Re: BLS-only ambulances to launch in San

[Guest guest]

Well, " Good " is a relative term, even when applied to APCO and MPDS.

As far as MPDS goes, only half the cards are as accurate as a coin flip

at determining the appropriate level of response.

And the other half aren't even THAT accurate.

l a wrote:

>

> The major problem with telephone triage is the lack of a standard

> questioning protocol in the communicaiton center. Some good ones are

> put out by National Academy of Emergency Dispatch as well as by APCO.

> The use of these protocols insures that dispatchers ask ALL the

> pertinent questions and don't lose focus and control of the call while

> trying to think of what to do next. The other major issue is a little

> harder to solve. It is the inability of some communications centers

> and personnel to work together on an incident without the power

> struggles. (all areas of emergency service run into this at some time

> --ex. police and ems at times have power struggles over crime

> scenes.) Telephone triage can and does work with the proper tools and

> training. It save time, money and lives.

> L~ former communications officer, training officer and comm center

> manager(police fire and ems)

>

>

>

> From: lnmolino@... lnmolino@...

> >

> Subject: Re: BLS-only ambulances to launch in San

> To: texasems-l

> Date: Thursday, April 2, 2009, 10:41 PM

>

> Telephone triage has proven so well in the past in Texas hasn't it?

>

> Does anyone read history or do we just continue to repeat it?

>

> Louis N. Molino, Sr., CET

>

> FF/NREMT-B/FSI/ EMSI

>

> Freelance Consultant/Trainer/ Author/Journalis t/Fire Protection

> Consultant

>

> LNMolino (AT) aol (DOT) com

>

> (Cell Phone)

>

> (IFW/FSS Office)/

>

> (IFWF/SS Fax)

>

> " A Texan with a Jersey Attitude "

>

> " Great minds discuss ideas; Average minds discuss events; Small minds

>

> discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

>

> The comments contained in this E-mail are the opinions of the author

> and the

>

> author alone. I in no way ever intend to speak for any person or

>

> organization that I am in any way whatsoever involved or associated

> with unless I

>

> specifically state that I am doing so. Further this E-mail is intended

> only for its

>

> stated recipient and may contain private and or confidential materials

>

> retransmission is strictly prohibited unless placed in the public

> domain by the

>

> original author.

>

> In a message dated 4/2/2009 10:35:58 P.M. Central Daylight Time,

>

> rob.davis@armynurse corps.com writes:

>

> On Thursday, April 2, 2009 20:44, " "

net>

>

> said:

>

> >

>

> > The 9-1-1 dispatchers will decide which should get sent out. Chief

>

>

> > Hood says he doesn't anticipate any problems.

>

> Does anyone ever?

>

> Rob

>

> ------------ --------- --------- ------

>

>

[Guest guest]

Well, " Good " is a relative term, even when applied to APCO and MPDS.

As far as MPDS goes, only half the cards are as accurate as a coin flip

at determining the appropriate level of response.

And the other half aren't even THAT accurate.

l a wrote:

>

> The major problem with telephone triage is the lack of a standard

> questioning protocol in the communicaiton center. Some good ones are

> put out by National Academy of Emergency Dispatch as well as by APCO.

> The use of these protocols insures that dispatchers ask ALL the

> pertinent questions and don't lose focus and control of the call while

> trying to think of what to do next. The other major issue is a little

> harder to solve. It is the inability of some communications centers

> and personnel to work together on an incident without the power

> struggles. (all areas of emergency service run into this at some time

> --ex. police and ems at times have power struggles over crime

> scenes.) Telephone triage can and does work with the proper tools and

> training. It save time, money and lives.

> L~ former communications officer, training officer and comm center

> manager(police fire and ems)

>

>

>

> From: lnmolino@... lnmolino@...

> >

> Subject: Re: BLS-only ambulances to launch in San

> To: texasems-l

> Date: Thursday, April 2, 2009, 10:41 PM

>

> Telephone triage has proven so well in the past in Texas hasn't it?

>

> Does anyone read history or do we just continue to repeat it?

