Did someone drop the ball?

[Jkimball]

Had a call today to respond priority to the county hotel for "unkown" (this is what came up on our tough book. No other updates through out the call.). Upon arrival. We were met by a very excited deputy saying that he tried to kill himself. The pt had multiple arterial bleeds and had lost a significant amount of blood. After the call we found out that this was called into the company directly. Fire was not responding due to it coming directly into the company and not through 911 dispatch. Does anyone think someone droped the ball on this? Shouldn't dispatch have taken the initiative, knowing this was a priority call to request fire respond as well? Or maybe ask some other questions besides answering the phone and just asking for an address to respond to, like why are we responding? If there are any dispatchers here please weight in.
We get this all the time were I work. One of the biggest pet peeves is that if it is called in directly to the company they can request the response priority. Like a "stable stroke pt in the other county that they want transported to an even farther away county because that's were the facility physician is associated with so they request us to repond priority 3. If they say there stable and a priority 3 they can request a destination facility. I've been called into my supervisors office multiple times for taking an unstable PT to the hospital 5 mins down the rd instead of the hospital 25- 35 minutes away in the next county and the physician is now pi$$ed. Does this happen to any one else or is just my company?

Sorry this was so long.
Just blowing off some steam I guess.
This has been really starting to get to me.

 

[DesertMedic66]

Wait, was the deputy the patient or was the deputy on the call?

 

[Jkimball]

No the deputy was not the pt. He just meet us outside and directed us in.

 

[DesertMedic66]

It’s completely possible that the deputy or his dispatch called your company dispatch and requested a unit. That would have bypassed the 911 system. In our area we don’t always respond fire when we get a private call.

 

[Jkimball]

Ya that's what happened. But they didn't ask any questions on why we were responding or for what.

 

[Jim37F]

So....my understanding of your question is that your dispatch assigned you the call via the business number vs 911 and not calling FD was legal or not, right? Regardless of the nature of the call itself...

I'm far from an expert in these matters, but I would hazard a guess that it boils down to how your agency is involved in the 911 EMS system (and how your FD responds to EMS calls). Is Fire the authorized EMS provider and would have sent their own ambulance if the call was dispatched via 911 without any involvement from your agency? Or is your agency the primary 911 EMS provider for the location of the call? Is there a pre-existing contract for you guys to respond to police requests without going through the normal 911 dispatching process? Does Fire even respond to all EMS calls normally, or only to certain ones? Are they ALS, BLS, or just EMR level?

My previous agency was a private company contracted by the ALS County FD that was the sole legal EMS provider in its jurisdiction (The Dept chose to staff ALS squads instead of ambulances and contract to a few different private companies for the ambulance response, primarily so their medics wouldn't be tied up on every BLS transport). In that case, it would be rather unusual for me to have gotten that call as you describe. The line guys in the station probably wouldn't care too much, the senior staffs who wear bugles and worry more about policy than responding to calls could potentially throw a legal hissy fit if they found out. Though even in that case it may not have actually been illegal, as I have been dispatched to calls where PD/Sheriffs called dispatch direct for a non emergent response/transport, though those were always either a) Standbys for SWAT or b) psych calls.....and more often then not they'd simply request a normal EMS response with Fire and whatnot....as if that doesn't muddy the waters there haha

On the other hand, if your agency is a primary 911 provider, and the address you responded to wasn't in some other agencies contractually defined Exclusive Operating Area, I don't see any issue with Fire not being called......but you really need to be a little more clear on the relationships between your agency and Fire and whos in charge of what during EMS calls. Where I'm at now (though still in Recruit Academy) Fire is only CFR, not even BLS, so I doubt we'd care much in this scenario, though it's possible the County Third Service EMS Agency might take issue if a private company did this, but since I do see AMR running around code 3 all the time anyway, I'm not so sure lol

 

[Jkimball]

Not so much that FD wasn't assigned just the lack of info and kind of playing the system.

