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Medical Dispatch (A despatch from #SMACCDUB)



“It’s my second time in SMACC congress and for many reasons I’m fond of it. One of these reasons is meeting people from other countries and learn from them. 
But I’ve noticed each time they ask me where i work and what my job is, they have a “?” in their eyes when i answer part of it is medical dispatch.
So let’s do this, let explain what it means (at least to me).

Medical dispatch is a challenging and very intersting part of my job.

We french guys are that crazy enough to put doctors on the phone. Not only and since a long time ago in medical prehospital vehicles (whether it’s cars or HEMS or medical ambulances) but also in confortable armchairs with telephones and computers.
Why ?
Because we believe in human. We believe in medical skills to provide the best usage of the dispatching “panoplie” : firemen, ambulances, resus teams…

So how does it work ?

If you call 15 you will first get an ARM (auxiliaire de regulation médicale) which is a kind of extra-dispatcher.
He / she will take the adress, information about the patient (1 ? 2 ? Several ? Ages ; former medical informations ; and so on), calm you down, if obviously needed send first rescuers (from basic paramedic to resus team) and deliver advices. Then choose which doctor to refer. In my SAMU, it can be :
– a GP (at night and on week ends) ;
– a toxicologist for poisonning stuff questions (“oh i ate these red mushrooms”) ;
– a pediatrician ;
– the one in charge of boats (local unique particularism) ;
– the emergency physician.

Half part of my worktime is to be that emergency physician.

You have all the toys.
You have all the responsibility.

You have to be aware of everything, all the time.
The actual location of your golden bullets, the SMUR, the medical resus teams.
If the weather is ok for HEMS and where.
Which ED are overcrowding (otherwise it won’t be helpfull to send patients quickly there). 
Availability of ICU beds in different hospitals (public or private).
And so on.

You need to listen to everything in that room, everytime. That is even writen on national guidelines : “écoute médicale permanente”.
To everything that is said or not said.
If this young ARM didn’t ask if the uncounscious patient was breathing “regularly” or not. Maybe witness thinks he is breathing when he’s gasping.
If that huge accident makes 90% of territorial firemen busy, so don’t expect they can have too many other missions fast.
If what your colleague seems to say on his phone means he will need your last SMUR soon.

Then comes phone calls.
The fondamental basis is simple : you have to listen to people. Patient with crapy voice complaining “it’s like if my chest was compressed, a terrible pain, and it goes to my jaws” is offering the diagnosis to you. And of course you will easily assess if breathless patient sounds like acute pulmonary oedema, asthma, or panic attack.

But you have to make a decision.
Ressources aren’t unlimited even if colleagues call you miss apocalypse.
You have rare GPS avalaible to visit patients. 
You have firemen. But not hundreds.
You have ambulances. But everyday, at noon and at six PM, you know that your needs will strongly exceed your possibilies.
And you have your golden bullets. The SMUR. A very few.

In my place, 1000-2000 files per day. 1 case = 1 file. Usually 1 file = 1 patient but for e.g.  for an accident with multiple victims, 1 file. That makes a lot of in and outcoming phone calls.

So you can’t send the big cavalerie to everybody, even it they ask to. Meanwhile, be sure the judge will never understand why you didn’t if it ends bad.
Every call are recorded on tape. You’d be surprised how fatigue can be heard on such a tape.

Here is your challenge.

To provide the best care but do not waste what you could shortly need somewhere else.

When you first work here, you soon understand that you’ve always learned and practiced medicine seing and touching patients.

Once a friend told me : “These are the same patients you are used to. But now you are blind and paralysed. You have to be smart. Want you can do is to listen, to think, to speak and to decide.”

It’s called hell by most of us.

It also gives you satisfactions.

Your range of tools are not only “sending” any type of vehicle or team. It’s also giving advices, from the basic ice on a contusion to CPR teached on phone while the teams are running.

The job includes patient’s trajectoire to the hospital too.
Avoiding overcrowding ED when an other possible.
Direct admission to neuro-ICU for stroke.
Getting the ICU red carpet ready for the patient with the SMUR team.

I feel happy when i hear the panic decreasing in the voice of the mother who just faced her child hyperthermic seizure, once i have told her that not only ambulance was on her way but also how common it was.
I feel proud when the one out of dozens patient with chest  pain i sent a SMUR is that one who has STEMI.

Medical dispatch is hell on earth.
Medical dispatch is also a place where you feel that discharge of that patient a few days later was possible because you taught his wife how to perform chest compressions, while you where sending resus team and get ICU and cath-lab ready for his admission. ”


Doc Adrénaline

(Editors note : Thanks to @DocAdrenaline for sending this post to me from Dublin, inspired by the spirit of FOAMEd. What she describes is very similar to a vital role of a RFDS doctor- Telemedicine and phone triage. We take calls from our base region and deal with any medical request or issue that comes in. It may involve simple advice, to prescribing medicines from the RFDS medical chest , all the way up to a full blown critical emergency aeromedical retrieval to a remote location)
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