INTERNATIONAL ACADEMIES OF EMERGENCY DISPATCH JANUARY | FEBRUARY 2017

FIGHT STRESS ONE NAVIGATOR HAS GETTING HELP TO 13 | BREATH AT A TIME 16 | GONE GLOBAL 42 | REMOTE SPOTS

PAGE | 22 REACHING OUT TO THE PUBLIC

SPECIAL INSERT 2016 IAED ANNUAL REPORT INSIDE iaedjournal.org THE INTERNATIONAL ACADEMIES OF EMERGENCY DISPATCH® 2016 ANNUAL REPORT

annualreport.iaedjournal.org OUR YEAR IN REVIEW

80 million calls a year using the MPDS®, FPDS®, and PPDS® 80,000,000+

62,000 MEMBERS WORLDWIDE

87,000 certifications in 46 countries 8 NAVIGATORs 21 languages

Number of Communication Centers: 2,650 129 39 23 11 11 11 The United States Canada The United Kingdom China Australia The Netherlands Italy

THE INTERNATIONAL ACADEMIES OF EMERGENCY DISPATCH BY THE NUMBERS:

Worldwide In 2016 The Medical Council of Standards introduced MPDS version 13.0 Certifications & Recertifications

Certifications: Recertifications: This update included the following enhancements: 20,981 21,896 • Ability to provide NARCAN instructions over the phone • Chemical Suicide identification protocol • Hands-on-chest “Fast Track” feature Number of CDE • Instructions for epinephrine auto-injector quizzes received • Stroke Diagnostic Tool added to Headache Protocol and graded: 16,959 • New Miscarriage instruction series

For an in depth break down of the new features v13.0 has to offer visit annualreport.iaedjournal.org. TheThe JournalJournal of of Emergency Emergency Dispatch Dispatch

Annual Pages 396,000 ReadershipAnnual 240 Annually Pages 396,000 Readership 240 Annually Articles CDE Articles 90ArticlesAnnually 12 & QuizzesCDE Articles Annually & Quizzes 90The Journal website launched this year! For exclusive content, visit http://iaedjournal.org12 The Journal website launched this year! For exclusive content, visit http://iaedjournal.org

Tri-ACEs Worldwide: 7 Medical, Fire, and Police Accreditation

Alpharetta Department Prince George’s County of Public Safety Public Safety Communications Alpharetta, Georgia Bowie, Maryland DISPATCHERS Boone County Salt Lake Valley Emergency Joint Communications Communications (VECC) OF THE YEAR Columbia, Missouri West Valley City, Utah

Harford County Department Salt Lake City 911 Bureau Lisa Siew Phei Fun Bethany O’Leary of Emergency Services Salt Lake City, Utah Asia Australasia Forest Hill, Maryland Xia Jing Harald Sulzbach Johnson County E-9-1-1 China Europe Communications Smithfield, North Carolina Mahmoud Mohamed Osman Middle East Medical ACEs: Fire ACEs: Police ACEs: ECNS™ ACEs: Louisa Ansell Letisha Ghanbari 147 31 6 1 United Kingdom United States

To access our full review visit annualreport.iaedjournal.org THIS IS MY CALL // THIS IS MY STORY // THIS IS OUR JOURNEY // THIS MY STORY // THIS IS MY CALL THIS IS

unfold Message from the Board of Trustees

Dear Academy Members, Friends, and Volunteers:

The purpose of the International Academies of Emergency Dispatch—“the Acade- my”—is to provide Emergency Dispatchers with the support they need to get the right help, to the right place, in the right way, at the right time—and do the right thing until “the troops” arrive. This year, again, you helped us achieve that purpose.

Our members are at the heart of what we do, the front-line heroes who take more than 80 million calls a year using the Academy protocols. This year, not only did we reach 62,000 members in 46 countries, but we certified an amazing 16,585 new members and recertified 19,477 more.

We could not hope to reach so many people without the tireless work of our instruc- tors. As of this year, more than 1,000 Academy instructors spent tens of thousands of hours traveling and teaching so that new dispatchers would know exactly how to use the protocols right the first time, and every time. In addition, this year has seen the Academy’s first move into web-based training, with the EMD Advancement Series™ celebrating its 17th year by moving online.

And of course, when it comes to providing the right help, to the right place, at the right time, quality assurance is critical. We are fortunate to have more than 7,000 ED- Qs™ in four disciplines bringing the Academy’s insistence on quality calltaking and accurate call prioritization to centers the world over.

Finally, in order to do dispatch right, we have to know what “right” is. That means research, and lots of it. This year marked the fourth anniversary of the Annals of Emergency Dispatch & Response, the world’s only peer-reviewed journal of dispatch research. Moreover, the volunteer members of the Council of Research and the Stan- dards Councils ensure that the Academy continues to develop protocol systems tied to the highest standards of care and practice, and the Curriculum Boards ensure that it is taught and understood correctly.

In short, our hats are off to you for being a key part of the world’s largest community of evidence-based practitioners of emergency dispatch. We believe what you do is import- ant enough to do right, and everything we do is dedicated to helping you get there!

Thank you.

Jerry Overton Chairman, Board of Trustees

annualreport.iaedjournal.org • •• COLUMNS JANUARY • FEBRUARY 2017 | VOL. 21 NO. 1

6 | contributors 7 | the skinny 8 | dear reader 9 | research 10 | ask doc 11 | from the emd side 12 | technically speaking 13 | guest writer 14 | q&a • •• SECTIONS BEST PRACTICES

16 | navigator prelude 18 | faq 20 | ace achievers

ON TRACK

32 | medical cde 36 | police cde 40 | blast from the past • •• FEATURES YOUR SPACE 22 | COMMUNITY OUTREACH 42 | cripple creek save Communication centers around the world are stepping 43 | recognition/honoring up their efforts in helping communities understand the telecommunicators critical importance of emergency dispatching.

CASE EXIT 28 | TRAINING Want your communication center to run like a well- 46 | the olympic spirit oiled machine? In order for all the components to work efficiently, you must implement an effective training program.

Follow IAED on social media.

The following U.S. patents may apply to portions of the MPDS or software depicted in this periodical: 5,857,966; 5,989,187; 6,004,266; 6,010,451; 6,053,864; 6,076,065; 6,078,894; 6,106,459; 6,607,481; 7,106,835; 7,428,301; 7,645,234. The PPDS is protected by U.S. patent 7,436,937. FPDS patents are pending. Other U.S. and foreign patents pending. Protocol-related terminology in this text is additionally copyrighted within each of the NAED’s discipline-specific protocols. Original MPDS, FPDS, and PPDS copyrights established in September 1979, August 2000, and August 2001, respectively. Subsequent editions and supporting material copyrighted as issued. Portions of this periodical come from material previously copyrighted beginning in 1979 through the present.

iaedjournal.org | THE JOURNAL 5 ••• CONTRIBUTORS

Art is a software instructor and IAED™-certified ED-Q™ instructor for Priority Dispatch Corp.™ He has been a fire and EMS dispatcher for 18 years and works at Union County Regional Communications in Westfield, New Jersey, USA. Art has been involved in 911 telecommunicator training and medical quality follow assurance since 1999.

ART BRAUNSCHWEIGER 11 | FROM THE EMD SIDE us

Daphanie has been a dispatcher with Martin County Fire Rescue in ™ Stuart, Florida, USA, since 2005, Follow IAED on where she is currently the Training Coordinator. She is a licensed Emergency Medical Technician social media for and has a bachelor’s degree in public safety. She is passionate about the mental well-being of amazing her dispatch family, including awareness of the various triggers that are inherent in this career. dispatcher stories

DAPHANIE BAILES 44 | YOUR SPACE and news, ACE announcements, Mary is with the Washington State Patrol where, for the past 10-plus years, she has worked prizes, and more! as a dispatcher, chief training officer, supervisor, and training program supervisor. She is certified by the International Association of Chiefs of Police as a Leadership in Police Organizations instructor. She is also a certified instructor for the Washington Criminal Justice Training Commission. MARY RANSIER 13 | GUEST WRITER

Jennifer is a Fire/EMS Dispatch Supervisor for Seminole County Fire Department, Sanford, Florida, USA. She has been dispatching

since 2004, with six of those LinkedIn: International Academies of Emergency Dispatch years in a supervisory position. Twitter: @TheIAED Passion for the dispatch world Facebook: International Academies of Emergency Dispatch and the people who work in it keeps her motivated.

JENNIFER SIRACUSA 45 | YOUR SPACE

6 THE JOURNAL | iaedjournal.org THE SKINNY •••

INTERNATIONAL INTERNATIONAL OFFICES ACADEMIES OF AUSTRALASIAN OFFICE EMERGENCY DISPATCH 011-61-3-9806-1772 110 South Regent Street, 8th Floor CANADIAN OFFICE Salt Lake City, UT 84111 USA 1-514-910-1301 USA/Canada toll-free: 800-960-6236 Intl/Local: 801-359-6916 EUROPEAN OFFICE Fax: 801-359-0996 011-43-5337-66248 www.emergencydispatch.org ITALIAN OFFICE [email protected] 011-39-011-1988-7151 MALAYSIAN OFFICE 011-603-2168-4798 U.K. OFFICE 011-44-0-117-934-9732 HAPPY NEW YEAR IAED JOURNAL STAFF CREATIVE DIRECTOR SENIOR DESIGNER Here’s a resolution we’d love you to keep Kris Christensen Berg Serina Nielson MANAGING EDITOR PRINT AND LICENSING ADMINISTRATOR Audrey Fraizer Jess Cook Audrey Fraizer TECHNICAL EDITOR WEB DESIGNER Brett A. Patterson Dave Tyler DIGITAL & SOCIAL MEDIA CONTENT EDITOR INTERNATIONAL TRANSLATORS Michael Rigert Hien Cam Giuditta Easthope o kick off the year’s first issue of the Journal, we thought SENIOR EDITOR Veronika Fagerer Josh McFadden Abbas Hamed it would be rewarding to provide strategies to keep your COPY EDITOR Lu Huan Heather Darata Michel Looyé Marco Mora New Year’s resolutions. Sara Scott T ASSISTANT EDITORS Audrey Gonzalez Zhang Shengdong Why? Studies have found that people who make resolutions Rebecca Tuft Carolyn Turcotte are 10 times more likely to change their behavior and, perhaps, ACADEMY STAFF enjoy longer and healthier lives. ASSOCIATE DIRECTOR | U.K. DIRECTOR OF INTERNATIONAL Beverley Logan RELATIONS It’s also our way of inviting members to make 2017 the year Amelia Clawson ASSOCIATE DIRECTOR | AUSTRALASIA Peter Hamilton ASSOCIATE DIRECTOR, MEMBER of contributing your talents to the Journal—printed and online. SERVICES ACADEMICS & STANDARDS ASSOCIATE Arabella VanBeuge Brett A. Patterson Since this is a resolution we want you to keep, we’ve included a ASSOCIATE DIRECTOR, INSTRUCTOR ASSOCIATE DIRECTOR OF ACCREDITATION SERVICES process that will surely place you among the elite 8 percent who Kim Rigden Bonni Stockman actually achieve their resolution. BOARDS & COUNCILS Step 1: Make your resolution specific. ACCREDITATION BOARD CHAIR CURRICULUM COUNCIL CHAIRS Jerry Overton Victoria Maguire (Medical/EMD Board) The Journal’s readers delight in the good news about emergency Mike Thompson (Fire/EFD Board) ALLIANCE BOARD CHAIR Jaci Fox (Police/EPD Board) Keith Griffiths Susi Marsan (ETC Board) dispatch: how your training and people skills contribute to the CERTIFICATION BOARD CHAIR Deanna Mateo-Mih (ED-Q Board) Pamela Stewart Gigi Marshall (ECNS Board) outcome and chain of response. These stories are most often COUNCIL OF STANDARDS CHAIRS RESEARCH COUNCIL CHAIR Brett A. Patterson (Medical/EMD) Tracey Barron published in the Your Space section, and in this issue we have two Gary Galasso (Fire/EFD) Tamra Wiggins (Police/EPD) articles in honor of National Public Safety Telecommunicators Michael Spath (ED-Q) Conrad Fivaz, MD (ECNS) Week. Regular contributor Art Braunschweiger (The EMD Side)

COLLEGE OF FELLOWS and new contributor Jennifer Siracusa offer their takes on the trials CHAIR UNITED STATES of emergency dispatch and the recognition the profession deserves. Marc Gay, Chair Bill Auchterlonie (Kansas) Robert Bass, MD (Maryland) Step 2: Schedule your goals and plan for the year. AUSTRALASIA | SOUTH AMERICA Catherine L. Bishop (Michigan) Frank Archer, MD (Australia) Christopher W. Bradford (Florida) Andrew K. Bacon, MD (Australia) (Emeritus) Geoff Cady (California) You might want to schedule a deadline for an article you’d like Peter Lockie (New Zealand) Steven M. Carlo (New York) Peter Pilon (Australia) Jeff Clawson, MD (Utah) Phil Coco (Connecticut) to develop. Regular columnist Daphanie Bailes keeps tabs on the CANADA Chip Darius, MA (Connecticut) Drew Burgwin (Br. Columbia) Kate Dernocoeur (Michigan) deadline, and in this issue she provides a tremendous response to Claude Desrosiers (Québec) Norm Dinerman, MD (Maine) Douglas Eyolfson, MD (Manitoba) Patricia J. Dukes, MICT (Hawaii) Martin Friedberg, MD (Ontario) James V. Dunford, MD (California) the Office of Management and Budget’s refusal to reclassify public Marc Gay (Québec) (Emeritus) Conrad Fivaz, MD (Utah) Marie Leroux, RN (Québec) (Emeritus) Gary Galasso (Utah) safety communication into the protective service. You could also Paul Morck (Alberta) Keith Griffiths (California) Wayne Smith, MD (Québec) Jeffrey R. Grunow, MSN (Utah) Darren Judd (Utah) write about an event, such as a baby delivery or cardiac arrest save. EUROPE Alexander Kuehl, MD, MPH (New York) André Baumann (Germany) (Emeritus) Jan de Nooij, MD (Netherlands) James Lake (South Carolina) Or, if you have a great idea but would rather leave the writing to Gianluca Ghiselli, MD (Italy) James Lanier (Florida) Jean-marc Labourey, MD (France) Stephen L’Heureux (New Hampshire) the Journal staff, we’ll be glad to do that for you. For example, in Harm van de Pas, MD (Netherlands) Victoria A. Maguire (Michigan) (Emeritus) Bernhard Segall, MD (Austria) Sheila Malone (Indiana) Gernot Vergeiner (Austria) (Emeritus) Susi Marsan (Georgia) (Emeritus) this issue we feature a couple from Victor, Colorado, USA, and it Christine Wägli (Switzerland) Robert L. Martin (California) UNITED KINGDOM | IRELAND Dave Massengale (California) all started through a call telling us about the event from the Cripple Trevor Baldwin (England) Jerry L. Overton (Utah) Tracey Barron (England) Eric Parry, ENP (Utah) Creek (Colo.) communication center. Michael Delaney (Ireland) Rick W. Patrick (Pennsylvania) Louise Ganley (England) Brett A. Patterson (Florida) James Gummett (England) (Emeritus) Paul E. Pepe, MD, MPH (Texas) Step 3: Acknowledge the sense of accomplishment. Chris Hartley-Sharpe (England) Ross Rutschman (Oregon) (Emeritus) Andy Heward (England) Joe Ryan, MD (Nevada) You’ve probably heard it before: Celebrating even small Stuart Ide (England) Doug Smith-Lee (Washington) Peter Keating (Ireland) Tom Somers (California) Ray Lunt (England) Paul Stiegler, MD (Wisconsin) successes will help keep you motivated and energized. A growing Andy Newton (England) (Emeritus) Michael Thompson (Utah) Janette K. Turner (England) Carl C. Van Cott (North Carolina) Arthur H. Yancey, II, MD, MPH (Georgia) body of research associates cultivating positive emotions on a Tina Young (Colorado) regular basis with psychological well-being, resilience, and living The Journal of Emergency Dispatch is the official bimonthly publication of the International Academies of Emergency Dispatch® (IAED™), a nonprofit, standard-setting organization promoting safe and effective emergency dispatch services longer. And living longer means you’ll be here next year, and the worldwide. Comprised of three allied academies for medical, fire, and police dispatching, the IAED supports first-responder- related research, unified protocol application, legislation for emergency call-center regulation, and strengthening the emergency dispatch community through education, certification, and accreditation. years after next, to continue writing for the Journal. J General IAED membership, which includes a Journal subscription, is available for $19 annually, $35 for two years, or $49 for three years. Non-member subscriptions are available for $25 annually. By meeting certain requirements, certified membership is provided for qualified individual applicants. Accredited Center of Excellence status is also available to dispatch agencies that comply with Academy standards. ©2017 IAED. All rights reserved.

