Friday, September 4, 2009

Fireman Doctor

Have you ever wondered how a 9-1-1 call translates into a trip to the local emergency department? What determines if the fire department shows up, or a private company like AMR?

When I'm not in the ED, I live in New Haven. When residents of this city (and most others in Connecticut) call 9-1-1 for a medical emergency, there are a number of steps between the call and an ambulance showing up. I've been riding around on ambulances this week, so have learned a bit about the system. This knowledge will help me in the ED, but could also be interesting to you, the random reader of this site.

Step 1: The call. You'll speak with an operator who tries to gather as much info as possible from you. Generally the info they need is your address and what happened. If bad things are happening, this is when to say it. "I stubbed my toe" is not bad. "My dad collapsed and hasn't woken up yet" is bad. This is where the 9-1-1 charge on your phone bill goes.

Step 2: The relay. Medical calls get routed to a dispatch system that tells the fire department and the ambulance service of the problem. If the ambulance service is integrated into the municipal department, this dispatcher will send the nearest paramedic to the scene, with the nearest ambulance to follow. Sometimes the nearest medic is at a fire station with an engine. That's why a fire truck may show up for a heart attack.

Step 3: Ambulance Dispatch. In many locations, the fire department only responds to the call for help. Those medics do not transport sick patients to the hospital. A second dispatch occurs to tell the ambulance where to go and how fast. (Lights & Sirens?) The ambulance tells both dispatches where it is headed so everyone is on the same page.

Step 4: The Scene. Most of the time, the FD is already there by the time the ambulance arrives and tells the transporting medic the story. A story in the Washington Post this week draws attention to this new role of firefighters in America's urban centers. Most of the time, in CT, the fire department goes to the next call while the ambulance continues care. The medic gives a call to the emergency department preferred by the patient about 5-10 minutes out, and before you know it, the patient is rolling through the ambulance bay doors.

All along the way, critical information is repeated, either in person, on the radio or in print. The patient hand-off between the medics and the hospital team may be the first of many during the hospital stay. What I typically forget from my view in the ER is that a complicated game of telephone was acted out even before anyone saw the patient.

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