911 and moving on. Unfortunately that's not really something that anyone will be able to change my mind on. 

And I was very careful in my previous posts to criticize ideas and not individuals, so please don't take my strongly worded opinions personally. h34r:


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## EMDispatch (Jul 25, 2012)

bahnrokt said:


> How much does a callers attitude and tone of voice play into how you dispatch a call? Maybe not on an official level but just a basic human reaction?



It all depends on what were told by the caller. Don't get me wrong, you get more emotionally involved when you have frantic caller, but you  have to keep distant and in control for the duration of the call. That should never affect the response.It feels really weird, but general I don't "feel" about calls (minus the pediatric arrests,etc) until after a shift. 

The problem is that those emotional callers tend to give us poor info. They tell us there's entrapment when there isn't. They also give us a wrong number of patients, and many will also confuse steam from the radiator for smoke.

I can't, nor would I dismiss any statements a single caller makes from an accident scene. I'll send out based on what they told me. Now if there are 2+ on scene (not drive-by) callers giving me conflicting info, I'll evaluate things differently. Still, I err on the side of caution and send for the worst case scenario.


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## DrParasite (Jul 25, 2012)

NVRob said:


> I don't know about other systems but if you call 911 here stating you drove past a car accident "the cavalry" will come. At minimum you will get 1-2 LEOs, an Engine crew and an ALS ambulance crew (we only run ALS so take that with a grain of salt, other systems may dispatch BLS and only run an ALS unit if certain parameters are met).


Damn, that's your cavalry?  Where I am, if you call reporting a major crash, you are getting: 1 FD engine, 1 FD ladder, 1 FD Battalion Chief, 1 FD Heavy Rescue, 1 BLS ambulance, 1 ALS ambulance, 1 EMS Heavy Rescue, 1 EMS Supervisor, 1-2 patrol units, and one PD ESU/Rescue (if they are available).  

a minor MVA (with injuries) gets 1 FD engine, 1 FD truck, 1 FD Battalion Chief, 1 FD Heavy Rescue, and 1 BLS ambulance (although they could probably get away with 1 BLS ambulance and 1 engine for most minor MVAs.


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## DrParasite (Jul 25, 2012)

NVRob said:


> If it's one of my coworkers or a firefighter that I know that's off duty it's a different situation but outside of those two situations I'm going to repeat everything you already asked because, frankly, I don't know you are trust you.


That's also why a doctor in the ER will repeat every questions you ask in the ambulance, as well as why every nurse who examines the patients will reask every questions you asked, and gave them the answer when you gave the nurses your report.  Same exact reason.


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## DrParasite (Jul 25, 2012)

bahnrokt said:


> How much does a callers attitude and tone of voice play into how you dispatch a call? Maybe not on an official level but just a basic human reaction?  I've noticed a pattern over the years that everytime a call is grossly over dispatched there is always a nervous nelly with her (sorry, but its almost always a woman) hands shaking and barely able to talk.  It's not her fault.  In her mind, a minor roll over might as well be a passenger jet hitting a football stadium during a sold out game.


Honest answer?  0 affect.  In fact, I had a report of a person from from a local LEO agency, and my exact response was "again????  really?? this is the 5th one tonight!!!"

Studies have shown that the tone of voice and attitude have 0 correlation with the severity of a call.  I can't tell you how many times i have been screamed at because the ambulance hasn't arrived for the "severe abdominal pain" that the 5-15 year old patient has had for 4 hours, while Ms. Watson calmly told me her 70 year old husband was experiencing chest pains, and needed an ambulance to check him out and take him to the ER.

I've also received 4 or 5 calls on a grossly horrific MVA, reports of entrapment, car into a building, person unconscious or dead, only for the first arriving unit to say "no entrapment, minor damage to the building, and no injuries."  

BTW, a rollover and a jet hitting the stadium get the same initial response from my agency (ALS/BLS/RESCUE/Chief). until an on duty unit arrives, confirms the situation, gives me an official size up, and tells me what they need, I won't be pressing the panic button and send all available resources to the scene.  The only thing that might change is with the Jet, I will be moving available units back to HQ, to ensure I have the staff the Mass Casualty and Special Operations units, but they won't go to the scene until a unit arrive and says they are needed.


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## NomadicMedic (Jul 25, 2012)

Do you find that your dispatch software either over prioritizes calls or under prioritizes calls? For example, in my system seizure calls normally PMD as an alpha level, however the dispatcher usually has medics respond to these calls even though our criteria is a medic only on a Charlie or above. 

In the other direction, the software automatically turns any "abnormal breathing" into a paramedic level call even though it may be total BS. For example, "did you stub your toe? Are you breathing normally?" Yes to the first question, no to the second means a paramedic unit.