iaedjournal.org | THE JOURNAL 7 ••• dear reader

MY 911 EXPERIENCES Always there when you’re needed

Josh McFadden

hankfully, I haven’t needed your and the fire was doused in no time. I never (PPDS®). I wanted to thank the dispatcher help very often. found out what started it but suspect it for following the protocols. T Don’t take that the wrong had something to do with the late-night Needless to say, the police showed up way. I’m sure you understand what I firework show the day before. promptly and had a little chat with the mean. After all, no one wants to be in a Earlier this year I was observing boys and the neighbor boy’s mother. I situation where they need to call 911, but the activities of the neighbors across didn’t see the neighbor’s friend ever again, anyone is sure glad you’re there when emergencies arise. I’ve called 911 three times in my life. The first time occurred when I was about 6. My older brother and I were messing around on the phone. We had just gotten done dialing a random number (which happened to ring some guy in Norway) when we figured it would be a great idea to dial that three-digit number we’d heard about so much in school. Apparently we had a lot of leisure time on our hands that day. We dialed the number; someone answered. My reaction: I quickly hung up. Naturally, a dispatcher called right back. Problem was, my mom answered the phone. Needless to say, I wasn’t allowed to touch the phone for a year. Plus, I was deprived of my favorite cartoons for a whole week. The two other times I’ve called 911 were for legitimate reasons. Sixteen years ago, my wife and I were enjoying a quiet Sunday dinner in our apartment. At one point, I glanced out the window toward the parking lot of the complex and saw orange flames shooting out the street (my wife said I was spying). and the disturbing drug activity seemed of the dumpster. The fire was close to The mischievous teenage boy, who was to have come to an end. some parked cars and not too far from known throughout the neighborhood My examples are relatively minor the nearest apartment. Who knew what for his antics, and a questionable-looking and tame compared with the calls you might have been in that dumpster that friend were conducting what I’ll call a take every day. Still, it was comforting could’ve increased the fire’s strength. business transaction. It wasn’t the type of to know that a skilled, well-trained I called 911 and explained the problem. business I wanted in my neighborhood. dispatcher was addressing my small issues. I remember being instructed not to try to When I made the call on this shady To think you handle situations like these, put the fire out. I was OK with that; my deal, the dispatcher walked me through and many more that are infinitely more garden hose wasn’t long enough anyway. I some instructions that were unmistakably urgent, is humbling. J stayed on the line until firefighters arrived, from the Police Priority Dispatch System™

8 THE JOURNAL | iaedjournal.org research •••

IMPROVE THE WORLD Research workshop leads to discovery, enlightenment

Tracey Barron

want you to write, type, or calendar the following dates: April 10 and I April 11, 2017. These are the dates of the inaugural Emergency Dispatch Research Workshop. To take advantage of this landmark event requires only a few steps. Register for the workshop, hosted by the International Academies of Emergency Dispatch® (IAED™) and the UCLA Center for Prehospital Care, and travel to New Orleans, Louisiana, USA, to participate. The workshop offers a unique hands-on opportunity to frame research into the further study of emergency dispatch, whether medical, police, or fire. Participants work in small beyond your ability or better left to the people pay attention to independent and groups to develop a plausible question experts. Maybe you fear peer rejection. effective sources of information collected and methodology. No prior research All of us have felt that way, and through a well-conceived scientific process experience is required. The sponsors still do occasionally, when conducting approach. In other words, when research is provide everything you need to succeed. research. But we’re here for you. We’ll conducted and applied properly, it can do The workshop is scheduled over help you break research proposals into a lot of good. We use research to make the two days. We will discuss the value of manageable studies and reasonable steps. world better. research, how research builds upon As a group, you will create a list of what Similarly, high-quality research into the work of others, and qualities that you need to do, and you will formulate emergency dispatch is crucial to the demonstrate good, sound research. your plan of attack for each step. You profession and the public. It provides Statisticians, the IAED, and UCLA will participate in an environment with important data to enhance police, fire, researchers, editors, and programmers will people who can provide the confidence and EMS case outcomes; improves the be available at your fingertips, ready to to pursue this project and future caller’s experience; assists in effective provide step-by-step support to identify research endeavors. decision-making; and ensures the viability research topics, design the projects, gather I like research. It’s not work to me. of emergency dispatch protocol. This is data, and perform statistical analysis. You Research is an opportunity to broaden my vital in our profession, where change is will leave well on your way to submitting knowledge and put new evidence into the constant and innovations are seemingly an abstract to the Academy’s peer- world. Even familiar topics in protocol introduced every day. reviewed scientific journal, the Annals and prehospital care interest me because Research moves us forward in of Emergency Dispatch & Response research substantiates the information or understanding and perfecting what (AEDR), or to any other referred journal points to a necessity to update what we we do. We need this understanding of of your choice. You could also leave ready presumed timely and relevant. protocol and its relation to public safety to organize a poster presentation for I know research is also a way to get an to create a viable future. Partnerships NAVIGATOR 2018. idea to the ears of the public and decision- forged through research lead to a Those leading the workshop will makers (such as the police chief, fire staggering amount of progress, and we are also help you get over a fear of research. chief, medical response team, and budget- eager for you to become a part of that. J Maybe you think research is an area makers). Despite what you might think,

iaedjournal.org | THE JOURNAL 9 ••• ask doc

PERSISTENT CASE ENTRY PDIs When frozen software perception is reality

Jeff Clawson, M.D.

Dr. Clawson: Ken: If Instructions pop up, and before Thank you for reaching out to us making the box slightly smaller width- continuing in ProQA®, dispatchers/ regarding your issue regarding closure/ wise to make it appear more as a box and calltakers need to click the red X to persistence of the Case Entry PDI box. not part of the Case Entry screen, which dismiss the red instructions box. This isn’t While this box can be closed via the red may help that perception; we will also always obvious, and if they don’t dismiss “X” box in the upper-right corner, we consider adding a “Close window” button the message box, they think they’re stuck designed it to also be closed in three other within the screen to identify beyond in unresponsive software. ways that are consistent with navigation doubt that it needs to be closed via any of This software design is sometimes within some other areas of the program. the five different methods. confusing, as the red box looks like an They are the: Again, thanks for contacting PDC™ instruction box, not an overlay box that 1. Escape button and the Academy with this issue, as this needs to be dismissed before continuing. 2. Space bar is how we evolve the protocol, software, Thanks, 3. Enter key and our QA processes. To date, there Ken Pitts It was done this way to allow folks have been over 10,000 modifications, Public Safety Systems Manager that are mainly keyboard users to be logic changes, and improvements in City of Cambridge, Emergency able to close it without reaching for the ProQA alone. Communications Department mouse. Personally, I prefer to use the Best regards and Happy Holiday Season Cambridge, Massachusetts, USA space bar, as it is the most movement to you, your family, and your center…Doc economical to utilize. We will consider P.S. If the above alterations are made, we will notify you of its availability in a future push of ProQA.

Dr. Clawson: Thank you for your response. And to be clear (and sorry if I belabor the issue), the fact that there are four or five methods to close theP DI box does little to help the calltaker who is unaware that there is a box that needs to be acknowledged and dismissed. They are in the middle of a cardiac call, and believe the software has frozen on them. Making the box slightly smaller or adding a “Close window” button should go a long way to avoid confusion. Thanks, Ken

Finally, the Doc adds: A software proof sheet was submitted on 12-27-16 to PDC Development to enact both of these suggested changes, which have since been done via Proof 6556. J

10 THE JOURNAL | iaedjournal.org from the emd side •••

THE INTERFACILITY PROTOCOLS Streamlining calls from medical facilities

Art Braunschweiger

any EMS agencies process calls respects, the fact the patient is currently Approval by an agency’s medical received from facilities staffed under the care of a medical professional. director is required before using either Mwith medical professionals. This brings us to an important protocol, and both protocols require that These calls are made by individuals cautionary note: Protocols 33 and 37 are response levels be locally defined and ranging in qualifications from unit not appropriate based on patient location authorized. In the case of Protocol 37, clerks to physicians, and they’re often alone. Use of either depends on not only the terms NURSE and DOCTOR must challenging for the EMD when the caller the ability but the availability of the be specifically defined and authorized and calltaker don’t understand each other’s needs. However, there are two protocols in the Medical Priority Dispatch System™ (MPDS®) that can help streamline patient assessment and call processing time: Protocols 33 and 37. Both are named Transfer/Interfacility/Palliative Care, and the latter is available exclusively in ProQA®. These Interfacility Protocols differ from the standard protocol, in part, because the decision regarding what resources to send is intended to rely on the joint evaluation of the EMD and the patient’s caregivers. In other words, we’re relying, in part, on the ability of the staff to accurately assess the patient’s clinical condition and transfer needs.1 For example, if chest pain Protocol 37 is reported, Key Question 6a on Protocol staff to assess and care for the patient. to ensure clinical confidence in caller 33 asks, “Could this be an MI (heart For instance, staffing varies by time of assessment. While specific facility approval attack)?” This type of question would not day. For example, while an assisted living isn’t required by the Academy, an agency appropriately be asked of a layperson. There facility may have registered nurses and/or may prudently choose to do so internally. are also questions to determine whether licensed practical nurses available during EMS agencies and responders should any special equipment or personnel are the day, nursing aides or lay caregivers consider the capabilities of both staff and necessary—a key consideration since a given may be the only staff available at night. facility before authorizing the use of these patient may require resources ranging from These qualifications differ considerably. specialized protocols. When properly a basic BLS crew to a critical care transport. Additionally, not all medical providers are implemented and applied, there’s no A second key difference is that no familiar with the different types of EMS question that interfacility call processing clinical Post-Dispatch or Pre-Arrival resources available locally. Therefore, there’s can be expedited and enhanced by taking Instructions (PDIs or PAIs) are required a caveat in the Additional Information advantage of these specialty protocols. by protocol. The caller is only advised section of Protocol 33 that reads: “It is not Both protocols require that the patient what type of response is being sent, to necessary to seek permission from the has been evaluated by a nurse or doctor, call back if the patient worsens and, nurse or doctor to upgrade the response although in Protocol 37 an agency’s in the case of Protocol 37, to have any level.” Similarly, if any doubt exists as to the medical director can authorize other levels advanced directives ready. This avoids ability of the staff to manage the emergency of licensure such as a physician assistant offering possibly unneeded or redundant they’re calling about, PDIs or PAIs from the to be considered a nurse or doctor for instructions and takes advantage of, and standard protocol should be offered. purposes of using this protocol. J

iaedjournal.org | THE JOURNAL 11 ••• technically speaking

DIG DEEPER I didn’t know ProQA could do that!

John Hancock

ave you ever owned a software software. It can do things that you might year of the patient’s birth in the designated program, PC, laptop, or phone have never known it could do. Unlike my field. Town squares all over the world Hand used it so often that you text-to-speech revelation, the software’s have erected statues in honor of software thought you knew everything about it capabilities have a great deal of practical use. instructors revealing the age gem. but then found out you didn’t? Although I’m sure some of you might be Did you know that you can watch a I’ll never forget the day someone aware of a few of these functional gems, I’m case in progress from the Case Summary pointed out the text-to-speech tool on also sure the opposite is true among others tab on an entirely different workstation? my PC. I was convinced that I was the because of the number of times I’ve heard, “I The calltaker engaged in the protocol won’t undisputed expert. I thought I knew DIDN’T KNOW IT COULD DO THAT!” know you’re there. You can neither interfere everything until someone showed me how This one is my favorite. If you enter the with the case nor can you open it and take to make it say what I typed. “I DIDN’T year a patient was born into the age field any control. You’ll just watch it unfold KNOW IT COULD DO THAT!” it will calculate the patient’s age. I never from afar. The feature has lots of practical There was little practical use, but I realized how popular this feature is with applications. You can use it to dispatch sure had some immature fun making calltakers who, for years, have received the call if you have no CAD interface. it say ridiculous things. Face it, nearly this answer to the age question: “Let me Trainees can watch the flow of the protocol. everyone has the maturity level of a check. Alright, his birth certificate says Supervisors and trainers can monitor 12-year-old itching to let loose. he was born in 1929.” Ugh. OK. It’s now protocol compliance. The same “I DIDN’T KNOW IT 2017. Subtract 9 from 17, carry the 1, etc. How about that Sudden Arrest Reset COULD DO THAT!” goes for our ProQA® ProQA will do it all when you enter the button? Some call it the “Dead Clown Eye.” The button is the big X between the Rule of Nines and the HAZMAT tool at the top of the program, and it brings you to a DELTA response and Arrest/Airway PAIs. It’s a lifesaver, so why, you might wonder, is the feature not available at Case Entry? It’s grayed out; you can’t use it until Key Questions and beyond. Why? Is it because nobody goes into arrest while in Case Entry? Of course they do. However, you have an equally powerful tool available in the ECHO response drop-down from the “Okay, tell me exactly what happened” field. Same result. You’re brought to an immediate send point followed by entry into lifesaving PAIs. The Dead Clown Eye would be repetitive at Case Entry. These are only three examples of features that you might not have known about until reading this column. There are plenty more, but since I’m limited for space we’ll stop here. Now if we could only get ProQA to give us text-to-speech. J

12 THE JOURNAL | iaedjournal.org Guest Writer •••

STRESS BUSTER Breathe in, breathe out

Mary Ransier

Author’s note: The terms “dispatch” and “dispatcher” are synonymous for all public safety telecommunicators, calltakers, and dispatchers or those who do a combination of those duties. The stress response is applicable to all.

