ER procedure - ambulance calls ahead

I think the answer to your question may somewhat depend on the time period you're writing about. I think originally the calls were made on something equivalent to a police radio; I imagine that when CBs were popular they might have been used; and these days, I'd think it would be a cell phone.

On terminology - What I've heard has been short and to the point, much like the calls that come over the intercom in hospitals with codes and short descriptions - adult male, 56, possible heart, etc. In transit, more information like vital signs is passed on to the hospital - blood pressure, pulse, any medical history the transporters have gotten, and any special needs the hospital should prepare for.

Hope that helps. Puma

If this is a situation of so many patients it rates as a small scale disaster, the call will likely come not from the paramedics on their radio, but from their dispatcher via her hot line to the hospital (if she has one, otherwise, her usual special phone number that the general public doesn't have (so the dispatcher is not getting put through the hospital's switchboard operator but dialing in directly).

There are regional differences in how people speak medically, but you're fine with the doc saying something along the lines of "multiple GSWs (spoken as 'gee ess double-yous')
right lower quadrant and upper leg (possibly id'uing which leg).

The RLQ comment is really necessary. They never say stomach. In referring to the abdomen, a shooting or stabbing or pain there, divide the belley into four quadrants: right and left, upper and lower. It will be spoken as "right upper quadrant", for instance, and written as RUQ. And this is one of the two quadrants the particularly light a fire under the ER staff, as that's where the bulk of the liver sits (other uh oh q is the LUQ because it has the spleen).

I worked on an ambulance for a short time. We had a radio. the hospital had a radio. We'd call in nearly every victim.
We'd tell the ER how many minutes we were away, Patients sex, vital signs, and why he was in the wagon (chain saw injury, gun shot, heart attack, etc.).
We would also tell them what emergency aid we were administering (O2, IV, CPR, etc.)
The ER Nurse would tell us which bed to take the patient to. They would be ready with the appropriate response

I agree with what RJK said.

Having ridden in an ambulance twice, I remember both times the person sitting in back with me communicating via radio (CB I assumed) my vitals and condiiton. The driver talked to the EMT in back occasionally. And he turned on the damned siren even though I begged him not to!! (I didn't want to put other drivers out. I'm so polite in pre-term labor.)

JoNightshade said:

I'm vaguely aware that when there's been some sort of large-scale crash with multiple injured parties, that the ambulance will call ahead to the ER to let them know what they are bringing in and when.

My question is, what do they call on? Some sort of radio system? The telephone? Is there any special terminology involved? Basically I have a scene with an ER doc (not in charge) who hears someone nearby take a call for multiple injuries coming in. The attending then assigns him one specific case.

Click to expand...

They have a person who listens to the police and ambulance radios and who keeps in touch with the emergency services dispatchers to let them know how many patients they can accept of what type.

You know you are getting X almost as soon as the ambulance driver does, and sometimes before. And you listen to the chatter as they are coming in so you can be ready for a smooth transition.

Even in the lab we had a scanner/radio going so we could clear the decks for transfusions and emergency lab tests, and get someone up there to grab the samples we needed.

""Someone shot in the stomach and leg""

That would be Gunshot Wounds in (pick a quadrant - any basic anatomy book tells you what is in which quadrant) and (pick a specific portion of a specific leg).

Most of the Phoenix ambulance crews would give an estimate of the damage: "GSW, mid thigh, visible bone fragments, heavy arterial bleeding" gets a different response than "GSW, right gluteus maximus, clean entry and exit wounds".

Starting point is that radios are used as much as possible, because everyone can listen in. Through listening, you become aware of what's going down, and ideally you can get a jump on things. I had one call when we were returning the ambulance to the station when over the police channel I heard a call for the police, with the police dispatcher advising the police that he would be requesting medical. We were responding before our dispatcher toned us out.

Depending on the size of the local is how many primary channels you have. But basically the system is that the police have one channel, the fire department has a different channel, ambulances may have a third, and from ambulance to hospital in on a fourth. Backup channels exist for when the primary one is in use.

