EMS Pre-Arrival Instructions

Excerpt

"911, what's your emergency?"

Nearly any circumstance resulting in a call to 911 involves a stressed or alarmed caller seeking help for himself or someone else. The person responsible for answering that call is assigned the crucial task of rapidly identifying the nature of the emergency, its severity, and the necessary resources to deploy, all while keeping the caller calm enough to answer the right questions. When specific life-threatening medical emergencies are identified, the following actions by the caller and recipient can be the difference between survival and death. "Pre-arrival instruction" refers to specific instructions or guidance provided by 911 dispatchers or public safety answering point call-takers to the individuals making the emergency call.

In 1974, the first organized effort to provide pre-arrival instructions was implemented in Phoenix, Arizona. Since then, numerous systems have replicated the intent of the initial program: identify the life threat and instruct the caller on appropriate and timely intervention to possibly save a life. MDPS, CBD, and Dispatch Life Support incorporate such instructions into specific call complaints. As of 1988, Emergency Medical Dispatch's use of pre-arrival instructions has been the standard recommendation of the National Association of Emergency Management Service Physicians (NAEMSP).

Pre-arrival instructions to patients or bystanders may include:

1. General: safety, medication, providing access for responders.

2. Hemorrhage control: direct pressure, elevating a bleeding extremity, possibly tourniquet application if needed.

3. Choking: Heimlich maneuver and recognition of cardiac arrest.

4. Cardiac arrest: chest compressions.

5. Respiratory arrest and drowning: airway and breathing maneuvers.

6. Childbirth: umbilical cord tying, infant care, and resuscitation.

One study published in 2000 revealed that 97% of community members surveyed would call 911 in an emergency, and 67% of respondents expected that calling 911 should result in receiving pre-arrival instructions for choking, a person not breathing, bleeding, and childbirth, when appropriate. At that time, however, many of these answering points were noted not to provide such instructions.