ow does the 911 industry The ultimate goal of RBT is to move Repeat.” 3 Increased oxygen intake restores forewarn for the inevitability telecommunicators past fear, surprise, blood flow to the brain, helps slow heart Hof stress? and other stressors to the point of muscle rate, and keeps dispatchers from sounding If stress is viewed as a disease, we memory or “autopilot.” This is achieved high-pitched when broadcasting. can vaccinate against it by training and through extensive, repetitive practice. In Tactical breathing is taught in preparing new employees appropriately. crisis and stress, the body will do what it’s professions where the ability to think Most military and law enforcement been programmed (or trained) to do.2 The rationally during stress response can academies prepare recruits for the real reptilian brain takes over. Realism and mean life or death. The technique is not thing by inoculating them against stresses practice battle stress on a cognitive level, groundbreaking. Lt. Col. Dave Grossman, encountered in their job functions improving employee success. a retired West Point psychology (shooting, handcuffing, driving, professor, travels the country etc.) The 911 industry can follow teaching the technique to thousands suit and use reality-based training of police officers and military (RBT) to counter stress specific members, among others, and says that to telecommunicators. it’s been applied in various realms, What emotions do new such as martial arts, sharpshooting, employees and trainees experience and Lamaze.4 most often? Similar to flu shots required Probably fear and worry. Trainers annually for effectiveness, the frequently fixate on their perceived same goes for tactical breathing ability to perform. The longer they techniques. The stress “inoculation” go without a critical incident, the must be practiced frequently to more detrimentally fixated the become muscle memory. employee becomes. We must move as an industry Combating the emotion cognitively Biologically, the body cannot to adequately prepare people for their requires acclimatization, described as discriminate if the stress response engages careers in 911. We need to include stress “prior success under stressful conditions because of a swarming bee attack or inoculation in training programs and […] to similar situations and promotes arriving late for work. The body will prepare dispatchers with RBT for this future success.”1 This is why RBT is respond by flooding chemicals into the remarkable job. J recommended. Exposure to scenarios in bloodstream and shunting blood toward a real-life setting helps the trainee move vital organs. Sources past fixation to knowing what to expect. How does blood get restored to the 1. Grossman D, Christensen LW. On Combat: The Psy- chology and Physiology of Deadly Conflict in War and RBT in professional training is rational part of our brain? in Peace. Third Edition. Warrior Science Publications; practiced through a series of exercises, Breathe. As simple and anticlimactic Millstadt, Ill. 2008. drills, and simulators. For example, a as it sounds, tactical breathing (combat 2. See note 1. dispatcher trained using RBT learns to breathing) is the best way to reverse the 3. Ingersoll A. “Ind(iana) Responders Use Breathing Tactic to Reduce Stress.” EMSWorld.com. 2012; Nov. 20. respond reflexively. The initial “rush” is stress response on a physiological level. “In http://www.emsworld.com/news/10831902/ind-re- expected, but the training helps them through the nose, two, three, four. Hold, sponders-use-breathing-tactic-to-reduce-stress (accessed manage initial reactions, expect, and rely two, three, four. Out through the mouth, Sept. 14, 2016). 4. See note 3. on RBT to help them focus and do the job. two, three, four. Hold, two, three, four.

iaedjournal.org | THE JOURNAL 13 ••• Q&A

TALES FROM DISPATCH Former dispatcher tells Exactly What Happened

Caroline Burau

aroline Burau is the author of two those years later, I was that different unless something bad happens. It’s books about emergency dispatch. person. I wanted to give credit to an basically a thankless job. We try to save CThe first book, “Answering 911: underrated profession. As I write in the people, but, think of it this way, the Life in the Hot Seat,” was published first chapter of the second book: people picking up the phone don’t get in 2007. The second book, “Tell Me So, I find myself wanting to write saved. We are the first point of contact. Exactly What Happened: Dispatches about it, again. Not because the story We hand it over and rarely hear what from 911,” was published in 2016. Both of my dispatching career is so unique, happens. If someone [not familiar with were published through the Minnesota but because it is not. Because if I dispatch] asks me about reading either Historical Society Press. During her tell you what it is like to answer 911 book, I tell them to go into the book 12 years in the profession, Caroline in White Bear Lake, Minn., I’m also with the best of intentions. Dispatch is dispatched for an ambulance service telling you a lot about what it’s like to not about what you see on TV. At one in Minnesota and White Bear Police answer 911 just about anyplace. moment it can be a nightmare, and, at Department, Minnesota, USA. 3. How did your perspective change over the next, it can be monotonous. Editor’s Note: Caroline’s answers are the years between publication of the 5. What interested you in applying for a job paraphrased from an interview and are two books? in dispatch? not direct quotes. Caroline: The first book was “You Caroline: My lifelong love of writing 1. Briefly explain how “Tell Me Exactly wouldn’t believe what just happened.” brought me to newspaper reporting. I What Happened” compares to your first As I said, I was new to dispatch and covered police, and that introduced me book, “Answering 911.” not at all prepared for the phones that to dispatch. I like people. I liked the idea Caroline: I wrote “Answering 911” never shut off, the angry and upset of being a part of what the police were during my first year at dispatching. callers, and the long hours sitting in doing but in the background. I thought At that time, I had no aspirations of the same place without a break. The it was a great way to help people, and I writing or publishing a book. Writing second book is more about “You get still believe that. about my experiences was a way of used to a certain amount of chaos 6. The title of the second book, “Tell Me helping me cope with a very stressful and stress. It no longer shocks you.” Exactly What Happened,” is similar to a job. I read my early essays at the Loft The perspective about my own life Case Entry Question in the Academy’s [a program for readers and writers also changed. I know bad things can protocol. Did the agencies you worked for founded in a loft above a Minneapolis happen. I went horseback riding, and use the dispatch systems? If so, you never bookstore], and it happened from all I knew about horseback riding mention their use in either book. Why? there. I was approached by the were from the calls about people Caroline: This is a memoir. I wanted to Minnesota Historical Society Press, getting hurt from falling off a horse. keep names and systems anonymous. I and they published “Answering 911,” I still haven’t been on a snowmobile, made changes that obscure identities, which was very well received. and I’m a Minnesotan. and I was really cautious about callers 2. What was your motivation to write the 4. Who is your intended audience? and patients I write about. I was second book, “Tell Me Exactly What Caroline: A lot of the readers [of concerned with protecting people and Happened,” particularly since you were no “Answering 911”] were dispatchers, and places. As I wrote in the second book: longer working in emergency dispatch? that’s what I expected. But the book also I am attempting to expose the way Caroline: Ten years had passed since the reached people outside the profession. this job has affected me without first book, and I was actually waiting Dispatch is misunderstood. It’s a lot more exposing those I’ve met along the way. for someone with more time in the important and interesting than people profession to write a book from that think. It’s definitely a profession. People To read the rest of the interview visit us at iaedjournal.org perspective. Nothing happened. So, all don’t hear about what dispatchers do

14 THE JOURNAL | iaedjournal.org

••• BEST PRACTICES | navigator prelude

CONTINENTAL APPEAL NAVIGATOR is simply the place for EDs to be

Audrey Fraizer

AVIGATOR keeps on getting Most of the six continents will be For NAVIGATOR 2017, the better, and that’s the honest, represented at NAVIGATOR, scheduled Academy organized an exceptional Nsimple truth. April 12–14 at the Hilton New Orleans number and variety of educational As more and more countries step Riverside, New Orleans, Louisiana, USA. tracks: Quality Assurance, Leadership, up to the Academy’s protocol process, Seven spin-offs of the original conference, Management, Research, Motivation, Stress NAVIGATOR grows proportionately in first held in 1988, have since been added Management, CDE & Training, Special scope to accommodate the world. in Europe, Australia, and Asia. Interest, Operations, Human Resources, In one word, protocols and No matter the continents hosting, Fire Protocol, Medical Protocol, Police NAVIGATOR are continental, a word however, NAVIGATOR offers the Protocol, and an International track that that in its usage can apply in both the impeccable venue for learning, discussion, connects the continents. geographical and cultural appreciation of and networking. Keynote speakers, gala You can feast on sessions providing the Academy’s sensibility. parties, vendor exhibits, great food (and solutions to workplace drama, shift The emergency dispatch protocols plenty of it), field trips to communication strategies, problem employees, morale and emergency nurse triage system can centers, and receptions are a big part of issues, critical incident planning, be found in six of seven continents, the NAVIGATOR fabric, but the focus training, social media, assisting callers Antarctica is the exception, although the remains on developing your protocol with disabilities, and the hot seat of Antarctic Fire Department, a division of know-how. news reporting. Madeline Marks, of Lockheed Martin’s Antarctic Support And this year, the Academy is the University of California’s Center Contract, does employ primary and offering a first-ever scholarship to for Research and Treatment on alternate dispatchers. Give the Academy NAVIGATOR for one lucky emergency Response to Extreme Stressors, will time, and we might be there. dispatcher. Stay tuned for more details. present a Leadership session outlining

16 THE JOURNAL | iaedjournal.org navigator prelude

the lessons learned from the Pulse Ultimately, traveling to pre- and post-conference sessions). Nightclub shooting. NAVIGATOR is much more than NAVIGATOR is a hearty continental The Academy welcomes back visiting a single country over a three- experience prepared with you in mind. J favorite speakers from past conferences to six-day conference (depending on and introduces speakers new to NAVIGATOR. Ricardo Martinez, of the popular “Within the Trenches” podcast, will make his NAVIGATOR 60 sessions debut as a speaker. He will record an 08|BALTIMORE episode of WTTP during NAVIGATOR, 09 acs interviewing IAED™ officials and NAVIGATOR attendees. He will also be presenting a session about his dispatch 60 sessions story and how he got into podcasting. 09|LAS VEGAS 09 acs To further show his dedication to emergency communications, Martinez is donating proceeds from his #IAM911 77 sessions T-shirt sales to sponsor a “Within 10|ORLANDO acs the Trenches Continuing Education 09 Scholarship” to NAVIGATOR for one lucky emergency dispatcher. Of course, a show of fun is never 11|LAS VEGAS 91 sessions far behind at NAVIGATOR. Keynote 13 acs speakers, gala parties, vendor exhibits, and receptions—as mentioned—are always a NUMBERS big draw. 91 sessions There is also a cultural appeal that 12|BALTIMORE keeps people coming back each year. 13 acs Protocols are about simplicity. The Academy develops protocol’s contextual platform for maximum efficiency at 98 sessions communication centers and, essentially, 13|SALT LAKE CITY 13 acs defines emergency dispatch universally. The process saves time and conserves resources. You aren’t flying by the seat of 100 sessions your pants or sending out the “cavalry.” 14|ORLANDO acs The cavalry is a description the 13 protocol’s inventor, Dr. Jeff Clawson, is known to use when an agency sends police, fire engines, paramedics, and 15|LAS VEGAS 110 sessions ambulances with lights and sirens blaring, 13 acs rather than the response actually required by the incident (e.g., a single ambulance without lights and siren). And, here’s 115 sessions another bit of trivia for the protocol 16|WASHINGTON D.C. acs record: New Orleans is the birthplace of 13 protocol. Charity Hospital was where Dr. Clawson, then an emergency room resident, was handed a form of recipe 17|NEW ORLEANS 109 sessions cards the chief resident called a cookbook 14 acs for handling patient flow. The rest, as they say, is history.

iaedjournal.org | THE JOURNAL 17 ••• BEST PRACTICES | faq

FEAR OF INFECTION Blood-borne pathogen fear should not preclude CPR

Brett Patterson

This question comes from a dispatcher who The current resuscitation standard for of cardiac arrest, there are a few provided a bystander with PAIs to assist a traumatic cardiac arrest is CPR with exceptions where withholding CPR trauma victim: ventilations. I know of no standard might be appropriate, as follows: that calls for withholding resuscitative •• Situations where attempts to Dispatcher: efforts based on a concern about disease perform CPR would place the I recently provided PAIs that transmission. The Ethics section of the rescuer at risk of serious injury included mouth-to-mouth ventilations 2010 Guidelines for CPR and ECC or mortal peril and compressions on a trauma patient. (unchanged in the 2015 Guidelines) has •• Obvious clinical signs of Such patients could be bleeding and only this on the subject: irreversible death (e.g., rigor potentially expose the bystander-rescuer •• Withholding and Withdrawing CPR mortis, dependent lividity, to blood-borne pathogens. Should we (Termination of Resuscitative Efforts) decapitation, transection, be telling bystanders to do this? Isn’t Related to Out-of-Hospital Cardiac or decomposition) there a risk to the bystander performing Arrest (OHCA)—Criteria for Not •• A valid, signed, and dated these instructions? Starting CPR in All OHCA advance directive indicating •• Basic life support (BLS) training urges that resuscitation is not desired, Brett Patterson: all potential rescuers to immediately or a valid, signed, and dated A call to 911 is considered by our begin CPR without seeking consent, DNAR (Do Not Attempt courts as an implied call for help. As such, because any delay in care dramatically Resuscitation) order we offer help in the form of the standard decreases the chances of survival. Aside from standards, we need to of care in dispatch. Our baseline is the While the general rule is to provide consider the risk/benefit ratio. The standard of care in emergency medicine. emergency treatment to a victim MPDS® has been advising and instructing

18 THE JOURNAL | iaedjournal.org faq

resuscitation for over 35 years, and I am persons, salivary transmission of blood- ​WHAT’S AHEAD not aware of a single case where a rescuer borne viruses is unusual, and transmission Journal takes many directions has contracted a communicable disease of infection has been rare: Only 15 related to a resuscitation effort. There documented cases have been reported. he March/April Journal is no data that I know of that shows Most of these cases involved a bacterial of Emergency Dispatch significant risk to laypersons who render pathogen, such as Neisseria meningitidis. Tmight make you laugh CPR, much less placing a rescuer “at risk Transmission of hepatitis B virus, and cry. of serious injury or mortal peril.” hepatitis C virus, or cytomegalovirus On the lighter side, A 1998 study looked at the risk and during CPR has not been reported; all readers should certainly get defining strategies for Infections acquired three reported cases of HIV infection a kick from a feature story during cardiopulmonary resuscitation1: acquired during resuscitation of an chronicling the mishaps on a PURPOSE: To estimate the risk for infected patient resulted from high-risk family vacation through fire, acquiring an infectious disease during cutaneous exposures. There have been police, and medical protocols. cardiopulmonary resuscitation or CPR no reports of infection acquired during Chalk up the family’s safe training and to identify strategies to CPR training. Simple infection-control arrival home to PDIs and PAIs minimize that risk. measures, including use of barrier devices, they receive along the way. DATA SOURCES: English- can reduce the risk for acquisition of A second feature is language articles published since an infectious disease during CPR and sobering with its look at the 1965 were identified through a search CPR training. Post-exposure protocols opioid epidemic sweeping of the MEDLINE database and can further protect potential rescuers the country. The Centers selected bibliographies. and trainees. for Disease Control and STUDY SELECTION: Studies that CONCLUSIONS: The benefit of Prevention attributed 17,536 contained information about transmission initiating lifesaving resuscitation in deaths to prescription of infectious organisms, particularly a patient in cardiopulmonary arrest painkillers in 2015, an increase HIV and other blood-borne viruses that greatly outweighs the risk for secondary of 4 percent from the might be transmitted through mouth-to- infection in the rescuer or the patient. previous year. Emergency mouth ventilation, contact exposures, and Nevertheless, use of simple infection- communication centers are needlesticks during CPR. control measures during CPR and CPR pitching in to curb problems training can reduce a very low through real-time surveillance, level of risk even further. PAIs, and overall awareness of In summary, while fear callers in danger of overdose. of contracting an infectious As always, members can disease is a significant factor look forward to fulfilling their in layperson reluctance to continuing dispatch education provide CPR, the chance of requirements by completing contracting an infectious the quizzes accompanying disease while providing CPR is the two CDEs. We also extremely low, and CPR is the highlight Allina Health EMS current standard of care in the communication center in resuscitation literature. Minneapolis, Minnesota, USA, Brett A. Patterson and the Joint Emergency Academics & Services Control Centre Standards Associate (JESCC), Guernsey, U.K. Medical Council of Happy reading! Standards Chair J Remember, we welcome DATA EXTRACTION: Descriptive your story ideas at editor@ and analytic data from each study. Source emergencydispatch.org. You DATA SYNTHESIS: Fear of acquiring 1. Mejicano G, Maki D. “Infections acquired during cardio- can also visit us on Facebook. pulmonary resuscitation: estimating the risk and defining infection, especially HIV infection, can strategies for prevention.” Annals of Internal Medicine. delay prompt initiation of mouth-to- 1998; 129(10):813-28. mouth ventilation. Although pathogens can be isolated from the saliva of infected

iaedjournal.org | THE JOURNAL 19 ••• BEST PRACTICES | ace achievers

The tapestry of a Cripple Creek overlook.