Private company, contracted 911 provider for the area. Local FD is ALS non transport. FD goes on every medical. No contract for PD. If they arrive first and decide they want the call they can take over our ALS unite ( don't really want to get into that mess of a discussion) depending on the crew (some are easy to work with others don't like us because we took over when they stoped transporting).

Now the FD dept. I work for is in a different county than my EMS company. Calls go to there company just the same as ours for 911 or private. But if it's an emergency response they are required to alert county so that we are also dispatched. The caller weather private or 911 cannot dictate what the response level is or who responds (fire or no fire)
They cover 95% of the county for 911 and regardless of the licence level or who arrives first, if its a medical the transporting agency is incharge and we can't take the call from them and use there truck to transport. (If my FD personnel acted the way I've seen some of the ALS departments act I would have them written up and suspended)

 

[EpiEMS]

Shouldn't dispatch have taken the initiative, knowing this was a priority call to request fire respond as well? Or maybe ask some other questions besides answering the phone and just asking for an address to respond to, like why are we responding?

What else would fire do? PD is already there, they can't hold pressure (or tell the patient to do so)?

I've been called into my supervisors office multiple times for taking an unstable PT to the hospital 5 mins down the rd instead of the hospital 25- 35 minutes away in the next county and the physician is now pi$$ed.

Sounds like you've made the right call...management doesn't stand up for you?

 

[Tigger]

Who knows if that's acceptable or not. We still have municipal dispatch centers in Colorado that don't use any sort of validated EMD. Some jurisdictions require ambulance providers to notify the municipality that they received a private line call, some don't. The AMR operation I work PT for actually EMDs private line calls and if warranted (anything over an Alpha level call), they have to ask fire to come.

 

[Jkimball]

PD won't roll with us and the pt was unconscious from about 1-2 liters of blood loss from about 5 lacs to different artery's.

 

[DrParasite]

Had a call today to respond priority to the county hotel for "unkown" (this is what came up on our tough book. No other updates through out the call.). Upon arrival. We were met by a very excited deputy saying that he tried to kill himself. The pt had multiple arterial bleeds and had lost a significant amount of blood. After the call we found out that this was called into the company directly. Fire was not responding due to it coming directly into the company and not through 911 dispatch. Does anyone think someone droped the ball on this? Shouldn't dispatch have taken the initiative, knowing this was a priority call to request fire respond as well? Or maybe ask some other questions besides answering the phone and just asking for an address to respond to, like why are we responding? If there are any dispatchers here please weight in.

Background on me: 15 years in EMS, including 5 years working in communications.

Are you the ambulance service for the entire area? Do you have your own communications center or dispatch center, or are you dispatched directly by the county 911 center? Do you ever go on calls that are not routed through the 911 system? What are the company's policies for handling calls that are sent directly to your agency? what is the training level of your dispatchers? EMT, EMD, 911, etc. (side note: just because you are an EMT doesn't qualify you to dispatch; in fact, it can make things harder because EMT and EMD protocols don't always line up).

putting my dispatch hat on: an "unknown" is not a priority dispatch. BLS ambulance only until additional information is obtained. So based on simply that information, no, I wouldn't have requested a FD response, because there are no known or suspected life threats present. Additional questions: who called it in? was it the patient, a bystander, the front desk person at the hotel? Did they give any information to the dispatcher? you are assuming the job wasn't done, when it reality, it might have been a simple case of "garbage in, garbage out." If they aren't given any information, despite asking, they can't give you anything. Someone requested an ambulance, 3rd party caller, with no additional information translates to an "unknown" dispatch. That's BLS all the way, maybe with a request for PD depending on your area (in my area, you wouldn't have even gotten a request from us to send PD).

The ball that was dropped was on the part of the PD. They should have updated their dispatch center with the patient's condition, who should have updated your dispatch center, and then update you, so you can call additional resources (if necessary). But other than that, unless you can get the tape of the original call that shows otherwise, than I don't think anyone at your agency did anything wrong.

