Swine Flu. NEVER ROUTINE. Baby does it. CDE introduces PAIs deliver when newest protocol No call is ever run of the mill nature hastens The National Academies of Emergency Dispatch May/June 2009 THEJOURNALJOURNAL OF EMERGENCY DISPATCH

NavigatorNavigator Bringing people together

THE JOURNAL | May/June 2009 1 Your newest trauma tool isn’t in here.

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Get a free copy of the Field Triage Decision Scheme: The NaƟonal Trauma Triage Protocol, the MMWR and other free resources at www.cdc.gov/FieldTriage INSIDETHEJOURNAL May/June 2009 | vol. 11 no. 3

4 | President’s Message 5 | Ask Doc 6 | Dear Reader 7 | In Memoriam 50 | Last Page First 51 | Contributors

18 | feature 30 years. From its beginnings in Utah, protocol 22 | feature continues march around Navigator. Join the dispatch community the world in celebrating a profession and its protocol through coverage of our annual conference, 32| feature this year held in Las Vegas. Legislation. Lack of regulations puts dispatch in vulnerable position Departments

OnTrack IndustryInsider Ruptured cord adds alarm to already anxious situation 8 | Medical CDE. Response 39 | In The News. Baby times two plus to epidemic takes advance accidental choking make planning YourSpace day to remember 12| All Protocol CDE. It’s all 44 | Stork Stories. Man follows dispatcher’s about being a professional Baby’s fi rst cry was instructions to the letter welcome music following car birth BestPractices Persistence moves caller 48 | Dispatch In Action. 16 | Quality Assurance. An from fear to confi dence CPR instructions puts breath emergency is never routine Emergency responders wait back into baby for person making the call in silent anticipation 17 | Frequently Asked Mom’s hand at solitaire Questions. fails to postpone baby

The following U.S. patents may apply to portions of the MPDS depicted in this book: 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; 7,428,301. FPDS and PPDS patents pending. Protocol-related terminology in this text is additionally copyrighted within each of the NAED’s discipline-specifi c 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.

THE JOURNAL | May/June 2009 3 J PRESIDENT’SMESSAGE Missing Bill. Making the best out of trying situations is something we all can do

to answer the anticipated business call from never know what the next call will bring or Scott Freitag, NAED President Hong Kong. Once I realized Bill wasn’t get- the emotional state of the person making ting out of the hole, that he was going to the call. The job not only requires the ability stay put in the muddy creek for the dura- to help someone through a crisis but, also, I told a story about Bill Boehly at the tion of that call, I drove over in the golf cart the empathy and expressive control to take Navigator conference, one of a million that and handed him a jacket. He finished his the distressed caller from a reactive to a pro- could be told to show the type of guy he phone conversation buoyed by mud. active response. Once help arrives, and the was. As those who knew him will agree, I told this story during the closing lun- dispatcher disconnects from a particularly there wasn’t much that could spoil his cheon held on the last day of Navigator as a tough call, the only relief may be the sort of good nature, not even landing nearly up to tribute to our good friend. Bill died in Feb- graveyard humor seen in high stress jobs. It’s his chest in mud while attempting his fi nal ruary 2009, several months after he was a way of protecting us from the horror or shot for the 18th hole during a raging North diagnosed with pancreatic cancer, leaving a tragedy we’ve witnessed in our heads from Carolina thunderstorm. tremendous personal and professional void. the situation described over the phone. That’s exactly what happened to Bill. The story exemplifi es his character, sense of Then there are the calls from people Bill and I were away from Salt Lake City humor, and dedication to Priority Dispatch abusing the system who knowingly make on NAED business and went golfi ng during Corp.™ and the NAED®. Even those in the outrageous calls that consequently jeopar- a free afternoon. A storm blew in but we audience who never met Bill laughed at the dize the lives of others. Others may ask silly decided to stay since this was the last hole story. He probably would have joined in. questions or demand police on the scene in our game. Bill takes a swing and the ball The stories told at Navigator are more to resolve a situation frustrating the caller. lands near the green on the other side of than fi llers, or ways to pass the time while Who hasn’t picked up a call from a driver a creek from where he stood. He was in a waiting for the technical details to catch who’s angry that another car cut in front at a fast-food drive-thru, or something similar? The absurdity makes us laugh while, at the same time, it adds to the day’s pressures, especially when police are sent to make sure there isn’t some type of emergency happen- ing. Each time it happens, those calls keep offi cers from keeping the rest of us safe. Navigator gives us the opportunity to share these experiences. Time and time again people tell me how important it is to hear stories about calls similar to the ones they receive. The same goes for issues inter- nal to the communications center or the “bad” press that might develop following an often sensationalized media investiga- tion of 9-1-1 calls. Navigator lets us know we’re in this together and, also, gives us the rare occasion to acknowledge our collective efforts. We leave re-energized and ready to Fearsome Foursome. Jon Stones, Adam Hinckley, and Ken Winward fl ank Bill Boehly during a local golf tournament. approach our jobs head on. This year’s Navigator was no different hurry, expecting a phone call, so he decides up with the intended program. Every- and, for some, the conference was especially to jump the creek rather than wait for me one attending Navigator is in some way inspiring because of the celebration of the to arrive in the golf cart. Well, as much as attached to an emergency communica- 30th anniversary of protocol. The only part we loved Bill, let’s be honest; Bill was not tions center. We may not share the exact missing was Bill. He could have told the built to jump. He could golf, but he wasn’t same sense of humor, but we do belong to golfi ng story much better, if he would have much good when it came to self fl ight. He a profession that demands we have one. told it at all. Outside his own family, this slammed feet fi rst into the mud. We’ve learned how to make the best out community was his life. Not even a plunge What did Bill do? He laughed, even of trying situations. into a muddy creek could keep him from while fi shing his cell phone out of a pocket It’s not easy being a 9-1-1 dispatcher. We making the best of a situation. J

4 THE JOURNAL | emergencydispatch.org J ASKDOC Swine Flu. Taking the pandemic by surprise

standing Chemical, Biological, Radiological, from NENA also in Las Vegas, they joined Jeff Clawson, M.D. and Nuclear (CBRN) Fast Track Commit- in the effort to post the links on their sites, tee that constantly monitors the Centers as did the CDC and others. The National for Disease Control and Prevention (CDC), Metropolitan Medical Directors consortium The National Academies of Emergency the World Health Organization (WHO), was also notifi ed on the afternoon of April Dispatch® (NAED) has received a fl ood of Health Canada, U.K. National Health Ser- 29 of the upcoming posts. Notification of letters and phone calls about the appropri- vice (NHS), the Australian Government all e-mail registered MPDS agencies, and the ate use of Protocol 36 Pandemic Flu and Department of Health and Ageing, and reaching out to even non-MPDS users, was the rapidity in which the Protocol and other sites for emerging trends and possible accomplished. All were notifi ed to check the technical documents relating to its appli- symptoms of new threats. We keep a close NAED website daily for updated materials. cation were released simultaneously to watch on these worldwide health trends The Academy has so far received stellar the reported outbreak and word of a pos- and plan accordingly. In the case of swine acknowledgment from many communica- sible pandemic. The following information fl u, the determination that a pandemic was tions centers, EMS organizations, and gov- should answer your questions. nearing was becoming apparent on about ernment offi cials, and numerous thank you The first question—proper use—is the weekend of April 25. letters for its pre-planning and the success- answered on our website. By going to We were nearly ready. ful cranking out of all finished materials http://www.emergencydispatch.org/, you Earlier last year, anticipating a poten- within 48 hours, as well as having a system can download the information. The site tial avian flu outbreak in the coming fall, in place to update and disseminate them includes a “Clarification” document that the NAED had begun work on several immediately. Had the NAED not set up a explains the differences between the Severe items for both ProQA® and cardset users. CBRN Fast Track Committee at Navigator Respiratory Infection (SRI) surveillance and When the swine flu hit, the CBRN Fast in 2003 and accomplished further protocol symptom identifi cation tool and Protocol 36; the information also clarifi es when to use them. Any emergency communication NAED’s proactive center, whether Medical Priority Dispatch System® (MPDS) user or not, can use the stance put printed tools under a special limited use license contained within them. However, swine fl u they cannot be incorporated into any 3rd party products or CADs, modifi ed in any response ahead way, or re-distributed for any other uses. The second question—our quick of the curve. response—takes some explanation. Those familiar with the Academy and its annual Track Committee conferenced on Mon- creation system in 2008, there would not Navigator conference held in late April day, April 27, and formally requested an have been any materials at all. When the have been particularly interested in the immediate release of all materials relevant chips were down, no other 9-1-1 related speed of our posting considering most of to the situation with modifi cations specifi c group came up with anything remotely the staff’s remote presence in Las Vegas to swine fl u. Since the materials were not like the full suite of materials posted by the for the conference during the height of due to be fully completed until this sum- NAED—and in 48 hours from CBRN alert the swine fl u spread from Mexico to other mer, 20 Academy and Priority Dispatch to completely mobilize. parts of the world; fi rst in the United States. Corp.™ (PDC) experts met later that same I am exceedingly proud of the hard With virtually the entire NAED staff and day in Las Vegas and conferenced with the work provided by the many people who key personnel (including IT, software, remaining writing, logic, programming, and helped with what turned out to be a nearly logic, website developers, Standards and translation staff in Salt Lake City. superhuman, but not totally unpredictable, Academics, and some translators) already Beyond all predicted likelihood, the international effort. at or in transit to the Navigator conference, materials—SRI responder information, sur- For future reference, the Academy regu- the timing could not have been worse. veillance adjustments, and response modi- larly posts important bulletins and updates How did the Academy accomplish the fication software—were finalized, tested, on the home page of its website. This site seemingly impossible? translated into fi ve languages, and posted on is an important and commonly traversed The simple reason boils down to our both the NAED and PDC websites within vehicle for the release of emerging, vital proactive agenda. The Academy has a 48 hours. With key management people information. Please check it regularly. J

THE JOURNAL | May/June 2009 5 J DEARREADER THEJOURNAL OF EMERGENCY DISPATCH

Timing isn’t NATIONAL NAED JOURNAL STAFF ACADEMIES OF COMMUNICATIONS/CREATIVE DIRECTOR everything EMERGENCY DISPATCH Kris Christensen Berg 139 East South Temple, Suite 200 MANAGING EDITOR Salt Lake City, UT 84111 USA Audrey Fraizer USA/Canada toll-free (800) 960-6236 Int’l/Local: (801) 359-6916 TECHNICAL EDITOR Fax: (801) 359-0996 Brett A. Patterson www.emergencydispatch.org ASSISTANT EDITORS [email protected] Heather Darata Cynthia Harmon Audrey Fraizer, Managing Editor Benjamin H. Rose INTERNATIONAL GRAPHIC DESIGNER ACADEMIES OF Jess Cook EMERGENCY DISPATCH Marialice Jones AUSTRALASIA OFFICE Mishael Ulibarri Lee Workman The tabletop Tomy Atomic rightly infl uence marketability, 011-61-3-9806-1772 GERMAN OFFICE WEB DESIGNER Arcade Pinball game featured but there’s also the whim of 011-43-5337-66248 Erwin Bernales ITALIAN OFFICE bells, power bumpers, and auto- consumers. What was it about 011-39-011-513-2588 matic scoring against a back- a soft sculpture doll that caused CANADA OFFICE ACADEMY STAFF ground of mushroom-shaped department store skirmishes 1-514-910-1301 U.K./EUROPE OFFICE PRESIDENT clouds. Manufactured in 1979, among parents of toddler girls? 011-44-0-117-934-9732 Scott Freitag ASSOCIATE DIRECTORS-USA it’s no telling how well this game Why were baby boomers intent Carlynn Page sold considering the accident at on proving they could remember BOARDS & COUNCILS Ross Rutschman ACCREDITATION BOARD CHAIR ASSOCIATE DIRECTOR-U.K. the Three Mile Island nuclear things that really didn’t matter? Brian Dale Beverley Logan ALLIANCE BOARD CHAIR ASSOCIATE DIRECTOR-AUSTRALASIA power plant near Middletown, The year 1979 also marks Keith Griffi ths Peter Hamilton Pa., in March of that same year. the beginning of something big CERTIFICATION BOARD CHAIR ACADEMICS & STANDARDS ASSOCIATE The meltdown propelled The in the world of EMS. As we’ve Jeff Clawson, MD Brett A. Patterson CURRICULUM COUNCIL CHAIRS DIRECTOR OF CURRICULUM DESIGNER China Syndrome into a block- chronicled over the past sev- Vicki Maguire (Medical/EMD Board) Larry E. Latimer, M. Ed. Mike Thompson (Fire/EFD Board) Bill Kinch (Police/EPD Board) INTERNATIONAL LIAISON buster film among a nuclear eral issues of The Journal and Tudy Benson Susi Marsan (ETC) energy apprehensive public, celebrated at Navigator, this RESEARCH COUNCIL CHAIRS MEMBERSHIP SERVICES MANAGER Arabella VanBeuge Brett A. Patterson, Medical/EMD although quite by coincidence year—1979—heralds the intro- Mike Thompson, Fire/EFD since its release date was but 12 duction of emergency dispatch STANDARDS COUNCIL CHAIRS Marie Leroux, Vicki Maguire (Medical/EMD) days before the disaster. protocol. The medical protocol Gary Galasso (Fire/EFD) During the same year, 1979, was not the immediate success Eric Parry, Jaci Fox (Police/EPD) two toys landed on the positive of the Cabbage Patch; no one COLLEGE OF FELLOWS Thera Bradshaw (CA) (Emeritus) side of success. In September was ducking fi sticuffs over the Geoff Cady (CA) CHAIR Steven M. Carlo (NY) 1979, two 30-year-old Cana- purchase of medical cardsets. Marc Gay Jeff Clawson, MD (UT) AUSTRALASIA/SOUTH AMERICA Phil Coco (CT) dians came up with an idea for In comparison to the reach Frank Archer, MD (Australia) Rex Comerford (IL) Andrew K. Bacon, MD (Australia) Brian Dale (UT) a game testing our knowledge of Trivial Pursuit, however, Peter Lockie (New Zealand) Chip Darius, MA (CT) Silvio Najt, MD (Argentina) Kate Dernocoeur (MI) of fairly inconsequential stuff. protocol has probably already Peter Pilon (Australia) Norm Dinerman, MD (ME) Patricia J. Dukes, MICT (HI) Trivial Pursuit sold 45 million exceeded the 45 million copies CANADA James V. Dunford, MD (CA) Drew Burgwin (Br. Columbia) Marc Eckstein, MD (CA) copies worldwide in its fi rst fi ve sold, at least in the number of Nicole Cimon, MD (Québec) Gary Galasso (CA) Claude Desrosiers (Québec) Keith Griffi ths (CA) years of sales. At about the same people benefi ting from the cen- Marty Friedberg, MD (Ontario) Jeffrey R. Grunow, MSN (UT) Marie Leroux, RN (Québec) Ed Jetter (OH) time, Babyland General Hospital ters using the system. Paul Morck (Alberta) Alexander Kuehl, MD, MPH (NY)(Emeritus) Wayne Smith, MD (Québec) Jim Lake (MA) in Cleveland, Ga., began produc- Of course, any anniversary Jim Lanier (FL) EUROPE Bill Leonard (AZ) ing a line of dolls, each slightly begs the question of where André Baumann (Germany) Stephen L’Heureux (NH) Gianluca Ghiselli, MD (Italy) Vicki A. Maguire (MI) different from the next. The things you’re celebrating will Bernhard Segall, MD (Austria) Sheila Malone (IN) Gernot Vergeiner (Austria) Susi Marsan (GA) Cabbage Patch doll was almost be in the next same number UNITED KINGDOM/IRELAND Robert L. Martin (DC) Trevor Baldwin (England) Dave Massengale (CA) an immediate hit, so much so of years. Unlike dolls push- Chris Carney, MD (England) Jim Meeks, PA-C (UT) Michael Delaney (Ireland) Shawna Mistretta (CO) that the large-headed doll made ing parents over the edge and Louise Ganley (England) Gene Moffi tt (UT) Chris Hartley-Sharpe (England) Jerry L. Overton (VA) headlines in Newsweek and The questions leading baby boom- Andy Heward (England) James O. Page, JD (Emeritus,1936–2004) Stuart Ide (England) Rick W. Patrick (PA) Wall Street Journal. For rea- ers down memory lane, you can Peter Keating (Ireland) Brett A. Patterson (FL) Ray Lunt (England) Paul E. Pepe, MD, MPH (TX) sons known only to advertising bet protocol will continue far Andy Newton (England) (Emeritus) Mikel A. Rothenberg, MD (OH) (1954–2006) Gwyn Pritchard (Wales) (Emeritus) Ross Rutschman (OR) (Emeritus) genius, both the game and doll into the future no matter the John D. Scott, MD (England) Doug Smith-Lee (WA) Janette K. Turner (England) Paul Stiegler, MD (WI) rode skyrockets to fame rivaled coincidence of world events or Fred Thorp, MPA (KS) UNITED STATES Carl C. Van Cott (NC) only by all-time best sellers like the mood of an often-capricious Bill Auchterlonie (KS) Sheila Q. Wheeler, MSN (CA) Bob Bass, MD (MD) Arthur H. Yancey, II, MD, MPH (GA) Monopoly and Barbie dolls. public. After all, wouldn’t you Christopher W. Bradford (FL) Tina Young (CO)

In most cases, it’s hard to tell rather be clutching a phone con- The National Journal of Emergency Dispatch is the offi cial bimonthly publication of the National Academies of Emer- gency Dispatch (NAED), a non-profi t, standard-setting organization promoting safe and effective emergency dispatch what will take off and what will nected to an emergency center services worldwide. Comprised of three allied academies for medical, fi re, and police dispatching, the NAED supports fi rst-responder-related research, unifi ed protocol application, legislation for emergency call-center regulation, and strength- land on the bargain basement using protocol than a vintage ening the emergency dispatch community through education, certifi cation, and accreditation. General NAED membership, which includes a Journal subscription, is available for $19 annually, $35 for two years, shelves. Not only do catastro- Cabbage Patch in your time of or $49 for three years. Non-member subscriptions are available for $25 annually. By meeting certain requirements, certi- J fi ed membership is provided for qualifi ed individual applicants. Accredited Center of Excellence status is also available phes like a nuclear meltdown disaster? I know I would. to dispatch agencies that comply with academy standards. © 2009 NAED. All rights reserved.