COMMUNICATIONS AT THE HIGHEST LEVEL Cripple Creek is well worth the drive

Audrey Fraizer

ou might think, “I’ll never who moved to Cripple Creek five years which was the same year the El Paso- get there.” ago with husband, David. “We retired Teller County 911 Authority instituted Y Scenic pullouts along an early because we didn’t want to wait the Medical Priority Dispatch System™ 18-mile winding road are breathtaking, any longer.” (MPDS®). For 23 years before that, and the numerous dirt trailheads cutting Not everyone retires early; a lot of Pritchard was a firefighter/EMT into the mountainsides are tempting to people never leave in the first place. navigating emergency vehicles up and follow. Abandoned historic mining sites, Jobs in the once extremely prosperous down some mighty twisty roads. She was Colorado blue spruce, and the occasional gold mining region can still be found in the second woman Green Mountain Falls, moose foraging at streams or in the tall retail (small businesses), the still-active Colo., hired as a firefighter/EMT. grasses of meadows opposite the standing though reduced in scale mining industry “This is home,” she said. pines are sights not often seen by people (Newmont’s Cripple Creek & Victor Pritchard shows pictures of the scenic living at sea level. Mine), casinos (Cripple Creek approved mountain view from her home’s front Anticipation builds. gaming in 1991), tourism, agriculture and window as eagerly as someone else might “Where is this place?” ranching, and city or county government. pull up photos of kids or grandkids, do-it- Destination Cripple Creek (pop. Diann Pritchard is director of the yourself gazebos, or the “free-range” donkeys 1,200), in central Colorado south of Pikes Cripple Creek Police Department 911 milling throughout Cripple Creek proper. Peak, is every bit worth the drive, and you center, which at an elevation of 9,494 feet The pampered donkeys, like most of the can ask just about anyone there to get the might be the highest communication buildings and homes in Cripple Creek, are same answer. center in the continental USA. She reminiscent of the golden days of mining. “We love it here,” said Ellen Moore, applied for an open position in 1996, The name “Cripple Creek” is, literally,

20 THE JOURNAL | iaedjournal.org ace achievers

quite by accident. One story has a more than 200 EMDs. The combined call be their QA analyst. He was promoted to cattleman and his assistant building volume climbs each year and has nearly supervise the authority’s QA/Training a shelter close to a creek when a gun doubled from 168,900 to 354,262 calls Department, and the job of tending the discharges, frightening a calf, which since the authority was created in 1995. ACE seed that Lofgren planted was now cripples its leg jumping over the creek. The six EMDs on Pritchard’s staff under the auspices of Ardelle Grima. Another story has two brothers building are dedicated to quality assurance (QA), She didn’t miss a step, Lofgren said. their log house near the same creek; one customer service, and all the other trappings “Ardelle was instrumental in helping brother falls from the roof and two days that made the Cripple Creek Police them maintain their scores and submit later their hired hand is thrown from his Department 911 center an Accredited their ACE packet,” he said. “She really horse. The two suffer “crippling” injuries. Center of Excellence (ACE) in April 2016. carried the ball over the goal line.” The communication center is on Jesse Avery, Dispatcher II, Training There is camaraderie among EMDs the first floor of police headquarters in a Coordinator, and EMD-Q®, led the and police officers. They know the building that was originally a dry goods process that took a year and plenty of casino owners, but not because of any store and boarding house. The exterior is hands pitching in to achieve. gambling habit. brick and, by law, the same goes for every “Our team worked hard for this,” Avery “They’ve explained the process to the commercial structure in the city’s mile-long said. “They are motivated by what they do casinos,” Lofgren said. “There’s a guy in downtown, rebuilt following a fire in 1896 and dedicated to achieving the goal.” security who knows the PDIs by heart. He that, in four days, destroyed two-thirds of They are also a community of EMDs can recite them.” the town and left 5,000 people homeless. to be envied and marveled, according to The EMDs peer-review calls, participate The police station is near the end of John Lofgren, Training Manager, El Paso- in four-hour training sessions on alternating the business district, west of the casinos, Teller County 911 Authority. Wednesdays, collectively test 100 calls antique shops, ice cream parlors, civic “Diann [Pritchard] and her team are in ProQA® each month, and compete and administrative offices, museums, the poster child of how to make ACE in their modified version of bingo. The fire station, and Heritage Center at the successful in a small community,” said first to blackout (covering all the squares city junction. Looking east toward Battle Lofgren, who received the Academy’s representing Chief Complaints) wins a Creek Mountain is a view that gives Instructor of the Year Award at Thin Gold Line bracelet. The Thin Gold people another reason to stay. NAVIGATOR 2016. “They’ve embraced Line is a universal symbol for police “You never get lost,” said the barista the protocol. For them, the ACE process dispatchers and signifies commitment to at a local coffee shop. “Mountains to the was like throwing gasoline on a stack of the officers and public they serve. east, and the road through town running dry wood and running with it.” During National Public Safety east to west, buildings north to south.” Three years ago, Lofgren was meeting Telecommunicators Week, Cripple Creek Pritchard gets her exercise walking with Pritchard and Avery on a regular Police Chief Michael Rulo dropped by up the sidewalk to municipal buildings, basis as the authority’s QA analyst and, at to deliver sandwiches, cake, and words dropping off subpoenas at Teller County that time, more than casually asked them of praise. courthouse, eating lunch with the police about ACE. “They’re absolutely an integral part of chief at the Pint and Platter restaurant “They were there, and it was now a emergency services in the community,” (a local favorite), or bringing reports to matter of putting it all together,” he said. said Rulo, who has watched the evolution city administrative offices. A national run “I think it was a matter of affirmation. of MPDS through law enforcement jobs of Hells Angels chapter representatives They needed someone to say, ‘You can throughout the two-county area. “I am held in Cripple Creek in July demanded do it. You’re there.’” awed by their talent and collaborative Pritchard’s full attention at the 911 center, They agreed but hedged on effort. They do an amazing job.” managing EMDs and acting as the liaison the commitment. The Cripple Creek Police Department of multi-jurisdictional law enforcement “We thought about this for a long emergency dispatch center handles officers and the FBI. time because our compliance has been in all police/fire/EMS calls within the “Things were quiet, peaceful,” she said. the ACE range for years,” Avery said. “We 1.3-square-mile town and fire/EMS in “But we were certainly prepared with more weren’t sure who would have the time.” neighboring rural jurisdictions. In 2015, than a month’s worth of planning.” As it turns out, Avery did or, at least, had they took 14,500 calls, of which many The readiness is personified in the level the space to add yet another hat to her job were related to tourists coming from of public services provided. Cripple Creek description that already included records lower elevations and experiencing the Police Department dispatch is part of the management, dispatch, quality assurance, effects of higher elevations. J two-county El Paso-Teller County 911 and reviewing the 35 to 40 EMD calls each Authority, comprising seven PSAPs and month. Lofgren, however, would no longer

iaedjournal.org | THE JOURNAL 21 • FEATURE | community outreach

Actress Helen Mirren looks on as dispatchers at London Ambulance Service are hard at work.

22 THE JOURNAL | iaedjournal.org community outreach | FEATURE • NOW HEAR THIS… Agencies around the world reach out to the public to help improve emergency response

Mike Rigert

magine a world in which every child, from age 8 on up, knew that he or she could dial 911 to get help during an emergency. IAnd in this hypothetical world, not only would children (and therefore, adults) know when and how to phone for emergency assistance, but they also could anticipate what types of standardized questions the emergency dispatcher would pose to them and what information callers would need to provide. What kind of impact would such a scenario have on community medical, fire, and police response? Needless to say, the resulting impact on that society would be equally life changing and lifesaving. But what if this fictional place was not some far away utopian planet but rather the actual near future of the area in which you live? Thankfully for present-day Earthlings, the future is now, as many public safety agencies are actively engaging young and old alike to develop a more informed citizenry when it comes to emergency calls. More and more, communication centers are investing in the significant returns that a dynamic and sustainable community outreach program can give residents—and dispatchers. Put simply, helping residents better understand 911 better positions calltakers to give them the most effective response possible.

iaedjournal.org | THE JOURNAL 23 • FEATURE | community outreach

The public sector Public safety agencies and communication centers worldwide are grappling with pertinent issues surrounding the use of emergency dispatch service, the national emergency number(s), and opportunities to reach out to the public for help in improving emergency response. For some agencies, educating folks about when and how to contact emergency dispatch centers, and what information callers should be prepared to provide a calltaker with, is a priority. Others are using community outreach programs and presentations to instruct residents how the emergency dispatch system works, explain why dispatchers using the Academy’s Priority Dispatch System™ ask the questions that they do, and even provide interactive opportunities to don a headset to experience taking mock emergency calls. Regardless of what types of The emergency response agency 118 Genova (Italy) has made an effort to reach out to and educate young people. community outreach/public education priorities and objectives agencies are In Italy, a major aim of agency 118 answer he gives them is always the same: engaged in, one thing remains constant: Genova’s emergency dispatch community “If you’re the caller, you are,” Furgani The more instructional contact outreach is to connect with youths. Eight said. “Follow the dispatcher’s instructions.” communication centers can have with times a year, the agency invites local Farther west along Italy’s the public in getting their messages out, high school-aged students to come learn Mediterranean Sea coast, in the district the greater the overall impact will be. about their communication center by of Imperia, Laura Alberto, a nurse and Whether it’s helping the community to participating in drills to practice calling EMD instructor with 118 Imperia, said correctly use the emergency dispatch the 118 national emergency number her agency also focuses community service or reducing mishaps that tie up along with hands-on training to follow a outreach on the next generation. limited agency resources, it ultimately dispatcher’s Pre-Arrival Instructions over Under the moniker “Primo Soccoroso leads to more effective emergency the phone to perform chest compressions a Scuola,” or first aid school, emergency response performance and the ability to on a mannequin. The students rotate communicators give two-hour lessons save more lives. through different stations during the about making an emergency call and events that include listening to an actual explain why PAIs are so critical during The young and the restless recorded emergency call and seeing how certain medical scenarios. During the It goes without saying that each agency’s the dispatching process works. event National First Aid Week, 118 priorities for community outreach are Dr. Andrea Furgani, an ER physician Imperia meets with elementary school based on a variety of factors, including and Q instructor with 118 Genova, said children who watch a video simulation of country; culture; population size; and students learn when to call 118 and when a call that requires BLS response to help available resources, such as personnel and not to call. They also learn about the Key them understand what the experience funding, unique geography considerations, Questions that calltakers will ask during would be like in real life. etc. What may be important for a an emergency, and why it is important to “It was really neat to get the kids communication center serving a large urban have the answers to those questions. involved and see them interested in populace within a small geographic area At the end of a presentation, Furgani learning more about 118 and what may be very different from the priorities of said they will often ask the children happens in the communication center,” a PSAP that serves a small, primarily rural who the first responder is during an Alberto said. population than covers a sizable swath emergency. After getting some answers, The agency also fields a booth at the of land. such as an ambulance or doctor, the area’s annual Festival della Salute, or

24 THE JOURNAL | iaedjournal.org community outreach | FEATURE •

health festival, in April hosted in the city program’s success? Survival rates, Hartley- communication center (averaging 800 of San Remo where community members Sharpe said. calls per day) that coordinates and shares can learn about everything from how to LAS’ average overall survival from call information with the government’s properly use emergency communications cardiac arrest from all causes is 9 medical, fire, and police dispatch centers. to healthy foods to yoga 101. Alberto percent. However, if a person happens They utilize an app that identifies and said they got an unexpected reaction this to be at one of the 3,000-plus locations dispatches the closest medics (often, in past spring at the festival when the staff that have public access to an AED, the the same neighborhood as the caller and screened its 118 calltaking video for a rate skyrockets to 59 percent, Hartley- driving traffic-skirting, medical gear- group of lifeguards. Sharpe said. equipped scooters called “ambucycles”) to “By the end of the video, they were “At sites that operate the LAS the scene. applauding us,” Alberto said. “They had accreditation standards, the survival rate As might be imagined, a unique no idea how much effort and training is 75 percent or greater,” he said. emergency communications and response goes into assisting 118 callers when there Perhaps the London Ambulance entity such as United Hatzalah also has is an emergency. It was very touching to Service’s biggest community outreach more specialized community outreach see their reaction.” splash has come from an unexpected needs than most agencies. In addition source. Oscar-winning actress Helen to the necessities of being completely Patron Dame Mirren, known for her portrayal of self-funded through donations and Chris Hartley-Sharpe, Head of First Queen Elizabeth (she was knighted a recruiting and training volunteers, the Responders and also a 30-year veteran of “dame” by the same monarch), became group also conducts public education the London Ambulance Service (yes, that a staunch advocate for the agency after campaigns to get people to understand London), said one piece to the community a scare that affected her personally. In that their medics can fill the time gap and outreach puzzle is education. LAS serves 2012, during a premier of one of Mirren’s provide lifesaving care prior to the arrival the Greater London area of the U.K. with films, a friend had a cardiac arrest and was of ambulance crews. Unlike in other a resident population of 8.6 million and saved by the quick thinking of a CPR- countries, Israel has no single national averages 1.8 million calls for service per trained police constable with the agency’s emergency number, so callers must year. A common practice that drains Voluntary Responder Group. The police dial several service numbers depending precious response resources is patients officer used an agency public access AED on what type of emergency they need with less serious conditions that call the from a nearby London subway station to assistance with. ambulance service for help largely because treat Mirren’s friend. Dovie Maisel, Vice President of they are either unaware of or unable to Mirren visited LAS headquarters, International Operations for United reach non-emergency resources, he said. received some CPR training, and has Hatzalah, said their agency utilizes “every But a major focus of the agency’s become a patron of the VRG’s registered means possible” to share their public community outreach efforts comes from charity that provides financial support awareness message with their intended getting the word out about a network to the certified voluntary medics that audience, from social media and word- of public access AEDs throughout respond to emergency dispatch calls of-mouth endorsements, to working the community connected to the alongside traditional first responders. with the news media to share their communication center. Promoted by “In these situations speed saves lives, and success stories. the London Ambulance Service through having immediate CPR and defibrillation “Volunteers are our biggest advocates,” the public ad campaign “Shockingly saved his life, without doubt,” Mirren said, Maisel said. “We don’t have to encourage Easy,” the idea is to encourage individual according to the U.K. press. them because this is their passion in life organizations to acquire their own beyond their personal lives. It’s about AED and recruit volunteers that can Have ambucycle, will travel engagement in the community.” then be mobilized to help during Thirty-six hundred miles to the cardiac emergencies. southeast, Israel-based United Hatzalah Back to butt dials “We have just gone live with an app is an organization with international In our modern smartphone age, (that) alerts them to the location of the scope that provides free EMS response technology can save lives. However, cardiac arrest and the location of the to all through certified volunteer its often-inadvertent misuse can also closest community defibrillator,” Hartley- EMTs, paramedics, and physicians cost lives. Sharpe said. “The alerts are generated in the community who typically can Rhonda Hinch is a Public Safety automatically by our CAD system using arrive on scene within three minutes. Dispatcher III with the Harford County MPDS® determinants as the trigger.” Authorized by Israel’s Ministry of (Maryland, USA) Department of How does LAS measure the Health, United Hatzalah has its own EMS Emergency Communications. In addition

