NOTED DISPATCH SYSTEM UTILIZED HERE

An Emergency Medical Dispatch system used by many of the emergency services featured on the television program "Rescue 911" is paying big dividends for patients and paramedics of the Cape County Private Ambulance Service.

Paramedic Stacey Sauerbrunn of Karnak, Ill., is one who knows that EMD can make a difference.

Sauerbrunn was at the local dispatch desk on July 16 when she answered the emergency line at about 4:50 p.m.

"A very hysterical mother was screaming that her 13-month-old daughter had drowned in the bathtub," Sauerbrunn recalled. "After I was able to calm her down, I found out the baby was out of the tub and laying on the floor. It had a pulse, but was not breathing and was unconscious.

"I started to instruct the mother to tell the father of the child how to tilt its head back to open the airway and start mouth-to-mouth breathing, when the baby vomited up a large amount of water.

"Neither one of them knew how to clear the baby's airway, so I told the mother to have the father turn the child over, and use his fingers to remove the material in its throat. As soon as the airway cleared, the baby started breathing again. I heard it crying very weakly over the phone."

The paramedics arrived a short time later, at which point tears began to flow from the eyes of a relieved Sauerbrunn, who realized the child was out of immediate danger.

Sauerbrunn said had it not been for the instructions relayed over the phone to the mother and father of the child, the infant might have gone into cardiac arrest and died, or suffered brain damage.

"I certainly have a new respect for the EMD system," she said. "I respected it before this, but now I know that it can save a life."

Ambulance service manager Mike Craig said the EMD system was developed in 1981 by Dr. Jeff J. Clawson, fire surgeon and medical director of the Salt Lake City and County Fire Department, specifically for emergency medical services.

"We use the EMD system on all calls except routine transfers," Craig said. "It is designed to obtain as much information as possible about the nature of the medical emergency, and if needed, provide pre-arrival medical care instructions over the telephone to the caller, or some other person, who is with the patient until the ambulance arrives.

"The EMD system is also designed to prioritize our calls to reduce the number of our code three (red lights and siren) responses."

Using a flip-card file that contains 32 sets of two 8x5 cards, Craig said the EMD system provides a prompt response to any type of medical emergency, or, in some cases, non-emergency. They include everything from a headache, cuts and bruises, to such life-threatening emergencies as full cardiac arrest.

There also are detailed instructions to assist a caller in childbirth until the ambulance arrives.

"For some reason or another, we haven't had to use the emergency childbirth procedure over the phone," Craig said. "But we've used just about all of the other classifications since we started the EMD system on Jan. 1 of this year."

Craig said the EMD system is based on the realization that the ambulance dispatcher is really the first person to respond to any medical emergency.

"We are seeing more and more that the information provided over the phone by the EMD to the caller can make a real significant impact in some of these cases," he said.

"Also, by getting as much information as possible about the nature of the emergency and the condition of the patient, our paramedics know what to expect when they arrive and what kind of equipment to take with them when they leave the ambulance."

Craig said the first, and most difficult, task the ambulance dispatcher often faces is calming the hysterical person on the other end of the phone.

"A part of the Clawson system is how to get the caller to calm down so we can get vital information about the emergency," said Craig. "We explain to them that with their help, there is a lot we can do while the ambulance is en route."

After getting basic information needed to dispatch the ambulance, such as location and directions and condition of the patient, the dispatcher tells the caller to stay on the phone.

The dispatcher then refers to the EMD checklist to see if any pre-arrival care is needed.

"It also reminds the dispatcher to ask those simple but sometimes ignored questions in the heat of battle, such as: `Is the door locked?' or, `Is there a duplex or apartment complex involved?'"

Craig said if pre-arrival care is needed, the instructions on the cards are written in such a way that a person with no medical training can begin basic life support procedures.

"Time is important," he said. "On long distance responses out in the county, we have about a four to six minute window in cases of cardiac arrest before irreversible brain damage occurs.

"Since we started using the EMD system, I have given CPR instructions over the phone several times to people who had no prior training in CPR."

Craig believes more and more emergency medical services organizations will go to the EMD system, not only for its pre-arrival patient treatment value, but also because it cuts down on the number of code three runs that are expensive and dangerous to ambulances and ambulance personnel.

While attending a three-day, EMD training course in Nashville, Tenn., last summer, Craig said Dr. Clawson told the class that in 1989, there were an estimated 70,000 accidents in the United States and Canada involving emergency service vehicles while responding on code three calls.

Clawson said some 7,000 injuries and at least 700 deaths resulted from accidents involving, or caused by, the emergency services vehicles.

"If you can reduce the number of code three runs by 30-35 percent, which is what they think the EMD system will do, you've saved a lot of lives and prevented a lot of injuries," Craig said. "And, at the same time, (you) still provide the same quality of patient care."