911 Dispatchers Seek Help in Nurses

June 7, 2008 — -- Most people know that their best bet for emergency medical attention is to call 911.

But what about refilling your prescriptions or diagnosing that peculiar rash on your arm?

They are hardly emergencies, but that doesn't stop many residents in Houston, Tex., as well as other cities across the country, from calling 911.

"A lot of people who call 911 do so for a non-emergency," said Dr. David Persee, Houston's director of Emergency Medical Services. "As many as 40 percent of ambulances sent out following a call end up not even taking anyone to a hospital."

So Persee developed a system to combat the problem that he says is tying up ambulances that could be responding to real emergencies. It's called tele-nurse.

"The system will operate in a way that when someone calls 911 and the dispatcher is confident it's not an emergency, the caller will be transferred to a nurse," Persee said of the program that the City Council passed Wednesday.

"The tele-nurses will have time to ask a lot more questions, and sometimes they'll advise the patients over the phone and others will tell the caller that they should seek medical attention in the next 48 hours," Persee said. "Then they'll get the caller in touch with a clinic or health care provider."

Persee estimates that of the 750 calls the Houston EMS squad responds to each day, 500, or about 66 percent, are transported via ambulance and the remaining do not require additional care.

As the tele-nurse program begins in the coming weeks, Persee says only 20 of those calls will be handed over to nurses until they are sure the kinks in the system are ironed out.

The cost of an ambulance ride – and the subsequent visit to an emergency room – is another factor influencing Persee's initiative. An ambulance ride to an ER in Houston averages about $400, said Persee, not including additional costs for mileage and the hospital care.

"Using the emergency department is probably the single most expensive way to care for a non-emergency," Persee said. "That's a big bill."

Can Nurses Do the Job of a 911 Dispatcher?

While Houston is not the first city to develop a 911 system that commissions the help of nurses – both Richmond, Va., and Philadelphia, Pa., have similar programs – medical professionals told ABCNEWS.com that the concept is still fairly new.

Dr. Linda Lawrence, president of the American College of Emergency Physicians, said that the plan could benefit patients as long as the nurses receiving the calls are properly trained.

"If the tele-nurses are appropriately trained and their screening is done very, very conservatively to err more on the side of using the emergency department than not, then for those who are truly easy to identify as non-emergencies, this system will be good," she said.

There is no denying, added Lawrence, that there is some risk in not treating a patient face-to-face, but that the program in Houston seems to have recognized that by increasing their liability insurance.

"There's always going to be the potential to miss a real emergency or misdiagnose when you're doing tele-triage," Lawrence said.

But Persee is confident in his dispatchers' ability to differentiate between emergencies and non-emergencies.

"We prioritize calls and we're pretty good about identifying what is a life-threatening emergency," Persee told ABCNEWS.com, adding that the department has been studying 911 calls and outcomes for six years. "A lot of people scream and panic on the phone but really what they're suffering from is just a bad laceration; it's just very bloody."

Persee estimates that less than one percent of basic ambulances that are sent to callers' homes ever request parademic back-ups.

Denise King, president of the Emergency Nurses Association, has similar concerns about overlooking at-risk patients.

"It's very difficult to gauge sickness over the phone," King told ABCNEWS.com. "There would definitely need to be strong and well thought-out protocol for the nurses to follow."

In the tele-nurse program that has been in practice in Richmond for more than a year now, the director said that there have been cases where nurses hand calls back to the dispatches and request that an ambulance is sent to the patient.

"But we've never had a non-emergency end up being an emergency," said Jerry Overton, the executive director of the Richmond Ambulance Authority.

And King reminds that nothing in the medical profession comes without risk, and neither will this program.

"These risks could be managed with solid quality insurance and oversight, but in the end nothing is really without risk," King said.

"Even when a patient comes in to get triage care face-to-face, unfortunately, we don't always get it right," King said.

"Just coming to the emergency room carries a certain amount of risk, as well."