6 THE JOURNAL | emergencydispatch.org Dr. Jeff Clawson isn’t exaggerating when The hair he did yank came out in clumps from his position as Director of Contracts he mentions National Academies of Emer- he laid on an open paper napkin. He had and Legal at Priority Dispatch Corp., and gency Dispatch® (NAED) co-founder Bill planned it that way, knowing the rest would he and Bonnie traveled extensively around Lloyd in the same breath as the existence of go that evening when his six grandchildren the world. They took their children, two at the fi re, police, and medical protocols. took turns at shaving his head bald. Some a time, to Paris, condensing days of sightsee- “We wouldn’t be where we are today, might say his action at the meeting was his ing into long jogs around his favorite city to much less be here, if it wasn’t for Bill,” Dr. way of bullying death. But it was more than point out the places he found remarkable. Clawson said during his remarks at the Nav- that, Bonnie said. When the cancer went into remission, igator 2009 closing luncheon. family and friends gave a shout, The Medical Priority Dis- declaring him a conqueror. patch System® (MPDS) meant Life to the Fullest. His optimism, combined with much more than a place to intensive medical treatment, invest the capital Bill earned Bill Lloyd walked a line had cheated death in a fashion during his lucrative career in similar to his full recovery from commercial and residential honorable to his beliefs a serious car accident occurring real estate. He was 100 percent years earlier while a senior in behind the doctor’s vision. high school. “It was more than a finan- But the cancer did not stay cial investment,” said Yvonne in remission. “Bonnie” Lloyd, who celebrated One year later, the monster their last wedding anniversary returned. Bill began a series of together in March 2009. “He operations and treatments to wanted something that had remove and shrink the tumors. meaning, something that would In true Bill style, he used the be of service to other people.” power of positive thinking; he Bill was that way in all he wanted to face the disease head did, even in the way he lived for on in his own terms through eight more years—seven longer research and prayer. than the prognosis given at the When the chemotherapy was time he was diagnosed with a no longer effective, he decided malignant sarcoma. He died to build up his immune system April 26, 2009, at his Salt Lake with an intake of essential vita- City home from complications mins, minerals, and enzymes of the disease. (238/day). He ate fresh fruits “His was a death much like and vegetables and plenty of red his life, very sweet,” Bonnie meat. He drank gallons of juice. said. “That may sound odd, Bill died, knowing he had unless you knew Bill. He loved fought death as honorably as he life. To him, life was one grand had lived life. adventure after another.” Bonnie said the last eight Those traits about Bill— years of their life brought an curiosity and optimism—help intense closeness to a relation- explain the Halloween costume 1941–2009 ship sparked from a distance he designed to look like a tumor during a junior high school and the Mr. Clean look he created after che- “He never complained,” she said. “He assembly and guided by their faith. motherapy robbed him of his full head of protected loved ones from witnessing his During his final days, they read the hair. They also explain the aggravation he suffering with humor. He wanted to make sweetheart letters written back and forth feigned months into chemotherapy during sure people would approach him, not wor- years ago, before their marriage, while he an NAED offi ce meeting. ried about what to say. His cancer was not was serving a mission for his church and “No one had ever seen Bill lose his tem- his private battle.” through his second year as a student of per,” said Priority Dispatch Corp.™ (PDC) The diagnosis ignited a zest intensi- architecture at Harvard College in Cam- Director of European Operations Tudy fied by the uncertainty of time. A patriot bridge, Mass. They married in 1966. She Benson, who developed a close friendship President Thomas Jefferson would envy, never lost track of the letters, despite sev- with Bill during the years they shared an Bill gathered his family—six children and eral moves related to his career. offi ce wall at the NAED. “But there he was, a growing number of grandchildren—for “He was a good man who wanted noth- standing up at a meeting, threatening to pull flag raising ceremonies on the Fourth of ing more than to make the world a better out his hair from his frustration at the rest July, resplendent with songs and speeches. place,” Bonnie said. “He did that. He lived of us sitting around the table.” Bill retired full time from the NAED and life to the fullest.” J

THE JOURNAL | May/June 2009 7 J MEDICAL CDE J ALL PROTOCOL CDE OnTrack • When the public health authority (or head of government) in your district, state, province, region, or county has offi cially declared a pandemic fl u outbreak/emergency. • When the EMS authority, system medical director, and the emergency communications center director have authorized its use. • When a response plan for each of the Protocol 36 Determinant Codes (including the suffi x codes) has been pre-approved by the EMS authority and the system medical director. Protocol 36 will help manage suspected fl u patientspat in a manner that utilizes scarce EMS, hospital,hos and community health care resources effectivelyeffe and effi ciently during a declared pandemic.pan Correctly routing flu patients at the fi rst point of contact with the EMS system (911,(91 999, 000, 112, etc.) will be critical in an emergingem outbreak environment.

Surveillance (done prior to Protocol 36 MPDS® v12, NAE-std. © 1979–2009 PDC. implementation) Prior to an offi cially declared pandemic, emergency communications centers may J MEDICALCDE be engaged in flu surveillance activities. The purpose of surveillance is to identify patterns, trends, and geographical clusters Protocol on Alert. Response to of symptoms. Such surveillance may be requested or required by local public health epidemic takes advance planning authorities to try to determine if a fl u out- break is occurring in your region. ProQA To complete this CDE, you will need to access Because Protocol 36 alters the way emer- —the software version of the Medical Pri- the Protocol 36 PDF document on the Academy gency medical dispatch is determined, and ority Dispatch System® (MPDS)—contains website. Go to www.emergencydispatch.org/ changes EMS responses to certain patients, a flu surveillance tool specifically for this flu.php, scroll down to #2, and select the link it must be implemented with a complete purpose: the Severe Respiratory Infection entitled “Protocol 36 - Pandemic Flu.” The PDF understanding of its use and underlying (Swine Flu) Symptoms screen. It is accessed document can then be viewed or downloaded. dispatch objectives. Since Protocol 36 is not by clicking on the “Severe Respiratory Infec- used during normal (non-outbreak) opera- tion (Swine Flu) Symptoms” (V) button on The International Academies of Emer- tions, it requires advanced planning and the ProQA toolbar.. gency Dispatch® (IAED) has developed setup, with “just-in-time” training and ori- This screen—designed and actively Protocol 36: Pandemic Flu (Officially entation for EMDs, as well as EMS admin- updated by the Special CBRN (Chemical, Announced), for managing EMD triage and istrators and responders. Biological, Radiological, Nuclear) FastTrack locally limiting EMS responses in the event Committee within the IAED—provides a of an official pandemic flu outbreak. This Limitations for Protocol 36 use set of possible fl u symptoms that the EMD protocol exists in both card format and in Protocol 36 is to be used under the fol- can record for patients suspected of having the computerized ProQA® program. lowing circumstances only: the fl u.

8 THE JOURNAL | emergencydispatch.org Since specific symptoms may change tion during an escalating crisis. Protocol lems, emphysema, stroke, etc. When no as a particular outbreak spreads and more 36 contains several OMEGA codes. Cases additional flu symptoms are identified in information is known about the disease, the assigned an OMEGA code allow for (but the Key Questions, the EMD must shunt IAED may rapidly update this screen based do not require) a non-ambulance referral or to the correct Chief Complaint protocol on information from various public health resource assignment. using the original complaint description organizations such as the Centers for Dis- given (i.e., Chest Pain, Breathing Problems, ease Control and Prevention (CDC), Health Selection of Protocol 36 Headache, Sick Person) so these conditions Canada, United Kingdom National Health Rule 1 means: During an outbreak, Pro- can be properly prioritized and treated. Service (NHS), Australian Department of tocol 36 will sort out suspected fl u patients Rule 4 means: Sometimes patients will Health and Ageing, and World Health Orga- from those who have other non-fl u related take anti-infl ammatory drugs such as aspi- nization (WHO). Updates will be posted conditions such as emphysema, asthma, rin, acetaminophen, ibuprofen, etc., to on the ProQA ftp (file transfer protocol) congestive heart failure, heart attack, stroke, relieve fl u symptoms. If the patient reports website for rapid download availability to etc. Therefore, after a pandemic is offi cially that he/she had a recent fever that was all ProQA users with a current compatible announced, the EMD must always select relieved by such a drug, it is still impor- software version. Protocol 36 when any of the complaints tant to record the existence of the fever Expert data-mining software (such as listed in Rule 1 are present. Cases not exhib- (at the time the drug was taken). Always FirstWatch™) can track special ProQA data iting any fl u symptoms will be shunted to the answer the fever question “yes” when the in near real-time to detect potential out- correct Chief Complaint through the MPDS caller reports a recent fever relieved by breaks within specific geographic regions interrogation process and assigned a Deter- medication. so emerging patterns and subsequent alerts minant Code consistent with the patient’s Protocol 36 can only work effectively can be made to the proper public health and condition (e.g., 6-C-1, 10-D-1, etc.). with precise and complete information; 100 governmental authorities. Rule 2 means: A patient with the fl u will percent compliance to the Case Entry and It is important to note that such surveil- almost always have at least one of the flu Key Question protocols is imperative in lance activity is done in advance of an offi - symptoms defi ned on this protocol. Dur- arriving at the correct Determinant Code and cially announced outbreak—and does not ing a declared outbreak, one fl u symptom response. Cutting corners to save time actu- call for the use of Protocol 36 at that point. present is an indicator the patient is a true ally makes the process less effective and may flu case. With two flu symptoms present, place certain patients at increased risk. Implementing Protocol 36 for a declared the EMD may reasonably conclude that the pandemic patient has the fl u; hence, there is no need Modifi ed responses during a pandemic to continue the remainder of the specific As previously mentioned, EMS Modifi ed triage fl u questions. The EMD will move directly responses during a pandemic may be signifi - Should a full-scale pandemic outbreak to Key Question 11 once two fl u symptoms cantly different (reduced) than those under reach your region, it will rapidly overwhelm have been identifi ed. standard operating conditions. Each agency the capacity of your emergency medi- Rule 3 means: Some patients whose must develop a pre-approved response cal response system. At the height of the Chief Complaint itself is a potential flu for every Protocol 36 Determinant Code pandemic, EMS resources will be severely symptom (due to their description of the (including all suffi xes) based on the current depleted due to extreme call load, overload complaint) will not have the flu. Instead pandemic level. or quarantining of receiving facilities, and a they may have other serious underlying high incidence of EMS workforce illness. conditions such as asthma, heart prob- Protocol 36 provides several options for Hospitals will become full. Flu patients down-scaling the response during an may require special treatment—including a escalating crisis response that is different from a standard Cutting corners mobile EMS response provided under non- Priority levels outbreak conditions. Some patients initially to save time First, the MPDS priority levels in Pro- treated by paramedics or ambulance per- tocol 36 (OMEGA, ALPHA, BRAVO, sonnel may be left at home. Sicker patients actually makes CHARLIE, DELTA) have been adjusted may be transported to designated patient to provide for a more aggressive triage of collection points that will serve as make- the process patients with conditions associated with the shift treatment facilities. Other patients less effective flu. For example, patients with abnormal may be given a limited amount of care over breathing and/or chest pain who also have the phone, with no mobile response from and may fl u symptoms are assigned to a lower prior- EMS units, due to isolation and quarantine ity level than non-fl u patients with diffi culty measures—or simply from complete ambu- place certain breathing and/or chest pain (on other Chief lance system depletion. Complaint Protocols). Protocol 36 will identify potentially patients at An OMEGA-level designation always infected patients and assign a Determinant allows for a non-ambulance response with Code that accounts for both the patient increased risk. the protocol at any time. This may include condition and the degree of system deple- transfer of the caller to a designated clini-

THE JOURNAL | May/June 2009 9 cal adviser, such as a registered nurse or nurse practitioner, who will complete a more detailed assessment of the patient/ caller and advice over the telephone and treatment instructions to the caller. Cer- tain patients may require isolation or quar- antine; this would be determined by the clinical adviser, and the proper home-care or treatment options would be explained to the caller.

Suffi x codes Second, the suffix codes reflect the degree of outbreak severity (and subse- MPDS® v12 in ProQA®, NAE-std. © 1979–2009 PDC. quent resource depletion) your system is experiencing at any given time. with these authorities so that any changes Shown here is a sample case that displays There are three suffi xes used for deter- in severity level are recorded and activated some MPDS determinants in the ProQA minant coding: A, B, and C. accurately within the MPDS. software matched with possible example These suffixes correspond with the ProQA will automatically assign the cor- responses for each of the fl u severity levels announced numeric severity level of the rect suffi x (severity level) to the case once (A, B, C). pandemic outbreak in your system or the EMD enters the current severity level in NOTE: These are only examples. All region. The assigned severity level will the Key Questions. The Key Question will actual responses are locally defi ned. depend on several factors, including: the be displayed as an (blue) operator question lethality of the fl u virus itself, the increase in ProQA (see below). Responder notifi cation of fl u symptoms in EMS calls, the degree of EMS responder The current severity level suffix is and infection control workforce depletion, and the amount of always attached to a Determinant Code so In order to facilitate responders’ correct hospital bed saturation in the local hospitals that a unique and different response can be use of infection control measures, the EMS and emergency departments. assigned for each severity level within that crew dispatched to the scene (when a locally- The EMS agency, in consultation with code. For example, a coding of 36-A-1B may determined EMS response is required) will the system Medical Director or Medical receive a different (reduced) response than be given the Chief Complaint and Deter- Advisory Group and Public Health Author- a 36-A-1A. A coding of 36-C-1C could minant Code during the call notification ity in your region, will determine (and may receive a different (and even more reduced) and unit-dispatch process. It will be at the modify) the pandemic severity level at response than a code of 36-C-1B to refl ect direction of the local medical control author- any time. Note that the severity level may the current, increasing degree of system ity (physician Medical Director or medical change from day to day; therefore, the EMD depletion—and, therefore, diminishing control board) to provide specifi c policies, center must be in regular communication level of actual response.response. prprocedures, and protocols for crew protec- ttionio and infection control during an out- brbreak. The EMD may (at the direction of llocalo medical and 9-1-1 authorities) provide a ddetailed responder script for the respond- ining crews. This responder script will typically ininclude the patient’s age, gender, status of coconsciousness, status of breathing, and Chief CComplaint—including the existence of any fl u symptoms.

This CDE is adapted from the Special Pro- ceduresced Briefi ng, which was designed to give you theth information needed to implement at dispatch, correctlyco triage, and set up potentially decreasing responseres levels to possible flu patients during a declaredde pandemic. The entire Special Procedures BriefiBr ng can be found in PDF format on the Acad- emy’sem website at www.emergencydispatch.org/fl u. php.ph Select “Just in Time Training for Protocol 36: SpecialSp Procedures Briefi ng” under #3. The brief- inging can be used and distributed for training when MPDS® v12 in ProQA®, NAE-std. © 1979–2009 PDC. preparingpr for a pandemic fl u outbreak. J

10 THE JOURNAL | emergencydispatch.org ✄ CDE Quiz Mail-In Answer Sheet CDE-Quiz G Medical Take this quiz for 1.0 CDE unit. Answer the test questions on this form. (A photo- Answers to the CDE quiz are found in the article “Protocol on Alert,” which starts on page 8. copied answer sheet is acceptable, but your answers must be original. Please do not enlarge.) 1. What is the number of the protocol altering EMS responses to certain patients during unusual Within six weeks, you will receive notifi cation of your (outbreak) situations? score and an explanation of any wrong answers. a. Protocol 6 (Breathing Problems) Once processed, a CDE acknowledgement will be b. Protocol 10 (Chest Pain) sent to you. (You must answer 8 of the 10 questions c. Protocol 26 (Sick Person) correctly to receive credit.) d. Protocol 36 (Pandemic Flu) Clip and mail your completed answer sheet along with the $5 processing fee to: 2. ProQA—the software version of the Medical Priority Dispatch System—contains a tool The National Academies of Emergency Dispatch specifi cally for the purpose of fl u surveillance activities. What is the name of this tool? 139 East South Temple, Suite 200 a. Severe Respiratory Infection (Swine Flu) Symptoms screen Salt Lake City, UT 84111 USA b. Altered Level of Consciousness screen (800) 960-6236 US; (801) 359-6916 Intl. c. Diffi culty Speaking Between Breaths screen Attn: CDE Processing d. Special FastTrack to Response screen Please retain your CDE acknowledgement to be submitted to the Academy with your 3. Potential outbreak surveillance activity is done in advance of an offi cially announced outbreak and application when you recertify. does not call for the use of Protocol 36 at that point. a. true Name ______b. false Organization ______4. During a true fl u outbreak, what number of fl u symptoms must be present for the EMD to Address ______reasonably conclude that the patient has the fl u? a. one b. two City______St./Prov. ______c. three d. four Country______ZIP ______5. An OMEGA-level designation always allows for a non-ambulance response that may include tansfer Academy Cert. # ______of the call to a clinical adviser. a. true Daytime Phone ( ) ______b. false E-mail: ______6. What are the three suffi xes used to refl ect the degree of outbreak severity your system is experiencing at any given time? PRIMARY FUNCTION a. X, Y, Z b. 4, 5, 6 ■ Public Safety Dispatcher (check all that apply) c. A, B, C d. 3, 2, 1 _____Medical _____Fire _____Police ■ 7. The current severity level suffi x is always attached to: Paramedic/EMT/Firefi ghter a. Case Entry. ■ Comm. Center Supervisor/Manager b. Post-Arrival Instructions. ■ Training/QI Coordinator c. a Key Question. d. a Determinant Code. ■ Instructor ■ Comm. Center Director/Chief 8. Who has the responsibility of providing specifi c policies, procedures, and protocols for ■ crew protection and infection control during an outbreak? Medical Director a. Dispatcher answering calls during an outbreak ■ Commercial Vendor/Consultant b. News media ■ Other c. Local medical control authority d. Ambulance crew responding to calls ANSWER SHEET G MEDICAL May/June Journal 2009 VOL. 11 NO. 3 (Protocol on Alert) 9. Rule 4 of Protocol 36 means: Please mark your answers in the appropriate box below. a. always answer the fever question “yes” when the caller reports a recent fever relieved by medication. 1. ❏ A ❏ B ❏ C ❏ D b. during an outbreak, Protocol 36 will sort out suspected fl u patients from those who have other non-fl u related conditions. 2. ❏ A ❏ B ❏ C ❏ D c. some patients whose Chief Complaint is a potential fl u symptom ❏ ❏ (due to their description of the complaint) will not have the fl u. 3. A B d. a patient with the fl u will almost always have at least one of the fl u symptoms ❏ ❏ ❏ ❏ defi ned on this protocol. 4. A B C D 5. ❏ A ❏ B 10. ProQA will automatically assign the correct suffi x (severity level) to the case once the EMD enters the current severity level in the Key Questions. 6. ❏ A ❏ B ❏ C ❏ D a. true 7. ❏ A ❏ B ❏ C ❏ D b. false 8. ❏ A ❏ B ❏ C ❏ D ❏ ❏ ❏ ❏ In order to receive credit for this quiz you must be certifi ed in the specifi c discipline it is designated for. To be considered for CDE credit, this 9. A B C D answer sheet must be received no later than 06/30/10. A passing score is worth 1.0 CDE unit toward fulfi llment of the Academy’s CDE requirements (up to 4 hours per year). Please mark your responses on the answer sheet located to the right and mail it in with your processing fee to receive credit. Please retain 10. ❏ A ❏ B Expires 06/30/10 your CDE certifi cate to be submitted to the Academy with your application when you recertify.

