INTERNATIONAL ACADEMIES OF EMERGENCY DISPATCH NOVEMBER | DECEMBER 2017
WORKPLACE THREE’S THE HANDLING TRAIN 9 | WELL-BEING 12 | CHARM 36 | INCIDENTS
PAGE | 20 HARNESSING THE POWER OF DATA
iaedjournal.org Fast and Flexible // POLICE Dispatching
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prioritydispatch.net/proqa | 801.363.9127 • •• COLUMNS NOVEMBER • DECEMBER 2017 | VOL. 21 NO. 6
4 | contributors 5 | the skinny 6 | dear reader 7 | ask doc 8 | technically speaking 9 | guest writer • •• SECTIONS BEST PRACTICES
10 | center piece 12 | ace achievers 16 | faq 18 | ng911
ON TRACK
32 | medical cde 36 | fire cde 40 | blast from the past
YOUR SPACE • •• FEATURES 42 | stork story 43 | dispatch in action 20 | HUMANIZING DATA 44 | off hours Agencies rely on data collection to drive policy-making decisions, justify budget proposals, and generate cost-effective operations. CASE EXIT 26 | DATA SURGE 46 | sam lanier Find out why data matters in this Q&A. 47 | fast facts 28 | ETC The Academy’s recent course for instructors provides a timely reinforcement of instructor troops for a course expected to explode with the release of ETC version 4.0.
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The following U.S. patents may apply to portions of the MPDS or software depicted in this periodical: 5,857,966; 5,989,187; 6,004,266; 6,010,451; 6,053,864; 6,076,065; 6,078,894; 6,106,459; 6,607,481; 7,106,835; 7,428,301; 7,645,234; 8,066,638; 8,103,523; 8,294,570; 8,335,298; 8,488,748; 8,494,868; 8,712,020; 8,971,501; 9,319,859; 9,516,166. The PPDS is protected by U.S. patent 7,436,937; 8,396,191; 8,670,526; 8,873,719. The FPDS is protected by U.S. patent 8,417,533. Other U.S. and foreign patents pending. Protocol-related terminology in this text is additionally copyrighted within each of the IAED’s discipline-specific protocols. Original MPDS, FPDS, and PPDS copyrights established in September 1979, August 2000, and August 2001, respectively. Subsequent editions and supporting material copyrighted as issued. Portions of this periodical come from material previously copyrighted beginning in 1979 through the present.
november / december 2017 | THE JOURNAL 3 ••• CONTRIBUTORS
Ron is from Cambridge, Keith is president of the RedFlash Massachusetts, USA, and has Group, a national consulting firm been a fire dispatcher for over that specializes in education, 30 years. He is an active regional outreach, and communications EFD instructor and serves on the for public safety and health care. IAED™ Fire Council of Standards. In 1979 Keith co-founded JEMS, Ron has taught more than 200 the Journal of Emergency Medical EFD courses. Services, with the late Jim Page. Keith serves as the chair of the Liaison Committee for the IAED.
RON RICHARD KEITH GRIFFITHS 36 | FIRE CDE 26 | DATA SURGE
Kimberly is the communication manager at the San Bernardino County Sheriff’s Department (California, USA). She is a California POST master instructor and holds a Master of Arts in Public Administration and a Master of Science in Justice Studies. She is the owner of Kim Turner, LLC, a corporation that provides 911 training and consulting.
KIMBERLY D. TURNER 9 | GUEST WRITER
Mary is deputy director of MACECOM, the 911 center for Mason County, Washington, USA. She previously worked with the Washington State Patrol for 10-plus years as a dispatcher, chief training officer, supervisor, and training program supervisor. She is certified by the International Association of Chiefs of Police as a Leadership in Police Organizations instructor.
MARY RANSIER GARRETT 18 | NG911
Art is a software instructor and IAED-certified EMD-Q® instructor for Priority Dispatch Corp.™ He has been a fire and EMS dispatcher for 20 years and is a former air medical dispatcher. He currently works at Union County Regional Communications in Westfield, New Jersey, USA.
ART BRAUNSCHWEIGER 8 | TECHNICALLY SPEAKING
4 THE JOURNAL | iaedjournal.org THE SKINNY •••
INTERNATIONAL INTERNATIONAL OFFICES ACADEMIES OF AUSTRALASIAN OFFICE EMERGENCY DISPATCH +61-412-580-283 110 South Regent Street, 8th Floor CANADIAN OFFICE Salt Lake City, UT 84111 USA +1-514-910-1301 USA/Canada toll-free: 800-960-6236 Intl/Local: 801-359-6916 EUROPEAN OFFICE Fax: 801-359-0996 +43-5331-20162 www.emergencydispatch.org ITALIAN OFFICE [email protected] +39-011-0688024 MALAYSIAN OFFICE +60-603-2168-4798 U.K. OFFICE 0808-234-4896 SNOW OR SHINE IAED JOURNAL STAFF CREATIVE DIRECTOR SENIOR DESIGNER Summer or winter, we’ve got you covered Chris Carr Serina Nielson MANAGING EDITOR DIRECTOR OF ACADEMICS Audrey Fraizer Isabel Gardett Becca Barrus TECHNICAL EDITOR PRINT AND LICENSING ADMINISTRATOR Brett A. Patterson Jess Cook SENIOR EDITOR WEB DESIGNER Josh McFadden Dave Tyler ’m going to be honest, I’m not a fan of Utah winters. I’ve lived SENIOR COPY EDITOR INTERNATIONAL TRANSLATORS Heather Darata Hien Cam Michel Looyé Giuditta Easthope Marco Mora here my whole life, and every winter is a test of my endurance. WRITER/COPY EDITOR Veronika Fagerer Sara Scott Becca Barrus Abbas Hamed Zhang Shengdong To those of you who live in even colder climes, I salute you. I Lu Huan Carolyn Turcotte I ASSISTANT EDITORS Audrey Gonzalez hope your nose doesn’t get frozen off. To those in the Southern Rebecca Tuft Hemisphere who are experiencing summer right now, I salute ACADEMY STAFF you, too. I hope your nose doesn’t get melted off. PRESIDENT DIRECTOR OF INTERNATIONAL RELATIONS Jerry Overton Amelia Clawson I’m not a fan of summer either. ASSOCIATE DIRECTOR | U.K. ASSOCIATE DIRECTOR, MEMBER SERVICES Beverley Logan Arabella VanBeuge Come to think of it, I’m not a fan of weather in general. I’m ASSOCIATE DIRECTOR | AUSTRALASIA ASSOCIATE DIRECTOR, Peter Hamilton INSTRUCTOR SERVICES ready to live in one of those climate-controlled bubbles you see in Bonni Stockman ACADEMICS & STANDARDS ASSOCIATE Brett A. Patterson ASSOCIATE DIRECTOR OF MEDICAL science fiction. CONTROL AND QUALITY PROCESSES ASSOCIATE DIRECTOR OF ACCREDITATION Brian A. Dale Kim Rigden I am, however, a fan of this issue of the Journal. We’ve got content that will help you up your dispatch game in Best Practices BOARDS & COUNCILS and articles that will remind you why you got into dispatch in the ACCREDITATION BOARD CHAIR COUNCIL OF STANDARDS CHAIRS Jerry Overton Brett A. Patterson (Medical/EMD) Gary Galasso (Fire/EFD) first place in Your Space. ALLIANCE BOARD CHAIR Tamra Wiggins (Police/EPD) Keith Griffiths Michael Spath (ED-Q) The FAQ, written as always by Brett Patterson, deals with CERTIFICATION BOARD CHAIR Conrad Fivaz, MD (ECNS) Pamela Stewart CURRICULUM COUNCIL CHAIRS the intersection of seizures and sudden cardiac arrests. There’s a RESEARCH COUNCIL CHAIR Victoria Maguire (Medical/EMD Board) Marc Gay Mike Thompson (Fire/EFD Board) Jaci Fox (Police/EPD Board) Center Piece about Vail Public Safety Communications Center Susi Marsan (ETC Board) Deanna Mateo-Mih (ED-Q Board) in Colorado, USA, and how they’ve adjusted to keep up with Gigi Marshall (ECNS Board) the needs of their community. (As a ski town, they probably COLLEGE OF FELLOWS appreciate the snow more than I do.) We also celebrate the CHAIR UNITED STATES Marie Leroux Bill Auchterlonie (Kansas) countrywide accreditation status of both New Zealand and Robert Bass, MD (Maryland) AUSTRALASIA Christopher W. Bradford (Florida) Frank Archer, MD (Australia) Steven M. Carlo (New York) Ireland in ACE Achievers. Andrew K. Bacon, MD (Australia) (Emeritus) Jeff Clawson, MD (Utah) Peter Lockie (New Zealand) Phil Coco (Connecticut) Peter Pilon (Australia) Brian Dale (Utah) Are you interested in doing research? Maybe you want to use it Chip Darius, MA (Connecticut) CANADA Kate Dernocoeur (Michigan) to increase efficiency at your center, or maybe you’re just curious Claude Desrosiers (Québec) Norm Dinerman, MD (Maine) Douglas Eyolfson, MD (Manitoba) Patricia J. Dukes, MICT (Hawaii) Martin Friedberg, MD (Ontario) James V. Dunford, MD (California) about how often people call in with a specific Chief Complaint. Marc Gay (Québec) (Emeritus) Conrad Fivaz, MD (Utah) Marie Leroux, RN (Québec) (Emeritus) Gary Galasso (Utah) Either way, our feature about humanizing data will help make Paul Morck (Alberta) Keith Griffiths (California) Wayne Smith, MD (Québec) Jeffrey R. Grunow, MSN (Utah) Darren Judd (Utah) research seem less scary and more accessible. EUROPE Alexander Kuehl, MD, MPH (New York) André Baumann (Germany) (Emeritus) To help keep you On Track, we have a Fire CDE that deals Jan de Nooij, MD (Netherlands) James Lake (South Carolina) Andrea Furgani, MD (Italy) James Lanier (Florida) Jean-marc Labourey, MD (France) Stephen L’Heureux (New Hampshire) with all things related to train protocols and a Medical CDE that Susanne Ottendorfer, MD, BBA (Austria) Victoria A. Maguire (Michigan) (Emeritus) Harm van de Pas, MD (Netherlands) Sheila Malone (Indiana) will help you with the when, the how, and the why of using the Gernot Vergeiner (Austria) (Emeritus) Susi Marsan (Georgia) (Emeritus) Christine Wäegli (Switzerland) Robert L. Martin (California) UNITED KINGDOM | IRELAND Dave Massengale (California) Agonal Breathing Diagnostic Tool (which will be called “Breathing Catherine McCormick-Bishop (Michigan) Trevor Baldwin (England) ® Michael Delaney (Ireland) Jerry L. Overton (Utah) Verification Diagnostic” in MPDS version 13.1). Dr. Jeff Clawson’s James Gummett (England) (Emeritus) Eric Parry, ENP (Utah) Chris Hartley-Sharpe (England) Rick W. Patrick (Pennsylvania) Andy Heward (England) Brett A. Patterson (Florida) Blast From the Past takes on the myth that keeping someone awake Stuart Ide (England) Paul E. Pepe, MD, MPH (Texas) Peter Keating (Ireland) Ross Rutschman (Oregon) (Emeritus) will keep them alive after they’ve experienced significant trauma. Beverley Logan (England) Doug Smith-Lee (Washington) Ray Lunt (England) Tom Somers (California) Andy Newton (England) (Emeritus) Paul Stiegler, MD (Wisconsin) Finally, our Case Exit features a TV dispatcher whose Cathal O’Donnell, MD (Ireland) Michael Thompson (Utah) Louise Todd (England) Carl C. Van Cott (North Carolina) contributions went uncredited for more than 120 episodes of the Janette K. Turner (England) Jonathan D. Washko (New York) Arthur H. Yancey, II, MD, MPH (Georgia) Tina Young (Colorado) show “Emergency!” The Journal of Emergency Dispatch is the official bimonthly publication of the International Academies of Emergency Dispatch® (IAED™), a nonprofit, standard-setting organization promoting safe and effective emergency dispatch services This is, of course, only the tip of the iceberg. To find out what worldwide. Comprised of three allied academies for medical, fire, and police dispatching, the IAED supports first-responder- related research, unified protocol application, legislation for emergency call-center regulation, and strengthening the emergency dispatch community through education, certification, and accreditation. other articles await, put on your boots (or your flip-flops) and General IAED membership, which includes a Journal subscription, is available for $19 annually, $35 for two years, or $49 for three years. Non-member subscriptions are available for $25 annually. By meeting certain requirements, certified come on in! J membership is provided for qualified individual applicants. Accredited Center of Excellence status is also available to dispatch agencies that comply with Academy standards. ©2017 IAED. All rights reserved.
