Play it safe: Call 911
in case of trouble

That's one of the messages being spread during national Emergency Medical Services Week, today through Saturday, sponsored by the American College of Emergency Physicians.

A new ambulance for Nanakuli will be blessed tomorrow as part of the activities in Honolulu, while an ambulance and emergency services personnel will be stationed at Honolulu Hale all week.

To help kick off the week, we asked Patty Dukes, chief of Honolulu's Emergency Medical Services Division, to advise readers on when they should call for emergency medical aid and when it's probably not necessary. Dukes (with an "s" and Duke, as in Patty Duke, the actress) has been a paramedic in Honolulu for 22 years, taking over as chief in November.

The "Don't Stall" slogan evolved out of a survey in the 1990s to see how long it took people to call for an ambulance, she said. It turned out, way too long: an average of nine minutes.

After the "Don't Stall, Call 911" campaign was launched, call times improved, but today, "there's still a little bit of lag time," she said.

Dukes emphasized it's important to call for medical help immediately if there is any chest pain or difficulty in breathing, a sudden onset of weakness on one side of the body, a severe headache, slurred speech or severe hemorrhaging of any kind.

If someone has collapsed but comes to, "it's still appropriate (to call 911) to be certain everything is well," she said.

You'd think people would tend to call for emergency help in those kinds of situations anyway, but some "would just rather wait it out" or get a second opinion, Dukes said. "I guess they're just afraid they're going to make a mistake. They're going to call an ambulance and it's not really needed, then they've embarrassed themselves and drawn attention to themselves. ... We try to reassure people that that's not the case."

It really does come down to being better safe than sorry.

On the other hand, there are situations when calling for emergency help isn't necessary.

If you've fractured a limb with bones protruding and are unable to walk, that's considered an emergency. Even if you broke a limb, but are able to get around, without any other life-threatening symptoms, or able to get to a hospital safely some other way, then there is no need to call for an ambulance, Dukes said.

Still, "it's not up to us as emergency medical dispatchers to question the integrity of our callers," she said. "If they're saying it's an emergency, we want to make sure we get to the scene to check it out to be certain. It doesn't matter if it isn't an emergency; we're still there to make the right choices and to help the patient make the right choices."

Dukes said her office is working with the state Department of Health to try to develop policies "on when we can reasonably and legally discharge patients at the scene."

Now, the only way patients who call 911 for an ambulance will not be transported is if they are adults, deemed competent to make a decision, who declare they do not want or need such help.

Those who are not allowed to make such refusals are minors or people under the influence of any kind of substance. If someone is violent, police will be called to help decide on transport to an appropriate facility, Dukes said.

Meanwhile, drivers are advised to be on the visual alert for any emergency vehicles on the road, since aural warnings often may not be heard.

With cars being built to be soundproof and drivers enveloped by the sounds of music or talk radio, it's difficult to hear a siren these days, Dukes acknowledged.

"It goes back to what you learned in driver's ed," she said. "You're supposed to check your rear-view mirror every couple of seconds."

And if you do see an ambulance approaching? "Pull out of the way of the ambulance in a safe manner: Flip on your turn indicator and change lanes," Dukes said. That doesn't necessarily mean to the right lane and that doesn't mean stomping on the brakes and coming to a sudden stop.

"We don't want people in the left lane to suddenly cross four lanes of the highway to get to the right," she said. "If they pull over to the median, that's a perfectly safe and proper thing to do."

Another safety tip: Don't "draft" in the back of an ambulance.

"That's dangerous to us and dangerous to patients and it's dangerous to (the tailing drivers)," Dukes said.

The EMS system is statewide, administered by the state, but left to each county to provide the services. In Honolulu, the city handles the contract, Dukes explained, while a private company handles the services in Maui and Kauai counties, and the Hawaii Fire Department does it on the Big Island.

On Oahu, the city's emergency dispatch center accepts more than 81,000 calls a year, about 66,000 of them generating responses (multiple calls for the same incident accounting for most of the other calls), Dukes said.

Honolulu has about 210 paramedics, emergency medical technicians and emergency medical dispatchers (all trained in emergency medical services); 18 ambulances; and two "rapid response" vehicles, one stationed in Ewa Beach and one in Kaaawa.

The latter are vans staffed with paramedics with everything necessary to respond to a call, but not able to transport a patient.

They are sent on calls in which an ambulance is not needed, such as helping to facilitate pronouncements of death, and used as backups in areas such as Kaaawa where ambulances may not be readily available.

The rapid response vehicle "is able to tend to life-threatening situations, making a difference right away," Dukes said. By the time an ambulance shows up, the patient is ready to be taken immediately to a hospital.

EMS Week is meant to recognize the work of paramedics and emergency medical technicians across the United States, Dukes said.

It's to pass on the word that "we'll get to your house and take good care of your family," she said. "It's kind of like bringing the emergency room to you. We can do a whole bunch of things for you before we even take you to the hospital. ... The only thing we can't do is surgery."

But even before an ambulance arrives, dispatchers can also make a difference. They are trained to provide "pre-arrival instructions" to people, such as in the Heimlich maneuver, CPR and how to deliver a baby.

"The most cool thing is (instructing over the telephone) how to deliver a baby," said Dukes, who's done that and considers it "the pinnacle of my career."

"People don't call us for happy occasions very often, and that's one of the happiest."

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