Brett Patterson

Brett Patterson

Best Practices

By Brett Patterson

We had a debate whether to triage an incident as trauma or sick, using this scenario as an example: A female is brushing her teeth. Her jaw locks up. What would you recommend?

Angela D. Thomas, EMD Fulton County Emergency Communications Center Atlanta, Ga., USA

As you have discovered, the difference between what is termed “trauma” versus “medical” is not always clear-cut!

Dispatch definitions are designed to get us to the right protocol; specifically, with trauma, protocol helps us to consider important factors such as the mechanism of injury and safety. On some calls, however, these concerns are very minor and using a medical protocol is not a problem.

Your scenario is a lot like other spontaneous injury complaints we sometimes receive, i.e., patient was lifting something, or even standing up out of bed, and heard a pop in the knee or hip followed by pain. In such cases, the “external force” is not very apparent because it is gravity, weight bearing or, in your case, movement.

While using Protocol 26: Sick Person (Specific Diagnosis) to rule out priority symptoms would not be a bad choice in your scenario, it sounds more like a traumatic injury affecting the joints of the jaw. While this would triage out to a 30-B-1 (Traumatic Injuries) because the jaw is part of the head, and Protocol 26 would likely come out as ALPHA if no difficulty breathing, I still believe Protocol 30: Traumatic Injuries (Specific) is the best choice considering that this is an actual injury. With a more severe injury to the jaw, the BRAVO response is appropriate because the head is involved. In this case, it is simply a slight over-triage, which the MPDS often does in the interest of erring on the side of the patient’s safety.

Brett Patterson, IAED Academics & Standards Associate Research Council Chair

Thank you for your prompt response. Your answer has cleared up the controversy our center was having regarding Trauma vs. Sick or Medical. We now have a better understanding between the two.


I have a calltaker who gave flawless DLS Instructions for CPR; however, on Panel 12 (CPR Compressions), the caller hesitated. Specifically, the calltaker was on Panel 12 when the caller said, “I need to call my mom, too.” The calltaker replied, “You can do that when the paramedics arrive,” and continued flawlessly with instructions. The caller then stated, “He’s not doing anything; he’s not breathing; he’s not doing nothing.” At this point, the calltaker asked if the caller wanted to continue CPR, and the caller said, “No, because he is not breathing. He’s not doing anything.” The calltaker replied, “We are doing CPR because he is not breathing, that’s why we are doing it. Do you want to continue CPR?” The caller answered, “Yes.” The calltaker resumed giving CPR instructions.

We are unsure how to grade these types of comments. The calltaker did not ask if the caller wanted to perform CPR but, rather, if she wanted to continue. Is this a critical deviation, freelance question? What do you recommend?

Melody A. BonAmi Manatee County Public Safety Bradenton, Fla., United States

From your further description, it sounds like the EMD had the best of intentions but simply used the wrong words. The calltaker explained that CPR was being done BECAUSE the patient was not breathing, and to explain to callers not to expect immediate results is completely appropriate, i.e., addressing the “Nothing’s working!” phenomenon. However, this should not have been followed by the direct question, since it counters a primary Academy position about not asking the caller’s permission.

his is not about freelancing, since enhancement was necessary in this case due to the caller’s reluctance. It has more to do about the content of what was said, and this is best addressed with education rather than performance deductions. I recommend a review of the above principles with the EMD and discussing better ways to handle such cases in the future, i.e., calming techniques and reassurance without asking permission.

Brett Patterson IAED Academics & Standards Associate Research Council Chair