november / december 2017 | THE JOURNAL 5 ••• dear reader
SCHEME OF THINGS What you do matters to callers
Heather Darata
s a dispatcher, I bet there have looked around. I didn’t see anyone, so I Turns out the police officer I saw had been times where you wished decided to climb up the stairs leading been quite close to my complex when I Ayou could have seen the out of the garage. I then noticed the had called the non-emergency number. outcome of the call—what happened at person I had been watching leave the I was amazed she had arrived on the the scene after you disconnected. garage I had watched him walk into and scene so quickly. The suspicious person Maybe you think that most calls head toward mine—taking a different was believed to have been looking in to the non-emergency line really don’t path than the one I was on. I went back car windows for items to steal. He was matter in the scheme of things. Well, let down in my garage and stood there startled out of the garage—presumably me share my experience to remind you for a minute, listening for movement. when the police arrived on scene. He had how important you are to those calling I turned and looked back up the stairs even dropped his own cellphone in the in for help. I had just come back down and was first garage he had gone into. I had just pulled into my complex startled to see a flashlight shining in my I was grateful the police arrived when one late summer evening when eyes. A police officer stood at the top of they did, and I know that’s because the something stood out to me. Something the stairs asking if I had noticed a guy in dispatcher took the information I gave seemed off about a particular person the garage. her and passed it on to the responders walking through the parking lot. I pulled Immediately after asking the quickly and efficiently. over and watched where he went. He question, she saw him near where I had If you ever wonder if what you stepped into one of the shared garages been standing and called out to him. I do makes a difference, I can tell you near mine. As a few minutes passed, he took my exit, not wanting to be caught firsthand that it does. I don’t know what didn’t come back out, and yet I didn’t up in the aftermath. A while later, we might have happened that night—but I think he lived in that building—he learned more of what had happened. know what didn’t. J definitely didn’t look familiar to me. I decided a phone call to the non- emergency number would alleviate my growing concern. It took me a minute to find the number since I had recently lost all of my saved contacts when my old phone had died. I soon called while keeping an eye on the garage he had entered, which was hard to see into because it was mostly dark—the lights hadn’t kicked on yet, as sunset was still approaching. When the dispatcher came on the line I told her I had noticed a suspicious person in my complex. To my best recollection, I gave her a description and told her where I had last seen him. She told me to call back if something changed. I decided that I really wanted to get home and proceeded to pull into my shared garage hesitantly. I parked and
6 THE JOURNAL | iaedjournal.org ask doc •••
PEDIATRIC BURN PATIENTS Upgrading response to meet severity
Brian Dale
Dr. Clawson: tried to solve the problem internally, but very difficult to manage pain in burn We were hoping you could help us we are at a loss. Any assistance would patients, as they are bad candidates for out with some questions and issues we be appreciated. sedation or paralytics, so this usually are experiencing with MPDS® Protocol 7: Thank you so much, rules out upgrading the response for pain Burns (Scalds)/Explosion (Blast). Kasey S. Young management. In addition, burns of this size Our agency has recently experienced EMD Quality Assurance Coordinator do not necessitate fluid replacement unless a number of calls involving pediatric Alameda County Regional Emergency the patient is already fluid compromised burn patients where the body area was Communications Center for some reason. less than 18%, but the injuries were quite Livermore, California, USA As a 33-year paramedic, I know the stress significant. For example, one of the most that a burned child places on the responders, recent calls was reported as a pediatric Dear Kasey, but the IAED tries to focus on the clinical scald to the face, which coded to a 7-A-1. I have referred the question to Brian acuity of the patient, especially on known However, it was also reported that the Dale, the Academy’s Associate Director outcome data, and what prehospital skin was peeling from her face. The of Medical Control and Quality Processes, interventions did to alter or impact that fire department arrived first on scene, and former Chief of the Salt Lake City outcome. We believe the current data upgraded the ambulance response, and Fire Department. ...Doc supports the current coding matrix found the patient was flown to the nearest in the MPDS relating to size and location of burn center. Our EMS agency and other Dear Kasey, the insult. We do know that explosions and cooperating agencies are looking for a way I have been asked to respond to your burns to the face that result in inhalation to upgrade any pediatric burn patient. inquiries about Protocol 7 and pediatric injuries create much sicker patients, but Protocol 7 does not assign determinants patients. Regarding your email question, with scalding burns as described in your based on the age or severity of the burn we do get periodic questions about this, email, this risk is extremely low. (3rd degree, 2nd degree, 1st degree). The particularly regarding burns to the face. If you have access to any data or only determinant that we identified The background on the latest version research that contradicts our position as relating to severity is the Significant is that we reached out to a number of on burn patients, please send us a link or Facial Burns (7-C-4), but by definition pediatric trauma/burn centers including the research itself so that we can review this would not apply to a patient who Primary Children’s and the U of U the updated information or treatment was scalded. Trauma Center here in SLC (Utah, USA). protocols. It is important to remember Currently, we prioritize an ALPHA We were unable to find any quantifiable that burns such as this can be life-altering as a code 2 response, and a BLS crew data to suggest a non-inhalation burn to and can lead to significant scarring and a could be sent. EMS has assigned different the face—in adult or peds—altered the protracted recovery period, but there is response priorities to each determinant patient’s outcome or prehospital mortality. little that we know of that a paramedic in the protocols. We are wondering if We do agree that burns to areas of the can do to alter this unless there is airway anyone else has experienced this issue. Is body such as the face, fingers, toes, head, compromise, real or suspected, or there a good way to upgrade a pediatric and other areas do necessitate transport significant volume deficiencies. response from initial dispatch without to a burn center for specific management, I hope this answers some of your lumping in all 7-A-1 patients? Or can you but the data does not support sending questions, and I would be willing to have provide us with the reasoning behind ALS units simply due to the area burned. a conference call if you think that would Protocol 7 and why it does not address Obviously, when there are inhalation assist in improving the answers I have given. burns by age or severity so we could burns, this alters the patient acuity Regards, present this to our cooperating agencies? and thereby the determinant coding Brian Dale We have researched the “Principles of within the MPDS (Medical Priority Associate Director of Medical Control EMD,” reached out to other agencies, and Dispatch System™). We know that it is and Quality Processes, IAED™ J
november /december 2017 | THE JOURNAL 7 ••• technically speaking
DETERMINANT CODES Part 1: Explore the possibilities
Art Braunschweiger
n my travels for Priority Dispatch®, and ECHO-level codes with advanced or Neck injury (with difficulty “We don’t use Determinant Codes” life support. OMEGA-level codes reflect breathing.)” I don’t know of any Iis something I’ve heard more than patient conditions that may not require responder who wouldn’t want to once. This is especially true in areas an EMS response. Accredited Centers know that. with single-tier EMS systems, where of Excellence (ACE) have the option of Some CADs are capable of accepting every ambulance is staffed with ALS utilizing a nurse triage system to discuss the Determinant Descriptor and passing (advanced life support) providers. If non-EMS options with the patient it to mobile devices in responder that’s your world, read on—you might before sending an ambulance. vehicles. For responders without that not be taking advantage of some Even in single-tier systems, sooner technology, a Field Responder Guide, good information. or later the number of calls in progress which is available in pocket-sized, spiral- Among other things, ProQA® acts as will exceed the number of ambulances bound flipbook form and as an app for a resource calculator: The appropriate available. A well-thought-out agency smartphones, allows a responder to look resources are dispatched based on the policy could allow a dispatcher to send up the Determinant Code. Even for a Key Question answers you select. There’s the only available transport unit to the dispatch center that doesn’t have CAD a little more to it than that, but it’s patient with the greatest clinical need, and uses manual cardsets instead of essentially what happens. The dispatcher with first responders sent to the others. ProQA, the Determinant Code can be doesn’t need to memorize the response ALPHA- and BRAVO-level responses given over the air. criteria for every conceivable situation. usually require only a BLS level of Determinant Codes can also drive care, with BRAVO being more urgent. notifications to stroke centers. A patient CHARLIE- and DELTA-level resources with CLEAR evidence of stroke and A well-thought-out usually require an ALS level of care, a time of onset less than the window agency policy could with DELTA being more urgent. As set by local Medical Control will be noted above, the Determinant Level can identified by the suffix “J.” For many allow a dispatcher to also be used to decide which patients stroke centers around the country, early send the only available merit a HOT response and which do not. notification is the key to mobilizing a The Determinant Level can also help the stroke team prior to the patient’s arrival. transport unit to calltaker make the decision of whether (This is the primary reason why the the patient with the to stay on the line, as DELTA-level codes Stroke Diagnostic Tool is included in greatest clinical need. generally indicate unstable or potentially ProQA medical and is not optional.) unstable patients whose conditions can Calltakers and dispatchers are
In version 13.0 of the Medical Priority Dispatch System™ (MPDS®) there are 1,828 possible Determinant Codes. Each can be associated with a specific response assignment: the resources that an agency MPDS® v13.0, NAE-std. ©1979–2017 PDC™. deems appropriate and—if an agency chooses—whether it should respond suddenly worsen. information processors, and ProQA is “HOT” (lights-and-siren) or “COLD” (no Responders can also benefit from a superb information-gathering tool. lights-and-siren). Typically, ALPHA, the information contained within Sometimes we don’t realize how much BRAVO, and OMEGA-level codes are the Determinant Code. For example, we can do with that information. Making associated with calls requiring basic life on a fall injury coding as a 17-D-5, the good use of that information benefits support (BLS) and CHARLIE, DELTA, Determinant Descriptor is “Chest everyone, especially the patient. J
8 THE JOURNAL | iaedjournal.org guest writer •••
HEALTHY WORKPLACE Does your center contribute to well-being?
Kimberly D. Turner
t takes about 35 seconds in a As supervisors, we often do not talent, competency, or likability. How communication center to realize it is a assign value to resources or support long would that last before you were Istressful career. The reporting parties, mechanisms because we did not receive frustrated, bitter, resentful, or angry? officers, and firefighters we support those things before being promoted. You We, as industry leaders, must realize are often the least of our stressors. As know the old saying: You parent as you that traditional paradigms built a strong with any profession under the sun, our were parented, which is also true with foundation that have carried us this far, immediate supervisor may be the primary leadership. We lead as we were led. but we must envision and create new source of workplace stress. Until we get serious about leadership, paradigms if we are serious about public Snap. That could be you. training, and true empowerment safety in which our 911 dispatchers and In a dispatch environment, an untitled we will continue to have toxic and telecommunicators play a vital role. They supervisor could be a training officer detrimental workplace environments deserve better. They have earned better … or lead in addition to the supervisor, for the first of our first responders. and so have you. J manager, or director. Yes, that includes We will continue having difficulties sworn personnel assigned to dispatch. recruiting, training, and retaining our Sources Empowering employees in their work staff. These difficulties are exacerbated 1. Kanter RM. Work and family in the United States: A critical review and agenda for research and policy. Family environment plays an integral role in by organizational structures that do not Business Review. 1989; Volume 2 (Issue 1): pages 77-114. their well-being (Kanter, 1977, 1993), and provide opportunities for promotional 2. Kanter RM. (1993). Men and Women of the it is the availability and access to reliable growth. Imagine being a patrol cop and Corporation: New edition. Second Edition. Basic Books; resources, support mechanisms, and working the same beat for 30 years New York City, New York. 1993. training that define empowerment. The without an opportunity for advancement other side of well-being at work is having or lateral assignment despite your work that challenges us as well as being given opportunities for growth and/ or promotion. Many of the components that comprise a healthy workplace are markedly absent in most dispatch centers. This is alarming, but it is not surprising. Resources may be as simple as a pen or pencil to write with, an actual map that is current, a comfortable chair, a computer- aided dispatch (CAD) system that actually works, or alternatively having thorough policy and training manuals. Unfortunately, many dispatch centers are replete with missing resources. Our support mechanisms include constructive feedback that is often packaged as a work performance evaluation. When was the last time you received an annual appraisal on time that was not a boilerplate—or worse an exact copy—of last year’s appraisal with the dates changed?
november /december 2017 | THE JOURNAL 9 ••• BEST PRACTICES | center piece
Jennifer Kirkland MOUNTAIN HOME Vail 911 is the place for adventure and EMD response
Audrey Fraizer
ail ski resort has had its bumpy been home to 911 since 1988. The room is according to Vail Public Safety years. Poor snow conditions spacious. A full remodel in 2017 included Communications Center (VPSCC) Vcoupled with the relatively ergonomic consoles and an updated break Director Marc Wentworth. small pool of Americans who skied were room. Windows show off the abundant VPSCC is the PSAP for all 911 calls known to trigger tremor-like impulses sunlight and a view to the north that originating in Eagle County. It dispatches along the nerve lines of all area operators. celebrates the beauty of the ski mountain. for 13 public safety agencies, and the About the only place seeing a lot of Folks in Vail admire skyscrapers of 24 EMDs handle 125,000 emergency winter action—and this was 30 years ago— the rugged sort, a skyline of incredible and non-emergency calls each year. In was the switchboard at the emergency powder bowls that can be accessed from 2014, the center purchased a Mobile communication center that blinked like chairs and gondolas sweeping the vistas of Communications Unit (MCU) that is an “arcade game”1 whenever snow or the Vail and neighboring Lionshead. staffed by specially-trained incident threat of snow closed Vail Pass. In the off-season from snow, the dispatchers and houses three dispatch Those days are history. The Town of mountains reign supreme for hikers, consoles and a conference area. The Vail in Eagle County, Colorado (USA), bikers, climbers, and anyone willing to vehicle is deployed during major is now a four-season tourist destination, enjoy the scenery at 9,000 feet above sea incidents, such as the Red Table Fire in with snow being only one of the factors level. Vail Town Square, styled in an urban July 2016 and the Gutzler Fire in July (albeit a big one) attracting more visitors mix of Swiss chalet hotels, restaurants, and 2017, and events attracting a huge global than there are residents to a town shops, plays host to year-round festivals. audience, such as the 2015 Alpine World founded for the adventurous. It’s a perfect place for all sorts of Ski Championships. And the switchboard? That’s long things to happen. The 2015 Alpine World Ski gone, replaced by modern technology In 911 terms, “People can injure Championships wrote its own chapter in in the Vail Municipal Building that has themselves in any number of ways,” communications. Four years of planning
10 THE JOURNAL | iaedjournal.org center piece
preceded the event, with training that Vail provides benefits to keep people in Even without the perks, people tend covered the “what-ifs” of nearly 221,000 public sector employment, such as ski to stay in dispatch. Kirkland is going on spectators—plus 500 athletes and their passes, housing down payments, and 16 years; Wentworth recently reached support teams and 2,200 volunteers— flex scheduling. his 14th year; CAD/Map Administrator gathered for the 14-day (Feb. 2–15) mega They also work in partnerships. For Rebecca Pacheco has worked 28 years in ski-racing competition.2 During the example, VPSCC partnered with Starting the center. championships, VPSCC partnered with Hearts to launch the PulsePoint CPR/ Sure, it’s the camaraderie, exceptional Colorado State Patrol (CSP) Dispatch. AED mobile app to help increase sudden outdoors, and small town atmosphere CSP dispatchers, working from a cardiac arrest survival rates in Eagle (once you lift the layer of tourism) that remote station set up inside the normal County. PulsePoint is tied to the county’s keeps people here. And where else would communication center, dispatched the computer-aided dispatch troopers assigned to the event. In addition (CAD) system and notifies to event staffing in the communication users and sends them center, the Event Command Post was a map to the location staffed daily with two dispatchers per of the person in need shift, two shifts each day.3 of CPR and the nearest The event went off without a public access location for hitch. Public safety never put practice an automated external into action for mass casualties, mass defibrillator. Since its evacuations, or any other potential launch, more than 500 crisis situations even remotely tied to an people have signed up unplanned disruption to the games. to receive the alerts. In “Everything we trained for never came another partnership, for to pass,” said EMD-Q® Jennifer Kirkland, the past five years Vail 911 Operations Administrator. Police Department’s Ragnar EMD-Q Tina Mojzer At the same time, VPSCC EMDs running team has donated continued their daily routine of giving funds in honor of a former police you get the variety of calls they receive? PAIs and sending responses to the normal sergeant, who died in 2011. The money Where else would you remind tourists emergencies called in by Eagle County goes to a college scholarship program for that a moose is not trying to initiate play residents, assisting animal control, the daughter. if it approaches you, or that a homemade monitoring fire and burglary alarms, Who would want to work anyplace flying machine might not make it across updating the travelers’ radio station and else? They care for one another and, the Eagle River? In late May, a bear broke Vail Cable TV, and coordinating response according to Kirkland, “There’s a high into a home in Vail and was caught by with other agencies at the private, local, level of professionalism. They’re very a security camera balancing on a piano state, and federal level. Since the resort dedicated to their work and the people bench and plunking a few notes on wasn’t shut down to local and visitor they serve.” the keyboard. skiers during the games, an injury on the Kirkland was a recent college graduate Can it get any better than that? slopes still required coordination with (majored in English and theater) when “Vail’s a great place,” Kirkland said. ski patrol for an ambulance dispatch to a she moved to Vail along with her former “We have it all here, and I can’t imagine pickup point at the base. boyfriend, and now husband, Justin, who living anyplace else.” J In 1990, dispatch applicants were was intent on returning to the place he monitored before hiring for unsuitable grew up after finishing his degree at the Sources personality quirks.4 Claustrophobics same college. He started as a volunteer 1. Flanagan T. “Keeping cool: Work is seldom the same old thing at the Vail Communications Center.” The Vail and complainers were always cut from firefighter and in 2014 became Chief of Trail. 1990; Jan. 19. the running. Today, there are still tests, the Gypsum Fire Protection District (an 2. Vail Valley Foundation. “2015 Vail/Beaver Creek FIS interviews, and background checks, but estimated 41-minute driving time west Alpine World Ski Championships/Final Report.” 2015; June 4. https://issuu.com/vailvalleyfoundation/docs/ the former 9 to 10 weeks of training has of Vail). vvf0724_2015_final_report_08 (accessed Aug. 14, 2017). morphed into an intensive 6 months. Kirkland applied in emergency dispatch 3. Eagle County Public Information Officers. Partner New hires accompany police and fire and has never looked back. Not only is she Profile: 9-1-1 Dispatchers—The First First Responder. 2015; Feb. 10. http://www.ecemergency.org/2015/ personnel on rides through the county, drawn to the outdoors (she’s a runner) but (accessed Aug. 14, 2017). acquainting them with landmarks, streets, also a super advocate of a career that always 4. See note 1. and popular attractions. The Town of throws something new in her direction.
