Nobody expects to have to call 911 for a medical emergency, but every year, thousands of people do it, many for the first time.
Callers are sometimes surprised by what it entails – from the amount of information the call-taker needs from them, to the number of tests and treatments paramedics and EMTs can perform on the scene.
There are ways to be better prepared for the call you may someday have to make for yourself, a friend or family member, or even a person who is injured or collapses on the street in front of you.
Before the call
Doctors may recommend that patients who have life-threatening allergies to medicine or food, or who have conditions that could limit their ability to speak for themselves (including seizures or diabetes), wear medical alert bracelets.
If you are on several medications, prepare a list of your medications and keep it handy at your home and in your purse or wallet. The Buffalo Fire Department has distributed thousands of packets called a “File of Life,” which is filled out and stuck on the home refrigerator with a magnet. “This gives us information about whatever allergies or pre-existing medical conditions you might have, which allows us to begin life-saving interventions with the benefit of that information,” says Buffalo Fire Commissioner Garnell Whitfield. “This speaks for you when you can't speak for yourself.”
If there is no list of the patient's medications when rescuers arrive, family members can gather up the medication bottles in a plastic bag and send them with the patient.
Finding the patient
Make sure your house number is large, visible and in an area that will be lighted at night so emergency personnel can easily find your house. “It's helpful to have high-visibility numbers on your house or on the mailbox at the end of your driveway,” says Bryan Brauner, a 15-year paramedic. He is chief operating officer of Twin City Ambulance, which responds to 36,000 calls annually in suburban and rural areas of Western New York. “It's very difficult to find numbers that are the same color as the house.”
“People [who call 911] assume that we can tell where they are, and although technology is good, it's not perfect,” says John Adolf, deputy commissioner/Emergency Medical Services for the Erie County Department of Health, which handles ambulance dispatch for the city of Buffalo. “Can you imagine trying to find somebody at the HSBC tower, if all you have is the street address? We can get to the building, but then how do you find that person?”
In some areas, carriage houses or cottages behind a main house have similar addresses. “If you get to that address and knock on the door of the front house and nobody answers, are you going to miss the person who needs service?” Adolf asks. “So callers should be specific.”
“Remembering to put a light on and unlock the door is helpful,” says Brian Lawson, director of public affairs at Rural/Metro Medical Services, which answered 115,000 calls across the region last year, between 40,000 and 45,000 in the City of Buffalo. If someone is available, “it's great if somebody can stand outside and wave us down,” says Lawson. “You'll see us coming, and the crew can spot a person waving their arms.”
“A few people have installed switches on their front porch light that makes them blink, not a strobe effect, but just blinking, and it's incredible how effectively that calls your attention to a house,” says Brauner.
Once on scene, the first responders may need help locating the patient, who might be in a basement, backyard or a remote area of the house. “If there is somebody in the house who can guide you right to the patient, it's always helpful,” said Brauner.
Answering the questions
First-time callers can get upset that the 911 call “doesn't go as fast as they would like it to go,” says Adolf.
“A lot of people who call 911 are dissatisfied by the number of questions they get, and they feel as though those questions are putting off the arrival of an ambulance,” says Brauner. “But the ambulance is being dispatched separately, at the same time as the conversation with the dispatcher, and how the caller answers those questions helps us know what level of care the person needs.”
“That's very important for people to understand: Yes, we are taking time on the phone here, but this is not stopping the response of the ambulance,” says Adolf.
The call-taker starts with “entry-level questions, which are pretty standard,” says Adolf. “We try to determine age and gender, and whether the person is breathing or conscious.” Adolf says many callers, even passers-by, “have more information than they know.” Even a simple answer, such as whether the person is moving, “may be a tip-off to the degree of severity,” says Adolf.
The answers to the questions help EMTs and paramedics prepare mentally and physically to best treat the patient, says Lawson. “It helps them determine the medications they might need to bring, what procedures they should be prepared to do, what assessments they might have to make. For the 911 caller to answer all those questions allows our crews to start working before they even arrive on scene, so they are not wasting time when they get there – they can get right to treatment.”
Adolph says the list of questions ranges from five or so, to eight or nine, depending on what is being reported. “I can appreciate that the caller is agitated, concerned and distracted, but if we can get their help to stay on the phone and answer questions, it really helps,” he says.
A person who calls 911 in a life-or-death situation may be instructed to take action. Call-takers have scripted step-by-step instructions to give to callers who report that the patient is not breathing, or is bleeding heavily, choking, or giving birth. “The gentleman who invented the program says, 'Make the caller the first first responder,' ” says Adolf.
But even in less dire situations, after the call ends, the lines of communication should be kept open. “We ask that if anything changes or the person's condition worsens, call us back,” said Adolf. “If you learn any new information, a follow-up call is helpful so we are arriving with the most up-to-date information.”
Finally, callers are asked to put dogs and other animals in a separate room, for everybody's protection. Any animal can react aggressively when faced with the startling arrival of emergency workers, or can accidentally trip someone carrying a patient. Also, when doors are held open, pets may escape. “You don't want to have to worry about them being out in the neighborhood. You have enough to worry about already,” says Brauner.
Some people are surprised to find out that their local fire department responds to emergency medical calls.
“Some people call and say, 'I don't want the fire department,' ” says Brauner. “They are saying, 'My house isn't on fire.' But firefighters are trained first responders, and many of them are EMTs. They are in the community and sometimes in a position to respond even before the ambulance can.”
In Buffalo, Whitfield estimated that 95 percent of firefighters are also EMTs. “We go to all life-threatening calls,” he says, as well as motor vehicle crashes and industrial accidents. “We are usually the first ones there, and all of our apparatus have defibrillators. Our guys are well-trained and able to respond and intervene on behalf of people who need medical help.”
What they do
Paramedics and EMTs can provide quite a bit of care on scene or in the back of an ambulance before it reaches the hospital, says Lawson. “There may be a misperception that an ambulance is just a mode of transportation, when it's actually an emergency room on wheels,” he says. For example, a paramedic and EMT can do an EKG on a patient suffering from chest pain and transmit that EKG to a cardiologist. After confirming that the patient is having a heart attack, the cardiologist mobilizes the team and sets up the cardiac catheterization lab. When the ambulance arrives at the hospital, the patient is taken directly to the cath lab for the procedure, saving precious minutes.
In the case of a heart attack or stroke, in particular, “Time is of the essence, and you're saving an incredible amount of time by assessing the patient in the field,” says Lawson. “Paramedics are trained to do that.”
Patients can also receive life-saving CPR and defibrillator treatments, as well as breathing assistance, including intubation and IV drugs, before they ever reach the hospital. “After our paramedic does everything they can do for you in the field, you are prepared to see a doctor,” says Lawson.
The ambulance crew will also know which hospital is best for treating which conditions. “In the case of heart attack, stroke and major trauma, there are certain facilities where you can get the best treatment,” says Lawson.
If the patient is a child, a parent or guardian will usually be allowed to accompany that child in the back of the ambulance. For an adult, a family member might be allowed to ride along in the front seat.
At the hospital, says Brauner, “That person should expect to be separated from the patient while they go through triage. The family member will go to the registration area and provide information, and when the hospital has prepared everything for the patient you will be able to go back and sit with them.”