Navigator 2015 Dazzles, Inspires & Connects

INTERNATIONAL ACADEMIES OF EMERGENCY DISPATCH MAY | JUNE 2015

16 | COMMITTED STAFF 53 | DISPATCHER HAS HAND IN 55 | ZENITH ALERTED HIGHWAY DRIVES HALL AMBULANCE SPECIAL DELIVERY EMERGENCY RESPONSE

PAGE | 28 NAVIGATOR 2015 DAZZLES, INSPIRES & CONNECTS

at the right time.  INDUSTRY INSIDER 12 | latest news updates

 SECTIONS Faster calltaking time means shorter time to dispatch. BEST PRACTICES

16 | ace achievers 18 | faq to the right people 20 | navigator rewind ON TRACK

–every call. 40 | fire cde  FEATURES | 44 blast from the past 22 | NURSE TRIAGE IN COMMUNICATIONS YOUR SPACE The Emergency Communication Nurse System™

50 | dispatch in action (ECNS™) satisfies the patient, responders, and providers through its logical, feasible, and That means faster, safer responders and safer communities. 54 | fast facts economical approach to EMS. 55 | retro space 28 | NAVIGATOR 2015 The Academy’s biggest and brightest NAVIGATOR to date took over the Paris Las Vegas Hotel the last week of April.

 COVER SHOT Follow IAED on social media. Photo by Michael Hewitt, Glitter Lens Photography.

www.prioritydispatch.net 800.363.9127 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. The PPDS is protected by | U.S. patent 7,436,937. FPDS patents are pending. Other U.S. and foreign patents pending. Protocol-related terminology in this text is additionally copyrighted within each of the NAED’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.

2 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 3  CONTRIBUTORS DEAR READER •• •

Doug is an attorney and founding INTERNATIONAL INTERNATIONAL OFFICES partner of Page, Wolfberg ACADEMIES OF AUSTRALASIAN OFFICE TIME TO GET EMERGENCY DISPATCH 011-61-3-9806-1772 & Wirth, a national law firm 110 South Regent Street, 8th Floor CANADIAN OFFICE focusing solely on EMS law. Salt Lake City, UT 84111 USA 1-514-910-1301 USA/Canada toll-free: 800-960-6236 IN YOUR He has written and lectured Intl/Local: 801-359-6916 EUROPEAN OFFICE Fax: 801-359-0996 011-43-5337-66248 extensively on dispatch law and www.emergencydispatch.org ITALIAN OFFICE [email protected] 011-39-011-1988-7151 HEART liability. He was a longtime EMS MALAYSIAN OFFICE provider and administrator prior 011-603-2168-4798 U.K. OFFICE to attending law school. 011-44-0-117-934-9732 Heather Darata COPY EDITOR

DOUG WOLFBERG IAED JOURNAL STAFF COMMUNICATIONS | CREATIVE DIRECTOR SENIOR DESIGNER 7 | ASK DOC Kris Christensen Berg Lee Workman follow MANAGING EDITOR PRODUCTION MANAGER Audrey Fraizer Jess Cook rom high above the Strip, Las Vegas looks vastly different TECHNICAL EDITOR WEB DESIGNER Brett A. Patterson Jason Faga Fthan it does walking on the street, tripping over others while DIGITAL & SOCIAL MEDIA CONTENT EDITOR INTERNATIONAL TRANSLATORS gazing up to find your destination. With hotels towering over Michael Rigert Abbas Hamed Victoria Cheema Sherri is the training and SENIOR EDITOR Giuditta Easthope you and people’s crazy antics distracting you, it can be hard to Josh McFadden Marco Mora operations manager COPY EDITOR Corike Nuibe figure out where you are unless you go above it all. us Nana Quackenbush Heather Darata for Waukesha County Sara Scott ASSISTANT EDITOR Carolyn Turcotte So, that’s exactly what we did. On Thursday night (April Communications, Wis., a Cynthia Murray 30), two co-workers, Devin Paulsen and Mike Rigert, and I took combined dispatch center in southeastern Wisconsin, just the next step (or you could call it a High Roller glass-enclosed ACADEMY STAFF west of Milwaukee, a land where ™ car on the world’s tallest observation wheel) and went into the Follow IAED on PRESIDENT ACADEMICS & STANDARDS ASSOCIATE the beer runs freely and locals Scott Freitag Brett A. Patterson air to see all that the Strip has to offer from an alternate perspec- proudly stack cheese on just ASSOCIATE DIRECTOR | USA COMMUNICATIONS DIRECTOR social media for Carlynn Page Kris Christensen Berg tive. From 550 feet—the highest point on the High Roller—it was about everything and call it ASSOCIATE DIRECTOR | U.K. DIRECTOR OF INTERNATIONAL RELATIONS Beverley Logan Amelia Clawson much easier to see things more clearly. great. You can contact Sherri amazing ASSOCIATE DIRECTOR | AUSTRALASIA MEMBERSHIP SERVICES MANAGER Not being a frequent visitor to Las Vegas, I can’t give you SHERRI STIGLER at 262-446-5085 or by email at Peter Hamilton Arabella VanBeuge 9 | LEAN IN [email protected]. dispatcher stories much in the way of landmarks or provide you with directions BOARDS & COUNCILS from one must-see attraction or shop to another. That made this ACCREDITATION BOARD CHAIR Susi Marsan (ETC Board) an eye-opening experience for me. and news, ACE Jerry Overton Deanna Mateo-Mih (ED-Q Board) ALLIANCE BOARD CHAIR RESEARCH COUNCIL CHAIR My co-workers and I found ourselves taking pictures while Keith Griffiths Tracey Barron intermittently dancing to the music played for everyone’s Art is a software instructor announcements, CERTIFICATION BOARD CHAIR COUNCIL OF STANDARDS CHAIRS Pamela Stewart Brett A. Patterson (Medical/EMD) and IAED™-certified ED-Q™ Gary Galasso (Fire/EFD) enjoyment. There was no fear of heights among us as we stood CURRICULUM COUNCIL CHAIRS Tamra Wiggins (Police/EPD) instructor for Priority Dispatch prizes, and more! Victoria Maguire (Medical/EMD Board) Brian Dale (ED-Q) next to the glass to view the plethora of lights beckoning us. Mike Thompson (Fire/EFD Board) Conrad Fivaz, MD (ECNS) Corp.™ He has been a fire and Jaci Fox (Police/EPD Board) I enjoyed not being caught up in the hustle and bustle found EMS dispatcher for 18 years and below us on the Strip. works at Union County Regional COLLEGE OF FELLOWS It was my view from the High Roller that helped shape Communications in Westfield, CHAIR UNITED STATES Marc Gay Bill Auchterlonie (Kansas) N.J. Art has been involved in Robert Bass, MD (Maryland) my experiences at NAVIGATOR. Just like I didn’t hesitate AUSTRALASIA Catherine L. Bishop (Michigan) 9-1-1 telecommunicator training Frank Archer, MD (Australia) Christopher W. Bradford (Florida) to go high in the sky, I approached some of you to learn more Andrew K. Bacon, MD (Australia) Geoff Cady (California) and medical quality assurance Peter Lockie (New Zealand) Steven M. Carlo (New York) Peter Pilon (Australia) Jeff Clawson, MD (Utah) about your conference experiences. And you were willing since 1999. CANADA Phil Coco (Connecticut) Drew Burgwin (Br. Columbia) Brian Dale (Utah) to share your thoughts and let this photo-happy person snap ART BRAUNSCHWEIGER Claude Desrosiers (Québec) Chip Darius, MA (Connecticut) Douglas Eyolfson, MD (Manitoba) Kate Dernocoeur (Michigan) a shot of you to share in this issue of the Journal. I appreci- 10 | FROM THE EMD SIDE Martin Friedberg, MD (Ontario) Norm Dinerman, MD (Maine) Patricia J. Dukes, MICT (Hawaii) Marc Gay (Québec) (Emeritus) James V. Dunford, MD (California) ated learning more about your centers and your reasons for Marie Leroux, RN (Québec) (Emeritus) Paul Morck (Alberta) Conrad Fivaz, MD (Utah) Wayne Smith, MD (Québec) Scott Freitag (Utah) attending the conference. Gary Galasso (Utah) EUROPE Keith Griffiths (California) And then NAVIGATOR attendees came together to hear André Baumann (Germany) Jeffrey R. Grunow, MSN (Utah) Jan de Nooij, MD (Netherlands) Darren Judd (Utah) Gianluca Ghiselli, MD (Italy) Alexander Kuehl, MD, MPH (New York) (Emeritus) the message keynote speaker Jason Hewlett shared during the LinkedIn: International Academies of Emergency Dispatch Jean-marc Labourey, MD (France) James Lake (South Carolina) James Lanier (Florida) Twitter: @TheIAED Bernhard Segall, MD (Austria) Closing Lunch—with his entertaining high jinks—of being in Harm van de Pas, MD (Netherlands) Stephen L’Heureux (New Hampshire) Facebook: International Academies of Emergency Dispatch Gernot Vergeiner (Austria) Victoria A. Maguire (Michigan) (Emeritus) Christine Wägli (Switzerland) Sheila Malone (Indiana) your heart and not in your head. We took the next step to- Susi Marsan (Georgia) (Emeritus) UNITED KINGDOM | IRELAND Robert L. Martin (California) ward getting in our heart by running around the room giving Trevor Baldwin (England) Dave Massengale (California) Tracey Barron (England) Jerry L. Overton (Utah) Michael Delaney (Ireland) Eric Parry, ENP (Utah) slap-happy high fives and bumping “chicken wings” with one an- Louise Ganley (England) Rick W. Patrick (Pennsylvania) James Gummett (England) Brett A. Patterson (Florida) other. Those “raptor selfies” we took provided a funny moment Chris Hartley-Sharpe (England) Paul E. Pepe, MD, MPH (Texas) Andy Heward (England) Ross Rutschman (Oregon) (Emeritus) with real take-home staying power: Don’t be a raptor at work Stuart Ide (England) Joe Ryan, MD (Nevada) Peter Keating (Ireland) Doug Smith-Lee (Washington) Ray Lunt (England) Tom Somers (California) (see picture on page 38 for info). Andy Newton (England) (Emeritus) Paul Stiegler, MD (Wisconsin) Janette K. Turner (England) Michael Thompson (Utah) I hope that as you reflect on your experiences at NAVIGA- Carl C. Van Cott (North Carolina) Arthur H. Yancey, II, MD, MPH (Georgia) Tina Young (Colorado) TOR as I have, that you find yourself willing and able to take the next step in your communication center—whatever that  The Journal of Emergency Dispatch is the official bimonthly publication of the International Academies of Emergency may be. Dispatch® (IAED™), a non-profit, standard-setting organization promoting safe and effective emergency dispatch services 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. 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 membership is provided for qualified individual applicants. Accredited Center of Excellence status is also available to dispatch agencies that comply with Academy standards. © 2015 IAED. All rights reserved.

4 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 5 ••• PRESIDENT’S MESSAGE ASK DOC •• •

WE’RE HERE FOR YOU SENSITIVE HEALTH INFORMATION Protecting the public in crisis comes first Does transmitting patient condition over the radio violate HIPAA law? Scott Freitag, IAED President Jeff Clawson, M.D., and Doug Wolfberg

hen the pandemic swine flu tious Disease Surveillance (EIDS) ty (N.Y.) Dispatcher James Ward Dear IAED: Doug brilliantly replied: a more secure means than via Wstory broke in April 2009, Dr. Tool (SRI/MERS/Ebola) following provided the PAIs that helped her We had a discussion at our center The short answer is no, there radio. A cellphone or other form Clawson pulled together experts in the initial Ebola outbreak. The to come to a full stop and out of regarding the topic of the Health would be no HIPAA violation by of encrypted or secured non-pub- EMS and EMD to develop new and EIDS Tool was released in ProQA harm’s way. Insurance Portability and Account- a 911 center/PSAP communicat- lic communications would be updated tools for use in the emerging on Aug. 8, 2014, and soon after that The Academy also makes it easy ability Act (HIPAA). ing HIV/AIDS patient informa- preferable. epidemic. So intense was his sense of was also available in cardset form at for members to participate in the The question that came up is: Is tion to a responding agency via Doug Wolfberg urgency that a “lockdown” work ses- no cost. protocol process—also at no cost— it a HIPAA violation if an EMD/ radio, because, generally speaking, Attorney, Founding Partner sion was held during NAVIGATOR, This tool is ever evolving and through a Proposal for Change dispatcher gives an update over the PSAPs are not classified as “cov- Page, Wolfberg & Wirth and no one left until the committee improving under the watchful radio to the responding EMS unit ered entities” under the HIPAA had a solution that could be distrib- guidance of the CBRN Fast Track that the patient is reported to have regulations. uted to the world at no charge. Committee, which received the Dr. HIV/AIDS, if the caller reported this The longer answer is—it’s a bad The result was the Severe Jeff Clawson Leadership Award at information to the calltaker? idea to give this information out Respiratory Infection (SRI) Tool NAVIGATOR 2015. We were reviewing the article over the radio, and it should not modified from the Academy’s SRI That’s not all the Academy has on page 14, Industry Insider news be done. My reasoning for this is Symptoms Surveillance and Crew provided at no charge to any center. section in the Nov/Dec issue of The that first, it could violate other Notification pop-up screen already Police Protocol 136: Active Journal. After reading it, we continue federal laws other than HIPAA (the in ProQA®, making it more consis- Assailant (Shooter) and the Accel- to be unsure about this issue. Americans with Disabilities Act tent with swine flu signs and symp- erator Stuck & Can’t Stop Vehicle Brian Baldwin [ADA] to name one) and state laws toms. The SRI signs and symptoms Protocol were also released for free Assistant Operations Manager regarding privacy. It could bolster checklist was made available in all in manual cardset versions. North Central CT EMS/CMED a claim of discrimination against then-current language versions of The Active Assailant (Shooter) Hartford, Conn., USA the providers and/or the 911 the MPDS®. Protocol, developed in coopera- center that the patient was treated One month later, a new proto- tion with the National Tactical Brian: differently on account of his or her col—Protocol 36: Pandemic Flu—was Officers Association (NTOA) and (PFC). A PFC gives members a way Wanting the best information pos- condition. If the information turns added to the protocols along with released in December 2012, was to introduce changes to standards sible on this delicate topic, I reached out not to be accurate (such as may an 8-page training guide that was made available to all emergency in an orderly manner that (after out to Doug Wolfberg, one of the top be the case when info is provided issued to ProQA and cardset users communication centers in addition meticulous review and discussion) EMS legal experts in the world: by a third-party caller), then there of the MPDS worldwide via the to a Special Procedures Briefing may be incorporated and provid- could be a suit for defamation due Academy and Priority Dispatch with information to direct callers ed to all users of the protocols Doug: to the fact that the information is Corp.™ websites. The new Protocol in lifesaving procedures before an throughout the world. Hope all is going very well for being publicized over the air. And, 36, in cardset format along with incident occurred. The Academy will always mon- you and the firm. I know this is if the information is accurate, a the training guide, was also made The Accelerator Stuck & itor international events and devel- probably an easy one for you, and claim for invasion of privacy could Doug and Doc: available free of charge to commu- Can’t Stop Vehicle Protocol was op the most effective approaches we have a basic answer, but do you be raised under state law, especially Your response is well received. nication centers globally, regardless developed in 2010 in immediate to emergency communications. have any words of current wis- if the plaintiff can establish that We always believed and continue to of Academy affiliation. response to a driver’s inability to The results represent a crucial dom and any documents/articles communicating the information believe that it is a good practice to Dr. Clawson recognized the stop the vehicle from accelerating function in readiness and response we could reference for this dou- wasn’t necessary to their patient protect and distribute information importance of experts poised to because the gas pedal was stuck. starting at the level of communi- ble-edged issue posed below: HIPAA care. Finally, infectious precautions responsibly. This response educated develop and issue dispatch-relevant The protocol can be used by cation based on belief, not the lure and HIV/AIDS? As we understand are supposed to be “universal,” so us on and clarified the HIPAA ele- information in response to interna- calltakers in all three disciplines of dollar signs.  it, HIPAA isn’t applicable per se singling out a patient for the use of ment. The response also validated our tional crisis and in turn organized (police, fire, and medical). at 911, but the broadcasting of a precautions that are supposed to beliefs on this matter. the Academy’s CBRN (Chemical, The protocol was put to test in patient’s condition, where in that be used in all cases could raise legal Brian  Biological, Radiological, Nuclear) November 2012 when Kelly Stoehr case’s patient could be identified by issues as well. Fast Track Committee of the Coun- called 9-1-1 because she couldn’t “Melvin Monitor” with his scanner, If a PSAP wants to give this cil of Standards. stop or slow her vehicle accelerat- is very troublesome. You da man on information out, it would be In 2014, members modified the ing at a high rate of speed along a this stuff! against my best advice, but if SRI Tool to the Emerging Infec- New York interstate. Orange Coun- Standing by the BatPhone … Doc they do so, they should choose

6 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 7 ••• ACADEMY RESEARCH LEAN IN •• •

