Abusing the 911 System Could Be Deadly -- Even for You!

When I teach my CPR and first aid classes, I usually like to start out by explaining to the students that the 911 system is not perfect. This might come as a surprise to many of you.

Why isn't it perfect? Well, let me list a few things. For one, emergency responders can get lost. There was one incident where two brand new Emergency Medical Technicians (EMT) in my old company took 20 minutes to respond to a 911 call because neither one of them knew their way around town. There were times where my partners and I got lost because either one of us was confused with the directions or the address wasn't clear enough. There was one time when my partner had to stop and ask for directions because one particular address almost seemed as if it didn't exist.

Emergency responders do break down. One time while responding to a 911 call, the sirens blew out! It was a brand new ambulance too, and already something happened to it! Go figure! There was another time where I almost got into an accident because the brakes on the ambulance almost gave out and we nearly rear-ended someone. Another time when I was responding to a call, we hit someone else's car because that person failed to yield to us. We ended up pulling to the side instead of going to the call, even though the accident was very minor with no injuries.

The ambulances that my company had weren't very reliable due to poor maintenance. We would have a parking lot full of ambulances and only four of them would be any good. In fact, the ambulances were so bad that each of them were known for a particular problem. In the mornings when EMT's were assigned their buses (we also called ambulances buses), it wasn't uncommon to hear people say, "Ah crap, I got Bus 33," or "Can I get another bus," or "You wanna trade buses?"

Dispatchers could be a cause for many problems. Dispatchers or 911 operators have the most important job in the 911 system since they are the first ones who get the call and are responsible for relating those calls to the right unit, getting down accurate information including address, etc., etc. Some dispatchers could get the information wrong and might end up sending a unit to the wrong address. Some dispatchers don't know how to speak clearly over the radios. One time while I was a volunteer EMT at Central Park in New York City, there were four of us EMT's in one bus and we were listening to this one particular dispatcher over the radio whose first language was obviously not English. Her strong accent really got in the way of her communication.

However, language isn't always the problem. Sometimes, dispatchers just don't know how to talk. One dispatcher in my old company talked so low that I had to almost struggle to understand what she was saying. Some dispatchers also don't understand that when they're talking over the radio, they have to really enunciate their words, otherwise emergency responders would just have to guess what they're saying.

In many smaller communities, there is a high dependence on volunteer ambulance companies. Some communities may have as little as one ambulance serving an entire communty. This would of course mean that if there are too many calls at one time, there would be no available units to serve your needs, and you'll unfortunately just have to wait your turn. It is very possible for there to be no available units to respond to any calls. There were times where my partners and I were kept over past our shift because no units were available, and when EMT's come late to work, that makes it bad for those who want to go home but can't.

But what really makes the 911 system not perfect is the fact that everybody calls 911 for literally everything, whether or not it is an emergency. This is what really makes a situation dangerous for those who truly need help: when an emergency responder is wasting time with someone who has a paper cut, that makes one less unit on the street, and therefore one less unit available to respond to a serious call. So if someone is having a heart attack, well, hopefully that person could hold out until somebody gets there.

Police officers have more flexibility in leaving a call quicker if they aren't really needed. The fire department have more flexibility in leaving a call if their service isn't really needed. The ambulance, however, does not have that flexibility. No matter how minor or silly the problem is, EMS responders cannot just up and leave, or else they could lose both their job and their license if they are brought to court and convicted.

What is Emergency Medical Services (EMS)

Before I go on any further with the imperfections of the 911 system, let me explain the medical service part of the system. Emergency Medical Services (EMS) involves an ambulance company that responds to medical emergencies. When you dial 911, the operator would specifically ask what your emergency is. Once you tell the operator what's going on, the operator would decide what kind of call it is, who should be responsible for the call, and how important the call is. If your situation happens to be medical, then the dispatcher may call just the ambulance or both the ambulance and the fire department (fire fighters are also trained to provide some medical attention -- so don't be surprised to see the fire department arriving on your door steps first).

