Procedure: Related Procedures: Section 700 Resource Depletion Procedure 710 (Holding calls) Effective: 03/23/16 Updated: 02/14/17 All Priority 1 through 3 calls shall be dispatched within one minute of when the medical call type changes from ?Medical Emergency? to a ?nal coding Chest Pain P1 or Falls P3) or when EMS is manually added to the agency group of a call for service. If there are no ambulance units immediately available a 980 unit shall be dispatched. If dispatch of medical responders (either ?re or EMS) or a 980 unit is not completed within one minute, the dispatch delay must be documented in a vanance. At the request of Paramedics Plus and at the direction of the REMSA board, the following procedure shall be followed when all ambulance resources have been depleted and there is a medical call holding. oDiSp 980 in CAD (sends automatic page) ODisp Fire/PD OResponder provide SEND update upon their arrival 0Reprioritize if necessary? ODisp 980 in CAD (sends automatic page) ODisp fire oResponder provide SEND update upon their arrival oReprioritize if necessary? nDisp 980 in CAD (sends automatic page) Olf no unit available within 10 minutes (980 will display a timer), disp SFFR OResponder provide SEND update upon their arrival OReprioritize if necessary* *If any call is reprioritized (or confirmed to still be) by responders based on SEND, or callers based or: offered information, poll units at hospitals and on scene calls. [f unable to respond within 10 minutes, immediately dispatch mutual aid* Priority 1 Calls Dispatch ?re PD Dispatch a 980 unit number in CAD First units on scene will provide a detailed SEND update Dispatchers will use the SEND information and reprioritize the call, if necessary if reprioritiaed, change the call type appropriately. If reprioritized to a P2 or P3, wait for the next available and most appropriate ambulance. If still a P1, poll units to determine ETA to clear/ en route (not ETA to be on scene) If ETA is less than 10 minutes, wait for available 13+ unit If ETA is more than 10 minutes, start the closest mutual aid Calls Dispatch ?re Dispatch a 980 unit number in CAD First units on scene will provide a detailed SEN update Dispatchers will use the SEND information and reprioritize the call, if necessary. If reprioritized change the call type appropriately. lf reprioritized to a P3 or remains a 132, wait until the next available and most appropriate ambulance. If upgraded to a Pl or mutual aid is requested, follow P1 guidelines. If ?re and 900 are both sent, ?re arrives on scene first and provides a SEND update that reprioritizes the call to a PS, 900 shall be downgraded to P3 and thus available for diversion to .. .. higher. priority. callsupgraded to Pl, determine if PD is needed. Dispatch a 980 series number in CAD If no ambulance is available after 10 minutes, dispatch ?re First units on scene will provide a detailed SEND update Dispatchers will use the SEND information and reprioritize the call, if necessary If reprioritized, change the call type appropriately. If reprioritized to a PZ or remains a P3, wait until the next available and most appropriate ambulance. If upgraded to a Pl, follow Pl guidelines. No polling will occur, unless upgraded to Pl. The dispatcher shall wait 10 minutes before starting ?re. If 13+ is en route to a 133, but is diverted to a higher priority call, start ?re right away, it is no longer necessary to wait the '10 minutes before starting a ?re. resource. li'ire has the ability to request a Pl or 1?2 response even if SEND update doesn?t support it. If upgraded to Pl, determine if PD is needed. Cardiac Arrest calls in Sioux Fallsw SFFR has been given the authority by Sioux Falls REMSA to declare time of death on unattended deaths. In the event that a Priority?3 Cardiac Arrest call is holding due to resource depletion, dispatch SFliiR to the call to confirm the death. On Priority~l calls SFFR will already be dispatched per standard procedure. If SFFR on scene con?rms an obvious death, or decides to stop working a patient on a Priority?1 call, they will notify the Fire Dispatcher: and the ambulance can be disregarded. (SFPD may still request Medstar on these calls for a transport to the morgue) M??The dispatcher should still dispatch SFFR at the 10 minute mark even if law enforcement is already with. You at least get some type of medical responder with the patient with only a limited delay. Medical Board approved Sill?3R to be able to cancel the ambulance in the presence of minor injuries and a PR8, SFPD cannot do that. PIIOth?land 5 Calls Dispatch a 980 unit when at level 1 or at resource depletion and you would have otherwise started a 900 unit to the call. (For example, if the ?patient ready? time is 1400, and you would have usually started a unit at 1350 to account for drive~time, then send the 980 page at 1350) Use of 980 Units Unit numbers 980? 