november / december 2017 | THE JOURNAL 11 ••• BEST PRACTICES | ace achievers
NEOC staff THREE’S THE CHARM Two countries, six centers, in real time
Becca Barrus and Audrey Fraizer
Good things happen in threes, and as communication centers were approved McConchie support staff at three centers, the “rule of three” (in Latin “omne trium for accreditation. in a consistent way, and at the same time? perfectum”) principle suggests, things “This was always part of their plan,” McConchie had an idea. that come in threes are perfect. said Louise Todd, Clinical Support Officer, She went to the PDC National Q to Why? Because that’s how the mind Priority Dispatch Corp.™ (PDC™). “They’re have them evaluate their QA process works. We look for patterns and trends, under an umbrella of one agency, so they objectively and provide unbiased and three is the number we’ve assigned are working toward the same standards suggestions for improvement through since the third century. [represented by the ACE].” their observations and discussion of Groupings of three are inherently It was the practical approach, said Laura current practices. National Q’s worked more humorous (three little pigs), McConchie, CCS Training & Quality with in-house Q’s, offering pointers for satisfying (bacon, lettuce, and tomato Manager, National Headquarters, St call review and following performance sandwich), rewarding (a genie grants John, New Zealand. They hadn’t actually standards, offering direct coaching, and three wishes), and effective when it considered going ACE separately, and giving constructive feedback. comes to remembering something it was time, she said, to finish a project The approach supported what important (stop, drop, and roll). that required an extra push in one of the McConchie knew they could achieve. In the case of three communication Twenty Points of Accreditation. They were working toward the same centers in New Zealand and the “All the parts were met except for ACE goal in tandem despite being in Republic of Ireland, two is not without compliance in our PAIs,” she said. “We separate locations. She submitted all the third. don’t get a lot of calls requiring them.” three applications through the online New Zealand The opportunity to provide PAIs was accreditation portal. The rule of three was in full force on similar in all three centers. EMDs needed “I was incredibly nervous,” she said. “I July 7, 2017, when New Zealand’s three practice and coaching, but how could was incredibly proud of staff and what
12 THE JOURNAL | iaedjournal.org ace achievers
they could do, but that didn’t make the system (Medical Priority Dispatch with geographic distribution confirming wait any easier.” System™), geographic information that the Christchurch Metropolitan Todd was in charge of reviewing the systems, and incident data transmission District was hardest hit. applications, which included uploading to ambulances. Due to the quake, the local ambulance 25 calls from each center recorded the “We’re a team,” McConchie said. “The service lost its CAD, and the New prior month. She completed a checklist of next available calltaker at any of the Zealand Civil Defense Agency lost its the Twenty Points of Accreditation and centers takes the call. If a computer goes ability to communicate with police and rated the calls according to the Academy’s down, or if something else happens, we fire in Christchurch. performance standards. Although time- can still handle the call.” consuming, particularly the call review, WFA celebrated its 90-year she turned the applications over as anniversary in 2017, having quickly as possible. been founded by the late Sir “I know how anxious agencies can Charles John Boyd Norwood get,” she said. on Nov. 9, 1927. It remains the Todd approved each application, only completely free ambulance making the next step on-site visits, and, service in the country.2 in the last stage, submitted the complete package to the Academy’s Board of Way it works Accreditation. McConchie answered the When an emergency call phone call she had been anticipating. (111) comes in, the Emergency “I was thrilled,” she said. “After the call Ambulance Communications Wellington Free Ambulance I was speechless. This was a huge project. Centres (EACCs) provide the Everyone did such an incredible job.” connection between caller and Emergency All rural and suburban calltaking and Ambulance Service providers. Calls from dispatching duties were shifted to the Virtual single system the North Island and the South Island Wellington and Auckland centers, giving The three communication centers—St are answered at centers in Auckland and EACC dispatchers in Christchurch the John Ambulance Service with locations Christchurch, respectively. Calls made ability to focus on emergency response in Auckland and Christchurch and the in central New Zealand are answered by within the Christchurch Metropolitan Wellington Free Ambulance (WFA)— EMDs at Wellington Free Ambulance District. With its communications merged in 2007 to provide a virtual single Headquarters in Wellington at North facilities fully operational, the system of emergency communication to 4 Island’s southern tip. Christchurch center became the hub of million residents and millions of vacation If all calltakers are busy at any one response activities in the city. and business travelers visiting the country of the centers, the system redirects the Even with suburban and rural calls each year (estimated 3.6 million in 20171). call into the national queue for either diverted, however, the Christchurch Nearly three-quarters of the population of the two other centers. The EACC EACC workload was significant. live in urban areas, leaving large rural areas CAD system also maintains real-time Dispatchers triaged calls and assigned them characterized by dramatic topography and information on the majority of ambulance to police and fire crews, tracked ambulance relatively small populations. resources available for deployment. requests manually, and used runners to The merger created a national Nationally, there are more than 445,000 communicate with Civil Defense. ambulance communication service, similar 111 calls for ambulances each year, and the In the hours after the earthquake, in concept to the country’s national fire number continues to grow about 3 percent police and fire in the metropolitan area had service created in 1975, which—in each each year. They dispatch a fleet of more from six to 24 calltakers and dispatchers case—provides advantages in cooperative than 600 ambulances, 250 rural doctors and in Christchurch triaging about 1,200 training, purchasing, maintenance, and nurses, 40 emergency helicopters, and the emergency calls and deploying personnel other support. A single network connects Coast Guard. They also coordinate patient through the nationalized system. Within the centers, and each center has remained transfer services for district health boards. 18 hours, rescue crews from other districts in its pre-merger location. Each manager arrived in Christchurch to assist with reports to the centralized Operating Board. Prime example event response. The joint structure in communication During the noon hour on Feb. 22, also increases the ability of standardized 2011, South Island was struck by a 6.3 Republic of Ireland call handling through shared technology magnitude earthquake. Within minutes, The Republic of Ireland’s three that includes a prioritized dispatch the number of incoming calls tripled, communication centers achieved
november / december 2017 | THE JOURNAL 13 ••• BEST PRACTICES | ace achievers
per year, everything for 17 fire authorities and four EMS from cardiac arrests to authorities. They field 40,000 fire and traffic collisions. special service-related calls and 90,000 The center, which EMS-related calls annually. According to is staffed by 155 John Moody, Third Officer at ERCC, they personnel, dispatches typically handle calls about small outdoor medical calls to 92 fires and traffic accidents. ambulance stations. In The center itself is staffed by 65 addition to calltakers dispatchers, and Moody said they don’t and Emergency experience high employee turnover. In Dispatchers (EDs), the fact, the ERCC has a zero percent rate NEOC also has Aero of staff attrition, which Moody ascribes Medical Dispatchers— to a mixed staffing model designed to Calltakers at the NEOC dispatchers who avoid burnout and other issues that may coordinate helicopters contribute to staff loss. accreditation singly, although they do for both the Irish Air Corps and the Irish share a history of using the Medical Coast Guard. International standards Priority Dispatch System (MPDS®). The ERCC has been an ACE The National Emergency Operations Motivated for ACE since 2006—the first center to become Centre (NEOC)—with centers in Murray said the NEOC promised accredited in the Republic of Ireland— Tallaght, Dublin, and Ballyshannon, the public the best possible over- and re-accredited in May 2017. Co. Donegal—was accredited in 2015. the-phone care it can offer and, “The decision was based on the desire The Eastern Regional Control Centre by aiming for accreditation, staff to show we followed internationally- (ERCC), which works with the Dublin members allowed themselves to reach recognized standards, thereby improving Fire Brigade (DFB), was accredited in the highest standard possible and the service offered to our city and 2006. All three centers have been using maintain professionalism. county,” Moody said. the MPDS for more than a decade. According to Murray, the ACE There was a transitional period when The NEOC works in conjunction with process went without a hitch. The progress was slow, but they worked the National Ambulance Service (NAS), staff was proactive, and when they first through it with detailed training and with the two centers serving all 4.7 million achieved compliance scores over a three- continued support from both inside the residents of the Republic of Ireland month period, they never looked back. center and the Academy. (excluding the area served by the ERCC). She advises other centers to remember For those considering ACE status, Calls to the two emergency lines, 999 that accreditation belongs to the entire Moody advises taking the Twenty Points and 112, are connected to an emergency staff; no single person can take the credit. of Accreditation as 20 individual steps. service operator who directs the call to the He also said as an agency, they believe in appropriate emergency service. Individual steps two distinct practices: learning as much as Nestled on the banks of the River they can by study and research and then Two operate as one Liffey, the city of Dublin has been asking for help with implementation. Similar to New Zealand’s network, around for more than 1,000 years. Both centers are grateful for the help the NEOC operates across two English and Irish are the main languages, of Beverley Logan, Accreditation Officer, sites on a singular Information and but there are significant parts of the IAED™; Kim Rigden, Associate Director Communications Technology (ICT) population that speak Chinese, Polish, of Accreditation, IAED; and Todd, who platform. The two centers—working as Russian, and French. reviewed the center’s ACE application. J one—were created as part of the NAS The Kilmainham Gaol, Trinity Control Centre Reconfiguration Project College, Saint Patrick’s Cathedral, and, Sources to centralize operations. of course, the world-famous Guinness 1. “Key tourism statistics.” Ministry of Business, Innovation & Employment. 2017; July 28. http://www.mbie.govt. The NEOC is partnered with the NAS, Storehouse are among the well-known nz/info-services/sectors-industries/tourism/key- and together they serve all 26 counties sites. The ERCC, in conjunction with the tourism-statistics (accessed Aug. 1, 2017). of the Republic of Ireland, an area of DFB, protects these important landmarks 2. Thomas R. “Wellington Free Ambulance marks 90 2 2 years ‘looking after its own.’” Fairfax Media. 2017; 27,133 mi (43,666 km ). According to and more from the threat of fire. Feb. 17. http://www.stuff.co.nz/business/better- NEOC Manager Kathrina Murray, the The service area of the ERCC and DFB business/89449311/Wellington-Free-Ambulance-marks- center dispatches around 320,000 calls is 571 mi2 (920 km2), and they dispatch 90-years-looking-after-its-own (accessed Aug. 14, 2017).
14 THE JOURNAL | iaedjournal.org ace achievers International Academies of Emergency Dispatch
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november / december 2017 | THE JOURNAL 15 ••• BEST PRACTICES | faq
WHAT IS AN EMD TO DO? Discerning generalized seizure from hypoxic seizure activity
Brett Patterson
Brett: matter. Please bear with me; the issue is However, is it sometimes possible to Do you have a good article on bigger than a breadbox. make a sound decision earlier, in Case seizure verses cardiac arrest (the logic The Rule you are referring to relates Entry, in the interest of identifying SCA of Rule 3 on Protocol 12: Convulsions/ to dispatch priority. Its wording was earlier? I think so, if the EMD considers Seizures)? We’re seeing a small trend revised in MPDS® v13.0 to clarify its the following important factors: initial with folks going to Protocol 9: Cardiac meaning. It states: “When effective scenario and clinical presentation. And, or Respiratory Arrest/Death when the breathing cannot be physically verified importantly, if the Seizure Protocol is Chief Complaint describes seizure-like by the caller, a seizure in a person ≥ 35 selected, follow-up is essential to rule activity. But what if it’s someone having is coded DELTA due to an increased out SCA. convulsions as part of their sudden probability of cardiac arrest.” This Rule Extremely key to the rapid cardiac arrest (SCA)? simply explains the rationale for coding identification of SCA, which we know Thanks, patients in cardiac age range higher than is so critical to the patient’s chance of Doug Smith-Lee younger patients when breathing cannot survival, is the caller’s initial description Project & Grants Manager be physically verified and the complaint of what happened, i.e., the presenting Clark Regional Emergency Services is seizure. scenario or recent history. Agency (CRESA) But more to the point of your We know that cardiac arrest outcomes Vancouver, Washington, USA question: How does the EMD discern the exist in Medical Priority Dispatch typical, and usually benign, generalized System™ (MPDS®) codes other than Doug: seizure from the hypoxic seizure activity those of Protocol 9. And we know what I don’t have any Academy articles that sometimes accompanies SCA? percent of cardiac arrest outcomes reside specifically addressing the discernment First, understand that Protocol 12 is in these other codes. For instance, we of hypoxic versus generalized seizures, designed to do this through questioning, know the D-1 and D-3 codes of Protocol but I do have quite a few thoughts on the coding, instruction, and monitoring. 12, Not breathing after Key Questioning
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and AGONAL/INEFFECTIVE Complaint description, but the scenario’s Selecting the correct BREATHING, contain a relatively high description strongly suggests SCA as the Chief Complaint number of cardiac arrest outcomes. We Chief Complaint? Case Entry Rule 7 also know that the D-2 and D-3 codes states “When the complaint description is Brett Patterson provides yet of Protocol 17: Falls, Unconscious or seizure, go to Protocol 12 regardless of another example: Arrest and Not alert, are atypically high consciousness and breathing status.” If a caller reports her 70-year- in cardiac arrest outcomes, as well as the Consider our earlier fall example, old father is complaining of severe, E-1, all DELTA, and C-2 codes of Protocol which is even more common. The caller ripping back pain between the 31: Unconscious/Fainting (Near). (Please sees and reports the fall, or perhaps just shoulder blades, so bad that he note that I am referencing MPDS v13.0 mentions the fall, but the complete nearly fainted, the EMD may key here). Also note that these codes prompt description involves a sudden collapse in on the words “nearly fainted” our PDI to retrieve an AED (the percent of a previously normal patient who and select Protocol 31, based on of cardiac arrest outcomes in a particular is now unconscious. Case Entry Rule Case Entry Rule 5, even though code drive these instructions). 7 states: “If the complaint description it is clear that the patient’s The scenario provided by the caller involves TRAUMA, choose the Chief primary complaint is classic AAA can contain some important clues Complaint Protocol that best addresses [abdominal aortic aneurysm] back regarding SCA. For instance, the sudden the mechanism of injury.” pain. This is because the Chief collapse of a person is often seen and What is an EMD to do? Complaint description “involves” reported as a fall. However, sudden I believe the key to these apparent a priority symptom, or rather collapse is the key to SCA identification, dilemmas is the application of the Chief “mentions” a priority symptom, not the reported fall. With regard to Complaint Selection Rules, specifically, not because near fainting is the seizures, the vast majority of generalized the literal interpretation of the wording Chief Complaint. What is the actual seizure outcomes are reported as “seizure,” versus the intent. Chief Complaint based on this not as a sudden collapse with a mention description? This is not for the of spasm, twitching, or jerking, and a caller to decide; the caller simply history of seizures is often mentioned. The EMD should listen provides the description. The EMD History is important, too, because our carefully to, and clarify must formulate the complaint data shows that the complaint of seizure based on the description, and this is 75 times less likely to be associated when necessary, the complaint is medical back pain, with cardiac arrest outcome when a answer to Case Entry likely associated with AAA. history of seizures is known. With regard Our SCA example is similar. to Protocol 31, which acts as a failsafe Question 3, and then The caller sees seizure-like activity, for SCA, the “mistake” is most often formulate that Chief but the caller’s description is not made at Case Entry when the complaint Complaint Description consistent with a generalized is unconsciousness and breathing is seizure. However, it is very UNCERTAIN, which should equate to into a Chief Complaint. consistent with SCA. The EMD SCA rather than unconsciousness. listens to the description and The first step to rapid recognition formulates the SCA complaint. of SCA is to listen very carefully to the The intent of these Rules was It’s the same with falls. The answer to Case Entry Question 3 and to guide EMDs with regard to their caller sees the fall and mentions ask for clarification when “exactly what interpretation of a caller’s complaint, the word fall in the Chief Complaint happened” is not perfectly clear. Then not to literally take a caller’s words or description, but the scenario be aware of what scenarios often lead to impression and translate that into a strongly indicates SCA. The trauma SCA, and don’t be misled by the caller’s complaint. In other words, the EMD Rule was never meant to steer initial impression or mention, i.e., fall, or should listen carefully to, and clarify the EMD toward a mechanism of even a complaint of sudden collapse and when necessary, the answer to Case injury protocol when the actual a mention of spasm, without a specific Entry Question 3, and then formulate Chief Complaint is medical, simply complaint of seizure, generalized seizure that Chief Complaint Description into because trauma was mentioned. activity, or accompanying history. a Chief Complaint. From that, the EMD Visit the Journal online What happens when the caller considers the Rules and chooses a Chief at iaedjournal.org for further mentions the word seizure, or describes Complaint Protocol. explanation and examples. J seizure-like activity in the Chief Brett J
november / december 2017 | THE JOURNAL 17 ••• BEST PRACTICES | ng911
Mary Ransier Garrett and Tommy* LEVEL OF ABSTRACTION Technology could take away self protection
Mary Ransier Garrett, RPL
hile in a meeting on a back to dispatch he told me his name, to not cry and instead paste a smile on Friday, I saw one of the Tommy*, and that he lived in the my face. WMACECOM (Shelton, apartments behind our building. Tommy told me he hadn’t eaten Washington, USA) dispatchers He had walked over to the police breakfast and only had a piece of cake frantically waving at me through department for help. Tommy and I and candy the day before because his the window of the dispatch center. went into my office where I keep a box mom had been sick. Our IT tech went They knew I was in a meeting—yet of toys for when my kids, or someone to the store and got Lucky Charms and the fact that they were trying to get else’s, come visit me. While we played, milk, and we had breakfast together. my attention meant it was something I asked questions trying to get more Tommy told me his birthday was the important. The dispatcher told me information from him about the next day and he was going to be 9 years there was a boy on the phone located situation at home. What school did he old and what presents he hoped to get in the police department lobby saying go to? Who was his teacher? How long for his birthday. We watched cartoons his mom wouldn’t wake up, and not had mom been sick? on my laptop. much else. Our agency is housed in the While answering my questions we I asked how he knew to come to the same building as the PD, so I walked up played with Hot Wheels cars. Aid and police department, and he said his mom front and entered the lobby. Standing police officers arrived, and we fed what had told him to do that if there was ever there was an 8-year-old boy in his info Tommy would give us to them. A an emergency. I told him he was very pajamas, barefoot, clutching the phone few minutes later my boss, the executive brave and did the right thing that day. The to dispatch as if it were a lifeline. He director, came out of dispatch and detectives came to interview him in my handed me the phone, and I told the mouthed to me that Tommy’s mom was office. His mom had been sick for a few dispatcher we were coming back there. DOA. I was mid-race with a silver race days and fell that morning, hitting her While walking through the PD car in my hand. It took all my willpower head. She also suffered from a GI bleed.