SAY IT WITH A POSTER HEALTH CHECK Showcase your research at NAVIGATOR 2016 Taking a pulse of your employee-management relationship Tracey Barron Sherri Stigler

project on shell recycling in the peer-reviewed Annals of Emergency tion is a great way for researchers to iscussion abounds in comm. from invading their workspace. Bugs “pump the brakes” when you feel A seafood industry as a means Dispatch & Response (AEDR). share work at conferences, symposia, Dcenters around the country are crazy stealthy, so you have to be your temperature rising. Give people to boost pH levels in the ocean, a The IAED research and infor- and other events. Consider the poster about health and wellness these days. meticulous in your search. the opportunity to explain, because solar-powered multipurpose ther- matics division welcomes, looks for- as an exhibit in a museum. Design a We are inundated with informa- In a past job, I worked in a middle none of us have all the answers. mostat device, and a quantitative ward to, and is eager to accept sub- presentation that attracts attention, tion about reducing stress, getting school health room where, as part of Watch the “pitchy” emails … it’s analysis of the role of mitochondria missions for poster presentation at circulates research, and invites collab- enough sleep, eating healthy foods, my duties, I was the poor sap tasked tough to diagnose their true intent. in Drosophila melanogaster lifespan U.S. NAVIGATOR. While they have oration and feedback. and exercising more. But could we be with pawing through countless Take these preventative measures are among the announced proj- already taken place at this year’s Don’t anticipate $75,000 in prizes forgetting to “take a pulse” on the con- heads of adolescent hair in search of for your whole team and you will ects qualifying for the Society for conference in Las Vegas, it’s not too dition of our relationship between (gulp ...) lice. Gross? You betcha. Nec- Science & the Public1 (SSP) science early to begin plans for NAVIGA- the dispatchers and their leadership essary? You betcha. Why? Because fair that took place May 10–15 in TOR 2016—this is your conference; team? How healthy are we ... really? you gotta catch them before they Pittsburgh, Penn. share your research work with your propagate! It’s the same concept with The pre-college participants peers and help move the dispatch Who’s the boss? bugs between staff and management. (grades 9–12) showcasing their research agenda to the next level. Since the beginning of time, If you fail to catch them early, you’ll independent research emerge from Dispatch researchers anywhere in there have been bosses and there eventually be dealing with a problem an international field representing the world are invited to submit their have been worker bees. There have of epidemic proportions! How can 70 countries, regions, and territories. dispatch research work to the IAED been leaders and followers, kings and you get your staff/management rela- Doctoral-level scientists review and poster exhibit. The poster presenta- servants, chiefs and officers, coaches tionship under a microscope to take a judge their work, with their decisions tion can represent any stage of the and players. Some people have been peek? Here are some ideas: affecting awards of more than $5 mil- research process—planned, prelimi- “poor” leaders. You may know the Meet regularly—In our comm. lion in prizes, including the top-place nary, completed, and/or published type. They have a dictator-type style, center, we have a group of represen- Gordon Moore Award ($75,000). research work. and they’re really good at playing fa- tative dispatchers from each of the At one time, the Society for The posters are judged according Next year, consider vorites and keeping secrets. They shy three shifts who gather once every A healthy team will Science & the Public had published a to the following parameters of the away from showing gratitude and month with the management team to large photo of the fair on its website scientific process: Is the question presenting your grace, know little about trust, and get the “real scoop” on departmental always foster a healthy (https://www.societyforscience.org/ posed well defined? Is the method even less about empowerment. issues rather than relying on gossip or intel-international-science-and-en- appropriate and well described? Is the research. On the flip side, some people have hearsay. This has been very effective work environment. gineering-fair) and it was a beauty data sound? Does the presentation been great leaders; visionaries and be- and helps boost awareness levels on to behold. Several rows of science adhere to the relevant standards for lievers who trust their underlings to both sides. The one- to two-hour projects adorn a large auditorium, reporting and data deposition? Ap- at the conclusion of NAVIGATOR; do the work they do best. The good meeting allows for great exchange, find that there is a continual infusion each within a space that accommo- pearance also matters. Research is the however, the opportunity introduces managers are often trained in the and the minimal overtime needed is of support and respect flowing into dates the young scientist, some room objective, but the elements of design your work to an international audi- art of Appreciative Inquiry (AI) (see well worth it. the veins of both management and to move, and a table on which the are the essential first step in drawing ence. You are recognized as the per- Editor’s Note) and servant leadership. Learn and invest repeatedly—Life- staff. A healthy team will always project is presented. an audience to your work. son advancing solutions to a problem Those that do are a catalyst for the long education is a crucial invest- foster a healthy work environment! If you do happen to be in the IAED and AEDR teams devel- or, at least, beginning the discussion. positive flow of internal relationships ment, especially when it involves area at that time next year, stop by. oped the exhibit for several reasons. between staff and management in learning best practices that can be Editor’s Note: For those of you who You will undoubtedly pick up on a The very act of announcing such an Final note your comm. center. applied at the center. Staff and man- are unfamiliar with the concepts of research fever leading to developing event moves the idea of research into To submit an abstract of your agement should encourage growth in Appreciative Inquiry, Sherri recom- a poster for next year’s (2016) poster actual practice and prompts the ex- research poster proposal for review Finding and fixing the “bugs” and for each other. Invest in the team mends David Nelson’s blog, The Human exhibit at the NAVIGATOR confer- ploration of issues puzzling you, your and approval, visit www.emergency- Everyone understands the concept and hold yourself account- Agenda (http://humanagenda.typepad. ence sponsored by the International agency, and the dispatch community dispatch.org/NAVIGATOR/cfpp. importance of preventative medi- able for your actions and how you do com/).  Academies of Emergency Dispatch® in general. The research posters presented at cine and it’s no different with your your job. Ask, “If not me, then who?” (IAED™). Even better, the initiative We chose research posters—rather NAVIGATOR 2014 are available for staff and management relationships. Communicate respectfully—Nobody shown by these students might stim- than one-page abstracts—to distrib- download at www.aedrjournal.org/ Take inventory. Figure out which responds well to negative commu- ulate thoughts for a research study ute at the NAVIGATOR Research archives/research-posters.  “medicines” your team requires to nication. Don’t complain without to publish in the IAED’s official Forum since a pictorial representa- either fix or prevent unhealthy bugs bringing a solution. Slow down and

8 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 9 ••• FROM THE EMD SIDE

SURF’S UP Are you ready to paddle and take on the swell?

Art Braunschweiger

ver find yourself jumping from pain?” If the answer is yes, there’s not And remember that ProQA® is Eone protocol to another, unable an automatic shunt to chest pain. pretty smart (programmed with logic to decide which one’s the most Why? Because if the caller didn’t paths to make it that way). If ProQA appropriate? You’re “protocol surf- mention it upfront when asked what doesn’t shunt, there might be a good ing”—something that has nothing to happened and reported something reason for it. The protocols have been do with the beaches of California else instead, such as “her heart is structured to consider what other or Hawaii. In this column we’ll look racing, and she can feel it beating problems are commonly associated at why this happens and how to irregularly,” then any chest pain with each Chief Complaint, and avoid it. reported after that is, statistically, less In our call reviews, our ever-vig- likely to be as serious than if it was ilant Qs are constantly reminding reported upfront. us to make the appropriate protocol Another sign or symptom that selection. As many of you have frequently adds uncertainty is abnor- learned, failure to choose a correct mal breathing. Abnormal breathing Chief Complaint Protocol is a Crit- is just that—any rate or quality of res- ical Deviation—so the pressure is on. piration that differs from the norm. At the same time, our calls don’t al- But even when the medical event ways neatly fit into one protocol or that prompted the call to 9-1-1 is caus- another. Let’s apply a little common ing difficulty breathing, that doesn’t sense along with the performance automatically make it the Chief standards that we’re all being held Complaint. Breathing difficulty is to (and yes, your Qs have to follow often the secondary complaint, re- Your newest trauma tool isn’t in here. those standards as well). Since gardless of the ABCs (Airway-Breath- this is not intended as a remedial ing-Circulation). Chest or abdominal training article, I’ll assume that you injuries, for example, can make it already know all Chief Complaint more difficult to breathe easily, so Seriously injured patients rely on you to give the best medical attention and care. To do that, you need selection rules found in Case Entry it’s not uncommon to have a patient and elsewhere. Instead, I’ll point out with some trouble breathing even if knowledge, experience and the proper tools. That’s why the Centers for Disease Control and Prevention a few things that aren’t as frequent- the Chief Complaint is unrelated to Avoid protocol surfing (CDC) has released the widely endorsed Field Triage Decision Scheme: The National Trauma Triage Protocol ly considered. the respiratory system. to help EMTs and paramedics choose the best transport destination for trauma patients. Designed in In the November/December In most cases, selecting the Chief issue of The Journal, Brett Patterson, Complaint Protocol is best when by focusing on the Chief partnership with other leading organizations and experts in injury care, the Decision Scheme has been Medical Council of Standards Chair, based on what happened, and is the Complaint or its cause. published in the prestigious MMWR Report & Recommendations. It’s a valuable tool that can help your wrote: “We have learned through out- most logical choice. If the patient is EMS system save lives. come analysis that priority symptoms having a seizure and isn’t breathing ‘discovered’ during interrogation on normally, Protocol 12: Convulsions/ react accordingly—or not—if one of a different protocol are generally Seizures is still the correct choice, those is found. associated with less acuity than the not Protocol 6: Breathing Problems, “Protocol surfing” can usually be priority symptoms that are part of which assumes a respiratory issue avoided if you focus on the Chief the Chief Complaint.” The protocols above all else. Over time, you should Complaint or its cause, and not what have been programmed to “think” build your knowledge and under- followed. There should rarely be this way with many combinations of standing of what certain signs or more than one shunt on any given signs and symptoms. For example, if symptoms are commonly associated call. Use your judgment and shunt Get a free copy of the Field Triage Decision Scheme: The National Trauma Triage Protocol, the MMWR you’re on Protocol 19: Heart Prob- with other Chief Complaints even if a truly high-priority condition and other free resources at www.cdc.gov/FieldTriage lems/A.I.C.D., there’s a Key Question though they might otherwise be a requires it, but otherwise, leave the that asks: “Does s/he have chest high-priority on their own. surfing to the beach. 

10 THE JOURNAL | iaedjournal.org  INDUSTRY INSIDER | news news

oration to globally improve The collaboration links the In five years, they will be the survival rate of individuals Alert System directly to Pro- required to provide that infor- experiencing sudden cardiac QA, and in the event of a car- mation for 80 percent of emer- arrest (SCA). diac arrest alert received by the gency calls. Heartsafe Living – AED dispatch center, ProQA will While there is agreement (Automated External Defibril- notify volunteers automatical- over the importance of hor- lator) Alert System brings ly by text message or by using a izontal-location data, objec- neighborhood volunteers, specifically developed app. tions from wireless service trained in using an AED, to the The arrangement comple- providers have raised ques- scene of an SCA, putting AED ments the companies’ analo- tions as to whether the FCC’s first response just around the gous goals, according to Ron efforts are achievable. Civil corner from anyone, accord- McDaniel, PDC Vice Presi- liberties groups argue that ing to Heartsafe Living – AED dent, Client Support. the plan lacks mention of pri- Alert System Director Michiel “The ProQA system brings vacy standards. PDC and Heartsafe Living working Wildschut. PDC’s ProQA max- greater awareness of the FCC E9-1-1 rules adopted Results positive for Larimer County together to save lives imizes first response at the Heartsafe Living – AED Alert in 1996 and extensively re- texting system emergency communication System to dispatch centers vised since enabled wireless Priority Dispatch Corp.™ and Heartsafe Living – AED center through scripted Pre-Ar- worldwide,” he said. “Together, providers to meet this accu- It’s been nearly six months Larimer County is the sec- (PDC™), the world leader in Alert System, developers of a rival Instructions (PAIs) within we are taking a global step to im- racy standard based solely on since Larimer County (Colo.) ond county in Colorado to in- emergency dispatch technolo- neighborhood heart assistance the Medical Priority Dispatch prove survival rates for the vic- the measured performance implemented a 9-1-1 texting stitute a 9-1-1 texting system. It gy, including ProQA® software, program, announced a collab- System™ (MPDS®). tims of sudden cardiac arrest.” of outdoor wireless 9-1-1 calls. system, and so far, the results is also part of the 2 percent of Tracking cellphone However, with many Ameri- have been positive. Public Safety Answering Points location efficiency cans replacing landlines with Though the system is un- (PSAPs) in the country who reduce the unnecessary and National Missing improves wireless phones, the FCC able to track how many of have launched texting systems. costly response. Children’s Day updated its E9-1-1 rules to in- these 9-1-1 texts were for emer- Primarily, this technology The comprehensive alarm observed in May The Federal Communica- clude requirements focused gencies, the total number of is designed to enable residents ordinance in Montgomery tions Commission (FCC) vot- on indoor location accuracy. texts sent is available. Fort Col- with hearing-impaired and County, Md., in 2011 alone, The U.S. observes Nation- ed unanimously in January to The new rules are intend- lins Deputy Chief Cory Chris- speech-impaired issues to have saved $1,385,000 in wasted real Missing Children’s Day improve the indoor location ed to help first responders tensen said in the system's first easier direct access to emergen- sources, recovered 9,233 hours on May 25 as part of a global of wireless 9-1-1 calls, requir- locate Americans calling for month, August 2014, a total of cy dispatch. However, it may of police patrol time, and re- program to help bring missing ing major telecommunications help from indoors, including 99 texts were sent. Christensen also be a more convenient and couped the equivalent of al- children home. companies to provide hori- challenging environments believes the majority of these efficient way for residents in most nine police work years. In 1984, one year after zontal-location information, such as large multi-story were test texts. The numbers general to report emergencies False alarms to which police instituting the day of obser- within 50 meters (about 164 buildings, where responders have been up and down in sub- to calltakers. officers respond have been vance, the National Center • NCMEC has assisted law feet) of a caller, and vertical are often unable to deter- sequent months, from 68 in The Federal Communica- reduced by almost 70 percent. for Missing & Exploited Chil- enforcement in the recov- information (within 3 meters mine the floor or even the September, to 85 in October, to tions Commission has man- According to county law, dren (NCMEC) was created ery of more than 202,667 (about 10 feet)—what floor a building where the 9-1-1 call 53 in November. December fig- dated that all wireless carriers each alarm user is allowed one by Congress as an informa- missing children since it caller is on—for 67 percent of originated. ures were not available at the must activate the service by “free” false alarm in a calendar tion clearinghouse and re- was founded in 1984. NC- emergency calls. time of this writing. the end of June. County program year. False alarm response fees source for parents, children, MEC’s recovery rate for reduces police are imposed for the second and law enforcement agencies, missing children has grown response to each subsequent false alarm in schools, and communities from 62 percent in 1990 to call when a woman dialed 9-1-1 Through more questioning, false alarms a calendar year, beginning at to assist in locating missing 97 percent in 2014 and ordered a pizza. The woman, Weisinger learned the woman $25 for a second false alarm and children and to raise pub- • As of Nov. 3, 2014, 711 chil- calm and quiet but with urgen- was not alone in the house and A study by the Communi- escalating to $1,000 per false lic awareness about ways to dren have been successful- cy in her voice, continually asked that the situation was dangerous. ty Oriented Policing Services, alarm for residential alarm us- prevent children abduction, ly recovered as a result of Weisinger how long it would The advertisement was U.S. Department of Justice, ers and $4,000 per false alarm child sexual abuse, and child the Amber Alert program take for the pizza to be delivered. made to help promote the NFL’s showed that in 2002, police for commercial alarm users. pornography. created in 1996 and operat- Initially wondering wheth- commitment to raise awareness responded to 36 million alarm The Montgomery Coun- The following facts are ed by the U.S. Department Dispatcher’s er’s real-life experience led to er the call was a prank, Weising- about domestic abuse. calls, with less than 10 percent ty Police Department’s False from the NCMEC website: of Justice intuitive thinking the creation of a simple, yet er asked if she understood that “I’ve never been somebody of the burglar-alarm calls re- Alarm Reduction Section • In 2013, there were 462,567 produces winning priceless message during foot- she had phoned 9-1-1 and if she who wanted notoriety, but I’m sulting from criminal actions. (FARS) administers the pro- • As of October 2014, NC- Super Bowl ad ball’s biggest game. had an emergency. The wom- glad it’s going to something entries for missing children MEC’s toll-free, 24-hour False alarms make up gram. FARS collected $1,128,875 under the age of 18 into the As an emergency dispatcher an said “yes,” and Weisinger good,” Weisinger said. “I’d love 10–20 percent of all calls to in 2011 in fees and maintains a call center has received Running a 30-second ad in Boulder, Colo., 10 years ago, knew she had dialed 9-1-1 and for people to understand what FBI’s National Crime Infor- more than 4,040,876 calls police, pushing many cities collection rate of 93.7 percent mation Center during the Super Bowl costs a Decatur, Ga., resident Keith ordered a pizza as a guise to re- distances others have to go to into a proactive approach to of all monies billed. since it opened in 1984 pretty penny, but one dispatch- Weisinger fielded a harrowing port a legitimate problem. to get help.”

12 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 13  INDUSTRY INSIDER | international news international news

The first of eight international NAVI- The fourth annual Middle East NAV- GATOR conferences got off to an exciting IGATOR drew 180 people to the Marriott start in February, and maybe most of all Marquis City Center Doha Hotel. In addition for Haitham Youssef, of the Hamad Medi- to the educational sessions, an exhibit hall fea- cal Corporation (HMC) in Qatar. tured the latest in dispatch technology. Youssef received the Dispatcher of the Topics presented at the conference in- Year Award during the opening ceremo- cluded CPR and epidemic preparedness, nies that kicked off the three-day confer- creation of geographical databases, a pa- ence (Feb. 3–5) in Doha, Qatar. The gradu- tient’s journey through prehospital care, ate of Qatar’s North Atlantic College was and the skills necessary to keep the caller drawn to the profession, both because of on the line during various police situations. his multi-tasking abilities and his profes- HMC Call Center Manager Sonia sional aptitude in handling emergencies. Bounouh gave a presentation analyzing “We are very proud of Mr. Haitham determinant drift to improve ambulance Youssef for being awarded the Dispatcher service resource deployment, and HMC of the Year Award,” said Brendon Morris, Communication Manager Ali Abbas Par- HMC Chief Operating Officer, who intro- siani discussed the cultural challenges duced Youssef. “This is a big honor for the encountered in implementing MPDS® ambulance service and for HMC.” and how HMC overcame differences to Middle East NAVIGATOR The HMC communication center was achieve the system’s maximum benefits. sets IAED stage for 2015 the Middle East’s first Accredited Center Several IAED™ instructors provided a se- of Excellence (ACE). ries of dispatch leader seminars.

