An EMD’s Dilemma
June 12th, 2008 | Published in Rant & Rave | 3 Comments
Consider this fictional scenario: A 13 year old boy discovers a man who is unconscious and not breathing in a playground. The man, who is aged about 30, has a hypodermic syringe sticking in a vein in his arm. There are no adults near the location just a couple of other kids.
The boy uses his mobile phone, quickly calls 999 for help and is connected to an emergency medical dispatcher (EMD) in the ambulance control room. The EMD begins the widely used Advanced Medical Priority Dispatch System (AMPDS) and correctly chooses the Overdose, Poisoning, Ingestion protocol.
Carefully following the AMPDS script, the EMD questions the boy and gets all the information needed to dispatch an emergency ambulance to the scene. The EMD then starts the lifesaving pre-arrival instructions part of AMPDS.
The EMD asks the boy if he is willing to help the man and he says he is. The boy begins mouth-to-mouth resuscitation guided by the EMD and continues to do so until the ambulance crew arrive 4 minutes later. The crew take over and successfully resuscitate the man.
The boy is hailed as a hero and receives an award from the chief executive of the ambulance service.
6 months later the boy becomes seriously ill and will suffer life long health problems maybe even death having been infected with hepatitis C by the transfer of body fluids from the man, a long-term intravenous heroin user.
Far fetched? A bit extreme perhaps but sadly, not impossible. I’ve listened to a real 999 call where the EMD gets a group of 11 to 13 year old children to pull an elderly man in cardiac arrest from his car and attempt to resuscitate him. The man survived.
Most adults, including ambulance clinicians, put into the child’s situation would refuse to do mouth-to-mouth. I know I wouldn’t do it. The risks are obvious and refusal would be considered a reasonable response even for an off duty pre-hospital care professional.
However, most children who would actually call 999 will follow the instructions given by the EMD in such a frightening and stressful situation because the EMD is highly trained to take control of an emergency situation and will be very persuasive, employing effective caller management techniques such as ‘repetitive persistence’.
Furthermore, the professional EMD is required to strictly follow AMPDS or risk disciplinary measures even dismissal for failing to comply 100% with the protocol.
Are you an EMD that has been put in this type of situation? Do you think that AMPDS is safe enough when dealing with young callers?
Please tell us about your experiences or opinions.
June 14th, 2008at 10:04 pm(#)
As an EMD for 2 years now I have to say I feel heartened by some recognition of the difficult position the EMD often finds themself in. Thank you.
A comment I would like to add is that we are trained never ask anyone if they are willing to help someone. The fact that they have made the call is the assumption that they are willing to help, and that they would say if they don’t want to. We don’t ask them, we tell them what they are going to do next.
Although it is my job to take control of a call and to ensure life saving instructions are being carried out by the person on the other end of the phone, I have to say, at home, I would be encouraging my children that it’s great to help people but NOT to be bullied into doing anything that may be dangerous. They may not be aware of the danger in a situation like this so I would explain and make sure they understood they were allowed to stand their ground and say no to an adult - even an EMD!
We seem to be under the impression in this day and age that the ‘youth of today’ are all rebellious and rude and don’t listen to adults or do as they are told anyway. This is a serious misjudgement.
August 11th, 2008at 6:08 am(#)
being a medical professional and a mother. it should not be legal to expect a child who is not aware of the dangers of blood born pathogens to put themselves at risk.I have told all of my kids to refuse to physically touch anybody.
August 29th, 2008at 9:29 pm(#)
I have worked for the service now for over 15yrs and I have to say the emds are now put in an unpresendented situation where calls are concerned, not only do they have to get the call through to the dispatch within 30 seconds but they have to ask questions that sometimes feel inappriopriate or face disaplinary action.
I have myself been in a similar situation and have gone against the training and the protocols and have kept the young caller on the line until the crew arrive but have not asked them to do cpr as the protocol states for the very reason above, as well as the fact it would be very traumatic for them to do so.
I feel that although in most respects ampds is a good thing they have taken away the basic instincts and common sense from the emd and unfortunately if you do use your common sense you can now be disaplined for not following the protocol to the letter. I find this a very sorry state to be in as obviously not all situations can possibly be covered.
I would also like to add that from both a control and crew point of view often ampds generates a hot response when a cold response is more appropriate and most times that is down to how the emd interperates the answer, at lot of the time the caller will just say yes to questions to get the ambulance at scene but an experienced emd will delve slightly deeper but this skill is quickly being lost due to current training, fear of litigation and even more so from the threat of disaplinary action by the service.