18 THE JOURNAL | iaedjournal.org ng911
When the chief of police came to having to do with the conflict between would telecommunicators still be able get Tommy from my office and take obedience to authority and personal to do it? Or is the level of abstraction him up front to his grandparents, he conscience. The conclusion being the what protects telecommunicators and thanked me for the cereal and play. I more abstract people are, the easier it is makes them so capable? It can be hard was heartbroken. The school brought to do harm to them. enough remaining emotionally detached counselors down to help break the news with just a voice on the other end of the to him that his mom was dead. I went phone. Adding the emotions of visual outside and cried. I couldn’t imagine Telecommunicators human contact could make the job that how my kids would feel. I wept for that function in an much more dramatic and distracting. boy and will never forget him. Several employees in the industry Coming face-to-face with the RP abstraction vacuum and labor unions have voiced that [Reporting Party] was not only hard on wherein we may hear “seeing” emergencies aren’t what they me, but our team as well. It’s not every signed up to do. I can relate in that I can day we have to “see” the tragedies we someone die, but talk to a child on the phone all day long deal with. As one of the supervisors we don’t have to put (and would prefer to)—but you put him working that morning pointed out, in my office eating cereal and the rules “Because we got to see the RP here in on gloves and touch of the game have changed dramatically. dispatch, this call had an emotional them. It’s easier to As professionals in the industry, it is effect on all of us. Generally, these important to keep the human element— calls are sad, but never do we get the fall into the trap of both employees and the public—in the opportunity to meet face-to-face the RP complacency when forefront of our decisions. Technology of a tragedy.” and advances in our service capabilities It has made me assess and re-evaluate you don’t have to will only continue, as change is constant. the preparation, or lack thereof, of our SEE that DV victim’s Making sure our telecommunicators are employees when it comes to NG911. ready and prepared for these changes Organizations in the industry have bruises, just hear is quite the undertaking but worth the focused intently on the technology and she hasn’t left her time and effort. Because what would interoperability components relating you do if you were face-to-face with to Next Generation; it’s a good thing, boyfriend yet. the RP? the future of public safety. Yet have *Editor’s Note: Juvenile’s name changed we thought through the impact to the to protect identity. J human element? Telecommunicators function in an When 911 was born, the intent abstraction vacuum wherein we may was to have a single number to report hear someone die, but we don’t have to emergencies and improve public put on gloves and touch them. It’s easier safety. The important component of to fall into the trap of complacency who would answer those calls (human when you don’t have to SEE that DV element) wasn’t readily addressed, which victim’s bruises, just hear she hasn’t left is arguably part of our uphill struggle her boyfriend yet. It’s easier to blow for classification and certification today. off that chronic runaway juvenile call Could we be setting our people up for when it’s not your kid. Sinek states, failure by not taking into consideration “Just like the conditions Milgram set in who will be answering NG911 calls? Are his experiment, the physical separation our organizations doing everything they between us and those on the receiving can do to ready telecommunicators for end of our decisions can have a dramatic “seeing” it versus “hearing” it? impact on lives …” (pg. 101) In his book, “Leaders Eat Last,” Simon Does the current level of abstraction Sinek discusses the idea of abstraction make it easier or harder to do what we and how it can play a huge role in how do? Statistically telecommunicators have we operate in organizations and society. “contact” with more people via phone The quilt MACECOM is making from agency patches for Tommy* Sinek illustrates this idea by examining than officers do face-to-face. If the call the Milgram experiment from the 1960s, volumes were face-to-face contacts,
november / december 2017 | THE JOURNAL 19 • FEATURE | humanizing data
Data collection streams agencies into the future
Becca Barrus and Audrey Fraizer
eople connect through data. It’s generated everywhere an individual basis to plan, evaluate, and monitor—for example, by everyone, in the private and non-profit organization to track spending and establish a budget. At this stage of an Psectors, by state and federal government agencies, and on international preoccupation with quality improvement and
20 THE JOURNAL | iaedjournal.org in areas of EMS education, outcomes, research, and reimbursement.1 Collection of 911 data complements EMS goals, not only to assess the current state of emergency communications, but also to help measure and improve performance and reach people in ways unique to technology. For the Priority Dispatch Systems, data can validate a change that was made to any of the systems based on internal data collection done at the International Academies of Emergency Dispatch® (IAED™). Finding the same or similar results across agencies speaks to the consistency of the protocols, regardless of where they are used. Data builds better interpersonal connections when we put it into human context: What type of data do I need to influence actions of the people I want to reach? What approach for collecting data will meet my goal? As every good quality assurance program recognizes, paying close attention to day-to-day operating data leads to discovering new insights about the agency and personnel. Once discovered, these insights can result in actions that can improve working relationships and customer satisfaction. As pointed out in Beyond EMS data collection: Envisioning an information-driven future for Emergency Medical Services: “Decisions are more likely to be effective and efficient when they are based on data.”2 And the sky’s the limit as long as you know what you’re looking for, where to find it, and how to apply it.
Data and algorithm An algorithm is an approach to building a model from data. It is a series of steps designed to solve a problem. In computer science applications, an algorithm is a sequence of actions customer satisfaction, it would be difficult operations. For EMS, devising strategies designed to show us how to perform a if not impossible to operate without for optimizing patient care through task. In daily life, this can be as simple as a quantifiable evidence. The world can no selective data gathering is a departure cake recipe or assembling a bookshelf. In longer spin on best guesses and gut feelings. from past reliance on military-based computer science, Pedro Domingos offers Data collection is also the expected trauma care models for the general public this definition in his book “The Master building foundation in public services. and a “what’s always worked” philosophy. Algorithm”3: “An algorithm is a sequence Agencies rely on data collection to drive As prehospital medicine has evolved, so of instructions telling a computer what to policy-making decisions, justify budget has the recognition of data as a quantitative do.” Algorithms, he explains, are reducible proposals, and generate cost-effective source for making a difference, particularly to three logical operations: AND, OR, and
november / december 2017 | THE JOURNAL 21 • FEATURE | humanizing data
NOT. At the core, algorithms are built on Active Rescues, and several more than 550 outpatient facilities, and a single out of simple rational associations. PSAPS have since joined the community. secondary PSAP keeping the Northwell Counselors refer to their PSAPs’ contact Center for Emergency Medical Services Data and text messaging save lists when circumstances indicate (CEMS) in orbit. teens on the brink immediate action is necessary and the Staffed by Emergency Medical Crisis Text Line (CTL) is a confidential PSAP, in turn, can request a ping on a Technicians (EMTs) and paramedics text message service for helping teens and cellphone. Major mobile carriers have trained in Emergency Medical Dispatch young adults experiencing a mental health- agreed to remove the hotline’s short code (EMD), the CEMS communication related problem. It’s available nationwide. from user records to ensure privacy and center emergency dispatchers handle How does CTL find people in crisis, or waive text message charges for the hotline. nearly 850 calls each day for intrafacility how do people find CTL? The developers transport among the system’s huge created an algorithm. Text messages sent network of hospitals and continually to the around-the-clock crisis counseling The joint venture track nearly 35 ambulances handling hotline (741741) are assessed based on reduced the time for close to 150 assignments each day. The messages received over the service’s history center also initiates EMS care for patients (these are the parameters in the algorithm Active Rescue by arriving to any Northwell hospital from and they could, conceivably, expand with nearly 50 percent. local municipalities. In times of disaster, time). The texts are routed automatically the center doubles as Northwell’s to a three-tier queue according to severity, Emergency Operations Center. with the highest priority given to messages In the first few months of operations, It’s no wonder that data collection that use specific words such as “cut,” the joint venture reduced the time for figures prominently in not only “hurt,” or “kill,” indicating the sender is Active Rescue by nearly 50 percent, from improving use of the Medical Priority actively suicidal. an average 60 minutes to 27.7 minutes. Dispatch System™ (MPDS®) in relation Trained crisis counselors available “The partnership proved the to prehospital patient care and response on the tier one queue connect with all value in creating relationships using but also the efficiency of the EMD potential suicidal texters in 13 seconds on an increasingly popular means of trained Emergency Medical Technicians average, according to Baylee Greenberg, communication,” said Michael Spath, and paramedics. CTL’s Director of Operations. Counselors Manager, Sunnyvale (California, USA) “We’re running data all the time,” further evaluate the situation through Communication Center, who first heard said Anthony Guido, EMT, former direct texting, and if there is clear about the hotline in a TED talk podcast Performance Improvement Coordinator, indication the person is pursuing a plan to (April 2016). “Technology gives us the Communications, Northwell Health cause personal harm, Crisis Text Line will ability to reach people in the moment of CEMS. “The same goes for all high- initiate an active rescue. crisis, and that’s powerful.” performing centers. We are always “Texting is very effective in reaching looking at ways to improve what we do.” people in a moment of crisis,” Greenberg Data-based decision-making New hire training was an area Guido said. “The word ‘today’ is the most often Data-based decision-making is an turned his attention to in 2016, but not used word, according to our database, and essential element in quality improvement, because he had heard any particular it doesn’t take more than three messages helping to assess the efficiency and complaints about the program. It was for the counselor to know the issue effectiveness of current processes and a matter, he said, of staying ahead of at hand.” modify the processes according to their needs. To assess current practice CTL was piloted in 2013 to address findings. Numerous methods exist for as the starting point for development, gaps in crisis communication for collecting data, including focus groups, Guido decided on a survey format in individuals uncomfortable with making surveys, reviews of internal records, and which students rate various aspects of calls to other hotlines or calling 911. numerical tracking of events. the program—such as ProQA® training Apparently, the hotline hit a nerve; so and quality improvement processes—and far, 45 million text messages have been Survey: Data promotes comment on what worked and what exchanged in 295 area codes. mentoring relationships didn’t work in learning about how the The hotline has also opened a window Northwell Health Center is a “data- center operates. Did they understand into the possibilities of NG911. driven organization”—an understatement what was expected of them? Did they In 2015, five text specialist Public for every department in the New understand the standards set by Northwell Safety Answering Points (PSAPs) York (USA) state-based mega health CEMS? For example, the results of the first partnered with CTL for location support complex boasting 22 hospitals, more survey showed that nearly 65 percent were
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uneasy with ProQA after completing their they need, EMS can’t provide,” she said. (ePCR) records, the study identified 265 training time. “We didn’t have the ability to sit down super-users accounting for 4,393 ePCR “This told me to bring back the with them for a few hours to figure out records and of those, the top super-users software instructors to address these exactly what they did need. We simply accounted for 797 responses. concerns,” he said. “Since the survey is didn’t know what we could do for them.” The study indicated vulnerable adults anonymous, no one feels intimidated In 2013, Baltrotsky left the streets for as a prominent group among super-users. by admitting something needs an inside job as an executive officer. The “They don’t know what to do, so they more explaining.” issue stayed with her and, as she learned, call EMS,” she said. The survey also pointed out the it was also a concern of the agency’s EMS Baltrotsky is optimistic about the importance of trending across multiple Medical Director, Roger Stone, M.D. He possibility of decreasing super-user classes, said Venessa Vangroski, gave her the go-ahead to collect data and reliance on EMS through community Northwell CEMS Trainer. For example, pilot efforts for appropriate referral within partnerships and referral. She is confident survey results strongly favored a the community. She created an EMS about the application of similar studies structure offering greater hands-on partnership with the county’s Health and and consequent referral programs beyond training following each module and less Human Services Agency (HHS). Montgomery County. book and lecture time. Learners want an Working with the communication “This is something any community instant pairing of seat time in class to seat center, Baltrotsky identified the top EMS can do,” she said. “The data is relatively time at the dispatch console. super-users during the first quarter of simple to collect and the agencies set “They want a live environment 2015 (January through March), finding up for referral are genuinely interested up front,” Vangroski said. “They want that the group had generated 128 total in participating.” live calls once they certify to get the calls. The individual super-users identified Baltrotsky submitted a poster abstract experience of working with the Medical were referred to HHS (at the time of of the research for NAVIGATOR 2017. Protocol and ProQA.” the next call to 911) and, as the source This survey, while in its infancy, is of quantifiable comparison, Baltrotsky CAD review: Extrication research in gaining support among the administrative retrospectively reviewed the call volume Butler County team and, in addition, connecting new before and after HHS intervention. Their Chris Davis, the 911 director hires to longer-term EDs through a call volume decreased to 64 percent for Butler County Emergency mentoring program. (from 128 calls the first quarter to 47 Communications in El Dorado, Kansas, Data collection boils down to calls the next quarter). A second phase USA, has been thinking about his current identifying what needs fixing and what conducted over a 14-month period (April research project for going on 20 years. doesn’t and quantifying the effect of a 2015 to July 2016) evaluated the potential For as long as Davis has been with Butler resolution designed to fix a problem. It’s effect of referral to HHS on EMS services. County, the fire departments they that simple. Using electronic patient care reporting dispatch for have been asking for more “We feel more accomplished at the end of the day,” Guido said. “It’s all about communicating and making those connections.”
