Pond Jumping NAVIGATOR Rallies U.K., European Dispatchers Iaedjournal.Org NEW V6.0 Update Get the Right Information

Firefighters In Pursuit Of Resiliency History Lives On FPDS v6.0 brings Acknowledging stress is Haleyville will always be more tools to dispatch first step in comeback home of first 9-1-1 call The International Academies of Emergency Dispatch November | December 2013 THEJOURNAL JOURNALOF EMERGENCY DISPATCH

Pond Jumping NAVIGATOR rallies U.K., European dispatchers iaedjournal.org NEW v6.0 update get the right information.

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to the right people–every call.

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Faster calltaking time g departments means shorter time to dispatch. BestPractices 18 | ECNS 19 | FAQ to the right people–every call. 20 | NAVIGATOR Rewind features 22 | ACE Achievers 24 | Resiliency OnTrack Developing tools to bounce back from work- 34 | Medical CDE related stress at the communication center MPDS pays close attention to challenge of consciousness. That means faster, safer responders receives highest priority. and safer communities. 38 | Fire CDE 30 | Across The Pond Fire calls can get tricky in a hurry. No matter the style of delivery, UK and Euro YourSpace NAVIGATORs focus attention on education, 41 | Last Call information, research, and the access to 42 | Stork Stories networking among peers. 44 | CPR

www.prioritydispatch.net 800.363.9127 The following U.S. patents may apply to portions of the MPDS or software depicted in this periodical: 5,857,966; 5,989,187; 6,004,266; 6,010,451; 6,053,864; 6,076,065; 6,078,894; 6,106,459; | 6,607,481; 7,106,835; 7,428,301; 7,645,234. The PPDS is protected by U.S. patent 7,436,937. FPDS patents are pending. Other U.S. and foreign patents pending. Protocol-related terminology in this text is additionally copyrighted within each of the IAED’s discipline-specific protocols. Original MPDS, FPDS, and PPDS copyrights established in September 1979, August 2000, and August 2001, respectively. Subsequent editions and supporting material copyrighted as issued. Portions of this periodical come from material previously copyrighted beginning in 1979 through the present.

THE JOURNAL | November/December 2013 3 contribut

KEVIN PAGENKOP TRACEY BARRON JOHN FERRARO COLLEEN CONRAD BRETT PATTERSON

An emergency communications Tracey joined the IAED™ after John is the executive director Colleen is deputy director over Brett is an Academics & manager, Kevin is a regular spending nine years with at West Suburban Consolidated Operations for SLC911. Colleen Standards associate and contributor to a number of EMS the ambulance service as a Dispatch Center in River Forest, is responsible for the day-to- Medical Council of Standards publications. With a background paramedic, EMD, dispatcher, Ill. He has been involved with day operations of the bureau, as chair for the IAED. His role o rs in quality assurance and and education manager. While public safety communications well as many other duties. She involves training, curriculum, instruction, he is passionate Tracey still teaches EMD, since 1993. Previously, he assisted in the consolidation of protocol standards and about improving the standards the majority of her time is worked at DU-COMM and fire and police dispatch offices evolution, quality improvement, and training required for spent working with European Northwest Central Dispatch and the move to the city’s new and research. He is a member emergency telecommunicators. agencies on research projects System, both in Illinois. John Public Safety Building. She was of the IAED College of Fellows Kevin is a frequent conference using the protocols developed teaches EMD-Q® for Priority the project manager for the and Rules Committee. Brett speaker, a certified ENP, and an by the Academy. Dispatch® and ETC courses at implementation of PPDS®. She became a paramedic in IAED ED-Q™ instructor. Harper College in Palatine, Ill., has worked for Salt Lake City 1981 and began his EMS 10 | ACADEMY RESEARCH and has enjoyed presenting at since 1982. communication career in 1987. 7 | QUALITY ASSURANCE NAVIGATOR since 2005. Prior to accepting a position 12 | HEADSET CONFESSIONS with the IAED, he spent 10 years 11 | CUSTOMER SERVICE working in Pinellas County, Fla.

19 | FAQ

JIM MARSHALL DR. LORI GRAY JIM LANIER JORDAN SEBRESOS

Jim, a certified EMDR therapist Lori is a registered clinical, Jim is the Alachua County Jordan is an instructional (M.A. Clinical Psychology), forensic, and rehabilitation Sheriff’s Office (Fla.) technical designer and technical writer specializes in 9-1-1 mental psychologist. She strives to services division manager. He for Priority Dispatch Corp.™ health and treatment of tackle the issue of trauma from has been involved with public Jordan earned a master’s traumatic stress. Jim is director multiple angles through her safety since 1984. Jim is an degree in instructional of the 911 Training Institute work with first responders (e.g., EMD, EFD, ED-Q instructor, IAED technology and learning from and co-founder of the 911 paramedics, firefighters, police College of Fellows member, Utah State University. He Wellness Foundation. Since officers), trauma victims, and has served on various boards, has worked in the training 2005, he has trained more than criminal offenders. Lori has and is a regular contributor and industry for close to eight 2,500 telecommunicators in received several awards for editorial board member of The years, and has been designing management of PSAP stress her work. Most recently, she Journal. emergency dispatcher training and call-related trauma. Jim is received the Odyssey Award for almost four years. Most 28 | RESILIENCY co-chair of the NENA Working for distinguished early career recently, Jordan completed Group on Acute, Traumatic, and achievement. the v6.0 update of all the EFD Chronic Stress. curriculum. 27 | RESILIENCY 25 | RESILIENCY 38 | FIRE CDE

4 THE JOURNAL | iaedjournal.org g DEARREADER

INTERNATIONAL INTERNATIONAL OFFICES ACADEMIES OF AUSTRALASIAN OFFICE EMERGENCY DISPATCH 011-61-3-9806-1772 What Stresses 110 South Regent Street, Suite 800 CANADIAN OFFICE Salt Lake City, UT 84111 USA 1-514-910-1301 USA/Canada toll-free: 800-960-6236 EUROPEAN OFFICE You Out? Intl/Local: 801-359-6916 011-43-5337-66248 Fax: 801-359-0996 ITALIAN OFFICE www.emergencydispatch.org 011-39-011-1988-7151 [email protected] Try a positive spin MALAYSIAN OFFICE 011-603-2168-4798 U.K. OFFICE 011-44-0-117-934-9732 Audrey Fraizer, Managing Editor IAED JOURNAL STAFF COMMUNICATIONS | CREATIVE DIRECTOR GRAPHIC DESIGNER Kris Christensen Berg Reeding Roberts MANAGING EDITOR PRODUCTION MANAGER | SENIOR DESIGNER Audrey Fraizer Jess Cook TECHNICAL EDITOR WEB | MULTIMEDIA MANAGER o, what causes you stress? the waves off Lake Michigan, for Brett A. Patterson Erwin Bernales SENIOR EDITORS WEB DESIGNER For me, the coming example. They are captivating to Mike Rigert Jason Faga James Thalman WEB SPECIALIST of winter is a stressor and watch, reminding me of sitting at COPY EDITOR Devin Paulsen S Heather Darata although that may sound rather an ocean shore and waiting for INTERNATIONAL TRANSLATORS ASSISTANT EDITOR Ammar Almshab Cynthia Murray Ana Corona shallow—considering the really hor- Godzilla to appear. Any given Giuditta Easthope SENIOR DESIGNERS Corike Nuibe rific stuff to pick from—it’s a time wind speed builds higher waves Chris Carr Nadine Schick Lee Workman Sara Scott Carolyn Turcotte of year that requires a concentrated in the winter, and these cliff-like effort to think positively. waves average about 4 to 8 feet BOARDS & COUNCILS ACCREDITATION BOARD CHAIR Jaci Fox (Police/EPD Board) This winter’s outlook—and high, although waves of 18 feet Brian Dale Susi Marsan (ETC) I took my first peek at the Farm- or greater are not unusual. ALLIANCE BOARD CHAIR RESEARCH COUNCIL CHAIR Keith Griffiths Tracey Barron ers’ Almanac forecast way back This is one of the contrasts CERTIFICATION BOARD CHAIR STANDARDS COUNCIL CHAIRS Pamela Stewart Brett A. Patterson (Medical/EMD) Gary Galasso (Fire/EFD) in July—is calling for the “Days between the Midwest and West: CURRICULUM COUNCIL CHAIRS Tamra Wiggins (Police/EPD) Victoria Maguire (Medical/EMD Board) of Shivery.” Below-normal tem- water cliffs vs. rock cliffs—but they Mike Thompson (Fire/EFD Board) peratures will cut a frigid swathe both offer a way to reconnect. ACADEMY STAFF through states east of the Conti- Mountains rimming Salt PRESIDENT COMMUNICATIONS DIRECTOR Scott Freitag Kris Christensen Berg nental Divide to the Appalachians, Lake City provide an ideal win- ASSOCIATE DIRECTOR | USA DIRECTOR OF EUROPEAN RELATIONS Carlynn Page Tudy Benson north and east through New Eng- ter stress buster, and the dry ASSOCIATE DIRECTOR | U.K. DIRECTOR OF INTERNATIONAL RELATIONS Beverley Logan Amelia Clawson land. The coldest temperatures air does seal our reputation for ASSOCIATE DIRECTOR | AUSTRALASIA MEMBERSHIP SERVICES MANAGER Peter Hamilton Arabella VanBeuge will be over the Northern Plains on champagne snow. Our Rocky ACADEMICS & STANDARDS ASSOCIATE Brett A. Patterson east into the Great Lakes. Over the Mountain light, dry snow makes roughly identical areas the Midwest tough packing for snowballs and COLLEGE OF FELLOWS CHAIR UNITED STATES and the Great Lakes, Farmers’ Alma- snowmen but what it lacks in Marc Gay, Chair Bill Auchterlonie (KS) Robert Bass, MD (MD) nac weather seer “Caleb” predicts water content creates a skier’s AUSTRALASIA Christopher W. Bradford (FL) Frank Archer, MD (Australia) Geoff Cady (CA) lots of snow. and snowboarder’s equivalent to Andrew K. Bacon, MD (Australia) Steven M. Carlo (NY) Peter Lockie (New Zealand) Jeff Clawson, MD (UT) Peter Pilon (Australia) Phil Coco (CT) I’m originally from the Mid- a surfer’s perfect wave. CANADA Brian Dale (UT) Drew Burgwin (British Columbia) Chip Darius, MA (CT) west and somehow survived 27 While Chicago obviously falls Claude Desrosiers (Quebec) Kate Dernocoeur (MI) Douglas Eyolfson, MD (Manitoba) Norm Dinerman, MD (ME) bone-chilling winters before mov- short of what it takes for great Martin Friedberg, MD (Ontario) Patricia J. Dukes, MICT (HI) Marc Gay (Quebec) (Emeritus) James V. Dunford, MD (CA) Marie Leroux, RN (Quebec) (Emeritus) Marc Eckstein, MD (CA) ing west of the Rockies to the high winter downhill skiing—appre- Paul Morck (Alberta) John Flores (CA) Wayne Smith, MD (Quebec) Scott Freitag (UT) Gary Galasso (UT) desert country. Chicago’s cold ciable land elevation and a dry EUROPE Keith Griffiths (CA) Andre Baumann (Germany) Jeffrey R. Grunow, MSN (UT) chases to the soul and, once fixed, climate—that doesn’t confine the Jan de Nooij, MD (Netherlands) Darren Judd (UT) Gianluca Ghiselli, MD (Italy) Alexander Kuehl, MD, MPH (NY) (Emeritus) settles in until the spring thaw. season’s board time to golf courses Jean-marc Labourey, MD (France) James Lake (SC) Bernhard Segall, MD (Austria) James Lanier (FL) Gernot Vergeiner (Austria) Stephen L’Heureux (NH) Going outside means bundling or nature preserves. Strong winds Christine Wägli (Switzerland) Victoria A. Maguire (MI) (Emeritus) Sheila Malone (IN) and layering, particularly if stand- hitting Lake Michigan in the right UNITED KINGDOM/IRELAND Susi Marsan (GA) (Emeritus) Trevor Baldwin (England) Robert L. Martin (CA) Tracey Barron (England) Dave Massengale (CA) ing at the edge of Lake Michigan direction create ideal surfing waves. Michael Delaney (Ireland) Shawna Mistretta (CO) Louise Ganley (England) Jerry L. Overton (UT) watching huge waves push to Some say winter is the best season Conrad Fivaz, MD (England) Eric Parry, ENP (UT) Chris Hartley-Sharpe (England) Rick W. Patrick (PA) shore. Now that’s something to see. for putting the surfboard to water. Andy Heward (England) Brett A. Patterson (FL) James Gummett (England) Paul E. Pepe, MD, MPH (TX) Stuart Ide (England) Ross Rutschman (OR) (Emeritus) That brings me back to the Surfing in temperatures Peter Keating (Ireland) Joe Ryan, MD (NV) Ray Lunt (England) Doug Smith-Lee (WA) initial question. What do you do below freezing Andy Newton (England) (Emeritus) Tom Somers (CA) Janette K. Turner (England) Paul Stiegler, MD (WI) Michael Thompson (UT) for stress? might not be Carl C. Van Cott (NC) Craig Whittington (NC) It’s taken me a long time, but everyone’s idea Arthur H. Yancey, II, MD, MPH (GA) Tina Young (CO) after more than a half century for reducing on this planet, with cumulative stress; however, Catch a fabulous slow motion months of winter adding up to viewing those video at vimeo. The Journal of Emergency Dispatch is the official bimonthly publication of the International Academies of Emergency Dispatch® (IAED™), a non-profit, standard-setting organization promoting safe and effective emergency dispatch services a quarter of that time, I realize who do could com/52593988 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 attitude and spinning a negative just be the few emergency dispatch community through education, certification, and accreditation. General IAED membership, which includes a Journal subscription, is available for $19 annually, $35 for two years, perspective can turn a stressor minutes of reprieve you need in 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 into something tolerable. Take your day to relax. g to dispatch agencies that comply with Academy standards. © 2013 IAED. All rights reserved.