iaedjournal.org | THE JOURNAL 25 • FEATURE | community outreach

“We want to teach them what happens on both ends of the radio,” Hinch said. The agency also has what it calls its Gold 911 program for recognizing local children who perform well, follow instructions, and stay calm on the phone during real emergency calls. Hinch and colleagues make a special presentation of the Gold 911 Award during school assemblies with invited government officials and media in attendance. Sometimes, they’ll even play the audio of the call for the student body. Hinch said Harford Co. DES tries to make a big deal about the assemblies in order to underscore the importance of teaching the children about appropriate emergency number use. They’re currently working on improving the measurement of their community outreach efforts. Second- graders fill out a brief survey at the conclusion of the school presentations, 118 Genova wants people to understand why dispatchers ask the questions they ask. and Hinch said they’re considering expanding the survey program by email to celebrating her 28th anniversary with “It’s not abuse,” Hinch said. “It’s to include visitors that have taken the the agency on Aug. 1, she has a total more misuse.” communication center tour. of 32 years of experience in public To help reduce the fraternal Hinch said Harford Co. DES gets safety, getting her feet wet early on as a twin culprits of wanton and reckless a lot of help from the agency’s public volunteer firefighter and EMT. freelancing with a cellphone, Hinch information officer who pitches relevant Harford dispatches medical, fire, has marshaled Harford Co. DES’ stories to the media and administers and police for 12 separate agencies and resources. Public education campaigns their social media outreach that serves a quarter of a million people. In are unleashed regularly at local fairs, includes Facebook, Twitter, and their 2014 alone, Harford Co. DES responded communication center tours, school official website. to nearly 240,000 calls for emergency presentations, and the like. “When we present a Gold 911 Award, aid covering a jurisdiction of 437 “In addition to 911, we have the police she’s really good about posting pictures square miles. non-emergency phone number printed and the stories,” Hinch said. “She’s always Hinch, who was the recipient of her on all the squad cars in the county,” posting about something.” agency’s Above and Beyond the Call Award Hinch said. “You can Google anything In the end, running an effective in March for her notable work with the 911 and find the number.” community outreach program to Education Program, said pocket dials are Harford also reaches out to local promote an agency’s critical emergency No. 1 on the most wanted list of emergency schools each spring, giving emergency dispatch role comes down to personnel, dispatch faux pas in Harford County. In dispatch presentations to second-grade Hinch said. Those individuals need fact, butt dials have gotten so bad that the students. They also conduct frequent to be well-informed, well-spoken, and agency began tracking numbers on them communication tours for school groups, genuinely enjoy reaching out to the last year. Between January and mid-August, Scouts, and agency EMTs who are public and the media to share their they received 14,501 accidental cellphone required to take the tour as part of their message. It’s all about engagement and calls and 2,139 via landline. Following training. Well-behaved youth groups making connections, she said. closely behind in the getaway car at No. 2 get to take a special walk through the “You want to make it fun, exciting, are calls to emergency dispatch for non- calltaking floor to listen to dispatchers and interactive,” Hinch said. J emergencies, she said. taking actual calls.

26 THE JOURNAL | iaedjournal.org

• FEATURE | training NO CUTTING CORNERS There’s no success without training

Josh McFadden

28 THE JOURNAL | iaedjournal.org training | FEATURE • NO CUTTING CORNERS There’s no success without training

Josh McFadden

he renowned philosopher, scholar, fix it. In a discipline where processing base of all employees … training and and scientist Aristotle once information quickly and accurately is development provides both the company Tremarked, “Excellence is an art won paramount, there are many that will resist as a whole and the individual employees by training and habituation. We do not act adding steps and time to the process. with benefits that make the cost and time rightly because we have virtue or excellence, Where experienced communicators have a worthwhile investment.”3 but we rather have those because we have learned to distance themselves from the Regardless of the type of job a person acted rightly. We are what we repeatedly do. gritty reality of the emergency scene, the performs, no matter what the industry Excellence, then, is not an act but a habit.” suggestion that they get involved with may be, starting an employee off on There are few professions where “acting caring for patients—through pre-arrival the right foot with proper training and rightly” is more critical than in dispatch. instructions—may cause discomfort.”1 instruction is vital to the person’s success. After all, with any given call, a person’s However, Page concluded that, Clearly, in the dispatching world, life might be on the line. In some cases, your “As we look back over the many EMS comprehensive training and orientation ability to respond correctly and accurately improvements that have occurred during should be non-negotiable. Dispatchers and to quickly relay the right help might the past three decades, it’s obvious that may resist it, but any good manager determine the fate of multiple people. many gaps in the system have been closed.”2 knows that lives depend on a well- Across the world, dispatchers are With such an important job adhering equipped, confident dispatcher. overwhelmingly performing their work to an evolving but critical system, is it any Frost further outlines four purposes tremendously, especially those who have wonder that the profession needs well- of training. Each of these is particularly access to the Medical Priority Dispatch qualified, well-trained people who are applicable to the communication center. System™ (MPDS®), Police Priority Dispatch dedicated to “act[ing] rightly”? System™ (PPDS®), Fire Priority Dispatch Turns weaknesses into strengths System™ (FPDS®), and the Emergency The general meaning and purpose Sometimes we hate to admit it, but Communication Nurse System™ (ECNS™). behind training each of us has weaknesses and areas in our Nevertheless, there are constant Merriam-Webster, one of the foremost work where we need to improve. No one changes and tweaks to the protocols as authorities on word definitions and is perfect. Even the most naturally gifted International Academies of Emergency meaning, has defined the verb form of the and talented dispatcher needs to iron out Dispatch® (IAED™) leaders and word “train” as “to teach (someone) the skills some wrinkles and refine rough areas. A emergency dispatch professionals seek for needed to do something (such as a job): major advantage with a training program improvements to help save lives. to give instruction to (someone).” Other is that managers can easily identify any James O. Page, Lifetime Emeritus definitions include “to form by instruction, flaws and then appropriately address Member of the International Academy discipline, or drill” and “to teach so as to them. By training employees, managers of Emergency Medical Dispatch®, make fit, qualified, or proficient.” can assess any gaps between an employee’s acknowledged that some people might Shelley Frost, a researcher with the current skills and the competency needed struggle to understand why change has consulting firm Studio D, succinctly for certain tasks. Next, the manager and to occur. He said, “Some insist that if the stated that training “presents a prime worker can discuss what steps to take to system isn’t broken, we shouldn’t try to opportunity to expand the knowledge make up this difference.

iaedjournal.org | THE JOURNAL 29 • FEATURE | training

In Frost’s words, “Providing the necessary program ensures that employees have a While the focus is much different in a training creates an overall knowledgeable consistent experience and background comm. center, the principles are the same. staff with employees who can take over for knowledge,” Frost said. “The consistency Author Jerry Shaw states, “Effective one another as needed, work on teams, or is particularly relevant for the company’s training saves labor by reducing time work independently without constant help basic policies and procedures. All employees spent on problem-solving and saves and supervision from others.” need to be aware of the expectations money in the long run by producing a and procedures within the company. better workforce.”6 Improves performance This includes safety, discrimination, and Training isn’t just for the new employee; administrative tasks. Putting all employees Cost and time savings it’s vitally important for even the most through regular training in these areas experienced workers in an organization. ensures that all staff members at least have More so than many other jobs, being a exposure to the information.” dispatcher brings a tremendous amount of pressure and stress. Each day is a Helps employees like their jobs more challenge, and these can take their toll. Imagine if new dispatchers were Burnout, emotional overload, lack of simply “thrown to the wolves” and left to motivation, and other factors can lead figure things out on their own. Obviously, to the erosion of one’s performance in the notion is ridiculous, but without a the communication center. Dispatchers good training system in place, this is how who once exceeded expectations and a person would feel. performed with excellence can easily Organizations that invest the time and falter under the heavy loads of difficult effort to train employees and arm them calls and exhausting days and weeks. with the necessary tools to be successful Fortunately, training offers a fresh have a significant advantage over those Dispatchers know as well as anyone new start and course correction in organizations that lack a structured how precious time can be. In your work, these situations. training program. When employers care every second that ticks away could be In addition, a well-trained employee enough about their employees’ personal the difference between living and dying. gains valuable confidence. This development to spend effort training Time is a valuable commodity, so the confidence may urge the person to them, the employees feel appreciated. And more you can work efficiently, the better perform even better and think of new when people feel appreciated at work, they off you and your center will be. ideas to excel. Continuous training also are more satisfied with their jobs. Newer dispatchers (and perhaps more keeps your employees on the cutting edge Furthermore, training can boost the seasoned ones as well) may lament that of industry developments. Employees morale of the entire organization and training takes too long and requires far too who are competent and on top of inspire loyalty. A recent poll conducted many steps. But think of how much better changing industry standards help your by the firm Louis Harris and Associates it is for your comm. center when employees company hold a position as a leader and found that among employees with poor get excellent training and happily and strong competitor within the industry.4 training, 41 percent desired to leave their effectively do their jobs for a long period company in a year or less. Conversely, of of time as opposed to a team full of Fosters consistency those employees who reported they had poorly trained, unmotivated, undedicated Dispatchers should have a sound access to excellent training opportunities, dispatchers. The latter come and go with understanding of the importance of being only 12 percent had any intention of frequent turnover. For managers, this consistent. After all, that’s one distinct leaving their company.5 means more hiring, more training, and more advantage of using the Academy’s protocols. headaches—over and over. When all dispatchers in a comm. center are How organizations benefit Turnover and replacement cost using the same protocols—and when centers Businesses that focus on generating includes exit interviews, administrative around the world are using it as well—it profits and making sales will find that functions related to termination, severance increases the likelihood that the right care is well-trained, proficient employees help pay and unemployment compensation, being administered to patients in need. It also the organization’s bottom line. Employees attracting new applicants to fill positions, holds all dispatchers to the same standards who respond to sound training practices entrance interviews, testing, travel and and keeps everyone on the same page. are in a much better position to do their moving expenses, pre-employment It’s the same with training. jobs effectively and are thus able to get administrative expenses, medical exams, “A structured training and development more done in a much quicker fashion. and employment information.7

30 THE JOURNAL | iaedjournal.org training | FEATURE •

Better performance as a result of training “Employees are interested in “Untrained employees cannot produce can minimize this turnover and can even performing their jobs well to advance high-quality products,” Amo writes. “They mean supervisors spend less time and energy the company, feel a sense of pride for also lack adequate knowledge and skills to worrying about team members’ output. a job well done, and advance to higher provide satisfactory customer service.” positions,” states business writer Tina Like any other business, your service to Sets expectations Amo. “When there is no training, the customer is paramount. But unlike in With a robust training program firmly employees do not understand how to retail, food services, or similar industries, in place, every member of your comm. do their jobs and none of these goals are when you fail to deliver, lives are at stake..9 center will understand from day one what possible. This leads to low morale among is expected for on-the-job performance. This workers, which results in employee Don’t take it lightly ensures greater consistency in everyone’s turnover. A company with a reputation By using the protocols, you have efforts and can help eliminate confusion for high employee turnover is also the best chance to succeed in your job and frustration that comes when employees unattractive to potential job candidates.”8 and to assist callers with a variety of don’t know what is expected of them. needs. Learning how to use the protocols Training programs establish standards and how to respond to a multitude of that comm. center employees must situations comes through dedicated follow. In turn, employees are motivated “Untrained employees training. No one can step inside a comm. to measure up to these requirements and cannot produce high- center from the street, sit down at a constantly improve in their work. console, and handle call after call with Another bonus for the comm. center quality products. They efficiency without properly learning the is that good training virtually eliminates also lack adequate tools of this all-important trade. valid claims from employees who say they Managers and supervisors must place were unaware of expectations. When knowledge and skills the highest priority in making sure their a person commits an error or overlooks to provide satisfactory staff members are thoroughly trained and something in their work, he or she can’t customer service.” ready to tackle the most difficult calls. plead ignorance and say, “I never knew Similarly, dispatchers must be willing to that” or “No one told me that.” accept the training and apply it to every facet of their job. Consequences of poor training One of the very last things you want to Every link in the emergency dispatch Resist the urge to skimp on training. see in a comm. center is a dispatcher who no chain wins when the dispatcher has the The results of inadequate training can be longer cares about his or her job. skills and training to succeed. J disastrous for your comm. center and for the dispatchers and team members who The callers suffer Sources work there. In the emergency response profession, 1. Clawson J, Dernocoeur K, Murray C. Principles of Emer- gency Dispatch. Fifth Edition. International Academies dispatchers and responders work with a of Emergency Dispatch; Salt Lake City, Utah. 2014. Dissatisfaction unique set of customers. Your customer is 2. See note 1. Being a dispatcher is challenging the person on the other end of the phone— 3. Frost S. “The Importance of Training and Development in enough, even when the person is armed frantic, exasperated, terrified, and possibly the Workplace.” Chron. Hearst Newspapers, LLC. 2016. http://smallbusiness.chron.com/importance-training-de- with all the tools and resources needed to clinging to life or relying on you to render velopment-workplace-10321.html (accessed Oct. 17, 2016). excel. But combine an arduous job with aid to a loved one whose life is in the balance. 4. See note 3. little or no training, and you have a recipe In other professions, poorly trained 5. “Increase Productivity & Job Satisfaction – Hire a Busi- ness Coach to Train Your Team.” Diad Consulting Inc. for major problems. employees will have insufficient 2016. http://www.diadconsulting.net/wp-content/up- If managers and supervisors fail to knowledge or motivation to help loads/2014/07/Increase-Productivity-and-Job-Satisfac- invest in their employees by offering customers. Consequently, the customer tion-22-to-88-percent-rev-3.pdf (accessed Oct. 18, 2016). 6. Shaw J. “Effects of Training on Employee Performance.” instruction, guidance, and correction, will become frustrated and upset and will Chron. Hearst Newspapers, LLC. 2016. http://small- when needed, employees will feel seek service from a competitor, possibly business.chron.com/effects-training-employee-perfor- unappreciated, undervalued, and never to return to the business that was mance-39737.html (accessed Oct. 18, 2016). unimportant to the organization. When unable to satisfy their needs. 7. See note 6. 8. Amo T. “The Negative Effects of a Lack of Training these feelings persist, it won’t take long for But that’s not often the case for in the Workplace.” Chron. Hearst Newspapers, LLC. the person to dread coming to work and communication centers. Your task is 2016. http://smallbusiness.chron.com/negative-ef- fects-lack-training-workplace-45171.html (accessed Oct. develop an apathetic attitude toward his or so much more important than selling 19, 2016). her daily tasks. a product. 9. See note 8.