In EMS, there are three types of workers: EMT-Basics, EMT-Intermediates, and EMT-paramedics. All of them provide the same function, except paramedics and intermediates can provide medication, but paramedics could also intubate and read ECG (or EKG) scans. Basics provide mostly traumatic (injury) attention such as splinting, delivering babies, bleeding control, CPR, first aid, etc. Not everybody in the ambulance is a paramedic, but all three types of these workers are generally described as EMT's.

If you would only notice this one thing, you would see that these medical types are trained to do serious work. They are there for life-threatening or potentially life-threatening situations. If you and your girlfriend got into a heated argument and she hits you with a frying pan so hard that it knocked you out, EMT's are there to help you. If your child swallows a penny again but chokes this time, EMT's are there to help. If you get into a serious car accident, accidentally sawed off your finger, got stabbed, etc., etc., that's when the EMT's come on scene to help you out.

EMT's, just like other medical professionals, are under what is known as protocol (basically, rules and guidelines) that they must be careful to follow or else risk losing their license. One such rule is that once you get in contact with a patient, you cannot leave until other procedures are followed: the scene becomes unsafe for you and your partner, another medical professional on either your level or higher comes to take over, if the patient signs a refusal for medical attention (RMA), or if obviously the patient runs away. No matter how serious or minor the call, EMT's can't just get up and go without following procedure. Unfortunately, when silly calls are made, EMT's have to be there until all procedure has been followed.

For instance, one time my partner and I got a call for an eye infection in a baby. First of all, an eye infection is not an emergency for the ambulance. For something like that, you need to head to the hospital yourself. We headed over there with lights and siren, arrived at the building, and walked up about three flights of stairs with all of our heavy equipment. When I first saw the baby, I didn't notice any infection. When the father pointed out what the problem was, my first thought was "You got to be kidding me!" It was nothing more than a tiny sty on the upper eyelid. A sty is a tiny bump around the eyelid or eyelash that could make blinking very uncomfortable. The baby didn't seem bothered by it at all, but the father never wanted us to take the baby to the hospital, but just to check out the eye. What's really bad is that this family was literally a few blocks away from the hospital!

Now ideally, after we've checked out the eyelid and saw that the problem wasn't serious, we could just leave. That would be every EMT's dream, but it ain't gonna happen! Now even though we know the problem wasn't serious, guess what? This call is an RMA, so yes, we still got to do the paper work! But first, we had to call dispatch to let them know the situation. Dispatch then has to have the supervisor call us so that he could approve the RMA. After that, we have to call medical control so that a doctor or approved nurse or physician assistant could approve the RMA. Then we have to check the baby out for vitals such as pulse and respirations (blood pressure wasn't necessary since it was only an infant). We had to do a quick look down to make sure nothing else could be wrong with the baby. Then comes the paper work. Afterwards, the parent must sign stating that he refuses medical treatment and transport from us. All of this work done for a very, very minor case, and it took about 15 or so minutes.

Just to let you know, EMT's are not doctors. They are not trained to diagnose problems. They are not there to prescribe medication, take X-rays, give counseling, or anything that a medical professional in a stable environment could do. And even if you see an ambulance sitting by a McDonald's doing nothing, don't think that they are getting paid just to chill. They are on stand-by, and when an emergency happens, they will be sent to a call. Actually, seeing an ambulance sitting around is a good thing -- it means that a unit would be available if something happens to you!

Now, what happens when an ambulance does take a patient to the hospital? After the ambulance arrives at the hospital, the EMT's take the patient to the emergency room where the patient would get triaged, meaning that a nurse would look at the problem and give it a priority. So for those who think that they would be seen quicker if they come by ambulance, think again! If you're problem isn't serious, you would be sent to the corner somewhere and wait forever. That's what happened to one of my patients. After we took her to the hospital and left, we returned to that hospital with another patient about six hours later. Guess what, people? Our first patient was still sitting in the emergency room. Maybe that's why she had us carry all those bags for her because she probably knew that she would be there for a while. What was funny was that on another day when I was sitting in an ambulance back at the station listening to the radio calls, I heard dispatch sending a unit to a familiar address for a patient who supposedly fell. It was the exact same patient with the exact same problem! When I talked with the EMT's who transported her, they described that they did what my partner and I had to do: help her carry her bags downstairs.