>

> Louis N. Molino, Sr., CET

>

> FF/NREMT-B/FSI/ EMSI

>

> Freelance Consultant/Trainer/ Author/Journalis t/Fire Protection

> Consultant

>

> LNMolino (AT) aol (DOT) com

>

> (Cell Phone)

>

> (IFW/FSS Office)/

>

> (IFWF/SS Fax)

>

> " A Texan with a Jersey Attitude "

>

> " Great minds discuss ideas; Average minds discuss events; Small minds

>

> discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

>

> The comments contained in this E-mail are the opinions of the author

> and the

>

> author alone. I in no way ever intend to speak for any person or

>

> organization that I am in any way whatsoever involved or associated

> with unless I

>

> specifically state that I am doing so. Further this E-mail is intended

> only for its

>

> stated recipient and may contain private and or confidential materials

>

> retransmission is strictly prohibited unless placed in the public

> domain by the

>

> original author.

>

> In a message dated 4/2/2009 10:35:58 P.M. Central Daylight Time,

>

> rob.davis@armynurse corps.com writes:

>

> On Thursday, April 2, 2009 20:44, " "

net>

>

> said:

>

> >

>

> > The 9-1-1 dispatchers will decide which should get sent out. Chief

>

>

> > Hood says he doesn't anticipate any problems.

>

> Does anyone ever?

>

> Rob

>

> ------------ --------- --------- ------

>

>

[Guest guest]

Where is the evidence that telephone triage or these dispatch schemes improves

outcomes or do we just do them because a consultant said they are the thing to

do?

Sent from my Verizon Wireless BlackBerry

Re: BLS-only ambulances to launch in San

To: texasems-l

Date: Thursday, April 2, 2009, 10:41 PM

Telephone triage has proven so well in the past in Texas hasn't it?

Does anyone read history or do we just continue to repeat it?

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/ EMSI

Freelance Consultant/Trainer/ Author/Journalis t/Fire Protection Consultant

LNMolino (AT) aol (DOT) com

(Cell Phone)

(IFW/FSS Office)/

(IFWF/SS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

In a message dated 4/2/2009 10:35:58 P.M. Central Daylight Time,

rob.davis@armynurse corps.com writes:

On Thursday, April 2, 2009 20:44, " "

said:

>

> The 9-1-1 dispatchers will decide which should get sent out. Chief

> Hood says he doesn't anticipate any problems.

Does anyone ever?

Rob

------------ --------- --------- ------

Yahoo! Groups Links

************ **Feeling the pinch at the grocery store? Make dinner for $10 or

less. (http://food. aol.com/frugal- feasts?ncid= emlcntusfood0000 0001)

[Guest guest]

Where is the evidence that telephone triage or these dispatch schemes improves

outcomes or do we just do them because a consultant said they are the thing to

do?

Sent from my Verizon Wireless BlackBerry

Re: BLS-only ambulances to launch in San

To: texasems-l

Date: Thursday, April 2, 2009, 10:41 PM

Telephone triage has proven so well in the past in Texas hasn't it?

Does anyone read history or do we just continue to repeat it?

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/ EMSI

Freelance Consultant/Trainer/ Author/Journalis t/Fire Protection Consultant

LNMolino (AT) aol (DOT) com

(Cell Phone)

(IFW/FSS Office)/

(IFWF/SS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

In a message dated 4/2/2009 10:35:58 P.M. Central Daylight Time,

rob.davis@armynurse corps.com writes:

On Thursday, April 2, 2009 20:44, " "

said:

>

> The 9-1-1 dispatchers will decide which should get sent out. Chief

> Hood says he doesn't anticipate any problems.

Does anyone ever?

Rob

------------ --------- --------- ------

Yahoo! Groups Links

************ **Feeling the pinch at the grocery store? Make dinner for $10 or

less. (http://food. aol.com/frugal- feasts?ncid= emlcntusfood0000 0001)

[Guest guest]

Where is the evidence that telephone triage or these dispatch schemes improves

outcomes or do we just do them because a consultant said they are the thing to

do?

Sent from my Verizon Wireless BlackBerry

Re: BLS-only ambulances to launch in San

To: texasems-l

Date: Thursday, April 2, 2009, 10:41 PM

Telephone triage has proven so well in the past in Texas hasn't it?

Does anyone read history or do we just continue to repeat it?

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/ EMSI

Freelance Consultant/Trainer/ Author/Journalis t/Fire Protection Consultant

LNMolino (AT) aol (DOT) com

(Cell Phone)

(IFW/FSS Office)/

(IFWF/SS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

In a message dated 4/2/2009 10:35:58 P.M. Central Daylight Time,

rob.davis@armynurse corps.com writes:

On Thursday, April 2, 2009 20:44, " "

said:

>

> The 9-1-1 dispatchers will decide which should get sent out. Chief

> Hood says he doesn't anticipate any problems.

