Where were you on the first dispatch?

[Guest]

So, where you? Tones are set off 3 times and your agency cant muster a crew. Then, after the first tones for mutual aid, a crew is miraculously established!

This is one of the biggest pet peeves i have with working in EMS. Why is it that so many people will sit and listen to see who signs on before they decided to get out of bed or up off the couch to drive over and get the ambulance on the road? Then, all of a sudden, M/A goes out and its like an act of God, a full crew is established. Ah, the relief!

Was whatever you were doing five minutes prior (when the original call for help went out) so important that you couldn't put it aside for an hour and help get the ambulance out in a timely fashion?

This isn't an attack on the volunteer system, as some will almost certainly feel it is, but a question from someone (me) who often feels frustrated when this happens. It seems more and more like a big game of "lets play ambulance!"

When this happens to me directly, i feel as though my job is made out to be a joke and that i'm left with my hands tied behind my back. So, there i sit with a pretty decent amount of training and a nice card, but sorry i can't leave because no one feels like getting out of bed at 4am.

Despite it all, i see newspaper articles and other public recognition swearing these our life savers, true angels. I'm not asking for a news paper article, I'm not asking for a medal or a plaque (maybe a cookie!) I'm asking for the respect i have earned. My job is not a joke, its not a game, and its not a hobby. So, do your patient and i a favor and stop acting like it. Get out on the first dispatch.

Sorry for the rant, its something that has been wearing on me for months now.

[irishfire2491 24]

I agree 100% It feel like to me it happens alittle to often and i will go to the extar extent and call M/A and jump on there ambulance to get the call covered when it happen I have seen some dept can't get a crew call M/A and turn around and go home and then the M/A dept have a hard time to get out. If you are going to go then go if not dont sign on and hope for M/A and go HOME. If I cant get a crew in 3 tones or 8-10 mins TOPS it goes M/A and i Respond to the SCENE to assist PT care and the M/A service that are HELPING your dept get YOUR call covered

[INIT915 1,119]

I believe a bigger insult is allowing a "boring/uneventful/routine" call go mutual aid, yet 10 minutes later when the "exciting" call, i.e. PI/Structure Fire, etc. comes in, units are absolutely stepping on each other to respond.

[emt301 4]

I believe a bigger insult is allowing a "boring/uneventful/routine" call go mutual aid, yet 10 minutes later when the "exciting" call, i.e. PI/Structure Fire, etc. comes in, units are absolutely stepping on each other to respond.

←

As a dispatcher I've seen this occur fairly often both in Westchester and Dutchess. To a large extent I'm sure that many members are just getting burned out by both their home/work commitments, and their obligations as a volunteer...therefore at least some tend to "pick & choose" the calls they will go on. I'm not bashing the volunteer service (of which I was a member for several years...and left due to my own time constraints)...but this points out one of the advantages of career/paid/combination fire departments & ems agencies that will respond whether the call is "boring" or "exciting". As has been brought up on emtbravo many times before, volunteer departments that are frequently in need of mutual aid really need to look themselves in the mirror, and decide if the time has come for the addition of some paid staff.

Edited April 14, 2007 by emt301

[Guest]

I believe a bigger insult is allowing a "boring/uneventful/routine" call go mutual aid, yet 10 minutes later when the "exciting" call, i.e. PI/Structure Fire, etc. comes in, units are absolutely stepping on each other to respond.

←

I agree, no doubt about it. As i said, i feel more and more like things are turning into a game/hobby then the provision of a vital service. We can talk here until we are blue in the face or our until our fingers fall off, nothing will change. The system has been allowed to operate like this, without oversight and with relative impunity, so long its probably beyond change. Whats most discouraging is when oversight does occur and accountability is trying to be enforced and then you have a riot of biblical proportions on your hands from you know who.

There is no doubt there are solid, professional volunteer crews out there - i had the privilege to server with one when i volunteered. But the unending battles of who's got more lights on their car, who's got what authority, getting emts/drivers to a scene, and anti-career stuff (IE: your taking away our ability to volunteer, your paid scum, your paid so your a guest in this building and we can kick you out blah blah blah, etc., etc.) is out of control.

