Ranking Dispatch Calls Could Save Lives
EMTs risk accidents for nonemergency cases

By April Taylor / Detroit News Washington Bureau
Steve C. Wilson / Associated Press
Monday, January 27, 2003

Dispatchers put emergency medical technicians and patients in danger when they fail to prioritize calls by degree of emergency. The result is EMTs rushing with lights flashing and sirens blaring to what they think is an emergency call that turns out not to be urgent.

"It's not ethical to run over a kid in a crosswalk because you were going in response to a call for a sprained ankle," said Dr. Jeffrey Clawson of Salt Lake City. "Every call to 911 is not an escalating medical emergency."

Clawson, an emergency physician and founder of the National Academy of Emergency Dispatch, said a crucial step in reducing risks to EMTs and the public is improving skills at the dispatch level, where emergency calls are received and ambulance assignments are made.

There are countless cases of ambulances being called to the scene of bogus or exaggerated calls.

Longtime firefighter Andre Lahens died last year in New York when his ambulance was struck by a drunken driver en route to a reported shooting, but the call turned out to be a false alarm.

Clawson's goal is to curb the use of red lights and sirens, which he contends fails to save lives or significantly improve response times.

A study last year in Prehospital Emergency Care that looked at 339 fatal ambulance crashes found that 60 percent of them occurred during emergency use.

Studies on how much time can be saved with lights and sirens range from an average of 43 seconds per run to 3.63 minutes. But a study that found a 3.5 minute savings said the quicker arrival didn't translate into clinically significant improvements for the patient.

Motorists often don't see flashing lights if they're approached from the side. Radios and soundproofing in cars sometimes prevent them from hearing a siren and even if they do, they can't always tell which direction it's coming from because of what is known in the industry as the "canyon" effect.

Pennsylvania attorney Douglas M. Wolfberg, a former emergency medical technician whose firm represents mostly ambulance companies, said he believes use of lights and sirens causes more deaths and injuries than it saves lives.

"I witnessed instantaneous panic reactions among automobile drivers who, after being approached by a fast-moving ambulance with siren yelping and lights blazing, didn't know whether to stop, swerve, pull over or just keep going," he wrote in a 1996 article in the Journal of Emergency Medical Services. "Many such drivers became hazards to themselves, to other vehicles, and to the EMS crew and patient."

Though the emergency services industry still hasn't come to a consensus on whether lights and sirens help or hurt, it does agree that it has to take responsibility for the outcome.

"While much talk has ensued regarding the public's responsibility to watch out or get out of the way, EMS should not blame the public for the problem of emergency motor vehicle collisions," according to a 1994 position paper by the National Association of Emergency Medical Services Physicians and the National Association of State EMS Directors.

Clawson said $250 is the average cost of training dispatchers to use his call-rating system in a three-day class. His system is now used in 20 other countries in 16 different languages. There are 2,500 agencies worldwide that use it, about 2,400 of them in the United States.

Fear of liability has stopped many institutions from putting an emphasis on delivering medical aid from the dispatch level because service operators don't want to be held liable giving medical instructions over the phone, Clawson said.

But he added, "There's never been a lawsuit in the history of the world for practicing medical dispatch correctly."

And, he noted, "there are dozens of lawsuits against people who do not use a priority dispatch system."

Ambulance operators who use the system have seen dramatic improvements in expenses, accident rates and burnout of paramedics, Clawson said.

In 1983, for example, the number of emergency medical vehicle accidents in Salt Lake City dropped 78 percent after the city implemented Clawson's dispatch system, Clawson said. Salt Lake now goes on all routine traffic accidents "cold," or without lights and sirens.

"There are going to be accidents", said Clawson, "but let's hope they're not due to negligence, and let's hope they're going on a legitimate emergency."