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Could triaging of nonemergent calls for EMS work?

EMS1.com News

January 13, 2011


EMS News in Focus
by Arthur Hsieh

Could triaging of nonemergent calls for EMS work?

By Arthur Hsieh

Editor's note: In New York, the FDNY is reporting hundreds of frivolous calls, even during the blizzard which already created a back log of calls and inability to get to patients. Editorial Advisor Art Hsieh says other public safety systems have already begun triaging of nonemergent calls to other lower-priority management systems, should EMS adopt this model too?

The Fire Department of New York EMS service is huge, even when compared to other large U.S. city departments. According to their website, the department's EMS units responded to more than 1.2 million calls for service in 2009, resulting in 940,000 hospital transports. The system was much criticized in December and January for an inadequate response during a major snow storm; the public outcry resulted in a demotion of the EMS Chief.

So, in the midst of all of the controversy comes this story. I had to chuckle when I saw it — what? Do people suddenly realize that they shouldn't call for a stubbed toe, just because it's snowing like all get out? Of course not.

Many of us have come across these calls for service that are often unnecessary and "frivolous." We get to call it that since we are there to physically evaluate the patient. We can patiently explain that their condition may not be the best use of the EMS system. Some patients may even agree and find alternative means of care or transport.

Of course, we don't always get it right either — there are cases that can appear minor but instead turn out to be much more serious. That's why we use protocols and checklists to make sure the evaluations are done right before making any decisions.

It's not fair to expect the communication folks to make that same level of determination. Last I checked, holograms and telepathic ability are still not available to EMS systems. Couple that limitation with a lawsuit-happy operating environment, and it's no wonder that even during a major crisis, we are loathe to turn down anyone for service.

I can't help but wonder though, that during a declared system-wide emergency some change in SOP could occur to reduce or restrict the call flow on well triaged service calls.

We already utilize that principle when we have major incident demands that outstrip EMS resources. It would make sense to have a well-constructed policy in place to help dispatchers perform additional triaging and transfer of calls during such a massively handicapped system.

Other public safety systems have already begun triaging of nonemergent calls to other lower-priority management systems. Could something work like that for EMS?

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at Art.Hsieh@ems1.com.
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