If there are multiple patients, are multiple ambulances supposed to be dispatched?

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Permalink Reply by Skip Kirkwood on July 30, 2009 at 10:25pm

Hopefully, the EMS agency tells the dispatch agency what to do for each particular call type.

In Wake County, an MVC-multiple or an MVC-pin gets 2 ambulances, an APP, and a district chief, along with an engine and a ladder or rescue. Once there, triage is performed and additional resources ordered as needed.

As a rule of thumb, we train our personnel to order one additional ambulance per RED tagged patient, and one additional ambulance per TWO yellow or green-tagged pateints.

In a couple of weeks, we take delivery on a 15-patient bus, which will help keep the number of ambulances used for green tagged patients down.

You can transport two boarded patients in our ambulances, one on the stretcher and one on the squad bench. But you can't provide much in the way of care to more than one patient, so we try not to double up if care en route is required.

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Permalink Reply by Annette Smith on July 30, 2009 at 10:41pm

In my area we tend to take this issue upon ourselves. We are fortunate to have many First Response Fire Depts who normally get to the scene and give us an immediate update as to number, and severity of patient's. We cover a large portion of a heavily traveled interstate, the call can come in as a rollover and one Medic Unit is initially dispatched.....but as the information flows through Dispatch that can change, I usually have at least one additional Medic Unit head toward the scene signal 50. We very often transport two Level One trauma patients in one ambulance. I have great faith in the vast majority of my Paramedics not only to be fast, but to be extreemly accurate in their patient accesment and treatment.

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Permalink Reply by TheCannulator on July 30, 2009 at 11:12pm

For a simple call of multiple patients we used to send everything. In reality though more than one isn't needed.

We send one wait for the sitrep and then move in other resources or change response with further call details.

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Permalink Reply by Justin P on July 31, 2009 at 1:29pm

Its really nice to wave a magic wand and have all the ambulances, district chiefs, and squad trucks you want, but for the vast majority of us, we need to manage scarce resources. I work in a rural part of Texas where we have three ambulances covering and area 60 miles wide by 80 miles deep. You can't send all three trucks to one single call, even if you have 3 reds. You send a primary unit, the first responders, and the FD. You order additional resources as needed. How many times do you get dispatched to a two car MVC with 5 patient's and only one or two go the the hospital with wip-lash? The dispatchers do have guidelines to follow such as sending a supervisor unit to multiple casualty scenes and coordinating multiple air units as needed. The job of EMS is a story of doing more with less, as we usually do.

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Permalink Reply by Chance Gearheart on July 31, 2009 at 5:15pm

Unfortunately, not every department has multiple ambulances to send on a single call. In Memphis, they would send an ambulance and an ALS Pumper with 3 EMTs and a Paramedic to each MVC, unless there was a police or off-duty firefighter on scene who reported multiple injuries or requested multiple units. The OTHER 911 company in Memphis only sends one ambulance to a call, unless it's a known multiple casualty, along with either an ALS or BLS engine company, and a rescue is sent non-emergency until its known that its needed. The reason for this is that they are a very busy 911 system, and cannot afford to tie up units on calls. If there is a critical patient, however, they call an additional unit to transport others, or if there is a pediatric patient since we have to take them to the most appropriate facility for peds. (It's an unwritten rule of practicality in Tennessee that only one critical patient to a unit)

Likewise, the other counties I work in, they will have either a police (Whiteville police are all trained to the first responder or EMT level) or volunteer fire first respond (Hardeman county and Hardin County have BLS first responder companies, but since they are volunteer, turnout is shakey depending on time of day) to the scene, and send all available units until they know what they have. Major difference in call volume, as well.


Sending all your units to a scene based on a most-likely paniced 911 call can come back to bite you in the arse sometimes, expecially in a rural county where the wreck may be miles away from the service area base, or in a high-volume urban system, where it increases the risk of incidents, and takes a valuable piece of apparatus out of service. It's important to have well-trained dispatchers who can handle the call and get the necessary information to triage and allocate resources.

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Permalink Reply by MK on July 31, 2009 at 5:39pm

Well, if both patients are not critical you can put on one the medic seat and other on the gurney. So, i waould say two patients in one ambulance.

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Permalink Reply by Skip Kirkwood on July 31, 2009 at 5:44pm

Does the FD say "send one pumper to check it out and call another one if there really is a fire?" Does the PD say "We'll send one car to see if it really is a bank robbery, and if he finds guys robbing the bank and shooting at him we'll send more?" Is it better for the patient to wait longer, in case another call might happen? I think that we're "enabling" the continued under-funding and under-staffing of EMS if we take this "do more with less" approach.

When do systems get more funding? When it is documented that they run out of ambulances.

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Permalink Reply by Nathan on July 31, 2009 at 5:44pm

You can have multiple "walking wounded" sit on the bench seat if needed. plus one on the cot. It shouldn't be a big deal to have more than one Pt to take care of.

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Permalink Reply by MK on July 31, 2009 at 5:48pm

You can take two patients you dont need a full army. I think thats ridiculous. Send one ambulance and assess them first. then triage. You dont need 3 or 4 when you still have to cover the area just like you dont need 10 medics on scene for one car accident.

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Permalink Reply by Nathan on July 31, 2009 at 6:05pm

Skip, I agree that you should send more if there is any doubt. But at the same time Im not sure it should be a big deal to take care of more than one patient.(as long as they are reasonably stable) It happens in the ER all the time and its handled just fine. It sounds like your thinking along those same lines with the bus your talking about getting. So are we justified in only wanting to tx one patient at a time in the rig? I think we can handle multi- tasking, just make sure you have enough help in the back with you (an extra EMT, maybe from the FD?)

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Permalink Reply by Skip Kirkwood on July 31, 2009 at 6:18pm

One CRITICAl patient, who in an ED would have a whole team taking care of them.

Two YELLOW patients, who need care but are not critical. Again, in the ED these patients would be cared for by a team of physician, nurse, technician, etc.

As many walking wounded as you can safely strap in. But, the authorities will tell you that being strapped in sideways, like on a squad bench, is VERY UNSAFE.

Why do we in EMS think it is OK to send 2 people to a code, when in the controlled safe environment of a hospital, where they do the exact same things, they will have 10 or so? And why do so many EMSers spend so much time worrying about the patients that we don't yet have, rather than the ones we've got right now?

EMS folks working on an ambulance should not be worrying about safeguarding the resources of the system. Providing enough of those to do all the jobs, with enough resources, is the BOSS's job!

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Permalink Reply by MK on July 31, 2009 at 6:42pm

Well one the medic bench seat have seat belts and one patient on gurney. It works well you dont need one patient for one ambulance.
We use one critical patient red tag for one. You dont need 10 medics just one. We do very well than the other system I started in with firemedics everywhere. all the fireman are emts, I am one and my partner medic. Works great. Like the system i started in for one MI patient a truck with 2 medics,fire engine with 4 or 5 then a bls car---not necessary, too much.

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