New 911 Rules Screen Minor Ills : Emergencies: Guidelines allow dispatchers to refer some callers to doctors instead of sending paramedics.

Until a few months ago, if you called 911 for medical help, you got it. Even if your complaint was a week-old bee sting or a stubbed toe, paramedics or firefighters trained as medical technicians were promptly dispatched to your door.

There were good reasons for such a broad policy. A Chatsworth woman had died in 1987 because dispatchers routinely turned down callers who did not sound as if they had bona fide emergencies. Public outrage and a hefty lawsuit followed.

Now, the pendulum has come to rest somewhere between those two extremes. Today, if you call 911 with a clearly minor complaint, a dispatcher may refer you to your doctor or local emergency room.

“We think of it as a referral service, as if you were calling your doctor and the doctor tells you to make an appointment for later in the day,” said Battalion Chief Dennis Keene, who is in charge of the quality assurance section of the Los Angeles Fire Department, which handles all 911 medical calls in the city.

Screened out under the new protocols are complaints that clearly pose no threat to life or limb: hangnails, bumps and bruises, splinters, boils and old wounds. One man who asked for an ambulance because his foot hurt after an assault 11 months ago was told to call his doctor.

If a caller has ingested a questionable substance but seems in perfectly good health over the phone, a dispatcher following protocols implemented Oct. 31 will set up an immediate conference call with a poison center before dispatching an ambulance.

No longer will a toothache automatically be categorized as a head injury and prompt a priority dispatch. If all other symptoms--heartbeat, respiration, skin color and the like--are normal, a caller may find himself referred to his dentist.

Still, Keene said, the new policy has eliminated just a handful of calls every day, fewer than 1% of about 650 emergency calls received.

“We are still going to err on the side of the patient,” he said.

Medical calls make up 77% of all emergency calls handled by the Los Angeles Fire Department. For a variety of socioeconomic reasons, city residents have increasingly come to rely on 911. Doctors no longer make house calls. Emergency rooms are too crowded to see patients promptly. Insurance policies are too expensive for many people.

The Fire Department still sends bills for its services, but will not turn down someone who seems unable to afford help.

The new dispatch protocols do not mean that all non-emergency calls have been weeded out.

Far from it. For reasons that Fire Department officials are at a loss to explain, people still call 911 to complain that their mothers-in-law are acting weird or their babies haven’t smiled lately.

Because such broad complaints can mask true medical emergencies, particularly in cases involving callers with limited ability in English, dispatchers generally continue to send help. Any complaint about a child under 3, for example, is still deemed an emergency upon the advice of medical consultants who note that toddlers are generally unable to articulate their symptoms, Keene said.

Paramedics and medical technicians still find that about 30% of their patients do not require transportation to a hospital. The budgetary savings have not even been measured, considering it is a mere 1% reduction in calls. But officials say paramedics are less likely to be out administering first aid when someone is having a heart attack two miles away.

“We’re still playing it safe,” said Gary Hirdler, a Fire Department paramedic working in Keene’s quality assurance department. “All it would take was one mistake and we’d be back to sending on every single call.”