Mutual aid likely woudn't have sped aneurysm response

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Editor's note: This is one of a series of articles in The Lebanon Voice exploring the use of determinant codes in the dispatch of EMS providers and the challenges as well as benefits it can bring to the people of Maine.

Lebanon and Milton rescue may now have a mutual aid pact that prompts automatic responses from both towns for many serious medical emergencies, including strokes, but that doesn't mean that a ruptured brain aneurysm like the one suffered by Lebanon Voice President Martha T. Soto-Galicia in February would trigger the automatic response even now.

Many might think that a ruptured brain aneurysm, which kills almost half of its victims outright, and leaves two third of those that survive with disabling complications, would draw the same kind of response as a diabetic emergency or trauma - or a chimney fire on the Fire Department side - but you'd be wrong.

That's because a ruptured brain aneurysm, also known as a subarachnoid hemorrhage or hemorrhagic stroke, does not display the symptoms of the more widely prevalent Ischemic stroke, which comprises about 85 percent of all strokes.

Drexel White, Emergency Medical Dispatch Program Manager for Maine EMS, spoke to The Lebanon Voice this week about typical instructions and questions used by emergency medical dispatch personnel regarding a stroke diagnostic.

They include: Have the patient smile. Now is the smile equal on both sides of the mouth?

Have the patient raise both hands.

Have them say, "The early bird catches the worm."

Finally, is the patient answering and following directions appropriately.

If the victim's smile is even on both sides, if they can raise their hands and repeat the requested phrase, it would not be diagnosed as a stroke, White said earlier this week.

However, there could be a change on the horizon: the use of determinant codes that are produced after a longer list of questions that could trigger an automatic response from Milton and Lebanon, that is, if they and Sanford Regional Dispatch, which handles Lebanon emergency calls, also used determinant codes.

Right now they don't, Sanford Regional Dispatch Center supervisor Bill Tower said on Wednesday.

And the reason is not just logistical, said Tower, but also philosophical.

"Determinant codes by the time you dispatch can take valuable time," Tower said. "You could be waiting several minutes to complete the determinant code questions."

Tower also said he doubted the rescue workers at volunteer departments would be able to devote the necessary time to learn the myriad of codes used.

"Within a lifesaving incident, it's more important getting people to the scene," said Tower, who added he can usually have boots on the ground and headed to an emergency in 30 seconds.

White, however, thinks determinant codes are beneficial because they take the human factor out of making the appropriate response.

But he realizes there has to be a culture change for them to be implemented. In the old model, the call comes in, the person in charge makes a spot decision based on his or her knowledge and they either "call in the cavalry" or determine a less urgent response.

In the system White advocates for, "The Medical Priority Dispatch System provides a consistent method of medical call processing. In addition to being of value to responding services, the determinant code is used for data collection and analysis to help centers quantify the types of medical calls received."

Even Tower believes that determinant codes will very soon become the general rule.

But White and Maine EMS as of now are not mandating them in hopes that EMS services, themselves, will soon begin asking dispatch centers to broadcast them, which would be a "sign that (EMS) services are realizing the value of using the codes as part of their response models."

A typical ruptured brain aneurysm is manifested by patients complaining of "the worst headache of my life," stiff or no feeling in the neck and nausea.

Taking questions as part of a determinant codes protocol, none of those drew a high-urgency response, however, what did was the "severe onset of sudden intense pain within three hours."

That would've generated an "18 Charlie 4 L," White said.

Charlie is a midlevel response which would trigger Advanced Life Support.

But without those codes being used by Lebanon or Milton, or broadcast by Sanford Regional Dispatch, all bets are off.

The Lebanon Voice asked Lebanon Fire-EMS Chief Dan Meehan if someone called up with symptoms like what Soto-Galicia suffered would that trigger an automatic response, to which he replied, "We would respond to what dispatch passes onto us, if we feel that "automatic" is needed and not done by dispatch then the crew on can have dispatch call for the automatic."

Soto-Galica suffered impaired eyesight, sudden onset diabetes and short-term memory loss as a result of the ruptured brain aneurysm.

Milton Fire and Rescue Chief Nick Marique did not return several calls for comment on this story.

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