Old 12-06-2018, 05:38 PM #1 (permalink)
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Default IMPORTANT 911 Training for ALS - Please Review & Comment

A couple years back, my first ever 911 call went poorly: they had no protocol for pALS.

That 'incentivized' me to get 911 aware, so I contacted my local 911 authority and began a discussion.

The attached is the first-pass result of my two years of encouragement.

Please read it.
Please comment.
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File Type: pdf ALS CDE.pdf (206.2 KB, 68 views)
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Old 12-06-2018, 07:15 PM #2 (permalink)
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Default Re: IMPORTANT 911 Training for ALS - Please Review & Comment

In my experience, EMTs won't get through much verbiage, so I would try for one page with the same themes as the ALSA's, though could be better written and should include discussion about end of life documentation (look on frig, ask CALS), protecting joints, lack of trunk control, not rolling unless CALS says it's OK, etc. Also, their 12/6 BiPAP trial settings should be 10/4. I'd be happy to help you polish one up if you'd like.

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Old 12-06-2018, 10:08 PM #3 (permalink)
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Default Re: IMPORTANT 911 Training for ALS - Please Review & Comment

Good work Greg!
Two more topics.:
No oxygen for ALS patients unless they are on some type of mechanical breathing assistance or are being manually assisted with an ambu bag to improve the depth of respirations and lower their CO2.
Look for an Out of Hospital Do Not Resuscitate Order along with other advance directives. The form must be the correct one for the state they are in and signed by a doctor to allow comfort only care during transport and in the ED. Also, encourage all EMTs to inform the public of the importance of this form to prevent unwanted resuscitation.
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Old 12-06-2018, 10:43 PM #4 (permalink)
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Default Re: IMPORTANT 911 Training for ALS - Please Review & Comment

Quote:
Originally Posted by lgelb View Post
with the same themes as the ALSA's
I asked ALSA about such a doc, and even searched, no one had a clue
Quote:
Originally Posted by lgelb View Post
should include discussion about end of life documentation (look on frig, ask CALS),
That would be the MOST form
Quote:
Originally Posted by lgelb View Post
Also, their 12/6 BiPAP trial settings should be 10/4.
That's in the ALSa doc. I don't think First Responders should mess with that.. ?
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I'd be happy to help you polish one up if you'd like
Absolutely
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Old 12-07-2018, 12:42 AM #5 (permalink)
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Default Re: IMPORTANT 911 Training for ALS - Please Review & Comment

There are various state-specific forms, like MOST, POLST and more. So I think it would be best to say "State-specific forms." (And while I'm here, hope everyone has done the one that applies to their state, if/as applicable.)

I'll post a draft when I'm done. Will stand by 10/4 settings for the BiPAP-naÔve as every guideline there is says minimize EPAP unless someone has another pre-existing sleep disorder. While there is some data to suggest EPAP can be titrated up in bulbar onset, if they had bulbar onset, they would not be BiPAP-naÔve.
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Old 12-07-2018, 04:50 PM #6 (permalink)
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Default Re: IMPORTANT 911 Training for ALS - Please Review & Comment

I lost sight of an important point, entirely my bad!

The target audience for this is the 911 Operators, not the EMTs
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Old 12-07-2018, 05:24 PM #7 (permalink)
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Default Re: IMPORTANT 911 Training for ALS - Please Review & Comment

Why? The 911 operators aren't medically trained and pass minimal info to the EMTs.

When the EMTs show up, they're the ones that are going to touch you...

Reminds me to remind everyone, register with the Smart 911 program in your city if they are signed up!
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Old 12-07-2018, 06:02 PM #8 (permalink)
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Default Re: IMPORTANT 911 Training for ALS - Please Review & Comment

Because they're the ones trying to keep us alive while the first responders are traveling.

And because ignorance kills.
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Old 12-07-2018, 06:17 PM #9 (permalink)
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Default Re: IMPORTANT 911 Training for ALS - Please Review & Comment

OK...well, I think there's a need for all 3, let's put it that way. If the operator gets involved, she can sing from the same hymnbook.

I also advise everyone to have a MedicAlert dogtag or bracelet, etc. if you are alone at any point or in case something happens with your CALS.
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Old 12-07-2018, 06:45 PM #10 (permalink)
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Default Re: IMPORTANT 911 Training for ALS - Please Review & Comment

Laurie, thatís an interesting point about medical alert bracelets. Besides saying ďALSĒ, should it say anything else, like about no supplemental O2, etc.?

I know itís probably not even legal to say DNR (do not resuscitate), but maybe it could say something like POLST or Advance Directive on file?
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Old 12-07-2018, 07:26 PM #11 (permalink)
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Default Re: IMPORTANT 911 Training for ALS - Please Review & Comment

MedicAlert actually allows for DNR wording if you submit documentation that those wishes are on file. Check their site.

If the EMTs see DNR, and I think there is a checkbox for "only comfort care" as well, the oxygen issue should follow suit, but they have nurses you can talk to about exact wording.
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Old 12-07-2018, 07:26 PM #12 (permalink)
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Default Re: IMPORTANT 911 Training for ALS - Please Review & Comment

Quote:
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Besides saying ďALSĒ, should it say anything else, like about no supplemental O2, etc.?
Mine says no O2 without Mech ventilation, and my ICE info.

But could we please exit this rathole and return to the subject?
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Old 12-07-2018, 07:53 PM #13 (permalink)
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Default Re: IMPORTANT 911 Training for ALS - Please Review & Comment

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If the operator gets involved, CALS.
"If"?!?

I have to admit to being baffled. My wife was with the operator for about 10 minutes while the FD and Medics were responding.

The operator was the one telling my wife to lay me flat.

How does your 911 differ?
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Old 12-07-2018, 08:33 PM #14 (permalink)
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Default Re: IMPORTANT 911 Training for ALS - Please Review & Comment

I have lived in communities where 911 was all volunteer, for example. No operator was giving any medical advice. So all I'm saying is, it's not a given.

I think Karen's comments/questions speak to how P/CALS get on in the emergency system. It is a continuum where there may be communication between levels, or not. I was reminded of this yesterday, as my MIL was admitted through ER (a couple of thousand miles away from here, alas) and the floor thought the ER had hung the first unit, the ER thought the floor was going to start it...she was in imaging/her room for hours with no blood products and a hemoglobin of 5.

So sorry to hijack, Greg, but I'm not sure we really are.

Anyway, working on the one-pager now (tough to keep to one!). Will give Karen a crack at it next. Thanks for letting us noodle! And glad your wife presumably had enough sense not to obstruct your airway!

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Old 12-07-2018, 08:54 PM #15 (permalink)
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Default Re: IMPORTANT 911 Training for ALS - Please Review & Comment

Definitely works that way here Greg- the operator keeps you on the line and gives you basic first aid while you give first aid to the person you are calling about.

A guide for those operators is a brilliant call Greg, thanks!
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