Notifications To Hospitals:The Dysfunctional HEAR System

[x635 4,066]

I was curious how your agency communicates with the recieving hospital. Are you still even required to notify?

It seems the HEAR radio system is mostly broken and non functional. Some ambulances don't even have one anymore, nor do some hospitals. If they do, it seems to be broken or in use by a taxi company.

I rely on my cell phone for notifications and medical control, but find it frustarating, especially in Northern Westchester where coverage is spotty at best. In Lewisboro/North Salem/Pound Ridge/Bedford, its for the most part non-existent.

Is it time for Westchester County DES to start looking into this issue? I think so. It's time for a new system, IMO a UHF encrypted repeater type system......cell phones are too unreliable.

[tbendick 27]

Lets hope that they looked at this as part of the New Radio system.

As far as the HEAR radio when I can use it I do. But you are correct most people are using cell phones.

How about the FDNY way. Only call in unstable patients, everything else you just show up. But being real this is an area that could use a good looking at by the Remsco and/or the county.

[mikerabbit 2]

Most of the hospitals in mid lower Westchester give you a real bad attitude when you dont call ahead even for the most basic transport. It has changed from a courtsey to a requirement in the ER staffs eyes. But as far as they are concerned it seems like over the past few years they have become overwhelemed with patients. Many times now you have to wait for a bed in the ER where as a few years ago there was always one availble right away.

BTW I usually have no broblem reaching the hospital with a HEAR radio as long as I am within a few miles. But you are right that traffic in the background is really annoying.

[Remember585 815]

Calling the ER is a pain in the a$$!!!

90% of the time we do any transports to Phelps, we have to be within a mile to reach them via radio.

Not to mention all the other traffic on 155.220 - we seem like we're in constant competition to make our transmissions.

As far as cell service - not a bad idea, however I have been put on hold awaiting someone up until we've backed up to the ER doors!

There is no easy solution to anything, but I am sure one will arise eventually.

[mikeinet 37]

Onondaga County you have to call it in to your dispatch - who then sends it to the hospitals through EMSystem.com - this also shows hospital statues (IE: Diversions/different statues such OR Closed.... ) it works pretty streamlessly in onondaga - it's pretty unheard of to just show up at a hospital up here.

[Guest alsfirefighter]

The answer is partially out there. The UHF Med channels that are under utilized in this area. Part of it is money to switch for the hospitals and some units radios. Other is when money was allotted for such through grants years ago, they were sucked into some other section of the county, right about the time Grasslands Hospital became Westchester County Medical Center.

[Guest]

To clarify mikeinet's post. The system in Onondaga county has been in place for some time. It originally started as a computer based Choral system. Each hospital ER has a computer terminal where they receive "clearances" via the internet through EMsystem.com. Providers only need to give an age, gender and chief complaint. This information is originally given to the dispatcher who puts it into the computer for the destination hospital to see. Our county fire control center has a number of terminals and Rural/Metro has one.

Essentially the only times when people need to call the hospital directly is when orders are needed, major traumas, MCI's or if the patient is "unstable," and of course ALS refusals We then us a UHF med channel system where we ask our county dispatch to assign us a channel, then the county tones the hospital. The protocol as to who answers the radio depends on the hospital. At University Hosptal (the trauma center) and St Joe's you will get a physician. Sometimes at University, an ER PA will answer but there is only one PA that works there. At the other hospitals it's pot-luck.

The beauty of the whole system is that it allows the EMT/EMT-I/EMT-CC/Paramedic to do patient care relatively un-interrupted by a long radio discertation. The other good part of it is that we can ask our dispatchers for a hospital status. They tell us what hospitals are open, on ALS diversion, or full diversion. We can then tell the patient the hospital status and allow them to make an informed decision about their destination.

Any further questions about the system, please ask.