We get this all the time were I work. One of the biggest pet peeves is that if it is called in directly to the company they can request the response priority. Like a "stable stroke pt in the other county that they want transported to an even farther away county because that's were the facility physician is associated with so they request us to repond priority 3. If they say there stable and a priority 3 they can request a destination facility. I've been called into my supervisors office multiple times for taking an unstable PT to the hospital 5 mins down the rd instead of the hospital 25- 35 minutes away in the next county and the physician is now pi$$ed. Does this happen to any one else or is just my company?

Again, what are your agency's protocols? can anyone call in an request an emergency response regardless of patient condition? IE, we just go lab results that look abnormal, and we don't want her waiting because we are understaffed, can you respond lights and sirens to get her out of here quickly?

As for your scenario, you are overriding the doctor, the MD, not trusting his medical judgement and experience (does your 6 months of education qualify you to overrule someone who has a bachelors degree (4 years) , then went to med school (3-4 years), then an internship and residency under a more senior doctor (1-3 years)? are you sure?) , possibly costing your company the contract with the facility, and now the family is at the wrong location (because you told them they would be going one place, when in fact took them somewhere else), and the patient can't get the treatment that their primary physician wants them to get because you decided to not do exactly why you were called in the first place. I can totally see why the doc is pissed and you were called into the boss's office.

 

[EpiEMS]

an "unknown" is not a priority dispatch. BLS ambulance only until additional information is obtained.

Shouldn't an "unknown" get a hot/priority/L&S PD response followed up by cold BLS ambulance (upgrade as needed)?

 

[Jkimball]

Shouldn't an "unknown" get a hot/priority/L&S PD response followed up by cold BLS ambulance (upgrade as needed)?

County hotel = jail with trained personnel inside in first aid.
We cover 911 for the area the call came in from.
We do have are own dispatch center trained to EMD.
We also have no contact with county dispatch
911 goes to county, forwarded to an EMD, Then forwarded to our dispatch.
The area that the call came in for is contracted for ALS.
Nursing homes from 3-4 county's call us direct for everything and anything.
Our protocol is that of there is anyone on scene with a medical license they can dictate response priority. Even for a CPR (No DNR) as a priority 3 because they don't want to upset the residents.
Just because a physician requests the pt be transported to one facility does not qualify them as an intervening physician (they have to be on scene and ride with us for that to happen). I've checked with med control from all county's and they all say if they are not on scene and willing to ride in you have to follow protocol. Witch means closest facility.
Some times we get response time of 45 minutes to the scene for a priority call because the didn't want to call 911.
I've unofficially been asked why I can't just follow direction and take them were they requested. And just do what your told. We have to many people here that do that because they are very new and don't know better. They think if the supervised said it was ok then they can go around protocols.

We requested an update on the call twice with no available information
There was medical staff on scene with the pt. Required 3 FD personnel in the back holding pressure on various limbs because we ran out of tourniquets. We called them as soon as we knew what was going on. They arrived as we were loading the pt.

 

[DrParasite]

Shouldn't an "unknown" get a hot/priority/L&S PD response followed up by cold BLS ambulance (upgrade as needed)?

In theory, I agree with you. But the city was chronically short staffed, and always had calls holding (assaults in progress, shootings, violent EDPs, etc), so an unknown wasn't a high priority for them. And we would get an ambulance as soon as we had one available (we were also short staffed). Their opinion was if the person requested EMS, than it was EMS's issue, not a LEO issue. Again, not my call, just doing what our written policy was.

County hotel = jail with trained personnel inside in first aid.
We cover 911 for the area the call came in from.
We do have are own dispatch center trained to EMD.
We also have no contact with county dispatch
911 goes to county, forwarded to an EMD, Then forwarded to our dispatch.

sounds a little inefficient, and like the telephone game, but it's not uncommon to have a dispatch system set up like that, especially when EMS is handled by a large 3rd party private EMS system. It's what happens when you outsource services to other agencies.

And I have never heard of a jail that was called a county hotel; in fact, most jails (outside of local PD holding cells) were staffed with nurses, and could do much more than first aid.