THE JOURNAL | November/December 2013 5 g PRESIDENT’SMESSAGE Last Call Final radio dispatch is hardest part in bidding farewell to fallen officer

Scott Freitag, IAED President

y bearing was fairly well under con- Crowds gathered outside the arena trol until the Last Call, and that’s placed hands over their hearts as the eight Mthe part that tears up anyone who pallbearers carried the American flag-draped has attended a funeral service for a police casket to the awaiting hearse. officer fallen in the line of duty. The funeral procession along the 1 mile Yes, the eulogies, the widows and chil - route to the cemetery was led by hundreds dren left behind, parents paralyzed by grief, of motorcycle police as they traveled slowly fellow officers in procession as a sign of soli- past thousands waving flags and flanking darity, the ceremonial flyover, and the loss to both sides of the street. They passed beneath the community pull deeply at my emotions. an American flag that firefighters had hoisted But it’s the Last Call that gets me every above the street earlier that day. The last time. The radio dispatch calling out the car arrived one hour after the first car had departed officer’s radio number forces me stopped at the site of interment. to acknowledge the tragedy of the officer’s The gravesite was dedicated and officers death; the risks we accept every day in pro- presented Sgt. Johnson’s wife the flag that tecting our communities. had covered his casket. Inside the folds were On Sept. 6, the Last Call was in honor of the spent shells from a three honor volley. Draper (Utah) Police Sgt. Derek Johnson, Taps played and four helicopters flew over- who was ambushed and killed on Sunday, head in the missing man formation. Sept. 1, while on routine patrol in Draper, a The Last Call was made in the silence city about 15 miles south of Salt Lake City. of mourning from the center that received Sgt. Johnson had noticed an oddly parked The Last Call Sgt. Johnson’s “mayday” call. Valley Emer - vehicle and pulled over to investigate. He was gency Communications Center (VECC) shot behind the wheel of his police cruiser forces me to dispatcher Kris Whitney, who took over and was able to drive a few blocks before the police radio at the time of the shooting, crashing into a tree. acknowledge gave the 42-second salute in a measured Sgt. Johnson never got out of his patrol and controlled voice (the full transcript is car or drew his weapon during the incident; the tragedy of in a Your Space story profiling Whitney). a man in the car Sgt. Johnson was stopping to She was truly amazing, and I wiped back investigate gunned him down. Despite heroic an officer’s tears listening to her. Sgt. Johnson will never efforts to save his life, the young officer died be forgotten, and I am forever humbled by that same morning. death. the steep price this officer paid in protecting Sgt. Johnson was 32-years-old. He leaves the community he served. behind a wife, their 6-year-old son, and a com- The day of his funeral, Sept. 6, was sunny According to statistics released in May munity of 44,000 residents, witnesses to the and warm, although I don’t think inclem - 2013 by the FBI, 47 law enforcement officers first Draper police officer killed in the line of ent weather would have kept anyone from were feloniously killed in the line of duty duty since the agency was established in 2003. attending. Six bagpipe players led Sgt. John- during 2012. I was told that police work had been his son’s casket into the arena where his services Circumstances involved investigations, life’s ambition, and it showed in his devotion were held. His widow and their son followed. traffic pursuits or stops, tactical situations, to law enforcement and the many awards he Family, friends, and fellow officers speaking ambushes, answering disturbance calls, received, including the Life Saving Award and at services recalled his dedication to police drug-related matters, robberies in progress, the Distinguished Service Award. He was the work. They will always remember his infec- and transporting, handling, or maintaining 2012 Community Policing Officer of the Year. tious personality. custody of prisoners. He was known, liked, and respected. An He was a smiling man, said a woman The officers brought altruism, bravery, estimated 1,200 people attended a candlelight introduced as his sister-in-law. and the spirit of public service to their work vigil held in his honor less than 24 hours after “Please make sure you smile today because and paid the ultimate sacrifice to help keep he was shot and killed. that’s what he would want,” she told mourners. their communities safe. g

6 THE JOURNAL | iaedjournal.org g QUALITYASSURANCE Lessons From Legos Each piece has a specific function

Kevin Pagenkop, ENP

grew up playing with Legos: the small, pieces, the incident can still be handled, help plastic bricks and shapes that when inter- sent en route, and assistance provided. Ilocked and pieced together built anything MPDS® Chief Complaint Protocol 32: from spaceships, to dinosaurs, to helicopters, Unknown Problem (Man Down) is often to fire engines. This Danish innovation was utilized in situations where the dispatcher one of the staples of my childhood toy chest. believes he or she does not have all of the Each gift-giving holiday I would eagerly information required to select a Chief await the familiar-sized box that contained Complaint Protocol. Case Entry Rule 6 a number of pieces proportional to the abili- clearly outlines the conditions that must ties of my age. The printed instructions pro- be present for Protocol 32 to be appropri - vided a step-by-step, brick-by-brick outline ate. Usage is based on a significant lack of how to create the object or theme of that of essential information rather than just particular Lego product. Inevitably, I would missing one small piece. When dispatch - either lose the instructions or drop one of ers don’t obtain as much information as the small pieces into the heavy shag carpet they would have liked, it doesn’t mean of my childhood living room, never to be that the call should be thrown away or seen again. Decades later, I’d like to think that “Unknown Problem” should be chosen that whomever purchased that property and by default. Just like Legos, the dispatcher remodeled it to his or her own preferences should be able to combine the individual found every lost Lego brick, Star Wars light- pieces to complete the whole. saber, and missing wheel from my Matchbox Guessing, relying on perceptions or cars (when they were still made out of metal biases, and/or questioning the integrity of and detailed in toxic lead paint). the callers is not the same as drawing on What was great about Legos was that past experience to make critical decisions even without the instructions, you were with incomplete information. If a box of usually able to complete the figure. Each Legos contained two wheels instead of piece had a specific function: a wheel, a The dispatcher the expected four, a bicycle or motorcycle wing, a windshield; and when a pattern or could be considered in place of a car; how - theme could be identified, each individual should be able ever, a spaceship or dinosaur would not be piece could be combined to complete the supported by the fact that wheels, in any whole. The more you played with Legos, to combine quantity, were present. If a caller advised the more you learned about the specific that someone was unconscious or altered, form and function of each piece and the the individual it would not be appropriate to only infer easier it was to “fill in the blanks” of the pieces to intoxication, nor would it be appropriate lost instructions and complete the item to simply select “Man Down.” Take all of anyway. The same was true when one piece complete the signs, symptoms, and information into or several pieces were lost. There was no consideration and begin piecing each block need to throw the toy away or give up try - the whole. together within the context of the situation. ing to assemble it; there was always value Experience cannot be taught or repli - in having the majority of the pieces. Pro - step-by-step, dispatchers must apply their cated; therefore, a priority should be on vided the essential elements were still in experience to interpret the information retaining employees so they can be devel - the box, something could be built. provided by the caller and try to “fill in the oped into dispatchers who have processed This is similar to emergency calltaking. blanks” to get the full picture. The more enough calls and put together enough puz- As there are a variety of different types of tenured dispatchers have more experience zles that they have the experience to select an calls, there is no template provided that can they’ve locked away in their toy chest to pull appropriate Chief Complaint Protocol, and be applied and followed for every incident. out and apply when processing a call. Pro - successfully provide assistance even when Without an instruction manual to follow vided they have the majority of the essential they don’t have all of the pieces. g