Asia NAVIGATOR brings home the dedication

The prospect of letting adults loose in strong advocacy in advancing the protocol NAVIGATOR 2015, which was held April a telecommunication display room might throughout the Malaysia emergency re- 29–May 1 in Las Vegas. be one way to describe the anticipation sponse system. 999 RC Kuala Lumpur is one of three of touring the 999 Response Centre (RC) “The NSC is dedicated to all phases of Public Safety Answering Points (PSAPs) in Kuala Lumpur, Malaysia, during Asia the disaster management process, and (Mr. under the Malaysian Emergency Response NAVIGATOR 2015, held March 17-19. Rodzi) recognized the significance of pro- System 999 (MERS 999). The PSAPs re- “The tour was a great success,” said tocol in its application to timely and pre- ceive all police, fire and rescue, hospital, Claire Ulibarri, Director, NAVIGATOR cise response,” Freitag said. civil defense, and maritime calls, and pro- Conference Coordination. “Everyone was 999 RC Kuala Lumpur also held the cess the calls using protocol for transfer to Control Center in Dublin receives ACE eager to see the innovations that Kuala spotlight because of its dedication to the dispatchers at secondary PSAPs. Lumpur represents for all agencies in the protocol system and because it served as 999 RC Kuala Lumpur and 999 RC The first day of working in a new Service (NAS), National Emergency quality but also caring and compassion- Malaysian system.” the host city for the three-day conference Melaka answer 999 calls in Peninsular Ma- building is thrilling enough, but couple Operations Centre (NEOC) in Dublin, ate,” Dunne said. “NAS’ aim is to provide The fourth annual Asia NAVIGATOR, highlighting educational sessions in the best laysia; 999 RC Kuching answers 999 calls that with International Academies of who received notice of their Accredited high-quality, safe, and efficient pre-hospi- sponsored by the International Academies practices of emergency response—call triage, in East Malaysia (Sabah and Sarawak). Emergency Dispatch® (IAED™) accredi- Center of Excellence (ACE) recognition tal care services, right across the Republic of Emergency Dispatch® (IAED™), drew leadership, accreditation, and technology. In 2007, Malaysia’s multiple emergency tation, and you’ve achieved the package on Jan. 26 2015, the exact same Monday of Ireland.” 189 attendees from Malaysia, Jordan, Viet- IAED Accreditation Board Chair Jer- numbers were consolidated into one (999) wrapped and tied with a bow. that they started to move into their new Serving a population of almost 4.6 nam, and the Philippines. In addition, IAED ry Overton lauded the Kuala Lumpur and the government of Malaysia appoint- “They walked into their new control building that also houses the NAS Train- million, NAS responds to over 300,000 President Scott Freitag presented an appre- center’s accomplishments. ed Telekom Malaysia (TM) to build and center facility and started functioning as ing College. ambulance calls each year and employs ciation award to Mr. Rodzi Md. Saad, Sec- “Kuala Lumpur was the first agen- operate MERS. The Fire Protocol was im- a center of excellence from day one,” said Martin Dunne, Director, NAS, said the more than 1,600 staff members across retary, Malaysia National Security Council cy in the region to implement the Fire plemented throughout MERS in 2013. IAED Accreditation Officer Beverley Lo- new facility reflects the strategic plan de- 100 locations. NAS has a fleet of 500 (NSC), and Principal Assistant Secretary, Protocol and, also, the first to achieve an Asia NAVIGATOR is one of eight an- gan. “How exciting is that!” veloped for the NAS. vehicles, including a Neonatal Intensive NSC Disaster Management Division. ACE,” Overton said. nual NAVIGATOR conferences the IAED “They” being the staff of the Health “We want to ensure that each patient’s Care emergency ambulance and a Mobile Freitag congratulated Mr. Rodzi for his IAED awarded the ACE certificate at presents worldwide. Service Executive, National Ambulance experience is not only safe and of a high Intensive Care Unit.

14 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 15  BEST PRACTICES | ace ace

wrinkled, dog-haired, or wearing a splash I am driven by nursing facilities. Hats, gloves, and scarves of yellow from a breakfast egg. were the ornaments on the Christmas tree Customer service figures highly in perfection. I am set up in the company’s business office. the employee’s rating, Corum said, and So, what’s not to enjoy about working the calculation is derived from surveys driven to make for Hall Ambulance Service? sent to every patient they transport. Hall, “You have to like what you do—have who splits his day between the mayor’s every day better a passion for helping others,” said Co- office and his administrative office, rum, who has worked either directly or reviews the surveys and makes sure any than the day indirectly in media promotions for the complaints—down to a bumpy ride—are before. company since 1996. “You realize that resolved. Once investigated, a member it makes Mr. Hall’s day when he sees his of his management team follows up employees coming to work smiling.” with the customer about their concern —Harvey L. Hall Hall’s career choice story is classic. with a phone call. In 2014, 66 percent of He tried something because of a respondents stated that Hall Ambulance friend’s dare, and the experience worked provided “exemplary” service across their so well in his favor that his life took an five measurements of success, with a abrupt turn at that very instant. total combined customer satisfaction Or, at least, as the story goes, after he talk- score of 95%. Dean, Reports Analyst, who has worked ed to his mom about accepting the dare. While Hall does keep his finger for the company for over 20 years, was a “She said give it a try,” Hall said. “So, directly on the pulse of business, he’s not vital link in the accreditation process. I did.” heavy-handed in his management style, LaFavor said the “Type A” personalities Hall was a young adult at the time, EMDs in the communication center of Hall Ambulance Service in Bakersfield, Calif. LaFavor said. dominant in the profession and certainly working as an orderly in a Bakersfield, “He trusts my leadership,” she said. “He Hall’s dispatch center employees were on Calif., hospital. He was at the bus stop HALL AMBULANCE SETS THE STANDARD invests in his people and what his employ- board from the start. It’s their competitive on his way home when a friend from Owner and staff driven to stay on top ees need to succeed.” nature, she explained. They are driven to high school approached him. The friend LaFavor started with the company 25 be better than everybody else. drove an ambulance, and when they were years ago, grouping her among the 160 To avoid the burnout that is common talking, he dared Hall to come on a run. Audrey Fraizer employees—of a total 390 employees—to among dispatchers, LaFavor also tries to Two days later, one day after the ride, he reach at least 10 years of service. Nearly encourage her staff to maintain a bal- was working for the company. After ten 50 percent have celebrated the five-year anced work and home life. years, and learning every facet of the busi- mark. Hall Ambulance Communications During their standard 12-hour shifts, ness, he embarked on his dream to build the Harvey L. Hall commands respect. “Doing things the Hall way.” and employee satisfaction and keeping up Technology Specialist Ed Smith started at she rotates them through dispatch and best ambulance company in America. And he also gives it back. So what does that mean for his with the state of the industry. They also the company 44 years ago. He was hired in calltaking positions every four hours, Whether he wears the mayor’s hat His employees refer to the company employees? establish and reach goals, setting them May 1972, and in 1975, he completed the stresses the importance of taking their or his ambulance service hat, there’s one owner as “Mr. Hall.” Others from Bakers- Hall laid a foundation of expectations apart from a run-of-the-mill operation. first paramedic program in Kern County. allotted 15-minute breaks, and encourag- clear objective. field—at least during the past 14 years— 44 years ago that is still followed today, The service’s communication center Three years ago, Hall presided over a es them to take lunch off grounds. Her “I am driven by perfection,” Hall said. generally address him as “Mayor Hall.” said Mark Corum, Director, media ser- adopted the Medical Priority Dispatch ceremony held to honor Smith’s 40th an- scheduling pattern for dispatching staff “I am driven to make every day better “I’m the city’s longest-serving mayor,” vices. “Each of us strives to meet or exceed System™ (MPDS®) in 1992 and achieved a niversary, remarking that he “was blessed” alternates weekends. This allows for the than the day before.” said Hall, who owns and operates Hall it every day, which makes us better in our medical Accredited Center of Excellence to have his service for so many years. employees to have every other weekend Hall Ambulance Service provides 90 Ambulance Service in Bakersfield, Calif. respective areas of responsibility.” (ACE) in 2011, re-accrediting in 2014. A “Mr. Hall treats us like family,” LaFavor off. There is little mandated overtime to percent of paramedic patient transports “It’s among the best jobs in America be- Hall Ambulance has never stopped $300,000 makeover in 2014 upgraded said. “No one gets lost in the shuffle.” cover an open shift. in Kern County, and both ground and air cause of the good things I get to do.” thriving since it opened for service on the center’s technology—software, radios, At the annual Christmas party in A community spirit of “giving back” critical care transport services. According The good things prompted Hall’s deci- Feb. 10, 1971, with an ambulance that Hall touch screens—and comfort level for the 2014, Hall praised the communication is essential to the balance, said Hall, who to the dispatch statistics: sion to start an ambulance service in 1971, purchased with a $10,000 loan. 18 EMDs. staff for their skills, dedication, compas- serves on the boards of four organizations • Dispatch service area—8,148.64 and it’s a drive that defines his business The first ambulance—which Hall “Everything is ergonomic,” LaFavor said. sion, and longevity. and is a past member of 11 other boards. square miles ethics and his approach to public office. parked and dispatched from home—was The annual recognition day, held on “We had zero turnover in 2014,” she Each year, Hall Ambulance partici- But that doesn’t mean he boasts about soon the first of two ambulances serving Feb. 10, identifies the top employee from said. “With short staffing being the No. 1 pates in community events to inform the • Dispatch service area popula- his accomplishments. a city of 75,000 residents. In the past 44 each division; the winning communica- issue in Kern County, it’s almost embar- public about emergency medical services, tion—864,000 “Mr. Hall is a modest man,” said Jenni- years, his fleet has grown to 86 ambulanc- tions specialist goes to NAVIGATOR. rassing when I’m the only one standing out-of-hospital care, healthy lifestyles, and • Number of calls dispatched per fer LaFavor, Manager, communications es and an air rescue helicopter operating Selection is based on specific job re- at meetings to say we’re not hiring in injury prevention. year—100,000 division. “He simply believes in investing out of 22 locations in Kern County, in- sponsibilities, such as calltaking response, dispatch at this time.” Employees carry the banner to give in his community and his people.” cluding Bakersfield (county seat), to serve the amount of time the individual has LaFavor rarely fills in on a shift back in projects that include the Gifts The communication center also pro- He’s not the center stage type and a population of 864,000. worked in the company’s dispatch center, because of consistent full staffing, so she for Seniors drive that in 2014 collected vides dispatching for another EMS pro- prefers shining the light away and focus- Corum said the secret to their success and good work habits. Every employee was able to concentrate on completing enough in donations to fill the stockings vider, Liberty Ambulance, which covers ing on the results of the company motto: is keeping a close account of customer wears a uniform, and no one shows up the Twenty Points of Accreditation. Carol of the county’s 1,314 residents of skilled Ridgecrest and Lake Isabella, Calif. 

16 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 17  BEST PRACTICES | faq faq

Brett A. Patterson Academics & Standards Associate Medical Council of Standards Chair

Brett: A calltaker is using cardiac/heart problems for blood pressure issues and, according to MPDS®, I am under the assumption that sick person with the priority complaint of blood pressure abnormalities would be the right choice over heart problems. Ashley Partridge, TC08 ED-Q™ Macoupin County Sheriff Department Carlinville, Illinois, USA

Hi Ashley: Your question is rather common, as there is some confusion regarding what sort of complaints are appropriate for Protocol 19: Heart Problems/A.I.C.D, and there is also a tendency to relate or “diagnose” some complaints, like blood pressure abnormalities or “heart attack” to this there is a specific code on this protocol for TWO CASES: WHICH PROTOCOL? protocol. Let’s address the latter issue first. Protocol 19 was such cases, 26-A-2 Blood pressure abnor- Callers’ complaints lack specificity If a caller provides a diagnosis in developed for mality (asymptomatic). I would add, how- response to “Tell me exactly what hap- ever, that it is always appropriate to clarify pened?”, i.e., “He has high blood pressure” signs or symptoms that the numeric abnormality is the only Brett Patterson or “He’s having a heart attack,” it is most reason for the call, i.e., “I understand that appropriate to simply ask the question clearly related to her blood pressure is high. Is she having again in order to solicit a sign, symptom, any symptoms?” or circumstance relating to the Chief the heart, namely Let me briefly clarify the first point I Brett: Case 2: Caller states, “I have recent- Paul: Complaint, i.e., the reason for the call. made above. When should the EMD use Need your advice on these two cases. ly been diagnosed with Deep Vein You are correct regarding Case 2, This is because the MPDS Chief Com- heart rhythm Protocol 19: Heart Problems/A.I.C.D? Case 1: When this call was answered, Thrombosis, and I’m having pain with even though the problem may actually plaint Protocols are sign, symptom, or When you think about it, “Heart Prob- the caller was heard saying “sit down before deep breaths.” Our EMD chose Protocol be in the lungs. The caller should clarify event based, not diagnostically based. complaints such as lems” is actually a caller diagnosis, much you fall down.” The caller then repeated 6: Breathing Problems. When she got to where it “hurts to breathe.” Most likely, There are two important exceptions, how- fast or slow heart like “Heart attack.” So, if the caller simply this phrase several times while the address the prescribed inhaler question, the call- this will come out as chest pain. Please ever. Without reading the next sentence, states “heart problem” or “heart attack,” and phone number were being obtained er answered “yes.” When the EMD asked remind your calltakers that the protocol can you name the two Chief Complaint rates, fluttering the EMD needs to clarify by repeating and verified. It sounded as though the her if she had used it yet, the caller said, does not attempt to diagnose but rather Protocols that are actually named after a “Tell me exactly what happened?” in an patient was either unable or unwilling to “No, I’m not having shortness of breath; determine what sort of evaluation and diagnosis? [short pause here ...] I will as- or skipping of attempt to obtain a sign or symptom that listen to the caller’s instructions. When I am having pain with breaths.” First instructions the patient needs. In this sume you thought of Protocol 13: Diabetic can be categorized. This protocol was the EMD asked “OK, tell me exactly what Law of Chest Pain: “Hurts to breathe” is case, ALS is appropriate. Problems and Protocol 28: Stroke (CVA)/ heartbeats, or developed for signs or symptoms clearly happened,” the caller said, “I don't know; not considered difficulty or abnormal Regarding Case 1, I think the EMD Transient Ischemic Attack (TIA). Nice related to the heart, namely heart rhythm she said she’s feeling pretty bad and has breathing. Because of this rule, we are did the right thing. “Anxiety” is really job! These “exceptions” are quite purpose- similar issues. complaints such as fast or slow heart rates, been sick for a long time. She’s crying.” wondering if Protocol 10: Chest Pain a caller diagnosis, and “sick” was the ful because data shows us that laypersons fluttering or skipping of heartbeats, or The EMD attempted to clarify this answer may have been an acceptable, or even predominant Chief Complaint. The generally get these right. Friends and fami- no accompanying symptoms, you are right similar issues that can be felt or sensed by asking “What kind of symptoms is she more appropriate choice in this case. attempt to obtain a better Chief Com- ly members of diabetic patients know the to use Protocol 26: Sick Person (Specific and that often alarm patients. It is also having right now?” The caller answered Thoughts? plaint was good, but I would encourage signs and symptoms of diabetic problems, Diagnosis), rather than assuming the prob- used, as mentioned in the protocol’s title, “anxiety right now, but I don’t know I look forward to hearing from you. simply asking “Tell me exactly what hap- and laypersons, in general, know the signs lem is related to a heart problem. Note the when there is an issue with an Automatic exactly what is wrong.” Our EMD chose Thank you for answering our past ques- pened” a second time, which normally and symptoms of stroke, although they definition of Sick Person in the Additional Implanted Cardiac Defibrillator, i.e., single Protocol 26: Sick Person. We are wonder- tions so quickly and clearly. works best as it focuses the caller on the often don’t call us soon enough. Information section of Protocol 26, which or multiple firings. ing if Protocol 25: Psychiatric/Abnormal Paul Hacker more recent events. If that doesn’t work, Anyway, back to your question. If the reads: “A patient with a non-categorizable Please do not hesitate to contact me Behavior/Suicide Attempt may have been Supervisor “What prompted you to call right now?” caller provides a specific diagnosis such as Chief Complaint who does not have an directly with any additional MPDS inqui- an acceptable, or even more appropriate Manitowoc County Joint Dispatch Center often does. high blood pressure, or even gives you a identifiable priority symptom.” And, in ries, and I’ll try to be brief next time. choice in this case. Thoughts? Wisconsin, USA Hope that helps. numeric blood pressure reading, but offers your case, and as you correctly mentioned, Brett 

18 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 19  BEST PRACTICES | navigator rewind navigator rewind

sions just to get the pressure up. Then we Everyone has a role— agencies with extended response times may stopped to give our breaths, and the blood elect to stay with Compressions 1st since this pressure went down, and then we just EMD, bystander, pathway provides 600 continuous compres- repeated that over and over. A lot of the sions and only adds ventilations past the minutes’ time, the person wasn’t getting and prehospital and 10-minute mark in an arrest, while agencies blood flow to their brain or to their heart.” with shorter response times will likely move Omitting the two breaths every 30 hospital providers. to the new Compressions Only pathway. compressions will not result in negative Importantly, the recommendations for Com- results since, Kupas said, the patient has “Think big but start small—make little pressions Only are for arrest with probable plenty of oxygen in the blood that early changes within your center,” he said. “Start cardiac etiology, i.e., sudden, unexplained in cardiac arrest; continuous compressions to measure things. Use assertive and ag- collapse. Patients with a known respiratory keep it circulating. gressive dispatcher-assisted CPR—do it in etiology, i.e., drowning, suffocation, etc., as well “When you’re doing compres- larger systems and with as much geogra- as children, should receive ventilations in con- sions-only CPR, you actually are also phy as you can cover. Celebrate successes junction with compressions, as is directed in providing some ventilation,” he said. and do a better job of getting feedback the current Ventilations 1st and Neonate/In- “The way blood moves in the chest with back to dispatchers.” fant/Child pathways. In either case, quality a chest compression, you increase the improvement efforts need to focus on assertive intra-thoracic pressure and decrease the Editor’s Note: Brett Patterson, Chair of the CPR instructions, rapid hands-on-chest times, intra-thoracic pressure, and those pres- Academy’s Medical Council of Standards, and quality CPR. A new Fast Track feature sure changes are what keeps the blood adds: “Version 13.0 of the MPDS® will in v13.0 enables this objective by linking Case moving. The same thing happens in the contain a ‘Compressions Only’ pathway for Entry directly to PAIs when presented with lungs, and as long as the airway is open, victims of OHCA. Local medical control will an obviously not breathing, suspected medical you get some ventilation.” have a choice of choosing either the current arrest. The ProQA® software will provide So what can dispatch centers do? Compressions 1st pathway or the new Com- real-time feedback to EMDs regarding their TAKING ACTION IN OHCA Kupas has a few suggestions. pressions Only pathway. We suspect that hands-on-chest times.”  EMD role can be pivotal to outcome

