THE SMALLER THE BETTER
October 14, 2013
By James Thalman
Old Saybrook, Conn., is what you’d call a quiet town. What the 10,000 or so permanent residents like to call it is the only place on earth where the Connecticut River Meets the Sound. Phillip Coco, director of Emergency Medical Services for the Old Saybrook Department of Police Services., says it’s a great town with one of the most committed call center staffs that side of Boston.
And things aren’t all that quiet, Coco told The Journal in July during a telephone interview. “Our resident population triples over the summer because we’re a summer destination, and 9-1-1 calls go up by more than that because people come here to play, and when people play, accidents happen,” he said.
Handling a potential three-fold spike in phone traffic, which normally averages about five to seven medical emergency calls per day in the off-season, might drown other small centers. But the dispatchers have made it a daily goal to be a reliable beacon for improving public safety as lighthouses have been drawing modern high-season tourists and guiding ships safely around the ever-changing shoals just off the banks, bogs, salt marshes, swamps, meadows, and flats along the tideland stretch of Long Island Sound.
That abiding commitment to public safety shows, and it continues with the Old Saybrook Emergency Communications Center becoming an ACE. It is rippling even wider with a commitment from both the police and fire departments to do the same within the next three years.
“Everyone from the dispatchers, to government overseers, to the field responders has taken up the commitment to the protocols,” Coco said, noting that the fire department actually came to them about how to sign up.
They didn’t need much coaxing and it wasn’t the usual territorial battle over shifting to a scripted call center. In the months since Medical Protocol implementation, utilization of the countywide hospital-based paramedics, who respond to provide advanced life support along with the local basic life support ambulance was reduced by 22% with no patient impact. This allows the paramedics to remain available to respond to patients who require their services.
“In a small place, that’s a huge number, and it speaks for itself,” Coco said. “This means we’re much more capable of evaluating and making the correct determinants on calls, including handling low codes or other nonemergency incidents. We used to over-respond frequently. Now we’re evaluating and responses are more appropriate. People are receiving the correct level of care, and our field response is at the proper scale.”
People might look at a catchment area with just 10,500 residents and ask how hard dispatch could be, Coco said. “It’s just as important to us to use our resources prudently here as it is in Boston or any big urban area. It’s the same level of commitment, and it requires everyone getting on board. That’s the key to becoming an ACE and more importantly, to having the best possible outcomes. Accidents and emergencies are the same everywhere, only the places and the people who are involved are different.”
For Saybrook, “it really became an accountability thing, which I guess all such efforts start out as,” Coco explained. “We were making sure that our citizens always had access to a paramedic by utilizing this limited resource much more efficiently.”
Their efforts to become an ACE were hinged on increasing the time paramedics were available for traumatic injuries and critically-ill patients by 70 hours. “Gaining that 70 hours, again, is huge for us and one that we’re just going to try to improve on.”
Numbers—getting the right ones—are central to obtaining an ACE designation, he said. “But in the end, that’s not what it’s about at all,” Coco said. “It gives a center something to shoot for, and there are results and data that can be analyzed. It takes a bit of extra work, but like we were more than pleasantly surprised to realize, we and other centers have more under our control than they think.”
Having numbers gives you something to show executive leaders, he said, noting that numbers are central to governing boards that oversee dispatching or any other publicly or mostly publicly funded service.
In the digital age, no one’s figured out a way to make accidents virtual or any less real or how to tend to them virtually, Coco pointed out. “What has helped is we can track exactly what we’re doing, if we’re getting close to those high marks you hope to achieve,” he said. “Again, it’s not the number, it’s what the numbers mean and how you respond to them that counts.”
A bit of advice for other centers considering getting on the ACE train is to make sure center leadership and veteran dispatchers, or even those who are rookies, take every opportunity to explain exactly what it is they do, why it matters, and who it helps.
“The more times you can tell that story, and do it in a way that the public and the supervisors all understand the program, the better,” he said. “The protocol really streamlined all that for us, plus there’s the usual reduction in liability with it because you’ve made the choices based on how a dispatcher is closely directed, not just by going with what they think is right. Again, all the information in making those decisions is in every call.”
Coco noted that the attitude was rooted in a healthy skepticism before the center adopted the Medical Priority Dispatch System (MPDS). Getting feedback won’t be a problem, he said.
“If people remain committed to the notion that it’s all about improving public safety, that’s an idea everyone can get behind,” Coco said. “Having the goal of achieving an ACE keeps people pretty focused. Triple ACE, here we come.”