PLEASE stop when calling 911 about car accidents

[mariomike]

Back when police comm centres were still staffed by coppers, there used to be the three "INs" of winding up in communications:
IN sh!t
INcapacitated
INcompetent

I think the police, and EMS, changed Communications from an assignment for Police Officers and Paramedics to a Direct Entry position for civilians hired off the street to save money.  There was an unsuccessful Human Rights complaint against the City of Vancouver regarding this:
"the mostly female police dispatchers, who are civilians, are paid 40 percent less than the mostly male contingent of fire department dispatchers, who are firefighters.":
http://www.straight.com/article/dispatchers-lose-case?#
Vancouver EMS dispatchers were not included because they are provincial, not city, employees. 
This is a story ( with some interesting comments! ) regarding TFS dispatch. It's in the same HQ as T-EMS, but they are two separate worlds ( and floors ) apart:
http://www.thestar.com/article/646628

Not sure why the reporter called it "a tired industrial complex". It's been a beautiful place since 1981. TFS joined us in 1998.

As I said, they treated me with nothing but kindness when I was in there. Even though I was not qualified to answer phones or dispatch, they made sure that I was involved in the process. They made me feel useful at a time when I needed a job to do, rather than sit at home.
That was back in the paper and pencil days, before computers! The telephone call receivers would time stamp the work ticket on a machine, then put it on a high speed conveyor belt with tracks to the specific radio desks up front. Each desk had it's own ticket rack and coloured status buttons. I can't remember what the colours meant, but they all meant something. I have sincere admiration for the work that they do. Then and now. They have a "third ear". One ear for the phone, one for the radio and the third for the room. Their eyes are in constant motion.
Since then, things have changed. 9-1-1 and cell phones have skyrocketed call volumes. There are now multiple callers for the same incident, but they each have to be processed. There's also Advanced Medical Priority Dispatch System (AMPDS). Pre-arrival instructions could include how to do CPR, the Heimlich Manoeuvre or how to deliver a baby. Dispatchers also have to work with a translations service, Poison Control, HAZMAT, TTC, swimming pools etc.
Used to be the about the only question was, "Where do you need it?" and not much else. Most calls were either "medical emergency" or "Unknown problem - see the wo/man".

P.S. I know you will be offline for a while Bass. Thanks for your posts, and have a great time!

 

[zipperhead_cop]

IMO, all call centers should be supervised by a full time, qualified member of the branch they are dispatching for.  IE) a police sergeant in our comms center.  The civilians rarely "get" how it is on the street most times.  Even if they are inclined to be helpful (which they frequently are not) the really don't know the right questions to be asking.  Nothing pisses me off like getting dispatched by the MDT to a break in report where they haven't so much as bothered to ask the name of the complainant! 

Also, IMO, the MDT's (Mobile Data Terminals aka computer in the car) have cause skill regression in the dispatchers.  When I was first on the job we didn't have the MDT's.  The dispatchers would be running address history, complainants and suspects on CPIC, looking for related calls.  Now, since we have the ability to get all that ourselves they are content to clear the call off their screen and let us do all the digging.  I don't mind getting stuff on my own, but don't get pissy when I need an assist and I simply am asking you to do your job! 

 

[mariomike]

IMO, all call centers should be supervised by a full time, qualified member of the branch they are dispatching for. 

Where I worked, if you are qualified and experienced in both Operations and Communications, you are truly Golden. You can pretty well write your own ticket. But, those people are very rare now. Even the short time I spent in Communications as a "helper" would not be allowed now.  Main reason being the two Divisions are in different unions. If like most of us, you are only qualified in one Division, you will never be allowed to Supervise the other. 
TFS only has the one union, so they can, and do, transfer within either Division.
TPS also only has the one union, but, unlike Fire, it is split into Uniform ( sworn Police Officers ) and Civilian ( Dispatchers ).

 

[zipperhead_cop]

Not so much as to supervise the civilians.  That should be done by one of their own.  But be there to vet the calls.  Be able to say "No, we are not sending a unit to that".  Or make the big people decision to clear a call without a unit attending, like a 6 hour old noise complaint with no call backs.  Or when a hot call comes in, tag up with a non-engaged call taker/operator and start digging for useful info in records, or prompting useful questions with the call taker (like: what is your name?)
Stuff like that. 

 

[mariomike]

Be able to say "No, we are not sending a unit to that". 