Josh McFadden

An EMD’s proper use of the Medical also knows dispatchers have a critical bystanders performing hands-only The CDE Protocol and a caller’s or bystander’s responsibility when taking a cardiac arrest CPR, as opposed to the traditional CPR ADVANCEMENT SERIES™ willingness and ability to follow the direc- call and providing the step-by-step CPR where the person administering aid gives tions can be the difference between life instructions. breaths in between compressions. Often, Computer-Based Continuing Emergency Dispatch Education and death in an Out-of-Hospital Cardiac “Dispatcher CPR saves lives,” he said. a bystander is much more comfortable Arrest (OHCA). “Many dispatchers feel like they’re going with and willing to use this method of • Reduces in-house training costs • IAED™-approved CDE hours “Everyone has a role to play—dispatch- through the motions when giving people continual compressions. ers, bystanders, hospital and prehospital CPR instructions. We need dispatch- In fact, Kupas said hands-only CPR • Helps reduce overtime costs • Documented individual post-test scores providers,” said Douglas F. Kupas, M.D., ers thinking every time they give CPR only increases the likelihood of the person Commonwealth EMS Medical Director instructions that it’s an opportunity to get surviving. He said using conventional • Learning format improves • Timely topics specifically relevant to the for the Pennsylvania Department of a survivor.” CPR results in a much-less dramatic de- skills and knowledge retention MPDS®, FPDS®, and PPDS® protocols Health during the “When Time is the En- And there’s no taking “no” for an cline in the death rate from the 10 percent emy: Perfecting Dispatch-Assisted CPR” answer, he said. drop per minute if no CPR is done at all. session at NAVIGATOR 2014. “The dispatcher must be assertive,” he But if you do compressions-only CPR, Kupas collaborates with resuscitation said. “We’ve moved away from the era of you reduce that even further, all the way leaders at the University of Pennsylvania ‘I can help you do CPR—do you want to to a 2-percent chance per minute that the ORDER TODAY and EMS providers in the Heart Rescue try?’ Dispatchers must be fully engaged in person dies. Call 800-363-9127 or visit www.prioritydispatch.net Project, a six-state effort to “increase the idea that if they are assertive in telling Hands-only CPR keeps a continuous survival outcomes of cardiac arrest by 50 people ‘here’s what you’re going to do,’ circulation through the body. PRESENTED BY: percent in five years.” and not taking ‘no’ for an answer, the rate “You have to do about 10 compres- PRODUCED BY: As a medical doctor and a paramedic of bystander CPR in their community sions to build up a pressure head,” he with 30 years’ experience, Kupas under- will increase. It makes a big difference, said. “Once you do that, you’ve got great stands firsthand the sense of urgency and that’s a mindset in the person.” compressions going. In the past, what hap- involved in cardiac arrest situations. He Kupas is a staunch advocate of pened was, it took a third of our compres-

20 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 21 Help is on the Way

Nurse triage enhances alternative emergency care

Audrey Fraizer

egional Emergency Medical Services “We are amazed at the call volume,” she said. Authority (REMSA) nurses were the “This was a needed resource in our community, par- R first line of defense for many patients ticularly for people who don’t know how to maneu- reeling from the fever, body aches, and cough ver the health care system.” due to a flu strain made even more troublesome because of a vaccine that did not fully meet the Nurse triage target strain. A hand in navigating at REMSA begins with a While they never met a single one of their pa- call to the 24/7 non-emergency Nurse Health Line. tients face-to-face, they were ready and able to get The registered nurse—there are eight on staff—an- them to the right level of care through an over-the- swering the call assesses the patient’s illness or injury. phone assessment and triage process that benefits The Nurse Health Line averages 2,100 calls a everyone involved. month; the nurses complete an ECNS protocol on REMSA’s medical communications center is about half of these callers. an Accredited Center of Excellence (ACE) and The Emergency Communication Nurse among the first centers in the U.S. to offer safe (ECN) uses the ECNS LowCode ™ software, and effective pre-hospital care through the Acade- which integrates with ProQA®, to triage the my’s Emergency Communications Nurse System™ caller/patient’s symptoms, provide further as- (ECNS™). REMSA is an emergency medical ser- sessment, and determine the level of care appro- vice based in Reno, Nev. priate for that patient. A patient with a critical, The comprehensive nurse triage system—com- life-threatening condition surfacing at any time prising more than 200 symptom-based algorithms, during the conversation is transferred to a REM- taking into account gender, age, and previous med- SA EMD. In this case, an ambulance is sent im- ical history—has far surpassed expectations in com- mediately and the caller is directly and seamlessly bination with a 10-digit Nurse Health Line, said transferred to the 9-1-1 Public Service Answering Elaine Messerli, registered nurse, Manager, Clinical Point (PSAP) and certified emergency medical Operations, REMSA. dispatchers (EMD).

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The registered nurses do not offer ad- Louisville Metro EMS (LMEMS) Satisfaction levels have since gone vice for definitive treatment, Messerli said. Finding alternatives to sending an ambulance and the subsequent ER visit for pa- through the roof, Miller said, and They rely on proven protocols when giv- tient care was a priority for LMEMS. The decision to look at what was available was ECNS has opened their eyes to a whole ing instructions to the patient; although, as based on practical analysis. The patient population was growing and wasn’t going to new world of alternative care. with an EMD, the ECN offers recommenda- stop, so it came down to either asking the city council for funding to buy more ambu- “We looked at ECNS as a means to an tions for managing symptoms until a prima- lances or taking a step back to evaluate what else they could do. end,” she said. “This was the solution. But ry care provider sees the patient, and the pa- “We knew we had to look at options for managing the non-emergent patients,” instead it opened our eyes to many more tient is diagnosed and prescribed treatment. said LMEMS Chief of Staff Kristen Miller. “We put a premium on identifying piec- alternative care ideas, programs, and proj- “This is an evidence-based program,” es of the pie, and ECNS had the clinical judgment we wanted. It’s a well-thought- ects we can offer to our community.” Messerli said. “The nurses are depending out system.” on their experience and a results-driven EMDs in the MetroSafe Communications Center are first in line to process ECNS program to provide health care benefits to LMEMS’ low-acuity calls. There isn’t a seven- or 10-digit number to call. A patient ECNS is the fourth pillar of pre-hos- our community.” assigned an OMEGA code or a subset of selected ALPHA codes during EMD interro- pital care offered by the Academy, REMSA has also started to implement gation is transferred to the ECN for further assessment. alongside the Medical Priority Dis- the OMEGA Determinant Descriptor, a The thought of talking to a nurse when calling 9-1-1, however, was not an im- patch System™ (MPDS®), Fire Priority group of codes within the Medical Priority mediate success for most patients. People didn’t know what the EMD meant when Dispatch System™ (FPDS®), and Police Dispatch System™ (MPDS®) that provide asking, “would you like to speak to a nurse” after assigned an OMEGA or subset Priority Dispatch System™ (PPDS®). Its an evidence-based guideline for determin- ALPHA code. They generally said “no,” preferring the ambulance response expected objective, however, goes beyond pro- ing the most appropriate type of care for when calling 9-1-1. viding instructions while callers await patients calling 9-1-1 with a request that is “We were asking for permission,” Miller said. “The EMD now explains that the response by EMS, fire, or law enforce- Gigi Marshall, RN, and Conrad Fivaz, M.D., of Priority Solutions Inc., not an urgent medical emergency. caller is being transferred to a nurse for further assessment.” ment personnel. have both played a critical role in the success of ECNS, the fourth The Omega codes allow very low acuity The strategy empowered callers; patients learned ways to self-manage care from ECNS defies the idiom of putting 9-1-1 calls to be transferred out of the EMS a registered nurse who listened and engaged in actual conversation. The interaction the cart before the horse. The “you call pillar of prehospital care the Academy offers. system to an alternate, more appropriate also brought a new perspective regarding frequent callers or callers whose conditions we haul” tradition is rapidly changing. level of care. This protocol does not result were non-emergency. ECNS was developed as a logical, feasible, and economical approach to EMS re- propriate responses over the course of our in a “non-response” but, rather, leads to an “A lot of folks don’t know where to turn,” she said. “They are not intentionally source allocation. The higher the acuity, the further the patient is pulled along the work. We know what needs to be done for alternative avenue of care for the patient.. misusing the system. They need help and don’t know their options so the safest way continuum toward a more immediate response, such as ambulance transport if the patients and direct their care.” A service directory of available health care to get help is by calling 9-1-1.” patient’s condition deteriorates dramatically over the course of the conversation. The skill set can be explained in stages resources generated for the community ECNS is not a substitute for the MPDS—the closest allied protocol system. ECNS of performance: information gathering, fo- served provides addresses, phone num- complements pre-hospital care that begins with the 9-1-1 caller seeking emergency cusing, remembering, organizing, analyz- bers, and directions to the selected health medical assistance. ing, generating, integrating, and evaluating. care resource nearest the patient. “ECNS is a single component of a comprehensive system,” said Mark Rector, Di- They are the same skills inherent in ECNS. The advantages so far, Messerli said, rector—New Business, Priority Dispatch Corp.™ (PDC™). “It adds an additional tier of “When we input patient responses to have been huge in terms of patient care resource allocation.” the questions we ask while using ECNS, a and cost savings. He also mentioned that ECNS is an important element to an integrated Mobile determinant is made,” Marshall said. “The According to the protocols, a patient Healthcare-Community Paramedic program. more urgent the patient’s presentation, the referred to an alternative out-of-hospital faster the determinant is identified. There setting, such as the primary care physician’s A nurse in the comm. center is a built-in rationale. ECNS is a very versa- office or urgent care facility, is at far less risk In addition to the upfront elements—such as the symptom-based algorithms—there’s a tile and useful tool.” of exposure to infections acquired in the lot going on in the background. ECNS incorporates the skills and experience of registered Similar to the other IAED pillars of hospital. EMS resources are reserved for the nurses into EMS, and that brings an overlay of professional care relatively new to the system. care, ECNS is vibrant, evolving to meet the more critically ill patients, and the same ap- “My position at Priority Solutions offers the best of both worlds,” said Gigi Mar- demands of EMS, 9-1-1 centers, and their plies to a hospital’s emergency department. shall, RN, ECNS Program Administrator. “It has allowed me to use my nursing care callers, said Conrad Fivaz, M.D., Emergen- “When people don’t know what to do, skills and my experience in education.” cy Response Operations Director, Priori- they call 9-1-1,” Messerli said. “This gives Marshall was an emergency room nurse for more than 20 years, taught nursing stu- ty Solutions Inc. (PSI) and Chair, ECNS them options and gets them to the right dents in the academic setting for the past decade, and then decided to take on a multi-fac- Council of Standards. level of care.” eted role that combines her professional background into pre-hospital nurse triage. And, as he emphasized, ECNS relies on A similar program has been offered in the ECNS pairs her skill of “thinking like a nurse” to the multiple steps she met daily on established well-defined metrics to draw U.K. for the past 12 years, and several other the floor. She is a critical thinker. She is logical and systematic. She applies reasoning as the user through a predictable, repeatable, centers in the U.S., Australia, and Africa have As one of the first medical emergency services of its kind to her guide to clinical decision-making to ensure safe nursing practices and quality care. and verifiable process. A time stamp feature introduced nurse triage. But as the next exam- offer prehospital care, REMSA uses nurses’ expertise and proven “Nurses approach a problem with the idea of what we hope to accomplish on be- added to ECNS Version 4.5 complements ple indicates, it’s not a one-size-fits-all process. protocols to instruct patients. half of our patients,” Marshall said. “We develop the pattern of recognition and ap- the demonstrable element in secondary

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tional Academies of Emergency Dis- patch® captured the international stage. and reaching (if not exceeding) objec- “Emergency medical services (EMS) tives. ECNS provides real-time evidence all over the world are looking for ways through use of the LowCode™ software, to conserve resources without jeopar- which integrates with ProQA®, to triage dizing patient care,” he said. “The award the caller’s/patient’s symptoms, provide recognizes telephone triage as a very further assessment, and determine the viable alternative. It’s a system gaining level of care appropriate for that patient. international momentum.” Secondly, as Messerli explained, Another study, published in the REMSA is accreditation-oriented. Every March/April 2015 Annals of Emer- department within the organization is gency Dispatch and Response (AEDR), tasked with attaining performance bars presented an analysis of cost savings specific to the operation. based on centers using ECNS: LMEMS “ACE fit into what the grant required and the MetroSafe 911 Communica- and what REMSA expects,” she said. tions Center and Medstar EMS in Fort “Being first was icing on the cake.” Worth, Texas. According to the results, Nothing taxing about April 15 An ACE stamp of approval on the patient records from a combined 3,976 REMSA achieves world’s first ECNS ACE innovative approach also speaks to cases analyzed saved nearly $1.2 million health care policymakers, Messerli said. nurse triage by recording time in relation to in payments by directing patients away from the emergency department to alterna- “An ACE is part of the strategy to an event’s particular starting point. tive points of care. The vast majority of patients—91.2 percent—ranked their experi- April 15 has a way of stressing out and I had heard that we might be first,” make sure this is sustainable,” she said. “The data is produced in a consistent, ence with the service as “highly satisfied.” Americans or, at least, making them a bit on she said. “But that wasn’t our goal. Our “The success of a program can keep it reliable manner,” he said. “We can measure edge. As you know, April 15 is that day your goal was accreditation and within the alive because others will follow the lead.” outcomes against the system’s recommen- Evidence = allies federal tax return must be postmarked and time of our grant. Once we started get- To achieve accreditation, Messerli put dations to improve performance.” Evidence-based EMS programs are also an ideal model for attracting participants in the mail. Dates past the postmark dead- ting close to submitting our informa- together a small team—the center’s CQI and funders through innovative programs, grants, and partnering with hospital sys- line can add penalties to what might be an tion, the momentum was there and we Coordinator who audits calls and gives Results win awards tems and care providers. already onerous payment due. knew we were the first ECNS users to feedback to the nurses, and an administra- A research study focusing on the effi- LMEMS applied for a grant through Passport Health Plan, which provides one- April 15, however, also holds a differ- submit.” tive assistant who downloaded data into the cacy of the emergency center nurse triage year $50,000 grants for innovative programs that improve the health and well-being ent meaning, albeit a positive one, for REMSA was awarded a $9.8 million Academy’s online system. Other REMSA system was selected as the recipient of of Medicaid patients in a 16-county service area. Regional Emergency Medical Services Health Care Innovation (HCI) Award in team members were pulled into the team to the 2014 Sophus Falck Scientific Abstract The grant became the seed money for ECNS implementation at LMEMS. Based Authority (REMSA), Reno, Nev. On that 2012 from the U.S. Department of Health collect essential information and data spe- Award for pre-hospital care at the Europe- on the program’s success at the end of the first year’s operation—estimated 30 percent day, the REMSA communication center and Human Services (HHS) to develop a cific to the Twenty Points of Accreditation an Society for Emergency Medicine’s 8th savings to patients in their medical transportation costs—LMEMS made the program went down in International Academies program that would respond to lower acu- as well as set goals and deadlines. She also ® ™ European Congress in September 2014. permanent and in the next year received a Bloomberg Foundation grant to add a sec- of Emergency Dispatch (IAED ) history ity and chronic disease conditions in urban, met well in advance with IAED Associate The study, titled “Using EMS Tele- ond nurse and management services for patients with chronic conditions who fre- as the first Accredited Center of Excel- suburban, and rural areas of Washoe Director Carlynn Page. phone Triage Data to Assess the Amount quently call 9-1-1. lence (ACE) for the Emergency Commu- County. Outcomes included reducing Page attributes their success to the cen- ™ ™ of Ambulance Resources Saved through The sky is the limit it seems from talking to Miller. nication Nurse System (ECNS ). unnecessary ambulance transports and ter’s foundation, resolve, and leadership. Telephone Triage,” found that out of more LMEMS has already added a paramedicine outreach program and, for the future, reducing unnecessary visits and hospital “ACE is all about compliance and than 2.6 million emergency 9-9-9 calls in is considering a stretcher van system to assist patients who have mobility concerns Not about being first admissions and readmissions while, at the about the structure behind it, and REMSA the U.K. that received a phone or face-to- and need transportation to an appointment or urgent care clinic. They’re also consid- Similar to tax day, Elaine Messerli, same time, improving patients’ health care is an agency that excels,” she said. face response between April 2011–April ering a 7-digit nurse help line. Registered Nurse, REMSA, Clinical Oper- experiences and saving costs and provid- The Twenty Points for the fire, police, 2012, nearly 90,000 were resolved through “ECNS is the most wonderful program in the world,” Miller said. “It made so much ations Manager Community Health Pro- ing jobs. It had to be community-centered. medical, and nurse triage protocols are “hear and treat” secondary triage response. sense to us from the start, and it now has led us to planning the addition of other gram, had set a deadline for achieving The Centers for Medicaid and Medi- consistent, with one exception: An agency More telling, the study found that spokes we can add to the hub of our EMS system.” an ACE for the protocol-based nurse care Services (CMS) administered the using ECNS must have a process in place those secondary triage responses result- The REMSA Nurse Health Line is part of REMSA’s Community Health Program triage system that provides alterna- award for a three-prong approach fea- for the Emergency Communication Nurse ed in deployment savings of 22.5 million which was launched in July 2012 as part of a $9.8 million Health Care Innovation tive referral options to callers with turing a Nurse Health Line—coupled with (ECN) to send calls back to the Emergency British pounds (or nearly $29 million) Awards grant funded by the Center for Medicare & Medicaid Services (CMS), De- non-life-threatening symptoms. ECNS—and community paramedicine and Medical Dispatcher (EMD) if the condition and saved the British ambulance services partment of Health and Human Services. The deadline, however, had nothing ambulance transport alternatives. escalates and emergency dispatch (ambu- 134,935 total unit hours. Messerli believes nurse triage is the wave of the future. to do with achieving ECNS accreditation Similar to all grants, fulfilling the lance) is necessary. Fivaz credits the results—the evi- “This will become the norm,” she said. “Avoiding overuse of ambulance and ER, before any other agency, Messerli said. requirements took data collection, REMSA reports quarterly data as part dence-based success potential of secondary when appropriate, is key to decreasing health care costs while still providing the best “Sure, it was an honor to be first, proven quality performance measures, of the HCI Award project.  triage response—as the reason the Interna- level of care to the patient.” 

