Communication... or a lack there of!

One of the topics that evolved to become near and dear to my heart in relation to EMS is the efficient and correct communication of information. Communicating information is important in all facets of EMS, from the call taker getting proper information from the caller, to the dispatcher relaying the correct information to the responding ambulance, and even from one responder to another. As an example, I have an old war story to tell, and as usual, some things have been changed.

Once upon a merry time, I was hanging around at the squad house, one of the nights I was just hanging out, I wasn't on duty, had no responsibility to run any calls, etc. Upon this interesting night in question, the duty crew was scattered to the four winds, each having gone their own way for the night. That being the case, when the tones dropped for a 911 call, I jumped in the truck with the one person from the crew that was still around. Dispatched as follows: “Ruraltown EMS, respond to 91 Hill Country Rd. for the suicidal female with the leg injury.” The run was dispatched as BLS only, and didn't meet any criteria for an ALS assignment.

Just before my new partner and I were going to pull out of the bay and respond to the call, a second member to the duty crew arrived at the building. I offered to jump off the truck, didn't want to crowd their style, but they said go ahead and stay, it's a psych call anyway, we might need the help. While in the process of responding to the call, the third member of the crew called us on a cell phone to let us know he was also responding, and we could pick him up a Ruraltown Elementary. We picked him up and continued on to the scene.

Upon arrival, we noticed there were 2 police cars on location, signed out with dispatch, made contact with the fire department guys who were just arriving and proceeded to knock on the door. After about 2 minutes of knocking with no answer, we called dispatch on the radio and asked for a call back to the location to get them to answer the door. Shortly thereafter, one of the police officers and a middle aged man walked around from the back of the house. The motioned us to follow them.

As we rounded the back corner of the house, I noticed a second police officer and a middle aged lady standing behind the house on a slight incline. They appeared to be talking. Making the first mistake of the night, I assumed this was our patient. The rest of my crew also made this mistake. I started to speak with the man whom I took as her husband, to record the pertinent details for the run sheet. As one of my crew mates attempted to make contact with the “patient” and figure out what was going on, the police officer stopped us and said, “That's not her, the one you're looking for is over there,” and turned on his flashlight, illuminating the prone figure of a much younger woman laying on the ground.

A quick assessment revealed the patient was probably intoxicated, although we couldn't be sure, was only semi-conscious, and more then a little combative. We learned from the patient's parents that she had a mental health history, including suicidal tendencies, and had decided to jump off the back deck.

But deck you say, that would make this a victim of a fall, and because the deck is a second story deck, and we're on a hill, that's greater then twice the patient's height right? That's a significant mechanism of injury, and requires an ALS dispatch (at least in NJ.) And oh, she's only semi-conscious, lets get us some help coming this way pronto.

Call dispatch, have the ALS unit assigned to the job, and fly the trauma helicopter. Local protocols dictate that a transport of more then 20 minutes to the trauma center, and the patient meets fly criteria. Semi-conscious patient definitely meets trauma criteria, even though we were not sure if decreased level of consciousness was due to the fall, or the alcohol.

As the paramedics are responding, they call us on the radio, looking for an update. It's kind of like a “hey, we heard this get dispatched, why the hell are you bothering us for this. It should be no big deal” message. Because of the terrain and where we were, the portable radio I had was worthless, so I ended up calling one of the medics on the phone.

I gave him the scoop, and explained where we were, what was going on (rest of the crew had the patient packaged), and that we were rolling to the landing zone to meet the helicopter.

While we were transporting the patient to the LZ, she stopped breathing for appox. 30 seconds. Upon arrival at the LZ, the patient was breathing on her own again. Paramedics arrived, did their thing, and shortly thereafter, the helicopter arrived and transported the patient to Big Town Trauma.

The whole point of that story is this:

Dispatched as “Suicidal female with a leg injury.”

End result – yeah, she was suicidal, and she had a leg injury for sure. But somehow, I get the feeling that the whole jumping off a deck, and only being semi-conscious thing was just a LITTLE more important then the suicidal feelings at that point.

NOTE: I've also worked as both a dispatcher, and a call taker. I sympathize with those individuals truly and honestly, it is a tremendously stressful job. I'm merely attempting to show how a lack of communication can lead to major problems in the field.