What You Should Know About RAMSES and Medical Emergencies

What does RAMSES mean to you when you call 9-1-1 and summon an ambulance?

The Spokane County EMS & Trauma Care Council's Resources Available for Medical & Surgical Emergency Services (RAMSES) is an online emergency and disaster system designed to provide hospital and pre-hospital diversion information to emergency room staff and patient transporting dispatch staff.

Veteran Emergency Department (ED) doctor, James M. Nania, MD, FACEP, said when the numbers of sick or injured persons arriving at Spokane's four hospital emergency departments began increasing in recent years those departments participated in the council's plan for disaster emergencies to better manage the overload. Nania is Spokane County EMS and Trauma Care Council Medical Program Director.

The Spokane County Dispatch Center dispatches and, based on information given by caller about location and condition of the patient(s), the nearest fire department's paramedic first responders are first enroute to the patient's location. One of American Medical Response (AMR) ambulance fleet, Deer Park Volunteer Ambulance or the Fairfield Volunteer Ambulance is also paged to the scene. If air transport is needed, it is dispatched.

Each hospital's status based on RAMSES codes is constantly available at AMR and onboard Deer Park Volunteer Ambulance. All ambulances receive RAMSES information via radio contact.

Each hospital's status based on RAMSES codes is constantly available at AMR and onboard each unit in their fleet and on Deer Park Volunteer Ambulance. All ambulances also receive RAMSES information via radio contact. The status codes, not to be confused with trauma triage codes (*see sidebar) help manage patient load so patients are taken to the nearest ED with the capacity to meet their needs.

Ramses includes the following status:

• Green: Staff and beds available, no restrictions.
• Yellow: Limited staff or limited beds available.
• Red: No staff or no beds, due to limits of available staffing, beds are filled to capacity, or required equipment temporarily unavailable.

The area's two trauma facilities, Deaconess Medical Center and Sacred Heart Medical Center, alternate weeks so one is always available to accept trauma patients -- those with life threatening issues where delay in emergency medical care may endanger a patient's life or limb -- regardless of the RAMSES status.

When a hospital emergency department activates Red it no longer admits patients until the overload is eased. In this scenario, the ambulance is diverted to the nearest hospital able to provide appropriate emergency medical care for the patient.

In the event all four hospitals reach Red status at a given time, all facilities again accept patients as medics continue to work through the caseload. Then, unavoidable delays may result.

According to the Spokane County EMS and Trauma Care Council's manual,

"In spite of ER divert (Red status) Deaconess Medical Center and Sacred Heart Medical Center should still receive adult major trauma patients. In addition, Sacred Heart Medical Center should still receive pediatric major trauma patients and Level I STEMI patients."

There are exceptions to every rule so even an overburdened hospital may receive emergency patients in their Outpatient Department as needed, instead of in the ED.

When an ambulance responds to a 9-1-1 call, the sick or injured person is stabilized and their condition assessed by First Responder, EMT, or Paramedic. By the time the patient is in the ambulance the senior medical officer has triaged the patient -- determined his or her condition -- and ranked it trauma, critical care, or emergent care.

A trauma patient will be transported to one of the two trauma facilities.

In all other cases, if the patient's doctor has been contacted, a MD-to-MD destination is given, or the patient may request a hospital of choice, or else the senior medical officer's judgment prevails, in conformance with Patient Treatment Rights.

Communication between hospital and ambulance continues during the run. If the medic learns the ED has gone from green to yellow or red status, the patient may be asked for their 'second choice' hospital. If the patient's doctor was called before the ambulance arrived, the receiving hospital will notify the patient's doctor of the destination change.

In the event you become that patient, have an alternative hospital in mind.

Patients who plan to go directly to an ED, instead of by ambulance, are wise to phone ahead to ensure the facility is not already overburdened.

When a walk-in patient arrives at the hospital emergency department a triage-nurse performs emergency screening and stabilization. Non-critical patients, including those in severe pain, wait along with others already in line.

The sobering reality is often a wait of up to several hours before a doctor first attends the patient.

Nania explained that area residents can take small comfort from the fact that places like Los Angeles, CA, Portland, OR, and in thousands of other metropolitan areas where populations increased years earlier than in the northwest, similar 'patient distribution systems' have been in effect for more than a dozen years. Spokane and the surrounding areas have only experienced this crisis for five to six years.

Three years ago Nania warned that the numbers of patients arriving for emergency medical care are forcing hospital emergency departments into Red Status more and more often. He predicted a dire situation would ensue if a major disaster occurs in our area, due to insufficient available medical resources. With the 2011 flu season ahead Spokane's four hospital emergency departments could become overburdened.

Deer Park Ambulance is the oldest volunteer ambulance company in the state of Washington, and veteran Chris Cato, Critical Care Emergency Medical Technician - Paramedic (CCEMTP), said,

"While the system is not perfect, RAMSES has improved and eased the situation tremendously."

Online information can be found at the following websites:

Trauma guidelines.

RAMSES webpage  provides links to hospitals, as well as other valuable sites. The EMS link takes you to the council's site.

Also, at Spokane County EMS & Trauma Care Council, 808 West Spokane Falls Blvd., Spokane, WA 99201, Ph: (509) 625-6290.