Edited April 14, 2007 by 66Alpha1

[Guest partyrock]

Before we start ushering these agencies off into the history books, do they establish ridding crews before hand? It certainly helped me get out alot more in my volley days to know that it was my call when I went out the door (I always hated rushing of to go to a call only to get down there and see it handled). It also offers some accountability for the members picking and choosing calls. Second crew, you're still gonna be calling and hoping, but it makes a big difference.

It does take a little more work on the officers part to ensure shifts are covered, with the right people it works and results in much better response times.

[Guest]

Before we start ushering these agencies off into the history books, do they establish ridding crews before hand?  It certainly helped me get out alot more in my volley days to know that it was my call when I went out the door (I always hated rushing of to go to a call only to get down there and see it handled).  It also offers some accountability for the members picking and choosing calls.  Second crew, you're still gonna be calling and hoping, but it makes a big difference.

It does take a little more work on the officers part to ensure shifts are covered, with the right people it works and results in much better response times.

←

Having crews in quarters works, sometimes. It really depends on the crew. When i was a vollie we had crews that were to be on during the nights, most of the crew i was on put in 24 hours (usually during summer months) or were in town and available via nextel. It worked well, but we were the only crew who was avilable for the full 24 hours. You had your typical manpower issues during daytime hours.

I find alot of agencies simply dont have crews. First come, first serve to the scene or to the rig. So, it seems to me, everyone stands fast and waits to see who calls in or if there is a driver or EMT, or whatever. So when no one calls in and everyone is waiting for the next person no one gets out...hence once M/A is requested you get someone who then feels obligated.

Interestingly enough, i know of a few agencies who DO in fact have crews but...for some reason still don't get out. Why? Beyond me. Maybe they only have an observer or driver or EMT for that day, IE: no one else signed up.

Either way you cut it the same issue arises...why isn't the ambulance getting out the door.

[firemoose827 324]

Having crews in quarters works, sometimes. It really depends on the crew. When i was a vollie we had crews that were to be on during the nights, most of the crew i was on put in 24 hours (usually during summer months) or were in town and available via nextel. It worked well, but we were the only crew who was avilable for the full 24 hours. You had your typical manpower issues during daytime hours.

I find alot of agencies simply dont have crews. First come, first serve to the scene or to the rig. So, it seems to me, everyone stands fast and waits to see who calls in or if there is a driver or EMT, or whatever. So when no one calls in and everyone is waiting for the next person no one gets out...hence once M/A is requested you get someone who then feels obligated.

Interestingly enough, i know of a few agencies who DO in fact have crews but...for some reason still don't get out. Why? Beyond me. Maybe they only have an observer or driver or EMT for that day, IE: no one else signed up. 

Either way you cut it the same issue arises...why isn't the ambulance getting out the door.

←

I am not starting arguments here, just merely issuing my opinion to spur discussion. A lot of what is happening, (or not happening) is people are forgetting what "Volunteer" means. I am a volunteer and have been so for 18 years. When I first started out as a young, cocky snot nosed rookie still living at home while going to school, I was able to LIVE at the firehouse. I was at EVERY call and drill and meeting. I was an 18 year old Captain running a squad, submitting the paperwork to become ALS certified ambulance, and specing out a new rig.

Now, I have a 7 month old daughter, I work 2 full time jobs, and when I am not working my wife is. I just cant feesibly make it to every call. That doesnt make me a bad person, and I dont think its fair that you say there are people who "wait ti see who fills out the call before responding." Maybe those people are like me, we cant respond from work unless its a dire emergency. Not my laws, my bosses. And when I am home sleeping, I only get about 5 hours sleep a night, I realy dont want to get out of bed any more for the old lady who fell out of bed. I respond whenever I can, and I help out wherever and whenever I can.

EMS today NEEDS to be paid, at least a staff of 2. With response times and survival rates you NEED 2 people right there to respond within 2 minutes or you open up problems everywhere.

