August 21, 2023
On Protocol 25, the definition of INTENDING SUICIDE states that “Local response assignment should consider responder safety, especially if the patient is injured and/or struggling to accept help.” Could you please help us understand why an injured patient can be a safety issue for the responders? And if it is an issue, isn’t it true for all emergencies?
Translation Team Lead
Priority Dispatch Corp.™
Patients who are actively suicidal (with a plan or in the process of carrying out a plan), may be very unstable emotionally, especially if they are injured, impaired, ambivalent about, or resistant to accepting help. If they are approached inappropriately, they may act out against themselves or others. This differs from other typical emergencies in that these patients may not want immediate intervention, whereas ill or injured patients normally do. Approaching a patient that wants help is generally safe, while approaching a patient with the intent and means to harm oneself may not be safe, especially when that patient is in a heightened emotional state. The definition simply states that these factors should be considered when assigning responses to this type of emergency. Responders with appropriate training specific to this type of emergency should be utilized.
Does that answer your question?
Brett A. Patterson
Academics & Standards Associate
Chair, Medical Council of Standards
International Academies of Emergency Dispatch®
Your answer is very clear. I was confused because in the definition it is not specified that the injuries are self-inflicted. My reasoning was that if they were self-inflicted the patient would have attempted to commit suicide, not just intending to commit suicide.
I hope all is great in your world.
Here is the scenario … an EMD receives a 911 call during which someone is administering CPR on a patient. We do not know if the person performing CPR is certified, medically trained, etc. Does the Academy have a position as to whether or not an EMD still provides instruction or requests the person to announce the count, as an example, to monitor things? I do not recall reading anything, but I want to know the Academy’s position. This situation happened the other day, and the EMD did not give any PAIs. In the past, it is my recollection that EMDs have still had them announce the count and things of that nature to help the person performing CPR keep track or stay on track and be supportive.
Thanks in advance for any wisdom you can offer.
My answer is a little gray, but necessarily so as there are many potential variables.
In short, we don’t want to do anything to interrupt compressions because we know interruptions decrease the chances of survival.
On the other hand, CPR quality also affects survival, and we want to do what we can to promote and encourage quality CPR, i.e., rate, depth, recoil, with minimal interruptions.
First of all, listen closely. How are things going on the scene? Are people talking nervously and asking questions, or is someone taking charge and conducting action? If any question exists about quality performance, just ask if you can be of any assistance. Ask if they have any questions. Politely coach without interrupting, i.e., be sure to press at least twice per second. Press hard and fast. I’ll help time you if you want. Or, alternatively, if you hear them doing what sounds to be a reasonable job, just stay on the line and encourage them. And gently remind them not to stop until the responder physically takes over compressions; don’t stop just because they have arrived.
One thing is certain. Do not worry about current CPR certification or other clinical qualifications. If they are pumping, that’s great. Even the AHA is promoting action over inaction, regardless of qualifications. Pump hard and fast, in the center of the chest. Stop only if the patient objects. That’s it.
Let me know if this helps.
Our protocol question concerns the electric motorized bicycles, skateboards, scooters, etc. Which protocol should be used for a crash on one of these? Protocol 29 for transportation or Protocol 30 for traumatic injury?
Currently for these types of vehicles we are using Protocol 30, but the question arose about the electric motorized ones.
Thanks for looking into this,
Venango County 911
Oil City, Pennsylvania, USA
The best way to approach this is to consider the circumstances and complaint rather than the motor, or lack thereof.
Protocol 29 was designed for traffic accidents. It addresses not only specific mechanisms of injury but also traffic concerns. It is not very specific to injuries.
Protocol 30 is much more specific to the complaint of injury, and it contains a safety net coding option for HIGH VELOCITY impact/MASS injury.
So, if the bike, electric or not, is hit by a car, for example, the mechanism of injury and the traffic issues are handled well on Protocol 29. However, if the complaint is a specific injury incurred from a fall or crash not involving multiple vehicles or other traffic concerns, Protocol 30 works well to address the specific injury. If this happens at high speed or involves mass issues, i.e., bike versus wall, the HIGH VELOCITY impact/MASS injury helps to avoid missing occult injury and potential under-triage.
Hope this helps and let me know if it doesn’t …
I received an overdose call from a male who was doing CPR and breaths on a female who had overdosed. The caller stated that his neighbor had Narcan and asked me to call the neighbor to bring the Narcan over to their residence. He was alone and had no way of calling himself due to being on the phone with 911.
Would it be a violation of law or HIPAA for another telecommunicator to call the neighbor and say, “Your neighbor has requested you bring Narcan to their residence at …….”? I looked at this as a life-or-death situation, and we should have called the neighbor as the caller asked. We weren't giving any medical history information to the contact person, only asking them to bring Narcan. What is your take on this situation?
Jonathan R Talley
Training Coordinator/Assistant TAC
Brunswick County Sheriff's Office 911 Communications
Bolivia, North Carolina, USA
Civil law generally views a call to 911 as an implied call for help. Unconscious patients cannot make informed decisions in the moment, and civil law assumes we all would opt for lifesaving intervention if we were able to, at least in the absence of advanced directives. And Narcan can be lifesaving in situations like you describe; it is the standard of care.
Additionally, the MPDS® directly asks if Narcan is available, and next door should certainly qualify.
I would commend an EMD for thinking outside the box and sending the idle bystander to get the Narcan. However, the simple fact that we are debating this retrospectively points out that the decision not to send someone to the neighbor’s house was made in the moment and without specific direction, so this discourse should be used as a learning opportunity for the future.
Thanks for sending us the question.