989 have been created in CAD. Metro dispatchers will dispatch all holding medical calls, in which there are no ambulance resources immediately available, to these phantom? units. A verbal dispatch is not completed. You do not have to hit ?end dispatch? when using these "units; dispatchers are still required to hit end dispatch after the verbal dispatch to fire and the ambulance unit responding. If a unit is diverted to a higher priority call and you have depleted all resources and the call will now be holding dispatch/re~dispatch a 980 unit to the call. The dispatch to a 980 phantom unit sends a page to all on duty P?l? units and 13+ administration. Call details are automatically included in the page. Dispatching the 980 unit creates a time stamp. It is not necessary to mark 980 units as acknowledge or anything other than ?dispatched? and ?10? 8 available status.? Once a 980 series page has gone out on a Pl call, this will prompt units that polling will start. Units may offer up their to clear without a prompt from the dispatcher. At times the dispatcher may need to speci?cally ask the unit. Responders who are currently at hospital are expected to have someone step outside to update the dispatcher with their 1A. The 980 series unit is left on a holding call until an ambulance unit is dispatched to the call. After a unit has been sent to the call, dispatchers will mark the 980 series unit 108/ available. When dispatching an ambulance unit to the call, it is necessary to use the ?dispatch? command in CAD first. Don?t directly mark the unit en route to save a step; this affects the time stamps. It is not necessary to provide a verbal dispatch when sending a 900 unit to a call after a 980 page has been sent. Give a short patient report and push end dispatch. Pomng At times it will be necessary for the EMS dispatcher to ?poll? on duty ambulance units. Polling allows dispatchers to identify an ETA for an ambulance to clear a call, clear the hospital or be available to copy another call. When polling occurs, 13+ units are expected to give an ETA to when they will be clear of their current status. Dispatchers shall use a phrase similar to ?965 what is your lil?llA to clear?? Poll units that are on 133 calls, at a hospital or on a standby call (structure ?re, SWAT). It is not necessary to poll units currently on P13 or 1323. Average on scene time and hospital turnaround time is 15 minutes. Dispatchers should remain aware of how long a unit has been on scene or at a hospital in order to identify when they can likely expect them to clear. For standby calls, such as structure fires or SWAT callouts, if there are emergency calls holding it is appropriate for ambulance responders or Metro dispatchers to check with the Incident Commander if the standby unit can be dispatched to a pending call and then backfilled with the next available ambulance. Units out at the hospital may not be able to use their radio to transmit out, however, they can still receive pages. When receiving a 131 980 series page, the expectation is for one of the crew members ?r -t to step outside as soon as possible to radio dispatch with their lo TA to clear time. Previously on scene unit timers were set to 20 minutes, these have been modified to 15 minutes. Previously at hospital unit timers were set to 20 minutes, there have been modi?ed to 15 minutes. At the expiration of a timer, the dispatcher shall check the unit?s status. This allows dispatcher to check on the safety of the unit, but also serves as a prompt to responders that they have been on scene for 15 minutes. It is not necessary to checlc status of units at hospital if there are no calls holding. MutualAid Should mutual aid be sent to a call and a 13+ units comes available while the mutual aid unit is still en route, the dispatcher will repoll the two units to determine the ETA to on scene. The unit with the shortest ETA will be asked to continue and the other unit will be advised to go 10?8 available. Mutual aid is the closest available ambulance. While this is typically MedStar, should you have an ambulance from Dell Rapids, Garretson or Humboldt clearing from a Sioux Falls hospital, the mutual aid request should be given to them ?rst. .ALS vs BLS does not matter. TransferCalls When resources are depleted, dispatch a 980 series unit when you would have normally dispatched a responding unit to the call. (This is immediate on 132/133 Transfers, and usually 15 minutes before ?patient ready? time on 134/135 'l?ransfers, to account for drive~time to the hospital/ facility) P5 Transfers should drop into your pending que 15 minutes before patient ready time, so the 980 dispatch on these calls should be nearly immediate as well. Transfer calls are not sent when you are at Level 1 or below. 132/133 Transfer calls are treated as emergency calls and dispatched even when at Level. 1. Paramedics Plus Dispatch in Texas will provide all facilities with a general one~hour ETA on all Priority~5 '1"ransfers"(30 minutes for VA calls). In the event that resources are depleted, and it becomes obvious the call will not be responded to within that onewhour time window (30 minutes for the VA), a call shall be made to Texas to advise them of the delay. This allows them to contact the facility to advise them of such, and potentially make other arrangements if necessary. WCalls at the VA will drop into the pending que as a Priority~4 to account for the difference in response time compliance. Unless special circumstances exist, dispatchers shall not dispatch Si- 1 to 1ransfer calls Without hire or P3) when Paramedics Plus does not have any trucks available. S1 14R may be started if requested by the facility. If a concern is identi?ed that mutual aid 18 needed due to resources being depleted, contact the Paramedics Plus supervisor to authorize mutual aid being started. 