I too dislike it when you go 3 tones for a "sniffles" call and go to mutual aid, only to have an MVA with entrapment 10 minutes later and get THREE full crews show up out of the woodwork. Todays vollies just dont have the heart, or the time to volunteer any more. Its sad, because I LOVE to volunteer and help people, but I cant help anyone when no one else shows up for the call.

Just my thoughts and opinions and I take NO jabs at any person or organization. Everyone have a great day and be safe.

[Guest]

Jonsey, i appreciate your response. The issue is, i KNOW definitively that there are people available. Tones go off at 4am, 3 pages + 1 M/A request THEN you decide to show up? Pretty clear that you were simply waiting to see who, if anyone, signed on the air.

I actually brought this issue up yesterday and i was told "Well, we are volunteers, you get paid, so i'm not going to make anyone take an hour and a half out of their day unless we absolutely have to." I ended it there, i knew if i took it any farther i would probably have a hypertensive crisis.

If thats the prevailing sentiment, then whats the point? In instances like this i really have to make a blanket statement, it's difficult to sit there and sort out each john/jane doe and see how often he/she responds. I know there are people that are gung-ho and do a great job. I do my best to acknowledge that and let them know after a job.

Either way, this trend seems to be the rule rather than the exception, unfortunately.

[Guest]

Jonesy said it quite well, and I give him a lot of credit for saying it. The decline in volunteerism is a national problem and not a reflection on any individual agency. But it is fact. Many of us wish volunteer agencies would just remember their priorities of putting patients first and admit they have response issues.

"Patients don't care if you're volunteer or paid", isn't that what many volunteers say when arguing against paid people? Right, the patients care that an ambulance arrives- staffed- within minutes of calling for it. Anything less is disgraceful and a disservice to the community.

[John Meeker Jr 0]

A volunteer service is just that. It is neighbors helping neighbors and you can't always be available when your neighbor calls you. I feel that the public needs to know the difference between a paid ambulance service and a volunteer. To get a town funded paid ambulance service will cost everybody hundreds of dollars more each year on property taxes. and Ambulance companies that charge per ride cannot afford to locate enough resources to cover the relative low call volume of upper westchester county. So wheres the answer?

Education is needed to control call volume to only emergency responses and find alterative transportation for the non emergency trip. Get some one to drive you if it is not life threatening?

I don't know the answer but as a Volunteer I give over 20 hours a week to my community and yes it will take 10 minutes for me to get to the ambulance and then another 5 to get to the scene if I don't have to wait for the second crew member. This is the norm for a person responding to the first set of tones. This is for informational purposes only do not tell me how unacceptable or unprofessional this is. For transportation purposes in my town this is the starting point and the public has to be shown that this is normal for a non manned setup and that if they need more services then they, the public, needs to pony up and find the services that meets thier needs. This may well be a different organization, but I personnally not willing to step up as the public and ask for more taxes.

[ex-commish 490]

A volunteer service is just that. It is neighbors helping neighbors and you can't always be available when your neighbor calls you. I feel that the public needs to know the difference between a paid ambulance service and a volunteer. To get a town funded paid ambulance service will cost everybody hundreds of dollars more each year on property taxes. and Ambulance companies that charge per ride cannot afford to locate enough resources to cover the relative low call volume of upper westchester county. So wheres the answer?

←

The answer is simple...you hire people if your volunteers can't do it. We contracted out for full time ems and it has been working out very well. Those hired are very good, decent people and have been welcomed as far as I can see. I believe people are willing to pay for service if it is needed.

[Guest alsfirefighter]

The answer is in many other areas. There are fees on top of everything that you do on a local, county and state level. Why shouldn't there be something that assists the emergency services? You want to build, add an addition, put on a deck, finish your basement you are supposed to get a permit and that cost additional money. Earmark some of those fundings or add a simple surcharge to it that goes to EMS or fire. Same thing on a state level...have an extra 2, 5, whatever $$ to licensing, car insurance (much like the fire 2% fund, but don't limit it to stupid bull$hit of what you can and can't do with it). There is money there to be found you have to think outside the box.

