One of the best things that happened to paramedic services was the creation of health information lines. There was a time when anyone with a healthcare concern or question would call the emergency services hotline for help. But, sometime ago in Quebec, the phone number 811 was distinguished from 911. The former was designated as the information line for health questions, the latter has become the emergency line.

Or, perhaps, there is a better way to describe what 911 is. In reality, there are some honest-to-goodness emergencies, where life and limb are on the line, but there are many other calls in there. Some are urgent and some are just looking for help. The emergency line is more of a direct access line for healthcare services. It’s a fast link to the healthcare system, especially if you don’t have easy access elsewhere.

We use the Medical Priority Disptach System in Quebec to triage calls to the 911 health centres, so we have a procedure for telling a true emergency from something minor. But, in either case, the caller is pretty much guaranteed to talk to a real live human being and have paramedics sent to help.

What about taking the tactic of telling people to stop calling the emergency system when there is no health emergency. Is that a plan destined for success? Should we make that move here?

A short digression: on the Metro in Montreal, they have promotional signs about how to make better use of the subway system. One of the posters advises that the safest way to for an adult pushing a toddler in a stroller to descend the sometimes three stories down into the subway tunnel is to take the child out of the stroller, carry the child and ask someone for help carrying the stroller down the escalator or stairs. There are no elevators on offer, and, to be honest, the escalators are not always working.

If you have ever been that person pushing the stroller, or if you’ve even seen that person making his or her way to the subway at the end of the day, you know very well that the advice presented on the poster is nearly pointless. At least, from the point of view of actually encouraging the stroller pusher to act as described, the poster makes no sense. Perhaps there are other reasons why an organization would want to promote this as their advice to users, but modify behaviour in any meaningful way it will not. The constraints on that person pushing the stroller are too great: there is the effort to move the child, rangling the child and dealing with stroller, trying to move down stairs, carrying the child’s belongings and your own, and so forth. The demand is unreasonable in the context.

Back to the health emergency phone line. The London Ambulance service has put a good deal of emphasis on trying to get people to decide if the have a ‘real emergency’ before calling the emergency line. But, promoting the so-called correct use of the emergency number has not shown good results. You can’t blame them for trying new intiatives – the London Ambulance Service receives more than 1.5 million calls per year. Many of the initiatives are very interesting and promising. But, the marketing campaigns are not, and people are still calling in droves.

The people calling paramedic services, however, are looking for help; they are not ordering pizza. The callers may have bunions, abusive lovers, a broken heart, hypoglycemia, hyperthermia, a scratch, a cut, a limb amputated or any of hundreds of other problems that we as paramedics have gone there to help with. They may have a doctor, money and relatives, or they may have none of these. A health services review of the London Ambulance Service found that there are structural reasons – from cellphone technology to an aging population – for why people are calling emergency services more often.

It is true that the phones keep ringing in the health communications centres, and that dispatchers, first responders, paramedics and our services need to come up with better ways to help these people. We will need to work with other healthcare providers and with people and services outside of the healthcare system to respond to these patients. Just like 811 was a good idea, we will put more and better services into place. But, asking the callers to stop calling is unreasonable in the context.