THE JOURNAL | November/December 2013 7 g ASKDOC

10 11 12

Paramedics• Is the afterbirth (placenta) outAsk yet? EMDs For Help • Are the mother and baby all right? High Risk10a Pregnancy Situations

Jeff Clawson, M.D.

13 14 15

Dr. Clawson: Wellington Free Ambulance in New Zea- F C hildbirth – delivery (Panels birth land is considering adding new material to F Childbirth19 – delivery (Panels 19–39)• Is it a boy or a girl ? 21 birth the guidelines for the field responders. The 19• Is there any green fluid 20 21 aim could be to assist responders to call com- in the baby’s mouth? munications for16 the provision of advanced 17 BREECH Delivery: BREECH Positioning: dispatcher-assisted instructions in cases of BREECH Delivery:Foot/FeetBREECH Positioning:Hand(s) without head you understand me so far? high risk childbirth using Pre-Arrival Instruc- Foot/Feet 28 Leg(s) Hand(s) without headArm(s)• without Do you head understand29 me so far? 30 Leg(s) ButtocksArm(s) without headCord without head tion (PAI) Protocol F. • Is the baby breathing now? • (After two pushes) Is the baby Buttocks Cord without head The directive would be significantout now? in • Is the baby breathing now? • Do you understand me so far? terms of recognition for the Medical Prior- 22 • Is the baby 23completely 24 out now? Time for 30 seconds. ™ ® 22 23 * 24 ity Dispatch System (MPDS ) system and • How many pulses • Can you feel a pulse in the cord now? the advanced childbirthF Childbirth instructions – delivery that are(Panels 1–18) did you feel?b irth • Can you feel any part of the baby? now provided by EMDs. In short, this would (On bed) (On bed) 31 32 33 be a good win for Emergency Medical Dis- (Not on bed) • Is the baby completely out? patchers (EMDs) and patient care here! • Is the baby completely out? Thanks again, • Do you understand? you feel a pulse in the cord now? Ruth Lloyd you understand? • Do you understand me so far? PDC Implementation Specialist 25 26 27 27 Australia/New Zealand 34 36 Wellington, New Zealand

• (Is the sac broken now?) Ruth: (No) • Was she able to get on her elbows and That is certainly “earth shattering” news— knees? the bleeding/cramping • Was she able to get on her elbows and • Has the bleeding/cramping stopped? • (Is the sac broken field responders being directed to call EMDs knees? stopped? now?) for instructions! It certainly is an amazing 39 win for the respect of EMDs and recogni - tion of the MPDS. You don’t see this sort of thing happening in EMS-land every day. This • Is the baby feeding (nursing)? • Has the bleeding/cramping stopped? MPDS® v12.2, NAE-std. © 1979–2013 PDC. • Has the bleeding/cramping is not a brand-new phenomenon since after stopped? the release of MPDS v11.2 in 2004, this has occurring in the early moments of a 9-1-1 and believes that the trained EMD, occurred sporadically in several countries, call. On a per 9-1-1 center basis, these appear EFD,F C orhildbirth EPD (or – d otherelivery agency), (Panels 19–39) mak - birth which have had communication centers to be rare occurrences, but pose significant ing a good-faith attempt to provide using the MPDS High Risk Delivery PAI clinical as well as ethical problems if not these instructions, should not be held protocols to advise crews at scene. dealt with accurately and immediately by responsible for any bad outcomes. This These very special protocols became a EMDs. Response time can be, and is often, should not be considered a legal inter- necessity after the International Academies lethal, or brain damaging, in such cases. The pretation, but a strong official opinion of Emergency Dispatch® (IAED™) encoun- Academy has adopted a policy statement of the Council of Standards and Board tered an increasing number of different regarding the EMDs’ involvement in such of Trustees of the IAED. types of what we call “high risk” delivery difficult situations (see Principles of EMD – cases in which critical care fell completely 4th Ed. page 8.5): This list of special delivery PAI sub-proto- outside the scope of the then current protocols includes: Footling Breech, Frank Breech, col, not to mention what any other 9-1-1-like The International Academies of Emer- Arm or Hand Presentation, Shoulder Dysto- centers could or would do. gency Dispatch considers situations cia, Prolapsed Cord, Ruptured Cord, Cord This High Risk Delivery protocol is actu- necessitating the provision of these Around Neck/Body, Amniotic Sac Encase- ally a group of nine protocols designed to instructions to be an extremely High ment, and Fundal Massage for serious post- address a host of different critical problems Risk-Inherent Situation Case (HiRISC) partum hemorrhage.

8 THE JOURNAL | iaedjournal.org In less than a year [after the release of experience with the Academy. “I reviewed practitioners like myself, an emergency phy- v11.2], Louise Ganley, now the clinical sup- the first breech delivery call brought to my sician and previous field responder, as well as port representative at the U.K. Office of attention today. It was a first-party caller, iso- emergency or general floor hospital nurses, PDC™, then told me that they provided this lated location, no one else on scene, 20 min- are not experienced in how to actually deal service for their operational staff at Great utes to the nearest ambulance. I think she with these situations, since we rarely, if ever, Western Ambulance Service in Bristol, U.K. was a first pregnancy, undiagnosed breech at do. We had the experts present to the Com- She stated, “It became very apparent that 38 weeks, who earlier had rung the hospital mittee that they knew, and they very quickly this was a good thing to do after one of our and been told not to come in too early in realized that just how to tell someone else EMDs, who was awarded dispatcher of the the labour. Two feet had presented in the how to actually accomplish these feats non- year in Dublin, provided PAIs for a breech bathroom, and the patient herself was on a visually was very much more difficult than and successfully delivered the baby who was mobile phone. The EMD adapted the script simply and physically doing it in person. presenting feet first, cord around the neck, beautifully to a first-party caller. The call It makes perfect sense that an EMD, with and was successfully resuscitated, all before started with the patient’s mother ringing the correct PAI tools, should be able to pro- the crew arrived on scene.” in from a suburb an hour away. The EMD vide help to scene responders as well as lay Tracey Barron, research & studies offi- goes to conference call, kept both mother callers, rather than simply leaving them to cer for IAED, formerly of South East Coast and daughter on the line and worked reinvent this “rare” type of wheel. It would Ambulance Service in the U.K, added that through PAI-F. Twenty minutes later the also seem that this dispatch-to-EMS crew their road staff “… were always advised to call baby is out, breathing, and all is well. It advice should be formally incorporated by in to dispatch during an ‘unusual’ birth so we makes all the reviewing of (the protocol) many more, if not all, EMS systems utilizing could provide these PAIs. We did this from drafts (as a member of the Council of Stan- the MPDS to safely dispatch. v11.2 onwards. While it was never part of dards) so worthwhile. Cheers.” If the goal is to help people, then regard- their formal clinical training, any member of Several other similar cases have been less of the origin of that care, even if it’s road staff that set foot in control was shown shared with the Academy since this special from an EMD armed with these advanced the instructions and advised to call in.” protocol set has been available to EMDs. protocols, these life-improving instructions In 2008, Dr. Andrew Bacon, medical When the initial High Risk Pregnancy/ should not only be provided here and there, director for the Melbourne Ambulance Delivery Standards Committee met, it but actively embraced by all. Service, Australia, shared this encouraging became very apparent that even medical Doc g

THE JOURNAL | November/December 2013 9 g ACADEMYRESEARCH Morning Dove Or Night Owl Does shiftwork affect EMD performance?