As I've also said before I do not worry about my taxes going up as long as I see a benefit. Public safety is a no brainer to me. My taxes have gone up, very little on the town side (thank you Mr. supervisor and town board) but I see the nice things that go on in my town and they are things that improve the overall appearance and particulary our parks which are used very much by me, my family and my fellow town members. The final answer is you get what you pay for!

Mr. Meeker, I enjoyed your post very much. You gave a nuts and bolts view into the situation. It is what it is...but just the point you put in about educating the public of what it is...is something that many of us stress is a weak point for both fire and ems. Great post brother!

Edited April 22, 2007 by alsfirefighter

[Guest]

A volunteer service is just that. It is neighbors helping neighbors and you can't always be available when your neighbor calls you. I feel that the public needs to know the difference between a paid ambulance service and a volunteer. To get a town funded paid ambulance service will cost everybody hundreds of dollars more each year on property taxes. and Ambulance companies that charge per ride cannot afford to locate enough resources to cover the relative low call volume of upper westchester county. So wheres the answer?

Education is needed to control call volume to only emergency responses and find alterative transportation for the non emergency trip. Get some one to drive you if it is not life threatening?

I don't know the answer but as a Volunteer I give over 20 hours a week to my community and yes it will take 10 minutes for me to get to the ambulance and then another 5 to get to the scene if I don't have to wait for the second crew member. This is the norm for a person responding to the first set of tones. This is for informational purposes only do not tell me how unacceptable or unprofessional this is. For transportation purposes in my town this is the starting point and the public has to be shown that this is normal for a non manned setup and that if they need more services then they, the public, needs to pony up and find the services that meets thier needs. This may well be a different organization, but I personnally not willing to step up as the public and ask for more taxes.

←

I just want to touch on a number of points. First, as was said before, if an agency cannot deliver the proper service in a reasonable time (personally, i would like a guaranteed 10 minutes or less) then it's time for some mitigation.

As far as education is concerned, I'm all for it. But, from where i sit, education is one part of the solution, not THE solution. I wounder how much it will actually decrease "unnecessary" or non-emergent transports - my feeling is little to none. The fact is, many feel that because their hard earned money goes into these services they are entitled to them. At the end of the day, you cant deny them a transport (unless of course they want to you to transport to a hospital which is some distance). So, where does that leave us?

Back at square one. Let say, in a perfect world, an education initiative alleviated all non-emergent transports (IE: general illness, simple transport to the hospital, and the like). Could you guarantee all the people that fall down the stairs, suffer broken ankles, dislocated shoulders, and other non-life threatening emergent situations a timely ambulance response? Probably not. Your non-emergent transports are just as likely to go without a crew as are non-life threatening emergent transports. I see it happen every week.

So, then what to do. An education initiative is important, no question. But, we also have to be downright honest with the communities we serve. If a community is willing to wait 15 min. + for an ambulance, then thats their choice and they can maintain that status quo. If a community isn't, then it's time to talking dollars and cents. Honesty is the key. If you want an ambulance in less than 10 minutes your going to have to start paying, and thats going to be reflected in your taxes. This is not to say you need a 100% paid agency, most ares don't have call volume to merit that. Hire a day crew mon-friday and maintain volunteer crews at night. The concept is very flexible, you can make it work in a thousand different combinations to fit your needs. The problem is getting people to swallow their "pride" and do the right thing.

Edited April 23, 2007 by 66Alpha1

[helicopper 1,050]

A volunteer service is just that. It is neighbors helping neighbors and you can't always be available when your neighbor calls you. I feel that the public needs to know the difference between a paid ambulance service and a volunteer.

←

John, great post and I respect your position. However, volunteer EMS is more than just a volunteer service and neighbors helping neighbors. It is an emergency medical service and regardless of whether crews are paid or volunteer, there is an obligation for the service to respond in a timely fashion to all calls.

Does this mean you should be donating more time and energy or making an even greater contribution? Of course not! It means that the SERVICE should be taking whatever steps necessary to insure that its constituents receive the service they expect and deserve.

The public should know who provides their EMS service - but they shouldn't find it out after dialing 911 when they need an ambulance.