THE JOURNAL | May/June 2009 11 J ALLPROTOCOLCDE

Dispatching Ethics in the Real World. It’s all about being a professional

maintained. This aims to protect the pub- ety or group making that definition—in By Malcolm Woollard lic’s interests. Rarely, in order to ensure other words, this may vary according to this, a member of a profession who does the period in history and according to the not meet the required standards may be accepted conduct and expectations of a A professional is defi ned by the Oxford barred from its practice by their peers. A particular culture.5 Therefore, the IAED’s Dictionary as “someone highly skilled.”1 professional (and, indeed, a profession) will Code of Ethics seeks to make these poten- However, whilst this unquestionably always put the public’s interests above his tially hazy areas explicit for dispatchers. describes the abilities of Emergency Dis- or her own and this expectation is made patchers (EDs), being part of a profession explicit for dispatchers in the IAED’s Eth- The Code of Ethics means much more than this. Profession- ics Policy.3 I remember some time ago walking als typically set rules for membership of into a large dispatch center, which I then their group, and these may be codified in Ethics managed, and seeing a calltaker quite liter- the form of standardized pre-entry criteria This has been defined as “the branch ally banging his head on the desk. He was educational programs and examinations. of philosophy that deals with distinc- fl ushed and the veins in his temples were They also establish standards of conduct tions between right and wrong.”4 Whether distended and pulsating. He looked like his for themselves and their peers, and in the something is “right” or “wrong” can also head was about to explode. Keeping a safe case of EDs, these are represented by the be described in terms of its morality and distance (making sure I was out of splatter International Academies of Emergency Dis- principles. Further, to be “ethical” in the range) I asked him what was causing his patch® (IAED) Code of Ethics.2 conduct of a profession, one also has to apparent frustration. It was only when he Perhaps one of the most important display integrity (“honesty” and “sound- put his caller on hold that I realized he was aspects of being a professional is the moral ness”). Exactly what actions are defi ned as processing an emergency call. “I’ve been duty to ensure that high standards of con- right or wrong, or good or bad, can only trying to tell this woman for 20 minutes duct, service delivery, and care are always be answered in the context of the soci- that she doesn’t need an ambulance!” he

12 THE JOURNAL | emergencydispatch.org explained. I explained back (now with the caring for the caller. His attitude was both considerable, additional strain. Doubtless veins in my own temples throbbing) that aggressive and obtrusive. He made it clear the call waiting time increased and callers this misunderstanding on the part of the to the caller that he thought she was stupid experienced longer delays before receiving caller would be best resolved by sending and that she was wasting his time. This is assistance than would have been the case her an ambulance—RIGHT NOW. not a caring approach. Callers are untrained had this EMD acted professionally. I am sure the dispatcher meant well—he in their role; dispatchers are highly trained This EMD, in denying the caller her was trying to protect the precious resources professionals. As such, we must recognize rights and by behaving in an aggressive and of the over-stretched urban ambulance ser- that behavior we may believe is inappro- abusive manner, did not “maintain the high- vice that employed us. Having counted to priate on the part of callers may just rep- est standard of personal practice” nor did he 10 and receiving his side of the story, I con- resent a lack of understanding. Callers and maintain the integrity of the IAED. cluded that this particular ambulance ser- dispatchers will necessarily have different I did, however, ensure that this dis- vice could go on employing us, and that we expectations; it is the dispatcher’s respon- patcher met the requirements of the second could use this as a learning opportunity. sibility as the trained professional, not the item in the Code of Ethics by providing him This dispatcher breached a number of callers, to recognize and cope with this. with a signifi cant opportunity to “improve points from the Code of Ethics. Firstly, he This dispatcher did not, by any stretch his professional knowledge, skill, and wasn’t placing the needs of this particular of the imagination, “establish or maintain an competence.” member of the public above his own. He thought he “needed” to maintain the avail- Putting it into practice ability of ambulances to respond to other So, as a dispatcher (EMD, EFD, or calls. He also “needed” to make it clear to A professional EPD), do you need to memorize the Code the caller that she should not waste his of Ethics and constantly mentally check time. Most of all he “needed” to win the will always that you are in compliance with it? Probably argument he had started with the caller. not. Most dispatchers are naturally ethical The caller thought she needed an ambu- put the public’s and professional in the conduct of their lance. Whether the caller was right or duties. But to be sure, always listen to your wrong about the appropriateness of the call, interests conscience: if it feels wrong, it probably is! the dispatcher was clearly placing his needs above those of the caller. above his or Postscript All experienced dispatchers and The United Kingdom introduced statu- responders can recount hundreds of exam- her own. tory State Registration for its paramedics in ples of calls where their ambulance service 2003. Several of my colleagues have spoken has been “abused.” However, many EMS in distressed terms about the Code of Con- systems throughout the world recognize duct, which every U.K. paramedic will now the difficulties and pitfalls inherent to honorable relationship” with the caller. He be measured against. “But this gives loads “no-send” policies as there are also many displayed little integrity, in that he knew the of protection to the public and little to us!” examples of disaster befalling patients caller was entitled to an emergency ambu- they agonize. Sounds to me like we’re in when an ambulance has been denied. The lance response, but said nothing to indicate danger of becoming a profession. rights and wrongs of no send are beyond the that this was the case. At best, this was dis- scope of this article, but suffi ce it to say the honorable; the less charitable may prefer to References policy of our agency was to always send in describe it as dishonest. 1 Pollard E., Liebeck H. (Eds) The Oxford response to an emergency call. Even more I am also sure that this dispatcher did Paperback Dictionary. Oxford: Oxford signifi cantly, the United Kingdom Depart- nothing to “assist in improving the public University Press, 1994. ment of Health has explicitly stated that understanding of emergency dispatching.” 2 Clawson J.J., Dernocoeur K.B., Rose an ambulance must be sent in response This caller would have been left with the B. Principles of Emergency Medical to every emergency call received. And so impression that the only way to obtain an Dispatch, 4th edition. Salt Lake City: this dispatcher was also in breach of the emergency ambulance was to engage in an Priority Press, 2008, p A.2. third item in the Code of Ethics: he neither unpleasant verbal fencing match with a 3 Clawson J.J., Dernocoeur K.B., Rose obeyed “all laws and regulations” nor did he dispatcher for 20 minutes prior to such a B. Principles of Emergency Medical avoid conduct which would cause (at least request being conceded to. Dispatch, 4th edition. Salt Lake City: potentially) “unjust harm” to the citizen he This dispatcher’s behavior did nothing Priority Press, 2008, p A.2. was serving. (despite his claimed intentions) to “assist 4 Was the EMD being “diligent in the per- in the operation of and enhance the per- Last J.M. A Dictionary of Epidemiology. formance of his occupational duties?” A formance of his dispatch system.” Instead, Oxford: Oxford University Press, 1995. dictionary defi nition of diligence is “putting he took at least 10 times longer than nor- 5 Woollard M. Ethical and Legal Issues, care or effort into what one does.” Judging mal to process one call. During the time he in: Greaves I., Hodgetts T., Porter by the degree of facial fl ushing exhibited by spent on the phone, his colleagues had to K. Emergency Care: a Textbook for this dispatcher he was certainly making an manage an already intense workload with- Paramedics. London: W.B. Saunders, effort, but it could be argued that he was not out his contribution, placing them under 1997. J

THE JOURNAL | May/June 2009 13 ✄ CDE Quiz Mail-In Answer Sheet CDE-Quiz G F ? Take this quiz for 1.0 CDE unit. Answer the test questions on this form. (A photocopied Answers to the CDE quiz are found in the article “Dispatching Ethics,” which starts on page 12. answer sheet is acceptable, but your answers must be original. Please do not enlarge.) 1. Perhaps one of the most important aspects of being a professional is the moral duty to maintain: Within six weeks, you will receive notifi cation of your a. high standards of conduct, service delivery, and care. score and an explanation of any wrong answers. Once b. the right opinion no matter what the customer says. processed, a CDE acknowledgement will be sent to c. upper hand in all communications. you. (You must answer 8 of the 10 questions correctly d. an attitude showing who’s in charge. to receive credit.) Clip and mail your completed answer sheet 2. The primary importance of every emergency call rests upon: along with the $5 processing fee to: a. the availability of ambulances. The National Academies of Emergency Dispatch b. the needs of the caller. 139 East South Temple, Suite 200 c. winning the argument. Salt Lake City, UT 84111 USA d. the amount of time spent with the caller. (800) 960-6236 US; (801) 359-6916 Intl. Attn: CDE Processing 3. The dispatcher must always win “the argument.” Please retain your CDE acknowledgement a. true to be submitted to the Academy with your b. false application when you recertify.

4. The dispatcher’s behavior should assist in the operation of the dispatch system. Name ______a. true Organization ______b. false Address ______5. The customer is rarely right because the professional knows what’s best. a. true City______St./Prov. ______b. false Country______ZIP ______6. The United Kingdom Department of Health has explicitly stated that an ambulance must be sent: Academy Cert. # ______a. in response to every emergency call received. b. when the EMS system decides it’s appropriate. Daytime Phone ( ) ______c. any time the patient demands an ambulance, even if the EMD disagrees. d. depending upon the Chief Complaint and destination. E-mail: ______PRIMARY FUNCTION 7. A no-send ambulance policy represents a best systems approach since such a policy cuts down on costs and saves the vehicles for real emergencies. ■ Public Safety Dispatcher (check all that apply) a. true _____Medical _____Fire _____Police b. false ■ Paramedic/EMT/Firefi ghter

8. Which of the following groups unanimously adopted the Academy’s Code of Ethics? ■ Comm. Center Supervisor/Manager a. Council of Standards ■ Training/QI Coordinator b. Advisory Board ■ Instructor c. College of Fellows d. Emeritus Board ■ Comm. Center Director/Chief ■ Medical Director 9. Another word for ethics is: ■ Commercial Vendor/Consultant a. aptitude. b. diligence. ■ Other c. dishonesty. d. principles. ANSWER SHEET G F ? May/June Journal 2009 VOL. 11 NO. 3 (Dispatching Ethics) Refer to the NAED website for the following question: Please mark your answers in the appropriate box below. 10. A violation of the Academy’s Code of Ethics could result in the suspension or termination of certifi ca- 1. ❏ A ❏ B ❏ C ❏ D tion and recertifi cation. ❏ ❏ ❏ ❏ a. true 2. A B C D b. false 3. ❏ A ❏ B 4. ❏ A ❏ B 5. ❏ A ❏ B 6. ❏ A ❏ B ❏ C ❏ D 7. ❏ A ❏ B 8. ❏ A ❏ B ❏ C ❏ D ❏ ❏ ❏ ❏ In order to receive credit for the quiz you must be certifi ed in any of the three disciplines. To be considered for CDE credit, this answer sheet must 9. A B C D be received no later than 06/30/10. A passing score is worth 1.0 CDE unit toward fulfi llment of the Academy’s CDE requirements (up to 4 hours per year). 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 certifi cate 10. ❏ A ❏ B Expires 06/30/10 to be submitted to the Academy with your application when you recertify.

14 THE JOURNAL | emergencydispatch.org

J QUALITY ASSURANCE J FAQ BestPractices

J QUALITYASSURANCE Taking it Personal. An emergency is never routine for person making the call

pletely alert. . .but he didn’t remember the She was in good hands and had been the By Michael Spath entire protocol (who would in that circum- entire time—from before the 9-1-1 call to stance?!). Thankfully, our EMD was there the operating table. to help him through the situation—and if Thank you all for the service you pro- There are reasons doctors avoid treat- things got worse, she could have told him vide for everyone’s family and friends every ing their own family members: emotions exactly what to do next. day—because it’s always personal for some- can interfere with objectivity; stress affects I’m reminded of that little catch phrase one, even if it’s routine for us. It’s uncom- judgment; and so on. What happens when we use so often: “So, we’re sure to do it right.” fortable to remember that all the time, but one of our own dials 9-1-1? How do we Even if they’ve heard the instructions before, that’s what made this particular 9-1-1 call treat him or her when he or she is the one a little reminder is better than none. With stand out for us. It was from a member of in the emergency situation? Does the pro- emotional stress involved, rational thought our family. It is very, very important to keep tocol still apply? becomes more and more diffi cult. We were in mind that the emergency is personal for I’ve written about making it personal there for one of our own last night. Thank- someone; we are helping someone who without taking it personally. fully, it was not a life or death emergency, but could be any of us someday. We are all Well, recently, things got personal for us it was a call for help—and we were there. members of the same family. at our center in Sunnyvale (Calif.). One of That morning, our senior’s mom went At the same time, it’s also important our senior public safety dispatchers called into surgery. The inflammation on her to occasionally remind ourselves of the 9-1-1 from his mother’s house. His mom abdomen had grown to softball size. Over extraordinary job we do and the excellent was suffering from severe abdominal pain the course of the night, while doctors sta- service we provide every day. We are there and she had a large mass swelling at the site bilized her condition, the infl ammation had when someone we know—or don’t know— of a recent injection. grown three times larger. She was apparently needs us the most. Compliance to the protocol can feel bleeding from the internal side of her recent Thank you. very awkward when it’s one of our own on injection. They would be going in to remove Michael Spath, ED-Q Instructor the other end of the line. Gathering infor- the pooled blood, wash away any clots, and Administrative Senior Public Safety mation from a stressed out responder or try to repair whatever was bleeding. Dispatcher, Sunnyvale DPS J dispatcher at the scene can be very diffi cult. The emotional detachment we usually carry can become uncomfortable; fortunately, the protocol helps us keep an emotional distance while, at the same time, showing our compassion in gathering the informa- tion necessary at a critical time of need. In our case, the EMD who had taken the call said, “I feel weird having to ask you all these questions.” Our senior’s response, in the face of a very scary situation, was inspiring. “That’s OK,” he said. “Without the questions I wouldn’t remember what I need to.” Throughout the call, he did remember a lot of the information we needed, vol- unteering conscious, breathing, and com-

16 THE JOURNAL | emergencydispatch.org J FREQUENTLYASKEDQUESTIONS What Difference Does it Make? The reasoning behind certifi cation requirements

Brett: with the public. The cost of certifi cation and of week. This study, in a suburban setting, I am a dispatcher for a large metro emer- 24 hours of CDE every two years is relatively showed an average 42 second difference. gency communications center that recently low compared to other costs associated with When discussing this issue with Dr. John introduced MPDS®. The protocol makes communications center operations. As Dr. Marler, associate director, Clinical Trials, sense to me and I believe it will help us bet- Clawson has been known to state, “The cost National Institute of Neurological Disor- ter serve the public. My issue is certifica- of EMD training is often less than the cost ders and Stroke (NINDS), he suggested tion. Several of the dispatchers, including of the chair the EMD sits in.” that although stroke treatment is time- myself, have been here at least five years. EMDs are a recognized part of the EMS dependent, the risks associated with HOT Why should we have to certify? response chain. Having EMDs practice responses (accident risk to responders and Brandon (last name and affi liation with- without current certifi cation is morally akin the public and anxiety risks to patients), did held on request) to sending out uncertified paramedics or not justify the minimal gain associated with EMTs. I would strongly advise current cer- saving only a minute or so when the patient Brandon: tifi cation for all EMDs using the MPDS. To was not in need of time-critical, airway inter- Certifi cation goes beyond the experience do otherwise is risky and seriously degrades vention. The Academy believes that stroke is and knowledge accumulated during your any commitment to quality patient care and a pre-hospital emergency and should dictate years spent in the profession. While that is responder safety. an immediate, ALS-level response. However, certainly important, the experience does not Brett Patterson since not all pre-hospital emergencies justify address the overall benefi ts certifi cation pro- NAED Academics & Standards a lights and siren response, HOT responses vides to agencies and the public. I will list a should be reserved for those patients with few, each applicable to the protocol you’re Brett: minute or second critical emergencies (i.e., using—fi re, police, or medical. From my experience, STEMI (ST-eleva- where the risk of arrest, airway problems, Certifi cation provides validation of cur- tion myocardial infarction, or heart attack) serious hemorrhage, or complicated child- rent skills necessary to use the protocol. and stroke patients may be sensitive to birth are present). Initial certification by NAED® certified unusual sounds, fl ashing lights, loud radios, With regard to STEMI patients, poten- instructors provides a sound foundation and sirens, sometimes to the point of jeop- tial ACS patients are generally assigned a for protocol use; continued certification ardizing chances of their survival. For that HOT response not necessarily because of ensures that EMDs are up to date with reason, is it better to forego the lights and the seconds saved for STEMI treatment, but regard to protocol evolution and other areas siren when transporting the patient? because of the risk of arrest and second criti- of Continuing Dispatch Education (CDE) Greg Natsch, Chief cal advantages of CPR and defi brillation. necessary to function in the ever-changing Bureau of Emergency Medical Services With that said, it is not the Academy’s climate of DLS. Missouri Department of Health & position to dictate local responses; we make Certification also provides limited lia- Senior Services general recommendations. For instance, bility protection through standardization while a CHARLIE-level response is recom- of care and due diligence on the part of the Greg: mended as ALS, each agency is encouraged EMD and agency. There is a great deal of The link between lights and siren to study the outcomes of individual Deter- controversy surrounding minimal to non- response and patient survival is not direct. minant Descriptors (C-1, C-2, etc.) and existent standards in EMD and many states However, several studies have suggested allocate according to resource availability are in the process of passing bills to require that the use of lights and siren saves mini- and outcomes. For example, an agency may minimum training and certifi cation. mal time. An urban study in St. Petersburg, choose to send an ALS unit COLD to a sus- The Academy strives to meet all of those Fla., compared all lights and siren responses pected stoke patient who is alert and breath- standards in its certifi cation process. It is far to the complaint of “Stroke—Not Alert or ing normally with speech or movement easier to defend a certified EMD in civil Not Breathing Normally” to the non-lights problems but send the same unit HOT for court because certifi cation validates a mini- and siren responses to the complaint of a like patient who is not alert or not breath- mum standard. While the Academy is not “Stroke—Alert and Breathing Normally.” ing normally. in a legal position to “require” certifi cation The difference was about 33 seconds. This The Academy has gathered a consider- for users of the protocol, it is highly recom- was an internal study in Pinellas County, able amount of cardiac arrest outcome data mended and the Academy is not able to back Fla., and was not published. A study out to assist agencies with this response alloca- an EMD or agency in a court of law if the of North Carolina published in Annals of tion process; send me an e-mail if you would EMD in question is not currently certifi ed. Emergency Medicine compared lights and like further information. The monetary argument is a reality but siren transports to COLD duplicates of the Brett Patterson has proven to be a poor excuse in court, or transports during the same time and day NAED Academics & Standards J

THE JOURNAL | May/June 2009 17 Centers of Attention. From its beginnings in Utah, the protocol continues to march around the world.

BY HEATHER DARATA AUDREY FRAIZER Testing Grounds. Dr. Jeff Clawson’s protocol was fi rst introduced into the Salt Lake City Fire Department’s comm. center 30 years ago. Eager to Switch. In the late 1990s, San Diego Fire-Rescue embraced the MPDS after realizing it was exactly what it was looking for.