A lot of people involved in emergency services become radio junkies. In our ambulance we have the main truck radio, and a portable. When I was on the department, I also had a personal portable. So we would leave the truck radio on fire dispatch (fire/medical had a combined dispatcher). Second radio would be set to the police channel so we could monitor them. Third radio was set to hospital to ambulance so we knew what other rigs were bringing in, unrelated to our problem. With practice, you can listen on all these radios at the same time. At the hospital, they had several radios, each tuned to the different channels.

Let's run through how this would play out:

Fire dispatch: Call number (each ambulance has it's own number), please respond to GSW at address. Report is from a 9-1-1 call.

Ambulance: 321 responding.

Fire dispatch: 321, then more call numbers, 9-1-1 is reporting multiple victims (as the 9-1-1 reports multiply, they become more accurate. Initially you're only going to send one ambulance. As people report more victims, dispatch will decide more units are needed). Police are responding.

Ambulance: 321, thank you. Where do you want us to stage? (At this point, if I hadn't heard the police were responding, I'd ask my dispatcher to confirm. For GSW, you do not go into the scene until the police are done getting shoot at. At this point, the hospital would begin to listen closely.)

Ambulance: 321 staged. Waiting. (This tells our dispatch that we are parked near the scene, but out of any danger. Until the police tell us the scene is safe, we aren't moving.)

Fire dispatch: 321, PD advise scene is safe, proceed to scene. PD advise there are four victims, two critical. (Police will usually tell us the number of victims if they can. They might not know and just give an estimate.)

Ambulance: 321 on scene. Assuming command. (First ambulance on scene will establish overall command of all ambulance until a higher ranking officer arrives. The senior EMT/paramedic would go and look quickly at the victims. He would probably put tags on each patient, although not necessarily. He'd decide who gets treated first and who treats who. Once he gets done, he'll get back on the radio.)

Ambulance: 321 to Fire Dispatch. Please advice hospital that we have four GSWs. We have one status one, one status two, and two status threes. (Most departments use some sort of quick code. With our department, status one meant "Oh, shit," down to status four, which means you probably didn't really need to call the ambulance.) Please request transport instructions.

Fire dispatch would repeat the statuses, then call the hospital on the phone. Understand that the hospital had listened in on the original call. By the time fire dispatch called, someone with some authority would be on the phone. The hospital would decide how many patients they could handle and advise our dispatch which patient would be going where. Hospital at this point would have a good idea of what resources it would be needing.

Fire dispatch and the on scene commander would coordinate who was going where. As the ambulance was leaving, the scene commander would advise what hospital to proceed to.

As the ambulance was en route, it would call up the hospital:

Ambulance: 324 to hospital.

Hospital: Hospital, go ahead.

Ambulance: Have 20 year-old male, GSW, right upper quadrant and thigh, thigh has exit wound, vitals are ..., patient unresponsive to verbal stimuli, patient has two high flow IVs wide open, O2 15 liters per minute, airway inserted. ETA 6 minutes.

The hospital would then repeat the information. Then the hospital would advise what room we would be taking the patient to. The hospital might also ask for additional information.

By the time you get to the hospital, the doctor has already begun to plan what's going to happen.

Best of luck,

Jim Clark-Dawe

If you need any help with what happens after they arrive, let me know. I've done my time in the trauma bay in med school and residency

From the scene to the hospital, they'd probably still use a radio. Transferring from hospital to hospital would be over the phone usually directly between physicians, because someone has to legally agree to take responsibility for a patient being transferred.

The "attending" physician is the physician whose name appears on the record. They are ultimately the ones responsible, and also the ones who get paid. For a patient who gets admitted to the hospital that would not be the ER physician, but almost certainly some sort of surgeon if this is a trauma patient. Your doctor in the ER making assignments would not be the "attending" physician but some sort of ER director/supervisor, maybe a chief resident making assignments for the other residents. The exception would be if the one getting the assignment is a resident physician working under the direction of a licenced individual. The residents might call the ER physician the "attending", but it is doubtful that anyone else would.

The term "attending" is almost never appropriate in referrence to an ER Physician. Even if the ER Physician is the only one who sees the patient, the "attending" is the one who either admits the patient to the hospital or the one to whom the patient is referred for follow-up. Nowadays, since some ER's might have attached Urgent treatment centers where they might have follow-up, then there might be exceptions, however, the term "attending physician" has very specific legal connotations.