Why So Many People Show Up When You Call 911

Have you ever wondered why so many people show up when you call 911? I get this question regularly in my job. I hadn’t thought about it too much until I recently read Jason McCarthy’s book about founding GoRuck. He relates being on the scene of an ATV wreck and getting a huge fire/EMS turnout. “Doubtlessly because they were bored,” he figured. No offense to Jason (I’m a big fan of GoRuck products, btw), but it’s not because they are bored. Let’s look at why so many people show up when you call 911.

I understand why patients ask this question; it can be overwhelming to have half a dozen people come into your home. I don’t fault patients when they ask this when they are sick or injured. It can be frustrating, however, to hear people with no background in fire/EMS make comments like, “they must not have anything better to do.”

I admit to having some of the same biases before I worked in public safety. Why it was necessary, I wondered, for a fire engine, an ambulance, and some other guy from EMS to show up when my neighbor suffered a simple fall. Was it just a small town where not much happened, and everyone was bored? Was everyone besides the ambulance crew just a “looky-loo,” just trying to see what was going on? Now that I work in this world I know that isn’t the case. In fact, I’m always appreciative the firefighters who show up on my calls.  Let’s dig just a bit more deeply into this question, starting with who shows up.

Who Shows Up When You Call 911

First, let’s look at who might show up at your house when you have a medical emergency, or on the street when you get into a wreck.

EMS Units

Ambulance: It’s pretty obvious that an ambulance will show up. The crew is two to three EMTs and paramedics. What’s the difference? You can read my explanation here on the difference between EMTs and paramedics. The ambulance is also the transport unit.

Second ambulance: Sometimes a second ambulance might show up. In the more rural areas of the county, I will frequently go to assist another ambulance on a high-acuity call like a cardiac arrest if I am nearby. Though it only takes one ambulance to haul, many hands are needed on busy calls. Volunteer first responder turnout in these areas may be low, and it may take a supervisor/QRV a long time to get there.

Supervisor/QRV: A supervisor or other senior paramedic in a Quick Response Vehicle may show up. In our area, a supervisor is dispatched on all “Echo”-level calls. These include cardiac arrests, emergency motor vehicle accidents, pediatric respiratory arrests, animal bites, etc. This is to provide additional hands.

Other Agencies

Fire Engine/Rescue Trucks: A fire engine may show up with as many as three or four fire fighters on board. The protocol varies according to jurisdiction. In my area the fire department is dispatched to all medical calls. In other jurisdictions, the fire department is the EMS service so this difference is less apparent. On traffic accidents a fire truck and maybe a rescue truck will be dispatched.

Law Enforcement: We have police officers and deputies on scene regularly, usually for one of two reasons. First, they are dispatched. If the call is a wreck law is sent for traffic control and accident investigation. In our area, law enforcement gets sent to the scene of all overdoses, that sort of thing. But sometimes they just choose to show up. Some cops are lazy and/or burned out and would never dream of responding voluntarily to a medical call, but many aren’t. These “high responder” types want to respond to emergencies and be helpful. If they are nearby they may stop to see if they can offer some assistance.

Why So Many People Show Up When You Call 911

That’s great, but we still haven’t answered the basic question: why do so many people show up when you call 911? One of the biggest reasons is that we never know exactly what we are getting into. When you call and say your 6-year-old has been bitten by a dog, we don’t know if there is a small, isolated puncture to the web of the hand of if the muscle has been ripped off his entire arm. When you call and say your mom can’t breath, we don’t know if she’s wheezing a little, or about to go into respiratory arrest.

The fact is, we rarely have a clue about the true nature of the call based on the nature of the dispatch. On about 95 out of 100 “emergency” calls we go routine the local hospital with a big, fat nothing-burger. But once in a while we’ll get a completely routine “citizen assist” that turns into an emergency trip to the big regional hospital. It makes sense to send resources early. They can always be cancelled if they aren’t needed.

The fact that we don’t know what we don’t know leads to additional resources being dispatched on many calls. But there are other reasons, too.

Speed

Fire department and first responders can often be there faster and administer life-saving care sooner. In many areas, like mine, fire and EMS are separate. Every city, town, and community has a fire department. Most have some paid personnel, and all have volunteers who live within the district they serve. This means they can be on scene really quickly. I worked a cardiac arrest about a month ago. The family refused to start CPR, but a fireman lived right down the street. He was on scene and started CPR within about 3 minutes of the 911 call. We did get a return of pulses on that patient, thanks to that fireman. On another cardiac arrest I worked last week firemen had started CPR and had already defibrillated the patient twice by the time we arrived on scene.

Most fire departments in my area employ people who are certified at least to EMT. This lets the fire department start a lot of treatments before we get on scene, aside from just starting CPR. . They can also get information like your medication list, medical history, and allergies, saving us time on scene.

Manpower

Though it may not seem like it when you call 911 for chest pain, having four or five or six responders on scene is a really good thing. First, even if your call is completely routine but you are immobile, having some lifting assistance is HUGE. We frequently find people in upstairs bedrooms and down in basements. Getting them out – especially with the average American being overweight – is challenging sometimes. Having some additional manpower just for this purpose is hugely helpful. And if they are ill, we don’t want to find that out and then call for the fire engine.

Then there is the gravest emergency: the cardiac arrest. It takes a lot of hands to “work an arrest” or “work a code.” You need people to do compressions. Someone needs to bag the patient. The cardiac pads need to be placed on the patient and an IV or IO (intraosseous) needs to be established. The patient needs to be intubated. Medications need to be pushed and shocks need to be administered. Compressions are tiring, so you need fresh people to swap out… Working a code is a LOT of work.

Not that we work a code every call (or even every shift) but if it was my mom or dad I’d much rather all the necessary resources be dispatched right away, and downgraded if it turns out they aren’t needed.

Specialized Tools/Skills

Sometimes QRVs (Quick Response Vehicles) and fire trucks carry additional equipment. This can be as varied as vehicle extrication equipment to cut a car open, or the LUCAS Device, a machine that does CPR compressions. In a jurisdiction adjacent to mine, supervisor trucks also carry whole blood – a really valuable resource if it’s needed. Usually these tools come with personnel to operate them. I know very little about vehicle extrication. Trust me, if you’re pinned in a car, you want the right people cutting you out. That may be the paramedics in some areas, but where I live we are all single-function medics – not who you want to depend on to cut you out of a car.

Legal Obligation

It is pretty rare that fire and EMS self-dispatch. They are normally dispatched based on agency policies. It’s worth mentioning that once they are dispatched they are legally obligated to respond. Again, they aren’t just out there because they are bored.

Conclusion

So that’s it, that’s why so many people show up when you call 911. They aren’t just bored and they aren’t just morbidly curious. Hopefully that sheds a little light on the subject, in case you were ever curious!