MD Judy Swenson remembers No one anywhere had tried anything like (P.L. 89-564) had established national the reaction to Dr. Jeff Claw- this before giving Dr. Clawson and his sup- standards for training emergency medi- son’s Medical Priority Dispatch porters the pioneer distinction in promot- cal technicians and minimum equipment System® (MPDS) when it was ing pre-hospital medicine starting at the requirements on ambulances; there was Eintroduced into the Salt Lake City Fire dispatch level. But 30 years ago, few knew no national single number to call when Department’s (SLCFD) communications about or appreciated his innovative proto- needing help in an emergency. center 30 years ago. col ideas. Public safety had yet to catch his By the time Dr. Clawson took over “There was a fair amount of resistance vision about the key role dispatch could play as SLCFD fi re surgeon in the late 1970s, from everybody—dispatchers, fi re fi ghters, in the chain of life as fi rst, fi rst responders. ambulances in many parts of the country administration—but obviously administra- Though an emergency medical doctor were dispatched via an answering service tion thought there was some good in it or fi lling a newly created role as the SLCFD that, in turn, paged the paramedics. In they would have not instituted it in the fi rst surgeon, Dr. Clawson was a relative out- the few centers employing dispatchers, place,” said Swenson, a SLCFD dispatcher at sider to the communications center. He had training was non-existent and the job of the time the MPDS was adopted. “Nobody driven ambulances and even dispatched dispatching was often relegated to some- thought that anything good would come out but his fledgling protocol needed more one not particularly interested in the of Salt Lake but it truly did.” than his hometown fi re department’s seal position. About the only bright spot on The SLCFD, Dr. Clawson’s hometown of approval. It needed to be given a chance the horizon, although yet unseen, was a fire department, was the testing grounds on the big stage. 1975 study coming out of Seattle, Wash., for the early development of the MPDS, showing that survivability of heart attack and the first in the world to integrate his A little perspective victims improves with early intervention standardized medical dispatch system. Its Emergency medical services were still in of Advanced Life Support (ALS). fire department dispatchers were conse- their infancy 30 years ago when protocol The report applied to EMTs and quently the original batch of trained emer- went public in 1979. Only 13 years earlier, paramedics, those providing ALS on the gency medical dispatchers (EMDs). in 1966, the National Highway Safety Act scene, and not the dispatchers answer-

18 THE JOURNAL | emergencydispatch.org Light a Fire. Stockton Fire Department ignited the spread Progressive M.D. Pinellas County was among the fi rst to employ a Achieving Excellence. Cleveland EMS was introduced to the of the protocol throughout California, which now has 187 full-time medical director who incorporated EMD into the position. protocol through a course offered in Florida and became the second licensed users. Proven Protocol. Instead of redesigning its homegrown model to ACE in 1993. First in the World. Albuquerque Fire Department prioritize calls, the San Jose Fire Department adopted the protocol in the Full-Time Infl uence. Austin-Travis County EMS welcomed became the fi rst Accredited Center of Excellence in 1993. late 1990s. aboard a full-time medical director in 1995 three years prior to imple- menting the MPDS.

ing the emergency calls coming into their made during his efforts to persuade others a paramedic for the Los Angeles City Fire centers. Dr. Clawson and others slowly to at least give protocol a try. Robert Mills, Department, had just completed a report acclimating to the role EMDs could play then a Stockton (Calif.) Fire Department on the Los Angeles state of EMS with Steve had to fi nd a way to apply that same kind fi refi ghter/paramedic was no stranger to the Balentine, a fellow paramedic and a mem- of interventional reasoning to their work. responsibility of answering 9-1-1 calls when ber of the union’s executive board. The late The natural place to start was the Salt Lake he enrolled in an EMD course taught near 1970s report affi rmed 9-1-1 call complaints Valley and, from there, move to other states where he worked. Mills neither liked the they had long circulated and proposed ways looking for a pre-hospital care solution. way he saw others treat dispatchers nor the to improve the system through phone triag- responsibility that came with the job lacking ing and basic medical education. Something had to break formal training. He found protocol a solu- Nobody wanted to have anything to do A major coup d’état, they knew, would tion to his long simmering aggravation. with the report or the priority dispatch pro- be the acceptance by a big center, one that “There was adoption of it in a central tocols Hurtado had read about in a 1981 wouldn’t back off from the radical changes place in California (Stockton) that became edition of JEMS magazine. proposed in dispatch response. The MPDS the ignitus of the spread throughout the “Hey, this is L.A.,” Hurtado recalled was had to present as a system showing its state,” Dr. Clawson said. the city’s response. “We’re the big leagues. potential savings in terms of emergency Stockton catapulted California into the Salt Lake City should be sending people here medical runs, manpower, wear and tear on new era of dispatch; it was just what the to ask us how we do medical dispatchng.” vehicles, and burnout while, also, proving protocol needed as way of introduction to Hurtado persisted but it took seven years its ability to help patients during the fi rst the bigger world. and a 60 Minutes broadcast in December critical minutes of their emergency. 1988 highlighting dispatch problems in agen- The domino effect cies including those in large cities like Los California, ho! Fred Hurtado, who was serving as presi- Angeles that put the ball in his court. The A significant nibble west of Utah was dent of United Paramedics of Los Angeles city of three million people depending on a through an early acquaintance Dr. Clawson (the city’s paramedic union) and working as center answering 205,000 EMS calls annu-

THE JOURNAL | May/June 2009 19 ally adopted the Priority Dispatch System. “Most medical directors for EMS systems land (Ohio) EMS, remembers a course From California central, the protocol worked in ERs and part time they would taken in Florida sparking a change in the spread up and down the coast. Today, Cali- help write protocols for the fi eld medics.” way Cleveland’s center operated. fornia stands as one of the heaviest protocol Dr. Ryan’s unabashed passion for EMS “I brought all the stuff back and put it user states, with 187 participating centers. motivated major medical groups like the on my supervisor’s desk,” she said. “Soon Major centers to adopt protocol during National Association of EMS Physicians after that we were using the system.” the next decade following Los Angeles’ (NAEMSP) to bring other medical doctors George Chaloupka, now EMS operations implementation included the San Jose Fire into the EMS fold. Communications cen- commander, said protocol addressed the Department, in 1997, followed later that ters in Florida following his lead now num- problems Cleveland was facing at its com- same year by the San Diego Fire-Rescue ber 135 licensed protocol users. munications center. While there were gen- communications center. “He got a small crowd of these doctors eral guidelines, there wasn’t anything to help Both wanted a system prioritizing calls interested in this non-visual medicine and prioritize calls and they were discouraged without the hassle of redesigning home- they became staunch supporters,” Patterson from providing the center’s version of pre- grown models they had used for years. said. “They were leaders in the EMS fi eld so all arrival instructions for fear of lawsuits and a “We said ‘yeah, you know, what we’ve the new docs out there—the ones coming out lack of continuity among dispatchers. got is good but what they’ve got is way bet- of school that were joining this organization— “I think Deborah was one of the ones ter,’” said Tom Anglim, currently San Diego were looking to them. Now there’s this whole that actually came over here and said that Fire-Rescue’s EMD quality improvement new culture of thought that ‘yeah, communi- she had found something that would give us manager. “There was no reason other than cations is part of our responsibility.’” a structure to work from instead of every- the fact that we were already doing some- But Pinellas County didn’t stop there. body doing their own thing,” he said. thing that looked like questions and we Dr. Ryan created a paramedic fellow- Dr. Clawson and Scott Hauert, national knew that MPC (Medical Priority Consul- ship program, selecting 15 medics from director of training at that time, fl ew into tants, now Priority Dispatch) was leaps and the center who could chose between two Cleveland with Hauert remaining at the bounds ahead of us.” tracks—clinician or quality improvement. center for several weeks to train during off

Moving south Protocol skipped its way across the coun- try during the intervening years. At about the same time Hurtado was ready to clinch the interest of Los Angeles, protocol landed its second big fi sh along the Atlantic coast. Sue Tolliver arrived in Pinellas County, Fla., at a time when the wheels of dispatch were being set in motion. It was 1986 and the company determining her transfer from the Midwest was bidding on a computer-aided dispatching (CAD) system for the county’s emergency communications center. Tolliver was familiar with the MPDS from her previous job in Kansas City, Mo., and once her company, Sunstar EMS, was notifi ed of its successful bid and the contract was signed, she was selected as the Pinellas County EMS Director of Communications. Patterson, who chose the quality improve- shifts. Dr. Clawson made periodic visits to She welcomed aboard Joe Ryan, M.D., as ment track, later established a program to provide orientation and executive training. Pinellas’ full-time medical director. raise and maintain Pinellas’ protocol com- The center that had adopted the MPDS Dr. Ryan was a progressive medical pliance. Within about six months scores cardset in 1991 switched to ProQA® in 1993 director incorporating EMD into his job tripled, from 27 percent to 95 percent. and became the world’s second Accredited with the county rather than keeping his “We were sort of an epicenter of EMS,” Center of Excellence (ACE) barely three distance, which was the direction most Patterson said. “We didn’t have the dis- months after the Albuquerque (N.M.) Fire medical directors took when it came to patcher who was just taking an address and Department. emergency dispatch. sending an ambulance. They were involved Austin-Travis County (Texas) EMS, “Joe Ryan was among very few doctors in how the system ran.” which implemented the protocol in 1998, that actually looked at communications From Florida, protocol branched in has a call volume fast approaching other as part of their role as a medical director,” directions north, south, east, and west, as major cities. Austin is the fourth largest said Brett Patterson, NAED Academics did the concept of placing a medical doctor city in Texas and sixteenth in the nation and Standards Associate and, at that time, at the helm of communications centers. and because the city is located within the a paramedic hired to dispatch for Sunstar. Deborah Brown, instructor for Cleve- center of Travis County, 20 EMS units are

20 THE JOURNAL | emergencydispatch.org located within the corporate limits and to adopt the protocol and it subsequently into a non-ambulance response category. another seven are strategically positioned approved a province-wide contract for ser- “We were able to do that up to the third within the county. Up to eight communica- vice and support. tier (of seven tiers) of calls because of our tion medics staff the EMS communications But not only had the protocol made it confi dence in the way the system worked,” center depending on the time of day and out of the states—it was also being used he said. the expected workload. mostly in French, the language of their call- The response to the crisis was one factor In 1995, the City of Austin EMS ers. Translation of protocol and certifi cation leading to the National Enterprise Mainte- Department, Austin Fire Department, and materials took more than one year. nance Agreement (NEMA) signed July Travis County Emergency Services Depart- “They were definitely the first inter- 25, 2006, in partnership with the Depart- ment jointly created and funded a full-time national other language and it was one of ment of Health, Ambulance Trusts, and medical director to be responsible for all the fi rst, largest implementations in North the International Academies of Emergency clinical aspects of out-of-hospital emer- America,” said Marie Leroux, a Priority Dispatch® (IAED). NEMA established the gency care in the city and county. Dispatch Corp.™ senior consultant who use of the Advanced Medical Priority Dis- They hired Edward M. Racht, M.D., was working for Urgences-Santé at the time patch System® (AMPDS) as the standard who, among his multiple assignments and MPDS was implemented. Urgences-Santé for emergency dispatch in the Emergency initiatives, directed emergency communi- also required the use of two languages at Dispatch Centres (EDC) and ambulance cations operations until, in fall 2008, he the same time in its ProQA package. The trusts. Eleven of the country’s 13 ambu- became the vice president of medical affairs center became the sixth ACE and the fi rst lance trusts and 24 EDCs have taken up and chief medical officer for Piedmont one to receive that distinction in Quebec. this new agreement. Newnan Hospital, in Newnan, Ga. Dr. Racht is a fi rm believer in the role of Moving transatlantic Where it all began the emergency medical dispatcher (EMD) Chris Hartley-Sharpe, a paramedic for The SLCFD communications center has in effective and improved patient outcomes. the London Ambulance Service with a traveled a road expanding from a single lane During his tenure in Texas, the center and background in research, took his training to a superhighway during the past 30 years. to the task in a study to choose a system Not only is protocol there to help during a meeting National Health Service (NHS) personal emergency but it’s also there for Canadian Trust requirements to prioritize emer- larger scale events affecting entire commu- Conversion. Urgences- Santé was among the fi rst gency calls. The MPDS was among two in nities. Few living in Salt Lake City two years centers in Quebec, Canada, the running. ago will forget the night of Feb. 12, 2007, to use the MPDS in the early 1990s after Montreal “There was obviously quite a lot of discus- when hundreds of calls fl ooded the police adopted the protocol and sion within the organization about which of and fi re communications centers reporting approved a province-wide contract for service and sup- the systems we should go for,” he said. “I did a lone gunman shooting people at random port. Urgences-Santé went on quite a lot of work going around the coun- inside a local shopping mall. to become the sixth ACE. try because a number of other services had “The protocol we used gave us the voice London Calling. The London Ambulance Service already started using the systems and learning of authority,” said SLCFD dispatch offi ce went live with the protocol a bit more about them, which was helpful.” shift supervisor Laurie Wilson-Bell in the less than two weeks before the millennium and cur- The result of his investigations put the Sept/Oct 2007 Journal. “We knew exactly rently serves a geographic MPDS in the world’s largest and busiest free what to say to calm them down while await- area of 620 square miles and a resident and com- ambulance service, covering a geographic ing help to arrive.” muter population of more area of 620 square miles and what is now Like their Rocky Mountain predeces- than nine million people. a resident and commuter population of sor, more than 3,000 centers worldwide more than nine million people. LAS went have integrated a Priority Dispatch System live Dec. 21, 1999, and to this day project to improve their 9-1-1 response and estab- NAED participated in several joint emer- manager Hartley-Sharpe relishes the reply lish emergency dispatchers as the fi rst, fi rst gency dispatch studies and submitted pro- he gave to an individual questioning the responders. Their involvement with the tocol enhancements through the Proposals sense of initiating call prioritization so close National/International Academies of Emer- for Change (PFC) process. In 2008, for to the millennium. gency Dispatch® (NAED/IAED) and the example, nearly 700 calls made in response “My response to him was essentially that further development of the police, fi re, and to allergic reactions led to a request for the it’s not nearly as risky as not prioritizing medical protocols are key to the continued Academy’s development of a PAI to autoin- them would be,” he said. success of everyone. The relationship sig- ject epinephrine. The LAS implemented ProQA in 2000 nifi es a two-way commitment, said NAED and achieved ACE status in 2002. On July Associate Director Carlynn Page. International crossings 7, 2005, the MPDS was put to the test in “They are dedicating resources to areas The MPDS crossed borders in 1991 response to the terrorist attacks on Lon- like quality improvement and feedback in with implementation in both Montreal don’s public transportation. James Gum- the form of the Proposals for Change,” she and Laval, the two largest cities in the prov- mett, LAS quality assurance manager, said said. “That helps them improve while pro- ince of Quebec, Canada. Montreal was the the center put its catastrophic incident plan viding invaluable assistance to the evolution fi rst major city outside of the United States in action, placing the lowest priority calls of protocol.” J

THE JOURNAL | May/June 2009 21 NAVIGATOR | THE CONFERENCE It’s All About You Navigator celebrates dispatch community

BY AUDREY FRAIZER HEATHER DARATA

avigator 2009 celebrated a community cre- ated by protocol during its 30-year jour- ney, which began in Salt Lake City, Utah, and has since wound its way through com- Nmunications centers around the world. The event, held the last week of April in Las Vegas, had all the trappings of the educational expe- rience emergency dispatchers have come to expect plus the glitter of showmanship both on the fabled strip and in the conference center. The event also held an eye toward the future.

22 THE JOURNAL | emergencydispatch.org THE JOURNAL | May/June 2009 23 NAVIGATOR | THE CONFERENCE

“I should have plenty of ideas to try out,” Stiegler, and a 33-minute documentary ing little respect, even among the public said EMD Kelly Thomas, dispatch supervi- film by the NAED chronicling the sto- it served. sor, First Responder EMS, Chico, Calif. “I’m ries of people instrumental in protocol’s “What we did in 1984 was innovative here for the week and it’s just beginning.” development and its climb to international because we sat beside the dispatchers for Thomas arrived early, attending the acceptance. EMD Rebecca Sims, from months on end,” he said. “No one had sat pre-conference session “Overcoming Neg- MedStar EMS, Fort Worth, Texas, received in those seats before. It’s because of all of ativity in the Communications Center” the Dispatcher of the Year Award, and in you that we’re here today.” taught by Nancy Banks, supervisor, com- an award new to Navigator, Paul Pepe, Brian Dale, battalion chief at Salt munications training, Peel Regional Police M.D., accepted the EMS Innovator of Lake City Fire Department (SLCFD) in Ontario, Canada. the Year Award from Jeff Clawson, M.D., and NAED Accreditation Board chair, The week ahead not only offered her co-founder of the National Academies of presented Dr. Clawson with a Lifetime and the other 1,052 attendees 60 confer- Emergency Dispatch® (NAED). of Meaningful Change Award after lur- ence classes to choose from but, also, an Dr. Clawson, who conceived the idea of ing him on stage with the 1979 version of abundance of keynote talks, award pre- protocol more than 30 years ago, acknowl- the SLCFD protocol training manual con- sentations, the displays of 53 vendors in edged Dr. Pepe, medical director, Dallas tained in its original green pocket folder. an expansive exhibit hall, and some good (Texas) Metropolitan Medical Response Acknowledging Dr. Clawson’s pref- old-fashioned fun found poolside and at System, for his outstanding contributions erence to stay out of the limelight, Dale indoor parties. to emergency medical services, including lauded him—albeit briefl y—for his three Wednesday’s opening session featured medical protocol, during a career span- decades of dedication and, in the interest a 4-minute song dedicated to 30 years of ning nearly four decades. The protocol, of the green folder, his fascination with protocol, composed and played by Dane Dr. Pepe said, was an innovation developed items relating to the protocol during its County (Wis.) Medical Director Dr. Paul from paying attention to a job once garner- 30-year history.

Twenty years in dispatch has Elizabeth Holcombe given Lynn Carrol many hats to Strathcona County Emergency wear and, at this stage of her Services career, that means switching Sherwood Park, Alberta, From the way they were laugh- The three laughed. Canada them depending on the day. ing and carrying on in the back Staley’s sliding into the chair at The variety, however, is the A change in management at of the classroom during a mid- the back table a few minutes major reason she likes the job Strathcona County Emergency afternoon break, you’d think past the 8:30 a.m. start time with Jefferson County (W. Va.) Services was all it took for Eliza- their friendship or, at least, time proved benefi cial. The issues Emergency Communications. beth Holcombe to attend her working together, extended she came eager to discuss “I like the job a lot,” she said. fi rst Navigator conference. The over the years. were similar to those brought “There’s a lot of variety plus 20-year veteran dispatcher, who But that wasn’t so. The three by Clarissa Larson, EMD, shift the ability to help people.” will soon become a lieuten- 9-1-1 professionals had met commander, Mesquite (Nev.) Carrol signed up for two pre- ant, was able to get a glimpse that morning in the Overcoming Police Department, to her conference courses dealing into sessions covering staff- Negativity in the Communica- right, and JoAnne Fleming, with personnel issues offered ing issues such as aging and tions Center pre-conference dispatcher/calltaker, Alberta by the National Emergency personality differences, how to class led by Nancy Banks, ENP. Health Services, Grande Prairie, Number Association (NENA). keep dispatchers engaged, and “I haven’t known them as Alberta, Canada, to her left. Both courses gave her plenty protocol compliance. “We’d like Navigator 2009 was also the of ideas she can take back to to eventually become an ACE,” long,” said Teresa Staley, EMT, supervisor for Morrow County fi rst NAED conference they had work, particularly in relation to a she said. J ever attended. recent move into a new center. 9-1-1 in Mount Gilead, Ohio. “My boss signed me up for “The long wait at the airport “Whether you’re from a large them,” she said. “And, I’m glad shuttle made me a few minutes or small center, the issues are late for class.” the same,” Larson said. “We he did.” J all want to get along, make sure

24 THE JOURNAL | emergencydispatch.org NAVIGATOR | THE CONFERENCE

“He’s much more comfortable mov- focusing on emergency medicine from “The character inspired career choices,” ing forward than looking back,” Dale said. the shifting view of an actor turned EMS Mantooth said. “As the face, I get the “But as he has always shown, if better is advocate. credit, but you are ones saving lives. I’m possible, good is not enough.” For many, the hour-long presentation not the hero. You’re my hero.” Randolph Mantooth—a.k.a. Johnny was a walk down television’s memory lane The Wednesday evening pool party Gage of the 1970s television show and a reminder about why they entered the drew few people into the water, although Emergency!—gave EMS a historical perspec- EMS profession, even many years after the it served as an icebreaker among the three tive with an opening session presentation show went off the air. generations of professionals now present in the workforce. The baby boomers through their Generation Y coworkers shared sto- ries about what brought them to the con- “[Dr. Clawson] is much more ference as well as the profession. While it was Johnny Gage who intro- comfortable moving forward duced Brant Butte, AMR communications manager in Seattle, Wash., to EMS, it was than looking back. But as he the adrenaline rush that’s kept him there for more than a decade, including a dozen has always shown, if better is years on the road and in the fi eld. “I was very excited to run calls,” said possible, good is not enough.” Butte, who became a paramedic straight out of college with a degree in physical educa- –Brian Dale tion and physical therapy. “The old timers

everybody does a great job, and understand the resentment an live by the golden rule.” older person may have given You may think you’re the only her, someone a generation center having problems with younger, place of authority. some negative attitudes, Staley The differences, however, are added. something she has learned to appreciate. “Our generation is “You come here and fi nd that more technology based and we isn’t so,” Staley said. “It may don’t want to slow down,” she be due to different situations, said. “But I also value the expe- Ron Shiner but negative attitudes affect rience baby boomers offer. A lot Sunstar everyone.” of them have been doing this Pinellas County, Fla. Fleming attributed a current, for a long time. That’s some- thing I really respect.” Decker is Even after a span of several although anticipated temporary, years since he last attended drop in morale to a master plan pursuing a degree in emergency management and homeland Navigator, Ron Shiner knew consolidating the former 32 cen- exactly what he was looking for. ters to three centers in Alberta. security, a career path brought to the forefront by world events As the chief training offi cer at “This is a massive change for U.S. Army Dispatch Supervisor Sunstar in charge of maintaining of the past decade. J us in a relatively short time,” Heather Decker, of Fort Riley, reaccreditation, the center’s Q she said. “It’s a huge issue. Kan., has never had a big prob- program, and training, Shiner Overwhelming. I volunteered to lem with supervising dispatch- was after information about come here to learn what we can ers older than her generation. training, morale, and behavior do about it.” She has heard the far end of —topics he found in abundance the baby boomer range may be during the three days of formal The same objective applied to harder to train and she does Staley and Larson. classroom presentations. Shin- er, who began as a paramedic in It’s not about changing the 1980s before later making the world. the move into the comm. center “This is about coming to a job as a dispatcher, also said Navi- where you can make a differ- gator gave him the opportunity ence,” Larson said. “When neg- to expand his network ativity gets in the way, we need of peers. J to do something about it.” J

