Tuesday, November 14, 2006

"American Ambulance, what's the address of your emergency?"

We answer each and every 911 call that comes into the dispatch center at American Ambulance in a manner that is standard in 911 centers throughout the country. The most critical thing we thing need to know is where someone's emergency is because without that key piece of information we have no idea where to send the people who are going to provide help on the scene. Whether it be the police, a fire truck, or an ambulance crew they need to know where they're going first and foremost.

After years of experience, I have come to the conclusion that when that question is met with someone screaming on the other end of the phone line it's probably not going to be a good call, though some are much worse than others. Such was the case this morning when I answered what was probably my fourth or fifth 911 call of the day (some days it seems to ring constantly and other days not at all - today was constantly) and my question was answered with a screaming female caller. I was able to get the address and phone number from the NPD dispatcher and after trying to calm the caller down was finally able to determine what was wrong and with who.

In September of 2003 I became a nationally certified emergency medical dispatcher with training specifically designed for these types of calls. We operate under a protocol through the National Academies of Emergency Dispatch and have a computer-based system that guides us step-by-step through each call by giving us the correct questions to ask and then, based upon the answers we receive, we can give pre-arrival instructions as well as send the appropriate emergency medical response. It's a great system and is right more often than it's wrong. As the first first responders, it gives us the chance to have the caller render assistance to the patient that may make a difference in how the call turns out.

That said, not everything that we say on 911 is scripted through the protocol. We are trained in the use of postive reinforcement as well as repetitive persistence,
which is the most effective method of reducing the caller's anxiety to below the hysteria threshold, but there is nothing scripted on the computer that tells you to say "you need to calm down so we can get ___ help", "if you want to help ____ you need to take a deep breath and calm down", etc., etc. Most times during a 911 call we don't need to calm down and reassure the caller but, when we do, it can be tricky to say the right thing to get the caller to a place where they can render aid to the patient before the "calvary" charges through the door.

The call that I took this morning took all of my training and then some as I tried to calm the caller down and walk her through the questions so she could help her loved one while the ambulance and fire department were enroute to the call. In cases like this, I stay on the phone with the caller until help gets there. Those minutes that it takes for help to actually arrive can seem like the longest in the world - not only to msyelf but to the person anxiously waiting for help to walk through the door on the other end. The most frequently asked question during this type of call is "when will someone get here?" and it never seems like soon enough - not to either of us. My caller would be calm one moment and then start to spiral towards hysteria again a moment later and it was my job to try to keep her as calm as possible.

All things considered, I thought today's call had gone well as the caller assured me several times that the patient was still breathing and she said she could feel a pulse. But as I gave her reassurance that she "was doing just fine" I said something that I normally never say to a caller which is that the patient would be okay. It probably doesn't seem like it would be a big thing to say that but when the crew finally got the patient down to the ambulance and began to transport, it was something that I wish I hadn't said as the patient had become what's known as a "working 100" or cardiac arrest. Though he had been breathing and had a pulse when the crew first got there he stopped doing both somewhere between the time he was loaded onto the stretcher and put into the back of the ambulance. When the EMT that was driving radioed in that they were transporting lights and sirens to the hospital with a working 100 my heart fell into my stomach as I knew exactly what that meant and it wasn't good.

I kept thinking of the poor girl who had called and how I had assured her that it was going to be okay and now there was a darned good chance that it wasn't going to be okay after all - that it was NOT going to be okay and never would be again. I felt like I had lied to her and betrayed her, that I had offered out false hope even though I had followed the protocol exactly except for that one small statement.

When the med-patch was given to Backus Hospital from the crew in the back of the ambulance, things sounded even more grim for the patient and my heart sank even lower with each passing moment. In my mind I kept hearing the caller lamenting that I had told her it was going to be okay, that I had lied to her, and I was just about ready to send myself home for the day to rethink my entire career choice.

God must have heard my silent prayers, though, as when they got to the hospital they were able to reestablish a pulse and the medic was credited with a "code save". Last I heard, the patient had been stabilized and put on a vent but was still alive in the Emergency Room. Only then was I finally able to heave a held-in sigh of relief. I'm sure he's not out of the woods yet but it sounds like he's got a fighting chance of survival.

Still, the whole thing shook me up a bit and will make me pay closer to attention to what I'm telling a screaming caller on the other end of the phone. It may even make me reevaluate my sanity in being in this career field but I doubt it will send me into Human Resources with my resignation in hand. Not yet anyway! But maybe I really DO need that thicker skin I've referred to before ...

