# Nurses Integrated into 911 Dispatch System



## Sasha (Jan 25, 2009)

> *Ambulances, Not Taxicabs*
> http://www.emsdailynews.com/?p=2742
> 
> One proposed change would incorporate specially trained nurses into the 911 system. Dispatchers would direct non-emergency calls to nurses, who would arrange prompt appointments to health clinics and transportation and offer immediate advice.
> ...



I think nurses into the 911 system would be a great idea. Ambulances are not sent on non-emergency calls, and at the same time people aren't discouraged from calling 911.


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## fortsmithman (Jan 25, 2009)

Here in Fort smith our EMS is already dispatched by nurses at the town's hospital.  Our service doesn't employ EMD's instead we use the local nursing staff.


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## Sasha (Jan 25, 2009)

fortsmithman said:


> Here in Fort smith our EMS is already dispatched by nurses at the town's hospital.  Our service doesn't employ EMD's instead we use the local nursing staff.



That's awesome! Does it cut down on the amount of toe pains x5 days you run?

I think it would also be beneficial because the nurse could do a better assesment than the dispatcher, correct? And learn if that "arm pain" is actually deferred pain from an MI and intiate an ambulance response. Not that they could do a full assesment over the phone, but a better patient interview.


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## Ridryder911 (Jan 25, 2009)

Wasted resources. Why pay $30.00 an hour for a dispatcher, as well it has been to be fatal in some cases (anyone remember the Dallas fiasco?). I would hope they have great malpractice, as most nurses have learned not to even give advice on the phone. 

Get a good EMD with appropriate screening and go from there. 

R/r 911


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## sir.shocksalot (Jan 25, 2009)

If anyone has seen how Kaiser runs their urgent care/ambulance transport you would see why this is a terrible idea. Nobody can be the true judge of a patients condition over the phone.


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## Flight-LP (Jan 26, 2009)

Sasha said:


> That's awesome! Does it cut down on the amount of toe pains x5 days you run?
> 
> I think it would also be beneficial because the nurse could do a better assesment than the dispatcher, correct? And learn if that "arm pain" is actually deferred pain from an MI and intiate an ambulance response. Not that they could do a full assesment over the phone, but a better patient interview.



Far from my dear, far from............

Rid pointed out a big aspect of concern, but another one is the fact that many people from all races and demographics get the false belief of entitlement. Houston has done this for a while now and there have been oogles of complaints from citizens that they "didn't get an ambulance or had to pay for their taxi or didn't get seen quick enough". Sorry, but you'll have to continue to run your non-emergent calls until the day comes that EMS can refuse transport for non-emergent patients. Some are starting to do so with mixed results, personally I like the private for profit's philosophy; if your non-emergent, you pay up front or you don't receive services. Law of supply and demand. Demand money and supply non-emergent medical care.............................


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## EMTCop86 (Jan 26, 2009)

As Rid stated, all we need is some good EMDs. It would be like calling my doctors office after hours that have nurses there. You call and tell them what is wrong and they say go to the doctor or the hospital, not much help at all.

As far as people calling for toe pain...the type of people that call 911 for that are gonna keep calling and want to be transported no matter what anyone tells them over the phone.


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## Sasha (Jan 26, 2009)

You guys brought up some good points.. I never thought of it that way!


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## karaya (Jan 26, 2009)

No Sasha, this may in fact be a very good concept that is worth bearing some more fruit. This goes way beyond "having good EMDs" and appears to be working well in other cities.

EMDs are dispatchers and work from a standardized question format to determine type of response and if additional assistance is needed from the EMD until the calvary arrives.

The problem unfolds when the EMD encounters a caller whereby it is clearly a non-emergency situation. There is nothing in place to assist the caller for non-emergency calls (from an EMD standpoint) and this is where the caller is transfered to a nurse call center.

In the case of Houston, TX they just penned a $6.8 million dollar, 5 year contract to Healthcare Alliance for registered nurses to provide first-aide advice, medical referrals and patient evaluations. According to the contract, there is a $3 million dollar liability insurance per incident. The nurses are not staffed within the 911 center, but located at Healthcare Alliance's call center.

Richmond and Philadelphia both have similar programs. Richmond's program, which has been in effect for a year, has never had a case where an actual emergency was transfered to the nursing call center.

