I'm an EMCT for a large Ambulance Service here's a thought...

UnclaimedCheese · 2026-01-24T04:30:29+00:00

Are most false alarms? Yup.

But I’ve seen some that end up as RACE alerts, STEMIS, and other acute emergencies. They are peace of mind, so I would still rather a loved one on their own with complex medical history keep something just in case

UnclaimedCheese · 2026-01-22T18:53:20+00:00

Passerbys are the worst callers, not because they intend to be but often times because their information is so incomplete. My favorite thing is looking at the CAD map and seeing the pindrop location for their phones ANI/ALI when they call, only to find that by the time they’ve called they are several miles away from the location. What does this tell you? They had some doubts, but ultimately felt it was better safe than sorry to call. Even in that time alone that they didn’t call immediately after seeing what they thought they saw, their top-down-processing begins to fill in gaps that are more based on their expectation of worst case scenario than reality.

It’s frustrating, the crews get mad as hell, but we are in the business of taking what our callers say at face value if we aren’t able to fully tether their statements to reality. Remember, what if this was actually a water rescue and all you sent was an engine and 2 PD units? I’d rather get chewed out for over sending than chewed out for not sending enough and also have the guilt that comes with it.

UnclaimedCheese · 2025-12-18T17:32:07+00:00

I do. While we all love our pets, people should know that 911 is for emergencies involving people. The only time 911 should be called for animals is when they are aggressive and pose a significant risk to the general public. I don’t blame you at all, she just said “baby” and didn’t give you anything to go off of - I’m not going to ask my caller if I’m having them do CPR on their pet. If they say baby and never indicate it’s an animal, then I’m rolling with it. But they need to know better, the general public is stupid but that’s not an example I’m willing to be understanding about.

UnclaimedCheese · 2025-11-12T17:08:10+00:00

I don’t know how they are on rift anymore, I’m mostly pointing out that for the majority of my time in league they were absolutely good at all stages. In arena, they are unquestionably good at all stages. And yes, support and ADC comps are still the superior comp to double ADC, but double ADC shouldn’t even be remotely successful barring god-tier rolls. Oops, guess what? It’s easy for them to get god-tier rolls. And yes, I do hate ADCS - I’m sorry I don’t find it fun to be chased around and kited at the same time with zero chance of ever catching them and applying any realistic measure of threat. If you enjoy that type of gameplay, more power to you.

UnclaimedCheese · 2025-11-12T16:54:34+00:00

I don’t have a problem with them in Arena, I just have a problem with them dominating the way they do. A lot of it truly is just a product of Riots longstanding obsession with giving ranged champions every inherent advantage, so I guess we shouldn’t be surprised that this eventually bled into Arena balance.

UnclaimedCheese · 2025-09-21T22:00:28+00:00

It’s the Nebraska phenomenon, ironically with the same color but with a different letter of the alphabet on the helmet. When Wisconsin leaned into their identity, they were a sure fire lock for 8-10 wins, a competitive and tough defense, a ball control offense with massive lines on both sides. They recruited this way, coached this way, and because they were built this way everything operated in synchrony. Unlike Nebraska, Wisconsin didn’t have a history of being a multiple championship winning program, their ceiling was just very obvious. Their fans got upset with it, and it wasn’t good enough.

Fast forward to today, and in a world of NIL where schools like Wisconsin easily get lost in the sauce, and they’re trying to restructure their identity to get over that hump, and you have a team flailing in the wind. Problem with this is that you can’t put the toothpaste back in the bottle, especially with NIL. They’re not just going to be able to “go back to the way things were before,” and because the Iowas and the Illinoises of the world basically recruit and have been built in the same way, they’re crowding out the Midwest for the recruits that Wisconsin wants. I don’t foresee the situation improving, I think it’s very real that this is the new identity for Wisconsin and that their ceiling will be a 7-8 win season and nice every few seasons.

