Hot Line Is Life Line for Patients
— Baltimore F. D. photos
The frustration of finding no hospital personnel ready to receive patients because of lack of notification is of deep concern to ambulance crews anxious to see the competent first aid and transportation care they provide followed immediately by required medical or surgical attention.
Sometimes a hospital cannot be notified of an ambulance run because the emergency department phone is busy or all the lines into the hospital are tied up. At other times, the notification is received by someone who does not know who should be told about the message.
So a way out of this confusion in Baltimore, Md., was sought by Dr. Carl Jelenko of University Hospital, who brought the problem to the Baltimore City Fire Department. After discussions with members of the department’s ambulance service and communications division, it was decided to install a “hot line” telephone system linking the fire alarm office directly with University Hospital’s emergency department.
This installation was put in operation last March, and the system was extended to 11 other general hospitals in Baltimore last September.
Call director installed
The red phone used in the original installation in the alarm office was replaced by a red call director when the system was expanded. The other call directors in the office are gray. The red call director is located so that either the ambulance or radio dispatcher has quick access to it.
When an ambulance crew encounters a case requiring immediate hospital attention, such as cardiopulmonary resuscitation, or a hemorrhaging victim, a brief description of the patient’s condition and the name of the hospital to which he will be taken is radioed to the alarm room. The code, “notify the hospital,” tells the alarm room that a physician is needed immediately upon arrival at the hospital.
The dispatcher then picks up the red phone, which gives him a direct line to the hospital emergency department without dialing. In the emergency area of each participating hospital there is another red phone marked, “direct line from the fire department.” It has a loud double bell and a red beehive light. Only a doctor or an emergency room nurse is permitted to answer this phone. The dispatcher gives the person answering the phone information on the incoming patient’s condition.
After the radio report has been made, the ambulance crew, secure in the knowledge that medical help will be waiting, can give full attention to providing needed care for the patient while transporting him safely to a hospital. The Baltimore Fire Department Ambulance Service stresses proper handling, proper care and proper transportation. From experience, it has been found that these are more important than ambulance speed. Reckless driving can be dangerous for both patients and ambulances. If necessary to avoid an accident, ambulances stop at red lights and stop signs and slow down at intersections.
Value seen evident
The first use of the hot line occurred during the weekend after it was installed in University Hospital. This hospital was notified that two seriously burned, elderly persons were being brought in by ambulance. Burn specialists were prepared to treat the patients immediately, and the two elderly persons survived. Dr. Jelenko stated that the hot line had paid for itself within the first 48 hours.
A couple of days later, a city fire fighter was trapped when his auto collided with a truck loaded with sand. Fire apparatus was summoned, and it was necessary to cut the fire fighter’s car apart to extricate him. An ambulance crew splinted both legs of the fire fighter, who also had serious internal injuries. University Hospital was notified and an operating room was readied for the patient. The credit for his recovery was given to the immediate mobilization of hospital personnel through the hot line.
“It is highly likely that any delay in the management of this particular patient might have led to even greater complication than was experienced by him—even to his demise,” Dr. Jelenko said in a report written for a medical journal. “We believe that the ability to manage his various problems immediately resulted from our prior knowledge of his condition, which was of tantamount importance.”
Approved by Hospital Council
Newspaper stories of the hot line’s effectiveness aroused the interest of the Hospital Council of Maryland, which sent a brief notification of the line’s availability to other Baltimore hospitals. The council recommended that other member hospitals install the hot line. The 11 other hospitals which joined University Hospital in the notification system found that a phone could be installed in their emergency rooms for a small fee plus the monthly distance rate of a direct line.
A feature of the call director at the fire alarm room is the use of the first four buttons, which are red instead of the usual white, to indicate the hospitals that also participate in the emergency squad doctor plan. Under this plan, surgeons are taken to the scene of an accident. They may give the victim sedation while he is being extricated, or they may even have to amputate on the scene.
The hot line can be used to notify hospitals of any incident which will result in many persons being taken to hospitals. It is the latest of the many firsts in the operation of the Baltimore Fire Department Ambulance Service.