After the patient has been triaged, we have to get a signature from a doctor, nurse, or physician assistant. This signature means that the patient is no longer in our care. We would head back to the ambulance, clean up anything that we need to, and let dispatch know that we're ready for service.

Being at the hospital could be pretty lengthy if it's a very busy day or night. EMT's cannot leave the patient at the hospital without a signature, because that could be abandonment due to the fact that no particular person took over the care of the patient. So until we get that signature, the patient is our responsibility. So if we have to wait a long time to get a signature, well, that just means one less unit on the street.

So no, it's not all about throwing a patient into the ambulance, racing to the hospital, dumping the patient there and then leaving. Transporting a patient is very involved, which is all the more reason why EMT's should only be used for true emergencies, not for nonsense.

What is an Emergency

I think that once people understand what an emergency really is, it would (or should) lower the 911 call volume and free up emergency responders for serious calls.

An emergency is urgent, needing immediate attention or else serious consequences could happen. If you're living in southern Texas where it could get up to 700 degrees and your air conditioner isn't working, that's an emergency because people, especially elderly folks, can die from overheating. In the same way, if you live in northwestern New York where people basically live in igloos and your heat is out, that's an emergency because people can die. If, on the other hand, your faucet is leaking or you have a crack in the ceiling, those are not emergencies. Those things do not need immediate attention, but they should be looked into soon because an emergency may happen if the problem goes untreated for too long.

So how do you know if you need to call 911 or if you could take care of the problem? Well, before we get into that, let's go over when you shouldn't call 911:

To be seen in the hospital quicker. You might as well take your butt to the hospital, because whatever problems you have doesn't need immediate attention.
Otherwise, you would know that if your problems are serious enough, you will be seen very soon. One time when my partner and I dropped off a patient at a hospital in Brooklyn, NY, we were getting ready to leave in our ambulance when one guy drove by us telling us that someone's been shot -- and that the victim was in his car! I rushed to the emergency room to let the guard know that we have a gun-shot victim, so he had the driver to drive to the emergency room entrance and he called for the trauma team. Then the trauma team was called for over the PA system. Meanwhile, both my partner and I along with several other EMT's rushed to get the patient out of the car and onto a bed, then all of us pushed him to the emergency room where the trauma team was waiting to begin work. That patient was seen right away.

To make a house call. Remember, EMT's are not doctors. Do not call them to just have something checked out. If you want something checked out, go to the hospital yourself.

For minor injuries. If you could put a bandaid over it, don't call 911. If your injury doesn't prevent you from walking to the hospital without problems, then go to the hospital yourself.

To have your blood pressure taken. Unless the ambulance has a special service for that, don't call them to have your pressure taken unless you're feeling like you're going to pass out. In that case, you would call 911 because you think you could faint, not because you want your pressure taken. In all calls, whether serious or not, EMT's will take your pressure regardless.

Because your water broke. Believe it or not, this is not necessarily an emergency. Even after your water breaks, it could still be hours until you deliver the baby. Your water breaking is only one of several indications that you're ready to deliver. If you're by yourself with no means of transportation, then call 911 if not a cab.

If you think you broke something. If you could still walk to the hospital without any problems, then do it.

These are just some of many reasons why you shouldn't call 911. The key is to only call when there is an emergency, but not everybody agrees as to what an emergency is. What may be an emergency to you is not an emergency to me. So, let's see what a true emergency would look like.

If a person is unconscious and can't wake up, that's an emergency. If a person isn't breathing or if the heart isn't beating, then we have an emergency. If a person is a victim of serious violence such as gun shots, stabbing, a brawl, etc., we have an emergency. If you were just hit in the face, go to the hospital yourself. If a person is having seizures, we have an emergency.