iaedjournal.org | THE JOURNAL 31 ••• ON TRACK | medical cde

SILENT KILLER See no evil, hear no evil, smell no evil

Audrey Fraizer

arbon monoxide is a stealthy killer. inappropriately used household items, fixing combustion engines or machines You can’t see, smell, or hear including malfunctioning gas- and oil- operating on combustible gases. Cthe silent reaper, and despite the burning furnaces, lawn mowers, portable Unchecked conditions at pulp mills, ease of preventing death, this toxic gas is generators, and charcoal grills.2 steel foundries, and industrial plants the leading cause of accidental-poisoning producing formaldehyde put workers at deaths and poisoning-related injuries Silent killer high risk for exposure and poisoning.4 worldwide. Each year in the United States, The great danger of carbon monoxide carbon monoxide (CO) poisoning kills at exists in its attraction to hemoglobin in Medical effects least 430 people and sends an estimated the bloodstream. Since carbon monoxide CO poisoning can occur suddenly 15,000 patients to the emergency room, preferentially binds to hemoglobin, fewer or over a long period of time. The initial according to statistics from the Centers for oxygen molecules are able to bind to symptoms of low to moderate CO Disease Control and Prevention (CDC).1 hemoglobin when carbon monoxide is poisoning are similar to flu symptoms but CO poisoning can infiltrate “routine also inhaled. This reduces the amount of without the fever. Early symptoms a caller domestic, occupational, and recreational oxygen transported throughout the body, might report include headache, dizziness, activities, and, also, in the wake of large- so the heart and brain receive less oxygen and nausea. As the carbon monoxide scale disasters such as those caused by than they need to function properly.3 builds up in the blood, symptoms hurricanes, floods, and winter storms.” In addition to the hazards already escalate to confusion and drowsiness, fast Unintentional, non-fire-related (UNFR) mentioned, other high-risk behavior breathing, fast heartbeat or chest pain, CO poisoning is a leading cause of includes adults and children riding in vision problems, and seizures. poisoning with toxic levels of the gas the back of enclosed pickup trucks, as Symptoms, however, are not the same resulting from malfunctioning or well as individuals working indoors for everyone affected. A person with a

32 THE JOURNAL | iaedjournal.org medical cde

low level of exposure could experience or patterns of injury either from natural One clue indicating CO poisoning is lifelong effects, and someone with causes or acts of terrorism. the number of people taken ill, according an extremely high level of exposure The system is integrated into the to Brett Patterson, IAED™ Academics & may have a full recovery. Outcome Medical Priority Dispatch System™ Standards Associate and Medical Council is unpredictable. (MPDS®) ProQA® software and of Standards Chair. Despite treatment, CO poisoning interfaced with CAD, ePCR, and “Everyone is exposed to small victims can die or suffer permanent, hospital emergency department and amounts of carbon monoxide throughout severe injury, and as many as 50 poison control data. FirstWatch was the day, and it’s inhaling too much that percent of all victims who recover instrumental in isolating the sources can cause poisoning,” Patterson said. “So, consciousness and survive can be left and area affected by high levels of CO in a medical event, as opposed to trauma, with lifelong impairments affecting in Oklahoma City and Tulsa, both the number of people taken ill and with the brain, endocrine system, nervous in Oklahoma, USA, resulting from the same symptoms would indicate system, and heart. Hypoxic-Anoxic (HA) residential use of alternate heating possible poisoning.” brain injuries, caused by a diminished sources during a power outage. EMD’s Third Law of Safety, found supply of oxygen to the brain, can The CO trigger added to the on the Additional Information card for result in serious cognitive, physical, and existing FirstWatch surveillance system Protocol 8, states: psychological impairments. connected to the Regional Emergency One patient down, trouble around? Removing the source (e.g., Medical Services Authority (REMSA) Two patients down, coincidence found? malfunctioning gas heater) after prolonged in Oklahoma City provided a symptom- Three patients down, danger abounds! exposure (days and months) doesn’t based application to identify clusters of necessarily remedy long-term effects on purported CO poisoning based on calls the brain. A study looking at chronic to the communication center. The real- carbon monoxide exposure reported seven time data collected, and mapped to call cases of chronic, subacute CO poisoning sources, gave responders the geographic symptoms after the source of CO was boundaries for contacting residents removed. The symptoms included changes regarding hazards of fuel-burning in memory, sleep, vision, sense of smell and appliances and devices. sense of direction, anxiety, and balance “The CO calls dropped once the problems. There is also the potential of residents were warned,” said FirstWatch heart damage due to prolonged exposure, Founder and President Todd Stout possibly leading to life-threatening cardiac during a phone interview. “This wasn’t complications years after the poisoning.5 about measuring levels of carbon monoxide but the people affected and Surveillance where the calls were coming from.” National estimates and surveillance activities have long relied on secondary Dispatch response data sources in the absence of an active The MPDS addresses EMS response national surveillance system for CO for CO poisoning in Protocol 8: Carbon poisoning. These sources include the Monoxide/Inhalation/HAZMAT/ National Vital Statistics System, the CBRN; nine Determinant Suffixes National Electronic Injury Surveillance distinguish the causative agent for Help is on the way System—All Injury Program, and reports specific response and safety purposes. An alarm from an in-home CO from hyperbaric oxygen treatment Suffix M delineates carbon monoxide. detector can help in identifying the facilities; however, because none of Because the toxic gas is nearly problem because they are made to these sources were developed specific to impossible to detect, and symptoms of sound at levels well below critical CO poisoning, there are limitations in acute and long-term CO poisoning mimic conditions; however, not all homes timeliness, quality, and availability.6 symptoms of more common illnesses, such or heating systems are equipped with FirstWatch, a dispatch-based syndrome as the flu, a person experiencing symptoms automatic sensors. surveillance system, is a possible exception who is calling 911 may be confused and If the dispatcher can identify due to the system’s ability to collect real- disoriented, while someone discovering suspected CO poisoning from the time data from 911 calls, indicating trends symptomatic victims on scene would have information provided, the MPDS and possible outbreak of disease, illness, little indication of cause. provides the lifesaving tools.

iaedjournal.org | THE JOURNAL 33 medical cde

The EMD will advise residents to leave for an emergency and a non-emergency •• Connecticut, New Hampshire, the home immediately and, if appropriate, response. Crews responding to the scene of Oregon, Pennsylvania, Rhode Island, ask the caller to leave the door open on the a known CO danger generally check CO Utah, Vermont, Washington, and way out to begin ventilation. The EMD levels at least twice: once before entering West Virginia require CO detectors in will caution the caller against open flames the home and again when inside. Levels all new construction. or anything that would cause a spark. may be checked at several locations inside. •• Florida also requires them in new Once the occupants are safely away If the source of the CO exposure construction and in every room with from the area, the EMD will gather can be eliminated and the premises a boiler.8 information for fire department and EMS ventilated to accepted standards of fresh CO poisoning is not a disease that unit response. The Determinant Code air, the residents may be allowed to go requires reporting for record keeping, and selected depends on the severity of the back inside. there are few programs that monitor and patient’s medical condition. publish statistics. The caller is told not to enter or Treatment In New York, annual counts and rates re-enter a hazardous or dangerous Treatment for CO poisoning is aimed of emergency medical treatment, hospital environment. If the call does not involve at replacing the carbon monoxide in the admission, and death from CO poisoning patients with illness or symptoms from blood with oxygen as quickly as possible. are monitored and reported publicly on exposure to fumes or hazardous materials, In the hospital, a patient may breathe the NYC Environmental Public Health the fire department will most likely pure oxygen through a mask placed over and Tracking Sustainability Portal. The respond without lights or siren (non- the nose and mouth to bring oxygen portal also provides data on annual calls emergency). A caller indicating illness to organs and tissues. A patient who to the NYC Poison Control Center for requires an appropriate medical response. cannot breathe independently will need suspected exposure to and/or poisoning There are DLS links to NABC- ventilator assistance. by CO, and investigations made by the 1 for Unconscious or Arrest, and In some cases, hyperbaric oxygen Fire Department of the City of New York INEFFECTIVE BREATHING and Not therapy is recommended to reduce the (FDNY) for CO incidents triggered by an alert patients. The direction not to touch carbon monoxide level in the blood and alarm or an adverse health event.9 J the patient (found on Panel X-7) is only the symptoms of CO poisoning. The way linked from Protocol 8 for Danger or this works is as follows: Sources Contamination and Chemical Suicide. •• The affected person lies down 1. Graber J, Macdonald S, Kass D, Smith A, Anderson H. “Carbon Monoxide: The Case for Environmental Public “Whatever is going to kill the patient, on a stretcher that slides into an Health Surveillance.” Public Health Reports. 2007; happening inside the body, is not changed acrylic tube. March–April. http://www.ncbi.nlm.nih.gov/pmc/arti- by urging them not to go to sleep,” said •• The pressure inside the tube is raised, cles/PMC1820437/ (accessed July 1, 2016). Dr. Jeff Clawson, inventor of the MPDS. and 100 percent oxygen is delivered 2. See note 1. 3. “Carbon Monoxide Poisoning.” Carbon Monoxide Kills. “It’s not going to sleep but what’s causing under high pressure. http://www.carbonmonoxidekills.com/33/carbon_ unconsciousness that kills you.” •• After treatment, the chamber is monoxide_poisoning (accessed July 1, 2016). There is no medical evidence suggesting depressurized slowly while the person 4. Shochat G, Tarabar, A. “Carbon Monoxide Toxicity.” Medscape. 2016; May 8. http://emedicine.medscape. 7 a bystander should stay with the patient to rests inside. com/article/819987-overview (accessed July 1, 2016). make sure he or she does not fall asleep. 5. Myers RAM, DeFazio A, Kelly MP. “Chronic carbon State actions monoxide exposure: a clinical syndrome detected by neuropsychological tests.” J Clin Psychol. 1998; August. Paramedic and fire CO poisoning is preventable by the http://www.ncbi.nlm.nih.gov/pubmed/9696105 department response correct installation, maintenance, and (accessed July 1, 2016). It would only be a matter of time for operation of devices that may emit the 6. Iqbal S, Clower J, King M, Bell J, Yip F. “National Carbon Monoxide Poisoning Surveillance Framework and an individual robbed of breath to become toxic gas, combined with the appropriate Recent Estimates.” Public Health Reports. 2012; Septem- unconscious. According to Axiom 2 on use of carbon monoxide detectors (also ber–October. http://www.publichealthreports.org/ issueopen.cfm?articleID=2892 (accessed July 1, 2016). Protocol 8, unconsciousness in a patient called carbon monoxide alarms). 7. “Hyperbaric Oxygen Therapy for Carbon Monoxide who has inhaled carbon monoxide is a As of March 2016, 30 states have Poisoning.” WebMD. 2014; June 4. http://www.webmd. bad sign. Hyperbaric oxygen treatment, enacted statutes regarding CO detectors, com/first-aid/hyperbaric-oxygen-therapy-for-car- bon-monoxide-poisoning (accessed June 30, 2016). which enables oxygen transport by and another 11 have circulated 8. “Carbon Monoxide Detector Requirements, Laws and plasma, may be necessary to prevent regulations on CO detectors. Here are Regulations.” National Conference of State Legislators. death or brain damage. The call quickly some examples: 2016; April 5. http://www.ncsl.org/research/environ- ment-and-natural-resources/carbon-monoxide-detec- turns into an emergency response. •• Alaska requires detectors approved by tors-state-statutes.aspx (accessed July 1, 2016). Operations to detect the presence of the state fire marshal be installed in 9. “Carbon Monoxide Surveillance.” Centers for Disease Con- CO and locate the source are the same all dwellings. trol and Prevention. 2014; Jan. 1. http://www.cdc.gov/co/ surveillance/rationale.htm (accessed June 30, 2016).

34 THE JOURNAL | iaedjournal.org MEDICAL CDE QUIZ | G

YOU MUST BE MEDICAL CERTIFIED TO TAKE THIS QUIZ CDE Quiz Mail-In Answer Sheet Answer the test questions on this form. (A photocopied answer sheet Answers to this quiz are found in the article “Silent Killer,” which starts on page 32. Take this is acceptable, but your answers must be original.) WE WILL NOT quiz for 1.0 CDE unit. PROCESS ALTERED SIZES. A CDE acknowledgement will be sent to you. (You must answer 8 of the 1. This toxic gas is the leading cause of accidental-poisoning deaths and poisoning-related 10 questions correctly to receive credit.) injuries worldwide. Clip and mail your completed answer sheet along with the $5 USD a. carbon dioxide (U.S. currency) NON-REFUNDABLE processing fee to: b. nitric oxide The International Academies of Emergency Dispatch c. oxygen difluoride th d. carbon monoxide 110 South Regent Street, 8 Floor Salt Lake City, UT 84111 USA 2. What is a leading cause of poisoning with toxic levels of the gas? Attn: CDE Processing (800) 960-6236 US; (801) 359-6916 Intl. a. structure fires b. natural disasters Please retain your CDE acknowledgement for future reference. c. unintentional, non-fire related CO poisoning d. farm waste Name ______

3. The great danger of carbon monoxide poisoning exists: Organization ______a. in its attraction to hemoglobin in the bloodstream. b. in its inability to turn into carbon dioxide. Address ______c. in its close association to other blood-borne diseases. d. in its binding power to pathogens in the bloodstream. City ______St./Prov.______

4. The initial symptoms of low to moderate CO poisoning are similar to: Country ______ZIP______a. flu symptoms, but with migraine-strength headaches. b. food poisoning, but without the diarrhea. Academy Cert. #______c. flu symptoms, but without the fever. d. nerve gas poisoning, but without the drooling. Daytime Phone ( )______

5. As many as 50 percent of all victims who recover consciousness and survive can be left with E-mail ______lifelong impairments affecting the brain, endocrine system, nervous system, and heart. a. true PRIMARY FUNCTION b. false Public Safety Dispatcher (check all that apply) 6. Secondary data sources in surveillance systems for CO poisoning tend to be limited in application due to: _____Medical _____Fire _____Police a. the lack of longitudinal studies. Paramedic/EMT/Firefighter b. development not specific to CO poisoning. c. data that is not scrubbed prior to study. Comm. Center Supervisor/Manager d. an inconsistent approach in isolating victims of CO poisoning for further study. Training/QI Coordinator