Rob Finger Jr., FF/EMT-P

Manlius Fire Department

Town of Manlius Professional Firefighters Local 3316

**Information contained in this post may not reflect the opinions of any agency I am affiliated with.**

[roeems87 0]

I don't know. From what I know, at least in lower Westchester it's not 100% required that you call ahead, and if you don't the hospitals won't be shocked. Unfortunately though, it's been my own experience that when you don't call and the hospital is busy, they don't like it. There have been times in the middle of the night (which depending on the nurse on duty) where the staff is totally together and after giving a report on the HEAR, the nurse (usually the same one who does this) will reply, "Ok, bed 11 on your arrival. <HOSPITAL>, out."

Besides that, we have two methods. We have the HEAR radio which works fine in our area and a phone on board each ambulance. Both are used.

[WAS967 97]

Allow me to get winded. :->

I only like HEAR for basic notifications. Especially when I'm not interested in hearing crap back from the hospital (if they don't like what I said they usually just say "10-4, <hospital> clear"). If I need orders i ALWAYS call. I rarely if ever call by HEAR. The only time we've done that recently was on a fatality in Bedford Village when we called M/C by HEAR because the cell phones don't work where we were. It's even come to be the recommendation lately that we call by cell though our dispatch center and have them conference us in to medical control. The reason being, most M/C consoles aren't recorded anymore and an issue arose recently where a doctor litterally told us to go elsewhere, we're all full up, and the president of the hospital had a fit. (o figure).

In regards to Phelps, the problem has been two fold for a while. Half of it was the crap radios they had in the ER (which have since been replaced). Half is the geography of the area. Everyone knows you have to go over the hill past Scarboro church to get a good signal to them. Back when I worked in Ossining we had a UHF radio tower on the water tower near the VAC. We could call M/C via the handhelds and get a nice clear signal to the hospital (it was connected via landline). That was cool. I remember doing a code and calling Dr. Kyi for orders from my portable. If only it was always that simple. Course now we have cell phones more often so we usually use them.

CT uses the CMED system. But that suffers from the same problem as HEAR. You have to be close to the CMED tower to get a patch. If you are in an outlying area, say, New Cannan and you need to hit Norwalk, it may be tough.

ERs need to get used to the idea of people rolling in without a call ahead. Thiey aren't the Outback steakhouse. Sometimes we're just too busy doing stuff to call ahead. Deal with it. Yes, it's nice to have, especially if you are say, White Plains (where they actually measure hospital time by THE MINUTE because they are so busy). Drives me nuts especially when I call ahead and tell them, say, I have an intubated patient and they haven't even called for a vent. HELLO. It's one thing if you are busy but come on people, it takes 5 seconds and is usally done by the secretary/clerk.

What i think Westchester County REALLY needs is a central medical control. Give Nicky a nice cushy office at DES and a Playstation. Let him or one of his designates be there 24/7 and EVERYONE calls them for orders. This way the care standard remains the same (No BS from old cronies not wanting to give Lasix cause they don't have a CXR) and a doctor is always available (How many times have you gotten the "Sorry, she's busy with a patient). Can't get a cell signal, no problem. Call 60 and have them patch the doctor over the dispatch channel in a pinch.

:blahblah: I'll get off my soapbox now.

[Guest]

Notification is a courtesy as is diversion. Now if the Medical Control doctor is busy, it is easier to beg for forgiveness then asking for permission. No lasix until chest x-ray, would that doctor let you do RSI?

[WAS967 97]

Yeah right. That will happen sometime between now and never.

Grayson for President.

[Guest]

I believe that Grayson is medical control for Mt. Kisco VAC.

On a tangent Dr. Newborn is leaving the ER at NWH

[WAS967 97]

Don't throw a party just yet. He's still going to be a NWHC, he's just going to be head of the hosptalist program. For those who might be unfamiliar, A Hospitalist is a doctor who specializes in taking care of patients while they are in the hospital. Kind of like a House Doctor with a snazzy name. The field is growing however and more hospitals (NWHC included) are embracing the specialty and bringing on Hospitalists. Many even have subspecialties....NWHC has several Pediatric hospitalists.

[Guest]

Yes I understand that, The RN's are VERY happy.