Does anyone ever?

Rob

------------ --------- --------- ------

Yahoo! Groups Links

************ **Feeling the pinch at the grocery store? Make dinner for $10 or

less. (http://food. aol.com/frugal- feasts?ncid= emlcntusfood0000 0001)

[Guest guest]

On Friday, April 3, 2009 10:22, bbledsoe@... said:

> Where is the evidence that telephone triage or these dispatch schemes improves

> outcomes or do we just do them because a consultant said they are the thing to

> do?

By " consultant " I assume you mean Shatner?

[Guest guest]

On Friday, April 3, 2009 10:22, bbledsoe@... said:

> Where is the evidence that telephone triage or these dispatch schemes improves

> outcomes or do we just do them because a consultant said they are the thing to

> do?

By " consultant " I assume you mean Shatner?

[Guest guest]

On Friday, April 3, 2009 12:44, lnmolino@... said:

> The Fly Car concept works well in parts of PA

Can you define " works well " for us? Can you point us towards some verifiable

statistical evidence that this has a positive effect on morbidity and/or

mortality, as well as proving there is no negative effect? Or is this just

anecdotal speculation?

Rob

[Guest guest]

Ya got me that was an anecdotal opinion based on 25 years of observation

(plus or minus a year).

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

(IFW/FSS Office)/

(IFWF/SS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

In a message dated 4/3/2009 5:41:34 P.M. Central Daylight Time,

rob.davis@... writes:

On Friday, April 3, 2009 12:44, lnmolino@... said:

> The Fly Car concept works well in parts of PA

Can you define " works well " for us? Can you point us towards some

verifiable statistical evidence that this has a positive effect on morbidity

and/or

mortality, as well as proving there is no negative effect? Or is this just

anecdotal speculation?

Rob

------------------------------------

Yahoo! Groups Links

**************Feeling the pinch at the grocery store? Make dinner for $10 or

less. (http://food.aol.com/frugal-feasts?ncid=emlcntusfood00000001)

[Guest guest]

I'm afraid that I have a major disagreement with your assessment. You say

" The use of these protocols INSURES (emphasis mine) that dispatchers ask ALL

the pertinent questions and don't lose focus and control of the call while

trying to think of what to do next. " I couldn't disagree more.

The major " evidence " of the efficacy of NAED's canned questions comes from

them.

Telephone triage may work, and it may not. There have been spectacular,

embarrassing, and costly failures, as in costing human life.

Use of a format of some sort makes sense, but reading canned questions simply

does not.

Fact is, regardless of the method used, much of the time, when we arrive,

things are different from what dispatch thought they were, in spite of their

questions.

The theory of telephone triage using nurses has failed in every case I have

ever heard of. Houston just started doing it again, and I cannot for the life

of me understand why.

If Dr. Clawson's canned questions are so great, then why would anybody need

a nurse to ask more questions? And what training do nurses get in telephone

triage in their education and training? Required to take EMS Telephone

Triage 211? Doesn't exist.

Well trained and educated communicators, using their knowledge and common

sense, are the best way to get the information out and send the appropriate

level.

Sit in any dispatch center, and you'll see that the best call takers use a

format that's based on the questions but vary them to meet the situation.

Yes, this does require rational, critical thinking skills, and those are in

short supply.

In the meantime, we still under triage because, as stated, things are often

not what dispatch led us to expect, even when all the questions were asked and

answered.

GG

>

> The major problem with telephone triage is the lack of a standard

> questioning protocol in the communicaiton center.  Some good ones are put out

by

> National Academy of Emergency Dispatch as well as by APCO.  The use of these

> protocols insures that dispatchers ask ALL the pertinent questions and don't

lose

> focus and control of the call while trying to think of what to do next.  The

> other major issue is a little harder to solve. It is the inability of some

> communications centers and personnel to work together on an incident without

the

> power struggles. (all areas of emergency service run into this at some time

> --ex.  police and ems at times have power struggles over crime scenes.)

>  Telephone triage can and does work with the proper tools and training.  It

save

> time, money and lives.

> L~  former communications officer, training officer and comm center

> manager(police fire and ems)

>

>

>

>

> Subject: Re: BLS-only ambulances to launch in San

> To: texasems-l@yahoogrotexasem

> Date: Thursday, April 2, 2009, 10:41 PM

>

> Telephone triage has proven so well in the past in Texas hasn't it?

