It seems like time for the second installment of information about EMS (Emergency Medical Services) in the USA, intended to help writers understand things from my own experience working on the local ambulance and being part of the country, state, and national networks that encompass our little unit.
If you missed the first part, you can click on the lick in the bar at the top of the page. I could easily link to it here, but I'm trying to reinforce the use of the bar. This may be a lingering mood from working with clients all day; I'm not sure.
At any rate, what I wanted to cover today, in brief, is the typical sequence of emergency response. I've noticed that this is one area where people typically have no clue other than what they see on TV and piece together from their own experience and their sense of logic.
So here you go in quick form:
1. Person calls 911 or activates LifeLine (who then alert 911).
2. 911 dispatches as necessary police, fire, and ambulance. Each service often has another dispatcher internal to it that is the contact point for 911.
3. Units arrive on scene (if dispatched) in the same order: police, then fire, then ambulance.
4. If the ambulance that was dispatched offers Basic Life Support only, that crew will make the determination and call their own dispatch to ask for Advanced Life Support or a helicopter transport.
There can be a little variation in this sequence, but honestly not very much. Here's why:
- The police can get anywhere faster. Their cars are faster than our trucks, they have a little more legal freedom, and they are already mobilized and not needed to load up from a station. The police are are responsible for securing the scene. If the scene needs the police, even if the other services somehow get there first, they will almost always wait for the police to arrive and make sure the scene is safe. Our number one priority is not the patient's health; it's the safety of our crew. If our crew isn't safe, the patient isn't safe either.
- The fire crew is also the rescue squad in most situations. That means they are the ones who are responsible for extricating patients from cars and stuff like that. There is no point in an ambulance getting there first. They also are often able to respond more quickly, because there are more fire units than there are ambulance units, and so they have a better distribution.
- The ambulance is where the EMTs or paramedics work. While many fire crews have EMTs on them, and even some police departments, most jurisdictions defer care decisions to the EMTs who are on ambulances. It is those folks who make the determination if more advanced services are needed or a helicopter might be appropriate.
So that's the order -- police, then fire, then ambulance, then helicopter (if appropriate). There are few exceptions to this sequence in most jurisdictions, though obviously not every service is required at every scene.
Finally, a clarification about helicopters. Helicopters are rarely faster than ambulances. When they are, it is usually because there is intervening terrain or traffic that makes travel by road difficult. Otherwise, it is so much quicker to mobilize an ambulance than an aircraft, that there is often not a whole lot of patient time gained in the end. When that's the case the main reasons to go with a helicopter are (a) to minimize transport time itself, or (b) to expedite delivery of the patient to a specialty center. Sometimes the total patient care time is not what's critical; what's critical is minimizing the time that the patient is being moved, and sometimes a helicopter can provide that. Most ambulances cannot bypass their own hospital system as easy as helicopter, so in a case when the EMT determines a trauma, burn, or other specialty care center is necessary, they may ask for a helicopter to ensure a beeline (almost literally) to that center.
Well, that's it for tonight. Hope it's helpful, and if you have any other questions, just let me know!
The soundtrack for writing this post was provided by Cracker.