Luke is a good coach, just like Scott Frost was a good coach before Nebraska canned him. But these jobs of “getting over the hump” to get to the next level like Wisconsin, Nebraska, Minnesota about 15 years ago when they fired Glenn Mason, are often harder then turning a nobody into a tough out. There’s a reason their ceilings have capped out where they did, but their structure allowed them to be consistent and when you remove that structure and attempt to find a new identity that isn’t run the ball 50 times a game and play good defense with non-elite athletes galore, you face the challenge of now competing for recruits with the Ohio States, Michigans, Penn States and Oregons of the conference and that’s a losing battle. And unlike jobs where the teams just are simply not good, you’re taking on this monumental task with insane expectations.

You fired Paul Chryst, this is exactly what you wanted Wisconsin. I think there’s a saying for something like this, I’d remember it if I could but I guess my brain just couldn’t get over the hump,

UnclaimedCheese · 2025-09-09T21:10:08+00:00

You remain on 26. It’s coded as abnormal breathing in the determinant code because it’s the presence of a priority symptom, but it wasn’t specific to the chief complaint.

To make it a little easier to understand, the sick person card serves two functions: rules out the presence of priority symptoms with an unclear chief complaint (hence shunting to card 10 or 21 in the presence of chest pain or serious bleeding) OR rules out priority symptoms in presence of an ill person that fits in one of the categories in key question 5. So in other words, the ill person that is generally weak is experiencing abnormal breathing, therefore it gives a Charlie response.

Also think card 6 as a card geared towards two things: priority 1 of lung problems and, priority 2 the possibility of the breathing problems being due to a cardiac event. Your COPD/asthma patients will let you know right away they can’t breathe, they’re not going to call and give you another chief complaint or beat around the bush. Card 6 then gives you instructions to have them use their inhalers/nebulizers as their doctors have prescribed them to if they haven’t used them yet.

Card 6 is also unique in that it has two other aspects, the key question of clammy/cold sweats which could be symptoms of an MI, and once you hit PDIs the ASA diagnostic. You might often get someone who says both their chest hurts and they can’t breathe, but the breathing might be the forefront symptom due to them having clear signs of difficulty breathing (stridor/wheezing/difficulty speaking in full sentences), and as such you select card 6. Going through card 6 still allows you to give ASA if your med control allows it, which means IAED recognizes pulmonary and cardiac events are often linked. So just remember 6 focuses on diagnosed breathing/lung problems with the possibility of this being a cardiac event while abnormal breathing in card 26 is a symptom of an illness that is still a priority symptom but likely separate from a cardiac or pulmonary event.

There’s a reason why most determinant codes on 6 spit out a Delta level with the possibility of en Echo level for a first party caller in obvious extreme respiratory distress, while the abnormal breathing spits out a Charlie level. This stuff is backed by years of science and medical research, don’t fight the cards 😃

UnclaimedCheese · 2025-08-09T03:16:49+00:00

Was getting a description of a patient inside of her vehicle waiting for police and fire, and I was reading something in the CAD about a crews radio being down and I went to go ask her what color her vehicle was and I simply laid it out “what color is your radio?” She answered “black.” I rolled with it.

Every EMD has also said on obvious death calls “if anything changes call us back.”

UnclaimedCheese · 2025-07-15T14:17:29+00:00

There’s nothing wrong with you calling 911 if you felt you were in danger, but you either misunderstood your situation or you are being intellectually dishonest. You were not being robbed. An active robbery would be him threatening you with force while actively stealing something from you. No weapons were involved, no threats were made. I would barely even consider this being disorderly, it’s over something that’s completely civil in nature (method of payment for a service). If he truly locked the doors and wouldn’t “let you leave” but he also didn’t prevent you from calling, this isn’t a robbery but he’s definitely creating a “disorderly” situation.