Tracey Barron

umans are designed to work during 1,373 9-9-9 calls coming into LAS during the day and recuperate at night. So it a consecutive three-month sampling of Hcomes as no surprise that a decline in emergency calls (June-August 2006) were performance has been documented in people randomly reviewed for compliance to the working 12-hour shifts.1 An Emergency Med- MPDS Protocol. ical Dispatcher’s (EMD) performance can be Day shift was defined as the hours affected as much by tiredness and sleep dis- between 7 a.m. and 7 p.m., and night shift turbance as any other shift worker; mistakes, applied to the hours between 7 p.m. and 7 errors, and omissions are made when the a.m. LAS staff work through a 24/7 rotat - mind and body cannot function at their best. ing shift pattern. Although those on the While it has been noted that some day shift handle more cases than night shift workers actually enjoy the variety of rotat- EMDs, the data was analyzed for mean coming shifts and that shiftwork can provide pliance, which showed no statistical differ- advantages to society at large, 2 the single, ence when adjusted for shiftwork. prominent conclusion from earlier studies is versus morning doves, for example—in some that additional research is needed in order to occupations, the shift system and its uncon- Findings eliminate the harmful aspects of shiftwork. ventional clock cannot be avoided. Due to The results of this study show that the In her book Asleep in the Fast Lane: The scheduling demands, it’s not always the early use of a structured set of symptom- and Impact of Sleep on Work, Lydia Dotto cap - bird that gets the day shift or the night owl incident-based protocols for triaging emer- tured the dilemma faced by all 24-hour dis- that works the hours before dawn. This, of gency 9-9-9 calls leads to equally high levels patch systems: “Industrialized societies are course, includes emergency dispatch. of compliance irrespective of the shift being the ones most divorced from the natural, worked, whether day or night. primitive cycle of day and night and they are Shiftwork and its effect on EMDs In addition, the findings suggest that a also the most dependent on and vulnerable A recent study looking at productivity protocol-driven process helps alleviate some of to complex technologies whose failure (often and performance of the EMD signified an the many factors that contribute to mistakes, brought about by human error) can exact a opening into research regarding the impact errors, and omissions being made, especially huge social and economic toll.”3 shiftwork could have on dispatch compli- across periods of time in which the mind and And that’s where the International Acad- ance. Specifically, the London Ambulance body may not function at their best. emies of Emergency Dispatch ® (IAED™) Service (LAS) NHS Trust studied whether According to the study’s authors, this is helps pick up the slack these many years the shift an EMD works has any bearing on an important conclusion in the world of the later. Let’s first review the factors. the ability to rapidly categorize calls and sub- ambulance service where time can be crucial sequently facilitate the dispatching of appro- to a patient’s outcome, and where the accu- Effects of shiftwork on EMDs priate emergency ambulance personnel.4 rate triage of a patient can directly impact Factors affecting performance are com- LAS uses the Medical Priority Dispatch the speed and level of response and care. g mon among occupations, and they include: System™ (MPDS®) to triage emergency 9-9-9 • Physical factors such as health and age calls, and more than 90,000 calls a month Sources (about one-fifth of the total number of calls 1 Rosa RR. Performance, alertness, and sleep after 3.5 years of 12 • Psychological factors such as attitude received in the U.K.) are handled at LAS h shifts: a follow up study. Work &. Stress 1991; 5: 107-116. toward work, motivation, sleep depriva- headquarters. 2 Peter Finn, “The effects of shift work on the lives of employ- tion, and stress ees,” Monthly Labor Review, October 1981, pp. 31-34; http:// Strict compliance to the protocol through bls.gov/opub/mlr/1981/10/art5full.pdf (accessed Sept. • Nature of work to be performed (the a quality management program is an integral 23, 2013). type: physical or mental, complexity: deci- component in LAS’ evaluation of EMD per- 3 Dotto L. Asleep in the fast lane: the impact of sleep on work. sion-making or rote work, and schedule: formance, and feedback plus patient out - Toronto (Canada); Stoddard Publishing Co. Ltd.; 1990. day work or shiftwork) comes are central to the study’s findings. 4 John Afolayan, et al., Consistency of Emergency Medical Dispatchers’ Decisions Using a Protocol-Based Triage System, While human performance often depends Methodology Annals of Emergency Dispatch & Response, Vol. 1, Issue 2, pp. on the individual’s internal clock—night owls For the study, a database consisting of 18-22.

10 THE JOURNAL | iaedjournal.org g CUSTOMERSERVICE Delivery Is Everything Spend time teaching telecommunicators the right way to speak to callers

John Ferraro

hen I started my career in 1993, opinion-based, and I was afraid my approach the theory of delivering a high was less quantitative than it should have W level of customer service to the been. When I became more familiar with caller had come a long way. Call screen - the Academy’s performance standards, I ing was no longer acceptable. If the caller realized the process is quantitative, and that wanted police for a neighbor’s grass that gives me the opportunity to address behav- was too long, they got them. If they wanted iors in a concrete way. It’s objective. The “yes” an ambulance for a stubbed toe, that’s or “no” questions take the opinion out of my what was sent. reviews. Did the telecommunicator explain As I look back, I realize that the end his or her actions throughout the call? Did of call screening probably had as much to the telecommunicator provide reassurance, do with liability concerns as it did with display compassion, and use the proper vol- treating the caller’s request with courtesy ume, tone, and rate? and professionalism. After all, what if the When a problem is identified, I immedi- neighbor’s grass was too long because the ately talk to the telecommunicator to pre- homeowner passed away? What if the vent the same mistakes from repeating. patient with the stubbed toe had a bleed - ing disorder or was on blood thinners, STOP IT! and the call was more serious than first Here’s a final piece of advice. reported? “When in doubt, send them out” How many times have you walked was a good step. • Have the telecommunicator listen to through the center and heard a coworker In the years that followed, customer a recording of 10 of his/her own calls, delivering poor customer service with every- and list customer service aspects of the service definitely improved several one looking the other way? A customer ser- calls that went well and others that notches with the idea of using a calltak - vice seminar I attended a few years ago went poorly. ing protocol. I think back to delivering offered some good simplistic advice: When CPR instructions for the first time in my • Send your telecommunicators to retail you hear poor customer service, STOP IT! career. In less than a minute, the caller customer service training, which is useful The next time you hear a co-worker being knew I was in control and there to help because of the customer loyalty angle—a rude on the phone, offer advice in a friendly until responders arrived on the scene. I concept that is sometimes lost on public manner. Delivery is everything. Explain that was doing everything I could to help the safety communications. you are not judging, but actually looking patient, and I remember being grateful • Complete a 30-minute training session out for the person. You do not want to see a that my instructions to the caller were that thoroughly covers the IAED™ Uni- co-worker disciplined. Exceptional customer more than, “They are on the way!” versal Standards for Customer Service. service = Proper care. Since this is your basis for quality assur- Several years ago, I received a call from a Where are we in 2013? ance reviews, it will give your telecom- woman who had called 9-1-1 when her hus- Now is the time for improvement as municators clear expectations on how to band passed away. She complimented the an industry, and I offer a three-pronged handle their calls. telecommunicator who received her call for approach for better customer service that I being so nice and helpful and said it actually learned through experience and training. • Utilize role-playing by having one helped her through a tough time. I was proud employee act as the caller and the other as of the telecommunicator and went looking Training the calltaker. The results are usually very for a quote to include on her recognition cer- We spend a lot of time training tele - entertaining, but educational. tificate. Here’s what I found: “Kind words can communicators, but how much time do be short and easy to speak, but their echoes we spend teaching them the right way to Quality assurance are truly endless.” —Mother Teresa speak to callers? Customer service train - When I began as an ED-Q™, the concept On every call and every call review, let’s ing can take many forms. Here are some of reviewing customer service was difficult remember why we decided to get involved suggestions: for me. I thought that my reviews were too in this field—to help people.g

THE JOURNAL | November/December 2013 11 g HEADSETCONFESSIONS Baby Your Baby Calltaking, like parenting, needs TLC

Colleen Conrad

have a very blessed life. individual’s choice or when a person is let Though I am aging, and I am go—the job and person aren’t the right combi- Ichubby, I feel there are things that over- nation. I don’t believe that anyone can truly shadow those issues. I have three amazing fathom what the job entails until putting blessings in my babies. They are MY babies. the headset on and hearing what’s coming I created them, with very little help, and through. No one can truly understand how it was through my guidance and love that many different hats dispatchers wear. they became the humans they are today. On a call-to-call basis, we switch hats The first time my husband called me a that include: marriage counselor, informa- “helicopter parent” I was terribly offended tion operator, psychologist, nurse, care - and wanted to punch him in the throat. I taker, social worker, translator, Google map told him that I relish the label “helicop - location finder and tourist guide, newspa- ter parent;” to me, it says I am an involved per journalist, clock, Dear Abby adviser, and loving mother. He had not walked in lawyer, veterinarian, social networking my shoes, did not know what my life had expert, punching bag and, of course, the been, and did not know the extent of the person giving the instructions that could bond formed. help save a life. When everything is said and done, we are That’s just the tip of the iceberg. a functional family with a few dysfunctional Call one may be the first of many mun- moments thrown in. dane and boring burglaries reported during If, from the outside, I appear to hover one day. Call two could be that guy who over my kids, it’s because they are the chil- blames you for every bad thing that has ever dren of a dispatcher. They have been over- happened in his life, calls you every name in protected and overcherished. They were not the book, and then refuses to listen to any allowed to do a lot of the things that their words you might have to say. Call three friends got to do. I knew the consequences could be the sweetest little old lady who of those actions, although that’s not to say patcher or calltaker. As with being a good has never had to call 9-1-1 until that very they didn’t get one over on mom every once parent, it’s a true calling to be a good dis - moment when she awoke to find that her in a while. patcher or calltaker. husband had passed away next to her dur - Now my babies are grown up and adding During my career, I have met many ing the night. to my blessings. I was given two grandbabies people who have tried to be dispatchers, and Every year, the first Sunday in February in 2013: an adorable granddaughter from my while many succeed, there are also many doesn’t go by without someone calling 9-1-1 son and a handsome grandson from my step- who have failed. This happens either by the to ask, “What time is the Super Bowl?” daughter. When I met my husband he was a I’ve heard of people calling 9-1-1 on the single father of two daughters who are now fourth Thursday in November to ask, “How my stepdaughters. long does it take to thaw a turkey, and how As I sat holding my granddaughter I was AS WITH BEING long does it take to cook?” humbled, amazed, and overwhelmed with And no matter the call, no matter the love. It made me think about my fourth A GOOD PARENT, situation, no matter the abuse you’re tak - baby, the baby I have nurtured for many ing from the other end of the call, we years—my dispatch career. IT’S A TRUE have to maintain a professional and empa- As we’re all well aware, not everyone has thetic composure. Sometimes, we have to what it takes to be a good parent. The same CALLING TO BE A bite our tongues. holds true for our profession—not everyone Obviously, not everyone can be a dispatcher has what it takes to be a good dispatcher. In GOOD DISPATCHER or calltaker. Not everyone can take care of your fact, I would say that, on some occasions, it’s baby, your career, as well as you do. easier to be a good parent than a good dis - OR CALLTAKER. Protect it, cherish it, and raise it right. g

