The US EMS System

[orderly]

Hey everyone,

Just wondering how most EMS systems are administrated and coordinated. As far as I am aware there are multiple ambulance services in a state. How do things like this work?

Dispatch (how are 911 calls received, triaged and dispatched?)
Coverage (making sure areas have ambulance coverage if a crew are on a job elsewhere)
Back up (job goes sour and another crew is needed)

Here, we have 1 statewide emergency ambulance service. All 000 calls go to the one Emergency Operations Centre and the jobs are dispatched from here also. The EOC can see where every ambulance in the state is and all crews across the state communicate with the one centre (using multiple dispatchers looking after geographical areas).

Tom

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[docB]

Good question but one that demands a very long and complex answer. I'll start out and hopefully others will add info.

In the US there are a lot of different system configurations. In fact each state and really each city has a different set up. Many systems use both public (i.e. fire department or police agencies) EMS and private companies (e.g. AMR). Each system decides how they will run their dispatch, first in, transports and so on. Often these arrangements become very contentious and contract negotiations are very aggressive. Lawsuits are common.

The systems work for the most part, some better than others. It is harder to move from system to system because they all work so differently. It's an extra hurdle to becoming comfortable in a new job.

 

[Dzerzhinsky]

Just wondering how most EMS systems are administrated and coordinated. As far as I am aware there are multiple ambulance services in a state. How do things like this work?

Dispatch (how are 911 calls received, triaged and dispatched?)
Coverage (making sure areas have ambulance coverage if a crew are on a job elsewhere)
Back up (job goes sour and another crew is needed)

In my particular tri-state area, each county runs its own EMS. We have a combined fire/EMS system that is (in two of the three states) career and volunteer; the third is career-only. There are also private ambulance services that can be used for transports. They don't run 911 calls.

All 911 calls go through the individual county's dispatch center. Based on information gathered from the caller, the dispatcher decides who and what to send. My jurisdiction has a relatively low call volume, comparatively, so we don't have issues with staffing. If we need manpower to hoist a 500-pound patient, we can pull in the firefighters. If we need more medical personnel, we have enough stations that we'll have it quick. Our transport times are also very low. If we need backup due to a hostile patient, our dispatcher won't send another medical unit; we'll get the cops, and we'll get a lot of them. Furthermore, if the call smells like something that could go sour (attempted suicide, etc), we respond routine instead of emergency and wait until they clear us to go in.

Obviously the private services exist and run transports, but they really are nothing but taxis. As such, they're contracted directly with whomever wants to be taxied.

 

[Julyjoe88]

Hey everyone,

Just wondering how most EMS systems are administrated and coordinated. As far as I am aware there are multiple ambulance services in a state. How do things like this work?

Dispatch (how are 911 calls received, triaged and dispatched?)
Coverage (making sure areas have ambulance coverage if a crew are on a job elsewhere)
Back up (job goes sour and another crew is needed)

Here, we have 1 statewide emergency ambulance service. All 000 calls go to the one Emergency Operations Centre and the jobs are dispatched from here also. The EOC can see where every ambulance in the state is and all crews across the state communicate with the one centre (using multiple dispatchers looking after geographical areas).

Tom

ok seeing as I have no clue what state your from let me explane this to you in very simple terms starting with universal dispatch from the time you dial 911.

what happends you dial 911 it begins to ring at your local dispatch center the dispater picks up and says hellow 911 ___ town area how may i help you?

but hears where crap gets nutz if you dial from a cell phone or the dispatch center is jammed chances are it will switch to your local state troopers dispatch center (mine in ct is in southbury) if that one is bussy then the next closest one will get it (that can be anywere in the United states) the best thing though is a story i heard about majic jack and how it routed every call for 911 to a local dispatch center in MN which not only flooded the center with BS calles but killed two people in that small town due to high traffic and not being able to filter out every bloody call which risided in a lawsuit and a "quick fix of the problem"

next coverage is based off of the DOT or your states department of health with OEMS. each city is gaurenteed coverage by an agency that it pays for with one or more other towns in most cases towns can pick and chooise for BLS coverage and ALS coverage between Volunteer BLS and a full time ALS paid or paid both. Ushually papers get signed and all that good political crap gets done. but back in the 70's it was way bloody diffrent ambulence companies would all get dispatched at the same time to one call and they would race eachother to the scene because whoever got there first would get paid for the job. and back then it was more or less load and go and not much on the medical side except for Oxengenate and acellerate. watch the satire "Mother, Juggs, And Speed" and you will get the idea of how it was back then.

lastly backup is ushually done by your state. in Connecticut we call it CMed they take care of the logistical crap when it comes to MCI's heavey mutual aide and assistance days (like when the town seems to explode) and just your adverage road closeing we need more people stuff. and to be honest they do alot of planning and pre-gameing for almost every senario that has been done.

Next is learning about the mess we have when it comes to certifications and why being NREMT certified means you dont practice in every state and why most state licences are non transferable. but thats more sanity for another day!

