Scenarioville is a lovely town with a population of 48,000, which includes a substantial elderly demographic, numerous busy and traffic-dense roadways, several parks and recreation areas, and generally a little bit of everything. Various outlying suburbs lie beyond our map and are covered by other services. (Years ago, Scenarioville was known as “Arlington,” and many of your maps still use this name.)
Scenarioville is fortunate to be served by three local hospitals, plus one more remote facility.
Memorial Hospital: a small community hospital. Almost 100 years old and much-beloved, it has a 14-bed ED, four inpatient floors, and a small ICU. CT and all routine services are available on-site, and it’s certified as a stroke center using videoconference “telestroke,” but they have no MRI or specialty resources; all pediatric, trauma, STEMI, and similar patients are transferred out by SEMS (for emergency “stat” transfers) or Flatline Ambulance, a private ambulance service.
St. Vincent’s Medical Center: a mid-sized hospital with a 28-bed ED, six inpatient floors, and two ICUs. CT and MRI are available, and there is a cardiac catheterization lab, although they primarily perform diagnostic and elective procedures; after business hours (Mon-Fri 9-5) they shut down. They are certified as a Level III trauma center and are fairly adept at stabilizing most traumatic injuries for transfer. CT and MRI are available 24/7; they are a stroke center and accept pediatric patients, although not pediatric trauma, and the pedi team generally consists of a single pediatric emergency physician.
Jefferson University Medical Center: JUMC is the teaching hospital for Jefferson University, a medical school located in the adjacent town. It’s a tertiary referral center for the region, with 36 ED beds, nine inpatient floors, and four ICUs. It’s a Level II adult trauma center, although they’re darn good and there are rumors that they plan to apply for Level I status soon. They take pediatrics, with a four-bed pedi wing to the ED, and accept pediatric trauma. They’re a stroke center and all typical imaging is available 24/7. They run a cardiac cath lab which is available 24/7; the interventional team is available within 30 minutes outside business hours, and they will usually activate based on the call of SEMS ALS, depending on how convincing they sound. Jefferson also has a helipad which receives patients from outlying suburbs, and will occasionally transfer out complex patients.
Intergalactic House of God: [not shown] the largest hospital in three states, and the nearest Level I trauma center. The House is located 65 miles north, and offers every service imaginable, including a burn center and a hyperbaric chamber.
SEMS is a public, city-based third service. It is a tiered system using transporting ALS (dual medic) and BLS units; calls are triaged by EMD and dispatched with the (hopefully) appropriate level of care. All calls are dispatched priority 1 (lights and sirens) except for confirmed stable patients from nursing homes or other skilled healthcare facilities. Cardiac arrests are double-dispatched with simultaneous ALS and BLS; in all other cases, the first-in unit can request further resources as needed. When both units are committed to a patient, BLS will split up to drive both units while the two paramedics continue patient care. In unusual circumstances it is permitted, but discouraged, for a Scenarioville firefighter to drive for a SEMS ambulance.
During the day, 3-4 BLS units are available in the city with 1-2 ALS. In off hours, that can drop down to two BLS and one ALS. SEMS operates one central base, and posts units dynamically to cover the city; other than the base there are three post locations designated Alpha through Charlie. One captain is on duty at all times, driving a non-transporting fly car; captains are generally highly experienced and trained for incident management, but not all are ALS providers. One private ambulance service, Flatline Ambulance, handles most transfer work in the city; they are also available for backup coverage when SEMS is experiencing an unusually call high volume.
SEMS BLS (that’s you) carries all typical BLS equipment, and is also trained and equipped to perform finger-stick glucometry, as well as administer nebulized albuterol. ALS has all modern gear including 12-lead ECG, intubation (but no paralytics), waveform capnography, and CPAP. For a full equipment list, see your BLS checklist here: Scenarioville BLS Checklist
You operate on a VHF radio channel, with two other channels available for major incidents or special operations. Each ambulance carries a single portable radio which can operate on VHF, as well as UHF to communicate with the fire department. Hospital entry notifications are performed over either a dedicated VHF channel or via recorded telephone line; however, online medical control can only be obtained from Jefferson Medical Center over the radio. BLS units are designated ”Ambulance” (or “A”) over the radio, ALS units are “Paramedic” (or “P”), and captains are designated “C” with a personal numeric. Dispatch’s callsign is “Operations.” Standard radio protocol is to state with who you’re talking to followed by your own callsign; for instance, the 61 might hail dispatch with “Operations, Ambulance 61.”
