Just recently, a story came out about how dispatchers at the LAFD are too slow when it comes to directing 911 callers to begin CPR. The story was picked up by print, Internet and television news outlets from all over the U.S., and it even created some talk radio buzz.
In defense, the LAFD claimed that some software issues needed to be addressed with the vendor.
Apparently, according to the LAFD, dispatchers cannot simply send units to a particular call — even if it is obvious from the caller that serious help is needed immediately. It seems that the dispatchers are forced to run algorithmically through a series of questions generated and required by the software in order to triage the call. Only after the computer has sufficient information can a rescue unit be dispatched.
The 911 call recording released in connection with this story is pretty compelling. The caller tells the dispatcher that the victim's skin is changing color before his eyes; that he is not breathing normally; that, while it appears he is breathing, there is no chest-rise and he is "very pale" and "very cold."
Even the newest graduate of a basic first-aid class knows that the caller is describing someone who needs medical attention STAT! Does the victim need CPR? Maybe, maybe not. I can see how that part might still be unclear, but the person turning blue needs paramedics.
"Are the paramedics on their way?" the caller asks in a voice trembling with anxiety and fear.
The dispatcher answers calmly, "Until I get through getting the information that I need, we're gonna have to wait until that happens."
Really? In 2012, that's the answer?
The real story
By itself, the story is rather damning, and the coverage did not cast a favorable light on an already beleaguered department. However, while everyone is focused on the fact that the caller did not receive CPR instructions sooner, there is a much bigger and more serious picture here, and everyone seems to be missing it.
This story shines a spotlight on a critical and universal problem, not just in Los Angeles, but in countless 911 systems across the country: lack (or total absence) of dispatcher discretion — or worse, of human discretion.
"Are the paramedics on their way?"
"Until I get through getting the information that I need, we're gonna have to wait until that happens."
What happened to the days when the trained dispatcher asked intelligent questions in response to each individual caller and acted quickly based on training and experience?
What happened to the days when certain key words or phrases, like "difficulty breathing," led to an immediate dispatch of resources with one hand while the phone was still in the other? (That's a metaphor; I know they wear headsets.)
The idea of withholding the dispatch of resources because all of the boxes were not checked is positively insane to me! Have we really adapted to a world filled with exciting technological advances by forfeiting common sense?
EMS systems all across the country have spent hundreds of millions of dollars to integrate more "efficient and cost-effective" systems, ostensibly to improve resource management and response times.
Like too many other aspects of life in 2012, the consumer more readily believes what appears on paper or a screen rather than what is plainly visible by simply looking at it in real life and in real time.
I have to tell you, the first draft of this column went into excruciating detail about system changes in response to shrinking budgets and growing 911 call volumes. It was painful.
Fortunately for you, I cut that all out because I can sum up my point simply and in a way that every EMS provider who ever lived will understand and agree: Toys are good, but people are better.
No computer will ever recognize the helplessness in a frightened mother's voice. No algorithm is necessary to know that if someone is not breathing, has no pulse, is short of breath, is unconscious, fell 20 feet or is bleeding uncontrollably, it does not matter how old they are or what their history is or how long it's been going on — get responders rolling.
You can ask the supplemental questions and communicate the relevant information to the responding units as needed. If it takes four and a half minutes to tell the caller to initiate CPR, at least the paramedics will already be on the way.
When software prevents the dispatching of resources, the problem is not the software; the problem is the system. When the toys of EMS tell the people of EMS what to do, stories like this one will give way to stories of lost lives and lost hope, and EMS will take yet another step in the wrong direction.
About the author
David Givot, Esq., graduated from the UCLA Center for Prehospital Care (formerly DFH) in June 1989 and spent most of the next decade working as a Paramedic responding to 911 in Glendale, Calif., with the (then BLS only) fire department. By the end of 1998, he was traveling around the country working with distressed EMS agencies teaching improved field provider performance through better communication and leadership practices. David then moved into the position of director of operations for the largest ambulance provider in the Maryland. Now, back in Los Angeles, he has earned his law degree and is a practicing Defense Attorney still looking to the future of EMS. In addition to defending EMS Providers, both on the job and off, he has created TheLegalGuardian.com as a vital step toward improving the state of EMS through information and education designed to protect EMS professionals — and agencies — nationwide. David can be contacted via e-mail at firstname.lastname@example.org.
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