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Sunday, October 25, 2009

The EMS 2.0 Buzz -- and Requisite Rant

I'm not under any illusions that people are reading this blog to learn what's going on in the fire/EMS universe. That's what Firegeezer and Happy Medic Headquarters and Fire Critic and others in that league are for. I don't hope to ever be that popular, and it is probably best for me to stay that way anyway.

So, no doubt you've heard of EMS 2.0 already. It's the latest buzz, and while I certainly like the concept, it is picking up steam so fast... almost too fast, and I am worried about it spinning out of control before liftoff. I want it to be useful, and not over evolve into a bigger mess than we already have. I have my popcorn handy though... should be fun to watch.

I had an event a few weeks ago that was almost bloggable, but not really. But then again, it was a silly event. And then it further dawned on me that my silly event was obliquely related to EMS 2.0.

Woo hoo! That's enough to go with. And I can use "EMS 2.0" in a blog post! I've arrived!

OK, seriously....

While the aspects of EMS 2.0 I have seen the most of involve a more dynamic outcome-based approach to providing initial contact medical assistance, to best utilize our resources, the aspect getting slightly less coverage as I see it is on the initiation side.

This is of course assuming I know what I am talking about. Perhaps I should stick with the power line stuff.

Anyway... I'm not sure how to move away from our current EMS initiation model, due to the litigation-driven culture we exist in here in the States, but at some point we have to stop throwing resources at problems when they're known to be not needed or not even asked for.

And so here's my silly personal story.

I was minding my own business, driving in the City, when I stumbled upon a two car "T-bone" blocking collision. As I pulled past the vehicles doing the automatic habitual size-up, it looked like all occupants were out, no airbags. It wasn't that hard of a hit.

I pulled off the road and made sure my cell phone was handy, but didn't want to call it in until I had useful information for the 911 dispatchers. As I approached, the drivers were moving their vehicles off the road.

No spills, no major hazards, no traffic problem. Looks like I am not needed. Still, I checked with them to be sure.

One of the drivers asked for law enforcement. All involved explicitly denied any desire for fire or EMS. Now, I am not convinced the brothers in blue are needed, either, for a non-injury accident with no tow truck required. I mean, c'mon, let's trade insurance info and move along. But they asked, I had the phone, I said I'd at least pass along the request.

911 Dispatcher: 911, what is your emergency?
Grumpy Dispatcher: Hi, this is firefighter Grumpy, I'm on scene of a non-injury, non-blocking accident at 45th and Main, and I have one of the drivers requesting law enforcement, if you have any units available.
911: You say there are no injuries?
GD: That's affirmative, all three involved parties are out and not reporting any injuries. One of them is rubbing her neck, but they're all OK.

What the heck, why did I just say that? Dang it, now I've gone and done it.. Crap.

911: You said someone is holding their neck?
GD: (sighing) Yes, but they have already declined medical attention.
911: OK, we're going to go ahead and send fire and medical just to be sure, so they can get refusals.

I had already played the FF card, so if my advice was going to be followed up front, we would not already be this far. No value arguing now.

GD: Well, since they've declined EMS, a Code 1 response is probably appropriate.
911: OK, they're on the way, thanks for calling.

Click.

Erg.

The drivers are exchanging information now. I approach to tell them that fire is on the way even though I said they weren't needed.

A minute or so later, I hear them. Yeah, 'hear'.

Rescue 14, then Engine 14, and then a private Medic arrives. All Code 3, all busting the nearest intersection to get into the parking lot we're in.

I sheepishly apologized to them and gave them the quick rundown. Refusals were obtained. Units returned to service. The guys knew the score, this kind of Code 3 refusal errand is not unusual here.

So at what point do we go back to realizing refusal forms need not be filled out unless crews are on scene in the first place? At what point can a dispatcher follow the advice of a verified FF to modify a response, or to cancel one... or not start one in the first place? If I had been on the radio, the cancel would have been heeded. Why not by phone? I'm still FF Grumpy, so why does my authority change depending on how I communicated?

EMS 2.0, we eagerly await your arrival. We'll be at the dock, waiting. Unless we're on our way hot to get another legal document signed.


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