Shark Attacks

Brett Patterson

Brett:

We have a debate going on as to how shark attacks would be handled under protocol. I say Protocol 3: Animal Bites/Attacks, but some think it should be Protocol 30: Traumatic Injuries (Specific) due to possibility of amputation or lacerations.

Ruth M. Barefoot

Communications Training Officer

Currituck County Communications

Currituck, North Carolina, USA

Hi Ruth:

Generally speaking, when a caller complains of a specific injury after the fact, either Protocol 21: Hemorrhage/Lacerations or Protocol 30 is appropriate. However, when there are concerns regarding mechanism of injury, the more specific protocol, when available, is appropriate.

For instance, consider a fall from a bicycle causing a broken wrist. The caller is likely calling about the wrist and, although the patient did take a “fall,” the injury is the primary concern and there are no high mechanism issues. Therefore, Protocol 30 handles this case just fine.

However, your shark scenario is a little different due to scene safety and mechanism issues. Protocol 3 makes sure we know where the critter is, that we keep others away and, even if this is not an issue, we have the DELTA 6–9 Determinant Descriptors to consider regarding mechanism of injury. So, while the injury itself may not be to a DANGEROUS Body Area, the mechanism of injury may warrant a higher response due to the potential for occult injuries.

Brett Patterson

Academics & Standards Associate

Chair, Medical Council of Standards

International Academies of Emergency Dispatch® (IAED^™)

Brett:

I have two questions.

1. A caller, a medic from one of our AID Stations, states that the patient is complaining of seizures. He does not believe that the patient is having a seizure right now; however, the patient suffers from Traumatic Brain injury (TBI). He does have a twitch, but it does not appear to be nor does he believe it is a seizure (words from the medic). Would it be accurate to use Protocol 12: Convulsions/Seizures?
2. Is it allowed to transfer a cardiac arrest (9E) call because it is not in your jurisdiction? Should we EMD the call or should we transfer the caller to the proper agency during a cardiac arrest, or any other ECHO call?

Clyde S. Matthews

Operations Officer

Fort Bragg, North Carolina, USA

Hi Clyde:

1. It is common for patients with a history of brain injury to have seizures or seizure-like activity. What the caller is actually describing is a focal seizure, or twitching of a part of the body. This is well handled using Protocol 12, following the Focal Seizure Pathway as noted in Key Qs 6 and 7. The call would likely code out as 12-A-4.
2. This is a relatively common question that is addressed briefly in “Principles of Emergency Medical Dispatch” in Chapter 11. Legal Aspects of EMD, under the section Abandonment. In addition to consulting the textbook, I have included my response to a similar, previous question. Let me know if this helps.

Brett:

In our EMD classes, your instructors told us that we are not allowed to hand over medical calls to agencies that do not EMD. I am unable to find anything that specifically states that in the book, although I did find the passage about dispatch abandonment. I am asking for something in writing stating that we are able or not able to give medical calls to agencies that do not EMD so we can accurately reflect this in our agency policies.

Thank you,

Rick Fisher

Laramie County Combined Communication Center

Cheyenne, Wyoming, USA

Rick:

The Academy has no power to allow or disallow agency policy. However, we can provide some expert consensus on this subject.

The term "abandonment" has been used in civil court to describe inappropriately transferring care of a patient from one level of care to a lower level of care, i.e., an ALS provider hands off a patient with ALS need to a BLS provider. If damage results from such a breach of duty, negligence may be established in civil court. While we are not aware of any related dispatch-specific lawsuits, expert council has advised us that this sort of abandonment is potentially litigious in the emergency dispatch environment if an agency that provides pre-arrival instructions knowingly passes a caller to an agency that does not provide pre-arrival instructions without first providing the current standard of care, and damage results and causation is shown.

If such a policy is currently in place in a given communication center, our advice is to diligently pursue safer alternatives that maintain the current, international standard of care in the emergency dispatch environment, which includes the provision of pre-arrival instructions. This due diligence should include informing medical control, risk management, governmental authority, and all involved in operational and communication center management of the potential problem, in writing, so that if a lawsuit is brought, it may be shown that a good faith effort was made to provide the current standard of care.

As always, the goal should be to provide the best care possible to emergency callers in need. Clearly, public expectation and expert consensus have established a standard of care regarding pre-arrival instructions. It is our opinion that the failure to provide standardized, clinically sound, and current pre-arrival instructions constitutes a breach of duty in our profession. In the interest of quality patient care, every effort should be made to uphold this important standard in our industry, regardless of jurisdiction.

Please let me know if I can be of any further assistance.

Brett