October 12, 2018
Jeff Clawson, M.D.
Los Angeles, California, has had a rocky history regarding emergency medical dispatch since the 1980s. A seminal case of Ziporah Lam that occurred Dec. 26, 1987, exposed serious problems in the city’s dispatch center there called Operations Control Division (OCD). The case made the front page of the LA Times and finally the CBS show, “60 Minutes,” which aired on Christmas Day nearly a year to the day the next year. As a result, but before this aired, Mayor Tom Bradley ordered a complete revamp of the center, which had basically an unstructured orientation course for calltakers, all of which were California State certified EMT firefighters with significant street experience before their assignment to OCD. The fledgling Medical Priority Consultants’ team and I were summoned by the mayor’s office to “fix the dispatch system.” Formal training and use of a structured protocol with scripted Pre-Arrival Instructions, including QA case review and feedback, were put into place, over the next several years.
Before this occurred, the paramedic union, United Paramedics of Los Angeles, led by paramedic supervisor Fred Hurtado, had been pushing the fire administration for years to fix things and specifically end the process of “no sending” if a call didn’t meet some unwritten definition of a non-emergency. They had placed significant pressure on city hall to do something. The Lam case achieved this goal (the hard way) as it was unfortunately classified both on the first and second call as a “no send.” The third call heralded her pre-arrest seizure, after which she died of an acute myocardial infarction (AMI). At our urging early on in the implementation process, we stressed that defining things in diagnosis-like terms was fraught with danger and indeed was the root cause of the Lam misfortune. This eventually struck a chord with the medical director and the Deputy Chief of Operations, Timothy De Luca (of De Luca’s Law fame), who issued this Departmental Bulletin No. 88-46. This issue’s Blast, while From the Past, is still very relevant today.