Any MIH medics? How does it work in your system?

[LanceCorpsman]

Just got hired as an EMT-I for a new MIH program here. We basically do discharge follow ups for high risk patients, blood draws and etc ordered by the docs. We also do the "non-emergent" responses for people who don't need the ED. Any of you work for a MIH program? How does yours work?

 

[SpecialK]

I don't see doing discharge follow-ups or blood draws as part of the role of the ambulance service. Discharge follow-ups are the responsibility of the GP or if appropriate the District Nurses.

We've had a single responder for low acuity work in Auckland and Christchurch for about 4 years now. There is two in Auckland during the day and one at night, and one in Christchurch. Control will assign a priority to a job when it is called in; the two lowest priorities are green and grey. Grey calls are held for response pending further telephone assessment by a nurse or paramedic, and those deemed suitable for a response is what Sierra targets. Green calls are suitable to wait up to two hours for an ambulance and at the moment some of them are assessed and if suitable referred to Sierra (or somewhere else such as the GP, A&M clinic etc). In the future, when there are more nurses and paramedics in control, all green calls will also be rung back while awaiting an ambulance to see if they can be diverted elsewhere or sent Sierra instead.

Sierra doesn't have anything additional or special; they have the same referral options as all ambulance personnel and I think this is sensible. They are just there to target work with a high likelihood of non-transport rather than sending a traditional ambulance. There was talk of using Nurse Practitioners at some point but I don't really think this would work very well.

It works very well, it adds the equivalent of one extra ambulance per day apparently.

Did you want to know something specific?

 

[EpiEMS]

Control will assign a priority to a job when it is called in; the two lowest priorities are green and grey.

Just out of curiosity, does this map to the US MDPS concept? What does a "green" or "grey" call typically entail?

 

[NomadicMedic]

Just out of curiosity, does this map to the US MDPS concept? What does a "green" or "grey" call typically entail?

The echo through omega MPDS isn't anything like the NZ system. We don't have a specific hold time to assign to people that call 911. In America, when you call, you get a unit. In NZ (and the U.K.) They can push callers down the queue and make them wait before an ambulance is ever sent.

 

[EpiEMS]

They can push callers down the queue and make them wait before an ambulance is ever sent.

It's quite rational, I must say.

@SpecialK, what're the criteria for determining that calls are "Green" or "Grey"? I presume it's some sort of structured protocol, but that could just be my U.S. bias.

 

[SpecialK]

Basically, about four years ago the old priorities 1, 2 and 3 were replaced with a new, unique five colour system. We do use MPDS but only the "front-end" as a triage tool, the response grid is completely independent of MPDS. I know from when I was in Control that MPDS was designed in America for Americans, and the "back-end" is completely "wrong" for how we operate; for example, we don't have "BLS" and "ALS" or multi-agency responses (the fire brigade do correspond to cardiac arrests but that's it). I've heard from the boss an MPDS replacement is sought in the medium term (the problem is there's not a really good one out there). I know implementing a custom-designed one has been thought of but I think that's probably a bit tooo weildly personaly.

Our system is designed on likely patient acuity based on patient report form data for each MPDS detriment. It changes periodically and this is a condensed summary:

PURPLE: Cardiac arrest. Immediate lights & siren response in 8 minutes. Tone-call station as required. All informed broadcast. Fire brigade co-response.
RED: Potentially immediately life threatening. Immediate lights & siren response in 8 minutes.
ORANGE: Urgent or potentially serious but not immediately life-threatening. Normal speed response within 30 minutes.
GREEN: Not medically urgent (can wait up to two hours).
GREY: Low acuity (for further telephone assessment).

This list is a bit out of date now probably but ....