Review of internal records: When EMS isn’t the answer Lt. Jamie Baltrotsky’s 17 years as a paramedic with Montgomery County Fire & Rescue Service, Gaithersburg, Maryland (USA), drew attention to an issue troubling communication centers everywhere: EMS super-users, the relatively small group of people within an EMS service region accounting for a disproportionate number of EMS resource use, beginning at the dispatch center. “It’s not only a matter of time and wear and tear on our resources, but also the help
november / december 2017 | THE JOURNAL 23 • FEATURE | humanizing data
complete information regarding traffic looking at rescue records coupled with the Audio call transcription was used as incidents that require extrication. calls from fire departments and whether or a novel approach to analyze interactions The information the fire departments not extrication actually took place. and identify factors affecting the want specifically is whether or not a The project is still in its infancy, but likelihood and success of bystanders semi-truck or tractor-trailer was involved Davis is optimistic about its benefits. The performing dispatch-guided CPR. and whether or not the incident was a fire department wants Butler County to According to results, Stage 9 head-on collision. The MPDS Protocol make an addition to the Protocol making it (determining if the patient is breathing 29: Traffic/Transportation Incidents is mandatory for dispatchers to specify when by giving airway instructions) took the intended primarily to identify possible a semi-truck or tractor-trailer is involved. longest time to complete. Stage 11 (giving medical response needs, and its focus is on They could file a Proposal For Change CPR instructions) also took a relatively mechanism of injury and symptoms such (PFC), but Davis isn’t convinced that such longer time to complete compared to as unconsciousness and injuries. a change needs to be made unless data the other stages. Stage 5 (establishing The Protocol does identify whether proves it beneficial to the MPDS. the patient’s age) took the shortest time any person is reported as pinned or to complete. trapped, but the fire department uses Download and transcribe: Results showed a high degree of different criteria, such as the involvement Finding the snags accuracy using transcription for data of a semi-truck or the report of a head- The importance of call review to analysis, with subsequent comparison to on collision, to decide whether to bring improve the dispatch process was a scripted protocols (MPDS) providing factors extrication equipment to the scene. finding produced in a study involving that might delay bystander CPR. Stages in The presence of these conditions may the download and transcription of which holdups occurred could be targeted make it more likely that they’ll need emergency medical calls. during dispatcher training and become the the equipment, but they don’t get that The study, conducted by a team of focus of future dispatch research. information until they get to the scene. U.K. researchers in cooperation with The IAED Research Division the Scottish Ambulance welcomed the study and in a Letter to Service communication the Editor piece published in the same center, reviewed suspected journal [Resuscitation] they wrote that Out-of-Hospital Cardiac [the IAED] “is always interested in Arrest (OHCA) calls in reviewing and advocating for high-quality which EMDs provided research that will help to improve any CPR bystander PAIs. Calls of the various aspects of our system, and were selected by MPDS in particular those process elements that classification from all involve dispatcher-caller interactions OHCA calls taken over a during time critical emergencies, such as three-month period in 2011. cardiac arrest.”5 Of the 50 calls downloaded Interestingly enough, the Academy’s and transcribed, 47 were own unpublished data analysis discovered confirmed cases of OHCA exactly the same results through a and of those, CPR was somewhat similar audit of CPR audio performed in 39.4 cases from multiple centers: “Since the Researchers divided completion of the study done by Clegg, To better understand the issues, PAIs into 12 stages, from the EMD et al. in May of 2011, the IAED Medical Davis attended a special research requesting the caller’s address and phone Council of Standards approved and workshop at NAVIGATOR in April number to CPR instructions (both mouth- released version 12.2 of the MPDS in June 2017 in New Orleans, Louisiana (USA). to-mouth and compressions). [Note: of 2012. This newer version eliminates There he worked with workshop The stages outlined for the study do not the instruction steps for opening the faculty, FirstWatch staff, and IAED correspond with the MPDS process (Case airway and checking breathing in cases representatives to define his methods Entry, Key Questions, and PAIs).] Time where the patient is not breathing, and goals for getting the data from each to progress through each stage, and move breathing ineffectively, breathing agency in his region. He is collecting data to the next, and the number of caller- agonally, or where breathing is uncertain, about calls dispatched as 29-D-5 from dispatcher interactions, were calculated to as determined in the initial patient CAD records in Butler County, Johnson evaluate possible holdups in performing description and assessment stage, known County, and Sedgwick County. He is also dispatch-assisted CPR. as Case Entry. As Clegg, et al. point out,
24 THE JOURNAL | iaedjournal.org humanizing data | FEATURE •
eliminating these steps saves nearly 1 whenever teaching an introductory in Las Vegas, Nevada (USA). Topics must minute of elapsed time and prevents the course to research and, in the class relate to dispatch in any discipline (police, caller from experiencing the frustration Carstaffin was attending, the mentors fire, ambulance, nurse triage), published of attempting to find respirations in a were impressive: Prehospital Care or unpublished. patient who is likely to be in a cardiac Research forum representatives, the arrest state already and may be gasping IAED Research Division, and a team agonally only—if presenting with any from FirstWatch, a company that turns “Once you’re connected respiratory activity at all.”6 raw data into information agencies can with the right resources use for situational awareness, operational Wide-open playing field performance, and clinical patient and the right people, Miyoshi Carstaffin caught the data outcomes. For the next three days, the you learn how to collection bug as a natural extension relative newcomers to EMS research of her work at Fulton County EMS, partnered in groups to design a research move forward.” Douglasville, Georgia (USA). She is the project, analyze relevant data, review agency’s Quality Assurance Officer and, associated scientific literature, and present among other responsibilities, she reviews their initial findings to the class as a whole. The IAED Research Division will calls and develops continuing dispatch Carstaffin worked within a group review all abstracts and, no later than education training. studying the Protocol 26 question, led March 9, announce the abstracts accepted MPDS Protocol 26: Sick Person by Isabel Gardett, IAED Director of for presentation. Posters are due by (Specific Diagnosis) was a nemesis to Academics. FirstWatch provided the March 23. All posters will be displayed at Fulton County EMDs and similar to many data (provided by agency permission NAVIGATOR. The author of the winning centers shared the dubious reputation as and cleansed of identifiers), and by the poster will be invited to the conference’s the most used and most misused protocol. end of course—by the beginning of Closing Luncheon, and the poster will Carstaffin couldn’t help but ask: When NAVIGATOR—Carstaffin was ready to be published in the Annals of Emergency an EMD coded the call as a 26, was it a 26 conquer the world of EMS research and Dispatch & Response, the Academy’s peer- according to response? Did the EMD miss a Protocol 26. reviewed research journal. Visit aedrjournal. stroke or a heart attack? How far were they Well, that may be an exaggeration. org to learn more about AEDR. Go to from the real medical problem? “I wanted The course, however, gave her confidence. aedrjournal.org/cfpp for more information to learn how to collect data,” she said. “I can do this,” she said. “I know how about the contest. J A brochure advertising a three- the process works.” day pre-conference research course at Page said it was the same with him Sources NAVIGATOR 2017 seemed like the when designing his first research project 1. Brogan J. “What’s the Deal with Algorithms?” Future Tense: The Citizen’s Guide to the Future. 2016; Feb. 2. place to start. Carstaffin registered and looking at the relevance of required http://www.slate.com/articles/technology/future_ scheduled her trip. She took a seat close paramedic training in reaching a tense/2016/02/what_is_an_algorithm_an_explainer. to the podium, but after a few minutes minimum level of competence. html (accessed Aug. 18, 2017). 2. Becknell J, Simon L. “Beyond EMS data collection: of listening to preliminary remarks, she “Once you’re connected with the right Envisioning an information-driven future for figured she had made a mistake. resources and the right people, you learn Emergency Medical Services (Report No. DOT HS 812 “I thought I was in the wrong class,” how to move forward,” he said. “There’s 361).” National Highway Traffic Safety Administration. 2016; December. https://www.ems.gov/pdf/ she said. “I had no idea what I had inspiration in knowing you can make an ems-data/Provider-Resources/812361_Beyond-EMS- walked into.” impact on people’s lives.” DataCollections.pdf (accessed July 21, 2017). The speaker, David Page, Director, 3. Domingos P. The Master Algorithm: How the Quest for the Ultimate Learning Machine Will Remake Our Prehospital Care Research Forum, IAED research possibilities World. First Edition. Basic Books; 2015. New York. University of California, Los Angeles Watch for an announcement of 4. Clegg G, Lyon R, James S, Branigan H, Bard E, Egan (UCLA), was used to that sort of the next IAED Research Forum at G. “Dispatch-assisted CPR: Where are the hold-ups during calls to emergency dispatchers? A preliminary hesitation. He is a disciple of research. NAVIGATOR 2018. In the meantime, analysis of caller–dispatcher interactions during out-of- “I was a curious paramedic, and research start getting your ideas together for the hospital cardiac arrest using a novel call transcription technique.” Resuscitation. 2013; Aug. 21. http://www. developed into a passion,” said Page, field IAED’s Annual Poster Contest. resuscitationjournal.com/article/S0300-9572(13)00451- paramedic with Allina Health EMS in The IAED is accepting research 6/pdf (accessed Aug. 15, 2017). Minneapolis/St. Paul, Minnesota, USA. abstracts through Feb. 23, 2018, for 5. Scott G, Olola C, Gardett I, Clawson J. “Shorter dispatcher-assisted CPR time-to-compression using the “Research is what I do when I want to know the annual poster presentation at latest dispatch protocol.” Resuscitation. 2014; Feb. 6. more about what I’m doing and why.” NAVIGATOR 2018. This year’s http://dx.doi.org/10.1016/j.resuscitation.2014.02.034 Page floods a room with resources conference is scheduled from April 24-26 (accessed Aug. 16, 2017). 6. See note 4.
november / december 2017 | THE JOURNAL 25 • FEATURE | data surge
PERFECT STORM Factors converge to create data surge
Keith Griffiths
ournal Editorial Board Member with less. You can’t really optimize the use communication center is because they and RedFlash Group President of the resources without good data. often handle administrative and other JKeith Griffiths interviewed Todd At the same time, elected officials are phone calls that aren’t entered into the Stout, CEO of FirstWatch, a Priority having to make tough decisions about CAD. It also helps track the total time a Dispatch® and IAED™ partner that helps where to spend their budget. Citizens caller is waiting before their call is picked public safety agencies improve by turning are holding them accountable for results, up, and whether the phone data includes raw data into actionable information. and that means using data to justify what information from the primary PSAP and Their focus: Why data matters. they’re doing. the beginning of the 911 call process from Q. Why do you think there is such a Finally, a new generation of leaders are the caller’s point of view. surge of interest in using data? just more comfortable with technology CAD data provides great real-time A. I believe there are several things and data. information about the call, including coming together at the same time for kind Q. What is the value of CAD data the exact location and the history of call of a “perfect storm.” EMS in general is vs. what you can get from ProQA® information. This includes time stamps, moving toward evidence-based practices Paramount? address changes or corrections, upgrades and decision-making. Public safety, and A. There are actually a variety of or downgrades from other responders on by that I mean 911, EMS, fire, and police, data sources in public safety, and their the scene, the units available and assigned doesn’t have enough resources. Many are components can be misunderstood. at the time of the call, the number of times even having to cut costs while their call Phone data provides real-time data we’ve been to this address before, whether volume grows. So, they need to do more that gives a good idea of just how busy the a patient or suspect was transported, the
26 THE JOURNAL | iaedjournal.org data surge | FEATURE •
state of the rest of the system, and even a problem with a single or only a few data how long the unit and crew has been on points and act on it, as if it were really a duty and how busy they were prior to the Leaders often work trend. Quite often, the supposed problem call. And actually, there’s a lot more. to make “decisions” is really just a normal change in whatever is ProQA Paramount data provides being measured, and when looked at over a clear, real-time, standardized view of when they should be time, it’s clear that it’s really an insignificant what the center knew about the patient thinking of making change, and the time spent on it was wasted. or call before any responders arrived, Another big mistake is implementing what instructions for treatment or “improvements.” a change throughout an organization medication were given to the caller, what without testing it on a small scale first. priority for the call was recommended Leaders get an idea, read some research, vs. what was used, and what resources I find it interesting how fire or even want to implement best practices were recommended. departments are using data to identify and from another organization, and create a ePCR and RMS data provides slightly target areas to reduce community risk, like policy and roll it out organization-wide. delayed data, which is typically not areas with high fire loss for smoke detector My experience is that even great ideas or available until the responder finishes distribution programs, illegal burning, fall projects almost inevitably need small or completing the chart, with much more prevention, and other cool stuff. large tweaks to work well in that specific detailed and specific information about Q. The opioid crisis is officially a organization, and other ideas or changes the call from a trained responder’s national emergency. What is the role of just don’t work in some places. perspective on the scene. public safety agencies in using data to aid If you start small and tweak the change Q. What are some examples of in preventing deaths? as you increase the scope, projects are how 911 centers are using data in A. Opioid overdoses are responsible almost always more successful. You also innovative ways? for over 30,000 deaths per year and hurt have the added benefit of being able to A. Oh gosh, this is a hard question to many more people directly and indirectly, abandon what turned out to be a bad idea. do justice to because there are so many as most addictions do. We are helping two The third thing that I see a lot is using ways that folks are using their center’s different research teams who are using old data to try to effect change. By that I data, and even when they are working 911 and EMS data to learn more about the mean waiting until the end of the month, on the same problems, they may take problem and find ways to help sooner. quarter, or—heaven forbid—the end of different approaches. What’s new or Public safety agencies around the the year in those annual evaluations to innovative to one agency may be similar to country are helping in the fight in many talk with folks about what they need to what another agency has done for years. different ways, but the most successful improve. For a lot of us who started in the That said, some of the cool ways seem to be using data to drive not public safety trenches, even a week from agencies are using dispatch data include only their own efforts, but many joint an event to constructive feedback is a long reducing the time police officers spend at task forces where EMS, fire, and law time. Research shows that the closer the hospitals with psychiatric patients so they enforcement are working with public feedback—positive or negative—is to the can be back on the street. Some places health and social services. They are not event the feedback is about, the greater the are balancing crew workload to manage only using data to look at statistical and likelihood of change and improvement, fatigue and reduce stress to improve geographical trends, but also notifying and the faster the change takes place. the safety and well-being of our crews teams in real time so they can try to The last thing that comes to mind is and patients. connect with the patient while they may kind of subtle. Leaders often work to make Another trend with our customers be most receptive to interventions. “decisions” when they should be thinking is to measure and improve what’s called We are starting to compile some best of making “improvements.” It may just “population health equity.” A hot topic in practices from our customers around be me, but I think a “decision” tends to be public health is working to ensure that all the U.S. and Canada. The variations thought of as final, something that needs folks in all areas and of all means receive and similarities are fascinating. The to be perfect, and sometimes is thought the same high-quality care and service. information at www.firstwatch.net/opioid of as an isolated choice, rather than as part That concept is also making its way into will be available soon. of an overall approach. But when people EMS. In many communities, response time Q. What are the biggest mistakes think about making “improvements,” they equity for all has been a requirement, but people make when trying to use data to seem to tend to be a little more creative now we’re measuring other qualitative make decisions? and flexible and are less invested in their measures, for everything from no- A. Well, there are a few big ones. “decision.” That translates to being able to transport rates to clinical quality. Perhaps the most common is to identify admit a mistake, adjust, and move on. J
november / december 2017 | THE JOURNAL 27 • FEATURE | etc
ETC instructor pool goes exponential
Audrey Fraizer
he 12 Emergency it. It’s a good way for students to get •• Larry Latimer, retired, PDC™ Telecommunicator Course their foot in the door, and it provides a instructional designer and IAED T(ETC™) instructors selected to background for new hires unfamiliar director of curriculum design, and attend a premier course in teaching with public safety.” current IAED instructor. practices reflect yet another step in the Marsan has been one of three ETC They’ve certified hundreds of evolution of emergency communications. instructors certified to train and certify instructors during the years since ETC’s “Emergency communications is an instructors, along with: introduction to dispatch education in 2000. accepted career path,” said ETC Board •• Dave Massengale, retired, EMS The Academy’s recent course will farm of Curriculum Chair Susi Marsan, who Coordinator, Sacramento Metro Fire that number exponentially and provides a led the 40-hour course in August at District (California, USA), IAED timely reinforcement of instructor troops IAED™ headquarters in Salt Lake City, associate director, and current IAED for a course expected to explode with the Utah, USA. “ETC is growing right with instructor; and release of ETC version 4.0.
28 THE JOURNAL | iaedjournal.org etc | FEATURE •
guidelines and provides certification; ETC certification, however, does not include the Academy EMD/EPD/EFD certification. Those certifications are taught in separate 24-hour courses. “ETC plants a seed,” Marsan said.
High school career path Valgene Holmes was given a choice. He could choose either corrections or telecommunications as a career path program for high school seniors aspiring to law enforcement with or without a college education. Holmes chose the latter and now nearly 17 years into the program he can take credit for giving a professional boost to hundreds of students and supplying 911 centers with employees qualified to do the job. Of the 500 students successfully completing the course, 175 have been hired in Houston, Texas, USA, metropolitan area dispatch centers. Holmes was surprised by the program’s success. Not that he developed the program on a lark, but he just wasn’t sure how it would take. “I didn’t know where it would go, and I’m very pleased with how well it’s worked for the students,” said Holmes, who had a long career in law enforcement prior to teaching at the High School for Law Enforcement and Criminal Justice in Houston. “I see students make life changes.” The High School for Law and Justice “It’s a huge relief,” said Marsan, ETC version 4.0 incorporates the (HSLJ) (originally the High School for Law training coordinator, Grady EMS national Recommended Minimum Enforcement and Criminal Justice) opened communications, Atlanta, Georgia, USA. Training Guidelines that identify the its doors in 1981 to encourage minority “We were watching the numbers and minimum requirements for a state interest in law enforcement careers. In knew we had to certify instructors to telecommunicator program. The 2000, Holmes introduced calltaking and meet the demand.” guidelines are not federally mandated. dispatching to the curriculum through a ETC was developed as a forerunner They are optional although strongly partnership with Greater Harris County in a communication career for both new recommended since being released in 911 Emergency Network. hires and high school and college students 2016 following months of collaboration Holmes started from scratch. His pursuing public safety education. among 18 representative members, experience in communications was The first version, released in 2000, including the IAED, National Emergency limited to talking over the radio to has expanded to a 40-hour certification Number Association, National Fire dispatch when he was a police officer and course covering technology, best practice Protection Association, National detective. His first step inside a center standards, interpersonal communication, Association of State 911 Administrators, happened while he was on the road, legal issues, quality improvement, and the Denise Amber Lee Foundation. learning about 911 communications, and an introduction to protocol, and Marsan said ETC meets or exceeds was invited into the Fulton County E911 stress management. every standard set by the minimum Center in Atlanta, Georgia, USA.
