They give advice over the phone to help callers while they wait for a rescue team
By David Hench
Portland Press Herald (Maine)
Copyright 2007 Blethen Maine Newspapers, Inc.
All Rights Reserved
Kevin Dickinson has no children of his own and has never been inside a hospital delivery room.
Yet a month ago, the Portland emergency dispatcher was coaching an expectant couple struggling to deliver a baby at home. Reading from an emergency medical dispatch checklist, Dickinson advised the father on the items he would need to bring the child into the world and reminded him to catch the head and shoulders, which would be slippery.
“I talked them through to the point where we were ready to give birth,” Dickinson said. The baby was born three minutes after rescue workers arrived.
Starting this year, dispatchers across Maine must be certified in emergency medical dispatching — identifying a patient’s symptoms, passing vital information to responding rescue workers and giving the caller medical advice until help arrives.
Giving medical advice over the telephone - often to a distraught caller — can be stressful but extremely rewarding for a dispatcher.
“When you get somebody who is choking or isn’t even breathing, it really does help to know you can do something,” Dickinson said, “because when you’re on the phone, it can seem like forever” waiting for help to arrive.
In some communities, such as Portland, emergency medical dispatching has been in place for years. In others, such as Westbrook, it is new.
“One of the things for dispatchers over the years has been that kind of helpless feeling. You can’t hang up the phone and go run over there yourself,” said Greg Hamilton, head of emergency dispatching for Westbrook, which also handles calls for Falmouth.
State law requires all emergency dispatchers to attend a three-day course in emergency medical dispatching and to get recertification every two years. Dispatchers train specifically on special situations such as childbirth and directing cardiopulmonary resuscitation for a heart attack victim.
“We had to do one (CPR) for a child at a day care,” said Don Durrah, lead supervisor for Cumberland County’s emergency dispatchers. “It becomes very emotional on both sides. Obviously, with the family member we’re giving instructions to, we actually have two patients at that point.”
Unlike in Portland, where the usual response time for an ambulance or a fire engine might be a couple of minutes, in rural communities it can take volunteer rescue workers 15 to 20 minutes or more to respond, he said. In those cases, giving CPR or dislodging a breathing obstruction can be the difference between life and death.
“This has certainly made a difference for some people,” said William Holmes, director of the Cumberland County communications center, which handles emergency calls for 13 communities, many of them rural.
The center started emergency medical dispatching in February 2005, and last year handled 3,094 emergency medical calls, Holmes said.
At first, some dispatchers and community leaders worried about liability or the training necessary to give accurate advice over the telephone, but dispatchers have warmed to it, Holmes said.
Dispatchers have training in CPR, but typically they don’t need specialized training in the medical procedures they are giving advice about. They follow precise written steps so they run little risk of giving bad advice or getting into legal trouble.
Al Gervenac, head of the state’s Bureau of Emergency Services Communications, said he knows of no lawsuits brought as a result of medical dispatching.
In Portland this week, emergency communications supervisor Brad Williams was one of the dispatchers working the telephones.
Williams first asks for a patient’s name and location, the problem and whether the patient is conscious and breathing. He sends an ambulance, then refers to the medical instruction card that best matches the situation.
A hand-held flip chart includes a list of dozens of primary symptoms. Each card lists additional questions, medical advice and follow-up questions.
Williams asks one caller whether the patient he has discovered on the ground has been having seizures. Can the patient talk? Is the person intoxicated? Is he or she elderly? Is the patient breathing normally? The answer to each question leads to different instructions.
Dispatchers are trained to deal with the unexpected. The more serious the medical emergency, the more deliberate the dispatcher.
“It keeps you focused,” Dickinson said.