THE JOURNAL | May/June 2009 25 NAVIGATOR | THE CONFERENCE

Annette Sharp Holly Raan Detroit Police Department Pro Transport 1 Calltaker Carol Hayes and Dis- Detroit, Mich. Cotati, Calif. patcher Trish Robinson obvi- ously have scant issue over fi ne.” The sarcasm might be a Annette Sharp decided to con- As a fi rst-time Navigator the core and work value gen- reason the two traveled togeth- centrate heavily on the police attendee and a clinical support erational differences research er to Navigator 2009 from their track since she doesn’t deal coordinator at her center, Holly attempts to defi ne. “It hasn’t home state of Alaska. Not only with other types of calls on the Raan paid special attention been at all diffi cult,” Robinson were they the lucky two in the job. She’s been a dispatcher for to the training classes. She’s said. “As long as Trish is will- rotation of choosing who goes 12 years but this was her fi rst working on developing training ing to bend, we get along just to the conference, but they shot at experiencing Navigator. materials since those at her also came at an optimal time At the end of the conference, center would benefi t from the considering the recent hire of she came away with a greater extra help after having adopted fi ve people under the age of understanding of what fi re, the medical protocols less than 22 (Generation Y), and a center EMS, and 9-1-1 personnel do. a year ago. The conference has with an age range between Sharp enjoyed the chance to been a worthwhile experience 21 and 62. “We have a lot of spend time mingling outside of for her. “It’s been a great help information to hand over to our the classroom as well as col- understanding where our boss,” said Hayes, who, like lecting information from exhib- call center’s at, where it’s Robinson, said she “loved” its and classrooms. “I do have coming from.” J the pre-conference sessions. some ideas to take back.” J “This is not a job for everyone,” Robinson said. “But when I meet people who say this is what they want to do, I’m quick to tell them about what I like about the job. I don’t want any- thing negative they might hear to get in the way of what they want to do.” J

would make fun of me because I was always in such a hurry to get going on a call.” “[Navigator] opened my eyes to Movie stars, showgirls, and Michael Jackson and Madonna impersonators aside, how we affect people everyday, the real showstopper was the demonstra- tion of police, fi re, and medical protocols in action on stage Thursday morning, the not only at the communications second day of Navigator. Actors “experi- encing” cardiac arrest, a home fi re, and the center but in our personal kidnapping of a boy from a playground kept the house entertained in their one- lives, also.” –Lois Clancy act renditions of emergency calls that the real stars—dispatchers—answer as the fi rst link in the EMS chain of command. que Fire Department Communications common, as indicated by Julie Baker, Mayo The live action was followed by on Center in New Mexico, 1993) to the new- Clinic Medical Transport/Emergency stage recognition of the Accredited Center est additions to the list of fi re accredited Communications (Rochester, Minn.). of Excellence (ACE) recipients and Com- centers (Harford County (Md.) Division “I don’t want to sugarcoat this for any- munications Center Managers (CCM) of Emergency Operations and Sarasota one, because it’s not easy,” she said. “It was course graduates. County (Fla.) Public Safety Communica- work, as everyone would agree. Every gray The ACE certificate is now displayed tions, both in April 2009). hair it gave me, though, was worth it when in 131 communications centers, from the Agency representatives accepting the I saw the look of pride on everyone’s faces fi rst center ever certifi ed (the Albuquer- ACE award had more than the certifi cate in when the acceptance letter arrived.”

26 THE JOURNAL | emergencydispatch.org NAVIGATOR | THE CONFERENCE

Melissa Cotnoir Emergency Communications Center Nashville, Tenn. Barry Coleman Melissa Cotnoir enjoyed the EMSA/Paramedics Plus ability to pick and choose Oklahoma City, Okla. classes from the various tracks. Since this wasn’t Barry Cole- Since this was her fi rst time man’s fi rst Navigator, the attending the conference after communications quality starting as a dispatcher with improvement supervisor for the Kelly Thomas straddles the her department 13 years ago, western division of EMSA knew fence between Generation X the differences among genera- she picked sessions that she what to expect from attending and Generation Y. It’s not an tions, she was looking forward was interested in, covering a last year’s conference in Bal- easy task balancing the two to bringing the information back variety of areas including some timore, Md. Coleman worked generations—despite her age to the center. “I should have of the management offerings. in the fi eld for several years and its relevance to the events plenty of ideas to try out,” she “It really broadens your view.” before making the switch to the infl uencing core and work said. “I’m here for the week However, Cotnoir is not looking comm. center nearly nine years values—but added to the mix to give up dispatching any time and it’s just beginning.” J ago. After sitting in on sessions are the baby boomers under soon. “Right now I really enjoy as well as having an opportunity her direct supervision. “That’s what I do. I don’t want to give to network, Coleman said he the reason I came to the con- up dispatching because was able to come away with “a ference,” she said. “I want to J it’s my passion.” different spin on things.” J learn how to become a better supervisor.” Thomas’ eight years in EMS is a combination of nonemergency transport, dispatching, and emergency transport. She credits the range of her experience and training as the reason she was selected as supervisor. By the end of an eight-hour course exploring

Twenty-one of the 26 graduates of the the last day of Navigator focused on the “If I actually told you everything that CCM course took center stage, led by Jaci fi re, police, and medical protocol and top- Fred has done regarding EMS and EMD Fox, quality assurance coordinator for the ics devoted to leadership, management then we’d be here all afternoon,” Dr. Claw- Medicine Hat 9-1-1 Regional Communica- operations, and special interests. son said. tions Centre in Alberta, Canada. The class, NAED President Scott Freitag opened The conference concluded with an she said, provided a collaborative approach the closing luncheon with a tribute to Bill update on the new Protocol 36 (Pandemic in resolving a multitude of issues common Boehly and Bill Lloyd, both of whom made Flu), which determines whether a patient to all centers. contributions integral to the advancement initially presenting with certain Chief Morris Tamanaha, of the Regional Dis- of EMS, the Academy, and protocol. The Complaints is a likely fl u patient or a non- patch Center in Pearl Harbor, Hawaii, said two men died just months apart this year infected patient. The Protocol, released CCM reinforced information accumulated from cancer. during Navigator, coincided with the during his career and introduced him to a Dr. Clawson presented Fred Hur- global outbreak of the swine fl u. network of people from centers of all sizes. tado with the annual Leadership Award, For Lois Clancy, public service com- “The camaraderie, or network, will be acknowledging his lifetime commitment municator offi cer II, Montgomery County something we will maintain for the rest of to EMS and the NAED. In his most recent (Texas) Hospital District, Navigator repre- our careers,” he said. “Large or small, we all roles, Hurtado, who was key to bringing sented a unique opportunity to attend a con- have the same issues.” protocol to the Los Angeles (Calif.) Fire ference devoted to her career of 20 years. The last day of conference had attend- Department, is an EMS/EMD consultant “This is my fi rst conference and I loved ees scrambling to 75-minute sessions for EMS Systems Solutions, LLC, and was it,” she said. “Absolutely loved it. It opened beginning at 8 a.m. sharp and ending min- recently appointed to the NAED Board of my eyes to how we affect people everyday, utes before the closing luncheon. Similar Curriculum. The two have known each for not only at the communications center but to the previous two days, classes held on almost the life of the protocol. in our personal lives, also.” J

THE JOURNAL | May/June 2009 27 NAVIGATOR | THE CONFERENCE

People Everywhere. Navigator 2009 combined education, networking, and celebration during its weeklong stay ringside the Las Vegas strip of never-ending entertainment. The annual conference gives dispatchers from communications centers around the world the opportunity to exchange ideas and laughs while attending everything from classes, exhibits, talks, poolside parties, and even golf tourna- ments. Pictures here include Conrad Fivaz, standing by his hole-in-one made during the Bill Boehly Memorial Golf Tournament; Randolph Mantooth, speaking at the mic during his keynote presentation highlighting his days as TV’s Emergency! star Johnny Gage and his current EMS advocacy; and Dr. Jeff Clawson, accepting the Lifetime of Meaningful Change Award for the many years he has devoted to EMS and his trademark emergency fi re, police, and medical protocol.

Johnny on the Spot. in a prime time slot and, since going off the air, a career promoting emergency services at conferences including Emergency! still making a Navigator 2009. splash 30 years later “Emergency! and MASH were my shows, and it was a marvelous experience seeing him (Mantooth) on stage,” He was the heartthrob of millions of admiring said Lois Clancy, public service communications offi cer II, fans and the reason behind many making EMS Montgomery County (Texas) Hospital District. their profession. He was the guy recommend- Mantooth held his audience spellbound for more than an ing injection of Ringer’s Lactate solution for the hour as a conference keynote with his tales of America’s critically injured patient lying inside the ambu- once most recognizable fi refi ghters and paramedics and the lance rushing to Rampart Hospital along the people responsible for making the prime time melodrama streets of Los Angeles. authentic. The show coincided with the widespread estab- He was Johnny Gage (Randolph Mantooth), lishment of emergency medical services paramedic pro- the TV star who made it through fi ve seasons grams across North America in the mid and late 1970s. J

28 THE JOURNAL | emergencydispatch.org NAVIGATOR | THE CONFERENCE

Swing Town. Fivaz, M.D., medical director, Priority Solutions, energized in that order. The foursome went on Highfl ying ball rides the U.K. Operations. “I knew it was close.” to fi nish fi rst against a fi eld of six other teams. winds of celebrity And, apparently, closer than he had imagined. Golf is a sport Fivaz picked up almost 20 years Fivaz hit his fi rst-ever hole-in-one on the par ago while in medical school. He found the serenity of the greens a perfect escape from Chaos could best describe the sight near three, 129 yard sixth hole, during the Bill Boeh- the rigors of study, much the same as he Hole Number Six at the Legacy Golf Course ly Memorial Golf Tournament held on Tuesday does nowadays when taking a break from his in Las Vegas. morning, April 28, at Navigator 2009. He hit the ball into the wind using a pitching wedge and demanding job. A club was thrown, a scream was heard, and watched it fl y over the fl ag. Fivaz has averaged about 30 games a year then came the thunder of feet stampeding over the past 19, bringing the total number of onto the green. The air was electric, etching “From there, it went right in,” he said. holes close to 11,000 shot on 18-hole courses. into memories a scene that people will still talk Fivaz’s teammates in the Captain’s Choice— Although the odds vary by course and experi- about in years to come. Ken Winward, Pam Stewart, and Howard Bla- ence, his chance at making the hole-in-one was “It was really quite nice,” according to Conrad ser—were every bit as stunned, ecstatic, and something around 4,000 or 8,000 to one. J

Travels with Dorothy. She’s a Navigator regular where destiny points, which is certainly no refl ection of her character. Dorothy PDP gets around, and her travels “I just have to make sure she goes with some- This year, Mark Rector, director, Priority Dis- cover so many years, that it’s a wonder the one who’s sure to make it back the next year,” patch Corp.™ Consulting Services, left with young miss shows little sign of slowing down. said Annette Jordan, Quality Improvement Dorothy, who looked quite fetching in the red Dorothy is a pig—a Priority Dispatch Pig (the supervisor for the Memphis (Tenn.) Fire Com- dress bearing Navigator pins collected during “PDP”)—ferried into the annual Navigator con- munications Bureau. her decade of travel. Rector plans to plunk her ference for the past decade compliments of In other words, mention you’re coming back in a place of distinction—a shelf overlooking anyone willing to accept the assignment. Once and the pig may be yours for the taking. his desk—as a daily reminder that he better remember to pack her in his bags next year. the week draws to a close, fans say their good- Dorothy, of course, is not a real pig, at least byes and the plucky pig departs the same way as she looks to those outside the tight group “I’m honored,” said Rector, who works out of she arrives, though courtesy of a traveler differ- of two-legged buddies accumulated since her the Salt Lake City, Utah, PDC offi ces. “I was ent than the previous and heading somewhere debut at Navigator 1999 held in San Diego. supposed to take her last year but our sched- on the map determined quite by chance. She’s a plush pink lady always ready to go ules didn’t cross.” J

THE JOURNAL | May/June 2009 29 NAVIGATOR | THE CONFERENCE

An Obvious Choice. Dispatcher of the Year knew the profession was right for her “Becca is awesome,” Allen do everyday. This introduces said. “Her heart is at the center them to a culture every bit like of what she does. To me, she’s a their own.” career dispatcher. She’s a part of The call submitted as part of the new generation entering the the nomination demonstrated MD Rebecca Sims has the type of profession.” Sims’ command of EMD protocol. background that might not come as Not only did Sims respond The patient was the passenger in a a surprise to those familiar with the remarkably well to a call involving car parked at an instant care cen- Edispatch profession. a premature delivery and prolapsed ter following premature labor and Prior to joining MedStar in Fort Worth, cord, submitted as part of her nom- upon learning an unsettling truth: Texas, two years ago, Sims worked at both ination, but she had also achieved her baby was delivering 13 weeks an emergency and a long-term shelter for the highest compliance score prior to the due date. The cord abused women. She was EMT certifi ed and among the center’s EMDs. The presented before the caller was a volunteer with MedStar. Sims attended distinction earned a scholarship able to get the passenger out of college to become a nurse and has plans of to Navigator along with coworker the car and the subsequent call to going back someday so she has the “framed Jolene Quigg, who achieved the 9-1-1 had Sims assisting while they piece of paper” to hang on a wall. But don’t highest compliance score among awaited the arrival of paramedics. expect to hear about her changing jobs once the center’s supervisors. “That’s the amazing part,” said she earns that degree. Sims fully grasped the signifi- Center Director Tammy Oberst. “I love what I do,” Sims said. “Dispatch cance of the award once arriving “The patient was at a care center is my real calling. That may sound odd but I at Navigator and meeting hun- but it was Becca’s instructions giv- do think that happens in this profession.” dreds like her, determined to make ing the child every benefi t at life.” Calling or not, the award Sims received a profession out of helping others. Eager to share in the Naviga- at Navigator 2009 no doubt says more The networking, or camara- tor and Vegas excitment, Sims about her than the B.S.N. credential ever derie, is a major reason Allen said brought along her parents, grand- could. The profession goes to the heart of they offer the scholarships. mother, sister, niece, and two her personality and a calling, if you will, so “Navigator is the greatest friends. As far as the award trophy strong that it fi gured into her selection as opportunity for us,” said Allen, is concerned, don’t expect to fi nd NAED Dispatcher of the Year. who has attended 11 Navigator it collecting dust on a mantle in MedStar QA Supervisor Melissa Allen conferences. “A dispatcher gener- her home. said Sims is a natural at dispatch and, ally works out of a box, not know- “I’ll bring it to the center,” she beyond that, she exemplifies what the ing that there are people out there said. “This is an award meant for agency looks for in its new recruits. experiencing the same things they everyone, and not only me.” J

30 THE JOURNAL | emergencydispatch.org NAVIGATOR | THE CONFERENCE

he word “surprise” popped into Fred Hurtado’s mind when he heard his name called to receive the Jeff Claw- T son Leadership Award. The only inkling Hurtado had that he Rallying might be the recipient was the fact that Dr. Clawson gave a rundown of some of the individual’s accomplishments prior to announcing the name of the recipient. the Troops. “Once he got far enough into it where the profi le started to fi t, I thought ‘uh oh,’” Hurtado said. Fred Hurtado urges The Academy was able to keep the “sur- prise” hush-hush, a particularly arduous task audience to keep since Hurtado was already scheduled to give two presentations at Navigator 2009. EMS army advancing Hurtado and Dr. Clawson met almost 25 years ago, several years after the article “Dispatch Priority Training: Strengthening the Weak Link,” detailing Dr. Clawson’s EMD program, was published in JEMS, “The dream lives on, the struggle contin- ment employee, new member of the Board catching Hurtado’s attention. ues,” he said. “Let’s keep on moving kids.” of Curriculum, television news guest (60 “I first met Fred at a convention simi- Hurtado has a passion for public safety Minutes), union president for United Para- lar to this,” Dr. Clawson recalled. “It was and said it has been a privilege for him to medics of Los Angeles, and EMD instruc- International Firefighters in Los Angeles be involved. tor for many years having likely taught in 1985 and I was cruising the exhibit hall “The recognition is nice but the positive more classes than anyone other than Brian and noticed that there was one exhibit that feedback comes from the people that you Dale and Brett Patterson. really wasn’t an exhibit—it was more like educate who in turn go out and touch the “If I actually told you everything that a card table with a couple of guys sitting lives of millions of people,” Hurtado said. Fred has done regarding EMS and EMD behind it—and I stopped and introduced “That’s really what it’s about. So I think that then we’d be here all afternoon,” Dr. Claw- myself and there was Fred. We struck up a any time any individual is recognized, the son said. conversation about dispatch stuff. He actu- recognition isn’t yours and yours alone. It’s Hurtado chose 911 CARES to receive ally had some codes and some data there at a function of all the mentors you’ve had, the $500 the NAED contributes to the the table that he gave me, which I still have. and all the associates and colleagues you’ve award recipient’s charity of choice. 911 The rest is history.” interacted with. For those of us who train CARES is a nonprofit agency founded The always self-effacing Hurtado or teach, it’s a function of the feedback that by Public Safety Training Consultants to thanked Dr. Clawson and then, turning to you get from dispatchers.” provide assistance to emergency commu- his audience, said he was proud to be part Highlights of Hurtado’s career include: nications professionals during their times of the EMS army. former paramedic, Vietnam vet, fi re depart- of personal crisis. J

THE JOURNAL | May/June 2009 31 Sitting Ducks. Lack of regulations puts dispatch in vulnerable position

BY AUDREY FRAIZER

ometimes, emergency dispatchers must feel like the brunt of all that might be wrong with 9-1-1. A mishap or com- plication preventing timely or adequate response comes right back to the place Swhere the process started, no matter the link or links in the chain that may be responsible. The dispatcher caught in the media frenzy is scrutinized and, for the most part, made to look incompetent or indifferent to the cry for help because of that one call, despite the literally hun- dreds and thousands of positive outcome calls during his or her career. The result: the loss of a dedicated employee singled out because of the media’s push for sensational news, or the potential loss of qualifi ed dispatchers from the fear of public humiliation in the case something does go wrong. Part of the problem may be a lack of directive; the dispatcher is the fi rst link in the chain of sur- vival, yet it is a profession with few regulations. All other medical professionals are regulated by states for the purpose of assuring the public that those providing the service are properly trained and supervised. Why doesn’t the same sort of legislative safe- guards hold true for emergency dispatchers?