The standard of care in NYS is not different if you are operating in a paid service or a volunteer one so why should volunteers get a pass on meeting the same response time expectations as their career partners?

If you want to give the public a referendum on what type of service they want to receive that's fine. But as Alpha said honesty is key and the agency must be willing to admit their limitations. Then a well-informed public will be responsible and not a small group within the agency.

[John Meeker Jr 0]

Many great replies.

I am not sure about the Emergency Medical Service Standard. This is a standard that the Emergency Meidical profession came up with. It might be the right standard for all people but it is not publicly known for what it is. Again education is important and this need to happen before any refferendum.

In a rural community you take what you can get and you are very happy when your neighbor shows up. that does not mean that Somers is a rural community and thats all we need. But it used to be rural and a lot of city folk have transplanted out to our county area. This is where education and ideas need to be shared to help people see what thier volunteer service gets them and what they need to do if they want to get the big city service. Then vote to spend the money.

To give the people what they want and need I will gladly swallow my pride to provide the needed services, but I need to know they want it not just that they deserve it because some one else says so. Its my taxes too.

There seems to be other issues blocking this matter in our little town and it has to do with our commissioners and paying people to do volunteer jobs. There seems to be conflicting laws (I don't know the ins and outs) that say we must provide but we can't do it this way. (very vage) So our option would be to drop BLS service and tell the town to pick it up but then the laws say we can't do that either because we have been providing for x years and are obilgated to provide it now. I'm confused at this point and feel that the public is the only entity that can demand and get a higher level of service mandated and forced past the town and the fire district. It sounds as if the service has to get worse before it will be allowed to change. Or do you know a source of about 50 ems personnel willing to join the volunteer department? Sorry for the ramblings, it is a point of concern but it is not cut and dry on how to solve.

[Guest alsfirefighter]

Mr. Meeker, I don't know whom is specifically passing around that info, but if what is being told to you is true there are several towns in Dutchess County that would be breaking the law. There is a whole section discussin this in the DOH resource guide that was given to all agencies some time ago.

On a side note, if anyone has any good jokes or magic tricks let me know, I'm at work today and would like to know a few in the event I have to entertain my customer while awaiting a bus to arrive.

[Guest]

Mr. Meeker, I don't know whom is specifically passing around that info, but if what is being told to you is true there are several towns in Dutchess County that would be breaking the law.  There is a whole section discussin this in the DOH resource guide that was given to all agencies some time ago. 

On a side note, if anyone has any good jokes or magic tricks let me know, I'm at work today and would like to know a few in the event I have to entertain my customer while awaiting a bus to arrive.

←

Taking things up at town board meeting or the like would be a great way of gauging what the public wants, just make sure you properly advertise prior. As far as tax dollars, as ALS has said, if extra money = better service then i have no problem. Likewise, i dont think many others would either.

ALS - http://www.riddles.com/ is a fun website hahaha.

[ckroll 101]

There are a number of issues here.

Response time: The patient sees the time from 911 call to the knock at the door as response time, and if the person at the door has drugs and a monitor, they've got care. I don't see time to transport as all that important so long as ALS, which is the standard of care, is on scene. I can fill 10 or 15 minutes assessing and treating on scene and the patient does not suffer for it. [The occasion where dispatch sent ALS and forgot to dispatch BLS I did need to tell a few stories to pass the time.]

Public Education: USELESS, actually worse than useless, it is a threat to public safety. Education implies rational thought, and no one is thinking rationally when they have an emergency. Assuming we could do the impossible and teach every citizen when to call for assistance, and to not call unless it was a real emergency... How is someone who is not medically trained and in the middle of a crisis going to make a good decision? We will still get "Echoed" to emphysema patients who 'can't breathe' because they forgot to turn the O2 back on after their cigarette... and we will have the nice elderly couple who doesn't want to be a bother calling when dad actually hits the floor from the chest pain. The only useful evaluation of a patient is by a trained medical provider on scene, not family, not someone working from a list on the other end of a phone. ALS should assess every patient.