26 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 27 Taking the Next Step

NAVIGATOR makes moving forward easy

Audrey Fraizer

here were so many shoes to fill, so many steps to And it really didn’t matter in which direction you follow, and a total of at least 3,000 left and right took your steps, because the conference always kept you Tfeet, that it’s lucky everybody had their toes point- moving forward. ed in so many directions during NAVIGATOR 2015. “Each of us experiences the same challenges at our cen- This was an event for the record books, said Academy ters, although never at the same time,” Freitag said during President Scott Freitag. his Opening Session remarks. “The next step for you may The reach was far beyond the numbers, the warm and sun- be very different than it is for me or the person sitting next ny weather, the poolside chairs, the buzz of slot machines, and to you. The goal is to go back and make your center better the thrill of Las Vegas shows, water fountains, and casinos. than it was before you came to NAVIGATOR.” “The impact of what do we affects millions of peo- New venues for recognition were particularly well re- ple all over the world in a very positive way,” Freitag said. ceived, and despite the beckoning finger of Vegas attrac- “By attending NAVIGATOR, by using the protocol Dr. tions, the packed on-site schedule and special events obvi- Jeff Clawson developed more than 35 years ago, we have ously ruled the week. Topping off the annual conference achieved equal voice in the chain of emergency response.” was the Instructor Appreciation Evening held pre-conference to honor their tireless dedication and the many miles Showstopper on the road and in the air they travel to teach certification NAVIGATOR 2015 in Las Vegas scored a record high of classes around the world. Dave Massengale, an instructor of more than 1,500 people in attendance representing 20 coun- many teaching credentials, received the inaugural Instructor tries. This year’s theme,⎯Taking the Next Step, ⎯exemplified of the Year Award, while he and 27 of his pioneering teach- the electricity connecting pre-conference workshops and ing associates were recognized for their early and ongoing in- events to the Closing Luncheon and presentation of the fluence in the EFD, EPD, EMD, Q, and ECNS™ classrooms. Dr. Jeff Clawson Leadership Award and Communication Board of Accreditation Chair Jerry Overton and Center Manager graduation certificates. There were more Academy Associate Director Carlynn Page donned suit sessions, more speakers, more vendors, and more opportuni- tails and white hats to greet the several hundred guests ties to network than ever before, igniting the passion emer- lining up at the door for the Accredited Center of Excel- gency dispatchers have for their profession. lence (ACE) party.

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Sandro Muschiett, Director, Tici- big step forward, and I am proud to have Dr. van de Pas wanted a process that would arrive at a correct response, and he was no Soccorso 144, Breganzona, Swit- spoken at and attended,” Guido said. “For adamant about being completely sure they helped the patient the best they could. He zerland, and the center’s Q, Christine a Q, there is nothing more important than asked questions, did the research, and observed. The three EMS dispatch centers in Waegli, said their attention to ACE was the delivery of your feedback, and at this the Netherlands now use the MPDS, with benefits that amazed even him. sparked at NAVIGATOR 2006, held year’s NAVIGATOR, taking the next step “Before protocol, 80 percent of the complaints had to do with dispatch,” he said. in Baltimore, Md. The center in south- for Qs spoke about improving your case “Now we have zero complaints. They have evaporated and, instead, we have people ern Switzerland, in the Italian-speaking review process and understanding how to thanking us. The nurses tell me they have no more sleepless nights second guessing canton of Ticino, which borders Italy, handle those seemingly gray areas of proto- their response.” achieved ACE in April 2015, two weeks col. The master Qs gave incredible insight.” Kimberly Stewart-Horan, Fire Communications Supervisor, Orange County prior to NAVIGATOR. Networking was a step no one could Fire District in Florida, said the steps may not always be simple, but they are well “On the way home [from Balti- miss given the crowds at the Opening Ses- worth the effort. Stewart-Horan fell into the luckiest job she could imagine when more], we started talking about ACE sion and Closing Luncheon, the Exhibit her application was accepted for a job at the Orange County Fire District commu- and the level of quality it meant for our Hall, the Wednesday evening dance-your- nication center. patients,” Waegli said. “We’ve always heart-out “Go-Go Lounge,” and the ear- “I loved dispatch from the second I started,” she said. But ask her why and she can’t believed that quality and ACE is more ly-morning call to pastry and beverages cite any one reason. “It’s everything about what I do,” she said. “I absolutely love it.” than the protocols. It is about the whole that fueled the daily first rush to sessions. The exact same sentiment didn’t greet the arrival of protocol. Dispatchers were system, the quality of care you provide, The 15 minutes allotted between sessions certified emergency medical technicians. They knew what their callers needed; they the network you create.” made for pockets of dispatchers talking, did not need a set of scripted questions to help them improve at what they already did A new track, aptly called Take the pointing directions, comparing notes, and best. “We weren’t kicking and screaming for the protocols,” she said. It was something Next Step, gave voice to the Academy’s synchronizing schedules. The two trips to Barry Luke, now-retired Deputy Chief, Orange County Fire Rescue, was determined drive to dispatch communication ex- the Las Vegas Fire Department communi- to accomplish, and she soon reached the same conclusion. cellence, highlighting the confidence cation center filled up within 20 minutes “We discovered this works,” she said. “Now all these years since, I don’t know how gained by investing in whatever it takes of their announced sign-up sheets. we did without the protocol.” Stewart-Horan has been at the center for 26 years and to make your center a star. Most chairs Some steps are less perceptible. it’s never been a question of should she go or should she stay. “I love this job as much were filled for the five sessions sched- The Medical Priority Dispatch Sys- today as I did the day I started. I love coming to NAVIGATOR.”  uled during consecutive time slots on tem™ (MPDS®) was the step that led to Friday, sending the message loud and clear to anyone irrational enough to gamble the It’s no wonder his peers voted him Su- a better night’s rest for emergency dis- odds between conference and casino. pervisor of 2014, said Madonna Valdez, patchers at RAV Brabant, MWN/BZO, Susi Vergeiner, Administrator, Priority Dispatch Corp. ™ Office, Brandenburg, the center’s day shift manager. “He’s not Tilburg, Netherlands. Austria, said there was no contest between the bright lights and glitter of NAV - out for himself,” she said. “He’s super ap- Harm van de Pas, M.D., Medical Direc- IGATOR and the jangly music, beeps and chimes, and whir of spinning reels of proachable and always knows to do the tor, Midden-West-Noord Regional Am- slot machines. right thing.” bulance Service St. Elizabeth Hospital Vergeiner remembers attending NAVIGATOR—before the conference went by Q courses routinely packed in 150 or Tilburg, said he had walked around with that name—when it was held at the Snowbird ski resort in Utah accompanying her more and Dr. Clawson’s presentation—“Bad an uneasy feeling about the process used husband, Gernot, while he investigated the protocol for use in Austria. The protocol Moon Rising at Dispatch—Dangerous Pro- in the country’s 1-1-2 centers following eventually found a receptive base in Austria, Germany, and Switzerland, and she lent tocol Omissions”—drew a full house of the death of a 17-year-old from a suspect- her superior organizational and people skills to an office that now coordinates all the close to 300 enthusiastic fans and followed pulmonary embolism. He trusted that administrative tasks in the German-speaking centers. ers. Kevin Willett and his merry band of the dispatcher—all of whom are registered “When we started, it was very small, and it’s been fun to be a part of this as it con- Public Safety Training Consultants always nurses—answering the patient’s call had tinues to grow,” Vergeiner said. “NAVIGATOR is fun, interesting, and a great place to pack in a crowd guaranteed to an hour of done everything possible for her, given catch up with friends each year.” fun in the interest of learning. the available tools at their center at that Just coming to NAVIGATOR pumped the confidence and energy levels of And talk about a full dance card. time, but was still thinking something Teodros “Ted” Deressengne, Supervisor, San Francisco (Calif.) Department of Emer- Tony Guido, Performance Improve- more could have been done. Dr. van de Pas gency Management. Deressengne, who was voted top supervisor by his peers, was ment, Communications, North Shore- convened a meeting among all the medical over-the-top enthusiastic not only because this was his first conference but, also, be- Long Island Jewish (NS-LIJ) Center for directors in the Netherland’s EMS system cause he was in his element. EMS, said the variety and number of Q to discuss philosophy. “There are all these people just like me,” he said. “We are the people never seen in classes offered⎯and the two-hour ED-Q Fo- “What were we trying to achieve?” the emergency. Yet, we know we make a difference. We give help at the critical point rum Live that welcomed a bit of Q spar- asked Dr. van de Pas, who is now a member when it’s most needed.” ring of opinion⎯had him moving in leaps of the Academy’s College of Fellows. “Our Once back at his center, Deressengne may very well be ladling bowls of his and bounds through the Paris Hotel con- core business was recognizing, sending, famous chicken noodle soup to co-workers while he regales them with stories vention center. and helping, yet we had nothing to sup- of NAVIGATOR. “This year’s NAVIGATOR took one port that.”

30 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 31  NAVIGATOR | ace people | NAVIGATOR  Robbin Melnyk Janet Dorsett Eddie Laning Cambria County 9-1-1 Ontario Police Dept. Barry County Emergency Services E911 Ebensburg, Pa. Ontario, Calif. Cassville, Mo. 9-1-1 Director EMD-Q Operations Manager

Robbin works for a smaller Eddie arrived in Las Vegas in of work. There was fighting, arguing, and de- agency that dispatches time for the pre-conference termination to work things out. I’m standing for 135,000 and uses the EMD-Q course, which he here today to say that if we could do it, de- police, medical, and fire took to become Q certified. spite all we went through, no doubt you can protocols. As the only So it was no surprise that take the next step, also.” one from Cambria County Eddie centered his attention NAVIGATOR 2015 was about Taking the Erica Carpenter attending the conference, on quality assurance classes Next Step—certification, accreditation, quali- Hays County Sheriff’s Office her goal at NAVIGATOR was to get a boost in improving ty assurance, developing leaders through the San Marcos, Texas to not only attend the pre- his Q knowledge. It was CCM course, technology, and improving the NAVIGATOR presenter conference Medical Instructor Eddie’s first time seeing what road that Academy pioneers have paved into Recertification Workshop—she’s NAVIGATOR has to offer, and the future. Several hats have changed along Erica found herself at a Regional EMD Instructor for he wasn’t disappointed. “I’ve the way, including the hat Dale handed to his NAVIGATOR 2015 in Las Vegas Priority Dispatch Corp.™—but The Ontario Police been impressed. They (the successor, Jerry Overton. for two reasons: to present to attend sessions beneficial Department is going through “The board wanted somebody interna- her session, A Meeting You to her and her staff. Robbin a transition period right now. tionally known and who had broad experi- Actually Want to Attend, paid special attention to the Beginning in June, the fire and ence in EMS,” Dale said. “We needed the right on Friday with co-presenter Management, Leadership, and police dispatch entities will be person to move us forward.” Melissa Pina and attend QA tracks and found herself separate after consolidating Overton was left standing tallest. Dale sessions about issues that in at least one Kevin Willett subsequently put on a new hat as Chair of are of the rare variety. “I love session. “I take a lot of notes. STEP UP TO the newly created Academy ED-Q™ Council coming to these conferences They know I’m going to come events) were all outstanding, of Standards and will continue to serve on both the medical and fire Council of Stan- and being able to present to back with a lot of ideas.” She and the food was good at EXCELLENCE dards. He was also recently promoted to Chief of the Salt Lake City Fire Department. this type of audience. It’s a shares those ideas in meetings all of them.” ACE sets world standard in “I’m quietly optimistic and scared as hell,” Dale said. high-end conference versus emergency communications Overton said it’s an honor to follow Dale and, at the same time, a tough role con- a local conference. This has sidering the shoes he’s been asked to fill. better audience participation.” more than 20 years ago. Fire Brian Dale was ready to tell Jeff Claw- “Brian has introduced ACE to the world,” said Overton, who has a 25-plus-year For Erica, the sessions dispatch has a staff of 13, son, M.D., not once but three times where career in EMS, including 18 years as Chief Executive for the Richmond Ambulance catching her eye were those with eight dispatchers, he could stuff the Academy’s Accredited Authority in Virginia, and past president of the American Ambulance Association. four supervisors, and a Center of Excellence (ACE) plaque 18 “I’m optimistic we’ll continue his lead.” manager. As EMD-Q®, years ago when the Salt Lake City 9-1-1 Overton didn’t waste any time. He announced the number of ACE recipients—22 back home, and some will then Janet was at NAVIGATOR—the communication center was navigating its new Accredited Centers of Excellence and 34 re-accredited centers during 2014,⎯ be implemented. Robbin third time she’s attended the way through the Twenty Points. bringing the total fire, police, and medical ACE count to 203, spread throughout five also enjoyed listening to conference—looking for new And it wasn’t in a file cabinet. of the seven continents. Opening Session keynote perspectives and information Instead, Dr. Clawson, inventor of the “We’re everywhere but Africa, and we’re working on that,” he said. to take home regarding standardized emergency communications Mainland China has seized the gold ring of emergency communications and, on the quality assurance her role in the center. protocol system, was so sure Dale could so far, six centers have achieved ACE, with two more in the works. Regional EMS track and those that talked She attended the Quality achieve ACE—and that he could help oth- Agency (REMSA) in Reno, Nev., was lauded as the world’s first Emergency Com- about dealing with traumatic Assurance and Training tracks, ers achieve the same—that he appointed munication Nurse System™ (ECNS™) ACE, and Allina Health EMS communi- events from a first-person particularly enjoying the ED-Q the-then EMS Division Chief for the Salt cations in Minnesota not only achieved medical accreditation but, also, one of perspective so she could Forum Live! session. Janet Lake City Fire Department (SLCFD) as the agency’s dispatchers, EMD James Domeier, was chosen as the Academy’s Dis- learn how other agencies attended some of the evening chair of the IAED™ Accreditation Board. patcher of the Year. have handled situations such events too, enjoying the Truth be told, neither SLCFD ACE Leaving the ACE binder in the past is a major step, especially for IAED Associate as fallen responders and networking opportunities at nor the Academy position happened over- Director Carlynn Page, who is the Academy’s ACE liaison. Early in 2015, the Acade- active shooters. This way, the ACE Casino Night. “It’s a night or, for that matter, instantaneously. my shifted to an online accreditation system that takes the paper out of the required Hays County can incorporate good conference.” But in the years to come Salt Lake City Twenty Points necessary to achieve ACE. others’ expertise when achieved a tri-ACE (medical, fire, and po- “No more packaging of binders for review,” Page said. “No more binders placed in planning for the inevitable. speaker CHP Sgt. Kevin R. lice), and Dale chaired the board for nearly off-site storage. No more going off-site to retrieve the binders every three years at the She also enjoys seeing familiar Briggs (retired) and attending a dozen years during a public service ca- time of re-accreditation. This is a step I’ve been looking forward to.” faces and meeting new ones. the NAVIGATOR Go-Go Lounge reer that has spanned 27 years. According to the last count, close to 80 agencies have signed on to the automated “The networking is incredible.” on Wednesday night. “That “I wouldn’t want to go back,” Dale system, which is a point bringing the story back to the NAVIGATOR stage and Acad- was very good. There’s a lot of said during the Opening presentation at emy President Scott Freitag, Director, Salt Lake City Communications Bureau. networking that goes on there.” NAVIGATOR. “It was tough. It took a lot “Go back and make your center better,” Freitag said. “You decide the next step.” 

