This is similar to Dave's post but more specific to who "should be" dispatched to an emergency call.
For example: A call comes in for some type of EMS emergency in County X. The designated EMS for that area is located about 6 miles away and will be about a 12 minute response time. Now, consider that less than a mile away across the river bridge in County Z is an EMS dept. that is also volunteer and will have a response time of approx. 5 minutes.
Points for discussion are:
1. Who "should" be dispatched for the sake of the pt?
2. Should EMS responses be based on Geo-political boundaries or "closest available?
3. Is dual response an option?
4. How is this issue handled in your neck of the woods?
5. What can we do to improve response times?

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Replies to This Discussion

Closest. Period. Give the tones. Three minutes, if you don't have a crew. The next tone set, should include the next closest agency as a dual dispatch. Adding to that, no unit should be canceled until one is on the road. Do not pander to the services who depend on, 2nd, 3rd tone outs. It's starting a trend, locally, where the dispatcher will play along and just keep dispatching tone after tone. I can't help but wonder what the mentality is on that, certainly the best interest of the patient is not in mind.

We cover a facility that is refused by the service who, lets say, would respond to a home across the street. They have the personnel, just don't want the call volume. Too bad. It's EMS, not a social club, do it or don't. I think staffing in some manner, should be required, over set call volume.
I think the logical response is for the pt.'s sake, closest available. As far as dual response goes, in my county (Blair) when a second due EMS unit is dispatched in place of the primary the QRS for that area is dispatched as well. This basically equates to putting a BLS unit on the road if the closest ALS unit is out and the pt. is waiting for the next closest. I would have to say that works pretty well, as most fire dept.'s in the county will get out pretty quickly.

I know here, turf wars run rampat....We have in one area in the central part of the county, 3 stations in a one mile area, all spawned by fear of each dept. losing this nursing home or that section of the interstate, etc. I think it's ridiculous, as they are financially screwing themselves. These 2 services staff four trucks on night shift for this reason, and a typical night wouldn't produce even 4 calls to give each truck a run, while down the road the city of altoona has 2 trucks on night and is busy most of the shift, whose making money there??? Even besides finances, it's dumb for the pt.'s. One of the stations I was referring to isn't in it's own coverage area, it sits in the other services area, it's only there for one nursing home it's contracted with. When I worked for that service, I was at that station and the other service got toned out for a choking pt. at Mcdonald's. The station I was at is at the far end of the McDonald's parking lot, literally less than a minutes walk away. (the "primary" truck, by the way, took about 4-5 minutes to get on scene) Dumb shit right there, if that pt. was my family, and I found that out, I'd flip shit.

The last part about response times, I've got one suggestion, and it goes back to turf wars, get the hell rid of "still alarms". A nursing home contracts with service A even though service B is closer. Well that's all fine and dandy, but here's how it goes. Pt. needs EMS......nurse calls over to the station......EMS crew takes the call......IF you have a lazy crew on that day.....they take a piss, get there shit together, hell, maybe have a smoke, finish there sandwhich...how can they do this??? Because it was called in to the EMS station, dispatch doesn't even know about the call until they mark up on the radio. And to boot, they won't mark up until they're almost there, to reflect in the call times that they aren't delaying care (to fend off service B) I've seen ALS calls go out this way and it took the crew 15 minutes to mark up on!!! I guess I could have told a supervisor about it...oh wait there was a supervisor on that truck....I"m so glad I'm out of that shit hole of a service.

Sorry for the long post....I'm bored
Scott, Chris and Blair, Thanks for your posts. It seems to me that Dispatch protocols need to be standardized in the state.
Since the governor signed the bill into law last spring giving Pa. municipal borough and twp. elected officials the responsibility
of selecting an EMS service for their citizens, this seems to cause some additional problems. What do most elected officials know about EMS anyway? With our current EMS manpower shortage, I wonder how the elected officials are going to provide EMS when there isn't anyone left to respond. I guess some important person is going to have to die before anything is done to improve the system. The EMS boat has been slowly sinking for years. The time to fix it is NOT after if has already sunk. My opinion is that EMS and politics are like water and oil. EMS needs to be under the direction of medical professionals, not politicians who have no clue whats going on but have the authority to make decisions which could adversely affect patient care. I just wish that our current EMS agencies, organizations and associations would realize these problems and fix them before more people have to suffer and die from delayed response times due to current laws, regulations and inconsistent dispatch protocols throughout the state. God help us if we start getting more MCIs in addition to our usual business.
John,

It's funny that you used the sinking ship analogy. There was a position paper written some time ago about the current EMS crisis. The author actually insisted that the EMS system NEEDS to fail completely. He contended that only then can the wide reaching changes needed actually be instituted. Start fresh and redevelop the system off of current practices and knowledge. Instead of the constant application of "band aid" solutions to trauma dressing problems. lol I do actually agree with this. I don't believe there is any way that we can make the number of changes needed with out redeveloping the ENTIRE system. From training requirements to actual licensing of medics, reimbursement, protocols, everything.
This should be all about the patient but as many of you noted it isnt. There is the way it should be and the way it is. Maybe in our lifetime we will see it be done with the patient in mind.
I guess it depends on what you think is more important - the patient or your ego.

Those who engage in turf issues have forgotten that we are here to serve sick and injured people, in a prompt and compassionate manner. If you knowingly cause a longer response, by designating anyone other than the closest appropriate resource to respond, you've forgotten why EMS exists.

