Transcription:
What First Responders Want You to Know About Calling 9-1-1

Scott Webb (Host): Many of us may avoid calling 911 because of the unknowns, like the types of questions first responders may ask, what's going to happen in the ambulance on the way to the hospital and what we can expect when we arrive. Joining me today to answer these questions and more are Carly Alley, Executive Director of Riggs Ambulance, Shawn Luce, Battalion Chief of the Merced Fire Department and Mandy Hall, Director of Nurses for the Emergency Department at Mercy Medical Center Merced Hospital. And this is Hello Healthy from Dignity Health. I'm Scott Webb. So first off, I want to thank you all for being here. We're going to try to educate folks on the value of calling 911. What happens when we call 911? What happens while we're in the ambulance on the way to the hospital? What happens when we get there and so on? So a lot to cover. Great to have all of your expertise today. As we get rolling here, Carly, when should we call 911?

Carly Alley (Guest): A good time to call 911 is any time you're suffering from a life-threatening illness or injury. And that's something where you're having difficulty breathing. Someone's not awake. They're suffering from cardiac arrest, any major break in a bone that has excessive bleeding or any time you're unable to get to the hospital on your own and you have a condition that you can't manage well at home, that would be appropriate. Those would be appropriate times to call 911.

Host: Yeah, well, that definitely helps Carly. And I think a lot of us, we've been in those situations where we were like, is this a 911 thing? Should I drive myself? Should I just, you know, rub some dirt on it and tough it out. So, good to know some basics of when to call 911, and Shawn want to turn to you. What can we expect when we call an ambulance? You know, when they show up at our houses and the lights are flashing and we opened the doorwhat can we expect?

Shawn Luce: So, you're going to get, not just an ambulance when you call 911, we're responding to a priority one or a life life-threatening emergency. The Fire Department's also going to show up too. And what we do, we work in a partnership together and provide, you know, basic level of care, sustaining care on those priority one medical calls. We're just working together between the EMS providers and trying to provide the best service for our citizens. So you're going to get an ambulance, staffed with two personnel, traditionally a paramedic and an EMT, and then you're going to get a fire engine. We're staffed with three personnel, all EMTs to help out with the needs of the patient.

Host: Yeah, it's really awesome. And my daughter who's 14 asked me recently, you know, she saw that there was obviously a call at somebody's house and she asked me, she says, how come the fire trucks always there, when there isn't a fire, maybe you could answer that for her and everyone else.

Shawn: We have the name fire department, right. So we do respond to fires still, so structure fires, vehicle fires, whatever. We also respond to vehicle accidents, which usually end up being some sort of a medical emergency as well. There's usually injuries involved in those. So, the ambulance responds to those as well, cause they transport the patients and provide a higher level of care, the paramedic care.

And then we respond to different rescues, somebody that you know, is down in a well or something. We've actually extricated a patient out of 150 foot well before; electrocutions, wires down, any kind of an incident that, that poses a safety risk, the fire department's going to respond to. So gas leaks, downed power lines. I mean the list goes on and on, but basically if something presents a life risk or a hazard to the public, then the fire service is probably going to respond to that. And that's pretty much a good reason to call 911 for the fire department, if there's a life safety risk going on, we're going to provide the crews to take a look at that risk. See if we can't mitigate it, or if not, we'll contact the people that can, and we'll just make sure that we keep people away from that risk.

Host: Yeah. And old habits die hard. Some of us from a certain generation are just always going to think of what you all do as being the fire department and firemen, but you do so much more, so good to know that you go out on these calls and that even the guys and gals on the firetrucks are capable of doing a lot of what the EMS technicians or ambulance technicians can do.

And wanted to bring you back Carly and ask, you know, when we think about the working together between fire departments and the ambulance service, how does that work and do you all folks work well together?

Carly: I feel that we do have really good partnerships, especially locally. I've worked in Merced for 16 years now. And I feel that we have really strong partnerships and good working relationships. Not only with our other first responders like the fire departments, but also law enforcement and hospital staff. And it really does take a group effort to get the patient the care that they need in the appropriate amount of time and the appropriate level of care also, and some stuff to expect on the ambulance side when we arrive, is we do have a lot of questions, and sometimes I know that that's a point of frustration for our patients.

The fire department is often first on scene. So they start asking their assessment questions, which are pretty much identical to ours. However, our intent in asking all of these questions is to get a really clear picture of what's going on with the patient so we can have provide the appropriate level of care, get them the care as quickly as possible, and also pass that information onto to hospital which is really necessary. We have to paint as clear as a picture of the patient's conditions to the hospital within about two minutes or less so that the hospital knows what to expect. They can get their appropriate staff together. If we have a significant or stat incident, make sure that they can get a bed or a room prepared for them if necessary or give us directives to go to another facility.