You get what you pay for: Yes you do and the public will scream like a cat in a bath tub if you raise their taxes. Divide calls by households and every 7 to 10 years a homeowner calls for an ambulance. Ponying up for service that 'other people' use and he doesn't... not popular. That ends up in a tax or fee for service debate. Then the wealthy/insured will get care and the poor or those on limited incomes won't. My town is 46 square miles and handles 2 calls a day. Money can't fix that.

Do we have a problem: I don't see anyone pointing to a single call where time to transport changed an outcome. Mortal injuries are just that, response time isn't going to change it. Respiratory and cardiac events can be treated/stabilized in the field by timely ALS. If ALS can't stabilize it in the field, chances are whether the time to hospital is 30 minutes or 40 minutes isn't going to change the outcome.

We have to work with what we have or can afford, guys. Pay ALS to evaluate and initiate treatment ASAP and get the transportation there when you can. You do that with medics in flycars and by pooling volunteer EMTs in ambulances that are staffed and properly located or by enhancing volunteers with a couple of paid ambulances staffed with a pair of EMTs that can float the county.

[Guest]

Getting the "transportation there when you can" is a dangerous statement as far as i'm concerned. Give them an inch and they'll take a mile, or so my experience has taught me. How far are you willing to bend "when you can," 15m, 20m, 30m, 30m+? Isn't it important to establish and maintain some sort of standard? I don't think were in the business of justifying $hit service by saying "meh, 10 minutes wouldn't have changed anything."

I guess we just have different views on this.

[ckroll 101]

" I don't think were in the business of justifying $hit service by saying "meh, 10 minutes wouldn't have changed anything." "

Transport time is situation sensitive. I prefaced my remarks by saying ALS was on location providing care. At that point ALS can update dispatch with better information. I can't remember a call I've done where 10 minutes to hospital would have changed outcome.

I agree that a standard makes sense but to date, no agency, Federal, State or County has done it. Remember the golden hour, so sacred for so long, was the result of too many beers and a cocktail napkin. There is no science to support it.

No doubt, transportation sooner is better, but it comes at a cost that needs to be justified. Rural EMS takes time. ALS on scene in 10 minutes from time of dispatch with transport on scene in 20 minutes from time of dispatch is realistic for most situations.

Keep it in perspective. In upstate NY the nearest ambulance can be 30 minutes away, hospitals an hour. When rafting the Grand Canyon of the Colorado River, just activating EMS requires a radio and a wait for a passing commercial plane to pick up the message and relay it to a rim station which sends a helicopter as available to confirm position and waits for rafters to reach an acceptable landing zone. Not that anything hazardous can happen in a 110 degree, mile deep crack in the ground stocked with white water, scorpions and rattlesnakes.

[Guest alsfirefighter]

Public Education: USELESS, actually worse than useless, it is a threat to public safety

I sincerely hope there is some pun within that comment. Considering that public education should be and is the mainstay of most emergency services missions. If in your case maybe we should all stop giving fire prevention, self protection measures, stroke identification, first aid/cpr classes all in one. Let's throw away the buckle up campaign! Then again while were at it, why not stop certain aspects of education for anyone. If you can teach a emt or paramedic something to make them calmer (well most anyway) and to identify and deal with a problem or issue, I don't believe you can't with the public either. Read most of my EMS posts that mention "issue" or "concerns" and I often discuss the lack of public education, especially on the EMS side.

The only useful evaluation of a patient is by a trained medical provider on scene, not family, not someone working from a list on the other end of a phone. ALS should assess every patient.

I partly agree with this with the exception that everyone you mention should be involved. Seattle and several other large cities with good EMD, good CPR programs, public access defib and tiered response have decent out of hospital cardiac arrest survival rates. I'd really like to know if it transpires to other calls.

I do disagree that ALS should assess every patient. That is why EMT's are so medic dependant where I am at now and are in several other places where I've worked and being I believe I know who you are, includes the town you live in. Keep tying up resources you don't have on BLS calls and you will have to throw money at the problem.