12 THE JOURNAL | iaedjournal.org IndustryInsider EMS personnel continue in prison in connection to swatting calls from an address that, unknown to officers at high risk to violence made in three states in a four-month period responding to the call, was the address of (Sept. 2012–Jan. 2013). his intended swatting victim. According to charges, Nathan Hanshaw, The information charges that Hanshaw of Athol, Mass., agreed to plead guilty to made swatting calls to police departments the charges of making interstate threats, across the United States, including depart- threats to use explosives, and threats to ments in Denver, Colo.; Ventura, Calif.; use a firearm. Making interstate threats and Waverly, N.Y. In each case, armed and making threats to use a firearm each police responses ensued. In response to carry a maximum penalty of five years in Hanshaw’s swatting call to Ventura, more Violence against emergency responders prison. The count of making threats to use than 40 local and federal officers arrived is certainly not confined to a specific city or an explosive carries a maximum penalty of at the purported crime scene, a hotel was country. According to an article in EMS World 10 years in prison. (It’s Time to Stop the Violence, May 1, 2013), a According to documents filed in U.S. 2005 National EMS Management Association District Court in Massachusetts, Hanshaw (NEMSMA) survey conducted in the U.S. and typically claimed during his swatting calls Canada found that slightly more than one in that he was a fugitive who was wanted two respondents (52%) reported that they had by the authorities and that he had taken been assaulted by a patient. hostages and was armed with weapons, In one study in a large California EMS sys- explosives, and nerve agents. He demanded tem, EMS personnel encountered some sort of cash and a helicopter ride to Mexico and violence in 8.5% of patient encounters and were threatened to detonate his bombs and subjected to violence directed at them in 4.5% kill his hostages if his demands were not of patient encounters. Of encounters where met. He also threatened to kill any law violence was directed at EMS personnel, 21% enforcement personnel who arrived at the involved nonphysical (verbal) violence only, location. According to court documents, while 79% involved physical violence. Hanshaw generally claimed to be calling To address the issue, NEMSMA launched LIFESAVER the End Violence Against Paramedics project and, in collaboration with the Center for Leadership, Innovation and Research in Bill would ban policies prohibiting EMS, developed an anonymous system for lifesaving medical help EMS practitioners to report near miss, line of duty death, and patient safety incidents by Assemblyman Rudy Salas’ bill was answering a series of questions in an online prompted by the February 2013 death of format. The EMS Voluntary an 87-year-old resident of a Bakersfield inde- Event Notification Tool pendent living facility. The incident sparked (E.V.E.N.T.) will aggregate national attention when a woman, who the data for analysis and use identified herself as a nurse, told the 9-1-1 dis- in developing EMS policies The system is patcher that her company’s policy prevented and procedures, and for use available at her from performing CPR. The dispatcher www. in training, educating, and emseventreport. implored the nurse to find someone else to preventing similar events org perform CPR and said she would provide from occurring to EMS per- instructions on how to do it, but the woman sonnel in the future. refused based on policy. The bill states that employers shall not Man charged in adopt or enforce any policy prohibiting swatting spree faces workers from voluntarily providing medi- 15-year sentence California lawmakers in September sent cal services, such as CPR. It does not require legislation to Gov. Jerry Brown that would bar or imply that employers should be respon- A 22-year-old Massachusetts man, notori- employers from having policies that prohibit sible for training their employees on emer- ous for his computer hacking, faces 15 years offering lifesaving medical help in an emergency. gency medical services or CPR. g

THE JOURNAL | November/December 2013 13 evacuated, and nearby streets were closed The majority of reported victims were The BLS also reports that California for several hours. white (72.5%), followed by African Ameri- was the highest-paying state for 9-1-1 oper- Swatting involves making hoax emer- can (21.6%), Asian/Pacific Islander (1.0%), and ators in May 2011, and workers in the state gency telephone calls in order to elicit American Indian/Alaskan Native (0.4%). made $55,070 a year on average. Workers an armed police response (from a SWAT Race was unknown for 4.4% of victims. in Nevada earned $52,770 on average, and team) for the purpose of harassing some - In 2011, a total of 5,880 law enforcement workers in Oregon, Washington, and Illi - one believed to be at the specific location agencies in the nation, representing coverage nois earned $46,430 or more on average. responders are sent. for over 87 million inhabitants, submitted Texas employed the highest number of NIBRS data. The majority of these reporting 9-1-1 dispatchers of any state, and workers FBI publishes annual agencies (51.7%) were located in cities with in Texas earned an average annual income crime statistics report fewer than 10,000 inhabitants. of $32,690. Bureau of Labor Program cares Statistics releases about decreasing deaths dispatch income figures from out-of-hospital The United States Bureau of Labor Statis- cardiac arrests tics (BLS) reports the average annual income of police, fire, and ambulance dispatchers was $37,460 in May 2011 (the most recent statistics available), while the median average (exact middle of the pay scale) was $35,930. During this same year (2011), the per - sonal per capita income in the United States was $41,560. BLS data show 9-1-1 operators in the top 10% in terms of annual income earned more than $55,640 in May 2011, while workers in the bottom 10% made less than $22,700. Agencies participating in the inaugural Workers in the middle 50% in terms of National Incident-Based Reporting Sys - annual earnings made between $28,240 and tem (NIBRS) statistical record, released by $45,120. Discrepancies in annual income can the FBI, reported 4,926,829 incidents that be caused by factors such as years of job involved 5,643,241 offenses, 5,946,990 vic- experience and overtime. tims, and 4,483,142 known offenders in 2011. According to the BLS, local governments Of the reported offenses, 65.4% involved employed 80,610 dispatchers in May 2011, crimes against property (i.e., those crimes in and those workers earned an average annual which the object is to obtain money, prop- income of $37,790. Dispatchers employed erty, or some other benefit), 23.4% involved by other ambulatory healthcare service crimes against persons (i.e., crimes whose companies earned $32,200 on average, work- Similar to the International Academies victims are always individuals), and 11.2% ers employed by state governments earned of Emergency Dispatch® (IAED™), the Car- included crimes against society (i.e., typically $41,190 on average, and those employed by diac Arrest Registry to Enhance Survival “victimless crimes” that represent society’s universities, colleges, and professional schools (CARES) is interested in tightening the prohibition against engaging in certain types made $35,580 on average. many links connecting the chain of emer- of activity, such as prostitution or gambling). gency care. The victim of an offense may be an And again, similar to IAED initiatives, individual (and can include a law enforce- the data CARES collects—at least a por - ment officer), a business, an institution, or tion of it—comes from some of the most society as a whole. In 2011, NIBRS reported reliable resources around: 9-1-1 computer- 4,305,708 victims who were individuals. Of aided dispatch system administrators who these, 29.0% were the victims of larceny/ have signed participation agreements to theft offenses and 28.5% were the victims of enter into the CARES’ database three assault offenses; these two offense categories data elements (time of call, ambulance had the highest number of victims. dispatch, and ambulance arrival) for each Considering age among individual vic- event, with events being matched based on tims, 24.6% were between 21 and 30 years date, approximate time, and location. old. Fifty-one percent were female and 48.3% Grady Emergency Medical Services, were male. Atlanta, Ga., which uses the Medical Priority

14 THE JOURNAL | iaedjournal.org Dispatch System™ (MPDS®), was a pioneer in this is probably a little-known fact—placed The CDC recommends a yearly flu vac- the program, collaborating with the Emory indoors. According to facts available from cine for everyone six months of age and University Department of Emergency Med- Find Me 911: older as the first and most important step icine to develop an out-of-hospital cardiac in protecting against this serious disease. arrest registry in the city of Atlanta. Key While there are many different flu viruses, elements included tracking EMS response the flu vaccine is designed to protect against times, including receipt of the 9-1-1 call, dis- the three main flu strains that research indi- patch of the ambulance, and on-scene arrival cates will cause the most illness during the of the ambulance. flu season. During the first eight years of the pro - In addition, there are preventative mea- gram (2004–2012), more than $2.6 million sures to take, including staying away from in federal funding was invested in the pub- sick people and washing hands to reduce lic health surveillance registry allowing it the spread of germs. People sick with the flu to grow from one community (Atlanta) to should stay home from work and school to eventual national participation and inter- prevent spreading influenza to others. national collaboration. On Oct. 1, 2012, Flu activity commonly peaks in the U.S. CARES transitioned from its oversight in January or February. However, seasonal by the Centers for Disease Control and flu activity can begin as early as October and Prevention (CDC) to a private funding continue as late as May. The CDC collects mechanism. information in five categories from eight The registry has expanded to 40 partici- different data sources to: pating communities in 25 states, as well as nine state-based registries (Arizona, Dela- • Find out when and where influenza ware, Hawaii, Illinois, Minnesota, North Car- activity is occurring olina, Pennsylvania, Utah, and Washington). • The FCC estimates that of the • Track influenza-related illness Out-of-hospital cardiac arrest is the roughly 240 million 9-1-1 calls placed • Determine what influenza viruses are leading cause of death among adults in the each year, 70% are now placed from circulating United States, killing approximately 325,000 wireless phones. • Detect changes in influenza viruses individuals each year, the majority of whom • At least 50% of all wireless 9-1-1 calls • Measure the impact influenza is hav- die before reaching the hospital. originate indoors, according to indus- ing on hospitalizations and deaths in According to information from the try estimates. the United States g CARES website, EMS dispatchers who can • Nearly one-third of households in the quickly take control of the call, assess the United States are wireless-only, with situation, and engage the caller in lifesav - no landline, making them totally ing actions are a crucial link in the chain of reliant on wireless phones during survival. According to the American Heart emergencies. Association (AHA), the recommendation is for dispatchers to initiate bystander CPR Find Me 911 plans to take several actions within one minute during potential cardiac in the coming weeks and arrest calls. months to push the FCC into moving forward quickly to establish a rea - Organization wants 9-1-1 to For more find place in wireless age sonable, measurable level of information or to location accuracy for emer- join, go to www. findme911.org Interested in joining hundreds of emergency calls made indoors gency responders, 9-1-1 dispatchers, and oth- using wireless phones. ers concerned about helping first responders find people in an emergency? Flu season never Then Find Me 911 might be for you. skips a year Find Me 911 is an effort supported by more than 125,000 individuals and national There’s nothing certain about the flu and local organizations recognizing the criti- season, except that the best way to prepare cally important public safety need to ensure requires the two “Vs”: vigilance and vaccine. that 9-1-1 works in today’s wireless age. And The Centers for Disease Control and despite the fact that the majority of 9-1-1 calls Prevention (CDC) states that while flu sea- originate from mobile phones, the Federal sons are unpredictable in timing and strain, Communications Commission (FCC) has no everyday steps and the annual vaccine can location requirements for mobile calls—and help people avoid the worst of it.