32 THE JOURNAL | emergencydispatch.org THE JOURNAL | May/June 2009 33 After all, this is a job that takes far more Iowa—Mandatory completion of telecommu- than lessons in phone etiquette or the ability State Rundown nications course within one year of hire to sit still for a 12-hour shift. The modern Kentucky—Mandatory Criminal Justice Infor- Alaska—Training course as a prerequisite to Emergency Medical, Fire, and Police Dis- mation System training for law enforcement certifi cation patcher (EMD, EFD, EPD) must be able to dispatchers Connecticut—Requirements for establishing quickly identify the seriousness of the prob- Maine—Extensive legislation includes EMD and maintaining an EMD program lem, dispatch the appropriate response, and protocol, quality improvement program, train- provide life-sustaining medical instructions Delaware—Extensive legislation includes ing curriculum, and testing process to the caller when necessary. statewide implementation of an EMD system Maryland—EMD services in accordance with These are skills best not left to chance, Florida—Voluntary training and certifi cation the curriculum and protocols approved by the without the benefi t of training and certifi ca- program for state dispatchers state’s EMS Board (see accompanying story) tion. The nature of the work and the con- Hawaii—EMD course requirements Mississippi—Standards for training and sequent public responsibility demand the certifi cation highest standards of accountability. Illinois—EMD education; protocols for prear- Yet, according to our research, only rival instructions to callers by system EMDs Missouri—Certifi cation requirements for enti- slightly more than half of the states have Indiana—Extensive legislation includes ties that conduct EMD training regulations for certifi cation, training, and mandatory EMD certifi cation, education, and continuing education. Many states have training something in place but preliminary research shows little consistency nationally. States EMD Program without regulations are leaving their com- and/or Requirements munications centers wide open to litigation. When something does go wrong, dispatch- ers become the focus of debate for reasons outside their control—nothing to support their efforts save, perhaps, for the training required to operate the equipment. The National Academies of Emergency Dispatch® (NAED) believes that every state needs regulations for certifi cation, training, and continuing education. For that reason, there is a model statute available on the NAED website. The essential elements are listed here, further down in the story. For more information, go to www.emergency- dispatch.org/ and click on resources. The map accompanying this story sum- marizes legislation available from the states and pertaining specifically to emergency medical, fi re, or police dispatching. The sum- maries give the state’s requirements, such as whether certifi cation is required and if the state mandates the use of protocol. We do not vouch for the effectiveness or relevance EMD Training of any state’s legislation. Our research was and/or preliminary in nature and compiled with- Requirements out judgment of a program’s merit. If we’ve missed what your state is doing or given an inaccurate summary, let us know and we’ll include that information, and any updates, in future issues of The Journal.

NAED model The basic enabling legislation areas are: • Purpose • Authority and Responsibility • Recognition Certification • Defi nitions (continued on page 36)

34 THE JOURNAL | emergencydispatch.org Montana—A plan in accordance to an Oregon—Criteria for the use of two-way enhanced 9-1-1 system, including training communications and procedures for sum- Protocol (basic telecommunicator and use of written moning and dispatching aid or automated EMD protocols) Pennsylvania—Requires EMD protocols at Nevada—Requirements for EMD all communications centers Protection. certifi cation Tennessee—Requirements for dispatch Protocol legislation takes New Hampshire—EMD licensing training requirements Utah—Coordination of a statewide emer- the gambling out New Jersey—Certifi cation through a gency medical communications system, of emergency dispatch 24-hour EMD training course approved by including dispatch centers the state No matter which Maryland county Public Virginia—Statewide emergency medical Service Answering Point (PSAP) receives a New Mexico—Dispatch training care system to improve dispatching, includ- 9-1-1 call involving a medical emergency, you’ll requirements ing EMD training, and center accreditation get the same method of response. North Carolina—EMD educational program West Virginia—Mandatory criminal Protocol. requirements background check to act as director of an The call process is standard; it’s consis- emergency dispatch center and 40-hour North Dakota—EMD curriculum tent and across the board, said Gordon Deans, requirements training program for dispatchers within one year of hire executive director, Maryland Emergency Num- ber Systems Board (ENSB). “A process depending on the person answering the phone, without something in place, is sort of like rolling the dice,” he said. “You don’t want that. Protocol gives you the sense you’re doing things right.” Maryland’s Emergency Medical Service (EMS) dispatchers must be EMD licensed and recognized as an EMD by a state-approved EMD program. They must also demonstrate Prearrival competence in medical protocols. Instructions Although communications centers directors can use a protocol system of their choosing, as long as it meets approved standards, the ENSB offers funding up to the level of Priority Dispatch System™ products. Only two centers have selected alternative systems for their medical calls. The ENSB is now working toward full adoption of the fi re and police protocols. A standard system has taken some con- Licensing vincing, at least for the current push for state- wide use of fi re and police protocols. The EMD protocol was adopted as part of the state’s standard for incident management. It’s written into law. The ENSB has taken on the task for statewide use of the fi re and police protocols and—in their drive—are fi nding that acceptance boils down to the same reasons EMD protocol has become such an important asset to communications centers. EPD Training “You talk about nationally accepted stan- dards and you see eyes light up,” he said. “People in the communications centers want things to go well. They’re overjoyed when there’s a system or process for handling the liability issues.” Quality The ENSB training subcommittee put States without any dispatch legislation Process together a plan that shows local administra- tors the value of the protocol. They brought (continued on page 37)

THE JOURNAL | May/June 2009 35 DUCKS (continued from page 34) Within the area of authority and respon- sibility lie the 13 essential elements requiring Tragic Inspiration. regulations by the states. These are: Grieving families turn to advocacy 1. Certifi cation of EMDs, EFDs, and EPDs, and their agencies following death of loved one 2. Recertifi cation of EMDs, EFDs, and Nathan Lee believed 9-1-1 was a per- while home with her two children, then EPDs, and their agencies fect system for getting emergency help two years old and six months. The two 3. Training and EMD, EFD, and EPD cur- in case his family ever needed it. He also boys were found in their bedroom at 3:20 riculum standards believed there was a standard process that afternoon when Nathan returned 4. Instructor standards every communications center followed. home from work. He immediately called “Most people do,” he said. “But not me. police to report his wife missing. 5. Continuing Dispatch Education Not anymore.” Even more disturbing surrounding the standards While Lee doesn’t hesitate to credit the circumstances of the murder was the lack 6. Approval of the Emergency Medical good work that many emergency dispatch- of response to 9-1-1 calls made to two (police, fi re) Dispatch Priority Reference ers do provide, the two communications communications centers while Denise System protocols selected by the agency centers contacted the day his wife Denise was still alive. One call came from Denise 7. Required use of an approved protocol was abducted and murdered gave woefully using the suspect’s cell phone and another reference system inadequate responses. from motorist Janet Kowalski, who called 8. Compliance standards for the protocol And now he’s set on doing something 9-1-1 to report what appeared to be a child reference system used about it. screaming and pounding on the window In March 2008, two months after of a blue or green Camaro. 9. Quality assurance (including random Denise’s murder, Nathan and Sean Low- Mark Lee said the mistakes that case review and performance reporting) ery established the Denise Amber Lee occurred the day Denise was kidnapped 10. Program governing standards for poli- Foundation. It is dedicated to improving emphasize the need for improvement. cies and procedures operations at emergency centers nation- “That night in that call center they had 11. Medical direction and oversight ally to make sure they are well staffed with to let some people go home early for fear trained personnel and have all the equip- 12. Prevention of misrepresentation ment necessary to perform their jobs as 13. Revocation and suspension of well as humanly possible. certifi cation Nathan and his father Mark Lee said the Within the area of recognition lie five foundation’s creation does not represent an essential elements the state should address. indictment of the profession. Rather, the These are: foundation symbolizes their approach for 1. Certifi cation programs driving change in public policy. The many they’ve met since his wife’s murder agree 2. Recertifi cation programs with their policy initiative once they realize 3. Continuing Dispatch Education they’re not out “to get them.” programs “The biggest struggle is making sure 4. Instructor programs they understand that I want to help,” Nathan said. “It’s the system that needs 5. Accreditation programs changing. There needs to be uniformity Within the area of defi nitions, the follow- in the way calls are answered.” ing should be addressed within the legislation or within the section describing administrative System failure rules: advanced life support provider, continu- Nathan’s view of the 9-1-1 system of overtime; they were having some phone ing dispatch education, compliance to proto- changed forever on Jan. 17, 2008, when issues and other things,” he said. “That is col, department, dispatch life support (DLS), his wife Denise Amber Lee was abducted what we are really trying to prevent from emergency medical dispatcher (EMD), emer- from their home in North Port, a city in happening again, that way there is never gency fi re dispatcher (EFD), emergency police west coastal Florida, and murdered. Her another 9-1-1 call that doesn’t receive the dispatcher (EPD), Pre-arrival Instructions, body was found two days later in a shallow correct response.” Post-arrival Instructions, quality assurance grave in a remote section of the city. The The two dispatchers answering the and improvement program, vehicle response suspect, Michael Lee King, was scheduled calls were later suspended without pay mode, and vehicle response confi guration. for trial in March. for failing to send patrol units to respond For more information, or for assistance in The sensational case made national to the critical call about a possible abduc- creating or improving your state’s dispatch headlines because of the horrifi c nature tion in progress. They were also handed legislation, contact NAED Associate Direc- of the crime—the suspect was a stranger six months of disciplinary probation and tor Carlynn Page. J to the family and Denise was abducted spent 12 hours in remedial training.

36 THE JOURNAL | emergencydispatch.org PROTECTION (continued from page 35) Legislative initiative [Department of Health]. The act estab- in NAED representatives to dispel misconcep- Call mismanagement led Nathan and lishes criteria for training dispatchers tions, such as the time a list of questions could Charlotte County Sheriff’s Offi ce Sgt. but without funding and mandates, it add to response time, and to emphasize quality Rick Goff, Denise’s father, to make an might never happen in many sections of assurance and its effect on calltaking. impassioned plea in support of legisla- the state. “The end result is a better quality call,” he tion regarding the certifi cation and train- Mark Lee said the foundation, among said. “We have to convince them that protocol ing of Florida’s emergency dispatchers. others, is out to change that. would get them the information necessary for Gov. Charlie Crist signed the measure “Many came forward during the an effi cient and timely response.” in May 2008; its effective date was Oct. process to sponsor bills making training A pilot program testing fi re and police pro- 1, 2008. mandatory,” he said. “Public sentiment is tocol in four counties provided a valuable les- “Those who were there to oppose pushing in the same direction.” son in effective communication, Deans said. the measure never got up to talk,” Mark A problem, of course, is funding for He shared the following tips for those who Lee said. “It was a very emotional speech a mandatory training program, especially want to effect change on the local, state, and on the behalf of Denise.” during the current economic crisis. national levels: Their story was so compelling Mark Lee, however, points to the fund- that the legislation became known as ing available through E9-1-1 legislation. Local the Denise Amber Lee Act. The bill’s “It has to be done,” he said. “Human • Prepare a plan explaining exactly what you beginning, however, dates back before error does happen but when the error want to accomplish and how your recom- Denise’s death to proposals for dispatch results in the death of one of our citi- mendations will accomplish the goals certifi cation introduced in both the Flor- zens, it’s unacceptable.” • Once you get buy-in from the various stake- ida Senate and House. Proposed legislation that would cre- holders, appoint a liaison who will maintain The rule, added to Florida’s Medical ate a mandatory curriculum of training contact; provide updates and progress Telecommunications and Transporta- of public safety dispatchers failed to reports before being asked tion Act, has all the makings for legis- win support during this year’s (2009) • Invest in a quality assurance program; you lation putting dispatchers at the same session. Still standing is the voluntary want an objective approach to evaluating level of qualifi cation as other emergency training program, a proposal that would call processing and in a deliverable format service workers. make certification mandatory by Oct. • Develop good relationships with local 12, 2012, and a pledge to bring the train- media; getting the word out when good ing legislation back to Florida legislators things happen can only work in your favor In the Name of Denise. Nathan Lee has devoted his life to the cause of emergency next time around. dispatch since the murder of his wife Denise “Legislation is a slow-moving pro- State and National Amber Lee last year in North Port, Fla. cess,” said Mark Lee, who talked about • When talking with state and national legis- his disappointment over the state’s fail- lators, identify clearly your subject of inter- ure to pass a training requirement and est (in this case, regulations governing a proposed certification requirement emergency dispatch) that wouldn’t go into effect for another • State why you are concerned about the three years. topic and how the issue affects the public The only consolation Mark Lee fi nds • Share personal experience (tell a story is the time element. about a CPR save or helping people leave “It gives us until next year to tweak a burning building) the proposal,” he said. • Put thoughts into your own words (if send- The Lee and Goff families would ing a letter or e-mail, be original—too many most likely prefer to talk about some- nearly identical messages may look as if thing other than the events surround- you’re part of a pressure campaign) ing that tragic day in January 2008. But, • Establish an ongoing relationship (become With one major exception. as Mark Lee said, they continue to tell a name your representative remembers) The certification and training Denise’s story for the good of any person • Get involved in the legislative process outlined in section 401.465 are not who may someday need the assistance of (attend meetings and give testimony at required; it’s optional and up to each emergency services. public hearings set up to gather informa- county’s discretion. While other sec- “This is a total learning experience,” tion about emergency dispatch) tions in the law—such as those applying he said. “We were a normal, happy family • Make sure you do your homework about to paramedics and emergency medical until this happened but our loss pushes the issue and follow-up when asked for technicians—include words such as us to get something positive done.” more information “must” and “required” when it comes Nathan said it’s something Denise • Keep others apprised of what you’re doing to licensure, the language applying to would want them to do. and work together to get the message dispatchers simply states that a person “She would want me to fix what’s heard by many “who desires” certifi cation or recertifi - wrong so no one else would get hurt like • Finally, don’t give up; most legislation takes cation “may apply” to the department she did,” he said. J more than one session J

THE JOURNAL | May/June 2009 37 I;FJ;C8;H((Å(* OEHA

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A web-based public safety toolkit designed to teach communities how to use 9-1-1 effectively and promote 9-1-1 educa- tion can be downloaded for local distribu- tion at www.intergraph.com/publicsafety/ toolkit.aspx. The software data company Intergraph produced the kit in partnership with the National Academies of Emergency Dispatch® (NAED), 9-1-1 Industry Alli- ance, Association of Public-Safety Com- Moving in the Fast Lane. Jerry Overton shifted his career from a national to an international focus as an advocate for ambu- lance driving safety. munications Officials (APCO), E9-1-1 Institute, National Association of State Overton, who’s leaving RAA after 19 hindrance than a lifesaver in EMS. Numer- 911 Administrators (NASA), and National years, will remain entrenched in public ous studies have shown that emergency Emergency Number Association (NENA). safety, though shifting his message to the medical vehicle collisions (EMVCs) due voice of safety inside ambulances around to excessive speed are the cause of injury, the world. Road Safety International Inc. death, property damage, and, consequently, 1. Call 9-1-1 only in an emergency 9-1-1 2. State your address: ______Guide Emergency is the developer of a “black box” monitor- signifi cant delays in transporting patients ing system used in emergency vehicles and to the hospital. ______driver safety programs. The system collects For example, according to the results 3. State your phone number: real time data and in increasingly louder of a study published in the April 2, 2003, ______tones alerts the driver when the ambulance edition of JAMA (Journal of the American 4. Explain the emergency is exceeding parameters of safe operation. Medical Association), during 1991-2000, 5. Do not hang up until told to do so The RAA has been using the device in 300 fatal crashes occurred involving its ambulances since 1993. occupied ambulances, resulting in the The kit contains: The monitoring and instant feedback deaths of 82 ambulance occupants and • A citizens’ guide for requesting system has significantly reduced acci- 275 occupants of other vehicles and emergency services dents related to excessive speed or other pedestrians. The 300 crashes involved a indicators of unsafe driving in emergency total of 816 ambulance occupants. The • A design template for a magnet response, according to Road Safety Inter- majority of ambulance crashes occurred with quick reference tips for calling national Inc. Founder Larry Selditz. during emergency use. (SL Proudfoot, NT 9-1-1 (created to fi t on a standard- “We’re not trying to make medics look Romano, MS, TG Bobick, Ph.D., PH Moore, sized refi rgerator magnet) like the little old lady from Pasadena,” he Div of Safety Research, National Institute said. “But medics tend to get into an adren- for Occupational Safety and Health, CDC. aline rush. They’re thinking of a lot of Ambulance Crash-Related Injuries Among Jerry Overton changes things because of what they’re approach- Emergency Medical Services Workers—United lanes in public safety ing. The device keeps the medic focused, States, 1991-2002) making sure they get to the scene in a safe Overton, who has long been a pro- and responsible manner.” ponent of the National Academies of Jerry Overton is taking his public safety Overton has found that the device also Emergency Dispatch® (NAED) protocol message across the country. The long-time cuts down on the cost and downtime asso- system, said the move offers multiple chal- director of the Richmond Ambulance ciated with preventive maintenance. lenges while keeping him in the front lines Authority (RAA) is leaving the East Coast “There’s less wear and tear on the vehi- of emergency response, patient care, and city-operated EMS system to continue his cle,” he said. their related technologies. career as president and chief executive The “black box” device is in line with “I’m very excited about the change,” he offi cer of West Coast-based Road Safety studies showing that the speed associated said. “This gives me another way to con- International Inc. with immediate response is more often a tribute to public safety.”