7. One clue indicating possible CO poisoning is: Instructor a. the presence of a barbecue grill indoors. Comm. Center Director/Chief b. the smell CO emits in a poisoning situation. c. the number of people taken ill and with the same symptoms. Medical Director d. flu symptoms and high fever. Commercial Vendor/Consultant 8. The Determinant Code selected for suspected CO poisoning depends on: Other a. the severity of the patient’s medical condition. b. the length of time between the onset of symptoms and the 911 call. c. other hazards present. ANSWER SHEET G MEDICAL d. the suspected cause of the poisoning (natural or manmade). Jan/Feb 2017 Journal “Silent Killer” Please mark your answers in the appropriate box below. 9. Operations to detect the presence of CO and locate the source are radically different for an emergency compared to a non-emergency response. 1. o A o B o C o D a. true 2. o A o B o C o D b. false 3. o A o B o C o D 10. Treatment for CO poisoning is aimed at replacing the carbon monoxide in the blood with: a. carbon dioxide as quickly as possible. 4. o A o B o C o D b. glucagon. c. oxygen as quickly as possible. 5. o A o B d. a combination of atropine and a reactivator. 6. o A o B o C o D 7. o A o B o C o D 8. o A o B o C o D 9. o A o B

To be considered for CDE credit, this answer sheet must be received no later than 2/28/18. A passing score is worth 1.0 CDE 10. o A o B o C o D unit toward fulfillment of the Academy’s CDE requirements. Please mark your responses on the answer sheet located at right and mail it in with your processing fee to receive credit. Please retain your CDE letter for future reference. Expires 2/28/18 iaedjournal.org | THE JOURNAL 35 ••• ON TRACK | police cde

BURGLAR, ROBBER, OR THIEF? Picking the correct PPDS Chief Complaint

Mike Rigert

tacy is lovin’ life. She’s returning a Hollywood heist movie or common and give callers the best emergency police home from a relaxing seven-day everyday usage (as in Stacy’s scenario), dispatch service possible. SCaribbean cruise during which these types of crimes are frequently used she devoured three “can’t-put-it-down” interchangeably or simply misused. If you Just the stats, ma’am novels, got a great tan, and chilled with find yourself in this camp, or if you just With this trio of PPDS® Chief some new friends. However, that vacation want a review, we’re here to chase away Complaints, two fall under the category euphoria came to a screeching halt any doubts. of Property Crimes (Burglary and Theft), when she pulled in the driveway only to In this Police CDE, we’re going to tackle and one goes under the Crimes Against discover that the garage back door had (apprehend, in LEO vernacular?) three People header (Robbery). This is an been kicked in and that her Apple laptop, Police Priority Dispatch System™ Chief important distinction because some her 55-inch smart TV, and some of her Complaint Protocols—110: Burglary (Break- critical calls for emergency help require most valuable jewelry are nowhere to and-Enter)/Home Invasion, 126: Robbery/ quicker, more aggressive action than be found. Suffice it to say, Stacy’s not a Carjacking, and 130: Theft (Larceny). others. Crimes Against People typically happy camper. She dials 911 and blurts Our goal, and the emphasis of this necessitate a faster response time than out to the EPD, “I’ve been robbed!” CDE, is to help the EPD choose the most Property Crimes because suspects, Sound familiar? Joe Public, and applicable Chief Complaint in a variety including suspects with weapons, may sometimes even newer dispatchers, of call scenarios, review key Additional still be at the scene and pose a continued can often get confused about the Information that will assist in Chief threat to the caller, bystanders, and criminal case terms burglary, robbery, Complaint selection, and compare and responding officers. and thievery. And in some ways, it’s contrast the three. We want to help you For example, Axiom 2 on Protocol no surprise. Whether it’s a line from better handle these types of police calls 110: Burglary (Break-and-Enter)/

36 THE JOURNAL | iaedjournal.org police cde

Home Invasion states, “Burglaries are So, you’re much more likely to select actually a burglary,” said Bob Pastula, usually property crimes, not crimes PPDS Protocol 130 followed by Protocol Priority Dispatch System™ Program against persons.” 110 than you are to have calls in which you Administrator—Law Enforcement. Despite this, the Key Questions for all would choose Protocol 126 three of these Chief Complaints begin as the most appropriate by asking the caller about weapons, the Chief Complaint. More suspect’s current whereabouts, and if often than not, this is anyone else is in immediate danger. This because theft cases tend to ensures that whether it’s a Crime Against be crimes of opportunity— People or a Property Crime, the Police property is left out in Protocol priorities of scene safety and the open (sometimes caller safety always precede efforts to unattended by the owner) apprehend suspects or collect evidence. and frequently in a public Statistically, Protocol 130: Theft space where suspects have is the most commonly selected Chief unfettered access to the Complaint of the three, according to items. On the flip side, findings from a 2013 study involving burglary and robbery two North American emergency cases usually require communication centers that was some degree of planning, tools to gain The EPD Course Manual also defines published in IAED’s Annals of access to buildings, and sometimes, access Protocol 126: Robbery/Carjacking as “any Emergency Dispatch & Response. Over to weapons. incident involving the taking of money, roughly 18-month periods, 456,711 police personal property, or any other article of calls with EPDs using the PPDS were Protocol CSI value in the possession of another from taken at two communication centers In this section, let’s further break his/her person or immediate presence, that were part of the study. Of those down the three individual protocols for a which has been accomplished by means calls, the research showed that Protocol clearer understanding of what each one is of force or fear and against her/his will.” 130 was selected as the Chief Complaint and is not: These include theft with the threat of a 57,222 times; Protocol 110: Burglary Protocol 110: Burglary (Break-and- weapon, theft with injuries caused, and came in second with 18,499 Chief Enter)/Home Invasion is defined in the carjacking. Protocol 126 does not cover Complaint selections; in third place came fifth edition of the EPD Course Manual burglary, theft without a weapon, or theft Protocol 126: Robbery/Carjacking, used as “the report of one or more persons without injuries caused. 4,420 times. breaking into, unlawfully entering, or With Protocol 126, Pastula said one Interestingly, the study found that remaining unlawfully in a building with difference between Robbery and Protocols Protocol 130 was the fifth-most used the intent to commit a crime. Examples 110 and 130 is that the perpetrator usually PPDS Chief Complaint among all calls include home invasion (breaking into has a specific, calculated target in mind, for police service. or unlawfully entering a home with while Burglary and Theft are more likely to the intent to injure, kill, or terrorize the be crimes of opportunity. residents or occupants) and residential or Some important keys to remember commercial break-in.” about Protocol 126 are covered under If someone’s backpack is taken from Axioms 1 and 2. First, Axiom 1 states, the corridor of a university building, “weapons are used or mentioned in or if a suspect holds up a convenience most robberies.” And second, Axiom 2 store using his hand in a hoodie pocket explains to the calltaker that “lock(ing) to simulate a pistol, neither scenario is doors and windows may be lifesaving.” a burglary. However, if suspects storm The EPD will use PDI-b to instruct the into an apartment with the intent of caller to lock doors and windows. “roughing up” the occupants for not Protocol 130: Theft (Larceny) is repaying a debt, Protocol 110: Burglary “any incident involving the taking of would be the most appropriate Chief property without the owner’s consent Complaint selection. and without the threat of force or “Most callers will say ‘I’ve been intimidation. Common examples include robbed,’ and nine times out of 10, it’s pickpocketing, shoplifting, theft of a

iaedjournal.org | THE JOURNAL 37 police cde

getting the caller to tell you exactly what happened will you know which Chief Complaint Protocol to use for the case.” Pastula said often the best way to get the right information or more information when the caller’s response to Key Question 4 is vague is to ask again. This approach also helps the EPD steer clear of freelancing and asking leading questions. “Repeat, ‘Tell me exactly what happened,’” he said. “Or, if you don’t get the information you need on Key Question 4, come back with, ‘I really need to know what’s going on right now.’” And on a final note, the EPD manual states remember “sometimes distraught callers have relatively minor problems and calm callers are reporting an extremely dangerous and volatile situation.” “Be aware that it is impossible to judge the severity of an incident based solely on the caller’s tone, rate, and volume of speech,” the EPD manual states. “You should always focus on what is being said rather than how it is being said.”

Book and fingerprint ‘em So, some of the major takeaways from this Police CDE are: •• Callers may initially tell you they’ve been robbed, when in actuality it’s a burglary or theft. •• Statistically speaking, theft calls are more frequent than robbery or vehicle, and theft from vehicle, but not remember when choosing a Chief burglary calls. robbery or burglary,” the EPD Course Complaint. Much of it surrounds the use •• Review the definitions for each of Manual states. Protocol 130 is further of Case Entry Question 4, “Okay, tell me the three EPD Protocols to aid you defined in Additional Information as “the exactly what happened.” in selecting the most appropriate act of dishonestly taking property from The manual says, “obtaining a Chief Complaint. another with the intent of permanently complete description of the problem is •• The answers you get to Case Entry depriving the owner of it (stealing).” essential for accurate classification of the Question 4 are crucial to correct Chief To reiterate from the AEDR study, incident.” Perhaps nowhere is this more Complaint Selection. If you don’t get EPDs are much more likely, statistically crucial than during police calls in which the key information you need the speaking, to answer calls where Protocol callers may be confused, have incomplete first time, repeat or restate, “Okay, tell 130 is the selected Chief Complaint as information, or fear for their own safety. me exactly what happened” until you opposed to Protocol 110 or Protocol 126. “Listen also for background noises that have the information you need. might indicate caller danger or other scene OK, great work EPDs! Now get out All signs point to Case Entry safety issues,” the course manual states. there and solve “the case.” J The EPD Course Manual points “The caller’s vague statement could refer out some other factors the EPD should to a burglary, a robbery, or a theft. Only by

38 THE JOURNAL | iaedjournal.org POLICE CDE QUIZ | ?

YOU MUST BE POLICE CERTIFIED TO TAKE THIS QUIZ CDE Quiz Mail-In Answer Sheet Answer the test questions on this form. (A photocopied answer sheet Answers to this quiz are found in the article “Burglar, Robber, Or Thief?,” which starts on page is acceptable, but your answers must be original.) WE WILL NOT 36. Take this quiz for 1.0 CDE unit. PROCESS ALTERED SIZES. A CDE acknowledgement will be sent to you. (You must answer 8 of the 1. A caller tells the EPD that his car has just been stolen after the perpetrator walked up, 10 questions correctly to receive credit.) pointed a knife at the victim, grabbed the keys out of his hand, and drove away. Which would Clip and mail your completed answer sheet along with the $5 USD be the most appropriate Chief Complaint selection? (U.S. currency) NON-REFUNDABLE processing fee to: a. Protocol 110 The International Academies of Emergency Dispatch b. Protocol 126 th c. Protocol 130 110 South Regent Street, 8 Floor Salt Lake City, UT 84111 USA 2. According to the study in the article, Chief Complaint Protocol 110 was selected for how Attn: CDE Processing many calls? (800) 960-6236 US; (801) 359-6916 Intl. a. 4,420 Please retain your CDE acknowledgement for future reference. b. 18,499 c. 57,222 Name ______

3. A gas station attendant calls and reports to the EPD that a teenage girl just pumped $30 of Organization ______gas and drove off without paying. Which is the most appropriate Chief Complaint selection? a. Protocol 110 Address ______b. Protocol 126 c. Protocol 130 City ______St./Prov.______

4. According to the research study, ______was the fifth-most chosen PPDS Chief Complaint Country ______ZIP______among all calls for police service. a. Protocol 110 Academy Cert. #______b. Protocol 126 c. Protocol 130 Daytime Phone ( )______

5. A frightened teenager who is home alone calls to report that he heard some glass shatter and E-mail ______can hear someone walking around upstairs. Which is the most appropriate Chief Complaint? a. Protocol 110 PRIMARY FUNCTION b. Protocol 126 c. Protocol 130 Public Safety Dispatcher (check all that apply)

6. In Protocol 126, Axiom 1 states, “threats are used or mentioned in most robberies.” _____Medical _____Fire _____Police a. true Paramedic/EMT/Firefighter b. false Comm. Center Supervisor/Manager 7. A convenience store owner calls to say that someone came up to the register as if he was Training/QI Coordinator going to purchase some cigarettes, told the owner to give him money from the register, and said he had a gun. Which is the most appropriate Chief Complaint? Instructor a. Protocol 110 Comm. Center Director/Chief b. Protocol 126 c. Protocol 130 Medical Director Commercial Vendor/Consultant 8. According to the EPD Course Manual, what is the most important piece of information the EPD needs in order to accurately classify the call and make the correct Chief Complaint selection? Other a. the address of the emergency b. whether or not weapons are involved c. whether the caller is in imminent danger ANSWER SHEET ? POLICE d. a complete description of the problem Jan/Feb 2017 Journal “Burglar, Robber, or Thief?” Please mark your answers in the appropriate box below. 9. What does Bob Pastula say is often the best way to get the right information or more information during the Case Entry Question, “Okay, tell me exactly what happened.” 1. o A o B o C a. Find out what the suspect is doing right now. 2. o A o B o C b. Ask the caller to give a complete description of the suspect. c. Repeat the question. 3. o A o B o C d. Tell the caller you can’t help them if you don’t get the information. 4. o A o B o C 10. The EPD Course Manual states, “It is impossible to judge the severity of an incident based solely on the caller’s tone, rate, and volume of speech.” 5. o A o B o C a. true b. false 6. o A o B 7. o A o B o C 8. o A o B o C o D 9. o A o B o C o D

To be considered for CDE credit, this answer sheet must be received no later than 2/28/18. A passing score is worth 1.0 CDE 10. o A o B unit toward fulfillment of the Academy’s CDE requirements. Please mark your responses on the answer sheet located at right and mail it in with your processing fee to receive credit. Please retain your CDE letter for future reference. Expires 2/28/18 iaedjournal.org | THE JOURNAL 39 ••• BLAST FROM THE PAST

PRIMUM NON NOCERE First Do No Harm

Jeff Clawson, M.D.

his Blast goes way back to the time when the MPDS® was first being concocted in draft form. As a very new emergency physician who was now working as the Fire Surgeon/Medical Director for Tthe Salt Lake City Fire Department (Utah, USA), this column in the monthly magazine Emergency Medicine was never to be missed. The December 1977 column specifically caught my attention, so much that I tore it out and saved it. Its Latin title, “Primum non nocere” means simply, “First Do No Harm”–a concept that takes center stage in both emergency dispatch and response. It taught me a lesson that I never forgot. Superficial evaluations and/or jumping to conclusions are always fraught with danger in medicine and public safety. The second case, while a little deeper clinically, also tells a story that should be learned as a general lesson for all. And those hits just keep on comin’ … J