Locally here in Merced, we don't have a trauma center, so we need to paint really good pictures for the receiving hospital. And we might get sent out a county to a trauma center or somewhere else. So one thing you can expect is a lot of questions. Sometimes they're similar. I understand that it can be frustrating for patients because they're uncomfortable and they want to get going. But patience with us is really important too, when we do go through those questions so that we can get the right care for the patient.

Shawn: Yeah. I've been in Merced here for just over 15 years in the system and we have a very strong partnership with Riggs Ambulance Service in providing that the EMS care, the prehospital care. We work together through training on different levels, sharing resources, and then in the partnership out in the field, we work together really well with crews as far as running calls and, you know, it would be a lot to ask a two person ambulance company to effectively work what we call a code blue when somebody's you know, heart has stopped, andthey're not breathing. And I think with our continued training that we do together and following the protocols that we have here in, in Merced County, that that partnership works really well for the citizens because they get an added level of care when both groups show up at the same time and we're able to manage the care, whether that's a vehicle accident where there some other situations that need to be handled, whether we're extricating the patient out of the vehicle and Riggs is providing that patient care. Or like I said, you know, like on a code blue where you just need more hands to provide that care. We work really well together on that.

Host: Yeah, that's awesome to hear that you all trained together, work together. That's great partnership. As you say, it only really benefits ultimately the citizens, right? Those in need, who need the care. So good to hear that you all work together so well. Mandy you haven't forgotten about you let's assume somebody does what we want them to do. Right. They call 911, EMS, ambulance, fire comes to the house and takes you to the hospital. What can we expect? What can they expect when they arrive at the hospital, after that ambulance ride?

Maranda Hall, MSN, RN, CEN (Guest): Well, as Carly said the hospital is just another extension in the continuity of care for our patients here. And so the staff at the hospital have been made aware from a very succinct report by the first responders as to what to expect when the patient arrives. That gives us the opportunity to set up if we have a real 911 emergency, or it gives us the opportunity to speak with the physician about what he may expect when the patient comes in. It's important to understand that regardless of how you arrived at the hospital, you're going to be evaluated in the same manner. Coming in through the ambulance, you'll be examined by a physician and based on your presentation and the level of your illness, you may or may not be required to go to the lobby and continue your care, the way that a regular patient who enters the front door of the hospital would. And in contrast, if you enter the front door of the hospital and have a life-threatening emergency, you'll be taken back quickly ahead of some other patients. And sometimes it's difficult for patients to understand that we're highly trained professionals that understand warning signs.

And we really do take a lot of effort to get the patients who are the sickest seen first. The way that we do that is we use a system called the emergency severity index. And it rates our patients on a level of one to five, one being the most severe, five being the least severe. And the nurses use a series of questions and a lot of critical thinking, from a lot of years of practice to make the determination as to what level each patient should be.

And after the initial 911 emergencies are seen, we take patients back, according to that emergency severity index.

Host: And is that what happens during triage? Is that where you're assessing the level, is that triage or is triage in the ambulance? I'm not sure if you want to take this one Mandy or you and Carly, but what is triage exactly. When is it done and is that how you determine what the appropriate level for a patient?

Mandy: Yes, in the hospital, triage is the emergency severity index and it does take place once a patient arrives at the hospital. We always provide an initial screening for our patients by a physician or an advanced practice provider to let us know whether the patient can go to the front for triage or whether they need to be triaged in the back of the hospital and be immediately placed in a bed because of an emergency condition.

Shawn: There's also a prehospital triage which is a little bit different. Basically, we're going to have limited resources and in order to provide the best service, what we do, we triage those as well. And so we're going to find people that have the most severe injuries that we can treat quickly, and we're going to categorize people and we're going to assess and put our resources where we can do the most good and as resources come in and we continue to update that triage.

And we continue to check on these patients so that we provide the best care. And so sometimes you might see, you know, somebody not receiving care and others receiving care. And that's based off of the guidelines that we follow as we look at whether they're breathing and whether their heart's beating and any other life threatening injuries, we're going to assess those and then act with what we have as far as resources, like I said, constantly updating what we can do and how we can best assess them. And again, we work together in that partnership to provide that care.

Host: Well, I'm glad to learn more, especially about the current standards for triage, cause my experience, and maybe I'm dating myself here, but I remember watching MASH when I was a kid and triage was such a big thing on the show, but now I actually really understand what it means and it could go on before, during and after ambulance rides, depending on the situation, the conditions and so on.

It's been really educational to have all of you on today. I want to give you all a chance. You know just final thoughts and takeaways. I'll start with you Carly, from the ambulance perspective, if you will, why do we want folks to call 911?

Carly: So we really do want people to utilize the 911 system for any true emergency that they might be having. Or as I said, there and condition that you can't manage at home and you're unable to safely get yourself to the hospital and you can't find a ride or you can't drive yourself. It's really important to utilize the 911 services to get you the help you need.

