Fox 5 DC has a story about a reported delay in getting help to a critically ill patient. You may recall that Washington DC has had a number of response issues in the past, and so at first glance it looks as if this is just another one of those situations. For a change, I get to tell you that no, it actually isn’t.
According to a D.C. police report, officers found the man unconscious and not breathing in front of the Sixth District Substation on Pennsylvania Avenue in Southeast D.C. The report says the officers deployed a defibrillator and began CPR, but for whatever reason, the 911 dispatch center only sent a basic life support ambulance.
This is what Ambulance 27 said to the dispatch center when they pulled up on the scene.
Ambulance driver: “Ambulance 27 to Communications, can you dispatch an EMS supervisor? ALS — ALS provider, we have CPR in progress.”
Dispatcher: “I copy Ambulance 27, CPR in progress.”
ALS stands for advanced life support, and a paramedic was then put on the call.
So the delay here is NOT initiating care because the police officers did that. The delay here is also NOT in getting an ambulance to the scene because Ambulance 27 was dispatched and responded in what thus far has been indicated as a timely fashion. The reported delay IS getting the Advanced Life Support to the scene.
Here’s the bad news, studies indicate that Advanced Life Support ambulances increases mortality. I know, it’s probably more of a shocker to the EMS provider to hear that all the stress being put on Advanced Life Support has NOT resulted in better outcomes. Therefore, the delay of an Advanced Life Support unit to this scene is a mute point. For that matter, statistically, the dispatcher sent the appropriate resource that would give the patient the best chance at survival.
This is a video from the Harvard Horizons Symposium featuring Prachi Sanghavi, PHD on “Is doing more, doing better? Basic versus advanced life support ambulances for medical emergencies”.
So there you have it. Although I do worry about a major metropolitan communications center that does not have auto-refresh on their CAD system, I see nothing erroneous done here by either the ambulance crews or the dispatcher. They sent the correct resources, the resource arrived, and because they are ingrained that the assumption of Advanced Life Support equaling better care, the request was put in. This is simply a case of the ambulance delay that really wasn’t.
It’s been slightly more than four years since I wrote the post On Why Basics Matter More Than You Think. Not much has changed in our culture since that post (not that a single blog post could change such a stubborn culture to begin with, even if I was the one who wrote it) but from the indications of the study we should probably start.