>

> Does anyone read history or do we just continue to repeat it?

>

> Louis N. Molino, Sr., CET

>

> FF/NREMT-B/FSI/ EMSI

>

> Freelance Consultant/Trainer/ Author/Journalis t/Fire Protection Consultant

>

> LNMolino (AT) aol (DOT) com

>

> (Cell Phone)

>

> (IFW/FSS Office)/

>

> (IFWF/SS Fax)

>

> " A Texan with a Jersey Attitude "

>

> " Great minds discuss ideas; Average minds discuss events; Small minds

>

> discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

>

> The comments contained in this E-mail are the opinions of the author and the

>

> author alone. I in no way ever intend to speak for any person or

>

> organization that I am in any way whatsoever involved or associated with

> unless I

>

> specifically state that I am doing so. Further this E-mail is intended only

> for its

>

> stated recipient and may contain private and or confidential materials

>

> retransmission is strictly prohibited unless placed in the public domain by

> the

>

> original author.

>

> In a message dated 4/2/2009 10:35:58 P.M. Central Daylight Time,

>

> rob.davis@armynurse corps.com writes:

>

> On Thursday, April 2, 2009 20:44, " "

>

> said:

>

> >

>

> > The 9-1-1 dispatchers will decide which should get sent out. Chief

>

> > Hood says he doesn't anticipate any problems.

>

> Does anyone ever?

>

> Rob

>

> ------------ --------- --------- ------

>

>

[Guest guest]

It exists mainly in the minds of the folks who sell the Priority Medical

Dispatch System.

GG

> Where is the evidence that telephone triage or these dispatch schemes

> improves outcomes or do we just do them because a consultant said they are the

> thing to do?

>

> Sent from my Verizon Wireless BlackBerry

>

>

>

> Re: BLS-only ambulances to launch in San

>

> To: texasems-l

>

> Date: Thursday, April 2, 2009, 10:41 PM

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>    

>

>             Telephone triage has proven so well in the past in Texas hasn't

> it?

>

>

>

>

>

>

>

> Does anyone read history or do we just continue to repeat it?

>

>

>

>

>

>

>

> Louis N.  Molino, Sr., CET

>

>

>

> FF/NREMT-B/FSI/ EMSI

>

>

>

> Freelance  Consultant/Trainer/ Author/Journalis t/Fire Protection 

> Consultant

>

>

>

>

>

>

>

> LNMolino (AT) aol (DOT) com

>

>

>

>

>

>

>

> (Cell  Phone)

>

>

>

> (IFW/FSS Office)/

>

>

>

> (IFWF/SS Fax)

>

>

>

>

>

>

>

> " A  Texan with a Jersey Attitude "

>

>

>

>

>

>

>

> " Great minds discuss ideas; Average minds  discuss events; Small minds

>

>

>

> discuss people " Eleanor Roosevelt - US diplomat  & reformer (1884 - 1962)

>

>

>

>

>

>

>

> The comments contained in this E-mail are  the opinions of the author and

> the

>

>

>

> author alone. I in no way ever intend to  speak for any person or

>

>

>

> organization that I am in any way whatsoever involved or  associated with

> unless I

>

>

>

> specifically state that I am doing so. Further this  E-mail is intended only

> for its

>

>

>

> stated recipient and may contain private and or  confidential materials

>

>

>

> retransmission is strictly prohibited unless placed in  the public domain by

> the

>

>

>

> original author.

>

>

>

>

>

>

>

> In a message dated 4/2/2009 10:35:58 P.M. Central Daylight Time, 

>

>

>

> rob.davis@armynurse corps.com writes:

>

>

>

>

>

>

>

> On  Thursday, April 2, 2009 20:44, " "  

>

>

>

> said:

>

>

>

>

>

>

>

> >

>

>

>

> > The 9-1-1 dispatchers will decide which should get  sent out. Chief

>

>

>

>

> > Hood says he doesn't anticipate any  problems.

>

>

>

>

>

>

>

> Does anyone  ever?