32 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 33  NAVIGATOR | dispatcher of the year people | NAVIGATOR  Jason Hay Miel van der Wegen Shirlene Attson Longmont Emergency Communication Rav Brabant Midden West Noord Ganado Fire District Center Hertogenbosch, Netherlands Ganado, Ariz. Longmont, Colo. Ambulance Service Manager Communication Supervisor Communication Supervisor Miel’s first trip to NAVIGATOR Shirlene’s second time GRACE UNDER PRESSURE portant dispatcher characteristic we look Jason decided to tag-team it at in the U.S. (he’s attended attending NAVIGATOR Dispatcher of the Year noted for ability to keep his cool for when reviewing calls, especially those this year’s conference. He and Euro NAVIGATOR before) involving PAIs.” one of the center’s dispatchers was certainly not a Although EMD James Domeier was thousands of miles away from Las Vegas, he Casey described Domeier’s comforting arrived in Las Vegas ready disappointment. In fact, he was certainly at NAVIGATOR’s Opening Session in spirit when announced as the and impressive influence the evening he to go their separate ways noticed one thing in particular Dispatcher of the Year. called 9-1-1 when his wife, Stephanie, was for the conference—all in the Hanna Padilla while on the field trip to the Domeier, of Allina Health EMS communications in Minneapolis, Minn., is a Spe- in the first stages of anaphylactic shock. name of collecting double Santa Fe Regional Emergency Las Vegas Fire Department cialist First Class with the Minnesota Army National Guard and among 40 soldiers Stephanie had just injected the medication the information to take back Communication Center Communication Center. “The from the 204th Area Support Medical Company that left Minnesota for training on she takes three times a week to alleviate home and take advantage of Santa Fe, N.M. questions are all the same— Sept. 14, 2014, for a nine-month deployment in support of the multinational force in the symptoms of multiple sclerosis. She the networking opportunities Dispatcher everywhere the same things Sinai, Egypt. The soldiers are scheduled to return this summer at which time Domeier called out to her husband at the onset of available during the sessions matter.” Miel also enjoyed will receive the award. odd sensations immediately following the NAVIGATOR 2015 was the first rubbing shoulders during the And although Domeier wasn’t at NAVIGATOR to accept the honor in person or prescribed routine. time Hanna had a chance to conference—especially at the share his story with the packed house, his absence was at least partially filled by the “I couldn’t breathe, and my throat was attend out-of-state dispatch Go-Go Lounge—with people people there willing to substitute in his shoes. constricting,” said Stephanie, a triage clini- training. “I’m glad I got the who do the same thing. “We “The multiple letters of recommendation made him stand out,” said Carlynn Page, cal nurse at Fairview Health Services in the opportunity. I was pretty had a very nice evening and Associate Director, International Academies of Emergency Dispatch® (IAED™). “He was Greater Minneapolis-St. Paul area. excited.” She took a little bit met a lot of nice people.” His noted for his teamwork and dedication, and he was distinguished for a calm demeanor, Casey found his wife awake and breath- of this and that, focusing grace under pressure, and ability to keep his cool. He truly exemplifies what we do.” ing. Her face was pale and puffy. Her speech on issues that affect her at Domeier was selected from among 18 nominations submitted based on his sig- was slurred. He couldn’t understand what work—stress and conflict, in (the first being in 2013 in nificant contributions to further the values and mission of the Academies through she was trying to tell him. Within seconds particular. “All of the ones Salt Lake City) was filled personal action, which includes compliance to the Academy’s medical, fire, and/or of making the call to 9-1-1, she was slipping that I’ve taken have been with leadership and police protocols. Although no one 9-1-1 call captures the honor, Page said Domeier’s in and out of consciousness. management sessions, consistent reassuring manner in providing Pre-Arrival Instructions (PAIs) is striking, “I tried to remain as calm as possible,” and events. Jason chose including Ivan Whitaker’s as evidenced in the 9-1-1 call between Domeier and Casey Whitley that was played for Casey said. “James was calm, and I knew to attend a wide variety of focus during the conference session, Too Complex With the NAVIGATOR audience. that if I did the same, we could work to- classes during his time at the was on the Medical track Too Many Rules—Just Let “His demeanor makes these stressful encounters easier for those calling 9-1-1,” Page gether to help Stephanie. He walked me conference, including Research sessions, and he “liked Them Get it Done! “He was said. “Demeanor tells a story about the person and the ability to lead. It’s a very im- through instructions, and I felt better them all." just straightforward and nailed knowing there was something I could do.” a lot of the stuff. It coincides Stephanie was unable to recall much of really helpful.” Hanna loved with our center.” But it wasn’t what happened during the next six hours be- Opening Session keynote just conference sessions where fore waking up in the hospital; however, she speaker CHP Sgt. Kevin she spent her time. While at said the experience—for better or worse—has R. Briggs’ (retired) the Opening Gala Reception opened her eyes to the dispatch profession. message, including his on Tuesday night, Shirlene “We were amazed by what we were 101 and Team Building for the mention of being thankful visited exhibitor booths shown during a tour of the communi- Communication Center Leader/ for his dispatchers. “That (his looking at exercise gadgets, cation center,” she said. “Before this hap- Manager. “It’s been kind of a message) was probably my treadmills, and other ways pened, we really had no idea about the smorgasbord of classes that favorite part. It hit home a little to stay healthy. Rounding remarkable job that they do.” I’ve gone to. I’ve tried to pick bit.” Being able to attend the out her time at NAVIGATOR Allina Health EMS Medical Director and choose classes.” Jason ACE Casino Night was another included mingling with other Chuck Kaufman credited Domeier’s ease said he enjoyed the networking enjoyable part of NAVIGATOR. conference attendees. “It’s fun and his ability to focus on the task at hand. aspect of the conference “That was fun.” to get away.” “He’s great,” Kaufman said. “And we’re and getting more thoughts, really honored for him considering the voices, and perspectives number and caliber of nominees.” from presenters and fellow Angela Fox, Manager, Allina Health attendees. “I try to take the EMS communication, said she was thrilled opportunity to sit down with to go on stage to accept the honor for him. new people.” “We’re so lucky to have him as part of our team,” she said. “We regret his absence, but that doesn’t change the great job he does—you all do—every day.” 

34 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 35  NAVIGATOR | instructor of the year people | NAVIGATOR  Christine Marshall Brenda O’Neal Teodros Deressengne Training Officer 9-1-1 Supervisor Supervisor Humboldt County Sheriff’s Office Madison County 9-1-1 San Francisco Department of Emergency Winnemucca, Nev. Huntsville, Ala. Management, Calif.

Christine’s dispatch career can Brenda planned her trip HEAD OF THE CLASS emy’s College of Fellows (of which he is the longest-serving member), and the influ- be described in halves. For the to NAVIGATOR with a Inaugural award honors ence protocol has had on the lives of the untold millions of callers, dispatchers, and first eight years of her (so far) focus on the Police Priority Dave Massengale field responders. 16 years, she answered 9-1-1 Dispatch System™ (PPDS®). “The Academy has been [and continues to be] a major part of his life,” said Carol calls and dispatched resources She supervises the 9-1- Dave Massengale has helped 18,000 Massengale, who, similar to her husband, has dedicated hundreds of volunteer hours without the benefit of the 1 staff that answers calls students achieve fire and medical certifica- in support of the Academy. “He’s been there from the start.” Medical Priority Dispatch for EMS, fire, and police; tion. He has also motivated at least 10 per- Massengale knew what his future held at the ripe young age of 15. He was a mem- System™ (MPDS®). During the however, her group processes Sheila Mills cent of that number in his courses, helping ber of the local Emergency Services Explorer Post program, under the auspices of the second half—the past eight only the police calls from Dispatcher others achieve higher classroom interest Boy Scouts of America, and, because of his age, placed in the communication center years—the communication answering through response Gold Cross Ambulance Service in preparation of the job he’s been doing rather than in the field. and transfers all incoming Communications since the beginning of protocol time. “I wasn’t old enough to go on an ambulance,” he said. EMS and fire calls to Salt Lake City, Utah “I remember the days when Dr. (Jeff) The experience made a positive impression. He liked it and made a career of com- the dispatchers working He’s the king of cool, the Clawson gave his personal approval to munications following several years as a firefighter/paramedic. His introduction to communications for the promoter of morale. He’s every instructor,” said Massengale, retired, the Academy came through Rich Saalsaa, a part-time dispatcher at the same center respective agencies. Although someone standing out in a Sacramento County EMS and IAED™ asso- who was at that time working on a computer program for the Academy (forerunner not a consolidated center, crowd but not because of ciate director, and current IAED instructor of ProQA®). per se, they all work under his San Francisco Giants ball extraordinaire. “That was quite the honor. “I was certified,” Massengale said. “I really liked protocol, and Rich said Dr. Claw- the same roof, with police cap buoyed in a sea of tables He had high expectations, and I was truly son was looking for instructors. I applied.” being the last discipline to impressed by the protocol and his vision The certified Emergency Medical Dispatcher (EMD) and Dr. Clawson-approved implement protocols. Brenda, for emergency communications.” instructor was soon on the road, going to centers in California promoting the use of who has been with the agency As Gold Cross Ambulance Dr. Clawson, inventor of the protocol protocol with the tools—transparencies, a projector, slides, and sample cardsets—fer- for 18 years, said she has long Service’s 2014 Dispatcher systems, apparently was equally taken by ried inside the trunk of his car. The 9-1-1 environment was notably different 25 years center has used the protocol, anticipated the change away of the Year, Sheila’s the then-new recruit and still is. On April ago, Massengale said. Protocol was a relative newcomer to EMS dispatch, celebrating and she wouldn’t have it reward was to attend 29, during NAVIGATOR’s Opening Ses- 11 years in operation at the time Massengale came on board. any other way. “It’s hard to NAVIGATOR 2015. The sion, Massengale received the inaugural “It’s amazing what Dr. Clawson has been able to achieve,” he said. “I’m very proud imagine not being an EMD,” covered in white linen. In distinction is performance Instructor of the Year Award, recognizing to be even a small part of that.” she said. Two years ago, the fact, Teodros “Ted” tends based, said Chris Nilsen, his talents and dedication in presenting Massengale was also among the 28 instructors honored with the IAED Pioneer sheriff’s office switched to to go unnoticed in a Communication Center EMD and EFD certification courses and Award presented at the April 27 Instructor Appreciation Reception. profession that’s much Director. Sheila was delighted mentoring new instructors. “The instructors receiving the award this year have been instrumental in helping the same for everyone upon receiving a text “At some point all of you have taken a the protocols spread around the world,” Clawson said. “They believed in the proto- from the “five Ws” journalism at NAVIGATOR and, in a way, announcing her trip to Vegas. course from the tireless instructors who cols from the very beginning and have been tireless in teaching tens of thousands approach (who, what, explains his anticipation to “NAVIGATOR has had a have been with the Academy for so many of dispatchers to ensure that the citizens in their communities receive the very best when, where, and why) to attend. He’s in his element. butterfly effect,” she said. The years,” said Pam Stewart, Chair, IAED emergency, health, and social services possible.”  calltaking and dispatch. “There are all these people sessions, the people, and their Board of Certification, who presented like me,” Ted said. “We’re the enthusiasm have encouraged the award. ProQA®, and their next step forgotten people, the people her to provide the best And chief among the dedicated and in- is drawing more of a focus never seen in the emergency. service possible. But she dustrious is Massengale. on the use of protocol to a Yet, we know we make a hasn’t always been in public The award took Massengale by sur- public that still asks why so difference. We give help at the safety. “A friend and I saw a prise, although he admittedly couldn’t many questions. “ProQA has critical point when it’s most traffic accident, and, at that help but notice the similarities between certainly helped,” she said. needed.” And if Ted senses moment, both of us decided his background and the long list of accom- “And our next push is more sagging spirits among his to become EMTs. My friend plishments read on stage before his name outreach in the community.” dispatch center, he’s the first went on to something else, was announced. to offer empathy and chicken but I stayed with the plan and “Pam did her homework,” he said. “I was soup (his specialty from the loved it. I later changed to very impressed.” kitchen). It’s no wonder his dispatch and it’s been great. Massengale is a person of few words She acknowledges the big peers voted him Supervisor The job gives me a greater when it comes to talking about himself. project ahead but said she’s of 2014, said Madonna Valdez, appreciation of the good He shies away from attention and acco- definitely up for the task. “I’ve the center’s manager of the things in my life. It creates lades and barely spent a minute on stage always believed we needed a day shift. “He’s not out for awareness that I wouldn’t accepting the honor and standing ovation. specific standard,” she said. himself,” she said. “He’s super have doing anything else.” He’d rather talk about public safety com- “It’s best for the center and approachable and always munications, the work done by the Acad- Dave Massengale accepts the Instructor of the Year Award during the Opening Session of NAVIGATOR. the people we serve.” knows to do the right thing.”

36 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 37  NAVIGATOR | closing luncheon numbers | NAVIGATOR 

THE GRAND FINALE Winners take to the stage at Closing Luncheon

The NAVIGATOR 2015 Closing Lun- cheon featured a long list of winners: a winning poster, award-winning teams, and a guy with a grand sense of humor who had no trouble winning over his audience. The award for the winning research 1,559 poster went to an EMS field supervisor attendees from North Carolina. Tracey Barron, IAED™ Research & Studies Officer and Chair of the Council of Research and Clinical Fo- cus Group, presented the award to Lee Van Vleet, MHS, NREMT-P, for his research poster “Time to First Compression During Dispatcher-Assisted CPR is Not Associated 20 48 with ROSC or Survival to Discharge.” countries exhibitors The research poster contest is in its third represented year and attracted a record 17 entrants for the 2015 award. Posters were judged by the Acad- emy’s research team and displayed during the conference in the Exhibit Hall. through a network that reaches across Jeff Clawson, M.D., presented the Leadership Award to the IAED’s 11-member the country. Crazy, fun, relevant, and NAVIGATOR CBRN (Chemical, Biological, Radiological, Nuclear) Fast Track Committee. enriching are the words defining the by the numbers “I lose a little bit of sleep each year deciding who will receive an award of recogni- class of CCM.” tion in my name,” Clawson said. “This year was no different. Excellence in leadership Each year at NAVIGATOR, NC- is a mission of the Academy, and one that I consider very important in moving emer- MEC recognizes public service agencies gency dispatch forward.” and their communication centers for Clawson said the CBRN Committee was born out of necessity in 2003, shortly meeting essential training and policy el- 133 110 after the outbreak of severe acute respiratory syndrome (SARS). It was established ements demonstrating preparedness for speakers sessions to identify and evaluate emerging public health or public safety threats, and to devel- responding to a missing child incident. op and update relevant emergency dispatch protocols and procedures for managing In 2014, agencies using the Academy these threats. protocols included Bentonville Fire De- “They are charged with being a dispatch early-warning system in the emergence partment, Bentonville, Ark., and Har- of critical situations happening anywhere in the world,” Clawson said. “And they have ford County Department of Emergency 450 taken this role on with great gravity and have done an outstanding job.” Services, Forest Hill, Md. closing lunch The CBRN team modified the Severe Respiratory Infection (SRI) Tool to become After a one-year hiatus from the dis- attendees the Emerging Infectious Disease Surveillance (EIDS) Tool (SRI/MERS/Ebola), re- patch crowd, keynote speaker Jason Hewl- leased internationally in August 2014 following the initial Ebola outbreak. ett not only had his audience in tears from Fast Track Committee members are: Arthur Yancey, M.D.; Chris Olola, Ph.D.; Greg laughing, but, also running in circles and Scott; Richard Alcorta, M.D.; Pamela Farber; Alex Garza, M.D.; Todd Stout; Debbie lines in and around tables in the banquet Gilligan; Conrad Fivaz, M.D.; Mike McKeage; and Tracey Barron. hall flapping their arms like chickens and Also taking the stage were the graduates of the 2014 Communication Center up on stage dancing. Hewlett played to a Manager (CCM) course and a representative from the National Center for Missing full banquet hall at the 2013 Closing Lun- and Exploited Children (NCMEC). cheon in Salt Lake City. Christine Bannister, Supervisor, Waukesha County (Wis.) Communications and NAVIGATOR 2015 was great from recipient of the annual David Connolly CCM Leadership Award, congratulated her start to finish, and just like the profession, fellow students for an experience that “changed their lives forever” through the posi- it’s all about the people. tive connections developed. “I love what I do,” said Tammy Ketter- “We were challenged and had the bonus of making those rare once-in-a- man, Manager, Rehoboth Beach 9-1-1 in lifetime kind of friendships,” she said. “Professional contacts have been forged Delaware. “It’s all about helping.” 

38 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 39  ON TRACK | fire cde fire cde