november / december 2017 | THE JOURNAL 29 • FEATURE | etc
“I was amazed,” he said. “I had no idea many are offered full-time positions enough to build the confidence needed about all they did. I had no idea how upon graduation. to answer calls and dispatch response. hard they worked to protect guys like me The students call HEC “the land of New recruits struggled, and who could [police officers] in the field.” opportunity” because of what it provides blame them? Holmes’ program debuted the same them while in high school and college. “We were left with having to start year IAED released ETC version 1.0. Just The good news has spread, which is one from the ground up,” said Ronald as Holmes had discovered, the Academy reason Holmes was eager to attend the Williscroft, QI/Training Officer, noted a void in basic telecommunications ETC instructor course. Winnipeg Fire Paramedic Service. “We education. EMD training and certification “Others have heard about the couldn’t expect them to jump into EMD was available but solely to agencies numbers of students hired and about the and EFD without any background.” implementing the Medical Priority agencies that are looking to hire them,” he The concern led to investigating what was available to fill the gap or, as Williscroft explained, give recruits the knowledge they needed to get going. Through their association from using the MPDS and later the Fire Priority Dispatch System™ (FPDS®), they discovered ETC and for the past five years, it’s been the sustenance behind telecommunication training. “ETC solved a lot of issues for us,” Williscroft said. “With the recruits, we saw the light bulb go on.” ETC is where training begins. Recruits spend six to eight months in training before they are allowed to handle the phones and radios independently. The first 10 weeks is classroom, which includes practice through simulated calls, followed by working alongside experienced staff. The result is a very low turnover, both among recruits who have applied without experience to the Dispatch System™ (MPDS®). EFD and said, “They want to know how to do the seasoned EMS staff transitioning into EPD were still under development. same at their schools.” communications from the field. HSLJ provides 135 hours of instruction “People stay,” he said. “They love over two semesters and includes lessons Jump-start for recruits the environment.” on CAD, VESTA/MapStar, TTY/ Information overload without The “environment” the Academy TDD, and texting, and the 40-hour ETC learning core communication principles establishes in the classroom convinced Course. Students train at HSLJ and the was a definite concern at the Winnipeg Williscroft that the ETC instructor course Houston Emergency Center (HEC) and Fire Paramedic Service, Winnipeg, would be a great fit for him. Teaching ETC earn ETC certification from the IAED Manitoba, Canada. Communication is top among his duties at the Winnipeg and Texas Crime Information Center/ center recruits must earn a paramedic Fire Paramedic Service, and his specialty in National Crime Information Center technician’s license and certify in EMD radio communications lends to a welcomed (TCIC/NCIC) certification from the (since 2000) and EFD (2008). While avenue of discussion wherever he goes. Texas Department of Public Safety. Manitoba EMS acknowledges EMD as The props he brings (antennas and radios, Upon graduation, a Texas Commission a key service, training and education in for example) convey information that on Law Enforcement (TCOLE) the public sector focuses on primary and dispatchers can use to troubleshoot their Telecommunicator License is required advanced care for paramedics. equipment, and the method he incorporates within one year of hire by a PSAP. An in-house training program covered in his training resonated at ETC. Holmes said students are employed the basics, such as policy and procedures “Everyone had their specialty area, and at HEC during their senior year and beyond using the protocols, but it wasn’t you could see the passion we all bring to
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the profession,” he said. “I like learning That’s the same thought Jody Mader Science Academy at Butler Community ways to incorporate pieces into my had when she started at the Allen County College. The course she helped design global knowledge.” 911 Communications Center, Iola, teaches categorization of agency-specific Kansas, nearly 10 years ago. It’s also the response, familiarizes students with CAD College and center reaction she hears during the ETC class operations, and offers experience in a Calvyn Swigart is part of his future she teaches to new hires at Butler County simulated PSAP center and tours of the unfolding. While in his junior year ECC and from the students enrolled in Butler County ECC. The Fire Science of high school, Swigart took a class in the same program Swigart attended. Academy is an option for students public safety through an Early College “This is more than answering phones,” attending the Early College Academy. Academy course at Butler Community said Mader, supervisor, Butler County Mader said the Academy’s Instruct the College and discovered that emergency ECC, where she has worked for the past Instructor ETC course provided “tips and communications is a profession he might nearly five years. “We impact people’s lives.” tricks” she can incorporate in teaching want to pursue for a career. New hires at Butler County ECC and curriculum development. Advanced Now into his senior year, he is an go through five months of training training and education are part of the intern at Butler County Emergency before answering calls and dispatching evolution Mader has seen during the past Communications Center (ECC), El independently. The 40-hour ETC 10 years. Dorado, Kansas, USA, and thinks it’s course comes first, followed by in-house “Emergency dispatch is no longer likely he’ll apply for a full-time position policies and procedures review and EMD considered just a job,” she said. “We are when he graduates and turns 18 (state certification. They train with experienced part of a profession and that requires mandated minimum age limit to work in staff on the floor for several weeks. Mader professional level education and training.” emergency dispatch). and Butler County ECC Director Chris The Butler County ECC is the “I’m definitely interested,” said Davis are the two certified ETC instructors, primary answering point for 18 Swigart, who provides administrative and ETC has been part of the new hire emergency response departments assistance at the EMD accredited center. training since 2005. throughout Butler County and “There’s a lot more going on behind the Mader also teaches a one-semester ETC dispatches more than 50,000 calls for scenes than I thought.” course through the Early College Fire service each year. J
november / december 2017 | THE JOURNAL 31 ••• ON TRACK | medical cde
TO USE OR NOT TO USE When, how, and why to use the Agonal Breathing Diagnostic Tool
Becca Barrus
Editor’s Note: The Agonal Breathing you, the EMD, should supply hands-on- AGONAL BREATHING is slow and Diagnostic Tool’s name is changing to chest CPR instructions immediately. irregular. The Agonal Breathing Diagnostic Breathing Verification Diagnostic in Tool in the Medical Priority Dispatch MPDS® version 13.1. What is AGONAL BREATHING? System™ (MPDS) is designed to help you, he caller is frantic; there’s AGONAL BREATHING the EMD, distinguish between effective something wrong with his mother. (sometimes called agonal respirations) and AGONAL BREATHING. TShe’s on the ground, unconscious, falls under INEFFECTIVE and she needs help immediately. After BREATHING in the Case Entry All about the breathing asking the other Case Entry Questions, Protocol. It is the result of a signal Breathing diagnostics are relatively you ask, “Is she breathing?” There is a sent from lower brainstem neurons as new to PAIs. pause. The response you get could be higher centers become hypoxic (lacking Pulse checks used to be part of CPR anything from “Yes” or “Uh, yeah, I think in oxygen) during cardiac arrest. 1 It’s a instructions and trainings—including those so” to “I’m not sure” or “No.” sign that the brain isn’t getting enough in the MPDS—until the American Heart In which situation should you use the oxygen, and unless there’s external Association (AHA) discovered in 2000 Agonal Breathing Diagnostic Tool? If you intervention, the patient will die. that laypersons were getting false positives; aren’t sure, you aren’t alone. The name To the layperson, AGONAL they were reporting their own pulse rate, itself makes it sound like you should use BREATHING can look and sound not the patient’s. it to confirm the presence of AGONAL like effective breathing; the patient’s In addition, Emergency Cardiovascular BREATHING. However, Emergency chest still moves up and down, and the Care (ECC) Guidelines published by Medical Dispatchers (EMDs) should patient makes gasping noises that can the AHA in 2000 stated that layperson only use it to confirm that a patient is be interpreted as breathing. The main rescuers were taking “far too much time” breathing effectively. If there is any difference between effective breathing to perform a pulse check and that their doubt as to the patient’s breathing status, and AGONAL BREATHING is that results were “extremely inaccurate.”2
32 THE JOURNAL | iaedjournal.org medical cde
A new measure was necessary, and the In the cardset, the instructions can be It cannot be overstated that the tool AHA decided on “signs of circulation,” found on Case Entry, Protocol 9, Protocol should be used to confirm that breathing which comprise purposeful movement 12: Convulsions/Seizures, and Protocol is truly present rather than confirm (goal-oriented activity, such as avoiding 31 in the Additional Information section. ineffectiveness of breathing. Don’t waste painful external stimuli) and breathing. In ProQA, the instructions can be valuable time second-guessing the caller’s In turn, the International Academies of accessed by clicking on the red question report that the patient isn’t breathing Emergency Dispatch® (IAED™) developed mark icon. You can use the Agonal effectively—get to hands-on-chest as soon a methodology focused on distinguishing Breathing Diagnostic Tool at any point as possible. between effective and INEFFECTIVE during questioning if you have reason to BREATHING in an unresponsive patient. doubt the effectiveness of the patient’s When to use it breathing. When the tool is pulled up, The Agonal Breathing Diagnostic Agonal Breathing Diagnostic Tool you are told to read the instructions Tool is provided as a safety net on The definition of INEFFECTIVE verbatim: “Okay. I want you to say ‘now’ Protocol 12. This is because some people BREATHING first appeared in MPDS every single time s/he takes a breath in, in cardiac arrest experience seizures or version 11.0, released in 2000. It was starting immediately.” convulsions, so some cardiac arrests may attached to Case Entry and Protocol 9: For both ProQA and the cardset you be reported by the caller as seizures. Cardiac or Respiratory Arrest/Death, will check a maximum of four breaths According to Rule 1 on Protocol 12, use so that three intervals of the detector is mandatory “after the are tested. The reason jerking/twitching has stopped for all that three intervals generalized (non-focal) seizure patients between breaths are who are breathing or whose breathing is tested is because the questionable.” Typical seizure patients Academy wants you will begin breathing normally after the to get the information convulsions stop, whereas patients in (whether or not the cardiac arrest will not: Their breathing patient is breathing will continue to get worse. effectively) as quickly The following are other instances in as possible, but they which the Agonal Breathing Diagnostic also want enough data Tool should be used outside of mandated points to ensure that use with Protocol 12. the data collected is The first is when you, the EMD, valid. Any interval have reason to believe that the caller equal to or greater may be mistaken in reporting that the than eight seconds patient’s breathing is effective. Secondly, Breathing Verification Diagnostic. MPDS® v13.0/13.1, NAE-std. ©1979–2017 PDC™. qualifies as AGONAL you should use the tool when the caller BREATHING, answers Case Entry Question “Is s/he and the definition was essentially the and you should begin CPR breathing?” with “Yes, but …” (“Yes, but it same as the current one. AGONAL instructions immediately. sounds funny” or “Yes, but it sounds like BREATHING was mentioned on they’re struggling”). the Additional Information section When NOT to use it Usually the caller will say if an of Protocol 9, but it was not defined The EMD should not use the Agonal unresponsive patient is breathing there, and there was no tool to help Breathing Diagnostic Tool in cases when ineffectively during Case Entry, in EMDs distinguish between agonal and the caller answers “No” to the Key Question, which case you would go to Protocol effective breathing. “Is s/he breathing?” or uses any of the 9 (after dispatching the appropriate The Agonal Breathing Diagnostic keywords associated with INEFFECTIVE ECHO code). Tool was introduced in MPDS version or AGONAL BREATHING: “Barely The Agonal Breathing Diagnostic 11.2, released in 2005, in conjunction with breathing,” “Can’t breathe (at all),” “Fighting Tool will also be used on Protocol Case Entry, Protocol 9, and Protocol 31: for air,” “Gasping for air,” “Just a little,” 31 if the patient is unconscious and Unconscious/Fainting (Near). Today, “Making funny noises,” “Not breathing,” if the caller answers “No” to Key Agonal Breathing Diagnostic Tool and “Turning blue” or “Turning purple.” In Question 1 (“Is her/his breathing instructions are available both on the those cases, the EMD should begin CPR completely normal?”). MPDS cardset and in ProQA®. instructions immediately.
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Scenario as a whole patient is actually in cardiac arrest before Emergencies don’t happen in a giving her CPR. A study conducted vacuum, and to ignore the surrounding To ignore the between 2004 and 2007 in King County, circumstances of a call is a grave error. surrounding Washington, USA, analyzed the number EMDs need to be mindful of the situation of people receiving CPR to assess the risks as a whole. As Brett Patterson, IAED Chair circumstances of a call of giving CPR to patients who are not in of the Medical Council of Standards and is a grave error. cardiac arrest.3 Of the 1,700 patients for Academics & Standards Associate, puts it, whom dispatcher CPR instructions were “EMDs are often so focused on protocol initiated, 55 percent were in arrest, but that they sometimes forget the scenario Failing to maintain proper airway 45 percent were not in arrest and did not surrounding it.” control is the main risk in performing require CPR. Of the 247 patients assessed For example, as Patterson believes, it’s CPR on an unresponsive but non-arrested in the study, 5 (2 percent) suffered a one thing if a patient gets hit on the head patient. If the caller is too engrossed in fracture due to compressions. and goes unconscious; it’s another thing giving chest compressions, the caller Scott said even though a very low altogether if the patient appears to be fine might neglect to make certain that the percentage of the people who received one minute and then is unconscious the patient’s airway is clear. In an unconscious CPR despite not needing it were actually next, especially if the patient is elderly. In patient whose heart is beating, the airway injured by the chest compressions, that is those situations, it’s much more likely to is flaccid (weak and soft), which can cut not the aim of the Academy. be a cardiac arrest case than not. In this off the flow of oxygen if not properly “Our goal is to be as accurate as we case, even if the caller reports the patient maintained by the caller. can,” he said. The MPDS strives to get is breathing effectively, you are justified What are the risks of using the Agonal the right help to the right people at the in using the Agonal Breathing Diagnostic Breathing Diagnostic Tool when the caller right time; giving CPR to someone who Tool to confirm. reports the patient is breathing effectively? is unresponsive but not actually in arrest, It bears noting that the name of The worst-case scenario would be if you while not deadly, is not ideal. the Agonal Breathing Diagnostic Tool used the Agonal Breathing Diagnostic Tool Dr. Jeff Clawson, the inventor of the is changing in MPDS version 13.1 to and discovered that the patient really is MPDS, addressed the risk of fracture cited “Breathing Verification Diagnostic.” breathing effectively, which is pretty good in the King County, Washington, study in Patterson believes that the current name as far as worst-case scenarios in dispatch go. an Ask Doc column in the Journal4: might be partly to blame for the tool’s The patient may still be unresponsive, but On the surface, this seems an misuse: “The name ‘diagnostic tool’ at least you know that she is getting oxygen. insignificant number, unless you are implies that it should be used to diagnose “It’s OK to be wrong,” Patterson said. one of the five. However, the MPDS agonal breathing rather than confirm that “It’s OK to assume they’re not breathing is used in over 3,500 communication effective breathing is present.” when they really are.” centers worldwide and literally affects If the caller begins chest compressions millions of patients. A standard practice Risks on a patient who is unconscious but actually of performing unnecessary compressions What happens if the caller reports has a pulse, the patient will react to the on roughly 50% of unconscious, the patient is breathing ineffectively, pressure by either moaning or moving, abnormally breathing patients has the you provide CPR instructions, and it which will let the caller know that he is alive. potential to cause tens of thousands of turns out that the patient was actually Patterson said, in this case, it’s fractures, and millions over a relatively breathing effectively? better to believe that the caller’s report short period of time. This hardly equates According to Greg Scott, IAED of INEFFECTIVE BREATHING is to “Do no harm.” J Operations Research Analyst, a patient’s accurate and immediately proceed to rib could crack or break during chest CPR instructions. Sources compressions, but the risk is very low. 1. Rea TD. “Agonal respirations during cardiac arrest.” The risk of the broken rib puncturing Why use it? Current Opinion in Critical Care. 2005; 11(3): 188–91. 2. “Part 3.” Circulation. 2000; 102: I-22–I-59. an internal organ, such as the spleen, and Why is checking for AGONAL 3. White L, Rogers J, Bloomingdale M, Fahrenbruch C, causing fatal internal bleeding is even lower BREATHING important? What’s wrong Culley L, Subido C, Eisenberg M, Rea T. “Dispatcher- than that. Err on the side of providing with applying hands-on-chest as soon as Assisted Cardiopulmonary Resuscitation: Risks for Patients Not in Cardiac Arrest.” Circulation. 2010; 121: CPR instructions when the caller reports any abnormal breathing is reported in an 91–97. INEFFECTIVE BREATHING; don’t unresponsive patient? 4. Clawson J, Patterson B. “Proposed Two-Question second-guess the caller. There is some debate as to the Pre-CPR process may hurt live people, misses airway control and does not insure safety for all.” The Journal of necessity of determining whether or not a Emergency Dispatch. 2013; 3: 6–8.
