In a situation where minutes count, first responders need to quickly assess the situation and make decisions that can ultimately save a life. Questions such as what level of care the patient needs, where to take them and how to transport them are all decisions that paramedics have to make.
American Medical Response is a private ambulance service, but also goes by Troup County EMS and has partnerships with the LaGrange Fire Department, Troup County Fire Department and Troup County 911 dispatch center.
Doug Norton, AMR operations manager for the south region of Georgia, said Georgia has two types of ambulances: Advance Life Support and Basic Life Support. AMR responds to each call with an Advanced Life Support truck that will have, at minimum, a paramedic and emergency medical technician.
A paramedic, the highest trained professional there, is the one that makes decisions for the patient care and transportation, Norton said.
Based on the evaluation, the paramedic will assess the patient and determine what kind of hospital is capable of treating the problem.
“We don’t have X-ray vision, we don’t have a lot of the tools the hospital does - the diagnosis equipment - to say definitely what is wrong with the patient. What we have to rely on is our training and our skills and doing an assessment,” Norton said.
At that point there are two options: load the patient up in the ambulance or call for a helicopter, which Norton said gains the team speed in a situation where time is vital.
“We make that decision based on will they survive the ride or do we need to get them their quicker,” he said.
Norton added that helicopters also provide a nurse on the scene in addition to a paramedic, which ambulances do not.
Norton noted that paramedics can only see outside injuries and cannot see what is going on inside the patients body and in all assessments, paramedics are taught to consider what he called the “mechanism of injury.”
“Even though you may not see something visibly wrong with the patient, consider the mechanism of injury,” he added. “Sometime we error on the side of caution … and take them to a hospital we know can give definitive care.”
With areas of concern being trauma, and injury to the heart and brain, Norton said patients are taken to hospitals that can provide definitive care in even the most advanced procedures and treatment.
Often times, patients are not taken to West Georgia Health because they need a specific type of surgeon or level of treatment that it cannot provide.
“West Georgia is a fine hospital. If you look at the hospitals in rural areas around here, (WGH) is light years ahead of everybody else, but the problem is they don’t see enough of those types of patients to warrant having all those surgeons there,” he said.
However, in the state of Georgia, the patient always has the right to choose which hospital they want to go to, Norton said, adding that the paramedic gives a suggestion based on the assessment.
Ambulances are not designed to treat patients, Norton said, but to stabilize and take them to a place that can fix them.
A paramedic also has constant contact with medical control where they can speak to a doctor and give the assessment and gain a second opinion. In an example where a patient has experienced a severe accident, but appears to only have minor injuries, a doctor and paramedic can work together to determine to take them to a advanced trauma center or by helicopter to err on the side a caution.
With cases that are usually trauma cases, such as gunshots or car accidents, helicopters will be on standby and hover until they are told if needed or not.
Though a helicopter can potentially save a life, it can also cost up to 10 times as much as a ambulance rides. In addition, insurance companies wont pay for helicopter transportation, which can add a hefty bill on top of already expensive hospital bills.
“I’ve seen them as low at $2,000 (and) as high as $10,000,” Norton said.
Patients cannot choose to decline or request helicopter transportation, he said, but patients are flown out when there is concern that they will not survive an ambulance ride or if the severity of the trauma or accident have a high risk of internal injuries that are not easily diagnosed on the scene.
Each case is unique with no definitive procedures for specific types of injuries, Norton noted.
“The one thing that is constant in our business is that every call is different,” he said.