As far as any other comment where transport time makes no difference. Yes when a trained medical provider arrives that stops the clock, but I still see why I shouldn't be able to transport when ready. Anyone who works with me knows that I keep a flow and keep things moving. I for one have had several calls where additional meds were needed to improve patient status that are above a Paramedic's scope of practice. Or the CHF full to the rim where popping nitro like chicklets, 100 of lasix and Morphine still didn't do it and their SPo2 was still $hitty their effort was still $hitty and they were in between needing a tube or more aggressive treatment. I also do not believe that my sole job is to just treat and stablize but also try to reduce the door to door time of the patient in the ER, make the best of a bad, often awkward or embarrassing situation and to teach them some things they might not know or even steer them where they can get it. If it happens again so be it...I'll explain it again. But I still see no reason as to why anyone who has an injury or significant illness should have to await an ambulance to actually get them to the hospital for any time. Regardless who is on scene.

I highly doubt that trying to explain to the family of someone who is signicantly and serious ill or injured that its ok because I'm here to treat and stabilize is something I want any customer to hear, nor do they. But then again that would be dangerous being explaining anything could be a form of public education.

On a side political note...if education implies rational thought...how is it that liberals deem themselves "educated." LOL. Sorry I had too!

[helicopper 1,050]

There are a number of issues here. 

 

Response time: The patient sees  the time from 911 call to the knock at the door as response time, and if the person at the door has drugs and a monitor, they've got care.

Public Education: USELESS, actually worse than useless, it is a threat to public safety. Education implies rational thought, and no one is thinking rationally when they have an emergency. 

You get what you pay for: Yes you do and the public will scream like a cat in a bath tub if you raise their taxes. Divide calls by households and every 7 to 10 years a homeowner calls for an ambulance. 

←

I agree that response time should be measured from the time 911 is called to the time some level of care is initiated. I don't think that has to be ALS for care to begin. Alot of benefits are realized in systems with tiered responses when the medic unit is cut loose to respond elsewhere by a BLS assessment. Your system may not have those issues but many do.

As for public education, ALS stated it very well and to echo his point I'll add that public education is far from useless. It has very real benefits and those can be seen everytime someone walks away from an accident because they were wearing their seatbelt or gets out of a fire because theychanged the batteries in their smoke alarm. Public education is not intended for "during the emergency" it is intended to educate people about what to do or how to do it long before there is an emergency. How do you think people know to dial 911 when they need help? Public Education!

That's right you get what you pay for and most people are paying enough to expect a reasonable response time and competent responders!

[Remember585 815]

I think, and I have been known to be wrong, that if your caller is put on the phone with a competent, trained EMD dispatcher (or Cop, Firefighter, etc.) then care is there BEFORE anyone actually arrives.

By giving good pre-arrival instructions and by correctly asking the EMD questions a call-taker can actually begin to mitigate a medical emergency. And, I firmly believe, if the 911 operator is doing their job and doing it well then it has a positive impact on the overall outcome of the patient. Some advantages I can think of:

It helps calm everyone down.

It gives basic first aid / CPR instruction.

It helps decide which resources to send.

The next issue that CKroll mentioned about ALS getting there and stopping the clock is correct, to a point. In my eyes the public feels as though help has arrived as soon as someone arrives and is able to render some form of care. Obviously a non-EMS Cop can't administer meds that a Medic can, but for the caller and others standing around waiting for help that man or woman in blue gives them a sigh of relief.

Is that what works? No if you mean getting appropriate care to the patient, but yes if we are talking about stopping that "panic clock."

ALS has said it time and time again about how beneficial a tiered response can be. It really is a shame that in some areas of our county that some form of certified EMS arrives in 5 minutes and in others there is nothing for 15+ minutes.

Educate the public by offering First Aid and CPR courses. Even offer Babysitting courses to help your community identify life-threatening emergencies so they know when to call. I would say 1/2 of the public will call for anything, 1/3 is too embarassed to call when they really should and the other 1/3 will call when it is appropriate without hesitation.

Oh, and to answer the "where were you on first dispatch" question - simply put I think ambulances should have dedicated crews and not depend on people showing up when the pager goes off. What guarantee is there that EMS will respond? Can't cover the majority of your calls in a reasonable amount of time, consider paying someone to do it. Money means nothing if it can save lives.