NBC Bay Area Investigative Unit Report: Bay Area EMS (8/27)

[dC0m]

I just saw a commercial on NBC Bay Area for their Investigative Unit where they will report on Bay Area EMS. I didn't catch all the details but they claimed they were investigating the "broken EMS system" :lol:.

Tune in on Tuesday, August 27, 2013 at 11pm for the full report (I think this is the right time lol).

Just wanted to give Bay Area peeps the heads up!

 

[dC0m]

Here's the link to the article for those who don't want to tune in:

http://www.nbcbayarea.com/investigations/Shooting-and-Stabbing-Response-System-Broken-in-Alameda-County-221401961.html

 

[chaz90]

That article was moronic. To classify failures of MPDS or those who call 911 as failures of an EMS system is shortsighted and simply wrong. Dispatch information and coding can only ever be as good as those who call 911. How often do 911 centers receive calls in which the caller states they "need an amber lamps" and hangs up? Yes, by MPDS this will most likely be classified as a Bravo "Unknown Problem." Sometimes this will be a cardiac arrest, but more often it's a cut finger or week old rash. In the case of the child who was killed by gunfire, the response time was already shorter than average for even Echo level calls. It is of course a tragedy, but one that does not sound as though it could have been prevented by dispach pressing a different button on their screen.

MPDS is not without flaws. The automatic Charlie level dispatches for transfers with "acute and severe pain," ALS upgrades for "abnormal breathing" from unrelated complaints, and drunks who are "not alert" and dispatched as Deltas grow tiresome, but this is the best we have at the moment. Busy systems need some way to triage calls and prioritize responses, and the public needs to understand that they have a responsibility to provide some level of semi accurate information when they contact 911.

 

[TheLocalMedic]

chaz90, I do agree to an extent with what you've said, however...

The easiest category to give a call is a Bravo response because it is a catch-all response mode. If you can't get good details about a call, or get someone just requesting an ambulance and then hanging up, or it's an unknown medical, you can punt it off as a Bravo. Typically this indicates that first incoming is code 3 while others are then code 2, which means at least you're getting someone there quickly who can get eyes on the situation and upgrade/downgrade any further response.

However, a report of shots fired or penetrating trauma with unknown details will also get a Bravo designation. Unless the victim is also "short of breath" or some such nonsense the call will remain a Bravo. So even if you have an ambulance code 3 because they're first-in on that call, they can be diverted to the Delta response for an intoxicated subject with "abnormal breathing" miles away.

Any report of traumatic injury, unless it is a known isolated extremity injury, should get a Charlie designation or higher. And known penetrating trauma should probably get a Delta. Granted, many shootings and stabbings aren't life threatening, but there are a large number that are and are being dispatched at Bravos.

And P+ definitely needs to get more ambulances on the streets.

 

[DrParasite]

Any report of traumatic injury, unless it is a known isolated extremity injury, should get a Charlie designation or higher. And known penetrating trauma should probably get a Delta. Granted, many shootings and stabbings aren't life threatening, but there are a large number that are and are being dispatched at Bravos.

defend your statement. why should a stabbing to the hand be a delta? or a GSW to the foot? why should a broken ankle be a Charlie?

from the clip: "why is a shooting not the highest priority call in the system"? because a peripheral shooting can typically be controlled by direct pressure, and an echo (cardiac arrest) needs different interventions or else the person is going to die.

Interesting: bravo calls get 2 EMTs, so they aren't even sending paramedics to the shooting calls. only charlie, delta and echo responses get paramedics (which is how the system is set up to be).

intoxicated individual gets a charlie response..... yeah, ask the guys in DC how all drunks are minor. Also they aren't drunk, since MPDS doesn't have a drunk option (despite I wish they had). They are categorized as unconscious (charlie response), unconscious overdose (charlie or delta response), or questionable life status (delta response, esp if the guy isn't moving and could be doa).

Clammy is BS... that's a MPDS quirk, but it can show a possible heart issue.

oh, and the shooting is BS also. a shooting with no further details is a bravo response. shooting to central part of body is delta, unconcious shooting victim is delta. it's not as smiple as "every shooting is a bravo.", there are several other factors.

btw, in case anyone cared, Echo responses are only to be used for arrests, or imminent arrests. Deltas are for serious life threatening injuries or illnesses (typically unconsciousness or cardiac issues), Charlies are for serious illnesses, Bravos are for injuries or illnesses typically not life threatening (but still need an ambulance), alphas are for ambulatory minor stuff (you could take a cab and be treated just the same), and Omega's can be referred elsewhere if your agency permits.

