Читать книгу Emergency Medical Services - Группа авторов - Страница 334

When a patient calls 9‐1‐1 and speaks with an emergency medical dispatcher, the complex process of providing optimal care has been initiated. This first point of medical contact, the interaction between the patient and telecommunicator, can influence every subsequent experience of patients during their prehospital and even in‐hospital care. Consequently, it is essential for the telecommunicator to initiate and optimize clinician–patient contact for the subsequent emergency medical services (EMS). The EMS clinician, in turn, optimizes contact with the emergency department (ED) or other destination.

Although many consider that the 9‐1‐1 public safety answering point is involved only in resource allocation such as dispatching ambulances, it also has a pivotal role in the provision of patient care [1]. The accurate identification of the chief complaint by the telecommunicator serves as an adjunct to the field personnel by allowing them to incrementally build on the dispatch “diagnosis” and initiate the appropriate therapy. If the telecommunicator incorrectly identifies the chief complaint, this may result in ineffective or inappropriate prehospital therapies, and even worse, it may introduce systematic biases that affect provision of patient care from the EMS clinician–patient contact onward [2, 3].

During the initial steps in the telecommunicator–patient interview, for example, if the chief complaint includes scene safety issues (e.g., drowning or electrocution), the telecommunicator decides on the protocol that best addresses the situation [3]. If the chief complaint involves trauma, the telecommunicator decides on the protocol that best addresses the mechanism of injury (e.g., fall, motor vehicle crash). When the chief complaint appears to be medical in nature, the telecommunicator chooses the protocol that best fits the patient’s foremost symptom, with the priority symptoms taking precedence. Regardless of which call is assessed, the subsequent dispatch information can influence the thought processes of the responding EMS clinicians and potentially influence how they approach the patient [4].In the case of drowning or electrocution calls, for instance, the responders are preparing themselves for the type of call, essentially reviewing in their minds the protocols and procedures to use when approaching the patient. For all calls, the EMS personnel consider their previous experiences to determine how to proceed when they initiate their own first medical contact.