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## EMDispatch (Jul 26, 2012)

It partially depends on how the agency is utlizing the software, and the imperfect nature of blindly assessing a person over the phone.

Many agencies don't define different response levels, or alter them from experiences. My agency currently doesn't distinguish alpha-delta any differently (all county units are ALS & respond on all calls). Our only special distinction is that echo calls recieve additional FD response. I'd venture to guess someone has told the dispatchers at some point to *** ALS to those siezure calls due to the probabilty of an arrest on a siezure call.

In terms of the software over prioritizing calls... Well it happens, but it does for a reason. The software and protocls identify priority symptoms (we use MPDS v12). When the system identifies a priority symptom it raises the priorty of the call. Not a perfect system by any means, but it is designed to assume the worst-case scenario until you can prove otherwise. Bottom line is better safe than sorry.


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## DrParasite (Jul 26, 2012)

while totally off topic, and probably should be moved to a new thread, but....


n7lxi said:


> Do you find that your dispatch software either over prioritizes calls or under prioritizes calls? For example, in my system seizure calls normally PMD as an alpha level, however the dispatcher usually has medics respond to these calls even though our criteria is a medic only on a Charlie or above.


Both.  It depends on the call.  I have heard some dispatchers that will over dispatch, especially seizure patients, out of fear they will actually be a cardiac arrest, when the guidelines say BLS only.  Similarly, our medical director wants all stabbings and shootings to be ALS dispatch, and has modified our dispatch protocols.  As such, a stabbing to the hand is an ALS dispatcher.





n7lxi said:


> In the other direction, the software automatically turns any "abnormal breathing" into a paramedic level call even though it may be total BS. For example, "did you stub your toe? Are you breathing normally?" Yes to the first question, no to the second means a paramedic unit.


all the time.  worst question in the dispatch script.  15 year old who has been sick all day, and is vomiting.  questions asked: are they breathing normally? answer: no, when they are vomiting they are not breathing normally.  ALS dispatch.

Paramedics hate the system, primarily for the "breathing normally" and "are they clammy" questions.  That and the sick person (with cardiac history).  As a dispatcher, very often I am 99.99% confident the call is BLS, despite how the caller is answering the questions.  

But my boss's boss wants me to dispatch according to the guidelines, and on that 0.01% of the time, when you are wrong, you will get hung out to dry for not following policy.  I don't agree with it, but it does happen, and in theory if you are following the guidelines, and get dragged into court over them, if you followed the dispatch protocols to the letter, the company will pay all your legal costs and assume any liability of any negative outcomes.


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## Handsome Robb (Jul 26, 2012)

n7lxi said:


> Do you find that your dispatch software either over prioritizes calls or under prioritizes calls? For example, in my system seizure calls normally PMD as an alpha level, however the dispatcher usually has medics respond to these calls even though our criteria is a medic only on a Charlie or above.
> 
> In the other direction, the software automatically turns any "abnormal breathing" into a paramedic level call even though it may be total BS. For example, "did you stub your toe? Are you breathing normally?" Yes to the first question, no to the second means a paramedic unit.



Ours does. Like you said its the "are you/they breathing normally" is the one that upgrades it. Another big one that upgrades calls are "Are they alert/acting normally". No = an upgrade due to an 'altered subject'.

We have an all ALS system. Well ILS fire departments with 4 outlying stations having an ALS engine then all ALS ambulances. Priority 1/2 calls are a code 3 response with a response from the fire department as well, priority 3 is a routine response with no fire response. So that stubbed toe will come out as a priority 3 then bump to a priority 1/2 when they say the patient isn't breathing normally, usually it only bumps to a p2 but occasionally it'll turn to a p1.

Our dispatchers can upgrade calls at their discretion if the software spits it out as a p3 but they hear something or think it warrants a code 3 response. On the other hand they cannot downgrade calls to a routine response even if they think/know it's total BS.

Sorry OP and mods for going off topic. Maybe if you have a free moment the dispatch oriented posts could be moved to a new thread?


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## Handsome Robb (Jul 26, 2012)

DrParasite said:


> That's also why a doctor in the ER will repeat every questions you ask in the ambulance, as well as why every nurse who examines the patients will reask every questions you asked, and gave them the answer when you gave the nurses your report.  Same exact reason.



I agree 100%

Although we have a pretty good relationship with the nurses and physicians in our system. Many nurses won't re-ask questions if we've built a good rapport with them, provide them with an excellent hand off report and have proven ourselves competent. If I give them a thorough report including vaccinations, height, weight, primary care physician and/or pertinent specialty physicians. They are busy and recognize that most of us are good at what we do and if we can make their job easier they take all the info they can get from us.

