Phone triage (Was El Paso etc)

[Guest guest]

There are so many problems with phone triage that cannot be anticipated and

planned for that any attempt to implement such a system is a recipe for

disaster.

No matter how well planned and implemented, there will always be the " outlier

call " that will fall through the cracks and the system will fail.

Attempts to try to triage calls using nurses seem to run in cycles. Somebody

tries it, a disaster happens (remember Nurse Myrick in Dallas) and the system is

dropped. Then time passes and folks get worked up about the system abuse and

somebody else tries it and the cycle revs up again. That seems to be happening

now.

The idea that nurses somehow have magical powers to decide what kind of response

needs to be made is, in my personal opinion, moronic. If phone triage is

possible, then why not have physicians do it. Can you imagine a single

physician who would agree to make response determinations over the phone? If

you know one, let me know.

Right now several large systems are doing nurse triage and more are discussing

it. Houston is doing it if I recall correctly, and I haven't heard of any

disasters coming out of that system, but a disaster is inevitable simply because

it's impossible to see what's happening on the other end and when you're talking

to medically unsophisticated people, you're not going to get reliable

information about what's really going on.

I'm not saying that when a person calls and says " I cut my finger while slicing

tomatoes " that the Cavalry need to be dispatched. It doesn't take a nurse to

determine that. But when somebody calls and says " I've got a stomach ache "

there's no way that person's condition can be evaluated over the phone. I don't

care WHAT Dr. Clawson or anybody else says. It cannot happen. No physician

would presume to be able to guess what that person's needs are without seeing

them, and no nurse, paramedic, or EMT, or Sheriff's dispatcher can either.

With all due respect to nurses, for whom I have the greatest respect (my

sister's one) there is nothing in their education and training that gives them

any better ability to make these determinations than an EMT or Paramedic.

Matter of fact, most paramedics would be better at it, if anybody could, but

NOBODY can do this. When nurses think they can, they are setting themselves up

for failure and a lawsuit. If I were a nurse I would run as fast as I could

away from such a job. It's unfair to everyone because the basic premise is so

flawed.

When the inevitable disaster happens, it will occupy the news cycle for 48

hours, prompt lots of bloggers to comment, the publicity will be damning, and

the programs will be put on hold or dropped. Some city and its EMS will be

relentlessly be raked over the coals, thereby damaging all the rest of the EMS

world and its reputation for honesty and integrity.

The truth is, nobody knows how to triage calls over the phone. For services who

persist in doing this, it's a matter of balancing the interests. They're

betting that they'll save more money by sending fewer assets to a call than

they'll spend in claims paid when the system doesn't work. That's cynical and

hard, but that's big bidness today.

Some experiments with sending a lower level response are being tried, and that

can work well, so long as the responses are in time to correct the situation if

a mistake were made.

Example: The " patient lift assist " call where a patient has fallen and just

needs help in getting back to bed. That call CAN be handled by a lower grade

response IF the right information is gained by the call taker and interpreted

correctly. But there's lots of room for screwups there as well.

If it's all about money, and it is, services are going to do what they think

they have to do, and they'll try all kinds of schemes to limit full blown

responses. Sometimes they will work, sometimes not.

It's a roll of the dice, and a sucker bet, in my view.

My opinions are my own.

Gene Gandy, JD, LP, NREMT-P

Bujia EMS Education

Tucson, AZ

Re: Re: Fewer Firefighters to Respond to Calls in El Paso

, Tx.

Wouldn't that be a form of phone triage? I thought we agreed that this has never

worked, even with well trained medical professionals. How would this possibly

work with minimally trained dispatchers? I fail to see this as a valid option.

Sent from my iPhone,

McGee, EMT-P, EMT-T

On Jul 30, 2010, at 6:22 PM, " rob.davis@... "

rob.davis@...> wrote:

On Friday, July 30, 2010 09:56, " lwd7734@... " lwd7734@...> said:

> Execellent points Gene, but what do we do in the mean time to educate the

public

> when it is appropriate to call 911?

After many years of pondering this question, I have concluded that public

education is not the answer. It just doesn't work. Instead, we should focus on

educating 911 operators to properly provide the needed resources and referrals

to the public when they call.

Rob