GREEN calls:

04B01A ASSAULT POS DANG AREA
04B01S SEX ASSLT POS DANG AREA
08B01 CO/INH/HAZ ALERT NO SOB
08B01C CO/INH/HAZ ALERT NO SOB
08B01B CBRN ALERT NO SOB
08B01R CBRN ALERT NO SOB
08B01N CBRN ALERT NO SOB
08B01G HAZMAT ALERT NO SOB-GAS
08B01M INH/HAZ ALERT NO SOB-CO
08B01S CO SUICIDE-ALERT NO SOB
08B01U INH/HAZ ALERT NO SOB
17A01 FALL NON-DANG BODY AREA
17A01G FALL NON-DANG AREA-GRND
17A02 FALL-INJURY >6HR
17A02G FALL-INJ >6HR-GROUND
17A03 NON-INJ FALL/PUB ASSIST
17A03G FALL/PUB ASSIST-GROUND
17B01 FALL POS DANG BODY AREA
17B01G FALL POS DANG AREA-GRND
17B02 FALL SERIOUS HAEMORRAGE
21A01 NON-DANGEROUS BLEED
21A02 MINOR HAEMORRAGE
21B01 POSIBLY DANGEROUS BLEED
21B02 SERIOUS HEAMORRAGE
21B03 HAEM/LAC-BLEEDNG DISORDR
21B04 HAEM/LAC-BLOOD THINNERS
25A03 CAT/DR IN ATTENDANCE
25A03V CAT/DR ATENDING-VIOLENT
25A03W CAT/DR ATTENDING-WEAPON
25A03B CAT/DR ATTNENDING-V&W
26O05 URINARY RET NO ABDO PAIN
26O06 CATHETER PROBLEM
28A01x CVA <35 NORMAL RESP <3H
28A01y CVA <35 NORMAL RESP >3H
28A01z CVA <35 NORM REPS ?TIME
30B01 TRAUMA ?DANG BODY AREA
30B02 TRAUMA SERIOUS BLEED
31A02 FAINT ALERT<35 CARD HX
35A01 EAS Referral for Sierra
35A02 GP Referral for Sierra
35A03 Nurse Referral for Sierra
35A04 Other Referral for Sierra
35A05 Sierra initiated follow-up
35A06 CLINICAL TRIAGE Followup
35B01 ACUTE ADMISSION <2HRS
04B00P ASSAULT POLICE REF
04B00F ASSAULT FIRE REF
05B00P BACK PAIN POLICE REF
05B00F BACK PAIN FIRE REF
21B00P HAEM/LAC POLICE REF
30B00P TRAUMA POLICE REF
30B00F TRAUMA FIRE REF

GREY calls:

01A01 ABDOMINAL PAIN
02A01 RASH/HIVES NO SOB
02A01M RASH / HIVES NO SOB-MED
02A02 SPIDER BITE NO PRTY SYMP
02A02M SPIDER NO PRTY SYMP-MED
02C03 MINOR JELLYFISH STING
02C03M MINOR JELLYFISH-MED
03A01 BITE/ATACK NON-DANG AREA
03A02 BITE/ATTACK INJURY >6HR
03A03 SUPERFICIAL ANIMAL BITE
04A01A ASSAULT NON-DANG AREA
04A01S SEX ASSLT NON-DANG AREA
04A02A ASSAULT INJURY >6HRS
04A02S SEX ASSAULT INJRY >6HRS
05A01 NON-TRAUMATIC BACK PAIN
05A02 TRAUMATIC BACKPAIN >6HRS
07A03 SUNBURN OR MINOR BURN
07A03E MINOR BURN <HAND SIZE
07A03F MINOR BURN <HAND SIZE
11A01 WAS CHOKNG-ALRT/BREATHNG
11A01F WAS CHOKING ALERT-FOOD
11A01O WAS CHOKNG ALERT-OBJECT
11A01C WAS CHOKING ALERT-LOLLY
11A01M WAS CHOKNG ALERT-LIQUID
11A01U WAS CHOKNG ALERT-?CAUSE
16A02 MINOR EYE INJURY
16A03 MEDICAL EYE PROBLEM
18A01 HEADACHE NORMAL BREATHNG
20A01C COLD EXPOSURE ALERT
20A01H HEAT EXPOSURE ALERT
20B01C COLD EXP COLOUR CHANGE
20B01H HEAT EXP COLOUR CHANGE
20C01C COLD EXP HX MI/ANGINA
20C01H HEAT EXP HX MI/ANGINA
23O01 POISON NO PRTY SYMPTOMS
23O01A POISON NO PRTY SYMP-ACC
23B01 OD NO PRIORITY SYMPTOMS
23B01A OD NO PRTY SYMPT-ACC
24A01 1ST TRIMESTER HAEM/MISC
25A01 PSYCH/ABNORMAL BEHAVIOUR
25A01V PSYCH NON-SUIC-VIOLENT
26O02 BOILS
26O03 BUMPS N0N-TRAUMATIC
26O04 CANT SLEEP
26O07 CONSTIPATION
26O08 CRAMP/SPASM/JOINT PAIN
26O09 CUT OFF RING REQUEST
26O10 DEAFNESS
26O11 DEFAECATION/DIARRHOEA
26O12 EARACHE
26O13 ENEMA
26O14 GOUT
26O15 HAEMORRHOIDS/PILES
26O16 HEPATITIS
26O17 HICCUPS
26O18 ITCHING
26O19 NERVOUS
26O20 OBJECT STUCK IN ORIFICE
26O21 OBJECT SWALLOWED
26O22 PAINFUL URINATION
26O23 PENIS PROBLEMS/PAIN
26O24 RASH/SKIN DISORDER
26O25 SEXUALLY TRANS DISEASE
26O26 SORE THROAT
26O27 TOOTHACHE (NO JAW PAIN)
26O28 SURFACE WOUND INFECTION
26A01 SICK PERSON NO PRTY SYMP
26A02 ABNORMAL BP/ASYMPTOMATIC
26A03 DIZZINESS/VERTIGO
26A04 FEVER/CHILLS
26A05 GENERAL WEAKNESS
26A06 NAUSEA
26A07 NEW ONSET OF IMMOBILITY
26A08 SICK PERSON OTHER PAIN
26A09 SICK - TRANSPORT ONLY
26A10 UNWELL/ILL
26A11 VOMITING
30A01 TRAUMA NON-DANG BDY AREA
30A02 NON-RECENT INJURY>6HRS
31A03 FAINT ALRT<35 NO CARD HX

 

[LanceCorpsman]

I don't see doing discharge follow-ups or blood draws as part of the role of the ambulance service. Discharge follow-ups are the responsibility of the GP or if appropriate the District Nurses.

We've had a single responder for low acuity work in Auckland and Christchurch for about 4 years now. There is two in Auckland during the day and one at night, and one in Christchurch. Control will assign a priority to a job when it is called in; the two lowest priorities are green and grey. Grey calls are held for response pending further telephone assessment by a nurse or paramedic, and those deemed suitable for a response is what Sierra targets. Green calls are suitable to wait up to two hours for an ambulance and at the moment some of them are assessed and if suitable referred to Sierra (or somewhere else such as the GP, A&M clinic etc). In the future, when there are more nurses and paramedics in control, all green calls will also be rung back while awaiting an ambulance to see if they can be diverted elsewhere or sent Sierra instead.

Sierra doesn't have anything additional or special; they have the same referral options as all ambulance personnel and I think this is sensible. They are just there to target work with a high likelihood of non-transport rather than sending a traditional ambulance. There was talk of using Nurse Practitioners at some point but I don't really think this would work very well.

It works very well, it adds the equivalent of one extra ambulance per day apparently.

Did you want to know something specific?

We aren't an ambulance service. We incorporate community medics and EMTs. Our objectives is to reduce unnecessary ER visits. Think of it more like "preventative medicine." So anything we can do to prevent people from going to the ER, we do.