THE JOURNAL | November/December 2013 15 INTERNATIONAL NEWS

Shanghai Skyline The Oriental Pearl Radio & TV Tower is a distinct landmark by the Huangpu River in the Pudong district.

the increasing percentage of nonemergency gency calls from one location and have the Shanghai’s changes in calls, which in 2012 was at 40%. discretion to decide the district responsible emergency medicine In addition, the Shanghai Medical for sending an ambulance. include dispatch Emergency Center will consolidate nine “The new measure aims to ensure that existing emergency dispatch centers into ambulances staffed with doctors are sent A change in the way Shanghai, China, one; the dispatchers will answer all emer - only to people with real medical emergen- handles medical emergencies can only mean the medical protocols are not far behind in dispatch response. An increasing number of nonemer - gency calls is behind the Shanghai medi - cal move that replaces doctors on many of the ambulance runs with less-intensively trained medical staff and—in the Academy’s interest—gives emergency dispatchers more decision-making influence. Part of the solution comes from Shang- hai’s first-ever paramedic program that will replace doctors with less-intensively trained personnel on ambulances trans - porting patients home from the hospital; nurses will be on board in patient transfers between hospitals. The Shanghai Medical Emergency Center, however, will continue to staff doctors on ambulances responding to emergency calls. In the past, no ambulance went out without a doctor, which included nonemergency trips. The system led to bottlenecks in dispatching ambulances to actual emergencies, and it was a problem exacerbated by Energy And Light The Oriental Pearl Radio & TV Tower and the Jin Mao Tower are symbols shaping Shanghai’s future and preserving its culture.

16 THE JOURNAL | iaedjournal.org cies,” said Guan Min, director, Shanghai Medi- According to Ambulance Operations geological area known as the “Iron Quadran- cal Emergency Center, in a story published in Manager Athar Khan, at least one member gle,” and characterized by large quantities of the Global Times (Sept. 3, 2013). of staff is attacked every day in London and iron ore deposits, mined by Vale since 2000. The Academy’s protocols are used by sev- at least two are verbally abused. Last year, Although CECOM is not new to the eral centers in China, with the Wuxi Emer- 451 medics reported a physical assault and complex, the center went live with the Medi- gency Medical Services communication center 737 were verbally abused as they responded cal Priority Dispatch System™ (MPDS®) and becoming the first in the country to achieve to emergency calls. the Fire Priority Dispatch System™ (FPDS®) Accredited Center of Excellence (ACE) status. “We have a duty to protect our staff and in August 2013. let them know if they’re about to be sent into CECOM’s calltakers (certified EMDs Flagged 9-9-9 calls indicate a potentially violent situation,” Khan said. and EFDs) provide Post-Dispatch Instruc- crucial information “We have to balance the need to protect our tions and Pre-Arrival Instructions and send staff and the need of the patient.” the appropriate response to the scene once When London Ambulance Service (LAS) determining the location. The agent, who medics respond to a 9-9-9 call at a flagged Protocol helps protect analyzes scene safety and gives first aid, address, they carry out a risk assessment— mine workers in Brazil forwards patient and scene information either for guiding management of patient to CECOM, which then mobilizes rescue care or deciding whether it’s safe for respond- 6,000 fire and EMS calls per year and transport. ers to enter. 10,000 employees Vale also offers an 800 number for Patient care management—the newest Two calltakers/dispatchers on duty 24/7 employees to call from their residence any 9-9-9 flag added to the system—provides the Now spread that over more than time they should need help, day or night, control room and ambulance crew with vital 226,460 square miles (three times the size of so they can receive instructions employees information about a palliative care patient, Nebraska, the 16th largest state in the U.S.), wouldn’t receive if they called 1-9-3 outside including patient wishes not to be resuscitated 10 mine locations, very hazardous conditions, the company lines. (DNR) in case of an emergency. The way it and a round-the-clock operation. “The emergency team members are true works, a flag is raised—metaphorically speak- What do you get? guardian angels of the operation,” said Julio ing—at the point the control room receives a “A challenge,” said Ross Rutschman, Yamacita, Vale Mine Operations general 9-9-9 call placed from an address of a Coordi- PDC™ medical and fire consultant. manager in Itabira, Brazil, at the time the two nate My Care (CMC) registered patient. LAS Let us introduce you to the Vale Mines protocol systems went live. “This is a noble has secured patient/family permission to communication center, the first EFD user activity, and everyone can count on the emer- access more than 7,250 patient records. and the second EMD user in Brazil. gency system anytime and anywhere. There According to the article “Coordinate My Vale is a multi-national diversified met- will always be someone ready to help.” Care from the perspective of the London als and mining company—considered the Vale’s Emergency Medical System also Ambulance Service” (London Journal of Primary world’s second-largest mining company—con- offers emergency trained groups in each Care 2013;5:111-12): The LAS clinical support trolling over 85% of Brazil’s 300-million ton mining complex composed of doctors, desk staff in the control room access CMC annual iron ore production. technical nurses, and nurses with advanced records and send a message about the patient to A call to Brazil’s 1-9-3 emergency number training, and any employee, contractor, or the ambulance crew. Once the crew arriving on from inside the boundaries of any of the 10 visitor involved in an accident at Vale can scene has assessed the patient, CMC informa- mines is answered by EMDs and EFDs at the access the system. tion is used to make decisions regarding treat- Emergency Management and Communica- Implementation of the protocol systems ment, referral, or conveyance. In April 2013, 67 tion Center (CECOM), in Itabira, Minas was concurrent with the fourth anniversary records were shared with crews on scene. Work Gerais, Brazil. Itabira is in the mountainous of Vale’s Emergency Medical System. g is under way to develop a Web interface that will enable address “flags” for new patients, alter the records of existing patients, and automatically update records within LAS command and control systems every 12 hours. Another flag that has been in place in the control room provides cautionary messages to crews arriving at addresses where response scene safety is in question. How - ever, responders only delay treatment if they believe they are in danger at the time of the call. Risks include people with a history of violence and aggression toward ambulance staff, addresses with dangerous animals or weapons, and patients with psychiatric or alcohol-related conditions and mental health disorders.

THE JOURNAL | November/December 2013 17 g ECNS g FAQ g NAVIGATOR REWIND g ACE ACHIEVERS BestPractices g ECNS A Long Time In Coming Nurse triage software link is now a PDC patent

with caller permission—transfers the caller call a nurse advice line,” Saalsaa explained. Brett Patterson to the center’s ECN. The ECN asks the caller “The health professional could pick up on further questions, with the answers driving symptoms of an impending MI and get the The patent process can take a long time a search through 212 medical protocols that individual to a hospital for evaluation using from start to finish, whether it’s granted or are powered through the software applica- the MPDS process, since the link is in place turned down. tion LowCode™. to safely transfer care.” But 11 years? Based on this structured assessment, the At any time during the call, the patient “I’ve never seen a patent take so long,” said ECN provides a Recommended Level of can request and receive ambulance transport Brent Hawkins, International Academies of Care from the 22 built into the system. These despite a low-acuity prognosis. Emergency Dispatch® (IAED™)/Priority Dis- include scheduling an office visit with the The interface also represents the continued patch Corp.™ (PDC™) legal counsel. “This was caller’s primary care provider, seeking a walk- evolution of the MPDS nurse triage system. a tough one. Most take two to four years.” in clinic for care, poison control, community Montreal, Canada, in its first adoption of At least it is a PDC victory for the patent crisis lines, or connection to a medical pro- the MPDS Omega Protocol, was a manual sys- application originally filed on May 7, 2002. vider for advice and The patent protects the “method and sys- self-care instruction. tem” for linking the Academy’s nurse triage The “seamless inter- system—Emergency Communication Nurse face” is unique among System™ (ECNS™)—and the Medical Priority triage systems, and it’s Dispatch System™ (MPDS®) to a computer- a “one-of-a-kind” for aided dispatch (CAD) system. emergency communi- The patent awarded to PDC on July 23, cations, said Richard 2013, expires in 2023, which is an almost Saalsaa, a principal two-year extension of the 20-year life of architect in the PDC a patent and granted due to the extended nurse triage software. length of review. The ECN can trans- So, what’s the big deal? fer the call back to the The ECNS provides alternative care for 9-1-1 calltaker at any patients calling 9-1-1 with non-emergent time if, for example, the health-related complaints falling within the patient’s condition dete- Academy-approved, low-acuity OMEGA riorates and the ECN Determinant Codes; the patent applies to determines an elevated the link making ECNS a seamless process for level of response is the caller, the communication center, and the required or the patient Academy-certified Emergency Communica- has downplayed symp- tion Nurse (ECN). toms that are actually Basically, ECNS is the Academy’s answer indicative of a more to providing quality care while, at the same serious condition. time, preserving resources better spent “Think of the classic on higher-level emergencies. For example, 50-year-old male who a caller might dial 9-1-1 with a complaint has been having vague symptomatic of a mild case of flu; rather pains in his body, but than sending an ambulance, the calltaker— feeling fine enough to