I bet if the dispatchers and call takers were given all the information they asked, and it was 100% accurate, many of the problems stated in the investigation would go away

 

[Jim37F]

defend your statement. why should a stabbing to the hand be a delta? or a GSW to the foot? why should a broken ankle be a Charlie?

from the clip: "why is a shooting not the highest priority call in the system"? because a peripheral shooting can typically be controlled by direct pressure, and an echo (cardiac arrest) needs different interventions or else the person is going to die.

Interesting: bravo calls get 2 EMTs, so they aren't even sending paramedics to the shooting calls. only charlie, delta and echo responses get paramedics (which is how the system is set up to be).

intoxicated individual gets a charlie response..... yeah, ask the guys in DC how all drunks are minor. Also they aren't drunk, since MPDS doesn't have a drunk option (despite I wish they had). They are categorized as unconscious (charlie response), unconscious overdose (charlie or delta response), or questionable life status (delta response, esp if the guy isn't moving and could be doa).

Clammy is BS... that's a MPDS quirk, but it can show a possible heart issue.

oh, and the shooting is BS also. a shooting with no further details is a bravo response. shooting to central part of body is delta, unconcious shooting victim is delta. it's not as smiple as "every shooting is a bravo.", there are several other factors.

btw, in case anyone cared, Echo responses are only to be used for arrests, or imminent arrests. Deltas are for serious life threatening injuries or illnesses (typically unconsciousness or cardiac issues), Charlies are for serious illnesses, Bravos are for injuries or illnesses typically not life threatening (but still need an ambulance), alphas are for ambulatory minor stuff (you could take a cab and be treated just the same), and Omega's can be referred elsewhere if your agency permits.

I bet if the dispatchers and call takers were given all the information they asked, and it was 100% accurate, many of the problems stated in the investigation would go away

But if someone calls in a shooting and doesn't provide anymore details, how do you know if its a minor extremity wound or a penetrating thoracic wound? If you're going to dispatch clammy as a higher priority call w/out more information because it might be a serious heart issue, why not err on the side of the shot patient and assume a Charlie response when no other details are given?

 

[Medic Tim]

But if someone calls in a shooting and doesn't provide anymore details, how do you know if its a minor extremity wound or a penetrating thoracic wound? If you're going to dispatch clammy as a higher priority call w/out more information because it might be a serious heart issue, why not err on the side of the shot patient and assume a Charlie response when no other details are given?

maybe it is different there but any shooting or assault regardless of designation gets a no lights no siren response until police clear us in.

these pts usually need an OR and it usually doesn't matter who gets them there.

 

[TheLocalMedic]

defend your statement. why should a stabbing to the hand be a delta? or a GSW to the foot? why should a broken ankle be a Charlie?

As I stated, isolated extremity trauma can be an exclusion, although I have had a case where someone bled out from a GSW to the foot...

Interesting: bravo calls get 2 EMTs, so they aren't even sending paramedics to the shooting calls. only charlie, delta and echo responses get paramedics (which is how the system is set up to be).

In Alameda, as in many parts of California, 911 ambulances are Paramedic-EMT, there aren't any BLS units running around taking 911 calls. New Jersey may have a different system, but here generally 911 calls will get a medic.

it's not as smiple as "every shooting is a bravo.", there are several other factors.

Unknown injury calls are automatically a Bravo response. Unfortunately that's just the way the system is set up right now. So yes, unless the caller says "he got shot and he's having trouble breathing" (which, to be honest is never what they say, it's always 'send an ambulance! Someone's shot!')

So yes, every shooting is generally a bravo.

I bet if the dispatchers and call takers were given all the information they asked, and it was 100% accurate, many of the problems stated in the investigation would go away

Wouldn't that be nice. Instead, how about we change EMD protocols and bump penetrating trauma up from an "unknown injury" with a Bravo designator to an automatic Charlie response.

 

[Handsome Robb]

So...they responded well under the accepted standard for echo level calls...what's the fuss?

MPDS exists for a reason. If I had a nickel for every time I was cancelled off a shooting or stabbing dispatch I'd have another toy with a motor.

Other people have said it, dispatch information is only as good as the reporting party. I could see modifying the coding if the area had a higher than average amount of gun violence and there was a problem with response times because units were being diverted. Staffing is a different issue. If there consistently isn't enough ambulances they need to run more units and hire more people.

For us, if a shooting or stabbing is confirmed to a central location, head, neck or proximal to the knee/elbow it becomes a p1 call and we cannot be diverted from it. Bravo coded dispatches are either p3 or p4. Maybe we have modified cards?

 

[chaz90]

For us, if a shooting or stabbing is confirmed to a central location, head, neck or proximal to the knee/elbow it becomes a p1 call and we cannot be diverted from it. Bravo coded dispatches are either p3 or p4. Maybe we have modified cards?