We could never say that. There's been too many lawsuits.
"If you have any doubts about whether you are experiencing a medical emergency, call 911. The ambulance will take you to the appropriate emergency department." Those are the exact words advertised by T-EMS. They are in red ink. 
You call, we haul. 
The Call Receiver must inform the caller that, "The ambulance is on the way." That is, they already have the ambulance rolling on a pre-alert.  They will be updated en-route. I think it's hard for some callers to understand that while they are being interrogated by the Call Taker and receiving pre-arrival instructions, the pick-up location has already been sent to a Radio Dispatcher who has started an ambulance.
Clock stopping Response time is the big thing. So is Unit Hour Utilization UHU.
Sometimes the caller just gives the location and hangs up. But you still have to go.
Once you get there, if nobody wants a ride, you have to do an "Aid to Capacity". That is, the patient(s), the parent or substitute decision maker has to answer three questions:
1) "What is wrong with you?"
2) "What could happen if I don't help you?"
3) "What will you do once I leave?"
After that, you have to do a "Refusal of Service: "I have been advised that I should have treatment and that treatment is available immediately. I refuse such treatment and transportation to hospital having been informed of the risks involved. I assume full responsibility arising out of such refusal."
You have to get the patient, parent or substitute decision maker to sign that, along with their name and address. Then the First Witness. Then the Second Witness. Then both crew members.
Of course, they usually tell you to shove it up your ......
You get a lot of refuse to go calls, because the Call Originator is very often a third party who isn't going anywhere themselves, but demand someone else go! hahaha

You mentioned those accidents collisions on the 400 series highways. The OPP usually go to them, but you likely do too. You know how it is. Multiple vehicles involved, which means plenty of potential patients. Even though most are wandering around in live lanes arguing about whose fault it was, checking property damage and talking on their cell phones. Because of the inevitable insurance claims ( off work with whiplash, headache and sore back ), you have to handle all the occupants of all the vehicles involved by the book. Which means K.E.D., collar and backboard.
Each year, T-EMS receives about 2,500 requests for information. They release about 700 Ambulance Call Reports, Dispatch Reports, Incident Reports, audio recordings and Statutory Declarations from Paramedics. Mostly to those ambulance chasers Personal Injury lawyers we see on the TV ads.
"Not documented means not done" is the medical-legal maxim.

Getting back to stopping at accidents. Reminds me of a multi-car P.I. we attended with the bus on the 401 at Yonge. The OPP later called our office about a car - undamaged - at the scene. They knew who the car was registered to, but there's no record of her at NYGH. She's a wife and mother, the family is going nuts and she's MIA. They figure we must have screwed up. That thought crossed our minds too! A couple of days later a guy walking his dog under the Hogg's Hollow Bridge finds a woman's body. Later ID'd as our missing lady. Back then there was just basic night lighting and simple guard rails for 6 collector lanes and 8 express lanes. Turns out she was a Good Samaritan who somehow got knocked off the overpass without anyone noticing!

 

[zipperhead_cop]

Yeah well, you're an ambulance guy.  You see things differently.  By and large, we don't give a fig what is going on at these idiotic calls unless they are deserving people who actually need help.  Two crack heads knife each other over the last rock?  Couldn't possibly care less.  YOU have to go and take extreme measure to save their stupid, welfare, diseased, useless lives.  Us?  We take some pics and stand by to have them lie on the stand about what happened. 
You can't tell me you didn't want to tell someone to go frag themself becasue they were claiming a stroke but you knew bloody well that they just wanted a free ride to the hospital and a shove to the front of the line just to get a free bottle of extra strength Tylenol.  How many waste of time CAT-scans have you seen? 
I guess the difference is that if our lame calls are ignored they rarely end up in someone ill or dead.  Paramedics are a different deal. 

 

[mariomike]

You can't tell me you didn't want to tell someone to go frag themself becasue they were claiming a stroke but you knew bloody well that they just wanted a free ride to the hospital and a shove to the front of the line just to get a free bottle of extra strength Tylenol.  How many waste of time CAT-scans have you seen? 

Don't forget the drunks. All night long running a shuttle service for them.
To show the increase in demand: In 1967 there were 45,000 calls in Metro. By 2005, it was 238,306 and rising steadily.

 

[Sheerin]

I find most of our 'clients' who are looking just for a ride don't even bother with making up some medical reason to be chauffeured to the emerg.  They know that regardless of what they say, they'll make it to the hospital.