18 THE JOURNAL | iaedjournal.org tem, allowing the physician’s staff to assess g FAQ patients who were considered low-acuity (OMEGA) candidates based on questioning at Case Entry. The Deciding Factor “There was no seamless integration and process in place to effectively gather the Chief Complaint or specific diagnosis information,” Saalsaa said. “They basically had to start from scratch.” U.K. ambulance services were looking for a comparable approach for treating low-acuity calls, but, similar to the Montreal system, were without a structured process to assist patients meeting the OMEGA criteria. Saal- saa came up with the solution. Several years ago, the ability to forward and return the caller without interruption was noted as a preeminent feature in the v12.2, NAE-std. © 1979–2013 PDC. 1979–2013 © NAE-std. v12.2, application during patent negotiations. ®

“This was clearly an interface that was MPDS needed; [it is] unique,” said Jerry Overton, IAED Clinical Advice Board chair. “No one exactly what happened,” so the symptom had anything like it.” Brett Patterson we are currently dealing with is abdomi- Overton was chief executive officer of nal pain. Could you clarify whether the Richmond Ambulance Authority (RAA) specific diagnosis has a bearing or not? in Virginia, which, at that time, was pilot - Brett: Jeffrey D.M. Liskin ing a Community Health Access Program I have a couple of questions for you Training and QA Coordinator (CHAP) that used computer software triage regarding the protocols. Litchfield County Dispatch, Inc. protocol for routing apparent low-acuity After debate, review, discussion at the Torrington, Conn., USA calls to a nurse. CHAP relied on the MPDS Dispatch Review Committee meeting, interfaced with the ProQA® software. and research, I’ll put this simply. Caller Jeffrey: Data screened during the 15-month states epigastric pain during Case Entry When a diagnosis other than diabetic pilot program showed outcomes were not after “Okay, tell me exactly what hap - problem or stroke is offered in response to adversely affected. The software-suggested pened.” The caller states he is a diabetic, Case Entry Question 3, the EMD should disposition guided by the nurse was effec- was vomiting in hospital the night before, attempt to obtain a more specific Chief tive and verifiable. RAA went live with the has an ulcer, and has esophagitis. The first Complaint description by repeating: “Tell program in 2006. complaint was epigastric pain. me exactly what happened.” Even in diabetic Saalsaa never doubted the veracity of The EMD, who usually is 100% com- or stroke cases, the Chief Complaint descrip- effective nurse triage. pliant in everything, chooses Protocol tion helps to confirm the reason for calling. “I was clear from the onset that this 26: Sick Person (Specific Diagnosis), and While it is true that Protocol 26 is subtitled would revolutionize a gap that existed in 9-1- I lowered his performance measurement “(Specific Diagnosis),” the protocol should 1-like call centers,” he said. “It was a question for Chief Complaint selection. I said he only be used when a specific sign or symp- of what to do with patients who clearly have should have gone with abdominal pain, tom cannot be obtained at Case Entry. no actual emergency. The MPDS Omega Pro- as epigastric is medically defined as In your case example, the caller did tocol opened the door for this invention.” upper abdomen (not to mention there is offer a specific symptom (epigastric pain). Saalsaa, who authored the patent applica- a rule mentioning epigastric pain within From your description of the EMD’s tion originally filed on May 7, 2002, attributes the abdominal pain protocol). The EMD thought process in the selection of Proto- the 11-year wait, at least to some degree, on originally contended that he didn’t con- col 26, it appears that the patient’s recent the difficulty patent officials had seeing the sider epigastric pain abdominal pain; history of vomiting and diagnosis of ulcer forest for the trees. however, he has since conceded after and esophagitis influenced the Chief “Interestingly enough, most of the hur- we reviewed multiple sources defining Complaint Protocol selection, rather than dles were to uniquely distinguish this from it as such. the presenting symptom. Ultimately, this our own patented systems for the MPDS,” His question at this time is: “Does “diagnosis” of the epigastric pain by the Saalsaa said. “It took some educating of the the patient providing a specific diagnosis EMD may have been correct; however, patent officials to see the distinctions of the (esophagitis) affect the Chief Complaint the Medical Priority Dispatch System ™ patent as being unique.” selection?” He argues that the lack of a pro- (MPDS®) is not designed to be diagnostic, The ECNS is the Academy’s fourth pil- tocol for esophagitis determined his selec- but rather to base response and pre-arrival lar of care. A center must be an Accredited tion of Protocol 26. I counterargue that the care on presenting signs, symptoms, and/ Center of Excellence (ACE) to offer ECNS symptom epigastric pain (aka abdominal or events. In this case, the protocol selec- to its 9-1-1 callers. g pain) was reported after “Okay, tell me tion should have been made based on the

THE JOURNAL | November/December 2013 19 complaint of epigastric pain and, if that and the patient’s breathing has been g NAVIGATORREWIND term was not understood by the EMD, deemed effective. the EMD is obligated to ask for another Please note that the instruction description of the pain. begins with “. . . make sure her/his head is ADA Overall, this seems like a well-intended tilted back . . .”, which implies this instruc- error in protocol selection by an otherwise tion has already been given. This could Compliance excellent EMD, with a resolution of sim- occur either coming from Panels 15a or 17 ple education. (most often), or perhaps after the EMD Current policies Brett A. Patterson has done an agonal breathing diagnos - might need tuning IAED™ Academics & Standards Associate tic test somewhere else in the sequence Medical Council of Standards Chair and breathing has been determined to be effective (airway already opened), Make no mistake about it: Stephan Bun- Brett: i.e., after starting CPR the patient starts ker wants the best qualified individuals pos- This is a situational protocol compli- breathing effectively. It was added as a sible answering 9-1-1 calls and dispatching ance question. “free-floating” panel (use when needed) response, and the best qualified individuals Caller reports diabetic unconscious because this can happen anytime dur - possible supervising those who have those breathing, 13-D-1. The only Key Question ing the sequence and, also, it provides responsibilities. (KQ) asked during KQs is, “Is he breathing an instruction when a healthcare profes- But that doesn’t mean finding or defin- normally?” Answer = Yes. The EMD chose sional is telling the EMD that the uncon- ing the “perfect” individual, because perfect the unconscious pathway and entered scious patient is breathing effectively. doesn’t exist. It does mean making accommo- Pre-Arrival Instruction (PAI) Protocol C: With that said, I would commend the dations so everyone has an equal chance at Airway/Arrest/Choking (Unconscious) EMD for his thought process and for notic- the ballpark. – Adult ≥ 8 Yrs. The EMD did not give the ing the availability of this ProQA feature. “We are all looking to recruit, hire, train, first instruction, “Are you right by him It is understandable that the availability of and retain qualified individuals in our agen- now?,” and went directly to C-16, which is this ProQA “button” may be confusing in cies, especially with the huge turnover most “Maintain and Monitor.” the sequence but this is simply how ProQA of us have,” he said. “And it could be the I did not see how the EMD could have deals with “free-floating” panels; they must accommodations we make that help us hang gotten to C-16 without giving the PAIs, so be available during the sequence. onto people.” I lowered his performance measurement Like your first question, this is an edu- Bunker was prefacing his talk “ADA for a major PAI deviation and told him we cational issue. Compliance for the Communication Center could discuss it. He brought to my atten- First, we need to understand the ratio- Manager” at the NAVIGATOR 2013 confer- tion that the “maintain and monitor but- nale behind an important Rule in the ence held in Salt Lake City; and while the ton” was available within PAIs in ProQA®; MPDS: “The airway of an unconscious subject may seem to address a certain “group” however, this was not a DLS Link within patient must be constantly maintained.” of individuals, the issues discussed present a the manual cardsets. He selected “main- The positioning of the caller who has one universal approach to hiring and developing tain and monitor” because he considered hand under the neck and the other on the any employee. the patient to be breathing normally as forehead enables constant monitoring for After all, shouldn’t every agency or busi- assessed in KQs. I told him I didn’t think patients who cannot maintain their own ness have job descriptions, policies and proce- he could do that, but I would find out. airway and prevents the caller from leav- dures, open dialogue between employer and My thinking is that we need to lay ing the patient. employee, and multitask adjustable chairs or the patient flat on the back and reposi - Second, “free-floating” panels in the consoles in place? tion the airway to properly assess nor - MPDS, which are designated by green or Of course, but that doesn’t mean the mal breathing. red title bars in the cardset, are to be used agency is ADA compliant. The ADA—or the Is there a rule that elicits the use of the when events happen out of sequence, i.e., Americans with Disabilities Act (ADA)—goes “maintain and monitor” in this situation? patient vomits (Clear Airway) or patient far beyond the more commonly recognized What is the intended purpose of having starts breathing (Breathing Evaluation). issues surrounding building access obstacles. that link within C-1 in ProQA, and how I hope these responses answer your The ADA aims at preventing discrimi- is it to be used correctly? Your thoughts questions and serve to aid your QI process. nation and counteracting distinctions that and insight on this would be greatly Please don’t hesitate to call me directly if establish “certain” group kind of thinking and appreciated. you need further clarification. categorizing people as such. The law, which Jeffrey Brett went into effect in 1992, provides equal pro- tection under the law and equal opportunity. Jeffrey: Brett: The ADA section on employment forbids C-16 (and the associated ProQA but- These responses were extremely discrimination against “qualified individuals ton in PAIs) is a “free-floating” panel to helpful and insightful. I feel that you’ve with disabilities.” be used AFTER a medical or ineffec - helped clear up quite a bit of confusion So, why is a 60-minute talk about the tively breathing trauma patient’s airway and misunderstanding. Thank you for ADA vital for communication centers? has been opened in previous panels; the taking the time to respond so thoroughly. “Because ADA for a PSAP is a topic sel - EMD is somewhere else in the pathway Jeffrey g dom discussed at length,” said Bunker, former