The area that the call came in for is contracted for ALS.
Nursing homes from 3-4 county's call us direct for everything and anything.

I know why they do it, instead of calling 911. It's a stupid reason, but it does eliminate the telephone game. But if you're the contracted provider, and this is a common occurrence, than I don't see the problem. Although I would ask your management why your dispatch doesn't call 911 for "priority" calls; you might be surprised by the response. surprised isn't the right word.... maybe have your eyes opened? or see what management's justification is?

Our protocol is that of there is anyone on scene with a medical license they can dictate response priority. Even for a CPR (No DNR) as a priority 3 because they don't want to upset the residents.

well, that's stupid, but again, if your protocol is to do that, follow your agency's protocol, or try to get it changed to something more sensible..

Just because a physician requests the pt be transported to one facility does not qualify them as an intervening physician (they have to be on scene and ride with us for that to happen). I've checked with med control from all county's and they all say if they are not on scene and willing to ride in you have to follow protocol. Witch means closest facility.

So you have your medical director's backing? good, so who care if you get pulled into the bosses office, you are following your medical director's directive. Let the doc get pissed, and have him speak to your medical director with any complaints.

Some times we get response time of 45 minutes to the scene for a priority call because the didn't want to call 911.

again, stupid, but if that's what your agency's rules are....

I've unofficially been asked why I can't just follow direction and take them were they requested. And just do what your told. We have to many people here that do that because they are very new and don't know better. They think if the supervised said it was ok then they can go around protocols.

sounds like your supervisor and medical director need to have a sitdown and get on the same page......

We requested an update on the call twice with no available information
There was medical staff on scene with the pt. Required 3 FD personnel in the back holding pressure on various limbs because we ran out of tourniquets. We called them as soon as we knew what was going on. They arrived as we were loading the pt.

If dispatch didn't have any more information, than they have nothing else to give. Assuming the jail staff made the call, without any information, than it's very likely they (dispatch) didn't have an update to give you. How many tourniquets did you apply? we have two in the bag and two in the truck, and the person only has 4 limbs to apply them to..... If you didn't have enough, maybe you should have called for another ambulance with more? or improvised and used a BP cuff or three?

 

[DrParasite]

Bottom line: you are making a lot of assumptions that dispatch screwed up, and I am guessing you haven't listened to the tape of the call, nor have you ever worked in dispatch to know what their rules, regulations, and protocols are.

It's very easy to Monday morning quarterback; it's much harder to actually do the job and make everyone happy.

 

[Tigger]

sounds a little inefficient, and like the telephone game, but it's not uncommon to have a dispatch system set up like that, especially when EMS is handled by a large 3rd party private EMS system. It's what happens when you outsource services to other agencies.

So long as the CAD is linked it shouldn't really be an issue.

 

[Jkimball]

One tourniquet in the jump bag. I also carry one of my own In my cargo pocket.

We don't really have contracts with most of the nursing homes. They just call which ever company they want. I've showed up on scene with 2 other company's to pick up the same pt.

 

[DrParasite]

So long as the CAD is linked it shouldn't really be an issue.

hahahahahahaha. That's assuming the CADs are linked...... some still reply on the POTS system to transfer 911 callers and to provide updates to other agencies. Yes, it still happens, especially with outsourced systems.

One tourniquet in the jump bag. I also carry one of my own In my cargo pocket..

sounds like you have a good reason to approach your management about getting additional tourniquets placed i every ambulance. I would suggest 2 in the bag, and 2 in the truck. after all, they are cheap and don't expire.

We don't really have contracts with most of the nursing homes. They just call which ever company they want. I've showed up on scene with 2 other company's to pick up the same pt.

I am hoping your agency billed the facilities for the response, as they spent resources getting there and were unable to charge the patient because another ambulance took the patient. And if they don't, then I would advise the SNF to call 5 ambulance companies, and the first one to take the patient gets the money. it's win for the SNF, with no downside.

Ahh the joys of working private EMS.