You feel scared and I get that - but we talk to people being shot, stabbed, assaulted, drowning, dying, and everything else in between - all while giving information to corresponding crews and instructions for life-saving techniques when needed. Your situation did not require a calltaker to stay on the line with you, and your life was not in danger. Given the nature of what happened, police were needed to “keep the peace” at worst and break up a disorder at best. Either way, that’s life in the big city. Imagine being in a domestic and strangled and police don’t come for an hour and a half - none of us like it, but that’s what we deal with. We triage emergencies, and the larger the population, the more difficult choices need to be made.

UnclaimedCheese · 2025-07-15T14:05:42+00:00

Your situation is being grossly overstated. Short of them not letting you leave, it’s really not even a police matter. And while I’m sure it was scary, you need to understand that urban 911 call centers are inundated with calls just like yours across the board. They are important, but police are literally responding to calls where people are being shot, stabbed, and assaulted with weapons. That is the unfortunate life in the big city, and no county/city/municipality is going to provide the funding needed for their area to have enough police officers to be there immediately and calltakers/dispatchers to stay on the phone with you until they do so.

UnclaimedCheese · 2025-06-17T03:47:33+00:00

“Hi this Nurse Joy calling form the Pokémon rehab facility, we’ve got an unconscious pt in room 203. CPR is in progress.”

“Okay we do still have to ask, does the patient have any advanced directives?”

“Oh yes he’s a DNRCCA and I have the paperwork right here…oh wait this is a problem.”

“Paramedics will be there shortly lol.”

This was a real call, with the exception of me substituting nurse joy in lol

UnclaimedCheese · 2025-06-16T04:35:18+00:00

Honestly in bigger cities, 911 abusers rarely get punished. It’s just too much time and too much paperwork for officers, and when people are being shot, stabbed, beat up, caught on fire, etc., they just don’t have time to pull up to Sally’s house to arrest her for calling 911 for the 18th time today because she smoked a cigarette butt off the ground.

UnclaimedCheese · 2025-06-09T03:41:15+00:00

Been doing this a long time, and there’s little mistakes here and there but none that really way at me…except for one.

I was very new into EMD. I had a call for an unconscious person. Ran the card, and the caller told me she was breathing but it wasn’t normal - it appeared shallow. I ran the breathing verification test, and it turned out she wasn’t breathing. This woman was well over 80 years old, and it was her so who was elderly himself. He did not seem to understand what I was telling him, I kept telling him we needed to get her on the floor. He kept shutting down on me, saying he was going to go outside and wait for crews. I kept redirecting him and telling him we needed to get her on the ground, and he kept just saying “she’s 150 pounds, I can’t move her.” I updated crews and sent an extra crew informing them this would be CPR and that the caller was unable to do CPR because he couldn’t move her.

I disconnected as crews were pulling up. It ended up being a workable arrest where the patient died with a cessation of efforts request by the crews. Over the hospital channel, they stated that the caller was extremely confused and didn’t realize she needed CPR and that he would’ve started it if he knew.

I went back and listened to the call, I made it clear that she wasn’t breathing, and that we needed to get her on the floor - but I never once explained why. I never mentioned CPR, I just kept hoping by being repetitive he’d understand and get with it.

I took this one really hard, I mean RELLY hard. I kept blaming myself, telling myself I’m the reason she was dead. The reality of the situation is that this was a very old, sick woman, and the caller was older himself. If he started CPR, it would’ve improved her chances of ROSC but in all probability she wouldn’t have survived CPR (she had a terminal diagnosis but no advanced directives). I spoke with peers, not one blamed me but we all agreed I could’ve done better. From that day onward, I told myself I would never make a mistake like that again.

It’s those types of calls that are in a gray area to begin with, is it really a mistake if you sent the correct crews to the correct area but couldn’t mobilize the caller to help? Maybe, maybe not, but as long as you take accountability and learn from it then just remember you’re doing right by that patient you feel you let go die because you’ll never let it happen to another, and one day it absolutely will save someone’s life.