THE JOURNAL | May/June 2009 39 911Lifeline proves vital understanding of the profession. online courses and he wants to encourage link in dispatch Wallach expected the life span of the making donations toward dispatch educa- website to surpass the average length of 44 tion scholarships. to 75 days most sites endure, considering all The future looks bright, he said. The 911Lifeline website is just what the site has to offer. The higher than average “This is turning out even better than I emergency dispatchers wanted. return rate to join the forums and blogs lets had anticipated,” Wallach said. “We’re rec- Or, at least, it seems that way. him know the site does provide what he set ognized. People know they can come to the The site is not only coming up on its out to do—create a space that serves as the site and fi nd it all.” third year but it also enjoys a higher than voice and face of 9-1-1 communications. average number of repeat visitors. Catching Wallach a little off guard, Michael Wallach founded 911Lifeline however, is the number of people using the Seven’s the lucky number in April 2006 as an online forum for tele- site daily for an on-the-job resource. The communicators and related professionals. online research library has become the hit Within months, he doubled the features to of dispatch. The U.K.’s Emergency Call Prioritisa- meet the requests of a growing audience The popularity really shouldn’t surprise tion Advisory Group (ECPAG) has granted and added a website to support a national Wallach. He has spent literally hundreds of its seventh consecutive approval to the membership organization. hours gathering information for the library Advanced Medical Priority Dispatch Sys- Today’s members have access to all and he’s organized the material by topic. tem® (AMPDS). sorts of information such as recorded His advisory team represents a range of ECPAG is an independent committee of interviews with 9-1-1 professionals, proj- 9-1-1 expertise, which adds to the breadth clinical experts responsible for advising the ect consultation, and peer written and of resources available. Department of Health on issues relating to reviewed articles. He also provides the With things going so well, Wallach natu- categorization of emergency calls, chaired public with access to the same chat rooms rally plans site enhancements. Once 501C by Peter Bradley, the U.K. Department of and forums as members to enhance their (nonprofi t) status is achieved, he will add Health national ambulance adviser and chief

RECOGNITION key roles in implementing EMD Quality Assurance programs at their agencies. The Denco Area 9-1-1 District (Texas) Board of Directors established the scholar- ship program nine years ago in honor of Dr. Groff, a primary care physician who served on the Denco board from 1992 until his death in August 2000. The living memo- rial commemorates his interest in bringing professional quality EMD training to tele- communicators within the district. Denco Area 9-1-1 District Training and Education Manager Patty Cross said the conference energizes the dispatchers. As part of the bargain, they incorporate something about what they learned at the conference in a training exercise available

Two For The Road. Denco Area 9-1-1 District communications professionals Jack Cottongame, left, and Stacy Inscore traveled to to others in the Denco system. Navigator 2009 courtesy of Dr. Allen Groff EMD scholarships. “I see a lot of enthusiasm when people come back,” said Cross, who has worked at Good attitude and protocol Denco for the past 19 years. “For many, it’s a chance to re-energize.” compliance net trip to Vegas Denco Area 9-1-1 District was cre- ated through voter referendum in 1987 Positive personalities coupled with Cottongame, Highland Village Police Dept. to establish an enhanced 9-1-1 telephone compliance to the MPDS® protocols communications manager, received the service for the citizens of Denton County landed two Texans from the Denco Area Dr. Allen Groff EMD scholarships based and all of the City of Carrollton. In fi scal 9-1-1 District in colorful downtown Las on requirements looking at everything year 2008, Denco 9-1-1 maintained the Vegas for Navigator 2009. from job performance to overall attitude. addresses and routing databases to deliver Stacy Inscore, Denton County Sheriff’s In addition to achieving high compliance 309,721 calls to the 11 Public Safety Offi ce 9-1-1 telecommunicator, and Jack scores, Inscore and Cottongame played Answering Points that it serves. J

40 THE JOURNAL | emergencydispatch.org RECOGNITION executive of the London Ambulance Service. ECPAG’s latest approval—a signature of excellence in the 999 environment—came Early retirement leaves those after extensive review of v12 codes recently released by the International Academies of left behind reeling Emergency Dispatch® (IAED). Centers in virtually every U.K. Ambu- lance Trust rely on the AMPDS for its safe, Winsett’s 38 years of public safety patient-centered method. The hundreds of service in Livingston County include two millions of callers during the past 30 years fi rsts—he was the fi rst emergency program the protocol has been in use have received manager and the fi rst 9-1-1 director. the best options and advice from trained Pollock began working in the 9-1-1 and certifi ed emergency medical dispatchers industry in 1991 and after retiring from (EMDs). In 2002, the London Ambulance the Michigan State Police he went to Service became the world’s largest Accredited work for Livingston County for 10 years Center of Excellence (ACE). as its fi rst assistant 9-1-1 director. The two were the team behind orga- nizing a centralized center from the Kickoff generates ground up, which meant the nuts and lots of interest bolts of remodeling the existing center, installing equipment and infrastructure, and shouldering administrative jobs such A national coalition organized to promote as balancing budgets, scheduling, and fi ll- technology-based networks among commu- Bruce Pollack ing out the paperwork. nications centers nationally filled an office “That was Dick Winsett and Bruce space and its phone lines during its recent Pollock who put that whole thing kickoff meeting. together from scratch,” Arbic said. “They The Advanced Emergency Communica- literally were a one-two punch for Liv- tions (AEC) Coalition, the next generation ingston County. I can’t overstate the loss of the advocacy group COMCARE, plans to of talent.” focus on policymaking through an alliance of As part of their remodeling plan, the national, state, and local organizations, includ- two top administrators put their office ing FirstWatch, the American Ambulance only one door down from the core of Association (AAA), the Emergency Nurses dispatch operations. It was a door, Arbic Association, the National Association of said, seldom closed to what was happen- EMS Managers, and the National Academies ing on the fl oor. of Emergency Dispatch® (NAED). “Winsett came in every morning and Together, the diverse members of AEC reviewed activity reports from the previ- will “develop and improve upon lifesaving ser- ous 24 hours,” Arbic said. “When things vices, procedures, training sessions, and tools occurred over the weekend, he insisted that maximize value for emergency respond- that the staff call him at home and keep ers and health care providers,” according to Dick Winsett him informed.” the organization’s website. Issues the coali- But it’s not only their “know-how” and tion proposes to tackle include incorporating hands-on dedication the center will miss. electronic medical records into fi rst response, The opportunity for Bruce Pollack and There is also their mastery of networking. mobile security devices, dispatch education Dick Winsett to take early retirement in Pollock and Winsett knew everything and and training, and other topics as they relate to March 2009 from the Livingston County everyone—at least it seemed that way— the delivery of 9-1-1 communications. (Mich.) 911 Central Dispatch center including area politicians, county offi cials, Telematics—the blending of computers hasn’t meant a silver lining for those they and township supervisors. They also had and wireless telecommunications technolo- left behind. a major say in selecting the people run- gies to improve information sharing over vast “You don’t fully appreciate how much ning the dispatch center. networks—will be chief among its concerns somebody was doing for you until they’re “The things they did for this county as was its predecessor COMCARE. However, not here to do it anymore,” said Don during that time frame from when the Arbic, who replaced retiree Winsett as center started until today were tremen- the center’s director. “I don’t even know dous,” Arbic said. “We’re doing the very how you begin to make up for that kind best that we can but wow, that’s a lot to of loss.” try to pick up.” J

THE JOURNAL | May/June 2009 41 AEC Chair Richard Taylor cautioned it cer- More information about the decision It’s a possibility that doesn’t sit well tainly won’t be the only priority. triage is available from the CDC at http:// with telecommunication advocates. Their “What data is of importance to emer- www.cdc.gov/fi eldtriage/. concern is not only over costly litigation gency response, from the communications defense but, also, the subsequent delay in center up to the PSAP, remains an issue and providing the technology to locate E911 an important one,” Taylor said. “We want to Potential litigation callers using wireless devices (cell phones). go broader. We don’t want to pigeonhole.” threatens E911 mandate “Imagine a future filled with dozens of For the past 10 years the COMCARE such cases against you, your customers, and Emergency Response Alliance has been the vendor members of associations,” said a voice of advocacy for improving emer- Recent litigation asserting virtually unlim- Kim Robert Scovill, senior director, Legal and gency communications and promoting ited patent rights in any location-based tech- Governmental Affairs for TeleCommunica- “end-to-end interoperability.” In 2008, the nology service could threaten or, at the very tion Systems Inc. in Annapolis, Md. “Even COMCARE Board voted to reorganize and least, put a hold on the ability of wireless car- the threat of litigation has a chilling effect on approached the Washington, D.C., consult- riers to comply with national mandates. the innovation of location-based services.” ing firm e-Copernicus to help establish a broader-reaching organization to continue RECOGNITION COMCARE’s work. For more information, go to the AEC Snowstorm no excuse to skip website at http://aeccoalition.org. awards celebration Trauma triage protocol Jeffrey Edwards thought a major revised snowstorm in the forecast might keep him away from an awards ceremony he figured would add yet another letter of The Centers for Disease Control and commendation to his already acclamation Prevention (CDC) is testing a revised fi eld heavy personnel fi le. trauma triage protocol with pre-hospital “I told the sheriff the weather may and emergency medicine groups. The rec- keep me from attending,” said Edwards, ommendations designed to standardize a sergeant and senior communications decision-making at the injury scene also officer with the Ontario County (N.Y.) offer guidance on new technologies such Sheriff’s Department. “I was basically told as vehicle crash notifi cation systems, which I would be there.” alert local emergency services that an acci- The commendation turned out to be dent has occurred and automatically sum- a much bigger deal than Edwards had mon assistance. anticipated. He was honored as Ontario Other key revisions include: County’s deputy of the year, a prize now Let It Snow. Weather doesn’t deter Jeffrey Edwards’ award. • Recommendations for the right sharing the same shelf as the communica- place and right time to best use tor of the year award he received several Instructor Development course as well crucial emergency care resources months later from the New York State as the Communication Training Offi cer Sheriffs’ Association Institute. course. Edwards is also involved in the • Vehicle crash damage criteria to “It’s been a good year,” Edwards said, New York State Sheriffs’ Association 911 help determine which patients may although a bit humbling for a guy who got Accreditation program and he designed require care at a trauma center into a public service career 20 years ago and maintains the Ontario County Sheriff A 36-member panel representing emer- for anything but the attention. Department’s website. gency medical services, emergency medi- Or the money, he is quick to add. “I do a bunch of extraneous things,” he cine, trauma surgery, and public health “It’s hard to be the one selected since said. “I need the variety.” revised this field triage decision scheme everybody works together,” he said. Edwards, of Canandaigua, Texas, originally developed by the American Col- “We’re a team, performing a service.” started at the 9-1-1 center in 1993. Over lege of Surgeons Committee on Trauma. The extra tasks Edwards takes on set the years, he has aided in the delivery of The CDC convened the panel with him apart, at least according to the cita- babies and among his most memorable support from the National Highway Traf- tion describing his contributions to emer- calls, he led emergency crews to a man fi c Safety Administration (NHTSA). CDC- gency communications. who had fallen 80 feet to the ground supported research shows that the overall The sheriffs’ association noted from a railroad trestle during a snowmo- risk of death was 25 percent lower when Edwards as a master instructor for the bile outing. The man survived. Edwards is care was provided at a Level 1 trauma cen- Finger Lakes Law Enforcement Academy, now the graveyard shift supervisor, where ter than when it was provided at a non- where his class load includes a two-week, he oversees fi ve to six dispatchers during trauma center. basic dispatcher course. He oversees the the busiest time of the day. J

42 THE JOURNAL | emergencydispatch.org The Federal Communications Com- cations processing centers. While NENA mission (FCC) requires wireless carriers to does not endorse any specifi c brand of pro- implement Enhanced 911 services, including tocol, the association bases its recommen- progressively more accurate location-based dation on what the National Academies of services. The mandate is part of the Wire- Emergency Dispatch® (NAED) has believed less Communications and Public Safety Act all along: call-processing protocol is the of 1999 (9-1-1 Act), established to improve most effective way to ensure the highest public safety through a nationwide, seam- standard of care for both the public and less communications infrastructure for emergency responders. emergency services. NENA’s protocol model, posted on its To offset the potential disruption in website in March 2009, cites the benefi ts meeting the FCC E911 regulation, advo- of protocol use as well as the cost factors cates asked Congress for legislation that involved with implementation and a sug- protects carriers against lawsuits claiming gested quality assurance process. Typical unlimited patents rights in any location- costs listed include purchase of a protocol based technology services. The E911 provi- system, training, certifi cation, public educa- sion was added to patent reform legislation tion, and recurring costs such as software that moved from the Senate Judiciary Com- licensing and maintenance agreements. mittee to the full Senate in April 2009. There are also recommendations to develop Revisions to patent law haven’t been targeted continuing dispatch education pro- confined just to the emergency services grams and a feedback loop to keep dispatch- industry. A variety of interest groups had ers aware of their performance. pushed for more than six years for legisla- The model is a voluntary standard devel- tion that would deter frivolous lawsuits and oped by a team with representatives from limit damages. several organizations, including the NAED. The amended patent law took effect It is the first time NENA has endorsed in May 2009 and the provision relating to structured calltaking for emergency com- E911 services applied to any unsettled com- munications centers. pensation claim fi led in the United States “They wanted to say something about Court of Federal Claims, beginning with the “This is not what you expect,” he said. structured calltaking, and hadn’t,” said Pri- date Jan. 1, 2007. “When you walk away from this course ority Dispatch Corp.™ (PDC) Consultant you’re going to approach emergency situ- Greg Scott, who with PDC Consultant Eric ations with a new perspective and a better Parry drafted the proposal the committee EMS training offers ability to identify hazards. I also have a bet- subsequently approved. “They wanted hands-on approach ter understanding of what other emergency something out there showing people how to to response role departments—such as fi refi ghters—experi- take calls, along with the elements involved ence during an emergency.” and the type of training needed.” CDP training for state, local, and tribal Parry and Scott drafted the model rec- The Center for Domestic Prepared- responders is fully funded by the Federal ommendation for NENA not only because ness (CDP) offers a three-day EMS course Emergency Management Agency (FEMA), of their NAED affi liation but, also, because preparing all emergency responders for the a component of the U.S. Department of of the leadership role they want NENA to effects of chemical and biological agents— Homeland Security. Round-trip air and take in call processing. including radiation and explosives injuries. ground transportation, lodging, and meals “There’s no drought on the number of The course gives responders the oppor- are provided at no cost to responders or bungled calls,” said Parry, NENA Educa- tunity to reinforce the EMS course triage their agency or jurisdiction. tion Advisory Board chair. “We need this and decontamination procedures while in For more information, go to http://cdp. and NENA has to be the one out front in an authentic toxic nerve agent environ- dhs.gov or call 866-213-9553. support of federally mandated standards.” ment. The course includes training at the —CDP Public Affairs Offi ce The recommended protocol standards Chemical, Ordnance, Biological and Radio- are available from the NENA website at logical Training Facility (COBRATF) in http://www.nena.org/standards/opera- Anniston, Ala. NENA endorses protocol tions/emergency-call-processing. The link The EMS course has been part of CDP for call processing brings you to a summary of the protocol. training courses for the past four years. Each While you’re at it, check out NENA’s rede- class can accommodate 40 responders. signed website. The new look makes it Michael Montgomery, an EMT dis- The National Emergency Number Asso- easier to fi nd the latest in 9-1-1 news and patcher from Oklahoma City, Okla., found ciation (NENA) has recommended the information, including EMS guidance in the course particularly relevant to emer- adoption of standardized call-processing swine fl u, meeting notices, and business and gency communications. protocols for use by emergency communi- industry updates. J

THE JOURNAL | May/June 2009 43 J STORK STORIES J DISPATCH IN ACTION YourSpace

Babe in Arms. Tricia Bellis welcomes her fi rst chance to hold Veronica, baby of David and Karla Gross.

Name: Tricia Bellis Comm. Center: Acadian Ambulance, Lafayette, La.

and David Gross. The family’s home in Gautier, Miss., is not exactly a stone’s throw from Acadian Ambulance in Lafayette, La., where Bellis works as a dispatcher. The two locations are separated by several hundred miles, although that’s nothing compared to the distance that day separating Karla from her husband. David is part of a construction brigade for the U.S. Navy and was serving in Iraq the day his second daughter was born. They had done the math prior to his departure and, consequently, scheduled back up in the form of Karla’s mother, Hilda Aguilar, and sister, Jael Castro. The drama started shortly after mid- night. Gross’ water broke, signaling an immediate departure to the hospital at Kee- sler Air Force Base in Gulfport, La. Before they got to the door, Gross went into heavy labor, precipitating a call that led to Acadian Ambulance, which covers the county in Mississippi where the Gross family lives. Bellis said everything sounded so calm, and it remained that way throughout the 10 minutes she stayed on the line, up until the time paramedics walked into the house. “It’s almost hard to imagine,” Bellis said. “You’d never know a baby was on the way from listening to them. They sounded so J STORKSTORIES calm and it all happened so quickly.” Gross had taken the phone and was relaying the birthing Pre-Arrival Instruc- Making a Joyful Sound. Baby’s tions in Spanish to her mother. She was translating from English at the same time fi rst cry was welcome music she was delivering her baby. Veronica was born after the second contraction and Bellis to Louisiana dispatcher was privy to the sound she said trumps the elation she felt from offering assistance to EMD Tricia Bellis thought fi eld response At least that was until baby Veronica victims of Hurricane Katrina. during Hurricane Katrina would be the entered her life from one state over. “I thought nothing could top what I saw apex of her emergency services career. Veronica is the second child for Karla there, until I heard the baby cry,” she said.

44 THE JOURNAL | emergencydispatch.org “The feeling was absolutely incredible.” “Mom now brags about being here to out. She was alone, so if she would have Two weeks later Bellis had the oppor- help,” Gross said. “No one believes her passed out, I wouldn’t have been able to tunity to meet Karla, Veronica, and big until she shows them the pictures of her help her or the baby.” sister 15-month-old Hannah during a trip newborn granddaughter.” Fralish received a stork pin and an out- made in honor of the event. The same goes for dad, who gets a standing service certifi cate for her actions “She didn’t let the baby go,” said Julie steady stream of pictures of his newborn to assist the 23-year-old fi rst-time mother Mahfouz, the Acadian Ambulance public daughter over the Internet; he listened to in delivering her baby. relations and marketing supervisor who the recorded audio of her birth, compli- “Stacey did an excellent job,” Scheppf arranged the introductions. “Dispatchers ments of Acadian Ambulance. said. “Her kind, confi dent, and understand- rarely get to do the entire birth so I wanted “I’ve held the baby up to the phone so ing demeanor was crucial in the delivery of to make this an occasion.” he can hear her,” Gross said. “He gets emo- a healthy baby boy.” Gross and her mom were no less tional. We’ll never be able to thank Tricia Fralish is happy to have been part of delighted with the way things happened. enough for her help.” J an event heralding the arrival of someone into the world. “As medical dispatchers, we are a part of seeing people leave this world, so I was Repeat After Me. Persistence happy to be a part of someone entering this world,” she said. “A unique part of our moves caller from fear to confi dence job is being able to help deliver a baby, and yet keep our hands clean the whole time.” The title of Lamaze coach wasn’t part and E911 supervisor. “It’s always in the back This was Fralish’s first delivery and of the job description EMD Stacey Fral- of your mind that this could go really good with this recent addition, the Outagamie ish signed on to when she was hired three or really bad in an instant.” County Sheriff’s Department Communi- years ago by the Outagamie County (Wis.) For Fralish, the instant came at 3:23 cations Center has aided in the delivery of Sheriff’s Department Communications p.m. on Jan. 7, 2009. An obviously dis- 10 babies—three girls and seven boys— Center. traught woman was calling from her home since 1995. J But it was a title she figured might in rural Outagamie County. She was alone Article was submitted by Sgt. Barbara J. Scheppf and Kati Stah- apply someday. and her baby was on its way. mann, Outagamie County Sheriff’s Department Communica- “Dispatchers know that every call can be In a moment’s time, Fralish became the tions Center, Wis. an emergency,” said Sgt. Barbara J. Scheppf, Lamaze coach, doctor, and the only one EMD coordinator/quality assurance chair who could help, Scheppf said. Fralish also became an expert on repeti- tive persistence. Listen to a Pin Name: Stacey Fralish “Usually when you hear screams like Comm. Center: Outagamie County that, it’s not a good thing,” Fralish said. Drop. Emergency Sheriff’s Department ”Although the pain was understandable, I Communications Center had to keep telling her to stop screaming responders wait in long enough to get her information. Once we got to the instructions, I kept using silent anticipation repetitive persistence to keep her focused on what she should be doing, and that Name: Roisin McComish really seemed to help.” Comm. Center: Calgary Public Safety The baby delivered in less than four Communications minutes from the start of the call. But when there was no cry right away, Fralish patiently instructed the mother on what The room was so quiet that the crowd to do next. After what seemed like an eter- gathering around Calgary Public Safety nity, the infant’s cry could be heard over Communications EMD Roisin McComish the phone prior to the ambulance’s arrival. could hear the click of the keys on her key- Fralish knew there were still steps to take board. The air held every word. to make sure both mom and baby were OK “There must have been 20 people listen- before relaxing. ing,” said EMD Janice Chalmers, who stood The Pre-Arrival Instructions were an poised in anticipation of what was about to asset, Fralish said. happen. “Everyone was silent, listening to “I felt confi dent that the medical pro- what she was doing.” tocol was going to help me,” she said. “The The event—two years ago—was a piv- only time I got really worried was when otal day for Calgary Public Safety Com- Stacey Fralish mom kept saying she was going to pass munications. By the time it was over, the