40 THE JOURNAL | iaedjournal.org blast from the past

iaedjournal.org | THE JOURNAL 41 ••• YOUR SPACE | cripple creek save

Teller County 911 takes calls within the county and transfers EMD dispatch to Cripple Creek 911. A call involving a heart-related condition is generally routed to helicopter dispatch from Memorial Hospital Central in Colorado Springs. “Chest pain and there’s a good chance the patient will be flown out,” said Diann Pritchard, Cripple Creek Police Department Dispatch Supervisor. “There’s only one main road that takes you down Ute Pass to Colorado Springs, so once you get started by ambulance you’re stuck.” On a good day, the drive along Highway 24 to Highway 67, between Victor and Colorado Springs, takes 90 minutes; a helicopter reduces travel to an estimated 12 minutes. Heavy snow and reduced visibility Gurtrude Wuellner’s call to 911 saved the life of her husband, Ralf. prevented medical helicopter service. Snow and ice glazing the single road like MORE THAN A MILE-HIGH EMERGENCY honey on a Bee Sting delayed ambulance response. Once Paramedic Eric Murray CPR offsets long drive down winding road arrived, it took seven tries with an AED to get back Ralf’s pulse. Audrey Fraizer Ralf assumes it wasn’t easy navigating the twisty, slushy, and slippery Highway 24, but he couldn’t say. The last thing he remembers is feeling queasy at the start ct. 21, 2015, was gearing up to Ralf had suffered sudden cardiac of his day and taking the aspirin his son be just another day for Ralf and arrest. Gurtrude found him facedown retrieved from the nearby convenience OGurtrude Wuellner, until an on the floor, unresponsive and his skin store and post office. event made it a day they will never forget. turning blue. She called 911. Gurtrude, however, does remember The Wuellners own and operate the EMD Cindy Link, at Teller County her anxiety intensified by bad weather. Gold Camp Bakery in Victor, Colo., USA, Sheriff’s Department 911 center in Nine inches of snow had accumulated in a city at a 9,700-foot elevation near Pikes Divide, started CPR immediately, giving Cripple Creek by 9 a.m. Peak. Every morning for the past eight instructions to Seanna Forte, a bakery Halfway down the road to Colorado years they’ve unlocked the shop’s doors employee, who relayed them to Gurtrude. Springs in a four-wheel drive ambulance, before dawn to bake pastries, rich in For the next 18 minutes, until firefighters Ralf came to. Five days later, he was back at natural ingredients and German culture. arrived from Cripple Creek, Link counted, the bakery, with two stents in place.. “You have to get there early if you want Forte repeated the counting, and Gurtrude “His heart is doing great,” Gurtrude a Bee Sting (cake),” said 80-year-old Theresa pumped her husband’s chest. said. “It does what it needs to do.” “Tarie” Huber, who has spent the majority “Cindy told me I was going to do CPR, “She (Link) doesn’t get rattled,” of her life in the once-bustling gold mining and so that’s what I did,” Gurtrude said. Pritchard said. capital of Colorado. “It’s that good.” “I didn’t think about whether I could do Pritchard nominated Link for a NG9- Huber stops at the bakery for a slice of this because I knew I had to do this. There 1-1 Institute Honors Award. Link won in the sweetened buttery pastry on her way was no choice.” the Public Safety Leader category. to a part-time job at the visitors center. It’s Cripple Creek is 49 miles southwest of “I am very proud of what we do,” not unusual to skip a week between Bee Colorado Springs, with about half of these said Link, manager at Teller County 911. Stings, but on this particular Friday in miles along Highway 24 at its junction with “I like being able to help people, and I 2015, Huber heard something that made Highway 67 at the city of Divide. Victor is like the pace. It feels like I’m where I’m her come running. another seven miles south of Cripple Creek. supposed to be.” J

42 THE JOURNAL | iaedjournal.org recognition/honoring telecommunicators

Jersey.” The best was “Bring Your Dog to Work Day,” with the stipulation of one per shift. We still don’t know who enjoyed the day more, the dogs or the dispatchers. For comm. centers with a little money to play with, being treated to a free lunch order is a simple gesture that’s always appreciated (you can rarely go wrong with putting food in front of a dispatcher). Some comm. centers organize a food theme for different days of the week (time to bring in that award-winning chili). Providing recognition formally through your city, county, or organization’s website also goes a long way. Some agencies present an award for Telecommunicator of the Year based on past performance or notable calls. The sad truth is that at some agencies, there’s a huge disparity between what the dispatchers do and what they’re officially recognized for. I have been to agencies THANK A DISPATCHER where they’re in the same job classification as clerical workers, with an hourly pay National Telecommunicators Week provides rate that’s not much better. Often, that’s the opportunity because decades-old job classifications and pay rates reflect the era when the job Art Braunschweiger involved only pencil and paper, a single phone line, and no minimum performance expectations. Comm. center administrators may not be able to solve that problem his isn’t about how we can do www.congress.gov/bill/102nd-congress/ in the short term, but they can make our jobs better. It’s about being house-joint-resolution/284/text to read the sure their dispatchers feel appreciated. Tappreciated for what we do. resolution’s full text. Surprisingly, studies show that employee Most dispatchers routinely handle Unfortunately, many of us don’t get recognition increases morale, increases calls and call volumes at levels that would recognition from our agencies, either. Last teamwork, and keeps employees engaged be utterly overwhelming to anyone else. year I asked a friend what his agency—a far more than what can be accomplished Ask any responder who’s done a “ride- large, regional center—did for them on with increases in pay. It’s been proven that along” in dispatch. Perhaps that’s the Telecommunicators Week. “We got a travel good pay keeps employees from leaving, problem: When excellence becomes the mug,” he said. I thought, “Really? That’s it?” but it doesn’t make them happier while norm, it doesn’t occur to management to Mugs are nice, but recognition for they’re there. That’s why establishing a acknowledge it. what we do needs to go beyond token culture of recognition is one of the most For comm. centers in the gestures of acknowledgement and involve important goals an agency can have. United States, one opportunity for genuine expressions of appreciation. Next time National Public Safety recognition is National Public Safety Many comm. centers have found ways Telecommunicators Week rolls around, Telecommunicators Week. It’s the to do this without spending a dime. Last make it count. (Kudos to you if you second week of April every year year my comm. center designated one day already do.) If you’re an administrator, and became law on March 26, 1992, of Telecommunicators Week as “Jeans come up with a plan. If you’re not, submit by an act of Congress. In doing so, and Fire Department T-Shirt Day.” The some ideas or a copy of this column. We Congress acknowledged that we departments we dispatched were glad to rarely seek recognition for ourselves, but “daily serve the public in countless donate shirts of various sizes as their way we do need to know we’re appreciated. J ways without due recognition by the of saying thanks. The theme for another beneficiaries of their services.” Go to day was “Wear Your Favorite Sports

iaedjournal.org | THE JOURNAL 43 ••• YOUR SPACE | recognition/honoring telecommunicators

you were beyond help. I talked to you and distracted you long enough for help to get there and take the gun from your hand. I used every resource available so we could find you when you rolled your car off the highway. I was with you when you took your last breaths. I felt your frustration and fear when the water was just too rough for you to help her. I reassured you when you begged for the minutes to disappear and for the ambulance to arrive. I shouldered your obscenities and continued to be your calming influence when you found your overdosed son. I prayed that you were at peace after you finally stopped the voices in your head. I told you to sing to your sweetheart, to calm him, to drown out the rest of the noise while we waited for EMS and fire to find your mangled truck. I was the first to hear your tiny but strong cries after you made your grand entrance into this MAKE NO MISTAKE world and silently cried tears of joy with your family. I am a first responder I prayed when I heard your “Mayday” call. I prayed because you are my brother Daphanie Bailes or sister, and when you hurt, I hurt. I train and learn every day, beyond what is required, because I am the one and only person who is not allowed to be caught Editor’s Note: Daphanie wrote her column in response to the Office of Management and off guard and not know what to do. So Budget’s (OMB) refusal to reclassify public safety communicators into the protective many lives desperately depend on me to service, the same classification as police officers and firefighters. The current classification know what to do or whom to call and to of 911 professionals under Standard Occupational Classification is under a category of make it happen in the blink of an eye. Office and Administrative Support Occupations. In a way, the OMB is correct. I’m not a first responder by the purest ’m not a first responder—that’s what so much more than those four walls or definition. I am a highly trained public lots of people say. How can you be a my voice. It is the voice of every caller safety telecommunicator. I am THE Ifirst responder? You just sit in a room. I or administrator on the phone, every FIRST, FIRST RESPONDER. I am the would like to invite those who think that firefighter and paramedic or EMT on the first to respond to that emergency with to step into my world. The world of the radio. It also includes the voices that don’t lifesaving instructions. I am the first to faceless, the nameless. The world where I go away when I hang up the phone, or alert law enforcement, fire, and medical am only known by the sound of my voice. walk out the door, or try to close my eyes. personnel to the cries for help. I am the A voice that can portray everything from I know I wasn’t the first person to put first to hear and feel heartache and joy love to loathing. A voice that can give me my boots on the ground, but my voice from people I will never know. I am the away if I dwell on the fight at home, the was the first you heard. I broke through first to comfort those souls in need. And fourth nastygram email of the day, or the language barriers to keep you safe. I I will be the first to invite you into these last bad 911 call. A world where I juggle instructed your loved one to give you four walls to experience my world. Not the feelings associated with multiple lifesaving breaths until help could arrive. I because I want a pat on the back or to calls, all at once. A world where I rarely told you to hide and kept you calm while have grandiose feelings of superiority, hear “thank you” or “I want to do that evil walked past your closet door. I heard but because I want you to understand it. when I grow up.” My world encompasses your wife’s screams when she realized #IAM911 J

44 THE JOURNAL | iaedjournal.org recognition/honoring telecommunicators

fault the CPR instructions I provided for the last nine minutes over the phone to a bystander didn’t save the life of the patient, because in the end we both know we can’t work miracles. We try as hard as we can, but that doesn’t always save a life.

Dispatch is about co-workers This job gives me lots of co-workers. Sometimes co-workers turn into friends and family, but co-workers may also decide that dispatch isn’t the right choice. A co- worker might stay for a year, a month, or less than a day. As dispatchers, we see tons of co-workers come and go. It reminds us about why we stay and what it takes to stay.

Dispatch is about being a lifesaver The way we handle a call from the phone ringing to the radio channel can Jennifer Siracusa has more than 12 years’ experience in dispatching. save lives. We bring babies into the world. We comfort a wife who loses her husband MORE TO DISPATCH of 50 years. We provide instructions to a mother who is holding her unconscious We are family and friends, and we save lives child, while trying to calm her down and make sure she is doing everything we Jennifer Siracusa ask. We are accountable for responders on scene and work closely with the commanding chief to ensure that each goes home safely and no one is left behind could tell you that emergency dispatch more. Compared to my family’s home, in a fire. We help people trapped in a bad is hard, that you go home thinking however, I don’t have a place to sleep or situation escape from harm. Iabout it, and that it takes multitasking a quiet space to go for alone time when I grow every day because of my skills to an entirely new level, but then I don’t like something someone said or profession. Every day, I learn something I would be telling you something you if I am having a bad day. Yet, we make it to improve the way I handle something already know about emergency dispatch. work despite sometimes trying situations. the next day. Although my title is So this is what I am going to tell you We are a family of dysfunctional, supervisor, I would gladly call myself an instead about the profession that has loving, and caring people. observer instead. I have the privilege of reshaped my life and my perspective on observing my family and friends save life during the past 12 years I’ve been in Dispatch is about friends lives every day and develop into the best the communication center. Emergency dispatch has given me a dispatchers I know! They aren’t perfect, friend in every person I work with and but they are my family, friends, co- Dispatch is about family talk to in the center, on the phone, and workers, and LIFESAVERS! This is my second family. I spend on the radio. My friend doesn’t always Thank you to every one of you during more time with the people in the have the same face and doesn’t always the upcoming 2017 National Public Safety communication center than I spend ask me how my day is, but I know that Telecommunicators Week, and thank you with my family at home. As family, I am friend is there for me. These friends help for coming into work every day and night expected to be part of an effective team, in different ways. A friend might help and being my superheroes! J even if some members act the same as locate an address, help me decide what cousins I don’t get along with or annoying to order for lunch, or remind me that brothers or sisters. I sit within arm’s reach I am human when mistakes are made. of them for eight to 12 hours a day or A friend understands that it’s not my

iaedjournal.org | THE JOURNAL 45 ••• case exit

THE OLYMPIC SPIRIT Emergency Dispatchers relish opportunity of a lifetime

Audrey Fraizer

he Colonie Police Department, worked a predictable eight hours on and Colonie Police Lt. Lorin Scott, Latham, New York, USA, won 24 hours off rotation. then in charge of the department’s TOlympic distinction through “It’s ironic that this will be the first communication center, said it was “really two dispatchers monitoring emergency time in three years that I’ll actually get a a pat on the back” for his crew, and medical calls at the 1980 games. weekend off,” he told Heins. credited the department’s progressive Edward Sim and Kevin Moore took six- The two dispatchers were selected approach to EMS communications. week leaves of absence to work the phones from eight civilian dispatchers who Colonie’s signal system also went to and radios for the Winter Olympics held at applied for the positions, and with the Olympics. At the time, they used 11 Lake Placid, New York, but it was a thrill-of- two others chosen from a neighboring different codes or signals varying from a-lifetime opportunity even if they weren’t communication center, bringing home a medal. they were responsible for “How many times can you get to work monitoring emergency in the Olympics?” Sim, then 22, asked medical calls for Lake Schenectady Gazette Reporter Barbara Placid Village and the Heins (Dec. 27, 1979). outlying areas of Keene As certified paramedics, Sim and Moore Valley, Saranac Lake, had the medical background required and Elizabethtown. plus upstanding reputations at dispatch. Orientation They knew how to answer calls, take and familiarized the volunteer relay accurate information, and dispatch dispatchers and volunteer ambulances. They were Johnny-on-the EMTs with the area spot for dealing with emergencies and their and equipment. They enthusiasm was undeniable. supplemented the 12 “We were excited to do the job,” said ambulance squads Sim, who dedicated his career to public normally servicing the area. service in Colonie. “It was something Sim said their bringing the world to our little community. Olympic calltaking and Volunteer dispatchers were busy during the 1980 Winter Olympics in New York. It was a big thing for the whole state of dispatching mirrored the New York. We would be a part of history.” jobs they performed for the Colonie non-emergency to emergency, each The job also had major benefits. Police Department. indicating the nature of the call to the Sim was in the medal-round men’s “The main thing they’re concerned with responding ambulance crews. ice hockey game when the United States is cutting down the response time for the Although Sim retired as a Colonie national team, made up of amateur and calls,” Sim said. “It is anticipated that the Police lieutenant in 2004, he stays active collegiate players, defeated the heavily number of ambulance calls will at least in Colonie public service. He’s been a favored Soviet Union national team. The triple during the Olympics (two weeks). member of the Colonie Volunteer Fire “surreal” atmosphere inside the Olympic Usually, Lake Placid averages 50 ambulance Co. for 42 years, serving as an ambulance ice arena is a highlight Sim will always calls during the entire month of February.” EMT, chief, president, and treasurer. He treasure, along with the ski jumping, Sim and Moore were each paid was named Firefighter of the Year in 1987. speed skating, a fiancé who waited $1,800, with the state picking up the tab Moore retired to the state of Florida. until after the games to tie the knot, for housing, meals, and transportation. The Colonie Police Department and enviable scheduling. He was home They stayed at Camp Adirondack, a communications division is a longtime user on weekends during the three-week former prison, with state police who were of the Medical Priority Dispatch System™ orientation, and during the games, he assigned to Olympic detail. (MPDS®), dating back to MPDS v10.0. J

46 THE JOURNAL | iaedjournal.org

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