Dispatching decisions

Wednesday, July 4, 2012

BERRYVILLE -- Picture this: A gruesome head-on collision on U.S. Highway 62. A 911 call is made. A dispatcher at the Carroll County central office at the courthouse takes the call, and immediately sends out first responders and paramedics, as well as police and fire to the scene.

What happens next?

First responders survey the situation, while keeping in constant radio contact with emergency personnel on the way to the scene. Their job: Stabilize the patient or patients.

Soon after, emergency personnel arrive. Trained medics take over for the first responders, who provide all the initial treatment information. The medics do their job.

The crash is severe. There are life-threatening injuries. What next?

If there's a need for a life-flight helicopter to come to the scene, should it be up to the trained medic to make the call and try to save a life?

Officials have been pondering similar questions as they have recently been debating the costs of emergency life-flight helicopters, the distance to regional life-flight helicopter bases, response times and who should make the calls if helicopters are necessary.

"When a call comes in and there is a need for a helicopter, if the patient is unresponsive and cannot make a request, it is up to the medic on the scene to request the one with the best ETA," Carroll County Sheriff Bob Grudek explained.

And these days, the one with the best ETA could include Air Evac, which has long been servicing the county, or it could include Mercy-St. John's LifeLine, which is now being allowed to service the county as well.

Grudek is moving forward with this type of new 911 system that spells out who should be called in case an emergency helicopter is needed on scene. Under the new plan, medics make the call on the closest available assistance --unless the patient is able to specify their own request and does so, and their life is not in immediate danger.

"It's an operations issue," Grudek said. "The bottom line is that there are no changes going to be made to the system. Mercy-St. John's will dispatch their own equipment. Mercy-St. Johns has the right to dispatch their own ambulances and their own people -- it's their right,"

Grudek plans to inform the county Justices of the Peace officially at the July 20 Quorum Court meeting at the Carroll County Courthouse.

"I don't want to exclude them," Grudek said. "There is a lot of misinformation being stated and I want to clear it up."

What Grudek speaks of are the two emergency evacuation helicopter agencies that serve Carroll County: Air Evac Life Team and Mercy-St. John's LifeLine.

"If there is a window of 10 or 15 minutes, it is up to the medic to determine if it is best to stand by and wait (for the preferred helicopter service provider) at the request of the patient," Grudek added.

Air Evac Life Team offers a financial guarantee through a membership for a nominal fee, which means that insurance companies are billed for emergency helicopter rides, not the patient. Air Evac members without their own insurance also are transported for nominal deductibles. Air Evac hubs are located in Springdale and Harrison.

Likewise, life-saving services are offered by St. John's LifeLine Air Medical Services, based out of Branson West, Mo.; however, there is a difference. For instance, a person insured with Medicare and supplemental insurance would not be charged the price of an emergency flight.

"A person would not have to pay the cost of the flight, because their insurance would pay a flat fee to us," said director of Mercy Lifeline D.J. Satterfield. "We bill your Medicare coverage."

LifeLine does charge for mileage. It would cost $14,000 for LifeLine to fly to Berryville from Springfield, but Satterfield says the insurance would cover that cost.

"We don't have memberships," Satterfield said.

Uninsured patients would have to incur the total cost of the emergency helicopter ride.

But Grudek says the issue isn't about memberships or the cost of the ride -- it's about saving lives.

"It's a decision for the paramedic to make," Grudek said. "I can't let my dispatcher make that call. It has to be made by the paramedic on the scene. It could be a matter of life or death.

"If the person is coherent and responsive and Air Evac is preferred, and it's not a life-or-death situation (and it's not going to become one) in 10 or 15 minutes, a patient can make that decision," he added. "Really, not much is changing. What it all boils down to is the money and the misinformation that people are being told. What matters is the closest available medical service in the event of an emergency."

Grudek said he had spoken with several county 911 agencies in Missouri who are serviced by two emergency helicopter agencies.

"They do the same thing: getting the paramedics on scene and determining the closest ETA," he said.

However, Grudek has met with opposition -- officials who have quietly questioned whether he should even be trying to change anything with the 911 dispatch system.

"The 911 system falls under the control of County Judge Sam Barr," Grudek acknowledged, which is in line with what state law says. "Prior to (Judge Barr) it was Richard Williams, and that's when I became sheriff."

In many Arkansas counties, the police dispatch and the 911 dispatch are separate operations; however, in 2004, through grant money from the state, both dispatch operations were put together at the county courthouse, where they remain today as one operation.

"The way the law reads, the county judge has the overall control of 911, but selection of the location and the supervision has to be with the concurrence of the sheriff," Grudek explained.

Eventually, Grudek would like to see the 911 dispatch offices moved from the courthouse to the county jail facility. But Barr, who presides over the Quorum Court, declined to comment much on the details of the sheriff's dispatch plan until he has more information.

"I'm really not ready to say anything about it until I understand it better," he said. "I just want to do what's best for the people of Carroll County."

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  • I am a retired Texas Paramedic. In Texas, the higest qulified medic on scean was in charge and made all the calls. The paramedic has a medical director and contact with the hospital at all times. The first thing a paramedic looks for is airway. How good is the patients airway. Also the Golden Hour. Will the patient have to be cut out of something. How much blood have they lost and the list goes on and on. In Texas a paramedic has to go through (at the time I went through the program)a year of training, learn skills that even RN nurses do not have to go through, then go into the hospital and do interships in all catagorys like OB, CA, Heart, Surgery, ER and so on. They must have so many hours in each. Then they have go go to the fire station and ride out with the ambulances and preform all the skills on the run and be evaluated by the head paramedic. Write reports to be read by the medical director. Then take a state board exam. After that they have to have so much continuning education over the next four years and take the state board exam every four years. Trust me, it is not as easy as you think. I know Arkansas is as good as Texas and I think that the paramedics should have charge in the field. They know what is going on and they have the skills to make the choice if they need to load and go or call for someone more skilled than they are.

    Just think what it would be like with out them.

    -- Posted by ozarkbill62 on Sun, Jul 8, 2012, at 8:20 AM
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