THE JOURNAL | May/June 2009 45 J STORKSTORIES then recently certifi ed EMDs were party to the delivery of the center’s fi rst and sec- ond baby using the childbirth and delivery Playing for Time. Mom’s hand at Pre-Arrival Instructions. For mom and dad, learning the number solitaire fails to postpone baby of babies they were expecting was some- thing they had only found out that day and they neglected to mention it at the start Haupert wasn’t exaggerating. Baby Jus- Name: Jessica Sullivan of the call. tin arrived within one minute of the call “Dad informed her [McComish] it Comm. Center: Boca Raton Police and as Sullivan dispatched a fi re-rescue crew was twins,” Chalmers said. “She calmly Fire Rescue Communications Center to the house. By the time they arrived, a put down the phone and said a few words clean and dry towel had been wrapped before going back to the caller saying, ‘OK, around Justin, and the shoelace that had sir, we are going to do this all over again.’” A game of solitaire on the computer kept dad’s shoe tied was now clenching the The second baby was breech and pre- may be better than a hot bath to augment baby’s umbilical cord closed. sented with the umbilical cord wrapped labor. At least, so it seems for Teresa Hau- “I can’t believe it, that it happened so around his neck. McComish was just fi n- pert of Boca Raton, Fla. fast,” Haupert said during the call, before ishing the instructions for pulling the cord Haupert was awakened close to 4 a.m. paramedics made it to their door. “Why over the baby’s head when the paramedics on March 29 from irregular pains she fi g- did she have only two contractions?” arrived at their door. ured were an indication of the baby to “Sometimes it just happens that quick,” McComish, as Chalmers recalled, gave come but not at that hour. She slipped out Sullivan said. “She may have had them dur- the set of instructions a second go around of bed, hoping not to disturb the sleep of ing the night without realizing it.” as if she had done the same a million times husband Kenn Haupert, and crept to the Paramedics transported mom and before. She seemed calm and was able to computer to play a game of solitaire to baby to Boca Raton Community Hospital, provide the instructions against a back- wile away the contractions. where they spent the day before returning ground of encouraging words rising from The baby was not keen on her attempts home bearing a certifi cate listing Kenn as an audience awed by the situation and to extend his father’s rest. The contrac- both father and assistant at delivery. McComish’s continued self-control. tions escalated during the hour Teresa While this wasn’t Sullivan’s fi rst deliv- spent at the computer, and shortly after ery call, it was the first time she heard a 5 a.m. her frantic cries from the adjoining baby she had helped deliver let out the wel- room jostled Haupert from his slumber. come to the world cry. Sullivan received a He grabbed the phone, and from the letter of commendation citing her calming background noise Boca Raton 9-1-1 EMD influence from Boca Raton Police Chief Jessica Sullivan could guess the assistance Dan Alexander and the good feeling that he was seeking as soon as she picked up comes from a call well delivered. the phone. “It was great,” Sullivan said. “A very “My wife is having a baby right NOW,” amazing call.” J an obviously panicked Haupert shouted Article was submitted by Michael O’Neil, division chief, Boca Raton Police and Fire Rescue Communications Center. Roisin McComish into the receiver.

McComish, on the other hand, remem- bers feeling all but calm and controlled during the seven-minute call. “I was a deer in the headlight once it was over,” she said. “I had to step outside. My nerves were shattered.” The two dispatchers played the tape over and over that day for those who were there during the call and others who stopped by the center once hearing about the sensational twin birth. “It made us feel so great about being an EMS dispatcher,” Chalmers said. “We went home that day with smiles on our faces, sat- isfi ed a good job was done and empowering the next shift for their day of challenges.” J Article was submitted by EMD Janice Chalmers. Jessica Sullivan

46 THE JOURNAL | emergencydispatch.org The speed of delivery, however, did not stem the crisis. Moments after the baby was Tense Seconds. delivered, the frantic parent reported a “bro- ken” cord. The umbilical cord had ruptured Ruptured cord at the time of delivery for reasons unknown to MacPherson. Although this was her fi rst adds alarm to experience with this type of complication, already anxious she knew the baby could die from blood loss without immediate intervention. situation MacPherson rapidly turned to the instructions for a ruptured cord and told the caller to clench the bleeding area of the Name: Joan MacPherson cord and squeeze it tightly for one min- Comm. Center: Medicine Hat Regional ute. Once the bleeding had stopped, the Joan MacPherson 911 Communications Centre caller tied one string above the rupture and another string below. It was about this “It was a good call. Everything turned out time that the ambulance arrived. great.” The early morning call to the Medicine “What a relief that was,” MacPherson Medicine Hat Regional 911 Com- Hat Regional 911 Communications Centre said. “They had trouble fi nding the place munications is the world’s first and only in Alberta, Canada, was almost over before so I wasn’t sure how long it was going to tri-ACE, having achieved triple accredi- EMD Joan MacPherson began—at least take them.” tation from the International Academies when it comes to a speedy delivery. This was the first call the center had of Emergency Dispatch® (IAED) at their “Everything happened so fast,” said received involving a birth complicated by a center in police, fi re, and medical. J Colleen Bachewich, Operations and Qual- ruptured umbilical cord, Bachewich said. Article was submitted by Colleen Bachewich, coordinator, ity Assurance coordinator. “Maybe 30 sec- “Complications are always scary, espe- Operations and Quality Assurance, Medicine Hat Regional 911 onds at the most.” cially when they involve a birth,” she said. Communications Centre.

Never a Dull Moment. Baby times two plus accidental choking make day to remember

Cheektowaga (N.Y.) Police Department there. Dean was nearly halfway through his 911 Emergency Communications Center Name: Edward Dean day when the second major crisis came in. dispatchers fi eld so many calls during any Comm. Center: Cheektowaga A male was choking from what appeared to given shift that it’s not unusual for them to Police Department 911 Emergency be a severe blockage. forget the details of any one call, no matter Communications Center “The caller was starting to panic,” Dean how dire the situation. said. “It wasn’t dislodging and all I could do Just ask EMD Edward Dean. was have her keep the Heimlich going.” The 20-year veteran of the busy cen- first shift started on Dec. 28, 2008, had Dean’s persistence paid off. Although he ter in north central Erie County routinely Dean calming the sister of an expectant does not recall what had caused the chok- answers 60 to 70 calls per eight-hour shift mom with contractions progressing so ing, it was out and the victim was breathing from an area that includes an international quickly that a trip to the hospital was out by the time paramedics arrived. airport, shopping malls, business parks, of the question. Dean switched to the Pre- “It’s not every day something like this railroad yards, and the usual trappings of Arrival Instructions (PAIs) for childbirth happens,” said Paul Hockwater, director of densely populated residential communities. and once he heard the newborn crying fi g- the communications center. “Ed’s use of the So, why would he remember exactly what ured the hard part was over. PAIs and his constant reassurance provided happened one day, three days after Christ- “I thought everything was fi ne until she a good outcome for everyone.” mas, nearly six months after the date? said another one was coming,” he said. “I Dean, who is past fi re chief for the vol- Well, when was the last time you deliv- took a deep breath and said ‘OK. Let’s get unteer Pine Hill Hose Company, was hon- ered twins and applied the Heimlich maneu- ready for the next one.’” ored for his assistance to the new mom and ver for a choking victim in the space of a Dean repeated the PAIs and paramedics choking victim at the annual Cheektowaga morning, while also bracing for calls antici- arrived moments later to fi nd mom and sis- Police Department Awards Banquet held in pated from an approaching winter storm? ter cradling the newborns. He disconnected March 2009. J

“We were jamming,” Dean said. the call. Article was submitted by Paul Hockwater, director, Cheektowaga The baby call that came shortly after The morning shift didn’t let up from Police Department 911 Emergency Communications Center.

THE JOURNAL | May/June 2009 47 J STORKSTORIES J DISPATCHINACTION Every Textbook Example. Man follows Parent’s dispatcher’s instructions Nightmare. to the letter following car birth CPR instruc- “Mom was calm; she wasn’t bouncing Name: K.C. Tull off the walls,” he said. “I was checking tions puts Comm. Center: Sussex County with him to fi nd out from her on anything breath back Emergency Operations Center, remotely close to the afterbirth so that Del. way I could tell him what to do with that into baby next. That was the only thing we didn’t get to.” The child delivery call K.C. Tull The keys to the call’s success—mother Sonnette Buzbee remembers going answered during the morning hours of and child were fi ne—was the caller doing to work Nov. 28, 2008, feeling “kind Sept. 6, 2008, is a textbook example of precisely what Tull told him and his con- of bummed” because her friend had to how things should go thanks to a coop- tinuous dialogue to keep Tull in the loop. cancel plans to visit over the Thanks- erative dad following every step in the dis- “He explained what he was doing, along giving holiday. patcher’s instructions. with [explaining to his wife] why I was giv- The Mobile (Ala.) Fire-Rescue The caller was driving his wife to the ing him the instructions,” Tull said. “That Department EMD admits the disap- hospital, when he was forced to pull over way, she didn’t freak out wondering what pointment fl eeting and all but vanished to acknowledge the whims of his soon-to- in the world he was doing with a shoestring when 45 minutes into her shift she be-born baby. when we came to that part.” took a call from someone in a clearly The father called 9-1-1 and reached While Tull has taken other childbirth frightening and desperate situation. Tull, a Sussex County (Del.) Emergency calls, none stand out like this one does. The “My baby is not breathing,” the Operations Center shift supervisor, who delivery went just liked he had learned and caller cried into the phone. “You’ve got stayed on the line providing post-delivery practiced although without a baby, when to hurry and get someone here right instructions while waiting the several min- he took the EMD course. now. She’s not breathing.” utes for responders to arrive. “It was probably one of the better calls Buzbee made it through Case Entry “He went right along with me the whole I’ve actually ever taken in a situation like and moved quickly through the proto- way,” Tull said. “I mean, didn’t miss a beat. that,” he said. “In the 13 years that I’ve col into Pre-Arrival Instructions (PAIs) Bless his heart he was a huffi ng and a puff- been here that guy did a tremendous job. for—as the father described—his unre- ing trying to get his shoestring out of his He was very calm, cool, and collected for sponsive baby. shoe to tie the umbilical cord off with.” the most part. I could tell he was very “Do something,” he pleaded. Tull had the man find something to stressed what was going on, but he did His baby’s lips had turned blue and wrap the baby in for warmth, and he kept everything and then some of what I asked her skin was turning purple. She was tabs on the mother’s condition. him to do.” J bleeding from the nose. Within seconds, Buzbee had the father starting mouth-to-mouth resuscitation, followed by chest com- pressions using his index and middle fi ngers. His wife took over the phone while he anxiously continued chest compressions, never stopping despite his voice trembling from the fear over his baby’s condition. Three minutes into the call, and into the third round of chest compres- sions, the baby let out a cry. The call disconnected once paramedics arrive at the family’s door. “It was very emotional,” said Buz- bee, who was later honored at a Mobile City Council meeting for her calm and K.C. Tull professional handling of the emergency.

48 THE JOURNAL | emergencydispatch.org Coming Up!

Your next issue of The Journal will provide sto- ries you surely won’t want to miss. In addition to the valuable continuing dispatch education (CDE) articles you rely upon for keeping credentials up- to-date, you can look forward to timely news briefs about the industry as well as the latest information about advances in protocol and software. And, while we’re on the subject of stories, let’s not forget that The Journal needs you! We are partic- ularly interested in stories of how the fi re and police protocols have helped you and the caller during an emergency situation. We’ll be running these fi rst- person stories in an issue slated for later this year.

Unforgettable Call We welcome your touching or hair-raising dis- patch story involving an extraordinary or otherwise unusual call. Don’t just think tragic circumstances. Our readers also value stories describing funny situ- ations—your discretion is appreciated.

Real Life Submit a story about something you think your peers may want to read about. Maybe your center has held a fundraiser for a charitable cause or maybe someone at your center has achieved something out- side of work you’d like to share. You can also send us a suggestion and we’ll do the follow up and story.

Dispatch in Action, Dispatch Frontline Send us stories highlighting how protocol helped in an emergency, such as providing the Pre-Arrival Instructions to follow in case of sudden cardiac arrest, house fire, or some other incident involving dispatch and the fire, Ventilations On police, or medical CDE explains excep January/February 2009 protocols. I[[oW_dXWXo HURRICANE! Centers batten “I was at the edge of my chair the but nothing, she said, prepares you down the hatches whole time thinking there was only for a call like that. This was the fi rst How to Submit The National Academies of Emergency Dispatch a certain amount of time I would be time she’d given instructions for It’s easy. You able to help.” infant CPR and the fi rst time she was can either send THEJOURNAL The baby survived and was as still on the phone to hear a positive us an article (500 healthy after the cardiac attack as she response from the person she was words or less) or was before. Buzbee later heard the assisting. In this case, she heard the you can send us a cause was a bacterial infection. She baby crying. story idea and we’ll has yet to meet the family, although The positive outcome only reaf- follow up. In either the parents were the ones initiating fi rms Buzbee’s career choice and her case, include your full recognition from both the Mobile dedication to helping people, even the name, the name of your Fire-Rescue Department and coun- ones she will never meet. communications center, cil members. “When something like this comes and your contact infor- “Maybe once this is more in the along, it makes you reevaluate why mation (e-mail and phone past, we’ll have that opportunity,” you do this, the good things dispatch- number) Send everything she said. ers do,” she said. “Knowing I was to Audrey.fraizer@emer- Buzbee had been on the job for there to help save this child’s life is a gencydispatch.org. We will three years when the call came in tremendous boost in my life, also.” J contact you.

THE JOURNAL | May/June 2009 49 J LASTPAGEFIRST Not Quite But Almost. Fire station was drive-in for baby’s delivery

Former EMD Robert Keddington Fire Department (SLCFD) hadn’t liked said. “I thought maybe someone would be remembers the birth of his 29-year-old the look on Linda’s face 30 minutes earlier there to help.” daughter Jaime like it was yesterday. when she was standing in the family’s living According to a story published the But, in this case, it wasn’t a situation room. Contractions fi ve minutes in dura- next day in the Salt Lake City based Deseret easily lost to memory. tion were coming two minutes apart. News, the chance panned out. Keddington’s Jaime entered this world from the front “I grabbed the children and took them relentless buzzing of the front doorbell at seat of a Ford Pinto curbside at Salt Lake over to the neighbors,” Keddington said. the Salt Lake City Fire Station awakened City (Utah) Fire Department Station #12 From there, it was getting Linda into the the two paramedics—John Zimmerman following her dad’s mad dash steering the car for a trip to the hospital—the same one and Steve Higgs—sleeping inside. subcompact 75 miles per hour from a sub- urb some 15 miles away. “I remember that day all too well,” said “It wasn’t a good thing for me Keddington, now the principal of Park Ele- mentary School in the city of Spanish Fork, when my wife said the baby was about 50 miles south of Salt Lake City. “I had to act fast.” coming.” –Robert Keddington The emergency medical protocols were still in their infancy (no pun intended) when the childbirth and delivery Pre- where they had gone earlier only to be sent They ran out and Zimmerman crawled Arrival Instructions (PAIs) would have home with a verdict of false labor. into the Pinto with Mrs. Keddington to truly come in handy for Robert and Linda But as things would have it, the baby deliver the baby in 35-degree weather. Keddington, then the parents of four chil- wasn’t going to wait. Keddington, familiar Higgs waited in the heated ambulance dren and one on the way. It was shortly with fi re station schedules because of his ready to whisk mom and baby to nearby after 6 a.m. on Wednesday, April 2, 1980, own job in dispatch, took a chance. Holy Cross Hospital. Jaime’s delivery took and the former EMD for the Salt Lake City “I pulled into the closest station,” he all of two minutes.

50 THE JOURNAL | emergencydispatch.org Linda later claimed her husband was Keddington, once both an EMD and an two to a shift, one answering the calls more nervous than she was that morning. EMT, left dispatching about 20 years ago and the other dispatching the equipment. But, then again, she had other distractions after earning his education degree from the Classified ads published in a local news- such as maneuvering about in the front seat University of Utah. He taught elementary paper during the same month as Jaime’s of a Pinto to deliver the 8-pound, 13-ounce school for many years and now serves as a birth showed a starting wage of $4/hour girl the newspaper story described as “quite principal at a school in one of Utah’s fastest for an entry-level dispatcher, which was chubby, with a little bit of hair.” growing public school districts. well above the national minimum wage Robert said Linda considers Jaime’s The 14 years Keddington spent in dis- of $3.10/hour. Most ads for dispatchers birth the best of her eventual seven deliver- patch were at least a dozen more than he required applicants to be able to type. ies, contrary to his recollection of his mad had anticipated, but those things happen Dr. Clawson was the fi re surgeon for the dash along the Salt Lake corridor. when raising a family, working full time, SLCFD and in 1980 he was one year into “It wasn’t a good thing for me when my and trying to find the perfect college testing his protocol system at the commu- wife said the baby was coming,” he said. major. The years there also coincided with nications center. By the time Keddington “That wasn’t something I wanted to hear.” the introduction of emergency medical switched careers and left the SLCFD, the Jaime, who turned 29 in April 2009, protocol at the SLCFD communications National Academy of Emergency Medical is the mother of four children. Her hus- center. Dispatch® (NAEMD) had been established band Spencer Taylor is in the U.S. Army “There was a doctor,” Keddington to develop and maintain the protocol now and scheduled to serve his third tour of recalled during a recent phone interview. used in centers worldwide. duty in Iraq. The fire station where they “I think his name was Clawson, yes, Jeff Keddington said he liked using the pro- stopped—144 West 700 South—has been Clawson. He had established this unique tocol system, having worked at the com- since converted into a podiatry center. The type of protocol system on fl ip charts and munications center both before and after Sisters of the Holy Cross ran the hospital we’d fl ip to a chart depending on what the its introduction. where Jaime was taken to until 1994. It is caller told us. I believe it was the first of “It was a good thing, especially for the now a regional center with more than 500 its kind.” new people,” he said. “It took the guess physicians on staff. In those days, dispatchers worked work out of what we were doing.” J CONTRIBUTORS

MALCOLM WOOLLARD MICHAEL SPATH BRETT PATTERSON

is professor of Pre-hospital and Emergency began 9-1-1 dispatching more than 16 is an Academics & Standards Associate Care at Coventry University (U.K.), an hon- years ago. He is the senior public safety for the NAED. His role primarily involves orary consultant paramedic with West dispatcher at the Sunnyvale Department protocol research, standards, and evo- Midlands and South East Coast Ambulance of Public Safety in Sunnyvale, Calif. lution. He is also an instructor trainer Services, a registered nurse, and an adjunct Spath is a NAED®-certified quality- and QI consultant. Brett is a member professor at Charles Sturt University, Aus- improvement instructor for police, fi re, of the NAED College of Fellows, Stan- tralia. A former deputy chief ambulance and medical protocols. He co-chairs dards Council, and Rules Group, and is offi cer, he is a member of the Trauma Care the NAED Call Processing board and chairman of the Research Council. He Council and the Joint Royal Colleges Ambu- is a member of the Q Standards Task became a paramedic in 1981 and began lance Liaison Committee and its Clinical Force. Spath and his wife Tammy own a career in emergency communications Guidelines Group. He is an associate editor and operate EDQ911, a quality manage- in 1987. Prior to accepting a position with for the Emergency Medicine Journal, ment consulting service. the NAED, he spent 10 years in Pinellas is an examiner for the diploma in Immedi- County, Fla. ate Medical Care (RCSEd), and is the chair QUALITY ASSURANCE PAGE 16 of the College of Paramedics. He’s earned FAQ PAGE 17 master’s degrees in Public Health, Educa- tion, and Business Administration.

ALL PROTOCOL CDE PAGE 12

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