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. )
I agree. We don’t much like giving the reports, either, at least not for the routine stuff. We do it anyway, because our protocols demand it. Give us the flexibility to make our calls one-sentence brief, and we’ll be happy to accommodate you.
I think there is a lot that can be gained by pushing a little more authority and flexibility down to the lower levels of the hierarchy. Personally, I would very much like to see a protocol for clearing a suspected c-spine injury in the field. That would save an awful lot of unnecessary work, and backboards are hardly the most comfortable place for our patients to spend their time. I’d also like a protocol that allows us to prevent people from using a $600 ambulance ride as a substitute for a cab…
Our biggest pet peeve (in my district, anyway) is the use of ambulances to transport otherwise-healthy people to the psych ward. There is no reason the police can’t do this, especially since we usually ask the police to ride with us anyway, or at least to follow us in.
Mike – the protocols for clearing C-spines and refusing ambulance rides to “non-sick” patients in the field would be welcomed by all, but will probably never happen due to lawsuit phobia. The trend in my area seems to be towards more time on backboards, not less.
On the topic of the EMS reports, they are occasionally quite handy in smaller hospitals, where you can at least start gathering together necessary resources or specialists, or decide whether to call a trauma alert. The least helpful are the ones that end with ” and we’re fifteen seconds away”.
I’m doing my Intern ED rotation, and I’ve been amused/distraught by what I overhear. Something like this:
“This is Rescue calling St. Vincent’s”
“This is St. Vincent’s, you’re loud and clear, go ahead Rescue.”
….silence…..
“Come back Rescue.”
….silence…..
They come through the door. “Yeah, it stopped working, but we’re not allowed to use the cell phone.”
Or half the time, it’s just garbled static. Using these one way radios is stupid, when cell phones are obviously more reliable, and can’t be easily scanned by voyeurs.
Mike, Amen to all that you said.
FWIW, our medics do call in on cell phones, and it is a ton better than the radios we used in residency. And crazy tho the interruptions make me, I value them. If nothing else, it does allow us to either clear a bed for them and assign it in advance, or if nothing else, make sure there’s an empty gurney waiting in the hall so the medics can offload, give report, and get back in service. And for the acute patients, of course, there is immeasurable value — but those are maybe 5% of the medic calls, what with toothaches now coming in by ambulance. Sigh.
The calls occasionally serve a purpose at my facility: “MBH, this is Ambulance 51, we’re bringing you a 51 year old unresponsive male with a sat. of 62%, we can’t get a line, we’re trying to intubate”, over. “A51, This is MD 35. We have no ICU beds, 3 vented patients already in our ER. I Beg of you@! Please take this patient to another facility!” “MBH, are you officially on diversion?” “No but we don’t have the resources to care for this patient” “Oh, OK, we’ll go to the CBH”
I call in for three basic reasons:
1. I have a violent MHA that you really ought to know about before I come in the door.
2. We’re working a 500, CPR call.
3. The patient is a police officer or firefighter.
Chuck,
What is the special woody with the police officer or firefighter? Sure we try to give them exceptional care but it gets carried just a little to far when half of the cities police force hangs around the ER for a comrads sprained ankle.
I guess shouldn’t be reading this blog for entertainment either.
Actually, the blog is meant to be read, and is maybe entertaining. Not so much for EMS radio.
I think they should still call on any unstable patient, or any patient for whom they wish to give non-protocol meds (obviously). In my joint, this is about 5% of ambulance patients. But everyone else should be quietly dropped off in the lobby to wait and be re-triaged by a triage nurse. No need to clutter up the hallways with chronic pain etc. I haven’t gotten very far with this one.
Couldn’t agree more with GruntDoc and Mike – little is gained in my view by routine radio reports; save the airtime and attention for those who need non-protocol orders or prep before we arrive (we are enroute with a 24 year old female, LMP 8 weeks, abd. rigid, B/P 80/P. ETA of 8 minutes. Please alert OR…) And yes, paramedics should be able to clear backboards. Maybe someday…
I’m really surprised you all can’t clear C-spine in the field. That been an EMT-B (or our local equivalent) skill for years in plenty of places. Good lord, is it useful.
So about radio reports… I guess my question is, if they’re do useless, why are we required to do them? It’s the docs that make us. It’s not actually written in our SOPs what we need to say or anything. I suspect that, like anything else, some people like them and some don’t…
My happy little ER recently passed a protocol requesting just chief complaint and ETA from incoming EMS units. Theoretically, a HIPPA nod to thwart those folks who live to listen and gossip about EMS calls.
Short, sweet and adequate, we can ask for more info…but rarely ever do!
Where I work (city hospital in New York, level 1 trauma), we get “notifications” on critical patients only. That means we get a land-line from (yes, really) the dispatcher, who has (if he or she is doing the job right), can give us age, sex, chief complaint, vitals, ALS vs. BLS, and pertinent info like intubated (or not), IV (or not), meds (or not), and of course ETA. Practically, we usually get 55M, GSW L chest, 60/P 150, ETA 3. Sometimes it’s even true.
But being a teaching hospital with a surfeit of residents hanging around, we go to the trauma slot, put on gloves and gowns, crack a chest tube tray and a intubation box, joke about calling the trauma team down, and when it ends up a 32F, vag bleed, 136/75 90, joke about calling them anyway.
But seriously, we get far more than our fair share of bullshit ambulance rides (The Bronx, need I say more?) and about half of our “notifications” are stable too. Nonetheless, this system works well for us. Who cares if EMS is en route with a 22M, stable vitals, chest pain for 2 weeks?
I say this as an ER resident and former paramedic (from a system where all ambulance runs were called in by radio no matter what the severity).