>

>

>

>

>

>

>

> Rob

>

>

>

>

>

>

>

> ------------ --------- --------- ------

>

>

>

>

>

>

>

> Yahoo!  Groups Links

>

>

>

>

>

>

>

> ************ **Feeling the pinch at the grocery store?  Make dinner for $10

> or

>

>

>

> less. (http://food. aol.com/frugal- feasts?ncid= emlcntusfood0000 0001)

>

>

>

>

>

>

>

>

[Guest guest]

Houston is not using nurses for telephone triage. We developed our own

dispatching criteria and have been using it for a very long time. We

continue to evaluate methods to better deliver the appropriate care the

caller needs such as the limited and trial program we have for using nurses

to assist callers who have non-urgent medical needs. We also have a program

that identifies repeat callers and our Health Department provides direct

contact with those individuals to determine if some other type of assistance

services will better help them with their chronic problem.

Our Tiered response and priority dispatching programs work well in our

systems as it was designed to benefit from those program designs. Some

departments operate well by sending an MICU unit on every call; however, as

a fire based system, we see the benefit of sending the most appropriate

level of service to a request for assistance. As with a call for " smoke in

the building " we can send either a single engine or an entire high rise box

alarm, depending on the information we get from the caller or callers. The

mere fact that there are multiple calls helps determine the type of response

that is sent.

I would not make a system conform to something as complex as a tiered

response program or priority dispatching if it does not serve the purpose of

being able to deliver the best care and utilize the available resources to

benefit the entire community. Systems wanting to explore these types of

programs should visit departments that operate them and see, listen and

investigate the pros and cons before jumping into one. Don't do it just

because someone else is doing it. Do what is best for your circumstances. Be

a leader in patient care, not a follower. Do things because they are the

right thing to do, not because they are the new thing on the block.

Response criteria, equipment, new meds, all can lure systems into areas that

don't really benefit the patient. They are just 'cool' to have. But if any

group, department or system wants to see how some of these things work and

even how they don't, you are welcomed to come visit us. We'll keep the light

on.

Almaguer, Sr. Captain

HFD - EMS Command

_____

From: wegandy1938@...

Sent: Friday, April 03, 2009 8:20 PM

To: texasems-l

Subject: Re: BLS-only ambulances to launch in San

I'm afraid that I have a major disagreement with your assessment. You say

" The use of these protocols INSURES (emphasis mine) that dispatchers ask ALL

the pertinent questions and don't lose focus and control of the call while

trying to think of what to do next. " I couldn't disagree more.

The major " evidence " of the efficacy of NAED's canned questions comes from

them.

Telephone triage may work, and it may not. There have been spectacular,

embarrassing, and costly failures, as in costing human life.

Use of a format of some sort makes sense, but reading canned questions

simply

does not.

Fact is, regardless of the method used, much of the time, when we arrive,

things are different from what dispatch thought they were, in spite of their

questions.

The theory of telephone triage using nurses has failed in every case I have

ever heard of. Houston just started doing it again, and I cannot for the

life

of me understand why.

If Dr. Clawson's canned questions are so great, then why would anybody need

a nurse to ask more questions? And what training do nurses get in telephone

triage in their education and training? Required to take EMS Telephone

Triage 211? Doesn't exist.

Well trained and educated communicators, using their knowledge and common

sense, are the best way to get the information out and send the appropriate

level.

Sit in any dispatch center, and you'll see that the best call takers use a

format that's based on the questions but vary them to meet the situation.

Yes, this does require rational, critical thinking skills, and those are in

short supply.

In the meantime, we still under triage because, as stated, things are often

not what dispatch led us to expect, even when all the questions were asked

and

answered.

GG

In a message dated 4/3/09 7:55:24 AM, jslilkitten@

yahoo.com writes:

>

> The major problem with telephone triage is the lack of a standard

> questioning protocol in the communicaiton center. Some good ones are put

out by

> National Academy of Emergency Dispatch as well as by APCO. The use of

these

> protocols insures that dispatchers ask ALL the pertinent questions and

don't lose

> focus and control of the call while trying to think of what to do next.

The

> other major issue is a little harder to solve. It is the inability of some

> communications centers and personnel to work together on an incident

without the

> power struggles. (all areas of emergency service run into this at some

time

> --ex. police and ems at times have power struggles over crime scenes.)

> Telephone triage can and does work with the proper tools and training.

It save

> time, money and lives.

> L~ former communications officer, training officer and comm center

> manager(police fire and ems)

>

>

>

> From: lnmolino (AT) aol (DOT) lnm

lnm>

> Subject: Re: BLS-only ambulances to launch in San

> To: texasems-l@yahoogrotexasem

> Date: Thursday, April 2, 2009, 10:41 PM

>

> Telephone triage has proven so well in the past in Texas hasn't it?