 

[Fedekz]

Hey everyone,

Just wondering how most EMS systems are administrated and coordinated. As far as I am aware there are multiple ambulance services in a state. How do things like this work?

Dispatch (how are 911 calls received, triaged and dispatched?)
Coverage (making sure areas have ambulance coverage if a crew are on a job elsewhere)
Back up (job goes sour and another crew is needed)

Here, we have 1 statewide emergency ambulance service. All 000 calls go to the one Emergency Operations Centre and the jobs are dispatched from here also. The EOC can see where every ambulance in the state is and all crews across the state communicate with the one centre (using multiple dispatchers looking after geographical areas).

Tom

The service I work for does the 911 for the majority of the counties across the state, and this is how my service runs things from the dispatch end...

Dispatch (how are 911 calls received, triaged and dispatched?)
-Almost all of the USA has Enhanced 9-1-1, which means if you call from a land line, the address will show up on the dispatch call takers screen. When you dial 911 you get routed to the appropriate public safety answering point (PSAP) based on what county you're in (note: if you dial 911 in X county/parish, your call taker won't necessarily be in that county/parish, or have EVER visited that county/parish so saying I'm at that McDonalds by the old coal mill isn't going to do a whole lot of good). The call taker usually has 2-3 screens, one is generally a high tech map (main screen), and the other one is a call taking screen. If you call from a land line, the address pops up on the screen via a database by all phone companies ... the map auto zooms to show where the call is located, and the nearest few units. The call takers/dispatchers still always (or should) ask to verify the address, and nearest cross street to reference to the crews. Then they will triage the call - get the general information about what is going on, chest pain, difficulty breathing, choking, cardiac arrest, etc. etc. once they have just the bare minimum about what is going on, they dispatch a unit to the address (via computer/automated radio traffic where I work), then work on whats going on in more depth. More and more services are beginning to use a program called PRO-QA, which automatically selects questions to ask the caller based on the chief complaint. It will have all the questions a crew could need, and the dispatcher just checks boxes for all that applies per question, and has a option to make a comment in a box per question. It will ask stuff like is the pt under 350 lbs (requires FD for lift assist?), skin conditions, area of bleeding, amount of bleeding, when it started etc. etc. Then once the dispatcher gets all the information he/she wants, they can just hit a button and all the information is put into an easy to read numbered paragraph and sent over the computers to the crew instantly - and the call back number is forwarded to the crew. You always should send the closest appropriate unit, and sometimes it gets hairy if you have 2 calls in the same area, with only one unit close by ... then you have to decide which emergency gets the ambulance. Usually you can have the fire department respond to either or both to assist until the ambulance gets on scene. Your dispatcher can call other services for mutual aid (they are usually called "roll overs"), and they can send one of their units into your district. The dispatch centers are really cool, and complex. They can instantly play back any part of a 911 call with a keypad, save it, and forward it to other dispatchers (i.e. if your taking a medical emergency that turns out to be a FD or PD emergency, you can take the call, and forward it to the appropriate person). The dispatcher can pan out his map, and see the units, if they are going to a call, it will have the unit number in a little box on the map, and have a marker for the call they are responding to, and then it draws a line between the unit and the call so you can see who is going where, and help them with directions.

Coverage (making sure areas have ambulance coverage if a crew are on a job elsewhere)

- This is the part I would have never guessed before I got into EMS ... there are times (frequently, once every 2 days) when a county has absolutely no units available (usually for 30 minutes or until a unit clears) in the entire county/parish. Sure, they can get mutual aid and have another unit from X or Y service respond, but still ... it could be a 30 minute response time. Anyways, there are areas called "posts", which is just a location in a part of the city/county that you are supposed to be in or around (at post, area of post, etc.). Usually the post assignments are stations, although not always ... and it can get boring sitting at a station all night so you can just drive around the area freely. My company has a guideline for where to have the units, designated by levels. Level 0 being no coverage at all, to level 9 coverage, which means too many units to know what to do with. If a unit gets a call in X area, they will shift a unit from a more populated (unit wise) area, to that area where the call originated from. We have somewhat of a "bank" of units in the center of the city, 4 to be exact. So if a unit gets a call on the outskirts of the city, a central unit will go out to the area of the call until the unit either gets a refusal, or transports and clears... then the central unit will return to the center. But there are definitively times when all units are on calls, and response times to emergencies are extremely long (like 30 minutes), it's scary. I personally believe we need more units, but that's not my decision...

Back up (job goes sour and another crew is needed)

Basically the same as the coverage method, if one unit gets a call, and decides they need assistance another unit will respond. Usually, they try to limit that by using the fire department and such. On things that will obviously need more than 1 unit, like a bad car accident, or a gang fight two will be dispatched right off the bat (don't want one unit taking the two rival gang members ... or taking them to the same hospital). One unit can take up to 3 patients on spineboards, so usually not too too many units are needed unless the patients are critical.