I started to post a comment over at EMS in The New Decade on this post,
but, as so often happens my comment started to take on all of the attributes of a blog post, so I decided to make into a blog post. Funny how that happens.
The fallacy is that these systems are designed, capable, or implemented with the goal of improving dispatch and triage accuracy. In fact, they are designed, capable and implemented with the goal of protecting medical directors from perceived risk of liability and consistency. That they do none of the above has not stopped their implementation over the past 20 or so years. Nor will it.
Most trauma calls, especially penetrating trauma calls, can be managed at the BLS level. Since we generally don’t infuse large volumes of IV fluids, rarely need to intubate, and for the most part should be prioritizing BLS management and transport to a trauma center, I can see what systems will divert ALS assets to medical calls, where they have a better likelihood of benefiting the patient. I also understand that ALS crews would rather do the “sexy” trauma calls.
Like most EMS systems, Oakland likely has too few ambulances and too many calls. So, any of the “card” phone triage systems, which are mostly on computer now, try to allocate resources in the manner least likely to cause complaints. Because it’s a sad fact that the only thing that most patients, the news media, and politicians care about when it comes to EMS is response time. Which is why the fire service likes to go to medical calls, pronounce themselves EMS providers, generally do nothing, and then denigrate the EMS crews to patients and bystanders. But I digress.
Ironically, my experience in the system where I worked was that calls were consistently over triaged. No matter how minor the complaint, the ambiguously worded “Is he breathing normally?” question would consistently result in an ALS dispatch for “Difficulty Breathing”. It didn’t matter that the person had dropped a bowling ball on his foot and was hopping about the room yelling, the answer would be “No, he’s not breathing normally.”, and bingo a fire truck and an ALS unit would be sent, only to be cancelled when the BLS crew arrived and got the true story.
I’d also disagree with Justin’s comment. The person who calls often has a good idea of what is going on and what is needed, but is directed down a particular path by a dispatcher who doesn’t want to get “dinged” for not putting in the highest possible priority. No matter that it will result in a higher level of response than is even remotely required. Their (often overly large) asses are covered and the system managers will reward this great triage.
NO ONE gets disciplined for sending ALS when it’s not needed. Or a (generally) big red truck staffed with people who really don’t want to do medical care, but are sent because there aren’t enough buildings on fire to keep them busy.