SEMS is blessed with generous and loose BLS protocols. Within the generally-understood basic scope, you are permitted to manage patients in whichever manner you deem best, as long as you can articulate why a reasonable provider would believe it would optimally benefit the patient. However, your service, including the CQI department, may not agree.
It’s a good service, and mostly staffed with good providers, although there are a few bad eggs, and the budget is always very tight. You do what you can.
Scenarioville Fire Department
SFD operates three stations in the city, each housing an engine, a ladder, and a command unit. Suppression apparatus are all manned by three firefighter/EMT-Bs, and are considered BLS units with all appropriate equipment. Ladder trucks also carry heavy extrication and rescue equipment. They can manage some basic high-angle rescue and hazmat scenes, but most special operations need to come from outside of town, usually a 30-60 minute ETA for the dive team, hazmat trailer, and so on.
SFD dispatches a fire unit to all 911 medical calls. Motor vehicle collisions are dispatched a ladder for blocking and extrication, or if an engine is closer, with an engine plus a ladder to follow. Scenarioville firefighters are mostly professionals with a good attitude, and they’ll lend you a hand or perform necessary initial lifesaving measures, but for typical medical calls they’re not very involved with patient care. They usually beat the ambulance to the scene, and will occasionally cancel you if there’s nothing notable; likewise, you can cancel them if you’re first-in and don’t need their help.
Fire operates on three UHF radio channels. Since EMS uses a VHF radio, your units are equipped with mobile (built-in) radios of both types; your single portable radio is dual-band and interoperable. The fire department’s dispatch is addressed as “Firecom.”
Scenarioville Police Department
SPD is a typical city police department. They dispatch a cruiser to all medical calls with scene safety concerns, and sometimes also to routine medical complaints depending on availability. SPD officers are all certified in CPR and carry AEDs in their cruisers, and when they do respond they’ll often beat fire and EMS to a scene. SWAT and the bomb squad, when needed, are borrowed from a nearby city as mutual aid.
They are available through SEMS dispatch by request of any crew on scene. If communicating directly on their UHF channel, dispatch is addressed as “Control.”
Scenarioville Dispatch Center
All 911 calls in the city come through a central dispatch center operating from an unknown location; rumor has it they’re sequestered in the basement of a local taco house. A call-taker records information and performs EMD, although not always very accurately or zealously, then separate dispatchers for Scenarioville PD, FD, and EMS send out their respective resources.
SEMS units monitor the FD channel, but are dispatched directly over their own radio. Your dispatcher is also available by phone, and your units carry a ruggedized cell phone (except for those that are broken or have mysteriously disappeared).
AirMed is a helicopter-based critical care ambulance based 30 miles outside of town. They serve the surrounding area and are funded by state subsidies and donations. They fly with a critical care paramedic and an experienced flight nurse, and are equipped for bedside laboratory analysis (i-Stat), ultrasound, chest tubes, central and arterial lines, pericardiocentesis, and RSI. They’ll land directly on-scene if a safe LZ can be found, or transfer patients from the city hospitals to other destinations; JUMC’s helipad is available to anybody if needed.
Requests for AirMed are made through your dispatch, who contacts them via landline. If weather is unsafe to fly, they will refuse the request without argument or debate. Lag time from request to takeoff is about 6 minutes during fair weather and 11 minutes in the winter, when the bird needs to be towed from the garage.
And finally, you…
You work on Ambulance 61, a full-time schedule alongside your partner, Steve Solid. Steve is a 20-year EMT who knows the area like the back of his hand, although he still appreciates when you locate an address on the map to confirm. He’s technically proficient, but medicine doesn’t exactly blow his hair back, so he usually lets you run the call and prefers to drive while you tech in back. He’ll do whatever you ask on scene but mostly leaves the thinking to you.
Take the dispatch, locate the address, arrive and manage the scene, assess the patient, find a reasonable working diagnosis, provide necessary interventions, and determine the best patient disposition. Have fun!