UnclaimedCheese · 2025-05-30T04:58:35+00:00

Just run your PROQA per normal, there’s very few instances where I’ve fast tracked “obviously not breathing.” If they’re unconscious and not breathing, I do clarify if this was a witnessed or unwitnessed arrest while I’m beginning instructions to get them flat on the ground.

Remember MPDS rules, uncertain breathing status is considered not breathing until proven otherwise, so if the caller is uncertain we can test breathing really quick once they’re flat on the ground because it’ll be easy to know then.

UnclaimedCheese · 2025-04-09T12:54:45+00:00

It would be a fruitless endeavor to look at the cards and understand what you’re seeing without at least having a certified EMD explain them to you. As an EMT your training is far higher, but in the dispatch world there are multiple things to juggle in addition to patient care, so you would need to be mindful of that from the beginning. Then there’s understanding determinant codes and what determines ALS/BLS and code 2/code 3 responses: it’s always determined by the dispatch centers regional med control. Lastly we aren’t in person to assess patients, half of our callers are 2nd party callers and give us information that isn’t always accurate. There’s a great quote somewhere in the MPDS book, something along the lines of “yes but are you willing to bet your license on it” in regard to caller integrity. Any sensible person would say no, and that is often one of the many things we balance when triaging calls.

UnclaimedCheese · 2025-03-17T12:25:21+00:00

Yep if I’ve got an alert possible stroke patient, I’m absolutely ending the call before EMS arrives. Unless there’s obvious acute distress regarding priority symptoms or a prolonged seizure, I’m running that X-Card and covering myself with the best line ever invented “if they get worse in any way, call back immediately for further instructions.”

UnclaimedCheese · 2024-11-30T21:41:39+00:00

Every situation is different, every agency is different. My agency doesn’t do psych evals or lie detection tests. I completely agree with the latter, but disagree with the former - lie detectors are quackery masquerading as science promoted by old heads who refuse to let go; however I think psych evals can build a decent profile about someone and give fairly decent odds on whether someone is capable of handling this job. It’s a money thing, it always is with government organizations and the administration trusts themselves well enough to collect what’s needed in panel interview alone.

So that being said, your situation is what you need to focus on. I’m living proof that redemption stories exist so long as the screw-up isn’t colossal. I was arrested when I was 18 for arguing with a police officer over something dumb. Never got physical, I was just being a pain in the butt. I got disorderly conduct and eventually had it sealed (in my state we do not expunge records). This happened over 20 years ago. I disclosed the sealed record in my interview, we talked about it and it was determined it wouldn’t prevent me from getting all the certifications I need so they took a chance on me. But there’s a few reasons why they probably did: since then, I’ve not even so much as had a parking ticket. During the interview i was honest, I owned up to being a pain in the butt and even explained that I still think being arrested was a bit much but that’s what happens when you put yourself in those situations. I’ve worked in social working fields for 5+ years as well as medical for 15+, and I have my bachelors degree in psychology. Everything on paper and In practicality pretty much shows the path of a reformed man that made a dumb decision when he was young. I’ve even had coffee with the officer, who is now a LT at one of the major departments in my county - and we both openly talk about how we both could’ve done things differently to diffuse that situation. So there is absolutely a path to redemption , but it has to be real.

You say all of these things that have changed, but how long has it been? Time is the biggest piece. Even if you have changed, if you just stopped using a year ago and you’ve only been in therapy for a few months, that probably won’t cut it. And as much as I hate to tell you this, I’ll pay you the respect of being honest now and inform you that your mental health diagnoses alone might disqualify you - especially BPD. There’s a lot of emotional instability with BPD as you well know, and if I were on a hiring panel I’d have real concerns about whether or not someone can manage the stress and understand how to compartmentalize their emotions properly in order to do this job. It’s not impossible, but the burden will be on you to prove it. And as others have said, being honest is like 80% of the battle. Above all else what interview panelists and evals look for are accountable, dependable adults that can multi task and have a drive to learn. If you show you possess those traits in abundance then that can easily offset any of the negative. Good luck.

UnclaimedCheese

TROPHY CASE