The basic structure

I had a question in another post from Medic who asked what the structure of the ambulance response was here in Melbourne. Basically the system here is probably pretty similar to many others. We have a multi level system that has non-emergency or routine transport cars that might take patients to regular dialysis appointments for example. We also have your normal ambulance (usually a Mercedes Sprinter) which has two paramedics on board. This can be two fully qualified paramedics, one fully qualified paramedic and a student paramedic or two 2nd or 3rd year students. We also have MICA (mobile intensive care) ambulances which have two MICA paramedics on board. These guys have a similar vehicle but carry more drugs and can intubate in the field. There are also MICA single responders and Clinical support officers who often drive around in Subaru Foresters that are very nice to drive. Recently the bike squad was introduced too. I think I wrote about them a while ago.

Oh and I shouldn't forget to mention the boys and girls in the sky - we have fixed wing planes and helicopters too. And..we get assistance from fire brigade first responders and several community first responder teams. Apologies to anyone I left out.

The more serious sounding jobs will get a dual response with a MICA ambulance and a standard ambulance being sent. If it gets crazy busy then there may not be enough cars around to send two, and you are then on your own. We have phone and radio support from a medical clinician if we happen to need it - but you can't call them up and say "um.. what do I do now?" - you need to ring them with a plan of action and a justification for wanting to go outside normal guidelines and protocols.

We have this thing called "the grid" which is the program that is used to dispatch us on Signal 1, 2 or 3 responses depending on the answers given to the call takers. Many jobs are reviewed by a senior clinician after they have been dispatched and upgraded or downgraded accordingly. This method seems to do a fair job of weeding out the jobs that have got an 'overly enthusiastic' response given out by "the grid". We have had the recent introduction of a 'referral service' where a team of specially trained paramedics actually ring many callers back and spend time talking to them to see if another service (such as a locum) might be more appropriate. This works well to eliminate many non emergency calls. And of course occasionally jobs will bounce back through after more info reveals a potentially serious problem.

Yes our dispatch system has major flaws like every other one does, but overall I think it works... most of the time.