is the maximum Recommended Exposure Death by • unusual odor/bad taste Limit (REL) established by the Nation- • tarp covering all or part of vehicle al Institute for Occupational Safety and chemical (or nearby) Health (NIOSH).5 • all windows and doors closed Sources for the sulfur in these lethal con- cocktail coctions include dandruff shampoos, pesti- A caller should look for the following cides, latex paints, and garden fungicides. involves a warning signs in and around a building/ surprisingly structure: Hydrogen cyanide • notices or printed warning signs in, on, Hydrogen cyanide is extremely toxic simple process or around the confined space in gas or liquid form and has a faint, bitter, almond-like odor. All routes of exposure that leads to • visible smoky fumes coming out can cause abrupt onset of profound CNS • door cracks or openings sealed with (central nervous system), cardiovascular, the release tape, clothing, towels, or other materials and respiratory effects, leading to death • unusual odor/bad taste within minutes. Exposure to lower con- of toxic • household cleaning products centrations of hydrogen cyanide may pro- concentrations duce eye irritation, headache, confusion, • buckets, coolers, or containers nausea, and vomiting followed in some cases by coma and death. Hydrogen cya- of poisonous • goggles on occupant nide is used in fumigating, electroplating, gases. • gloves on occupant mining, and in producing synthetic fibers, plastics, everyday cleaning products, dyes, If the caller reports any of those and pesticides.6 warning signs, ProQA will distinguish STAY ALERT TO POSSIBILITY between unequivocal criteria and equiv- Toxic chemical mix poses threat to responders MPDS and FPDS Protocols caller must be warned not to approach or ocal criteria to give a predictive value The International Academies of Emer- enter vehicles or rooms where unrespon- based on the evidence. gency Dispatch’s® (IAED™) instructions sive people may have attempted chemi- Caller or bystander symptoms—dizzi- Audrey Fraizer for suspected chemical suicide were first cal suicide, especially bathrooms, cars, or ness, lightheadedness, abnormal breathing, released in v6.0 of the Fire Priority Dispatch other small spaces where a tiny amount burning/irritated eyes—further indicate System™ (FPDS®) and similar sections will of gas can quickly reach lethal concen- the possibility of chemical suicide. soon be released in v13.0 of the Medical Pri- trations. ixing common household chemicals products are more readily available—in 9-1-1 communication centers play in the ority Dispatch System™ (MPDS®). Proper initial questioning is vital, and Response to the scene Mcan produce a lethal combination cars, closets, or other enclosed spaces.2 The event of a chemical suicide; the questions For an agency using only the MPDS, the it is crucial that scene safety information If a chemical substance is suspected, and a potentially deadly one to bystanders method has gone international, fueled by they ask provide the backdrop to appropri- dispatcher should go to Protocol 8: Carbon is immediately relayed to all responders responders should follow their agency’s and responders coming on-scene to an in- the ease of finding instructions and even ate response. Let’s take a look at the char- Monoxide/Inhalation/HAZMAT/CBRN and the caller is provided with scene safe- hazardous materials operational protocol tentional detergent suicide. pre-made warning signs to post at the acteristics of two gases commonly used in to get the caller’s description of the hazards ty instructions. Comm. center staff using and procedures, including the request for Death by chemical cocktail involves a scene from the Internet. chemical suicide. on-scene and, if a chemical suicide is report- ProQA® will tell the caller to “listen care- assistance from the appropriate HAZMAT surprisingly simple process that leads to In 2010, there were 36 chemical suicides ed, notify appropriate Fire/Hazmat teams fully” and ask “without putting yourself in team before entering the “Hot Zone.” the release of toxic concentrations of poi- in the U.S., and in the six months between Hydrogen sulfide and initiate the appropriate response. The danger, do you see, or know of, any of the Deputy Chief Jake Oreshan, New York sonous gases; hydrogen sulfide and hydro- June 2010 and the start of 2011, there were Hydrogen sulfide is a colorless gas with dispatcher should also provide the caller following things,” which could indicate a State Office of Fire Prevention & Control, gen cyanide are the most common gases at least 27, indicating that the incidence is the characteristic foul odor of rotten eggs. with safety instructions beginning on X-7. potentially dangerous scene and the possi- and an expert in chemical suicide and re- produced by those intending to take their rising. Of 72 chemical suicides documented The gas is a highly flammable and explo- For agencies using both Medical and bility of chemical suicide. sponder safety, recommends the “10 sec- lives using this method. in the U.S. between 2008 and 2011, at least sive gas with a flash point of 500 degrees Fire Protocols, the IAED advises the use A caller should look for the following onds to save your life” rule. Cleaning products that contain acids 80 percent have resulted in injuries to po- Fahrenheit. In comparison, a cigarette will of FPDS Protocol 61: HAZMAT for scene warning signs in and around a vehicle: Responders should take an extra 10 (such as muriatic or hydrochloric acid) can lice officers, firefighters, emergency work- light at 1,200 degrees Fahrenheit. Hydro- safety, which also prompts the dispatcher • notices or printed warning signs in, on, seconds upon arrival to size up [the sit- 3 be mixed with compounds that contain ers, or civilians exposed to the gas. gen sulfide can affect the body if it is in- to notify EMS for anyone in immediate or around the vehicle uation] including peering into the ve- sulfur (such as pesticides and insecticides) Awareness on the part of responders is haled or comes in contact with the eyes, danger, who has the chemical/substance on • visible fumes coming from vehicle hicle and looking for pails, buckets, or to generate hydrogen sulfide. Hydrogen the first step to preventing personal injury skin, nose, or throat. Headache, dizziness, them, or who is sick or injured. In the case other mixing vessels in the front or rear cyanide gas is created using an acid source or death in their response to the scene. Any- and an upset stomach can result from of chemical suicide, the dispatcher should • smoky or foggy windows seats, containers of acids and pesticides, and cyanide salts such as sodium cyanide one who enters the space without proper inhalation of low concentrations. High- provide instructions beginning on D-1. a yellow or green residue in the vehicle, 1 • household cleaning products or potassium cyanide. protection may quickly become a victim. er concentrations (500–1,000 ppm) will and vents that may be taped off. If the • buckets, coolers, or containers By some counts, more than 2,000 peo- cause rapid unconsciousness and death by Warning signs incident occurs in a structure, such as 4 ple in Japan have taken their own lives Deadly chemical mix respiratory paralysis and asphyxiation. Communication center personnel • goggles on occupant an outbuilding or other contained area, (between 2007 and 2011) inhaling gases— The toxicity and recommended safety A ceiling value of 10 ppm for a 10-min- should be alert and aware of the warning • gloves on occupant there may not be any written warn- in most cases hydrogen sulfide since the precautions underscore the importance ute maximum duration in the workplace signs for this type of call. For instance, the ings present. Responders need to be

40 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 41 fire cde FIRE CDE QUIZ | F

CDE Quiz Mail-In Answer Sheet extremely cautious when investigating YOU MUST BE FIRE CERTIFIED TO TAKE THIS QUIZ Answer the test questions on this form. (A photocopied answer sheet suspicious odor calls inside a structure.7 Answers to this quiz are found in the article “Stay Alert to Possibility” which starts on page 40. Take this quiz for 1.0 CDE unit. is acceptable, but your answers must be original.) WE WILL NOT PROCESS ALTERED SIZES. Responders at the scene must wear ap- A CDE acknowledgement will be sent to you. (You must answer 8 of the propriate protective clothing, including a 1. What are the most common gases produced by those intending to take their lives using 10 questions correctly to receive credit.) chemical suicide? positive pressure self-contained breathing Clip and mail your completed answer sheet along with the $5 USD a. chlorine and phosgene apparatus, to breach a window or door to b. hydrogen sulfide and hydrogen cyanide (U.S. currency) NON-REFUNDABLE processing fee to: effect a quick response for an unconscious c. nitrous oxide The International Academies of Emergency Dispatch victim. If the person can't be awakened, 110 South Regent Street, Suite 800 responders should perform a thorough in- 2. Of 72 chemical suicides documented in the U.S. between 2008 and 2011, what percentage Salt Lake City, UT 84111 USA of these has resulted in injuries to police officers, firefighters, emergency workers, or Attn: CDE Processing vestigation before entering the space to as- civilians exposed to the gas? (800) 960-6236 US; (801) 359-6916 Intl. sist. They must consider wind speed when a. 20 percent Please retain your CDE acknowledgement for future reference. determining evacuation of nearby struc- b. 40 percent c. 60 percent Name ______tures, and if the chemical suicide occurred d. 80 percent inside an apartment complex, they must Organization ______consider evacuating everyone from that 3. Hydrogen sulfide has the characteristic foul odor of: building.8 Responders can punch a small a. spoiled milk. Address ______hole in a car or home window to insert b. burned pudding. c. rotten eggs. City ______St./Prov.______air-sampling equipment to determine the d. tainted meat. presence or absence of hydrogen sulfide Country ______ZIP______4. What is the concentration of hydrogen sulfide necessary for respiratory paralysis and or hydrogen cyanide. Anyone exposed to asphyxiation? Academy Cert. #______the poisonous vapors should be decontam- a. 5-10 ppm inated with soap and water. If the victim is b. 50-100 ppm Daytime Phone ( )______still alive, responders should remove his or c. 500–1,000 ppm her clothing and clean him or her before enforcement and fire/EMS response. Law E-mail ______5. Hydrogen cyanide has an odor that has been described as: transporting. A sheet should be used to If the person can't enforcement and ambulance crews arriving a. dehydrated fruit. PRIMARY FUNCTION cover deceased victims; body bags are not be awakened, on the scene immediately recognized the b. faint, bitter, almond-like. recommended.9 situation and called for a HAZMAT team c. deviled eggs. Public Safety Dispatcher (check all that apply) d. compost. responders and evacuated the area.  _____Medical _____Fire _____Police Sarasota County PSC Sources 6. All routes of exposure to hydrogen cyanide can cause abrupt onset of profound CNS, Paramedic/EMT/Firefighter Sarasota County Public Safety Com- should perform cardiovascular, and respiratory effects, leading to death within minutes. 1 Chemical Suicides: The Risk to Emergency Responders. Comm. Center Supervisor/Manager a. true munication in Sarasota, Fla., processed U.S. Department of Health & Human Services. 2014; Nov. b. false Training/QI Coordinator three chemical suicides calls in a little over a thorough 4. http://www.chemm.nlm.nih.gov/chemicalsuicide.htm 10 (accessed Jan. 5, 2015). Instructor a year. 7. The IAED’s instructions for suspected chemical suicide were first released in: investigation 2 Goode E. Chemical Suicides, Popular in Japan, Are The first came from a North Sarasota a. v6.0 of the FPDS. Comm. Center Director/Chief subdivision on April 6, 2009, from a moth- Increasing in the U.S. The New York Times. 2011; June 18. before entering http://www.nytimes.com/2011/06/19/us/19chemical. b. v5.0 of the FPDS. Medical Director er who found her 30-year-old son uncon- html?pagewanted=all (accessed Jan. 5, 2015). c. v12.2 of the MPDS. d. v5.0 of the PPDS. Commercial Vendor/Consultant scious. She was given CPR instructions, 3 Turono K. “Chemical Suicide Identification Guide for 911 the space. Other and paramedics responded for a cardiac Communications.” Central Florida Intelligence Exchange. 2011; February. 8. For agencies using both Medical and Fire Protocols, the IAED advises the use of: arrest. Scene responders noted a chemical 4 a. FPDS Protocol 61: HAZMAT. Kalusche H. Engineer Research and Development Center, ANSWER SHEET FIRE odor inside the house and left immedi- patcher to send a full HAZMAT response b. FPDS Protocol 54: Confined Space/Structure Collapse. F Vicksburg, Miss., el.erdc.usace.army.mil/workshops/ May/June 2015 Journal “Stay Alert to c. FPDS Protocol 57: Explosion. ately, initiating a HAZMAT response. No prior to the arrival of law enforcement 04jun-wots/kaluschue.pdf (accessed Jan. 5, 2015). Possibility” d. FPDS Protocol 67: Outside Fire. warning signs were posted; however, par- and EMS units. 5 Agency for Toxic Substances and Disease Registry (ATS- Please mark your answers in the appropriate box below. DR). 2006. Toxicological Profile for Hydrogen Sulfide. tially empty containers of the pool acid The third call came on Feb. 6, 2010, Atlanta, GA: U.S. Department of Health and Human 9. What does the “10 seconds to save your life” rule mean in chemical suicide response? 1. o A o B o C and lime sulfur liquid used were found. again from Siesta Key Beach with the same Services, Public Health Service. http://www.atsdr.cdc. a. Dispatchers should wait 10 seconds from the time of the call to dispatch 2. o A o B o C o D The second report came on Nov. 24, situation of a bystander reporting a male gov/ToxProfiles/tp114.pdf (accessed Dec. 18, 2014). response because of the associated hazards. b. Dispatchers should tell bystanders to count to 10 while moving away from a 6 See note 5. 2009, from Siesta Key Beach. A bystand- slumped over the wheel of a car at a beach suspected chemical suicide inside a parked vehicle to gauge appropriate distance. 3. o A o B o C o D er called 9-1-1 to report a male slumped access parking lot. Signs taped on the car’s 7 Oreshan J. “The Chemical Suicide Phenomenon.” Fire c. Responders should take an extra 10 seconds upon arrival to size up [the situation]. Engineering. 2011; Jan. 28. http://community.fireengi- 4. o A o B o C over the wheel of his car at the north end windows warned of a possible suicide. How- d. It takes 10 seconds to suit up in HAZMAT gear. neering.com/forum/topic/show?id=1219672%3ATop- 5. o A o B o C o D of a beach parking lot. Signs taped to the ever, the caller failed to mention that each ic%3A254637 (accessed Jan. 5, 2015). 10. Anyone exposed to the poisonous vapors should be decontaminated with soap and water. 8 Kansas City Regional TEW – Inter-Agency Analysis Cen- 6. o A o B window cautioned: “Suicide Danger Hy- of the five homemade, computer-printed a. true ter. Hydrogen Sulphide Suicide Deaths: Firefighter Safety b. false drogen Sulfide Inside.” The dispatcher signs included instructions to call police & Survival Message. 2010; March. 7. o A o B o C o D coded the call a suicide, which initiated and HAZMAT, and a sixth handwritten 9 See note 8. 8. o A o B o C o D a dual response of law enforcement and sign had a warning that read, “One breath 10 Adams K., “Rotten Eggs! Almonds! You would be sur- fire/EMS, but used Protocol 61 in ProQA. can kill!!! H2S Suicide” with drawings of prised to find what they have in common.” 2008; October. 9. o A o B o C o D Sarasota County Sheriff’s Office Public Safety Communi- The dispatch code in the CAD was auto- skulls and crossbones. The call was coded To be considered for CDE credit, this answer sheet must be received no later than 06/30/16. A passing score is worth 1.0 10. o A o B cations Center. CDE unit toward fulfillment of the Academy’s CDE requirements. Please mark your responses on the answer sheet locat- matically updated, notifying the fire dis- a suicide that again resulted in a dual law ed at right and mail it in with your processing fee to receive credit. Please retain your CDE letter for future reference. Expires 06/30/16

42 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 43  BLAST FROM THE PAST BLAST FROM THE PAST 

Jeff Clawson, M.D.

he Take Home affects response time, jeopardizes responders T The following article published in the absent of effective triage, and increases crew fa- August 1983 issue of Fire Chief Magazine is as tigue and stress by dispatching personnel to calls relevant today as it was 32 years ago. Namely, that they are not needed on. Finally, while some a dispatch center is an important element of view the diversity of systems as an asset to tailor emergency services and critical to saving lives expectations to local residents, it can also be con- and property but its ability to support field re- sidered a liability in cases where local standards sponders is dependent on having correct policies fall below generally accepted standards and, as and procedures in place that clarify expectations a result contrary to beliefs, the patients are the of dispatchers and field units and coordinates ones suffering the consequences. system resources. Maximal response practices We again thank Dorothea St. John and Reg- and inconsistent dispatch is not only inefficient gie Shephard, Jr., for such “time” immutable un- internally to the agency, but it also adversely derstanding and advice.

44 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 45  BLAST FROM THE PAST BLAST FROM THE PAST 

46 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 47 ? F G | UNIVERSAL CDE QUIZ

YOU MUST BE 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 “Blast From The Past,” which starts on page 44. Take this quiz for 1.0 CDE unit. is acceptable, but your answers must be original.) WE WILL NOT PROCESS ALTERED SIZES. A CDE acknowledgement will be sent to you. (You must answer 8 of the 1. When was this article originally published? 10 questions correctly to receive credit.) a. 1983 Clip and mail your completed answer sheet along with the $5 USD b. 1993 (U.S. currency) NON-REFUNDABLE processing fee to: c. 2003 What could be d. 2013 The International Academies of Emergency Dispatch 110 South Regent Street, Suite 800 more important than 2. It is medically feasible to dispatch less than an ALS unit on many EMS incidents and to Salt Lake City, UT 84111 USA drive without red lights and sirens not only during transport but during initial response. Attn: CDE Processing protecting our children? a. true (800) 960-6236 US; (801) 359-6916 Intl. b. false Please retain your CDE acknowledgement for future reference. Name ______3. What does “stacking” calls in reference to ALS response mean? a. sending the same ALS unit on multiple calls Organization ______b. holding the call until a unit is available c. organizing calls by type—fire, police, and ambulance—to determine priority response d. arranging ALS units in terms of desired outcome Address ______

4. Should a 17-year-old male with abdominal pain and fever (felt to be appendicitis) be City ______St./Prov.______treated as a prehospital emergency requiring red lights, siren, and paramedic response? a. always Country ______ZIP______b. probably not Academy Cert. #______5. What percentage of EMS response requires only Basic Life Support? Daytime Phone ( )______a. 20–30% Announcing 9-1-1 CommuniCAtion b. 40–50% helping to ProteCt our Children c. 60–70% E-mail ______Center Best PrACtiCes in CAses of d. 80–90% is as easy as 1-2-3! PRIMARY FUNCTION missing Children 6. Salt Lake City’s development of medical priority dispatch training and certification of 1. download NCMEC’s 9-1-1 Communication Center Best Emergency Medical Dispatchers (EMD) achieves the following: Public Safety Dispatcher (check all that apply) A missing child is a critically important and high Practices in Cases of Missing Children document from a. further defines the concept of call screening _____Medical _____Fire _____Police profile event that can rip the fabric of your agency b. allows for more formal medical control www.missingkids.com/911 and community if not handled correctly. In terms c. may prove more economically feasible to the fire service Paramedic/EMT/Firefighter d. all of the above Comm. Center Supervisor/Manager of urgency, use of resources and potential impact 2. request a copy of the Public Safety Telecommunicator Training/QI Coordinator on the community, a missing child requires a level 7. Key Questions in the medical protocols emphasize: Checklist for Missing Children. a. the importance of obtaining symptoms (e.g., chest pain). Instructor of readiness akin to a disaster. This joint initiative of 3. Apply to attend NCMEC’s CEO Overview Course in b. the importance of making a diagnosis (heart attack). Comm. Center Director/Chief NAED, APCO, NENA, National AMBER Alert and the c. the importance of billing the correct carrier. Alexandria, Virginia. d. the importance of collecting information about the cause of an accident or illness. Medical Director National Center for Missing & Exploited Children Commercial Vendor/Consultant (NCMEC) was created to: 8. The concept of priority dispatching can easily go hand in hand with systems of: Other a. lights and siren response for every medical call. b. mutual aid. · Promote awareness of the critical role of c. tiered response, that is, dispatching only what is needed. ANSWER SHEET ? F G UNIVERSAL the 9-1-1communication center in handling Ceo overview Course d. sorting response depending on the order of calls received. May/June 2015 Journal “Blast From The Past” Please mark your answers in the appropriate box below. missing and exploited children calls 9-1-1 Communication Center Managers and Directors are 9. A tiered response system is structured to permit the shutdown of the response at any point. 1. o A o B o C o D invited to apply to attend the two-day oveview course a. true · Develop and endorse best practices b. false 2. o A o B held at the National Headquarters of NCMEC in Develop tools for handling incidents of Alexandria, VA. Courses are conducted approximately 10. What is the first step to take once the decision is made to change your present system of 3. o A o B o C o D · dispatch? missing and abducted children every six weeks at no cost to participants. 4. o A o B a. Apply for funding. b. Conduct a thorough system evaluation. 5. o A o B o C o D c. Talk it over with your local city planner. d. Introduce the change immediately before anyone can disagree. 6. o A o B o C o D for more information, visit www.missingkids.com/911 or email [email protected] 7. o A o B o C o D 8. o A o B o C o D 9. o A o B 10. o A o B o C o D To be considered for CDE credit, this answer sheet must be received no later than 06/30/16. 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 at right and mail it in with your processing fee to receive credit. Please retain your CDE letter for future reference. Expires 06/30/16

