Black Hole No More

Sherri Stigler

The psychological struggle of providing bystander instruction only to be left in a vast “black hole” of the unknown outcome is the bane of an Emergency Dispatcher (ED). While EDs understand the need to protect patient privacy, they still long for the rest of the story, what happened to “their” patients. The information rarely comes full circle, until now, at least partially, thanks to a partnership between Waukesha County Communications (WCC), Wisconsin, USA, and the hospitals receiving patients transported by WCC dispatched ambulance services.

Concept

In late 2016, EMS Coordinator Mark Meske, Waukesha Memorial Hospital (WMH), and Dr. Mark Schultz, who also practices at WMH and serves as Medical Director for WCC’s EMD program, discussed extending a patient outcome program that had been successful in the EMT/paramedic community. The program of providing a medical analysis of a STEMI (major heart attack) played out in the advanced care (hospital) setting showed field responders how their emergency care affected patient outcome. Would the same information benefit EDs?

Dr. Meske approached me with the idea. To say I was enthusiastic is an understatement. I knew the EDs would welcome more pieces to their story. Collaboration started with the addition of ED-specific data to the existing EMS report, including time of the 911 call, time EMS was notified (toned), on scene time, and time of initial hands-on-patient contact. Time bubbles for hands-on-chest were provided in the report when EMD-instructed bystander CPR was initiated. The hospital would forward the reports to WCC staff.

Workflow

We developed the following process:

1. STEMI case called into WCC is received by WMH
2. Patient receives care and undergoes appropriate medical procedures to relieve blockage per hospital protocol
3. EMS Coordinator gathers patient data and either calls or sends an email to me (WCC Training and Operations Manager) requesting dispatch times
4. Training and Operations Manager reviews the call and provides the relevant information (in cases of bystander/EMD assisted CPR compressions, the time of hands-on initiation are mined from the call’s audio recording to provide exact hands-on-chest time)
5. EMS Coordinator emails completed report to the WCC Training and Operations Manager

The EMD involved in the case is first in line to review the report, followed by prominent display on the EMD information bulletin board that also features the monthly quality assurance reports and other EMD notifications.

Reaction

The reception among staff is unanimous. They love it.

Jim Korsmo, EMD, said the program eases stress-provoking uncertainty.

“When a dispatcher is invested emotionally by giving CPR/Heimlich/childbirth instructions, it is vital to the psychological well-being of the calltaker that they are able to have some closure,” Korsmo said. “The STEMI report I received helped me fully understand what happened to the man I worked to help save, and I appreciate that.”

In addition to emotional well-being, Korsmo applauds the program from a knowledge perspective.

“It's important that dispatchers have, at the very least, a basic understanding of how major cardiac events occur,” he said. “The reports give us a clearer understanding of the caller-reported pulseless, non-breathing patient. Dispatchers have an almost instinctive reflex to ask ‘why.’ They want to know what happens. These reports put the whole puzzle together.”

Our next step involves determining whether the reports positively impact the quality of protocol compliance as well as an EMD’s psychological need for closure. We are considering extending the program to stroke events.

This is a win-win for the profession. It’s exciting to give staff the rest of their story. Seeing the fruits of their labor enhances ED commitment to protocol. Information-sharing programs provide that ability.

Finally, the project provides me with topics for research posters in years to come.