WVAC 911: Lessons from EMS — Nature of calls
When the alarm sounds at WVAC headquarters, and before we run out the door and respond to the scene, we listen to dispatch for the critical facts.
Our calls fall under two main categories: sick (medical) or injury (trauma).
If it is a medical emergency, the dispatcher will provide us with the nature of illness, or NOI, such as difficulty breathing, seizures, allergic reactions, dizziness, or general sick calls, to name a few, along with the location, age, gender of the patient. For example, we may receive a call for “123 Made-up Ave., 82-year-old male with difficulty breathing.”
Trauma calls are less frequent for Wilton than sick calls. In fact, in 2017 the percentage of medical calls to trauma calls was 63% medical to 37% trauma.
The most common mechanism of injury, or MOI, for trauma calls is “falls.” In these instances, it is very similar to information for a sick or medical call; however, we’ll get additional information such as the distance of the fall, surface struck, and part of the body injured. In these cases, we’ll also want to know if the patient was taking blood-thinners.
As one can imagine, the most common trauma calls involving more than one patient are motor vehicle accidents, or MVAs. The priority information is the location, the number of patients, the mechanism, and details about the mechanism that give an indication of the level of trauma.
Once we have the information we need (location, NOI/MOI, number of patients), we have to decide the types of resources required for the call. The first decision to make is whether it requires advanced life support (ALS), which would require a paramedic, or basic life support (BLS), which could be managed by EMTs. Based on the information provided by the caller, dispatch follows pre-determined guidelines as to who will be dispatched. This is also important, as it will determine our travel mode by which we respond to the call — lights and sirens, or normal travel.
Once on scene, it may then be determined that the medic is not required, and he or she may be canceled. On the other hand, if a call is dispatched as BLS, and the situation is later assessed as ALS, the EMTs would request a paramedic on scene or to intercept on the way to the hospital. Paramedics are able to start IVs, deliver numerous medications, and provide advanced airway management such as intubation, which are outside of the scope of practice for EMTs.
Other resource decisions are based on the number of patients, which may require more than one ambulance and crew, and the physical location of the patient in the home or facility. If the patient cannot walk, is on the second floor, and the location has no elevator, then we know that we’ll most likely have to use a stair-chair. If the patient has low blood pressure, and should not sit up, then we’ll most likely use a Reeves flexible stretcher. We may also ask the fire department or police department to assist in moving the patient to ensure safety for ourselves (our backs) and the patient.
So what is the lesson here? Please make sure you provide 911 with all of the relevant information so we can best prepare and bring the appropriate resources to the scene. If it is a sick call, please provide the symptoms, starting with the chief complaint or main issue. Breathing issues and decreased level of consciousness should be priority information for sick calls. If it is a trauma call, please tell 911 whether the patient is on blood thinners. Please stay on the line until the dispatcher has all his or her questions answered, and follow the instructions you’re given. Finally, always tell us if there is more than one patient and the location.