Get over the territory thing.

Skip
Skip, The problems aren't so much between the depts., rather the dispatch protocols in different counties within the state are not geared to "closest available". The only way to "get over it" as you say is to have the politicians change the dispatch protocols and the laws in the state. So far, its still a problem. Rural areas have some unique problems that urban areas don't seem to have.
I'm not sure what the closing sentence is supposed to mean. You can have screwed up systems just as well in an urban area as in a rural area - and there's more of them to screw up!

So you have state laws that say what unit gets dispatched? I admit that I have been away from PA for some time, but when I practiced law there I spent a lot of time in Act 43 and never say anything about that subject in the state EMS law. Surely it could have been put there since, but .... wow. What politicians make dispatch protocols? And is there something that would prevent even different jurisdictions, like cities or counties, from having an agreement to cooperate to do what is best for the patient?

My vast experience with dysfuctional EMS systems (LOL) has taught me that the problems arise, and the solutions can be found, much closer to home. If the regional EMS leaders supported doing the right thing, and the local squads agreed, how could anyone object? The only objection could come from people putting turf ahead of the well-being of the citizens. THAT doesn't look at all good in the local newspaper......

SKip
Skip, what I meant by rural areas having some unique problems is this. Rural areas (in Pa) have typically been served by volunteer organizations. There are more "rural" areas in Pa. than urban areas. Although there are fewer citizens per square mile in the rural areas than in the cities, the primary response areas are generally larger in comparison. Due to distance, terrain and adverse weather conditions, rural services experience some different challenges in providing EMS than urban services. The converse of that is that urban services have their own unique challenges. Maybe I misinterpreted what you said about "Get over the territory thing". I didn't take offense to that comment but I wanted to point out that its not a "turf" issue here in our local area between local depts. My son JJ is Chief of our local vol. dept. as well as Platoon Chief with our regional health system and he has always put the best interest of the pt. first. We have had mutual aid agreements with other depts for many years and it seems to work out well from that perspective. Pa. state law states that the Borough Council and Township Supervisors are charged with the responsibility of providing EMS. This law was signed by the gov. approx. 1 year ago. Problem is that most elected officials know little to nothing about EMS, although we try to educate them every chance we get. The supervisors can choose whatever service they wish and there is nothing in the law that says they have to choose the closest available licensed BLS service. Our county communications center is notified which station to dispatch via "box cards". The comm. ctr. dispatches as they have been directed to do so by the governing municipality. To my knowledge,there is no law on the books in Pa. that states that the closest available unit is to be dispatched. One would think that such a law would make good sense but when you have politicians (elected officials) making the laws, rules and regs, you take what you get.
You made reference to the EMS Act (Act 45) when you were in Pa. I was on the Pa. EHS Council back then and we drafted the recommendations for that Act. Once the lawyers in Hbg. (no offense to lawyers) got done hacking it up, it wasn't anything like what we proposed and was pretty weak and general. The VASC Program(Vol. Amvb. Service Certification) we had prior to Act 45 passage was alot better. Several years went by and I was called back to that committee to help rewrite Act 45. Although it was a little better the second time around, it was far from what we needed and proposed.
Currently, there is a draft revision to our existing EMS law that is being proposed, but it has to go thru the legal process of several committees and then be passed into law. I don't recall reading anything in the revision to specify "closest available" unit.
We do have many experienced, educated and seasoned EMS personnel in our county who have worked for years to get us to where we are today. Its a never ending struggle as I'm sure you well know but we just keep working towards improving the system the best we can.
Thanks for your comments Skip. If you are ever back in Pa., we'd be honored to show you our system.
John, I'll take you up on your offer! I am going to be a speaker at the next PEHSC conference, so grab me up and show me around.

Thanks!
Once you cross county borders, you might be changing dispatch centers. Are you accounting for the dispatch delays with inter-county communications? County A has to dispatch the appropriate units in their county, and also call County B and request that they dispatch unit X for the call. Then County B needs to dispatch that unit. Likewise, all updates between the 911 caller, other responding units, and Unit X need to go through County, unless Unit X has a radio to communicate with County A.

We've been discussing this locally, because part of our territory has a 2nd due medic that is coming from the next county over. There is a move to change the dispatch cards AWAY from this unit because they have limited ability to talk with our BLS units and County. Also, in our case, there are other ALS units in county that might actually have shorter response times.
Solving that particular problem should just cost a few bucks. Add another channel, or add another radio. Doesn't PA have a state-wide radio system? At one point I recall that PA was going to be the poster child for a state-wide, trunked 800 mhz radio system from MACOMM.

If people want to be inter-operabe, it's just not that hard. If you're in a trunked system it may cost $4,000, if you're not it may be just $500.

Closest = fastest, unless your system is really messed up. If that is the case, fix the system, THEN do the closest.


Jon said:
Once you cross county borders, you might be changing dispatch centers. Are you accounting for the dispatch delays with inter-county communications? County A has to dispatch the appropriate units in their county, and also call County B and request that they dispatch unit X for the call. Then County B needs to dispatch that unit. Likewise, all updates between the 911 caller, other responding units, and Unit X need to go through County, unless Unit X has a radio to communicate with County A.

We've been discussing this locally, because part of our territory has a 2nd due medic that is coming from the next county over. There is a move to change the dispatch cards AWAY from this unit because they have limited ability to talk with our BLS units and County. Also, in our case, there are other ALS units in county that might actually have shorter response times.

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