That's not to say that there aren't nurses out there that don't listen to a word we say when we give them a report and redo all the work that we did.


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## JakeEMTP (Jul 26, 2012)

This shouldn't be just about you and how much the nurse likes you.

Those nurses also need to understand they must build a rapport with the patient and there are some things that they should document based on their own assessment. It sounds more like they are failing to do an important part of their assessment. Going to court with just documented hearsay without doing  their own personal assessment gives another meaning to "WNL".  For some this would be like writing down the last set of vitals from a patient's chart for a transfer and using them as if you just did them. Sometimes the timeline of when the questions were asked and re-asked is relevant.  Some patients also don't like to be talked over and not given the opportunity to correct whatever information was given incorrectly. That is then in their record from which others might use to determine treatment. When the nurse is then questioned why it was documented as such it will then be known he or she didn't assess or ask any questions. That makes the nurse look incompetent.

Some patients may be asked the same questions over and over to establish a baseline and any deviation from it.  Sometimes it is  a good thing when a patient recalls being asked the same questions earlier and by who.


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## Handsome Robb (Jul 26, 2012)

JakeEMTP said:


> This shouldn't be just about you and how much the nurse likes you.
> 
> Those nurses also need to understand they must build a rapport with the patient and there are some things that they should document based on their own assessment. It sounds more like they are failing to do an important part of their assessment. Going to court with just documented hearsay without doing  their own personal assessment gives another meaning to "WNL".  For some this would be like writing down the last set of vitals from a patient's chart for a transfer and using them as if you just did them. Sometimes the timeline of when the questions were asked and re-asked is relevant.  Some patients also don't like to be talked over and not given the opportunity to correct whatever information was given incorrectly. That is then in their record from which others might use to determine treatment. When the nurse is then questioned why it was documented as such it will then be known he or she didn't assess or ask any questions. That makes the nurse look incompetent.
> 
> Some patients may be asked the same questions over and over to establish a baseline and any deviation from it.  Sometimes it is  a good thing when a patient recalls being asked the same questions earlier and by who.



Out of that entire post that's what you picked out?

Agreed they should do their own assessment but there are things that I can pass along that don't need to be asked again. Do you know how frustrating it is to be asked the exact same set of questions over and over again? It can be misconstrued as demeaning to the patient, "why isn't anyone listening to me" comes to mind. What's the point of doing an assessment and passing finding along if those findings are going to be completely disregarded?

If you don't like it then that's your choice.


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## DrankTheKoolaid (Jul 26, 2012)

Thats exactly why I tell my patient's to expect to have the exact same questions asked over again in the ED at least once maybe twice more.  That way they at least can expect it and not think nobody is paying attention to them.


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## JakeEMTP (Jul 26, 2012)

NVRob said:


> Agreed they should do their own assessment but there are things that I can pass along that don't need to be asked again. Do you know how frustrating it is to be asked the exact same set of questions over and over again? It can be misconstrued as demeaning to the patient, "why isn't anyone listening to me" comes to mind. What's the point of doing an assessment and passing finding along if those findings are going to be completely disregarded?
> 
> If you don't like it then that's your choice.



Can you give an example of what they don't need to be asked again?

Besides just the assessment questions there are other things the patient will be asked over and over. You might even have noticed there are sometimes signs posted in the patient rooms, that is if you go past the ED, which inform the patient for their safety they will be asked the same questions over and over. These include personal identifiers such as name and birthdate. Every health care worker from the phlebotomist, RN, LPN, Radiology Technician, ECG Technician, CT Scan Technician, Respiratory Technician, Admitting clerk and so on will ask that patient for their name and birthdate even if they just saw the patient a few hours before and know who they are. That is a policy in probably every hospital in the United States. 

Also, as part of the patient education and re-education process, they may be asked to give the names of their medications, dosages and indications several times. Repetition is sometimes a good enforcer and patients won't be so ignorant of what their are taking and why. Again that is a good safety tool.

When that patient is transferred to another part of the hospital or even if another RN picks up that patient, the same questions and another thorough assessment will be done. At each shift change, the oncoming RN will again assess the patient. Your one time assessment is not the only one to be considered. Patients change. Even just while moving the patient from the ambulance to the ED, there can be a change in condition or mentation. If you are doing a CCT call, you should do your own assessment before assuming care for that patient and ask questions for clarification even if the RN just asked them.

If you work with patients and care about them, the choice is to do what you can to ensure safety rather than just copping an attitude and walking off pissed because you heard someone ask the same questions you just did. Again, it is not just about you. The whole patient care process and the plan of care must be considered with safety and the correct information provided for that care to continue beyond your ambulance.


