The Politics of Emergency Response

17 March 2016
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Over the last few weeks I’ve had conversations with several insightful people in order to get a better understanding as to how the various Medical Emergency Services are engaged, how advanced Emergency Planners (as potential users) leverage the EM services … and how they don’t absolutely rely on them and why.Cry for Help 5

My particular interest was for rescue in real wilderness areas such as where I spent most of my time as an Oil & Gas surveyor and had fortunately, never had to test out the Emergency Response System. Although I stated that these remote situations were my area of interest, I often thought that the answers that were offered were for a different situation, even when rephrasing the question it didn’t seem to affect the (second) answer.

Not surprisingly I guess, contacts at AHS (Alberta Health Services) and STARS (Shock Trauma Air Service Society) were incredulous when I suggested that making the first call to my supervisor might be a better option than calling either STARS or 911  (a conversational stimulant, trust me) but it seemed as though a switch just flipped, red lights were everywhere … “what could my supervisor possibly do that they could not? This would only extend the time ’til rescue so how is this good? They couldn’t possibly know the correct questions to ask or be able to connect efficiently with ‘real’ rescue crews.” Wow, did I just step on a land-mine? Was I crazy, dumb, not thinking straight, ill informed … “this should NEVER happen, NOT a good plan!”

When the steam cleared I suggested a very real scenario:  “What if you could yell HELP only once … who would you communicate that one word to … your mother? … 911? … STARS? or your supervisor? … Which one would have even a slim possibility of getting you out alive?” Unfortunately, their answer was to ignore the nuance of the question and to reinforce their solution as the most sensible, as if this was not possible … a real conversation would always be possible.

Cry for Help 4I can’t resist thinking that following their thought pattern may have cost someone their life already … how would we know?

Let me clarify: When the 911 or STARS call is connected and someone yells ‘HELP’ and the call disconnects, what can either 911 or STARS possibly do? … they don’t know who it was … nor where they are … the call might be traceable to a 30km radius of a cell tower but that won’t happen immediately … they’ll likely wait to see if the call comes in again … what if it doesn’t?

My supervisor would either know my voice or by deduction determine that it was me and he knows (more or less) where I should be … that’s about a thousand times further ahead than 911 or STARS … isn’t it? … he (or she) can sound the alarm; makes perfect sense to me.

I also asked “Who is it that decides whether a ground or air crew is activated for a particular emergency?” Previously I’ve been told that a doctor decides … makes sense but I’ve never seen an ER doctor take that call (don’t ask why I’m in ER more than I should be). So that really wasn’t the correct answer.  This time, one answer was that STARS ONLY flies if either an EMT or an RCMP makes the call … and only while on the scene. I knew that this mustn’t be true as I’d never heard of anyone waiting that long in a remote situation but my head was nearly chopped off when I suggested that that wasn’t always true …  “I’m sorry if that isn’t the answer you wanted but that is the only way STARS flies!!”  Whow … sensitive or what! … is there some sort of territorial boundary that I’m pissing too close to here?

I was sure that it had to be possible, as a mere mortal, to be able to convince someone who wasn’t on the scene that engaging STARS was the correct thing to do so I called someone from the Oil & Gas Industry who takes Emergency Response Plans extremely seriously to get a feel of how he sets up an ERP that covers some drastically diverse scenarios.

Most of his work is in the same kind of remote locations that I was wondering about … and I found out a few things that we take for granted and that aren’t exactly openly confessed. Things like; even if STARS is contacted either directly or via 911 … even if the weather is perfect, they may not be available to respond as they may be committed already; or they may be redirected part way out to your emergency to a more pressing situation … “really?” says I. “Yup, that’s why I always have local helicopters fully informed and geared-up as part of the ERP. They’re working directly for me then so there’s no rerouting!” … “and if we ground transport I have 3 or 4 transfer locations kept clear for meeting AHS ambulances and always on the main route, preferably the highway, so that they can’t get lost” he says “I always personally meet everyone that I’ll be communicating with so that there is no confusion as to my seriousness and thoroughness … so when I tell them we need their assistance, they respond!”

So, there you have it … STARS does fly without RCMP or EMT on the scene first but you’ll need to be cool, calm and collected to make it happen … but don’t count on them entirely! and should I go back to working in the field, I know who I want covering my back!

– Rob Coutts


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