When you consider that Houston determined they spend over $50 million a year on non-emergency calls, $6.8 million for nurses to field non-emergencies may be money very will spent and saved for the citizens.


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## VentMedic (Jan 26, 2009)

karaya said:


> No Sasha, this may in fact be a very good concept that is worth bearing some more fruit. This goes way beyond "having good EMDs" and appears to be working well in other cities.


 
I agree. Hospital and healthcare systems have been using a "nurse call" sytem for years. 

As mentioned by karaya, the call will be directed to the RN after the dispatcher decides it is non-emergent. However, the RN may also have a say otherwise if something else is discovered during the conversation.

The Nurse call center may also be able to arrange for appropriate transportation. Many on these EMS forums are saying "no transport" if it is not an emergency but can not advise someone in a wheel chair of what other company can get them to the hospital or doctor's office. In other words, talk is cheap if you can not provide reasonable alternatives. At least the RNs have been stepping up to the plate to make this happen for the last 25 years. So far it has been working well with the exception of the Houston incident 20 years ago. 

There are many aspects of health care that EMS providers are not aware of because they have kept themselves isolated in many ways. Imagine what could be accomplished if everybody started working together including all of the EMS agencies to the various health systems and professionals.


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## mycrofft (Jan 26, 2009)

*Count me out.*

I've turned down recruitment for "advice nurse" positions. Many people are "poorly educated health care consumers" to some degree or another (as are we when we try to self-diagnose!) and the phone is not the medium to try to triage all except the most obviously minor cases...but then, wouldn't the biggest disasters appear at first to be "obviously minor"?

I've know some nurses who worked as "advice" (telephone triage") nurses. They quit when they figured out they were not only being worked like 
boiler-room phone marketers, they were seemingly expected to make sure an undefined (to them) percentage of their callers did not receive emergency care. This was against their better judgement and training and they quit. Some are comfortable with this, my contacts were not.

Public health nurses are another matter, designed to work independently to a great degree and acting as proactive agents, seeing the pts in their milieu, and can determine care from that point. Trouble is, they are not cheap, and nowadays their long historic immunity from violence and theft has been steadily evaporating.

PS: if it pays well enough, I have experience both as a dispatcher and nurse


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## Sasha (Jan 26, 2009)

What is this Houston event people keep referring too?


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## medic417 (Jan 26, 2009)

At the hospitals that I know of by each phone is a scripted message that basically states that without seeing you we can not give you any advice.  If you feel it is an emergency either come to the ER or call the ambulance.  

Why? Because somewhere, someplace someone gave wrong advice, possibly right advice but caller failed to give proper information.  This led to lawsuit and now like everything the extreme of no advice has come into play.  

But honestly there is no real good way to treat and examine a person over the phone.  How about just allow the Paramedics to respond then if they do not need an ambulance tell them where they need to go for proper treatment and then leave?  Much better than having nurses give advice sight unseen.


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## fortsmithman (Jan 26, 2009)

The nurses who dispatch do not give advice they just record the info and pass it to us.  Our deputy coordinator wants to hire an EMD but the town administration says no can't afford it.  They came to this because the nurses are already onduty and doesn't cost the town anything.   Most of our hospitals nurses as well as our doctors are short term locum positions.  Our medical director is in our capital city.


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## firecoins (Jan 26, 2009)

Wouldn't nurses cost more than EMDs?


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## VentMedic (Jan 26, 2009)

medic417 said:


> At the hospitals that I know of by each phone is a scripted message that basically states that without seeing you we can not give you any advice. If you feel it is an emergency either come to the ER or call the ambulance.


 
There are many reasons for that including discouraging the ED from being a call center. 

However, you might see if in your hospital listing of public numbers if there is a number for general info about doctors and services. Often people will be directed to call that number at least during the daytime if it isn't 24 hours. 

They also have that usual disclaimer, "hang up and call 911 if an emergency" with each call placed.

Again, a Paramedic unit may respond and tell them they should just go to a clinic.  However, the Paramedic may not know the specifics of each clinic or the various types of non-emergency services available.  Just telling someone they don't need an ambulance, look up a clinic in the yellow pages and take a cab is not appropriately advising someone either.  

I know that is probably not what you meant but that is the way it may come across to a patient.  Nurse call services can give specific information about certain clinics and services as well as directing them to a Social Service agency if necessary.


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