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## Handsome Robb (Jul 26, 2012)

I still want to know where I "copped an attitude" or made it "all about me".

I'll just go crawl back in my hole since I'm obviously a sub par provider who has no business caring for patients.


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## atropine (Jul 26, 2012)

Don't use your skills off duty, that is what 911 is for. The only time I've seen my friends use their skill and I'am talking ALS stuff was for a syncope patient on a flight coming back from Hawaii, up in the air you can do what ever you need to do, and the flight attendents are very greatful.


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## joezeeger (Aug 10, 2012)

*A rare story where those on scene don't know what to do.*

On a rock climbing trip in Southern Illinois, we were having lunch after a day of climbing when we heard a loud thump in the distance and then the sound of a girl screaming. We ran in the direction of the screaming and found a girl who had fallen 50 feet off a cliff screaming. She had a compound leg fracture. That wasn't the bad part. There was a paramedic lying next to her and a very nervous and panicky EMT who had no clue what to do. 

The girl was trying to cross a stream at the top of the cliff and slipped and fell. Then the paramedic who responded did the same, but wasn't as fortunate. Seemed like he broke his neck. There were a lot of nervous people panicking and my brother took charge and told everyone an ER nurse is here (his girlfriend) and to back the hell off. (She wasn't too happy about that but went along with it)

 In the end, she got the EMT to calm down and take her to his ambulance. They ended up retrieving a backboard from the ambulance and they all coordinated a heli transport for the injured medic. Whatever happened to the girl and when she finally received care, I don't know, but her condition was not as serious as the paramedic's.


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## msaver (Aug 12, 2012)

It all depends on the situation, but you are very limited in what you can do. If it is possible, I would recommend acquiring a jump kit/trauma bag that you can carry in your vehicle. Your squad may furnish this for you, just ask your Lt. or Cpt. If it's a serious crash, do not try to extricate the person, for you may compromise the spine. However, if they are are at immediate risk of dying where they are have someone assist you, and very carefully move them paying close attention to their spine. Do not try to splint any injuries if a rig is on its way. More than likely it would be something makeshift and need to be redone by the arriving crew. When you're off-duty the only thing you can really treat is some life threatening situations.


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## NYMedic828 (Aug 12, 2012)

> With great power comes great responsibility


-Uncle Ben


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## Tigger (Aug 12, 2012)

msaver said:


> If it is possible, I would recommend acquiring a jump kit/trauma bag that you can carry in your vehicle. Your squad may furnish this for you, just ask your Lt. or Cpt.



Things that I am not going to do, volume #1. If I asked my boss for a first in bag he'd laugh at me and then probably fire me.


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## Veneficus (Aug 12, 2012)

msaver said:


> Do not try to splint any injuries if a rig is on its way. More than likely it would be something makeshift and need to be redone by the arriving crew. When you're off-duty the only thing you can really treat is some life threatening situations.



If a splint is working why would a crew take it off?


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## NomadicMedic (Aug 12, 2012)

If somebody had a patient splinted when I got there, I certainly wouldn't take off the splint… In fact, I probably would high-five the splinter.


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## Martyn (Aug 13, 2012)

NYMedic828 said:


> Some of you guys think wayyyyy too far into your capabilities as a rescue-randy passerby...
> 
> Stop, ask if everyone is alright, call 911, sit back and watch the show.


 

I like your line of thought NY lol


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## chillybreeze (Aug 13, 2012)

me too!  ^_^


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## NYMedic828 (Aug 13, 2012)

After reading through this entire thread again, I have outfitted my vehicle with a new jump bag in the event one of these off-duty situations should occur.

Here's what is inside it.


For calling people who can actually do something. (and playing games if I get bored waiting for them)






For enjoying the show





For making the popcorn


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## Veneficus (Aug 13, 2012)

If you are going to carry around a grill like that, maybe replace the popcorn with a steak or something...


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## MacrossForever (Aug 13, 2012)

Steaks? who the hell is he waiting for? I like the jiffypop idea, though that should be enough entertainment without the need for the phone to play games.


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## Veneficus (Aug 13, 2012)

MacrossForever said:


> Steaks? who the hell is he waiting for? I like the jiffypop idea, though that should be enough entertainment without the need for the phone to play games.



steak should be rare, at room temperature about 1 minute or so on each side.


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## STXmedic (Aug 13, 2012)

Veneficus said:


> steak should be rare, at room temperature about 1 minute or so on each side.



Quoted for truth


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## MacrossForever (Aug 13, 2012)

Okay, I guess you have me there. So would your Jump Bag look something like this?


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## Veneficus (Aug 13, 2012)

I think that'll do it.


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