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Response assignment, determinant codes said key

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Editor's note: This is one of a series of stories produced by The Lebanon Voice highlighting the need for faster medical response times in West Lebanon and the need for better recognition of aneurysms by rescue personnel nationwide.

AUGUSTA, Maine - The Emergency Medical Dispatch Program Manager for Maine's Emergency Medical Services wants to change the culture of ambulance service statewide from what it's been in the past.

"The old culture was you get a call, you pile whoever you have at the station into the ambulance and go down the road, hot," said Drexell White on Tuesday.

"Lot of EMS providers were going lights and siren to a call where that difference in speed was not going to make a difference," he said, adding it was a danger to rescue personnel and the patient.

On the flip side he said that responses to calls for acute care can just as easily draw a limited response when they should've "called in the cavalry."

In the case of a call to a dispatch center that serves a part of Lebanon near the Milton (NH) town line, he said, "Nothing would preclude that dispatcher from calling Milton if they thought their ambulance could get there faster. One dispatcher in a communications center might say 'Call Milton,' while another might not think of it.

That's where something known as "determinant codes" comes in. A determinant code is typically made up of a letter-number-letter format. The first component, a number from 1 to 36, indicates a broad category of medical emergency incidents; the second component, a letter A through E is the response determinant indicating the potential severity of injury or illness based on information provided by the caller; and third and final component, a number, is the subdeterminant and provides more specific information about the patient's specific condition.

The determinant codes are based on questions asked by a dispatcher of the victim of a medical emergency or someone speaking for them.

A Baseline Response Example, not necessarily one that is in place in Maine or elsewhere

"With the use of determinant codes, Dispatch can get Advanced Life Support, such as a paramedic out sooner," White said.

White said he's trying to get more local EMS services to use determinant codes.

"When the dispatcher gets a determinant code to EMS, then they know what their response should be," he added.

Right now White said he is drafting a plan to get determinant codes for prehospital patient response.

He said many local ambulance providers now get their dispatch information in "plain English" and like it that way, and White said they'll still get it that way, but with the determinant codes in addition, so that whether an ambulance should go "hot" to the scene, or whether fire or police or a paramedic should be sent, is better articulated.

In neighboring communities like Milton and Lebanon, which both have obvious needs for mutual aid in various sections of their respective towns, "It's important to have a preplan in place," White said. "We call it a 'response assignment plan.'"

A response assignment plan basically spells out what a response will be in the event of an emergency, and what level of emergency will trigger what response.

With determinant codes, the parameters run from A to E, A being the most minor and E being the most life-threatening.

"Obviously, if a guy has dropped a brick on his foot, it hurts like hell but it's not life-threatening," White said. "At the other end - an E - you have serious conditions like heart attack or respiratory failure that are life-threatening where you want to come out with your big guns."

White said that New Hampshire and Maine use the same determinant codes so that it should be easy for Milton and Lebanon to hammer out a mutual aid agreement that goes as far as they want.

The two towns could have an agreement that if Sanford Regional Dispatch determines a particular response, the Response Assignment Plan could encompass a coordinated effort no matter the severity of the condition.

"It could be a (Lebanon) EMT basic for an alpha level; for Bravo, a (Lebanon) EMT Basic with Lights; for Charlie, a Milton EMT with paramedic from Frisbie; and for Delta, a paramedic from Frisbie and Milton Police," White said.

White says that once the dispatcher knows the assignment response plan, they can dispatch all necessary resources, allowing the responding ambulance personnel to concentrate on patient care, not making the calls.

While White is pressing for determinant codes and protocols to expedite a coordinated and consistent response model, he acknowledged that mutual aid "gentlemen's agreements" still exist in many towns in which no formal agreement has ever been signed.

The problem with these, he said, is when one chief resigns and another retires, these agreements often fall by the wayside putting the public at risk.

To illustrate the point, former assistant Lebanon rescue chief Jason Cole recently posted on one of his pages that when he was assistant chief, Milton and Lebanon had an automatic mutual aid agreement to cover District 6, the area of West Lebanon near Prospect Hill Road, Champion Street and other nearby areas.

Cole's post was in response to a series of articles in The Lebanon Voice detailing the plight of Martha Soto-Galicia, the president of the newspaper, when she suffered an aneurysm on Feb. 12. One of the articles dealt with the fact that Milton never heard the tone so didn't send mutual aid.

Milton Fire and Rescue Chief Nick Marique said later that Milton and Lebanon had never had any such automatic mutual aid agreement, explaining that if called they would respond, but that didn't happen Feb. 12.

White believes these so-called "gentlemen's agreements" should be replaced with something more ironclad and consistent, like a response assignment plan.

"The components are available to do this," he said. "You still have to get local EMS officials to get together and decide how they can improve their response to any call.

Nick Mercuri, the Emergency Medical Services Chief for New Hampshire, agreed communication between the communities is key.

"It comes down to regional dispatch, and the two towns," Mercuri said today. "The dispatch center can facilitate, and they can implement, as long as the communities agree. If they're onboard it's OK. Anything can be implemented with approval."

"It means getting people like-minded together to see what's the best thing for our patient that we can do," said White.

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