970 is a management crew that may be available during business hours. When staffed, they will notify dispatch that they are 10?6 at headquarters, unless resources are depleted and there are calls holding. lhe 970 units shall be automatlcally assigned to P1 calls that are holding when resources are depleted. 1 or all other calls, 970 will be noti?ed via the 980 sci 1L8 page and may Offer up to handle the call is able to do so. 970 should not be assigned to calls when other ambulance crews are available. They can offer up to take a call if they are closer and able to do so. SENDUpdates The first responders on scene of a medical emergency are required to provide a detailed SEND update to the dispatcher. Once the SEND update is received, the dispatcher will use the EMD card sets to determine if the call needs to be reprioritized or remain the same. Some cards chief complaints will not be able to be reprioritized based on the SEND update. You may need to prompt responders for additional information. Be cognizant of the medical update you are giving responders. Identify what are triggering the emergency response. Responders than can mirror back your update to help identify changes to patient status. Should the call be reprioritized, the call type will he changed appropriately. It is not necessary to use the upgrade downgrade CAD command codes. Dispatchers shall document the SEND update and new determinant code (if necessary) in the narrative of the call for service. As part of SEND, responders have the ability to request a lights and sirens response. Dispatchers shall follow this request. There may be times that 900 will arrive on scene first. In these circumstances, they still have the expectation to give a patient update. 1f the patient update includes criteria to reprioritize the call the dispatcher will do so. 900 does have the ability to disregard fire if they believe they can handle the situation; if 900 says to ?disregard ?re? dispatchers shall follow this request, however, they should still provide a patient update. If 900?s update meets 132/131 criteria, verify if PD or ?re are needed. If an update is unclear ask for clari?cation from responders. If additional information is needed from responders, prompt them. An date of ?Conscious, Alert Breathin si i?es that all three as ects are ?normal?. In the a g? presence of abnormal or difficulty breathing, the update will include this additional information. (Le. ?Conscious, Alert, Difficulty Breathing?) CallerCallbacks Should a reporting party call back to ask why the ambulance hasn?t arrived on scene yet, the call taker will immediately ask, ?Has anything changed with the patient?? Con?rm the Call takers will reprioritiae the call, if necessary, based on the changes provided. Phrases that can be used to calm callers are: The ambulance will be there as soon as possible We have noti?ed the ambulance of your call and they will be en route as soon as possible if center activity allows it, call takers can remain on the line to provide reassurances and calming statements . LincoliiCountyCalls If resources are depleted and Pl call is holding, poll units, if ETA to clear is more than 10 minutes, contact Lincoln County dispatch and advise them to start their appropriate mutual aid ambulance. Lincoln County ?rst responders are not trained in SEND and therefore won?t be able to give SEND updates. Upgrade downgrade responders based on request by first responders or Lincoln County dispatch. Dispatcher discretion is always acceptable. There are many situations that cannot fully be addressed or accounted for in procedure. Dispatchers using good logic and judgement are able to use their discretion in getting the appropriate resources to medical emergencies. When this happens please send an email to the on duty supervisor, the Deputy Director and QA Coordinator. SFFR can still use their discretion in requesting mutual aid based on the circumstances of the call. If 'I?yler dispatchers are requesting an ETA, provide a good faith estimate based on What is currently going on in the system. You are not creating an uncontrollable expectation, Tyler understands that the system activity can quickly change. Incxdent Numbers Each patient needs their own incident. number. If you have a call with multiple patients, the ambulance crew should be asking for an additional incident number. Verbalize updates on the radio as necessary. In the event Paramedics Plus has depleted their resources and there are no available ?re trucks to respond, the dispatcher will: Manually send a resource depletion page indicating no ?re units available Contact the Paramedics Plus Supewisor to determine if mutual aid is needed