July 17, 2017
It’s 3 a.m. here in New Zealand, and we are having a discussion on shift about what protocol you would go down for: "Not well, can't stand, foaming at mouth, mouth dropped, history of cancer" with no further info given or obtainable, except for halfway through questioning when the caller says, "She’s just bumped her leg on the table, and now it’s bleeding—but that’s the least of my worries." The caller then says, "She’s got white stuff on her lips," and then again on Case Exit, she says, "Yeah, she has a history of stroke, too, by the way."
I went down 26: Sick Person (came out as a 26-D-1) but curious on what everyone else would do.
Options for 28: Stroke (CVA)/Transient Ischemic Attack (TIA) were discussed as with 12: Convulsions/Seizures, but nothing was enough to push for those protocols.
Emergency Medical Dispatcher
St. John Ambulance
Christchurch, New Zealand
These are non-specific complaints, and Protocol 26 was the most appropriate selection; anything else suggested is really an attempt to “diagnose” the problem and is not appropriate in the DLS environment. And while the scraped leg is a tempting target, it is obviously incidental to the Chief Complaint and can easily be addressed using the Target Tool to offer some bleeding instructions after handling the call on P26.
Hope that feeds the discussion, and thanks for the question!
Academics & Standards Associate
Chair, Medical Council of Standards
International Academies of Emergency Dispatch®
One of our new dispatchers went to the EMD course last week and posed a question in reference to CPR instructions. On Protocol C: Airway/Arrest/Choking (Unconscious) Panel 4: Pathway Director, it states Ventilations 1st for Overdose/Poisoning and Toxic inhalation. The dispatcher’s concern is whether this could potentially create a second patient if we tell the caller to put his or her mouth on the person’s mouth and the patient had taken some sort of poison or inhaled a toxic substance.
Could you please advise on how to answer her?
City of Kissimmee Central Communications Center
Kissimmee, Florida, USA
Please note that if you are dealing with any sort of serious contamination, Protocol 8: Carbon Monoxide/Inhalation/HAZMAT/CBRN should be selected by Rule (v13.0, Case Entry Rule 6). And note the first DLS link on Protocol 8 for “Danger or Contamination,” which links directly to X-7, where the caller is advised to stay away from, and not touch, the patient. So, in short, when dealing with scene/patient contamination, one never gets to Panel C-4.
There are, however, toxic inhalations that do not pose a threat to rescuers after the patient is removed from the environment, e.g., carbon monoxide, methane, etc. This is why the term “toxic inhalation” is included in the Ventilations 1st Pathway.
Hope that helps.