Walk into a dispatch center and you’ll hear questions like, “Is your mom breathing?” “What is the color of the smoke coming out? or “What kind of medicine did you take?”
Most people dial 911 during the scariest times in their lives, and on the other end of the line are emergency dispatchers like Gilbert Lopez of the San Bernardino County Fire Department.
“It can be overwhelming,” Lopez said. “It could be smooth or chaotic navigation right off the bat.”
Until very recently, dispatchers terminated most 911 calls by dispatching an ambulance.
“We were all taught, ‘You call, we carry,'” Lopez said.
This is an effective protocol when the caller needs an ambulance, but the fact is that an increasing number of 911 calls do not require a paramedic escort to an emergency room. When non-emergency calls come in, they can weigh heavily on the system. Dispatchers cannot respond to other calls that may be more important, ambulances are routed to places where they are not needed, and emergency room nurses and doctors are behind in treating patients who do not have not really need to be admitted, leaving ambulances tied up in hospital parking lots rather than on the street, ready to respond to a real emergency elsewhere.
Leigh Overton is the EMS supervisor for the San Bernardino County Fire Department. She said about 20 to 30 percent of all 911 calls are not true emergencies.
“They don’t need a response from lights and sirens,” Overton said. “Most people call because they don’t know what to do.”
Another effect is felt in hospitals, where emergency rooms are filling up with patients who should have been looking for other options.
“Many people who don’t need an ambulance may need treatment within four hours,” Overton said. “They may need 12 hours and urgent care or a doctor’s appointment may be extremely appropriate for them.”
Instead, visiting an emergency room is costing people thousands of dollars in medical bills that didn’t need to happen.
“An unnecessary ER visit to an uninsured patient could break them [financially]”, Overton said. “It could break anyone.”
NBC 7 Investigates has been investigating the problems with the EMS system for months. In June, we revealed how patients spend hours waiting to get into local hospital emergency rooms, waiting inside the ambulances that brought them there. Again, many of these patients did not require this trip, which prevented paramedics from responding to other emergencies until the transfer of patient care took place.
For the past three years, San Bernardino County dispatchers have been trying a better option. They transfer non-emergency calls to a nurse dispatcher. This professional determines the level of care the caller needs. This care could include calling a ride-sharing service to take them to emergency care, helping them find a 24-hour pharmacy, or connecting them with other medical experts.
“It’s our job to help calm the patient down and let them know they’re talking to a professional who’s going to help them get the level of care they need,” Overton said.
It is also possible that these calls will still receive an ambulance dispatched if the nurse determines that she has reached that level or if the patient requests one.
Overton showed NBC 7 Investigates an example of a call where a woman accidentally drank a drug that was supposed to be vaporized through an inhaler. The nurse dispatcher put the caller in touch with a poison control center who determined that she was not in immediate danger and ensured that she was in contact with her regular doctor.
“In my experience, uh, there’s a huge sigh of relief,” Overton said. “These calls usually end very, very well with a very satisfied customer.”
The city of El Cajon is embarking on a similar system called the Nurse Navigator program. The $300,000 pilot program is being finalized. The city council has a vote scheduled for July 12 to select a contractor, a company called Access2Care. This company falls under Global Medical Response, which operates the AMR ambulance company.
At a council meeting in March, local lawmakers welcomed the idea.
It’s a win for the patient, said board member Steve Goble.
“It’s a win for the hospital system, and it’s a win for the city,” Goble said.
Deputy Mayor Michelle Metschel agreed, telling the council, “If we combine that with public education, I think it will be a win-win situation for everyone.
Lopez said public awareness is important because callers often push back when transferred to a nurse. However, he said, ultimately callers realize that connecting to care over the phone, instead of an expensive trip to the emergency room, is the better option.
Paying for these programs isn’t that simple, as the money can come from local, state, or federal funding. Some programs receive money from health insurers, who benefit from fewer claims from their customers, but some ambulance companies and hospitals may not be supportive as it may reduce their profits.