ER: One Phone Call Away
Just suppose: You get up in the morning and walk into the bathroom and find your husband slumped on the floor. Would you know what to do?
Dial 911, of course. But what then?
Did you know that most times the dispatcher gets your address, name and phone number on the screen? Don't waste precious time repeating these facts. The dispatcher who answers the phone is trained in "structured interrogation," according to Bartholomew Tortella, MD, medical director of Trauma Services at UMDNJ-University Hospital in Newark. You will be asked a series of questions. Depending upon your responses, which are simultaneously entered into the computer, further questions will come up in a particular sequence.
Is he conscious? Is he breathing? Is he sitting up or lying down? Does he require CPR? If so, do you know how to administer it? No? You'll be talked through the steps by the person on the phone line.
In the meantime, an ambulance will be dispatched to your home. Is the door unlocked? Is the light on? Is someone else with you who could flag down the ambulance? In the case of a heart attack or brain attack (stroke), choking or poisoning, minutes perhaps even seconds can be crucial. If a child calls 911 and hangs up before giving information, Tortella says it will be assumed to be an extreme emergency and will be handled as such.
The dispatcher will make some decisions. Do you need emergency medical technicians who can take vital signs, apply bandages and give oxygen, and, of course, transport you to the hospital? Or is this a case for the paramedics, who can do endotracheal intubation, and start IVs and medication while in radio contact with physicians in the ER?
NorthSTAR the helicopter you may have seen land on the Garden State Parkway or Route 78 is another option. It carries out 800 missions each year, 80 percent of them trauma cases.
Who requires emergency care in New Jersey? According to the trauma surgeon, three categories of patients come through the doors of the ER: individuals with old problems that have gotten worse such as asthma, diabetes and chest pains; those with new problems such as deep cuts, flu and pneumonia, or a broken bone; and acute emergencies heart attacks, brain attacks and auto accidents.
A common problem is choking, says Tortella, who points out that the Yellow Pages in the phone book have clear instructions for what to do. "The key approaches are a mouth sweep, back blows, the Heimlich maneuver and of course, a call for help," he says. "But having the instructions posted in your kitchen might be critical in a moment of panic."
Another is heart attack, which he says can present with chest pain and shortness of breath not related to exertion: "An elephant on the chest is how it's often described and early morning is when it usually happens."
Tortella says that people delay too long before seeking medical help: "Medications can dissolve the blood clots and open up clogged heart blood vessels if they're administered within two to four hours of symptoms."
Asthma attacks often occur when the weather changes or when someone has been lax in taking medications. He advises against "toughing it out at home where you'll only get sicker."
Tortella offers surgical wisdom about bleeding: Direct pressure on the site of bleeding or to the pressure points using a cloth, not paper towels Ð will usually stop the flow. The pressure points are located at areas where you normally feel a pulse: the wrist for finger or hand bleeding; the inside of the elbow for forearm bleeding; the armpit for upper arm bleeding; the back of the knee for lower leg and foot bleeding; the groin for thigh and leg bleeding. Tourniquets, he says, are rarely needed and often create problems.
When will the ambulance head for the trauma center? If someone's in shock, can't breathe, has had a penetrating wound to the torso, a pelvic fracture, an amputation, if extremes of age are compounding a medical condition, or it's taken a long time to extricate someone from a vehicle after an accident, then trauma services are needed. "Time, not distance, is the key factor here," advises Tortella. "If it's less than 15 to 20 minutes away, the ambulance will drive there. If it's longer, they'll call the NorthSTAR helicopter."
The trauma surgeon gives some final words-to-the-wise: Keep your wits about you in an emergency. Call EMS early. Calm down and slow down. Take your own pulse first it might be the one that really counts.
Winter 1998 Table of Contents