If a person is coughing too much, that's not an emergency. In your throat, you have a flap that separates your wind pipe and your esophagus called an epiglottis. This thing stays open 24/7 to allow air to come in and out of your lungs. The only time that thing would close is to let food and liquid pass on by, or if you are holding your breath. When food gets into the wind pipe (trachea) because you were laughing and eating at the same time (which confuses the epiglottis), your body would immediately try to push that food back out by coughing. Usually, coughing does the trick, so when someone coughs, just let them cough. Don't pat their backs or give them water. As long as they could cough, they are all right.

Now if the person is choking, that means that the food is too big for the body to cough out and the trachea is blocked. When it's blocked, no air could come in or out of the lungs, so the person would suffocate. This person cannot cough, talk, laugh, sing, sneeze, curse, or anything that involves air usage. This person would start turning blue around the lips because his body is being starved of oxygen. In this case, you would call 911. As for a child, even if he was choking but you successfully got the child to breathe again, you should still call 911 so that child could be monitored just in case his trachea swells up. So if a person verbally says that he's choking, he's not. He's just coughing too much.

A heart attack and cardiac arrest are different. A heart attack means that the heart is in trouble and cannot pump properly. Cardiac arrest means that the heart stops and the person is usually unconscious. Both cases are emergencies, but a victim with cardiac arrest cannot call 911. If you think that you're having a heart attack, call 911. Classic signs are chest pains, numbness in the left arm, fear of impending doom, sweatiness, etc.

If a family member is diabetic and you notice that she looks spaced out, then perhaps her sugar is too low. If you can't give any medication, then give her something sweet and call 911. Even if you give her something sweet and she returns to normal, still call 911 because she could faint at anytime because she might quickly burn that sugar off.

If a person is having any sort of seizure, whether it's the big one where they convulse all over the floor or if it's a minor one where all the person does is stare off into space, call 911 so they could get checked out.

If your baby is crying for hours, don't call 911. Crying is not life-threatening nor is it an emergency. If you baby has a high temperature, has a rash, or just looks sick, don't call 911. Take the baby to the hospital yourself. Fevers are not necessarily life-threatening, and in fact, they are the body's way of killing off viruses. You might find that your baby has a high temperature but appears normal. Normally, a fever nearing 104.0 degrees is considered serious, but it's not for EMT's to deal with. Call a doctor or nurse first, because most likely they would ask if the child is behaving abnormally or if the child isn't eating. But if everything else is fine, they might tell you to give tylenol -- which I disagree with because all tylenol does is prevent the body from fighting off whatever it needs to.

Now, what if you're just not sure if a situation is an emergency or not? Well, you've probably been told that you should call 911 anyway, which isn't always a bad thing to do. However, don't call 911 if you decide after thinking about it for two hours that maybe it's an emergency. If you even have to question whether or not it's an emergency, then it's most likely not an emergency. A true emergency is unquestionable. Non-emergencies are those that you have to think about.

If you seriously don't know whether or not to call 911, then pretend that there was only one ambulance in your town. Now ask yourself, "Do I really want to use that ambulance for my problem, or could I go to the doctor myself?"

Remember, anything that you could go to the hospital for without any problems isn't a 911 concern. If the situation is definitely out of your control, call 911.

When it's You who need an Ambulance

Perhaps you're the type who believe in calling 911 for everything you could think of. Not that you're purposefully abusing the system, but you make too much of a habit in calling 911. You might not realize how much of a cause you could be to someone else's trouble -- or death. Maybe it might take a dreadful situation to happen to you to realize how deadly it could be to overuse the system.

You were just in a fight with your abusive boyfriend once again. This time, your boyfriend was so drunk and drugged up that he stabbed you multiple times and then fled. You are losing a lot of blood and if something isn't done soon, you would surely bleed out.

