STATEN ISLAND, N.Y. — It’s a beautiful weekend morning and you’re talking with neighbors. One of the older members of the neighborhood mentions that he’s not feeling well. He saysthat he has had indigestion all morning. He looks pale and mentions that he feels weak. Your first thought: “Looks like a heart attack.”
You tell him that he probably should go to the hospital, pointing out some of the clear signs of heart attack that he is experiencing. He agrees. 911 is called.
First, the fire truck arrives. “What?” You wonder why the firefighters are here — there’s no fire. Next, an ambulance pulls up and the crew speaks briefly to the firefighters as they treat the patient. You hear the discussion about whether the paramedics can make it there before they get the patient to the hospital. Wait a minute. Paramedics? Who is it that’s treating the patient? Now you’re really confused. And you’re not alone.
Typically, on Staten Island, when a call is received at 911 for a medical emergency, the Fire Department is dispatched. On the fire truck there is a certified first responder and/or a New York State Emergency Medical Technician (EMT) who is also a firefighter. When the firefighters arrive on the scene, the medical personnel will bring oxygen to the patient while awaiting the ambulance.
For the previously mentioned patient —an older man with chest pain who is possibly having a heart attack — the 911 dispatcher will try to send a paramedic (advanced life support, aka ALS) unit. There may be a basic life support (BLS) unit closer, and they will be dispatched first or along with the ALS unit. There are more BLS units than ALS units because of the specialized training required to become a paramedic.
There are two basic emergency medical technicians (EMT-B) on the BLS ambulance. They have the ability to administer oxygen, aspirin and monitor vital signs including blood pressure, pulse and respirations. The EMTs can administer some medications for breathing, as well as give albuterol by nebulizer and epinephrine through an EpiPen injection. If the EMTs find that the patient is in need of more treatment than they are trained or able to provide, they will request that the dispatcher send paramedics. The difference is in the training and extent of what they are allowed to do.
Paramedics are the highest level of EMTs and carry more than three dozen different medications that can be given intramuscularly, intravenously, by inhalation, into the nose, and into an intubation tube for pediatrics. The paramedic unit can also analyze an in-depth electrocardiogram, providing medication, shock, or pacemaker capacity if necessary. The EMTs and paramedics often work together to treat the patient.
It can be confusing to call 911 and not know why certain medical help does or does not show up. Just know that the decisions are always made with the patient’s best interests in mind.