>

> Does anyone read history or do we just continue to repeat it?

>

> Louis N. Molino, Sr., CET

>

> FF/NREMT-B/FSI/ EMSI

>

> Freelance Consultant/Trainer/ Author/Journalis t/Fire Protection

Consultant

>

> LNMolino (AT) aol (DOT) com

>

> (Cell Phone)

>

> (IFW/FSS Office)/

>

> (IFWF/SS Fax)

>

> " A Texan with a Jersey Attitude "

>

> " Great minds discuss ideas; Average minds discuss events; Small minds

>

> discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

>

> The comments contained in this E-mail are the opinions of the author and

the

>

> author alone. I in no way ever intend to speak for any person or

>

> organization that I am in any way whatsoever involved or associated with

> unless I

>

> specifically state that I am doing so. Further this E-mail is intended

only

> for its

>

> stated recipient and may contain private and or confidential materials

>

> retransmission is strictly prohibited unless placed in the public domain

by

> the

>

> original author.

>

> In a message dated 4/2/2009 10:35:58 P.M. Central Daylight Time,

>

> rob.davis@armynurse corps.com writes:

>

> On Thursday, April 2, 2009 20:44, " "

>

> said:

>

> >

>

> > The 9-1-1 dispatchers will decide which should get sent out. Chief

>

> > Hood says he doesn't anticipate any problems.

>

> Does anyone ever?

>

> Rob

>

> ------------ --------- --------- ------

>

>

[Guest guest]

Houston is not using nurses for telephone triage. We developed our own

dispatching criteria and have been using it for a very long time. We

continue to evaluate methods to better deliver the appropriate care the

caller needs such as the limited and trial program we have for using nurses

to assist callers who have non-urgent medical needs. We also have a program

that identifies repeat callers and our Health Department provides direct

contact with those individuals to determine if some other type of assistance

services will better help them with their chronic problem.

Our Tiered response and priority dispatching programs work well in our

systems as it was designed to benefit from those program designs. Some

departments operate well by sending an MICU unit on every call; however, as

a fire based system, we see the benefit of sending the most appropriate

level of service to a request for assistance. As with a call for " smoke in

the building " we can send either a single engine or an entire high rise box

alarm, depending on the information we get from the caller or callers. The

mere fact that there are multiple calls helps determine the type of response

that is sent.

I would not make a system conform to something as complex as a tiered

response program or priority dispatching if it does not serve the purpose of

being able to deliver the best care and utilize the available resources to

benefit the entire community. Systems wanting to explore these types of

programs should visit departments that operate them and see, listen and

investigate the pros and cons before jumping into one. Don't do it just

because someone else is doing it. Do what is best for your circumstances. Be

a leader in patient care, not a follower. Do things because they are the

right thing to do, not because they are the new thing on the block.

Response criteria, equipment, new meds, all can lure systems into areas that

don't really benefit the patient. They are just 'cool' to have. But if any

group, department or system wants to see how some of these things work and

even how they don't, you are welcomed to come visit us. We'll keep the light

on.

Almaguer, Sr. Captain

HFD - EMS Command

_____

From: wegandy1938@...

Sent: Friday, April 03, 2009 8:20 PM

To: texasems-l

Subject: Re: BLS-only ambulances to launch in San

I'm afraid that I have a major disagreement with your assessment. You say

" The use of these protocols INSURES (emphasis mine) that dispatchers ask ALL

the pertinent questions and don't lose focus and control of the call while

trying to think of what to do next. " I couldn't disagree more.

The major " evidence " of the efficacy of NAED's canned questions comes from

them.

Telephone triage may work, and it may not. There have been spectacular,

embarrassing, and costly failures, as in costing human life.

Use of a format of some sort makes sense, but reading canned questions

simply

does not.

Fact is, regardless of the method used, much of the time, when we arrive,

things are different from what dispatch thought they were, in spite of their

questions.

The theory of telephone triage using nurses has failed in every case I have

ever heard of. Houston just started doing it again, and I cannot for the

life

of me understand why.

If Dr. Clawson's canned questions are so great, then why would anybody need

a nurse to ask more questions? And what training do nurses get in telephone

triage in their education and training? Required to take EMS Telephone

Triage 211? Doesn't exist.