Same everywhere I've seen. Penetrating trauma with any "Priority" symptoms (the usual unconscious, difficulty breathing, etc...) or reports of injury to the core or proximal extremity upgrades it to a 27Dx. Here, I feel like many shootings are dispatched as "Police Actions" anyway. Cops on scene or/on a PD call suddenly report shots fired or a victim found, and the cavalry is dispatched without a proper EMD code. My old place often used "Uncoded Medical" for shootings as well if the cops reported needing EMS for anything, including a shooting or a stabbing.

The issue is kind of moot here anyway. If there's a 27Bx dispatch, it's almost guaranteed dispatch will choose to add ALS on the call. I suppose I could support the "unknown details" penetrating trauma dispatches being upgraded to at least a Charlie response however. It does seem like there's more potential from these calls than the nursing home "not alerts."

 

[Christopher]

I'd wager that the truck gets bounced to the Delta call because the shooting/stabbing has nothing to it as confirmed by officers on scene...otherwise the crews will stay enroute even if it is a 27B.

A lot of the times we will run routine until law arrives, so even if it were a 27D we're not getting there any sooner.

 

[EMDispatch]

Just for everyone's reference , 27 Delta Codes are for unconscious, not alert, central or multiple wounds, and multi-patient incidents... Everything else is a Bravo or Alpha.
Like others have said, a lot of the problem is going to fall on caller. They are emotionally, evasive, and often uncooperative. It can be a struggle to even get an address at out people in these sorts of situations, and as a result call takers get frustrated and dump the call to an unknown status, which yields the Bravo response.
There is possibly a failure on the part pf the EMDs. It's too easy jump to the unknown status codes in high stress situations instead of pushing interrogation. It's impossible to determine if that's the case without hearing the tapes.

 

[Jim37F]

Just for everyone's reference , 27 Delta Codes are for unconscious, not alert, central or multiple wounds, and multi-patient incidents... Everything else is a Bravo or Alpha.
Like others have said, a lot of the problem is going to fall on caller. They are emotionally, evasive, and often uncooperative. It can be a struggle to even get an address at out people in these sorts of situations, and as a result call takers get frustrated and dump the call to an unknown status, which yields the Bravo response.
There is possibly a failure on the part pf the EMDs. It's too easy jump to the unknown status codes in high stress situations instead of pushing interrogation. It's impossible to determine if that's the case without hearing the tapes.

Ok thanks, even though i knew you were talking about dispatch codes, I was reading them as MOS's lol

 

[gclol]

Actually they have bls units running the 911systemonly in Oakland , they run 5150 calls and alpha calls , sometimes patients gets mistriaged but they can get upgrade if emts can't do anything for the patient and require als , the bls units were meant to relief some stress on the system but they can only do so much with 2 day cars and 1 night car

 

[Handsome Robb]

Actually they have bls units running the 911systemonly in Oakland , they run 5150 calls and alpha calls , sometimes patients gets mistriaged but they can get upgrade if emts can't do anything for the patient and require als , the bls units were meant to relief some stress on the system but they can only do so much with 2 day cars and 1 night car

I'm not understanding who you're responding too.

 

[gclol]

As I stated, isolated extremity trauma can be an exclusion, although I have had a case where someone bled out from a GSW to the foot...



In Alameda, as in many parts of California, 911 ambulances are Paramedic-EMT, there aren't any BLS units running around taking 911 calls. New Jersey may have a different system, but here generally 911 calls will get a medic.



Whoops forgot to quote

 

[Aprz]

Gclol, what's the deal with Patient Plus? I thought they stoppered operations and laid off most of the guys, but I still see them driving around. I am assuming this is the BLS crews you are talking about.

 

[gclol]

Gclol, what's the deal with Patient Plus? I thought they stoppered operations and laid off most of the guys, but I still see them driving around. I am assuming this is the BLS crews you are talking about.

Yes they all got converted to als back up, no one got laid off the people who left , left on there own terms , all cct medics got hired at rm , all the type 2 units got converted to als back up with one as a back up car just in case a unit breaks down , all the way units got rebranded and are used as als units now , in the end people got what they wanted , to work als in alco. The union helped out alot they did slot of work to prevent anyone from getting laid off and took precautions of things like this to happen

 

[94H]

Also they aren't drunk, since MPDS doesn't have a drunk option (despite I wish they had). They are categorized as unconscious (charlie response), unconscious overdose (charlie or delta response), or questionable life status (delta response, esp if the guy isn't moving and could be doa).

I've seen drunks dispatched as Bravo Overdoses (Dont have my handbook in front of me for the codes)

 

[chaz90]

I've seen drunks dispatched as Bravo Overdoses (Dont have my handbook in front of me for the codes)

I think this is dispatcher discretion. I've also seen them coded as Omega "Intentional ODs" without priority symptoms.