8 comments:

  1. I gotta tell you, it's ok if you told her it was, "gonna be ok", even if he had died. Technically it would be against what you are suppose to say, but maybe she really needed to hear that. Even if someone had died, and we all know what that is like, you wouldn't have really lied to her, she will get thru the pain of the loss of a loved one,and she would be ok. It sounds like my friend, that you are being a little too hard on yourself, that you try so hard to be detached, but dang it all to hell and back, you're human too. Just try your best and forgive yourself for the empathy and reassurance that you gave that person. Just don't let it happen again!! :)-

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  2. I can tell you what its like from our side. I was on that call. I am the one that was driving. The sinking feeling and the adrenalin is very emotional. In 6 years it hasnt changed. What happens if they do die, how do you explain to the family you did all you could and it wasnt enough? What we do sometime just will never be enough. The worst is having to face the family after. Some of us do well with it, some dont. My saving grace is an awsome medic in the back(one that I hope to be and to live up to) and you guys to talk to when the shit hits the fan. YOU are our rocks and our guiding light in that tower. We may give you all a hard time when its busy but you are there when we need you and you all are not appreciated enough. Yesterday was prime example. Along with my other call right after that one. You Linda, are the DISPATCH GODDESS and you will always be.

    629

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  3. Linda, from someone in the field 29 years I have this for you: If every one of us that ever said to a family in need that "it would be all right" threw in the towel, then there would be no one to render aid at all. You did the one compassionate thing you could in that moment. It shows you have a heart; which those of us under you daily guidence well know. Forgive yourself and go on. If the inevitable happens for that family, yes it will be all right because as Area 51 says they will get through the grief and purhaps in the back of that girls mind she will remember the compassionate dispatcher she talked to in those moments. Stay with it kiddo it gets easier.

    MJC 469

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  4. Even though it's been so long since I've been on a "real" call, that I've forgotten which end of the IV goes into the pt, I DO remember the ones from the past. You did the same thing ANY compassionate person would do - you reached out in a time of need. They may never be "our" emergencies, but they are "someone's" emergencies - and it's THEIR loved ones in trouble. How can we NOT reach out? If ever I hear that you stopped being the warm, caring person you are, and withheld emotional "medicine" from a caller, why I'll storm up those stairs myself, and then you & I are gonna "Have Words!" Please keep the faith, and keep doing what you're doing! We love ya!

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  5. Oh...and KAC, yeah - good luck with that Paramedic thing. It takes special people to be dispatchers and paramedics: it's never easy to be on the phone NOR on scene for these calls. Sounds like you aquitted yourself well, KAC, glad to know you're one of us at AASI! ;-)

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  6. Linda, if telling that caller that it was going to be OK was what calmed her down wnough to listen to you and to follow your directions, how can you fault yourself? Sometimes we need a little hope, weather false or not, to give us the resolve to do what needs to be done despite our emotions in a time of crisis. You did what you could to get the job done, be proud!

    KAC even though i have resigned to the fact that I will never win a popularity race against Linda, thank you for your kind words about us dispatchers. I know I was somewhat included in your comments.

    I too have had those calls that I wonder if I said the right thing... my little boy from 2004... Linda you remember that one? It still haunts me.

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  7. This comment is for Jennifer. You need not worry about a "popularity race" against Linda nor ANYONE for that matter. You are your own person with gifts, talents, and, gasp, FAULTS. This statement applies to EVERYONE who calls themselves "human". As you are no Linda, so Linda is no Jennifer.
    I'll admit, I wasn't too fond of hearing your voice over the radio, and I thought you were abrupt, attitudinal, and uncaring - much like "Big John". HOWEVER, that opinion has CHANGED for the better. I realized that not only do you dispatchers have, easily the roughest job in EMS, but I also got to know you a little better. Now, I think you're efficient, knowledgeable, and VERY human on the other side of that mike. I hear it in your voice when you try to suppress a laugh or even a frustrated sigh.
    You're a good dispatcher - you all do a great job upstairs! We as road crews are an irrascible lot, and we can be mean - but ask any of us individually (in private), and we'll tell ya - we are grateful for the dispatchers we have watching us from up in the "Bubble". Keep doing what you're doing, Jen, and know that we love you too!! As for this bulldog, he's glad to have gotten to know you!! (BTW, I remember THREE way conversations when I come upstairs to see Linda!)

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  8. Thank you Bulldog, I know I come across gruff, I always have. Thanks for taking the time to realize there is more to me underneath that rough exterior. :)

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