48 THE JOURNAL | iaedjournal.org  YOUR SPACE | dispatch in action dispatch in action

of marital bliss, wanted to thank her earing of the lapel stork pin com- personally. Wmemorates an upbeat sequence of Two months later, on Dec. 10, 2014, events for EMD Lorraine Welsh. Cindy and Wayne stopped by carrying a The dispatcher was party to the birth box of doughnuts and eager to put a face of a healthy baby girl, and the 100 percent to the EMD they credit for the critical compliant call was the first to be so hon- first step in saving Wayne’s life. ored through the new awards program at “They were the cutest couple ever,” the Northern Ireland Ambulance Service Simms said. “Cindy remembered things I (NIAS), Health and Social Care Trust, had told her to do. They made me realize control room in Belfast. how remarkable 9-1-1 can be during that The recognition Welsh received one critical moment in a person’s life.” week after the call was occasioned by They also made Simms and Schmidt International Academies of Emergency laugh with their good-natured banter and Dispatch® (IAED™) Accreditation Officer sense of humor. Beverley Logan’s well-timed visit. “Cindy said since the devil apparently Everything about the event, from the didn’t want her husband, he was still hers call received on the morning of Jan. 20 to to look after,” Simms said. the presentation on Jan. 28, was “absolute- Wayne talked about how cataract ly brilliant,” said NIAS Control Training surgery on one eye gave him the ability to and QA Officer Heather Lyons. clearly see the lines on his wife’s face. They couldn’t have scripted it any “Cindy told the doctor not to do the better. other eye, “ Schmidt said. “It was a great call to listen to,” Logan They escorted Cindy and Wayne on a said. “And one that I was honored to be DEVIL OF A GOOD TIME tour of the center, and Schmidt present- a part of when the badge/certificate PINK IS FOR GIRLS Fun-loving couple stops by center ed Simms with a lifesaver award pin. She was presented.” Awards program provides also gave them frames to hold the photo For starters, the baby’s father arrived to say thanks for CPR save taken during their visit, engraved with home after working the night shift to color-coded praise personal messages: Wayne’s read, “Melissa find his wife in active labor, with con- Simms, Wayne’s guardian angel,” and tractions barely two minutes apart by the Melissa’s read, “Wayne’s Guardian Angel, time he made the call to 9-9-9. The hospi- Melissa Simms.” tal is a 25-minute drive from their home. oking about a near-death experience compressions-only CPR. Simms has been in dispatch for The birth took off rapidly from there, honor of receiving the first stork pin in a among the 10 pins Lyons designed. Three Jtakes a good sense of humor and a re- “Cindy hesitated,” Simms said. “She eight years—seven of those years at the Welsh said. rewards program Lyons initiated on Dec. pins recognize consistently high protocol ally strong relationship when the incident was afraid she might hurt him since she Waukesha consolidated center—and it “I thought we would have a little 1, 2014, was the icing on the cake. compliance; another three acknowledge involves a spouse. had never done CPR before.” was a second choice after an accident more time,” she said. “Instead, I had to “It was nice to be the first [to receive exemplary customer service; and there At least, that’s what Cindy and Simms persistence convinced Cindy prevented her from her first dream job: move very quickly through the different the recognition],” she said. “You can really are two pins for separate lifesaving Wayne [last name withheld] would lead to try; her reassurance and counting field police work. She didn’t want to Pre-Arrival Instruction (PAI) links.” get emotional about these things.” events (one involving CPR and the other you to believe. along to maintain the rhythm kept Cindy work in a forensics lab or behind a desk Within seconds, dad had the baby girl Logan was impressed upon hearing the involving a save that did not require “They had us in stitches the whole pumping up and down on her husband’s compiling reports. in his hands, but that didn’t make the sit- recorded call. CPR, such as instructions that save a time they were here, we were laughing so chest for the nearly six minutes between “I like working with people too much uation any easier. The cord was wrapped “Despite the rapid progression, choking patient). hard,” said Shelby Schmidt, Supervisor, the time of the call and the ambulance’s for that,” she said. around the baby’s neck, and the baby did Lorraine remained on track, moving to Belfast’s NIAS has a fleet of over Waukesha County (Wis.) Communica- arrival on-scene. Paramedics brought out The communication center has pre- not appear to be breathing. Welsh quickly a more appropriate part of the protocol 300 ambulances covering 14,100 square tions. “It was supposed to be a meet and an AED to restore a normal heart rhythm. sented the ideal environment. While not relayed instructions on how to remove with each element of new and updated kilometers (5,600 square miles) in greet, and they were here for 90 minutes. He was transported within 30 minutes every call turns out as well as Cindy and the cord and check the baby’s breathing. information she received,” she said. “She Northern Ireland and serving a popu- They were so much fun.” “That was the last we knew,” Wayne’s, she “loves” what she does and the “He told me she was breathing,” said really was professional throughout the lation of 1.7 million. The NIAS control The occasion to meet the couple was Schmidt said. ability to help through the application of Welsh, a dispatcher at NIAS for 20 years. call and most certainly contributed to the room receives around 150,000 emer- not predicated upon fun, of course. Jump ahead exactly one year and the Medical Protocols. “It was really a good feeling to know all calmness of the caller.” gency 9-9-9 calls and 40,000 general On Oct. 24, 2013, Cindy called 9-1-1 to guess who rings up Waukesha County “You can’t bring everyone back,” she was going well for everyone.” Lyons said the awards program is a practitioner (GP)/hospital urgent calls report a medical emergency involving her Communications? said. “You just try to do all you can do for This is the third baby that Welsh way of showing, “look, you’re doing a per year. There are 46 EMDs with nine 73-year-old husband, Wayne. Cindy told “Cindy was looking for the dispatcher that person in that moment.”  has aided in the delivery. They’ve all great job here.” to 10 EMDs on duty at any given time. EMD Melissa Simms that her husband who took her call that day,” Schmidt said. been girls, and she stays in contact with “EMDs get hammered all the time, NIAS also has 10 EMDs on GP/hospital was having a stroke, and Simms proceed- “She had started thinking that without one of the families that stopped by for so it’s good to put something positive in urgent call duties using Protocol 35: ed through Case Entry Questions. Melissa’s coaxing, she wouldn’t have introductions. place,” she said. Healthcare Professional Admission, a He wasn’t conscious, and he wasn’t done the CPR.” The opportunity to help is the major The stork pins come in two colors— health care facility protocol specific to breathing. Simms immediately went to The couple, going on their 54th year factor in Welsh’s job satisfaction. The pink for girls and blue for boys—and are the U.K. 

50 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 51  YOUR SPACE | dispatch in action dispatch in action

n his 7 1/2 years at Columbia County I(N.Y.) 911 dispatch center, Dana Petty has taken countless calls for a variety of emergencies. But he’d never had one like the call he took last October. On that unforgettable day, Petty used the Medical Priority Dispatch System™ (MPDS®) to guide Frank Eschenberger though the steps of delivering his baby boy in his home. The delivery was successful, and the baby was healthy. On Feb. 5, 2015, with now-four-month-old Jace in tow, the thankful couple visited Petty at the dispatch center to offer their gratitude for helping bring their pride and joy into the world. “I’ve never had someone come back and thank me before,” Petty said. “It was a pleasant surprise. It was kind of exciting. They were a nice young couple. I held the baby, met the family, and we chatted for an hour.” It took the Eschenbergers a few SUPER BOWL SAVE months to track Petty down. They knew SPECIAL DELIVERY Dispatcher makes winning one of Petty’s co-workers and had initially Dispatcher, couple meet sent Petty a message though Facebook, play to aid fellow dispatcher but the message got stuck in a different months after baby delivery folder. It wasn’t until late December that Petty saw the message. Schedule conflicts and bad weather further delayed the meeting. But Frank and his wife, Saman- he big play on Super Bowl Sunday But one time was all it took, and 30 “We’re a pretty good group of people tha, were at last able to meet the man who the affirmative. After Frank announced “Unfortunately, we deal with a lot of Tcame before the game even began. seconds later, Kenney was breathing that work together,” Sevelowitz said. calmly and skillfully turned a traumatic to him that the baby was a boy (a fact the tragedy in this line of work, but good calls Thomas Kenney, Litchfield County just fine. Whether it was Sevelowitz’s back- situation into a joyous occasion. Eschenberger’s had chosen not to learn like this make the job worthwhile,” said (Conn.) Dispatch dispatcher-in-train- “I’ve never had to do the Heimlich ground as an EMT or his training as a Petty answered Frank’s call at 10 p.m. beforehand), Petty told him to “tie a string Columbia County 911 Director Robert ing, was munching on some pretzels before,” Sevelowitz said. “That’s when we dispatcher, it all came together. on Oct. 4, 2014. Though he has taken or shoelace tightly around the umbilical Lopez. “It’s a great feeling for a dispatcher during a moment of downtime when realized that it was a little more serious “I think it’s a combination of about 20 calls during his career where cord” and to put the baby in his mother’s when they can hang up the phone and one didn’t glide down his throat like the than we thought.” both—protocol and my EMT back- the caller said the mother was in labor, arms. By this time, the fire department know that they made a difference. In this others had. Kenney didn’t feel any aftereffects ground,” he said. this was the first where he actually went had arrived. Petty congratulated the case, the dispatcher helped bring a new “She (trainer Melissa Lindgren) turned from the choking incident once the pret- Training and QA Coordinator through the step-by-step Pre-Arrival parents and ended the call. The entire life into the world. It doesn’t get much around,” Kenney said. “I guess I wasn’t zel was dislodged. Jeff Liskin said recognition of the Instructions (PAIs) to deliver the baby. conversation took just four minutes. better than that.” breathing properly, making weird noises.” “I stopped eating those pretzels,” he said. entire shift is in the works. The other Petty asked the question “Can you see Petty said he wasn’t panicking at all Petty said he would be ready and Lindgren and dispatcher Adam Sevelowitz remembers the room two dispatchers in the room at the any part of the baby now?” When Frank during the call and shrugs off any notion willing to field a similar call in the Sevelowitz looked at each other. returning to normal after the scare. time—Jen Pratt and Martin Rinko— responded that he could see the head, Pet- of being heroic. In fact, he praised Frank future, should the occasion arise. He’s “I heard Melissa say ‘are you “The mood in the room lightened up a continued manning the phones and ty knew his training and ability to follow for his composure. grateful for the protocols and couldn’t choking,’ and I saw Tom standing up bit after we realized he was OK,” he said. radios while Lindgren and Sevelowitz the protocols would be put to the test. “I had the easy job; I just read what was imagine trying to do this challenging hitting his chest,” Sevelowitz said. “All “We went back to work.” helped Kenney. “I knew this baby was coming,” on my computer screen,” Petty said. “The job without them. of the sudden he gave the universal Kenney had been at the center for one Litchfield County Dispatch uses the he said. “I concentrated on giving the dad was calm during the entire call. He “I wouldn’t even want to consider do- sign for choking.” month at the time, coming from another Priority Dispatch System™ protocols instructions.” should be getting all the credit for this. I ing this without the protocols,” he said.  Sevelowitz jumped up to perform center nearby where he had worked for (medical, fire, and police). The center Petty went through Protocol F: Child- wish all callers were that calm. If you had the Heimlich maneuver to dislodge the five years as a dispatcher. Sevelowitz has dispatches for a population of 96,615 birth – Delivery, and within minutes, a prototype caller, it would be him.” persistent pretzel. Lindgren grabbed the been with Litchfield County Dispatch people, 33 fire services, 18 ambulance Frank excitedly reported “It’s coming Each year, Columbia County 911 AED while Sevelowitz performed the for four years, having worked a total of services, 3 paramedic services, and 1 out right now! I got it! I got it!” Petty takes about 35 calls involving pregnancy Heimlich, just in case things took a more seven years as a dispatcher after beginning police department.  instructed Frank to make sure the baby and childbirth. Most, however, result in serious turn. a career in public safety as an EMT. was breathing, to which Frank replied in normal hospital deliveries.

52 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 53  FAST FACTS | hands-only cpr RETRO SPACE •• •

ZENITH MEANT HIGHWAY EMERGENCY Long before 9-1-1, Zenith summoned assistance

HANDS-ONLY Audrey Fraizer CPRCPR as there ever a time callers did anything, in short, that spelled high- hazards caused 62 percent of all Wnot punch in the numbers re- way E-M-E-R-G-E-N-C-Y. traffic accidents in the state and served for an emergency to complain Apparently, not everyone spelled accounted for 105,437 violations in about parking tickets, request help in the word the same way. 1954, prompting the Zenith 1-2000 This June, in honor of National CPR Week, the American Heart Association is calling on all Americans to learn finding a stray cat, or to report a pizza A male caller in San Francisco emergency phone number. how to give Hands-Only™ CPR by watching a simple one-minute video at heart.org/cpr. Once you have delivered to the wrong address? asked for Zenith 1-2000 for a forecast As direct-dial toll-free service learned CPR, give 5 people you care about the power to save lives by equipping them to act quickly in crisis. Well, in 1955—the little-known of road and weather conditions in declined in cost, the once-popular Ze- debut of emergency calltaking—the Kansas City, Mo. A female caller nith toll-free numbers nearly disap- California Highway Patrol (CHP) dis- residing in Concord, Calif., alerted 383,000 covered that such a number meant CHP to the dead dog on her doorstep. out-of-hospital sudden cardiac arrests occur annually many things to many people, and not Another male caller told the oper- 88% always what had been intended. ator he had a dispute over a recent of cardiac arrests occur at home The result? parking ticket. >8% A dilemma common through the CHP Commissioner B.R. Caldwell of people who suffer cardiac arrest outside the hospital survive ensuing decades: delays in reporting was gracious in reminding the public 32% and responding to situations of real of the number’s true intent. CHP was of cardiac arrest victims get CPR from a bystander danger and importance. happy to help people with problems x 2 or 3 According to the Bakersfield Cal- unrelated to the highway system, but Effective bystander CPR provided immediately after sudden ifornian (March 15, 1955), the trouble don’t use Zenith 1-2000 to report cardiac arrest can double or triple a victim’s chance of survival began in February 1954 when the them. CHP’s local numbers, listed highway patrol announced Zenith in the telephone directory, were the 1-2000 (931-2000) as the unique numbers to report incidents unre- number to speed the reporting of lated to emergencies on highways in 424,000 people, each year, experience non-traumatic out-of-hospital accidents and other emergencies unincorporated California. cardiac arrest (OHCA) assessed by EMS personnel anywhere on stretches of highway in The reason is simple, Caldwell California’s unincorporated areas. explained. 60% A Zenith number was a toll- A story in the same edition of the of OHCA victims are treated by EMS free number introduced in the U.S. Bakersfield Californian explains, “A during the 1950s. The calling party person calling Zenith 1-2000 will be 25% of OHCA victims treated by EMS have no symptoms would simply specify “Zenith” and connected directly to the one of the before the onset of arrest the operator knew not to authorize patrol’s emergency radio dispatch charges. The letter “Z” and “Operator” stations. These stations were set up to peared. Telephone companies in most 23% were co-located on a rotary phone. handle emergencies. If the telephone service areas have stopped assigning of EMS-treated OHCA cases have an initial rhythm of ventricular fibrillation (VF) or ventricular tachycardia (VT). As such, they If a motorist made an error when re- lines are tied up by routine calls, it new Zenith numbers, although the could respond well to treatment with an automated external porting an emergency, the first twist could mean a delay in sending help to exchange is credited as the catalyst to defibrillator (AED) of the rotary dial summoned the a bad accident.” the universal emergency number 9-1- operator. The operator didn’t need Poor driving behaviors, however, 1 used throughout the U.S., which, to check to see if the charges were were game in choosing the number like its predecessor, experiences a authorized—they always were. to dial, according to Caldwell. CHP high volume of non-emergency calls. Motorists using the “Z” number officers were particularly on the Although the number might no

Coronary heart disease accounts for about 550,000 of the 927,000 adults who die as a were urged to ask the operator for lookout for potentially hazardous vi- longer exist in California highway result of cardiovascular disease that number to pass along word of a olations, such as speeding or moving reporting, the name Zenith has not bad accident, obstacles and damages too fast for conditions, failing to yield been lost to state history. Zenith 1200 potentially jeopardizing travel, and the right of way, turning improperly, is the official name of CHP’s maga- other hazardous conditions. or driving while intoxicated. zine that in 2014 celebrated 60 years Zenith 1-2000 was reserved for These four types of traffic of continuous publication. 

54 THE JOURNAL | iaedjournal.org may/jun 2015 | THE JOURNAL 55 Two weeks that will change your life...

...and unleash your inner superhero.

THE COMMUNICATION CENTER MANAGER COURSE ONLINE SESSION BEGINS: Aug. 24, 2015 ON-SITE: Sept. 20-25 & Nov. 8-13, 2015

“CCM was life-changing. I learned a lot and developed solid relationships with people I might never have known.”

— Michel Gravel New Brunswick EMS Moncton, NB, Canada

Request for Inventory Bar Code

Full Item Description: Journal May June 2015

Category: PUB Presented by: Online registration for the 2015 course is now open. PDC (D) / IAED (I) / PSI (S) / REGENT (R) / BOTH (B) / FIRE (F) / POLICE (P) / MEDICAL (M) /AQUA (AQA) / EDQ / ANNALS (ANLS) / PROQA (PQA) Fitch & Associates GoDiscipline: to www.emergencydispatch.org/certccmcourse/ New Discipline ______on behalf of IAED™ or call SharonIAED Conroy at (816) 431-2600 Language: for NAE more course curriculum and

Simplified Item Description: JRNL registration information.

Reverse Date (assigned by Erin): MJ2015 NENA has approved this course as credit toward recertification Inflow Code: I-NAE-JRNL-MJ2015 ™ for the Emergency Number International Academies of Emergency Dispatch Professional designation.

56 THE JOURNAL | iaedjournal.org BARCODE IMAGE: *I-NAE-JRNL-MJ2015* I-NAE-JRNL-MJ2015