Archives for March 26, 2006

EMS radio reports: relics like the radios they use?

Here’s how it’s supposed to work: EMS comes to your house, evaluates your loved one, initiates the appropriate stabilizing treatment, and starts to the Hospital, a brightly lit, spotless facility staffed with knowledgeable and highly-trained professionals awaiting your arrival. On the way they “Call it in”, usually over a radio, so the ED knows what’s coming in. Seasoned veterans can find fault with nearly everything in the above sentences, but stick with me here.

The only part of this I want to talk about right now is the EMS radio call. In theory, this is a terrific link in the chain, one which could make things smoother for all concerned: a general outline of the problem, their acutiy, what’s been done and how that’s working out. Several things could happen, depending on acutiy, resources available, etc. Ideally, the department would be readied for their arrival, a nurse assigned, and a swift and efficient transfer of the patient and information.

Here’s how it actually goes around here: there’s a 30 second to 2 minute long call in (with the mic button held down the entire time, so you can’t break in, ask a question, you get the picture) which is taken by whichever nurse has the time to answer the radio. The gist of the call is relayed to the Charge Nurse (if they didn’t take the call themselves), who adds that tidbit to the 244 already percolating in there. Except for the truly sick or injured who will need to be seen within seconds, no action is taken to prepare for their arrival. Why? Because getting space for the ones who are truly sick is quite an effort, and it always displaces people from a room to the hall, and that’s when there’s a place on the wall in the hall for them.

Back when it was Johnny and Roy making the call-ins, and there weren’t 20 ambulances arriving an hour, the call in made more sense. Now it serves no purpose other than to a) make sure we’re still open to EMS traffic and b) alert us about those few terrifically ill or injured folks; the medical therapies are very protocol driven and direct communication is only needed for protocol deviations (and when things don’t fit the protocol, that happens). All the rest is wasted effort, for EMS an the ED staff.

I think my joint needs to do away with the EMS call-in, or at least only make it when there’s one of those people who are really sick or a question needs to be answered. The rest of the time the EMS dispatcher could call and say “one there in ten minutes with chest pain”, and that’s more efficient for everyone. (That would also allow for the ‘we’re closed’ check).

And, the one-way radio? Relic from way-back. Yes, very very useful in disasters, and pretty reliable here in the flatlands. However, they’re supposed to facilitate communication, and the three minute monologue about grandma’s vomiting, past medical history, breakfast and whatever else is just that, a monologue, which isn’t really communication in any usable medical sense. Brevity is not, apparently, rewarded. Also, there are still people who live to listen to EMS / police radios, and we don’t need to give them entertainment. Just use the cell if you need to call, it’s a 2-way thing, and that’s more useful anyway.

(A Don’t-Write-Letters concession: Your mileage may vary; you may need the EMS call in to martial resources. You might like hearing that one medic who thinks this is a filibuster that cannot be stopped until the patient is in the ED. )