34 THE JOURNAL | iaedjournal.org MEDICAL CDE QUIZ | G
YOU MUST BE MEDICAL CERTIFIED TO TAKE THIS QUIZ CDE Quiz Mail-In Answer Sheet Answer the test questions on this form. (A photocopied answer sheet Answers to this quiz are found in the article “To Use or Not to Use,” which starts on page is acceptable, but your answers must be original.) WE WILL NOT 32. Take this quiz for 1.0 CDE unit. PROCESS ALTERED SIZES. A CDE acknowledgement will be sent to you. (You must answer 8 of the 10 questions correctly to receive credit.) 1. Emergency Medical Dispatchers should only use the Agonal Breathing Diagnostic Tool to confirm that a patient is breathing effectively. Clip and mail your completed answer sheet along with the $5 USD a. true (U.S. currency) NON-REFUNDABLE processing fee to: b. false The International Academies of Emergency Dispatch 110 South Regent Street, 8th Floor 2. AGONAL BREATHING is a sign that the brain is: a. getting too much carbon dioxide. Salt Lake City, UT 84111 USA b. suffering from internal bleeding. Attn: CDE Processing c. not getting enough oxygen. (800) 960-6236 US; (801) 359-6916 Intl. d. not processing external stimuli. Please retain your CDE acknowledgement for future reference. 3. Which of the following is NOT a sign of circulation as outlined by the American Heart Name ______Association in 2000? a. breathing Organization ______b. pulse c. purposeful movement Address ______
4. In which version of MPDS was the Agonal Breathing Diagnostic Tool introduced? City ______St./Prov.______a. 11.1 b. 11.2 Country ______ZIP______c. 12.0 d. 12.2 Academy Cert. #______
5. In the MPDS cardset, the instructions for the Agonal Breathing Diagnostic Tool can be Daytime Phone ( )______found on Case Entry and which of the following protocols? a. Protocol 9: Cardiac or Respiratory Arrest/Death Email ______b. Protocol 12: Convulsions/Seizures c. Protocol 31: Unconscious/Fainting (Near) PRIMARY FUNCTION d. All of the above Public Safety Dispatcher (check all that apply) 6. Any interval equal to or greater than ____ seconds qualifies as AGONAL BREATHING. _____Medical _____Fire _____Police a. five b. six Paramedic/EMT/Firefighter c. seven Comm. Center Supervisor/Manager d. eight Training/QI Coordinator 7. You should use the Agonal Breathing Diagnostic Tool when the caller reports that the patient is “barely breathing.” Instructor a. true Comm. Center Director/Chief b. false Medical Director 8. The name of the Agonal Breathing Diagnostic Tool is changing in MPDS version 13.1 to Commercial Vendor/Consultant ______. a. Breathing Verification Diagnostic Other b. Breathing Diagnostic Tool c. Confirm Effective Breathing d. Ineffective Breathing Tool ANSWER SHEET G MEDICAL Nov/Dec 2017 Journal “To Use or Not To Use” Please mark your answers in the appropriate box below. 9. What is the main risk of performing CPR on an unresponsive but non-arrested patient? a. breaking a rib 1. o A o B b. failing to maintain proper airway control c. causing a cardiac arrest 2. o A o B o C o D d. rupturing internal organs 3. o A o B o C 10. In the King County, Washington, study, what percentage of the 1,700 patients for whom dispatcher CPR instructions were initiated were not actually in cardiac arrest and 4. o A o B o C o D did not require CPR? 5. o A o B o C o D a. 35 percent b. 40 percent 6. o A o B o C o D c. 45 percent d. 50 percent 7. o A o B 8. o A o B o C o D 9. o A o B o C o D To be considered for CDE credit, this answer sheet must be received no later than 12/31/18. A passing score is worth 1.0 10. o A o B o C o D CDE unit toward fulfillment of the Academy’s CDE requirements. Please mark your responses on the answer sheet located at right and mail it in with your processing fee to receive credit. Please retain your CDE letter for future reference. Expires 12/31/18 november / december 2017 | THE JOURNAL 35 ••• ON TRACK | fire cde
A TALE OF TWO PROTOCOLS Protocols 70 and 75 handle some scary issues
Ron Richard and Josh McFadden
rains have moved across this 2016, Amtrak moved over 31 million Two train protocols country for about 200 years. The passengers, on more than 300 train The Fire Priority Dispatch System™ Tconcept has not changed much in routes—an average of over 84,700 people (FPDS®) had just one train-related Chief all that time; it’s still a heavy steel vehicle per day.2 With all these people and Complaint until 2009. Starting with on wheels, moving along steel tracks. products moving about, public safety FPDS version 5.0, the Chief Complaint In 1840, 3,000 miles of railroad track agencies should be aware of other hazards was split using data and research obtained had been built in the U.S. By 2016, that related to the railroad industry. through input from protocol users number had increased to 93,000.1 Rail speed ranges from 62 to 86 and submissions through Proposals The next time you’re waiting at mph, with a projected goal of reaching for Change. a railroad crossing and counting the 140 mph. (European trains already Protocol 70 addresses Train and rail cars going by, just think of all the reach speeds of 165 mph.) These greater Rail Collision/Derailment. Example pollution not being created by this conga speeds could cause a potential for more situations for this protocol would be any line of cars. One hundred rail cars cause devastating accidents. train collision/derailment accident on fewer pollutants than the equivalent Amtrak was formed in 1971. Airports tracks or at railroad crossings. Also, as of 200 tractor-trailer trucks driving the and airlines, as well as highways with Rule 5 states, “If a train incident involves highway. That’s two or three locomotive their improvements, have changed the both a collision/derailment and a fire, use engines compared to the exhaust from way people travel. But train lines have Protocol 70.” two hundred diesel engine tractor-trailers pretty much gone unchanged. The latest Protocol 75 is used to handle a and their refrigeration units. project is to increase the height in tunnels Train and Rail Fire. This would be for By the late 1960s, people were so double-decker passenger cars can pass. any reported fire to the locomotive choosing passenger planes and airports Remember that freight trains can pull engine, passenger cars, or any freight with air traffic control systems. Rail well over 100 cars, and passenger trains compartment rail cars whether stationary travel started to lose its ridership. In usually pull a lot fewer. or moving. The Determinant Codes
36 THE JOURNAL | iaedjournal.org fire cde
on both protocols address the exact of vehicles may be a tanker or a tractor- P = Passenger (commuter) train, S = location of the train including whether trailer (semi). Subway, T = Trolley, and U = Unknown. it’s above ground level, below ground Remember, also, that Rule 2 states, There are no BRAVO-level level, in a tunnel, over water, etc. Suffixes “All derailments are considered to have Determinant Codes for this Protocol. identify the type of train, and the caller’s electrical hazards until proven otherwise.” Instead, there are eight DELTA-level answers to Key Questions can uncover Similarly, according to Rule 4, “All Determinant Codes, one CHARLIE-level any hazards. incidents involving trains, subways, or Determinant Code, and one OMEGA- commuter rails are considered HAZMAT level Determinant Code. The dispatcher Protocol 70 incidents until proven otherwise.” A will select the Determinant Code Protocol 70 has DELTA- and HAZMAT incident is “an incident based on where the train in question is CHARLIE-level Determinant Codes. If involving a gas, liquid, or solid that, in any located or whether the incident involves a person is trapped by the train without quantity, poses a threat to life, health, or buildings/structures (75-D-1) or vehicles collision or derailment, the call is coded property.” All HAZMAT calls have a DLS (75-D-2). Key Question 3, “Where as 70-D-1 “Person trapped by train (no link to Panel B-4. exactly is the train?” and Key Question collision/derailment).” All collision/ 4, “Are there any buildings/structures derailment incidents are assigned a Train on fire or vehicles on fire?” will provide this DELTA-level Determinant Code. These One of the challenges for public information. After Key Question are all determined by asking the first safety dispatchers is a moving train fire. 4, the dispatcher can dispatch the three Key Questions: What type of train The locomotive engineer may not even appropriate response and then return to is involved? Where exactly is the train? know that part of the train is on fire. The Key Questions. Are there any buildings/structures or dry vegetation of summer causes many For a private caller, Key Questions 5–8 vehicles involved? railside brush fires that could span over a will help the dispatcher determine which It’s important for the dispatcher to mile or more. Getting these trains to stop DLS Links to choose. If these questions understand some key definitions in this could take longer as dispatchers make reveal Caller Danger – Not Trapped, Person protocol. One of the Determinant Codes proper notification to rail officials. on Fire, Danger Present – HAZMAT, or is 70-D-8 “Collision/Derailment on Protocol 75 has nine Determinant Tunnel Fire situations, the link will be to BRIDGE/TRESTLE.” A bridge/trestle Suffixes to differentiate the type of train something other than Panel X-1. is defined as “a structure spanning and involved: C = Cable car, F = Freight train, If the train and rail fire concerns a providing passage over a gap or barrier L = Light rail, M = Monorail, O = Other, moving train, this situation should be such as a river or roadway.” There are four CHARLIE-level Determinant Codes on Protocol 70: 70-C-1 “LARGE FUEL/FIRE LOAD vehicle on tracks,” 70-C-2 “COMMERCIAL vehicle on tracks,” 70-C-3 “Other vehicle on tracks,” and 70-C-4 “Unknown situation (investigation).” The protocol defines LARGE FUEL/FIRE LOAD vehicles as “Vehicles, usually large in size, that can carry large amounts of combustible materials. These may pose additional threats during firefighting operations and require additional resources.” A bus, camper, or motor home may be considered to be a LARGE FUEL/FIRE LOAD vehicle. A COMMERCIAL vehicle, meanwhile, is defined as “Any vehicle that transports products related to business or trade. The products can be dangerous or hazardous.” Example of these types
november / december 2017 | THE JOURNAL 37 fire cde
stuck between the two gates at a railroad crossing. The eight-car passenger train struck the vehicle, and both ended up 650 feet from the point of the collision. This caused a flash fire that destroyed the lead car. The SUV driver and five train passengers died in the crash, and there was $3.7 million in damage.6 Getting an exact location for these types of accidents helps the responders gain a closer access point to set up a command point. Not all of these situations happen at railroad crossings. Sometimes the best path is bringing equipment through backyards or business parking lots.
Train tunnel accidents Most major cities have subway systems. Problems can develop from stalled trains forcing evacuations, smoke in tunnels, and/or train fires or collisions. assigned the OMEGA-level Determinant a toxic solution? Maybe a vapor or cloud Many operations in these Code, 75-Ω-1 “Moving train.” Unknown from a train storage yard? Both are environments cause responders to use the situations requiring an investigation are HAZMAT situations. utmost caution. Examples of these types coded as 75-C-1. One could receive calls reporting of environments include dark tunnels, accidents in rail yards. Injuries from rodent-infested areas, areas with high- Train problems—out of the box workers could include getting their feet voltage power equipment, and limited Besides situations involving collisions stuck in switching equipment as well as egress points, to name a few. or train fires, there are other emergencies other heavy equipment injuries. Trains and rail yards are all around that happen involving train properties. These are just a few examples of us. If everyone uses caution around these Emergencies associated with fixed train situations that can happen within any areas, everyone can enjoy the memories of equipment and properties can be handled train/rail property. being a little kid and being in awe of these using other protocols within the FPDS. magnificent machines. J At train stations, you could receive calls Railroad crossings reporting people stuck in elevators or and derailments Sources entrapped by escalators. You could also In the United States, there are about 1. “The Geography of Transport Systems.” Hofstra 3 University. Department of Global Studies & Geography, receive calls reporting electrocutions 5,800 train–car collisions each year. One Hofstra University. 2017. https://people.hofstra.edu/ because unauthorized personnel walked is almost 20 times more likely to die in geotrans/eng/ch3en/conc3en/usrail18402003.html along track lines or tunnels with electrified a crash with a train than with another (accessed Aug. 15, 2017). 4 2. “Amtrak.” Wikipedia. Wikimedia Foundation, Inc. third rails (an additional rail placed motor vehicle. Each year, approximately 2017; Aug. 7. https://en.wikipedia.org/wiki/Amtrak alongside or between the rails or a railway 600 people are killed and 2,300 injured (accessed Aug. 8, 2017). track designed to supply power to a train). in these accidents.5 Railroad guards are 3. “Train Accident Statistics.” McAleer Law. The McAleer Law Firm, P.C. 2017. https://www.mcaleerlaw.com/ Passengers slipping or falling from used to signal that a train is approaching. train-accident-statistics.html (accessed Aug. 8, 2017). platforms could indirectly include train People should never park their vehicles 4. “Crossing Collisions and Casualties By Year.” Operation interaction. Police may also need to be on the tracks at a gated crossing. One Lifesaver. Operation Lifesaver, Inc. 2017; March 5. https://oli.org/about-us/news/collisions-casulties dispatched if the injury was from a push should never drive or walk around gates (accessed Aug. 8, 2017). (assault). Each jurisdiction should have that are in the closed position, especially 5. See note 3. procedures in place to stop inbound with red lights flashing. 6. “Preliminary Report: Highway-Railroad Grade Crossing trains and make a safety zone for In February 2015, in Valhalla, New Collision.” National Transportation Safety Board. 2015; Feb. 3. https://www.ntsb.gov/investigations/ responders to operate. York, USA, a commuter train carrying AccidentReports/Pages/DCA14MR006_preliminary. How about a reported rail car leaking 650 passengers crashed into an SUV aspx (accessed Aug. 15, 2017).
38 THE JOURNAL | iaedjournal.org FIRE CDE QUIZ | F
YOU MUST BE FIRE CERTIFIED TO TAKE THIS QUIZ CDE Quiz Mail-In Answer Sheet Answer the test questions on this form. (A photocopied answer sheet Answers to this quiz are found in the article “A Tale of Two Protocols,” which starts on is acceptable, but your answers must be original.) WE WILL NOT page 36. Take this quiz for 1.0 CDE unit. PROCESS ALTERED SIZES. A CDE acknowledgement will be sent to you. (You must answer 8 of the 10 questions correctly to receive credit.) 1. How many miles of track were there in the United States in 2016? a. 3,000 Clip and mail your completed answer sheet along with the $5 USD b. 9,700 (U.S. currency) NON-REFUNDABLE processing fee to: c. 50,000 The International Academies of Emergency Dispatch d. 93,000 110 South Regent Street, 8th Floor 2. How many passengers rode Amtrak trains in 2016? Salt Lake City, UT 84111 USA a. 300 Attn: CDE Processing b. 84,700 (800) 960-6236 US; (801) 359-6916 Intl. c. 31 million Please retain your CDE acknowledgement for future reference. d. 300 million Name ______3. Trains in Europe can reach speeds of up to ______mph. a. 140 Organization ______b. 165 c. 200 Address ______d. 250 City ______St./Prov.______4. Rule 5 on Protocol 70 states that if the train incident involves both a collision/ derailment and a fire, you should use Protocol 75. Country ______ZIP______a. true b. false Academy Cert. #______
5. All collision/derailment incidents on Protocol 70 are assigned a ______-level Daytime Phone ( )______Determinant Code. a. OMEGA Email ______b. BRAVO c. CHARLIE PRIMARY FUNCTION d. DELTA Public Safety Dispatcher (check all that apply) 6. On Protocol 70, what DLS Link should you use for HAZMAT issues? _____Medical _____Fire _____Police a. Panel B-4 b. Panel C-1 Paramedic/EMT/Firefighter c. Panel X-1 Comm. Center Supervisor/Manager d. Panel X-2 Training/QI Coordinator 7. How many Determinant Suffixes are there in Protocol 75? Instructor a. 5 b. 7 Comm. Center Director/Chief c. 9 Medical Director d. 11 Commercial Vendor/Consultant 8. On Protocol 75, you should always link to Panel X-1. a. true Other b. false ANSWER SHEET F FIRE 9. Which of the following is true? Nov/Dec 2017 Journal “A Tale of Two Protocols” a. A person is 20 times more likely to die in a crash with another vehicle than in a Please mark your answers in the appropriate box below. crash with a train. b. A person is 20 times more likely to die in a crash with a train than in a crash 1. o A o B o C o D with another vehicle. c. A person is equally as likely to die in a crash with a train as with another 2. o A o B o C o D vehicle. d. There are no available statistics regarding automobile–train collisions. 3. o A o B o C o D 4. o A o B 10. Why is it important to get an exact location of a train accident? a. So responders can gain a closer access point to set up command. 5. o A o B o C o D b. So fewer bystanders will be affected. c. It’s not important; you only need to know the approximate location. 6. o A o B o C o D d. So authorities can take measures to prevent accidents from occurring there in the future. 7. o A o B o C o D 8. o A o B 9. o A o B o C o D
To be considered for CDE credit, this answer sheet must be received no later than 12/31/18. A passing score is worth 1.0 CDE unit toward fulfillment of the Academy’s CDE requirements. Please mark your responses on the answer sheet located 10. o A o B o C o D at right and mail it in with your processing fee to receive credit. Please retain your CDE letter for future reference. Expires 12/31/18 november / december 2017 | THE JOURNAL 39 ••• BLAST FROM THE PAST
KEEP THEM AWAKE? No, keep them breathing
Jeff Clawson, M.D.
