5 Stages of an EMS Call for Laypersons

For nearly 33 years now, in an assortment of systems and jurisdictions, I have been in the Emergency Medical Services, or EMS and have been responding to people's cries for help in their times of need. I arrive and often find that people are unaware of the various stages of an EMS call, so I take the time to teach them. I am a firm believer in Sir Francis Bacon's "Knowledge is power." My teaching moments may occur at the scene, during a ride to the hospital, or afterwards when I'm speaking with the family in the waiting room to let them know what's going on.

1. CALL TAKING/DISPATCH

It's 3:37 AM on a Tuesday morning and you're awaken from sleep with a feeling of impending doom. It feels like you have an elephant sitting on your chest and you can't breathe. You begin to panic as sweat drips from your forehead. You turn to your spouse and awaken them and ask them to call an ambulance.

"9-1-1 Operator, what is your emergency?" You give the trained, calming voice on the other end detailed answers to their specific questions and then you hang up after they tell you that an ambulance is on its way. You breathe a sigh of relief knowing that help is coming. This first stage is achieved through a variety of ways, depending on where in the US you live. Most of the time these days, your call is routed to a PSAP, or public safety access point, sometimes referred to as a 9-1-1 Center.

The people here take your call, determine what resources are needed, and dispatch those resources to the scene of the emergency or accident based on the answers you provide to their questions, so please be patient and remain calm. If the wrong resource shows up or is sent to the wrong location because of incomplete information, did you really save any time by being short or snippy with the 9-1-1 Operator?

2. RESPONSE TO THE SCENE

"Central to Medic 409 and Ambulance 393, respond the McDonald's on Old State Route 46, near the Hess gas station for a male in the lobby of the restaurant having difficulty in breathing, this is a Code 3 response."

Based on the information that was received by the 9-1-1 Operator, the area in which you live, and the time and day of the week of the call, a variety of emergency services units and privately owned vehicles (POV) with flashing lights may be responding to the call. The EMS personnel have already begun sizing up the scene, determining what equipment they may need, what hospital may be the most appropriate to take the patient to, and most importantly, how to get to the scene in the quickest AND safest manner.

The response may be impacted by a variety of factors. Weather, location of the nearest and/or most appropriate unit, the type of unit responding, the conditions of the roads, lighting and debris along the route of travel, and a multitude of other things. Just because the ambulance building is down the block, doesn't mean that the one and only crew isn't responding from the hospital 25 minutes away.

3. ARRIVAL ON THE SCENE/PATIENT CARE

"Medic 25 is arriving."

"Medic 25, acknowledged. Arriving at 1803 hours. Please advise if you need any further assistance at the scene."

"Medic 25 will advise, Central"

Depending on the nature of the call, the location of the call, or a combination of other factors, patient contact and patient care may be delayed. With COVID-19 this year, many times EMS crews had to don (put on) PPE, which included suits, masks, gloves, face shields, and then carry all of their equipment up several flights of stairs.

Also depending on where you are, various levels of care may be available. To keep it simple for this article, let's just say that there are two levels of care, basic (EMTs) and advanced (paramedics). If you're fortunate to have an available advanced unit on scene, they can begin many of the treatments that the Emergency Department would, but sooner. Getting this treatment sooner can literally mean the difference between life and death.

While through their calm demeanor and methodical approach it may seem that the paramedics are "wasting time," they in fact are collecting all relevant data and developing an appropriate treatment plan. Implementing the care on scene can serve the patient much more than attempting to begin an IV in the back of a bouncing ambulance, possibly traveling at highway speeds.

Even being "just 10 minutes from the hospital" doesn't mean that the patient is 10 minutes from care. First, the ambulance has to arrive. Then, the patient has to be unloaded and rolled into the Emergency Department. After that, they are assessed by a triage nurse (after the triage nurse has assessed any other ambulances that may have arrived minutes before you). And finally, they are put in a room or bay to await being reassessed by a nurse and then doctor. We can see how being "just 10 minutes from the hospital" can mean 30 to 75 minutes from definitive care.

4. TRANSPORT

While in a major, urban center, a large teaching university medical center may be 10 minutes away, in a rural and remote town, the small, community hospital may be over an hour away. The transport of the patient is more than just getting them from A to B.

The basic and/or advanced care that has been initiated at the scene is continued. In one of my medic stations, we work out of a Chevy Tahoe 4x4 and intercept with the neighboring local volunteer agency while they are en route to the hospital. Again, there is a pause in transport, to assess, and treat. The pause may only be long enough to load my gear and ask a few questions, while my vehicle is secured and out of the way.

Based on the complexity of the call and the size of the vehicle (a van or a box/truck style), family may not be permitted in the back of the vehicle because the crew needs to be able to move around and deal with the ever evolving needs of the patient. In addition, with the advent of COVID-19, safety concerns of a different nature are present. If you see an ambulance with its lights and sirens, PLEASE, slow down, pull over, and yield the right-of-way.

5. HOSPITAL ARRIVAL AND REPORT

"Good evening doc. We have a 64 year old male with a past medical history of.... He is currently prescribed and compliant with.... He has no allergies. Today, we were called because he was involved in a motor vehicle collision and is complaining of...."

While various areas of our country are in different stages of dealing with COVID-19, visitors may or may not be allowed into the Emergency Department. Going with the presumption that they are, you may be whisked off in one direction and asked to provide information to the Registration Clerk, while your loved one is taken in another direction and placed in a room or bay with nurses and doctors awaiting their arrival.

At this stage, the EMS practitioners are giving the ED staff a full report on what has happened, including the events leading up to this visit. They need to be able to provide the staff with an accurate past medical history, a complete and up-to-date list of medications and allergies, and what treatment modalities they provided at the scene or en route to the hospital. This is WHY the EMS crew cannot accept an answer of, "they've been there before, the hospital will have all of that information."

While it may be true that the hospital has that information, it is not readily available at the time that the patient arrives, especially, if they haven't been registered yet. The continuity of care is based on all of this information, as well as, the ability for the EMS crew to accurately document this encounter is based on you providing this information.

WHAT CAN YOU DO TO HELP?

• You can make sure when you call 9-1-1, or your local service, that you give them all of the information they ask for and that you are the last one to hang up.
• You can prepare for the arrival of emergency service crews by turning on outside lights, unlocking doors, clearing any paths to the patient, and having a written list (or collection of bottles) of all of the medications the patient takes.
• You can trust that the qualified and competent EMS providers are NOT wasting time at the scene and are doing all that they can do under the circumstance.
• You can make sure that you always yield to emergency vehicles, because they are either responding to an emergency or a hospital.
• Lastly, you can make sure that you meet the patient at the hospital, with all of the history and medications written down, you have any current insurance and ID cards, and that you do not go through red lights following the ambulance.

Please like and share. Let me know what you think, or if there are any other questions you may have that I can answer for you.

ABOUT THE AUTHOR:

Mike Chanat currently is a paramedic Field Training Officer at Rockland Mobile Care (Rockland County, NY) and has 32+ years of emergency services experience.

He holds a Master's degree in Public Safety with a concentration in Emergency Management from Capella University.

His field of experience is diverse and he leads and trains EMS clinicians so that they can provide quality care to their communities.

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