It can be incredibly frustrating. 

 

[zipperhead_cop]

IMO, unless you are unconcious, or suffering from a trauma wound or diagnosed heart failure in progress (as shown on a paramedics heart monitor) you should have to pay $20 to even get to talk to the triage nurse.  That would weed out 80% of the useless baggage.  If you are actually sick or your kid is, you can find the money.  Make the $20 100% refundable on your Ontario tax return. 
The money can be collected by the paramedics prior to their transporting as well.  Otherwise, via con Dios dickweed. 

 

[mariomike]

The money can be collected by the paramedics prior to their transporting as well.  Otherwise, via con Dios dickweed.

Ambulance crews have never collected money in this city. It wasn't our job to argue with people we were sent to help. ( Even if some plenty were dickweeds. hahaha! )
The hospitals send the bill in the mail. It's $45 for residents with OHIP. Private insurance will cover that. Welfare and D.O.A.'s are free. If the M.D. feels you did not need the ambulance, the hospital can bill you $240. There is no charge if you receive treatment from Paramedics, but refuse to go to hospital.

There is something new called "Community Referrals by EMS: CREMS. I will just copy/paste. Sounds like a good idea for some of our lonely shut-ins. Remember the "I've fallen, and I can't get up!" lady on TV? They are nice people, but they are also the ones who keep the phones ringing off the hook.

"Community Referrals by EMS or CREMS is a simple procedure that enables paramedics to link at-risk and in-need people to health care and support services in the community.
Paramedics responding to 911 calls often discover that their patients need additional care that is outside the current scope of paramedic practice. Most of that care and support is available in the community but the problem is inadequate linkage of patients to the organizations that provide the services.
Paramedics can successfully link people to the care and support that they require by making a Community Referral by EMS or CREMS. That linkage can have a profound impact on people’s health and their quality of life.
The original pilot of the Community Referrals by EMS or CREMS program in a small area of Toronto proved to be very successful. In addition to establishing and improving care for people in the community, there was a noticeable impact on EMS resource utilization."
http://www.torontoems.ca/main-site/news/temsTV-index.html

P.S. The new Staging rules came out today, Bass. That will be a lawsuit for sure. Maybe an Inquest too. Two Dispatchers, Two Paramedics and one Supervisor Superintendent were suspended for one call! That must be a record!
http://www.toronto.ca/emssoprecs/
http://www.toronto.ca/your_health/pdf/ems-MoH-LTC-report.pdf

























 

 

[mariomike]

Scott and Zipperhead-Cop's good advice on this subject reminded me of some of the time wasters I have been sent on. Strangely enough, most happened after we changed our call-in number from 489-2111 to 911.

Drive by callers who don't stop are a problem. And not just for car wrecks. Motorists will call in for piles of clothes and sleeping bags under overpasses and the ravines, etc. That can be seen from a highway. The locations given are often not very specific, because they are off road.  We used to get a lot of those calls from the Gardiner Expressway at Sunnyside, before they "evicted" them. Rosedale Valley was another. When you got there, if there was nobody home, you would usually try to scatter the debris a bit, so drivers would stop calling.
Maybe they thought they were doing something nice for society by calling and sending us on a wild goose chase.

Got a call from a borderline obese gent about 60 years old living in an old style apartment building. The elevator was out of service. So he called 911. Tells us he wants to go get checked out for something or other at a hospital.
OK, glad to be of service. Had to carry him down all those flights of stairs. We get to the lobby of his building. He hops off our stair chair, says he changed his mind about going to the hospital, walks to his car, gets in and drives off to somewhere. Probably dinner and a movie. "Refused to go - refused to sign", so no charge. We called them "courtesy calls". 

Friends and neighbours used to drive each other get to the hospital, if they weren't in severe distress. Not anymore.
Just a few, of many, many, examples. I didn't really mind, because I was happy to have a job and liked helping people, but it does make you wonder of the cost of it all.
Anyway, here is a story from CNN. Sorry it is from south of the border, but the story sounds pretty familiar.
"911 abuse: Calling with the sniffles
Chronic abuse of 911 for non-emergency issues is wasting billions of dollars every year and overwhelming the safety net of health care. And taxpayers are left with the tab":
http://money.cnn.com/2009/08/24/news/economy/healthcare_911_abuse/index.htm?postversion=2009082407