You dial 911 and explain your situation. The operator tells you, "An ambulance would be out there as soon as possible." But the operator also asks if you want him to stay on the line with you, and you said yes. He tries to give you directions on keeping yourself alive, including telling you to stay calm. Five minutes past by, but no one showed up. Eight minutes past by, and still no one shows up. You are gradually losing consciousness.

Finally, the police show up and they do what they could to keep you alive. They grabbed whatever they could to bandage up your wounds to stop the bleeding. One officer calls frantically over the radio for the ambulance, but still no one shows up.

After twelve minutes went by, the fire department shows up and starts to bandage up the wounds with their equipment. They give you oxygen to help calm you down, but finally you go into shock (meaning that your heart is beating faster than usual due to the lost of blood) and fainted. Finally, your heart stops, and your breathing stopped next. The fire fighters begin CPR.

Almost immediately after your fainting, the ambulance finally arrives. They quickly placed you on a stretcher, hooked you up with oxygen, and started performing CPR while transporting you to the ambulance. They rushed you to the hospital where the trauma team was waiting for you. The doctors and nurses frantically begin to revive you, and after ten minutes, you were brought back to consciousness. You were almost lost.

After you were released from the hospital after a long stay, you filed a lawsuit against the city because the ambulance's long response time almost cost you your life. But your claim was dismissed because every unit had a job on the night you were injured. The ambulance was short-staffed that night and only had four units on the road, all of which were handling non-serious cases. The fire department was also short-staffed, only having a few units on the road, all of which were responding to fires, medical calls, or other traumatic situations. Then police had their hands full with a bunch of dispute cases, suspicion calls, and other calls that weren't necessarily emergencies. Unfortunately, you just happened to be one of the many who have to wait for help to arrive.

Now, what is the likely hood that you would have to wait this long for help? Well, it depends on where you are, but regardless, tying up the 911 phone lines with small concerns can cost someone else his life. Sometimes, it takes something serious to happen to us before we could finally realize the error of our ways. The police, fire department, and EMS already have their own problems that could make response time long, such as turnovers, poor vehicles, incompetent staff, etc. Citizens abusing the 911 system makes things even worst for both you and your community.

So before you pick up that phone and dial those three numbers, ask yourself: would anybody I know be affected if I dial this number for my problem; is this problem something the ambulance really need to see; can I not handle this problem myself? Emergency responders are there to save a life. Help them to do just that by not burdening them with your insignificant issue.

Other Helpful Tips for calling 911

If you need information on something, dial 411 (or 311 if your city provides this service), not 911.

If you need information from the 911 communications center, call their direct phone number, not 911.

Never make a prank phone call to 911. You could be either fined or jail -- or maybe both depending on the nature of the call.

For minor issues, such as noisy neighbors, a car alarm that won't stop, a cat in the tree, etc., call the appropriate agency directly through their phone number. The police, fire department, and EMS all have individual numbers that you could call for any non-emergencies.

Never assume that the 911 operator knows your address. Not all communication centers are equipped with Enhanced 911 (or E-911, which would allow operators to see where you live when your number shows up).

Don't tie up the phone line by giving too many details to the operator. Keep it short and simple, giving only the facts that matter instead of giving an entire story. If the operator needs any additional information, he or she would let you know.

Remember, the 911 operator is only there to dispatch your information to the appropriate emergency responder. If nobody shows up at your door, it is not the operator's fault (at least not usually). The 911 operator cannot make an emergency responder come any faster.

Never argue with the operator. This doesn't make an emergency responder come any faster.

As a general rule, if an emergency responder takes too long to come to you, then either they couldn't help it or your situation wasn't serious enough. Remember, all calls have priorities, and if your call isn't serious, you won't get an immediate response.

Don't keep dialing 911 if an emergency responder takes too long to get to your place. Dialing 911 every two minutes doesn't get things done any quicker -- it just annoys the operator and ties up the lines.

If you accidentally called 911, don't hang up! Tell the operator that you dialed by mistake. If you just hang up, a police officer would be at your door as a precaution (that is, if your city has the E-911 system).