Using EMT Skills off-duty

[Veneficus]

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."

 

[Tigger]

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.

 

[DrParasite]

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.

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.

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.

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.

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
By MARY ANN BOURBEAU
STAFF WRITER
OLD BRIDGE: An emergency worker was struck by a car and killed while responding to a Route 9 accident yesterday, police said.

An elderly woman who was involved in the initial accident, who was suffering from chest pains, also died.

James Dodridge, 52, of the Old Bridge Red and White Volunteer First Aid Squad, was responding to a minor three-car accident on Route 9 north, just north of Ferry Road, at about 6:45 p.m. The vehicles involved in the initial accident had pulled over to the shoulder of the road. Dodridge pulled onto the center median, since his vehicle arrived by way of Route 9 south. As he attempted to cross Route 9 north, he was struck by a car.

Dodridge was taken to Raritan Bay Medical Center in Old Bridge, where he died from his injuries, police said.

Police would not release the name of the woman who died, pending notification of her family, but said she is an Old Bridge resident. The scene was cleared about 9:30 p.m. No charges were filed yet as the incident is still under investigation.

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.

 

[NYMedic828]

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.

 

[CANDawg]

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.

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.

 

[Veneficus]

: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.

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?

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

experience.

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?

 

[NYMedic828]

: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.

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

 

[NYMedic828]

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.

 

[Handsome Robb]

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)

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.

 

[EMDispatch]

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.

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.

 

[bahnrokt]

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.

 

[CANDawg]

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:

 

[EMDispatch]

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.

 

[DrParasite]

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.

 

[DrParasite]

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.

 

[DrParasite]

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.

 

[NomadicMedic]

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.

 

[EMDispatch]

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.

 

[DrParasite]

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

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.

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.

 

[Handsome Robb]

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?