Also, if you do have a 20 minute ride time to the hospital, we can start treating you and getting you comfortable and managing your condition prior to arriving at the hospital, which really gives you some time and then we can do life saving interventions within 20 minutes that greatly increase your chance of survival from things like cardiac arrest, stroke, abnormal heart rhythms, allergic reactions, even breaks or internal bleeds.

We can do quite a bit with a short amount of time, transporting you to the hospital. So calling and having that benefit of being treated while you're enroute to the hospital is really important. One other important piece to keep in mind is that the EMS system and ambulance services are not intended to be a kind of like a primary care physician where we come and check you out and take your vitals and check your blood sugar and let you know that you're doing good.

And then we don't transport you. Our intent when we arrive on scene is absolutely to transport you. And I think sometimes that gets lost in the weeds, especially during COVID. A lot of people didn't want to go to the EDB. Theywanted to stay at home as long as they could, but that's really not the intent of the 911 service. And I'm speaking to this point, it's important because while we have some really cool interventions that we can do, and we can absolutely treat multiple conditions, we don't do full diagnostics to rule out conditions that are underlying or that you can't see on the surface. So it's really important if you feel that you need to call and you have made the call, go to the hospital and get checked out. We can do an on the surface view really quickly, but we might not be seeing something that is there and that is life-threatening or going to become really problematic for you in the near future. So it's important that you call, make sure you let us transport you too.

Host: That's so interesting that you say that, you know, despite all the interventions and technology and expertise, it's not a mobile doctor's office, right? It's not a mobile hospital per se, that you're there to transport people safely, effectively, to call ahead to get them to the hospital, to get the care that they need. So if you're going to call, please accept the ride, right?

Carly: Absolutely. Yes.

Host: And Shawn I wanted to give you an opportunity. What are your final thoughts and takeaways from the fire perspective, the value in calling 911 and how you can help folks.

Shawn: The reason why the fire service is here, the reason why we have EMS and the reason why we have, you know, the hospitals is to provide care to people that are in need. And when that care is life-threatening, that's part of our job. We're going to show up and we're going to do what we can to alleviate whatever you've got going on to help you get to where you can get the best care possible.

And that's going to be at the hospital with doctors that have access to all the tools and all the diagnostic equipment that they need to do what's best. But in that meantime, there's a lot of stuff that can be done to give you a better outcome. If somebody's suffering from a stroke, there's a time associated with a better outcome than there is if you don't have any care.

And so that's why it's important to call 911 when you think that there's something that's serious going on. And then like Carly mentioned, allow us to transport to get you there, because we can provide stuff in the ambulance, or even before the ambulance gets there, we can give, you know, certain interactions that would help and give you a better outcome.

So by doing that, and then trusting in the ambulance provider to get you to the hospital, they can do more things on the way there right. A little bit safer, they're trained in driving. Whereas if you try to drive yourself with a life threatening emergency with somebody in the back.

They're not getting any extra care at that time. They're just getting to the hospital. So yeah, we want to provide the best service possible to the citizens. That's what we're here for and we want to help you out to have the best possible outcome.

Host: Yeah, definitely and you mentioned stroke, something like that. You know, time is brain. Time is heart. Every second, every minute counts. And it's not just a free ride, or a ride to the hospital, there's care and interventions and expertise and calling ahead and so on. And so Mandy I'll give a last word to you from the perspective of the hospital. You'll help patients. You'll treat patients no matter how they get there, of course, but when it comes to those that come by ambulance who've called 911, maybe you can just speak to the value in how quickly, safely and effectively they get there.

Mandy: It really is a great benefit for people who are having a life-threatening emergency to reach out to the EMS system, because they are very highly trained professionals that are able to intervene and begin those life-saving measures that we've been talking about from the beginning and a lot of people will call the hospital to ask if they should come.

And I think it's really important that the public understand that we can't do a full assessment over the phone. So we're not really allowed to give any information, except that if you feel you have an emergency, please come to the hospital. If you do have an emergency, the EMS system are the eyes and the hands of the physicians at the hospital. And they report that information and really allow us to prepare for patients to come in.

Host: Well, this has been great today. Really educational, so much information and for me, and I'm sure for listeners as well, just many, many benefits to calling 911, having the experts show up, taking that ride to the hospital. What happens when you get there, triage and otherwise. So thank you all. And you all stay well.

For non life-threatening emergencies visit dignityhealth.org/er, to take advantage of Mercy Medical Center's In Quicker Online Tool by selecting your estimated hospital arrival time and waiting at home until your time to be seen. If you're experiencing an emergency called 911 immediately. And if you've found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Hello Healthy, a Dignity Health podcast. I'm Scott Webb. Stay well.