Well trained and educated communicators, using their knowledge and common

sense, are the best way to get the information out and send the appropriate

level.

Sit in any dispatch center, and you'll see that the best call takers use a

format that's based on the questions but vary them to meet the situation.

Yes, this does require rational, critical thinking skills, and those are in

short supply.

In the meantime, we still under triage because, as stated, things are often

not what dispatch led us to expect, even when all the questions were asked

and

answered.

GG

In a message dated 4/3/09 7:55:24 AM, jslilkitten@

yahoo.com writes:

>

> The major problem with telephone triage is the lack of a standard

> questioning protocol in the communicaiton center. Some good ones are put

out by

> National Academy of Emergency Dispatch as well as by APCO. The use of

these

> protocols insures that dispatchers ask ALL the pertinent questions and

don't lose

> focus and control of the call while trying to think of what to do next.

The

> other major issue is a little harder to solve. It is the inability of some

> communications centers and personnel to work together on an incident

without the

> power struggles. (all areas of emergency service run into this at some

time

> --ex. police and ems at times have power struggles over crime scenes.)

> Telephone triage can and does work with the proper tools and training.

It save

> time, money and lives.

> L~ former communications officer, training officer and comm center

> manager(police fire and ems)

>

>

>

> From: lnmolino (AT) aol (DOT) lnm

lnm>

> Subject: Re: BLS-only ambulances to launch in San

> To: texasems-l@yahoogrotexasem

> Date: Thursday, April 2, 2009, 10:41 PM

>

> Telephone triage has proven so well in the past in Texas hasn't it?

>

> Does anyone read history or do we just continue to repeat it?

>

> Louis N. Molino, Sr., CET

>

> FF/NREMT-B/FSI/ EMSI

>

> Freelance Consultant/Trainer/ Author/Journalis t/Fire Protection

Consultant

>

> LNMolino (AT) aol (DOT) com

>

> (Cell Phone)

>

> (IFW/FSS Office)/

>

> (IFWF/SS Fax)

>

> " A Texan with a Jersey Attitude "

>

> " Great minds discuss ideas; Average minds discuss events; Small minds

>

> discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

>

> The comments contained in this E-mail are the opinions of the author and

the

>

> author alone. I in no way ever intend to speak for any person or

>

> organization that I am in any way whatsoever involved or associated with

> unless I

>

> specifically state that I am doing so. Further this E-mail is intended

only

> for its

>

> stated recipient and may contain private and or confidential materials

>

> retransmission is strictly prohibited unless placed in the public domain

by

> the

>

> original author.

>

> In a message dated 4/2/2009 10:35:58 P.M. Central Daylight Time,

>

> rob.davis@armynurse corps.com writes:

>

> On Thursday, April 2, 2009 20:44, " "

>

> said:

>

> >

>

> > The 9-1-1 dispatchers will decide which should get sent out. Chief

>

> > Hood says he doesn't anticipate any problems.

>

> Does anyone ever?

>

> Rob

>

> ------------ --------- --------- ------

>

>

[Guest guest]

Houston is not using nurses for telephone triage. We developed our own

dispatching criteria and have been using it for a very long time. We

continue to evaluate methods to better deliver the appropriate care the

caller needs such as the limited and trial program we have for using nurses

to assist callers who have non-urgent medical needs. We also have a program

that identifies repeat callers and our Health Department provides direct

contact with those individuals to determine if some other type of assistance

services will better help them with their chronic problem.

Our Tiered response and priority dispatching programs work well in our

systems as it was designed to benefit from those program designs. Some

departments operate well by sending an MICU unit on every call; however, as

a fire based system, we see the benefit of sending the most appropriate

level of service to a request for assistance. As with a call for " smoke in

the building " we can send either a single engine or an entire high rise box

alarm, depending on the information we get from the caller or callers. The

mere fact that there are multiple calls helps determine the type of response

that is sent.

I would not make a system conform to something as complex as a tiered

response program or priority dispatching if it does not serve the purpose of

being able to deliver the best care and utilize the available resources to

benefit the entire community. Systems wanting to explore these types of

programs should visit departments that operate them and see, listen and

investigate the pros and cons before jumping into one. Don't do it just

because someone else is doing it. Do what is best for your circumstances. Be

a leader in patient care, not a follower. Do things because they are the

right thing to do, not because they are the new thing on the block.

