NURSING HOMES AND 911
October 18, 2016
By Art Braunschweiger
This week I did ProQA and AQUA training for a dispatch center in the Pacific Northwest. At one point, a dispatcher in the class said, “The nursing care center in our area isn’t going to be happy about having to answer more questions. They’re impatient enough as it is.” I’ve heard that before, and dispatchers never seem to be happy about dealing with long-term care (LTC) facilities over the phone. Yet we still have to get certain information and ensure the patient receives the proper care prior to EMS arrival.
My dispatch center has a number of LTC and specialty care facilities within the county, and I take calls from at least one each day. I sympathize with the frustrations I hear. There are a few techniques, though, that help make these calls go smoother.
First, understand that staff members on the other end of the phone are often as frustrated with you as you are with them. In their mind, they expect to be able to request an ambulance and be done with it. They don’t understand why you’re asking “all these questions,” as a caller put it to me once. Put simply, there’s a conflict of expectations. To combat this, many dispatch centers have had great success with on-site visits to the facilities they serve. Educating the staff on what questions will be asked (knowing what to expect) and why (how it benefits the patient and them) can go a long way in gaining their cooperation.
Understand, too, that the staff member calling you—especially if he or she is a nurse—is probably very busy. Many of these facilities are understaffed. When they perceive the process of requesting EMS is taking too long, they’re quick to let their impatience show. Deal with that by acknowledging their needs, not defending yours. As soon as the caller has told you what happened and/or what he needs from you, acknowledge his need to get back to what he’s doing: “We’ll get them right out to you. I have just a couple of quick questions and then I’ll let you go.”
Medical professionals dislike being treated like laypersons. When we ask Awake and Breathing, sometimes we can almost hear the eyes rolling on the other end of the phone. Yet we have to ask, because we can’t see the patient and don’t know to what level, if any, our caller has been trained. So be up front about that. “I just need to confirm: Is she awake?” [Caller answers] “Is she breathing?” This sends the message that you trust in his ability, but have to check. (And it’s an enhancement to the protocols, not freelancing.)
Another key to minimizing impatience is to avoid gaps and work quickly. It helps if your caller senses that you’re making an effort to go through your procedures as quickly as possible. Partway through Key Questions (KQs) I’ll acknowledge the caller’s cooperation by saying, “I appreciate the help; all this information is going to the EMTs so they know what to expect.” (In my world, that’s literally true—they’re seeing the ProQA information on the mobile device in their ambulance.)
Some dispatchers complete KQs only to leave out the Post-Dispatch Instructions (PDIs), assuming that the caller will know what to do. This is a liability issue; you cannot assume that your caller or the staff at any given time will know what to do for a medical emergency. Always initiate PDIs—and PAIs, if called for—and if the caller declines, accept it and document it. Many will welcome direction, and some will need it.
In the next column: two protocols that can streamline calls from medical facilities.