Editor’s Note: This column was originally printed in the Letters to the Editor section of the Salt Lake Tribune on June 7, 2016.
ver since we started watching movies, at least of the “talkie” kind, we have heard cowboy, after soldier, after cop, after ambulance driver, after bystander make the common statement about a victim, “Don’t let them go to sleep!” or they’ll Edie. Everything from slapping, to smelling salts, to cold water, to just plain cajoling them has been tried with some success on the silver screen. However, the fact that nobody “really” dies in the movies or television, doesn’t mean that it works. All the while this recurrent moment has simply created a monstrous urban and rural myth: Keeping a dying patient awake will prolong or prevent their death. In a letter to the IAED’s local newspaper the Salt Lake Tribune, Dr. Clawson “saves the truth” while putting this notion to a proper, and needed, death—all within the 200-word “Letter to the Editor” limit. J
40 THE JOURNAL | iaedjournal.org blast from the past
June 7, 2016
Letter: Keep them awake? No, keep them breathing
Let’s set a ubiquitous, medical legend to rest (“City worker to the rescue,” June 3). Time and time again, a lay helper or reporter mentions that an injured patient was “kept alive/saved” by keeping them awake—based on the myth that if the patient goes to sleep, they’ll die. As an emergency EMS and 911 physician, I can unequivocally state that this just isn’t so. Whatever is going to kill the patient, happening inside their body, is not changed by urging them not to go to sleep. With external or internal bleeding, shaking or urging the patient to “stay awake” can actually make the problem worse by increasing blood pressure, thereby pumping out more blood, which their body is working to preserve. To help with “passing out,” the best help is keeping their airway open—no pillows behind their head, simply keeping their head tilted back—not forward. “Helping” grandpa with a pillow just hastens suffocating when he needs oxygen the most. This happens all the time and is a common, silent killer happening well before the EMTs or paramedics arrive. Every 911 dispatcher knows this and will so advise when needed. It’s not “going to sleep” but what’s causing your unconsciousness that kills you.
Jeff Clawson, M.D. Salt Lake City
november / december 2017 | THE JOURNAL 41 ••• YOUR SPACE | stork story
background. Gaines was confident and the perfect textbook example for giving step-by- step pre- and post-delivery instructions. It was a delivery without complications and a great first child delivery call for Gaines. “No one was impatient at all,” he said. Atchley credited Gaines’ approach to the job. “Matthew is very low-key and competent,” Atchley said. Gaines started in emergency dispatch in 2013, fresh out of college with a bachelor’s degree in sociology and criminal justice. He said it’s a great place to work, even when it is nearly 2 a.m., and the call comes in two minutes before your shift ends. “I like it,” Gaines said. “I like getting up in the morning knowing I’m going to be helping people. I like being able to calm people down.” Rogers Police Department 911 center handles radio traffic for police, fire, and Matthew Gaines EMS units and all incoming 911 and non- emergency calls for the City of Rogers. The center is staffed by 1 communications SWEET SOUNDS coordinator, 3 supervisors, and 18 Crying baby is music to some ears dispatchers, and they are going on their ninth year using the Medical Priority Audrey Fraizer Dispatch System™ (MPDS®). The city, located in the northwest portion of the state in the Fayetteville- “ e got a baby” were probably The area from where the call was made Springdale-Rogers area, is one of the the best four words EMD does not have a dedicated ambulance fastest growing areas in the nation, and Matthew Gaines heard, at response. This section of the county relies emergency communications is growing least in the course of the nearly three on a volunteer fire department. Response right alongside projections. minutes he was providing childbirth PAIs time in Rogers city proper is generally less “Our call volume has gone up by to the caller, the baby’s grandmother. than five minutes about 20 percent for each of the last three And for the next 14 minutes while Despite the wait, unusual even among years,” Atchley said. “Our plan is keeping waiting for the ambulance to arrive, volunteers rousted from the sack, no one current on all technologies, offering Gaines was connected to the sweet seemed rattled. Gaines kept them on the comprehensive training, and having a sounds of a baby crying and three adults line. He was there with them. Mom and strong quality assurance program.” fussing over the newborn girl. grandmother were altogether calm and The 911 center also uses the Fire “I was very relieved,” Gaines said. “It collected. Dad followed the PAIs that his Priority Dispatch System™. The CAD, was one of those calls we don’t deal with mother-in-law repeated to him from her 911 telephony, and radio consoles were all often, and I had to get everything right.” station at the phone. updated in the past 18 months, and the And that’s exactly what Gaines did. The baby let out the first wail seconds radio system is scheduled for an upgrade Before we go any further, however, after her introduction to the world. The next year. A new fire station is slated for we need to get something straight. cord was not wrapped around her neck, opening in 2019. In July, the fire department “This was a county call, not inside and for the next little while, the new baby added an additional peak hour ambulance. the city limits,” said Communications and mom stayed warm courtesy of dad. Atchley credits the motivation of public Coordinator Vicki Atchley, Rogers Police “I think we’ve used about every towel we service employees: “We’re professionals, and Department, Arkansas, USA. have,” dad can be heard commenting in the it shows.” J
42 THE JOURNAL | iaedjournal.org dispatch in action
On a call the day before going live with ProQA, Michie relied on the MPDS cardset [which SAS had been using since version 11.1] to provide instructions for auto-injecting epinephrine. The caller, she said, was experiencing the first stages of an allergic reaction after returning home from a run, and the medication on hand showed a past expiration date. Michie referred to Expired Injector Kit instructions, citing studies that showed kits 5 to 7 years past their expiration date still had more than 70 percent of epinephrine left, and kits 2 to 3 years past still had 90 percent left. The caller injected the medication. Michie started in the SAS communication center nearly three years ago after 12 years in police dispatch. She’s always been in emergency services for one simple reason. “I love it,” she said. “We can make a difference in someone’s life.” Audrey Michie And as far as being the first in her center to answer a call requiring naloxone administration? “We get calls for CPR DRUG OVERDOSE every day,” she said. “We’re used to it. All SAS ready with naloxone instructions the instructions are there for us to follow.” During the past six years, the NNP Audrey Fraizer in Scotland had distributed more than 20,000 take-home naloxone (THN) kits.1 The SAS sends an ambulance for a t was a perfect storm of EMD training But is anyone really ready once the patient symptomatic of an overdose to for Audrey Michie, calltaker from the life-or-death call comes in? What if you’re reduce the potential of a toxic relapse and IScottish Ambulance Service (SAS) the first to receive the call, meaning you provide access to emergency care.2 communication center. have no one’s experience to guide you? The SAS operates with three On June 13, the center went live Michie was ready. Less than 24 Ambulance Control Centres (ACC) with ProQA® and the Medical Priority hours after going live with v13.0, Michie in Inverness, Cardonald, and South Dispatch System™ (MPDS®) version 13.0. answered a call describing a female Queensferry. The three ACCs handle The new version includes instructions patient who was unconscious and “barely over 800,000 calls every year and dispatch for administering epinephrine (Protocol breathing,” following a reported drug ambulances to over 650,000 emergencies P) and (Protocol Q) Narcan/naloxone in overdose. The patient had already been and requests from doctors to transfer both nasal and injectable forms. given one dosage of naloxone, available patients to the hospital. Michie works out Prior to implementing the new through NNP. The single dose, however, of the South Queensferry center. J software, the SAS EMDs had received proved ineffective, prompting the call training in naloxone administration to 999. Sources for callers reporting a patient who is “I instituted the second dose, and the 1. “Naloxone can temporarily reverse the effects of a heroin or methadone overdose.” http://www.sfad.org.uk/get- unconscious, not alert, or changing patient came to in seconds,” Michie said. help-now/supporting-your-loved-one/harm-reduction/ color due to a suspected drug overdose. “From barely breathing to snorting and naloxone (accessed Aug. 9, 2017). Training complements Scotland’s National her color coming back and talking, she 2. McAuley A, Bouttell J, Barnsdale L, Mackay D, Lewsey J, Hunter C, Robinson M. “Evaluating the impact of Naloxone Program (NNP), established in was coming back.” Michie disconnected a national naloxone programme.” Addiction. 2016; 2010 to reduce the number of drug-related once an ambulance was on scene and Nov. 6. http://onlinelibrary.wiley.com/doi/10.1111/ deaths through distribution of the drug. with the patient. add.13602/full (accessed Aug. 9, 2017).
november / december 2017 | THE JOURNAL 43 ••• YOUR SPACE | off hours
subject: people. Art is something in her veins, and she’s been interested since she found art classes among the easiest for her in school. “I think I got the talent from my dad,” Giles said. “I was always doodling or doing something on the side.” Around the time she got into running, she also picked her graphite back up. Sketching combines the best of Giles’ artistic side and her dispatching side. She works graveyards and passes the time sketching while doing a job she loves. First, she started sketching her children. Then a niche developed. She specializes in sketching loved ones that have passed on. When people see one of her sketches, they tend to request that she draw one for them. “From there it [the number of requests] just kind of blew up,” Giles said. “It’s always of a loved one.” Amber Giles (second from right) surrounded by her children Some of those requests come from those in the public safety community. A fellow dispatcher asked Giles to sketch THE EXTRA MILE her father and his three brothers. One Dispatcher puts heart into everything she does of the brothers had been murdered at 15 years old. All three of the living brothers Heather Darata went on to serve in law enforcement and wanted a sketch to show the four of them together. mber Giles is passionate about marathons (13.1 miles), she knows that Other sketches are for family. everything she does. running a full marathon (26.2 miles) takes One of Giles’ cousins experienced a A When she’s not working as more intense training—about 2 ½ hours bad reaction on her way home from a a dispatcher at the Utah Valley Dispatch every other day. Giles’ running dreams dental procedure. The cousin’s heart Special Service District in Spanish Fork, include training for the 50-mile Lake to stopped and her dad performed CPR. Utah, USA, she spends most of her time Lake Relay from Gunlock Reservoir to She recovered and her parents wanted a with her four children (8, 10, 11, 14). Sand Hollow Reservoir in Utah in March sketch to reflect the feeling that a higher But she also loves her alone time. 2018 and the St. George Marathon in presence was with them during that Where does she look forward to going October 2018. She also wants to continue tense situation. once or twice a week? Giles loves trail training for a fitness competition that Besides the challenge of capturing a running in Provo Canyon (especially includes lifting weights and running. moment in a sketch that people can’t get Bridal Veil Falls) and in the Canyon After training for four months for this from a photograph, what keeps her going? Glen Park area. She has been running competition, she had to postpone her “I try to embrace this crazy life and for 10 years, but she switched to trails training because of a family situation. make every day an exciting adventure,” after hurting her knee running on Giles hopes to enter the competition the Giles said. hard pavement. Trail running lets her next time around. And then there is the best of both keep going. “I wanted to do something a little worlds—sharing her hobbies with her “I think it’s a source for me to get different,” Giles said. “I still lift weights. I children. out and be free from stress,” she said. really do want to do it.” “They love seeing [sketching] projects “Therapeutic I guess.” Something else that captivates Giles that I’m working on,” Giles said. “I While she has run quite a few half is sketching. Her medium: graphite. Her encourage them, especially with that.” J
44 THE JOURNAL | iaedjournal.org off hours
firefighter with Unified Fire Authority, Salt Lake City, Utah, USA, plan to go together. Ideally, they’d land a six-month contract, her as a dispatcher and him as a firefighter, and go backcountry skiing on their days off. Lenhart said Murphy encouraged her to switch from a career in hotel management to dispatch when he changed careers to firefighting. She said the change improved their relationship, making them better problem solvers and teaching them to keep calm under stress. “Working as a first responder really puts things in perspective,” Lenhart said. “When you’re talking with someone whose child is choking, losing your keys isn’t as big of a disaster as you once thought it was.” Although you couldn’t tell by simply talking to Lenhart, who is bubbly and optimistic, she has had her share of hard Katie Lenhart calls. In July 2017, she was on the phone for two hours with a suicidal caller while they tried to ping his location. She ended HIGH KICKS AND HIKING up losing him over the phone. That really Karate, skiing, and … Antarctica? shook her; she sobbed at her desk and her supervisors sent her home, but when Becca Barrus she got home, she couldn’t bring herself to get out of her car. Thankfully, she doesn’t get calls like that every day, but atie Lenhart’s uncle enrolled her your instincts. Even if you can only see the impact of similar calls is unavoidable. in karate as soon as she could a few feet in front of you, you have to Lenhart stressed the importance of Kwalk, and she hasn’t stopped keep moving ahead, staying centered and hobbies and goals outside of work. Going moving since. not panicking. You can’t stay at the top out on the slopes before heading into the “He taught me, ‘You can do more of the mountain; you have to go down. communication center helps keep her than you think you can,’” said Lenhart, a Difficult calls are the same way—you personal and professional life separate. dispatcher at Salt Lake Valley Emergency have to plow forward, trusting your She doesn’t internalize all the pain she Communications Center (VECC), West instincts and relying on the protocol. hears over the phone. Valley City, Utah, USA. When it isn’t ski season, Lenhart “You’re there to help,” Lenhart said, This mantra, originally used to stays in shape by hiking and training “but the grief is not yours to carry.” J motivate her to do difficult high her lungs to handle strenuous workouts kicks, has served her well in both her at high elevations. This kind of professional and personal life. Lenhart exercise, however, isn’t only getting achieved her black belt 10 years ago and her ready for ski season. “I want to be a still practices karate in her day-to-day life. dispatcher in Antarctica,” she said, her She’s also an avid skier, averaging about excitement infectious. 50 days of skiing in Utah per season. There are many qualifications for Lenhart doesn’t just ski on days that being a dispatcher in Antarctica, from are clear; she loves going out on storm needing at least two years of dispatch days, which she likens to dispatching— experience to passing a physical exam. you have to stick to the basics and trust She and her husband, Sean Murphy, a Katie Lenhart
november / december 2017 | THE JOURNAL 45 ••• Case Exit
search enlisting the LACoFD PIO County’s Retirement Association, he found the guy he was after. His name was Sam Lanier. Lanier was recommended for the show by James O. Page (1936–2004), who is considered by many as the “father of modern emergency medical services.” Page was a LACoFD battalion chief at the time and was contracted as a technical advisor and writer for “Emergency!” Page’s book, “The Emergency Companion,” provides a history of the TV series and includes the inside scoop of several episodes and several of the show’s characters. In the book, Page said Lanier was every bit the professional on screen as off: “He had a great voice and an even cadence while broadcasting ... over the years I never heard him lose his composure or confuse his role with that of a field VOICE OF ‘EMERGENCY!’ commander.”2 TV dispatcher goes without a name Lanier appeared briefly in two episodes of the show: “Stewardess” (Season 5, Audrey Fraizer Episode 1) and “Equipment” (Season 5, Episode 4). Interestingly, Lanier was also the (uncredited) dispatcher for one o you happen to have an Old Pal Angeles, California, USA. The dispatcher episode of “The Hardy Boys/Nancy Drew Model PF-3300 tackle box lying pinpointed locations using street maps Mysteries” (1977–1979). He worked as a Daround substituting for a spool from a Kodak Carousel slide projector dispatcher from 1958 to 1977 and then and thread sewing kit or, maybe, buried built into the console. To page either one as a fire safety adviser to film production under a heap of waders, fishing poles, and station or multiple stations, depending on companies in the Los Angeles area until his the fish locator you might have received as the severity of the incident, the dispatcher sudden death in 1997. He was 65 years old. a gift but never got around to using? would depress buttons on a signaling Ruggeri credits Lanier with sparking his You know the kind I’m talking about, system preset to activate each station. career in EMS and police work, including especially if you’ve been around as long Supporting crew of Station 51 included fire dispatch. as I have and are a fan of the TV show professional firefighters. LACoFD You can read more about Lanier and “Emergency!” (1972–1977). The Old Pal Firefighter Mike Stoker, who played hear an audio clip of his famous baritone Model PF-3300 tackle box made by the still- himself, as did LACoFD Captain Dick voice at emergencyfans.com/people/ in-existence Woodstream Corporation was Hammer were often featured on set and so sam_lanier.htm. the black box that Los Angeles County Fire was the voice of the LACoFD dispatcher. By the way, if you happen to have an Department (LACoFD) paramedics Johnny Although rarely seen on camera (it only Old Pal Model PF-3300 tackle box available, Gage (Randolph Mantooth) and Roy happened twice), the dispatcher was heard the National EMS Museum (emsmuseum. DeSoto (Kevin Tighe) were sure to bring to in virtually every episode. org) would be interested in taking it off emergencies. The tough and durable box— He was always there, sending out your hands. The same goes for a Motorola actually used at the time by LACoFD— responders and tackle boxes without so Quik Call I, just like the one used back in carried in the utility cabinet on the back much as a line in the show’s lists of credits. the day of “Emergency!” J of their Squad 51 truck contained their The star without a name to his credit medications, while a wood-panel box labeled bothered “Emergency!” fan Eric D. Ruggeri, Source “IV” contained IV bags and equipment. sending him on a quest to find the voice 1. Ruggeri ED. “A Man Known By His Voice More Than His Name.”Emergencyfans.com. 1997; August. http:// Squad 51 was dispatched—or, at that could be heard in “each of the 120-plus www.emergencyfans.com/people/sam_lanier.htm least, dispatch was filmed—at the Keith regular episodes”1 during the six seasons (accessed July 7, 2017). E. Klinger dispatch center in East Los the series aired. Following an extensive 2. See note 1.
46 THE JOURNAL | iaedjournal.org EMER ENCY
12 0 1 72 10 1 77
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