Response criteria, equipment, new meds, all can lure systems into areas that

don't really benefit the patient. They are just 'cool' to have. But if any

group, department or system wants to see how some of these things work and

even how they don't, you are welcomed to come visit us. We'll keep the light

on.

Almaguer, Sr. Captain

HFD - EMS Command

_____

From: wegandy1938@...

Sent: Friday, April 03, 2009 8:20 PM

To: texasems-l

Subject: Re: BLS-only ambulances to launch in San

I'm afraid that I have a major disagreement with your assessment. You say

" The use of these protocols INSURES (emphasis mine) that dispatchers ask ALL

the pertinent questions and don't lose focus and control of the call while

trying to think of what to do next. " I couldn't disagree more.

The major " evidence " of the efficacy of NAED's canned questions comes from

them.

Telephone triage may work, and it may not. There have been spectacular,

embarrassing, and costly failures, as in costing human life.

Use of a format of some sort makes sense, but reading canned questions

simply

does not.

Fact is, regardless of the method used, much of the time, when we arrive,

things are different from what dispatch thought they were, in spite of their

questions.

The theory of telephone triage using nurses has failed in every case I have

ever heard of. Houston just started doing it again, and I cannot for the

life

of me understand why.

If Dr. Clawson's canned questions are so great, then why would anybody need

a nurse to ask more questions? And what training do nurses get in telephone

triage in their education and training? Required to take EMS Telephone

Triage 211? Doesn't exist.

Well trained and educated communicators, using their knowledge and common

sense, are the best way to get the information out and send the appropriate

level.

Sit in any dispatch center, and you'll see that the best call takers use a

format that's based on the questions but vary them to meet the situation.

Yes, this does require rational, critical thinking skills, and those are in

short supply.

In the meantime, we still under triage because, as stated, things are often

not what dispatch led us to expect, even when all the questions were asked

and

answered.

GG

In a message dated 4/3/09 7:55:24 AM, jslilkitten@

yahoo.com writes:

>

> The major problem with telephone triage is the lack of a standard

> questioning protocol in the communicaiton center. Some good ones are put

out by

> National Academy of Emergency Dispatch as well as by APCO. The use of

these

> protocols insures that dispatchers ask ALL the pertinent questions and

don't lose

> focus and control of the call while trying to think of what to do next.

The

> other major issue is a little harder to solve. It is the inability of some

> communications centers and personnel to work together on an incident

without the

> power struggles. (all areas of emergency service run into this at some

time

> --ex. police and ems at times have power struggles over crime scenes.)

> Telephone triage can and does work with the proper tools and training.

It save

> time, money and lives.

> L~ former communications officer, training officer and comm center

> manager(police fire and ems)

>

>

>

> From: lnmolino (AT) aol (DOT) lnm

lnm>

> Subject: Re: BLS-only ambulances to launch in San

> To: texasems-l@yahoogrotexasem

> Date: Thursday, April 2, 2009, 10:41 PM

>

> Telephone triage has proven so well in the past in Texas hasn't it?

>

> Does anyone read history or do we just continue to repeat it?

>

> Louis N. Molino, Sr., CET

>

> FF/NREMT-B/FSI/ EMSI

>

> Freelance Consultant/Trainer/ Author/Journalis t/Fire Protection

Consultant

>

> LNMolino (AT) aol (DOT) com

>

> (Cell Phone)

>

> (IFW/FSS Office)/

>

> (IFWF/SS Fax)

>

> " A Texan with a Jersey Attitude "

>

> " Great minds discuss ideas; Average minds discuss events; Small minds

>

> discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

>

> The comments contained in this E-mail are the opinions of the author and

the

>

> author alone. I in no way ever intend to speak for any person or

>

> organization that I am in any way whatsoever involved or associated with

> unless I

>

> specifically state that I am doing so. Further this E-mail is intended

only

> for its

>

> stated recipient and may contain private and or confidential materials

>

> retransmission is strictly prohibited unless placed in the public domain

by

> the

>

> original author.

>

> In a message dated 4/2/2009 10:35:58 P.M. Central Daylight Time,

>

> rob.davis@armynurse corps.com writes:

>

> On Thursday, April 2, 2009 20:44, " "

>

> said:

>

> >

>

> > The 9-1-1 dispatchers will decide which should get sent out. Chief

>

> > Hood says he doesn't anticipate any problems.

>

> Does anyone ever?

>

> Rob

>

> ------------ --------- --------- ------

>

>