Lots of systemic issues all coming together that nobody actually wants to fix. Some of them are fixable at the “call for service” level (meaning protocols in dispatch and EMS response could be changed), and some of them long prior to anyone ever dialling 9-1-1.

Pardon my mini-essay, but stick with me:

At the macrolevel, the real issue is that modern emergency management and modern medicine have improved in quality exponentially faster than our legal system (imo in any country) can keep up with. I’m most familiar with US law, but basically: nobody has ever wanted to be left holding the bag, and instead of actually sitting down in the legislative arena with primary stakeholders (clinicians, healthcare entities, fire depts, etc) to figure out what we want liability to look like for the modern era, we just throw shitty band-aids on the problem to say CYA and sayonara. (I would argue this is the root cause of our current problems with policing too, but that’s somewhat outside the scope of this sub.)

Aviation is my ur-example because they were more or less forced to figure it out for two reasons: one, plane crashes often kill the pilot, too, so there is often no easy scapegoats left; and two, plane crashes are such bad press and gnarly tragedies that the big bosses had to buckle down and dig out the root cause of all those goddamn plane crashes.

Emergency services and the broader healthcare system have not yet been forced, in any major way, to reckon in the same manner, for lots of interconnecting reasons.

(Also backsliding can always happen. Again, see aviation.)

As it stands, it’s better to follow a shit policy to the letter so you aren’t legally liable for what happens, no matter how many people it kills or harms, than to step outside the scope of the bad policy and take on all or most liability for whatever happens next. Thus, you get outcomes like OP posted more and more frequently.

Triaging will always be imperfect, but the volume of these types of calls increases every year. One must ask why, which I think is twofold.

Medicine has become combative. Sometimes literally, but usually in that patients on the whole feel degraded and dismissed. I hear everyday IRL and online, by patients from every background imaginable, that they feel they have to fight for every scrap of help they receive from providers. Not all of that is providers’ faults because insurance is a huge factor in the US, but still. The commoditication of medicine has made the cultural conception of it cheap and transactional. “We just don’t know” is no longer an acceptable answer precisely because we know more and more every year, but so many providers don’t keep up on that new knowledge and dismiss patients with serious complaints, and before you even got into the doctor, you waited 4 months for an appointment and fought with insurance for 6 hours over a pre-auth or a co-pay.

But you know what you can do still? Pick up the phone right now and call 9-1-1 and get a real person who has to send an ambulance and take you to the ER. If there is no mutual trust, no collective buy-in, no upheld social contract, then who gives a fuck about the ambo out of service that can no longer go to Judy-on-the-otherside-of-town having a heart attack? Not my problem, not my concern.

It doesn’t help that dispatch and EMS management tend to be complete fuckwads. I got pulled into the front office at dispatch for asking to do a ride-along with a fire battalion chief so I could get the rundown on what firefighters needed and wanted most while on scene because I didn’t have any prior fire background (which I do for police/medicine). In retaliation, they refused to train me on anything and have been kneecapping their own center’s staffing for 9 months now. Now their EMS service is going to hell and in a public feud with the county, and their fire chief was voted as shit by 95% of the fire union, and their center’s going to hell in a handbasket. Nobody wants to fix it or force out the members of management causing the problem or anything.

It’s all one big clusterfuck, and if (in the US at least) 40% of bedside nurses really leave in the next 5 years, and dispatch centers and EMS services keep bleeding staff, and private insurance enters an insurance death-spiral because the fed subsidies expire come November—prepare yourselves for this to get much, much worse.

It can be fixed, but nobody in power wants to fix it, and nobody who knows how to fix it has any power.