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

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Permalink Reply by Chance Gearheart on July 31, 2009 at 7:59pm

Wait? So you're suggesting we throw system status management in the trash and actually procure a few more units than are deemed necessary by the desk jockies?! My God Man, the ambulance service managers and county commissioners would want you on a pike pole!

Face it, SSM is a thing that's here to stay, at least in the short-term. In an ideal world, we'd have enough ambulances, and never have to triage a call according to priority. The problem is, when you send out everything on every little "possible" incident, you leave yourself vulnerable to a PR nightmare when you do get that Charlie, Delta, or Echo level call that has to wait longer than the national average.

Skip Kirkwood said:

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 8:05pm

Not true Skip, In a small hospital that does not have much code experience that is the case but in a big hospital that does a lot of codes there is much less hoopla; A doctor, maybe an RT, two nurses and a tech or two. And the only reason for more than one tech and one nurse is to rotate the compressions. (put two medics and an EMT in the back of a truck and thats plenty to run a code in my opinion) That being said, let me clarify, Im not talking about a code, not necessarily talking about a red tag either. Im talking about the bulk of the patients at your run of the mill MVC, we can handle more than one. Again dont get me wrong, Im not advocating reducing EMS and getting by with the minimum! Im just saying we underestimate ourselves if we say we can only handle one patient at a time... well maybe some should stick to only one. Too many people =chaous

just my opinion

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Permalink Reply by TheCannulator on August 1, 2009 at 6:32am

Skip,

Our resource response change was based case data collection and subsequent change in AMPDS.

Our last fatal Ambulance crash was sending and ambulance to a crash that never probably even needed a crew. Moist patients at crashes aren't injured and most aren't injured severly.

If the story changes enroute response is increased. It comes down to good call taking.

Sending the cavalry for nothing patients could actually keep them away from those actually needing them.

Skip Kirkwood said:

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 Skip Kirkwood on August 1, 2009 at 10:08am

Yes, Chance, you read me correctly. If by SSM you mean a system that has only enough EMS resources to handle the expected number of calls, and nothing more, then yes, I am opposed to that, just like I am opposed to the notion that EMS should "pay for itself" through transport revenues. And I don't accept that such is "here to stay" because it is not accepted everywhere even now.

EMS folk need to get politically aware and active. How about we level the playing field? If we're going to run EMS that way, let's also run PD, FD, and the snowplows that way.

A long time ago, a really sharp paramedic officer taught me that in multiple patient events, you should have enough resources to treat patients concurrently, not consecutively. I believe that makes for good patient care. I also don't believe that you worry about patients you don't yet have (those who MIGHT call 911 while you are busy doing something else) at the expense of those that you've already got.

I want enough people at a scene so that we can do timely patient care, even if the FD has to cut metal, put out flames, or do other stuff that would keep them from helping EMS. I want enough on the scene so that there is a supervisor to coordinate and look out for things that might not be readily apparent. I want extra vehicles to protect my medics from folks driving by, and I want a safety officer to help keep people from getting hurt. In short, you have to have RESOURCES to run a complete, professional, safe incident.

I also think that by not doing this, by helping to stretch your systems as thin as you describe, you encourage, enable, and empower those who do not provide you with the resources that are needed to do the job right! In some of those "bad SSM" communities where EMS runs a .5 or .6 UHU, you've got dozens of engine companies running 1,000 calls per year or less (UHU .15 or so). Why would you encourage that? Run the calls well, with all the resources that you need, and if you run out of resources, you have the business case to get more! Don't be afraid of the potential negative publicity - use it to your advantage!

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Permalink Reply by Jerry on August 1, 2009 at 1:12pm

This is like asking how many attorneys it takes to change a light bulb (regards, Skip). [There is no answer; they couldn't ever agree]

In our area we have empowered (yes, you read right) dispatch to commit resources based on caller information and categorize calls as "MVC - usually gets 1 engine and 1 amb; MVC-extric/Pin - gets 2 engines, 1 truck and 1 amb. However, an multiple patient scene (MPS) 3 to 9 victims (patient status to be determined) get a fire box alarm (3 engines, 1 Truck, 1 BC) and 3 ambulances and 1 Amb Supervisor, primary P-1 and secondary P-3. An MCI (10+patients) gets a second alarm (6 engines, 2 Trucks, 1 BC and 1 Deputy Chief, 5 to 10 ambulances (remember Mutual Aid!), primary P-1 and all others P-3 and 1 Amb Supervisor. The P-3 units are considered "conditionally available" for P-1 calls they could be diverted to and then replaced on the assignment. Until the first unit arrives on scene and provides a size up no unit assignments are changed/slowed or canceled.

Is it perfect? No, but it really enhances on scene operations and everybody KNOWS what is coming; before everybody make it up on the fly and nobody knew what was committed. There was no consistency between units arriving and the adding units. We reviewed 36 months worth of data, in approx half the "multiple patient scene" calls units were being assigned up to 35 minutes AFTER the initial dispatch. In one instance; it was 97 minutes from the call dispatched time (that's when the clock starts) to the last patient being transported from the scene and another 12 minutes to the hospital!

Before all of you tell me that it won't work in "my system" please understand that I am not arguing for this approach for any system other than the one that we know it works in, ours. Every one has to assess or reassess the resources in their community. the other thing to keep in mind is that this has to happen every time, no exceptions,and maybe even drill it on occasion.

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Permalink Reply by Annette Smith on August 1, 2009 at 9:20pm

I could use about 4 more Medic Units for my County....if we're placing orders.....in reality, I'm very fortunate to have 6 for a 530 square mile area which icludes two Cities, a Univerisity and many rural towns. We run out of Units on a REGULAR BASIS....maybe some "bailout money" for our 911 system?!.....

Chance Gearheart said:

Wait? So you're suggesting we throw system status management in the trash and actually procure a few more units than are deemed necessary by the desk jockies?! My God Man, the ambulance service managers and county commissioners would want you on a pike pole!

Face it, SSM is a thing that's here to stay, at least in the short-term. In an ideal world, we'd have enough ambulances, and never have to triage a call according to priority. The problem is, when you send out everything on every little "possible" incident, you leave yourself vulnerable to a PR nightmare when you do get that Charlie, Delta, or Echo level call that has to wait longer than the national average.

Skip Kirkwood said:

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 dr-exmedic on August 4, 2009 at 9:46am

TheCannulator said:

Moist patients at crashes aren't injured

Ah, so it's the dry ones that are the problem. ;)

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