20 THE JOURNAL | iaedjournal.org Making Accommodations An enlarged cardset is one way an employer can accommodate an individual. MPDS® v12.2, NAE-std. © 1979–2013 PDC. training, certification, and compliance officer descriptions do establish what the person vidual,” he said. “Any harassment must be for Maine’s centralized 9-1-1 system. must be able to accomplish on the job; an nipped in the bud. That can only lead to bad And that can be to an agency’s distinct employer should be sure to describe the feelings and retaliation.” disadvantage. job’s essential functions completely, objec- The accommodation doesn’t have to The ADA defines “disability” and distin- tively, and in enough detail to support break the bank, either. An employer can’t use guishes between what’s included and what’s why they are important to the overall job dollars as a defense, although the employer not in the definition. duties, Bunker said. has a final choice among the appropriate For example, ADA covers a person with “Job descriptions are the unsung task that accommodations available. An employer, a disability that limits major life activities gets the little bright blue star,” Bunker said. for example, can pick the $350 multitask such as hearing, walking, and speaking; the “You don’t have to have them, but it sure chair rather than the chair that costs double, law does not protect a person with a prison helps potential applicants decide whether as long as the less expensive model meets record or quick temper (without a docu - they can meet the job’s requirements.” the individual’s requirements for modifica- mented psychological condition), despite Maine’s 26 PSAPs use the same application. An employer is not required to make potential consequences for that individual tion that’s been “tweaked” according to the an accommodation if it would impose an regarding employment. specific needs of that agency, generated from “undue hardship” on the operation of the The ADA outlines the accommodations a statewide job task analysis (JTA) for the employer’s business. an employer can make for the individual to position of dispatcher/calltaker. Bunker said he could easily fill a week - accomplish the job’s essential functions. Bunker also recommends an employer long workshop with the amount of infor - For example, a person with a documented ask qualified applicants for a dispatcher or mation he has learned from studying the life-altering disability may request—and calltaker job to sit at a console prior to a for- ADA in preparation for NAVIGATOR and receive—modifications to the physical work- mal interview. Since an employer cannot ask serving as a member of the Maine Commis- space, revised training programs, and a break whether a person has a disability—even if the sion for the Deaf, Hard of Hearing, and from full-time work schedules to part-time. disability is obvious—or needs accommoda- Late Deafened. An employer is required to accommodate a tions, the chance to observe the job in action “I’m a proponent of ADA,” he said. “But known disability of a qualified applicant or gives applicants a window for a decision and there are many parts of the law an agency employee, but is not required to make accom- invites a “two-way” dialogue. should know because there are parts that modations for situations the employer might If the qualified applicant hired requires make it a specialty all its own.” anticipate, although at the time, don’t exist. accommodations, the request and reason There are plans an agency can put in for the subsequent modification must be About the speaker: Stephan M. Bunker recently place, however, that protect an employer kept confidential and, as Bunker recom - retired from the Maine 911 bureau where he was in the hiring process and help the applicant mended, ADA training for dispatchers, the manager for statewide dispatcher training and determine if the job is suited to interests and calltakers, and their supervisors should certification. He now consults for police and fire abilities. Many elements in the process work include issues that must not be disclosed dispatch training (Maine 911 LLC). The recipient much the same way they do in the overall or discussed openly. of the 2012 Dr. Jeff Clawson Leadership Award, employment process. “You must be very cautious about disclos- he is also an IAED™ instructor for ETC, EPD, For example, while the ADA does ing any information because of the potential and EFD in the U.S. and Canada. Contact him not require job descriptions, written job damage it could cause the agency and indi- at: [email protected] g

THE JOURNAL | November/December 2013 21 g ACEACHIEVERS All Aboard Take a mentor along for the ACE ride

Achieving ACE Mike Clayton and Sara Lyvers have a lot to smile about.

The Center That Roared Stephanie Scott and Sara Lyvers are part of the St. Joseph County Fire Dispatch team, which High Five Julie Studon and Holly Whiteford work with the rest of the team to made ACE its very real and intended destination. continually achieve ACE standards. Marsan, training coordinator for Grady Atlanta—approximately 134 square miles. Audrey Fraizer EMS communications, and Betsy Cobb, With a fleet of 46 ambulances and a staff of Grady EMS quality assurance coordina - 300, Grady EMS has provided EMS services St. Joseph County Fire Dispatch is the tor, had actually made the “all points” offer for 120 years. little center that did. after achieving the same goal a year earlier The Grady EMS communication center Reminiscent of the popular children’s and coming on stage to accept the award at is a secondary Public Safety Answering Point book, The Little Engine That Could, the cen- NAVIGATOR 2012. At the same conference, (PSAP), and it receives more than 120,000 ter in South Bend, Ind., relied on optimism Marsan and Lockhart co-presented sessions emergency calls per year processed by two and hard work to reach what might seem an relating to training and emotional recovery dispatchers, four calltakers, and one super- impossible obstacle for a center of its size. in a stressful profession. McCloughen co-pre- visor per shift on a 12-hour rotating shift. Repeating the little blue engine’s famous sented two sessions at NAVIGATOR 2013. The PSAP moved to an upgraded facility in words, “I think I can, I think I can”—at least, But not everyone interested in pursuing February 2011. They use the Medical Priority perhaps, under their breaths—the 15 dispatch- ACE goes to NAVIGATOR, and not every- Dispatch System™ (MPDS®) and are one of ers, Dispatch Director Coni McCloughen, one knows someone with ACE experience. four ACEs in Georgia. and Operations Manager Nancy Lockhart “That’s why we decided to put Grady St. Joseph County Fire Dispatch is a sec- were able to turn the mantra into “We did out there,” Marsan said. “Not everyone has ondary PSAP serving unincorporated South it, We did it, We did it” in a relatively short the same opportunities, and we believe it’s Bend, which comprises about 400 square eight-month haul. important to mentor those who want to miles and provides fire and medical dispatch And all it took, aside from the “I can” atti- achieve ACE but [who are] without the ben- to 108,000 residents. The center receives an tude, was a little help from their friends. efit of attending the workshops.” estimated 13,000 emergency calls per year “We didn’t want to recreate the wheel, Aside from ACE and everything that processed by three dispatchers on first and and we were looking for someone to offer goes with the accreditation, St. Joseph second shifts and two dispatchers on the to help us through the process,” said Lock - County Fire and Grady EMS have little else night shift. They use the MPDS and the Fire hart, who is quite proud of the fact that in common, demographically speaking. Priority Dispatch System™ (FPDS®). their center is the “first and only” Medical Grady EMS is the hospital-based emer- The communication center is located in Accredited Center of Excellence (ACE) gency care component of Grady Health Clay Fire Territory Station 2, built in 1962 awarded in the state of Indiana (on Nov. 11, System; it provides basic and advanced life and remodeled in 1998. Station 2 (renamed to 2012). “We contacted Susi Marsan, and she support emergency ambulance services to Station 22 in 2013) is one of five fire stations gladly accepted.” any resident and visitor within the city of in Clay Territory, and houses the fire chief,

22 THE JOURNAL | iaedjournal.org operations chief, fire marshal, division chief Cobb and Marsan held countless training of EMS, training officer, deputy fire mar - sessions with their staff, and Cobb relied upon Accredited Centers shal, and—since 1982—the 19-foot by 24-foot inexpensive and creative awards, such as $5 bills of Excellence space allocated to dispatch. Prior to establish- in helium balloons (out of pocket), gift cards, ing a dedicated dispatch center, calls were casual dress days, and added longer breaks dur- answered in a funeral home and forwarded ing which Cobb would work for the dispatcher EMD Re-ACE to a volunteer fire department for response. during his or her time away from the console. 14 City of Miami Department of Fire The dispatch center introduced the They offered their “success tips,” advice, & Rescue; Miami, Fla., USA MPDS in 1994 at a time when county police and cheerleading abilities to McCloughen dispatchers answered medical calls. It offered and Lockhart. 29 El Paso County Sheriff’s Office; a measure of preparedness, especially for the “We made ourselves available,” Marsan said. Colorado Springs, Colo., USA self-reliant population of rural South Bend, Lockhart was amazed at their level of Lockhart said. help and encouragement. 48 M.D. Ambulance Communica- “We don’t have minor calls,” she said. “Our “Their support and their ‘you go guys’ tions; Saskatoon, Saskatchewan, calls involve very sick people. Around here, were really helpful,” Lockhart said. Canada they don’t want to rely on public services for St. Joseph County Fire put together an help, preferring to fix things on their own.” award system: designing their own T-shirt 53 Citrus County Sheriff’s Office; Five years later, St. Joseph County Fire contests, cooking challenges, rides with the Inverness, Fla., USA assumed control of ambulance/EMD dis- fire department, and posting the names of patch in unincorporated parts of the county, QA “superstars” on a magnetic board. Dis - 54 REMSA (Regional Emergency and the state has since mandated certification patchers were involved from day one; after Medical Services Authority); for all emergency medical dispatchers. ACE all, Lockhart said, “It is about their work. It’s Reno, Nev., USA was always on their “to do” list but it wasn’t about what they do daily.” until NAVIGATOR 2012 that Lockhart and They studied the Grady EMS 20 Points 79 Rehoboth Beach Police McCloughen dug in their heels. binder; followed the recommendations of Department 9-1-1 Center; “We wanted to do it right,” she said. Ivan Whitaker, the IAED ™ QA task force Rehoboth Beach, Del., USA St. Joseph County Fire had questions member assigned to evaluate the 20 Points ready: where to start, how to get people on submitted by St. Joseph County Fire; and lis- 92 American Medical Response – board, and how to keep the momentum tened closely to Kim Rigden-Briscall’s NAVI- Oregon Communications; Port- going throughout the process. Lockhart and GATOR talk “How to Impress Your Board of land, Ore., USA McCloughen didn’t need their hands held Accreditation Reviewer.” through the process, but more-or-less wanted “They were a tremendous help,” Lockhart 111 Montgomery County Hospital a kick-start and someone reliable to go to, if said. “They made sure we stayed moving in District EMS; Conroe, Texas, USA necessary. In other words, their center closely the right direction.” mirrors the resourcefulness of the residents St. Joseph County Fire celebrated its 114 Raleigh Wake 911; Raleigh, N.C., under their jurisdiction. ACE at a combined firefighter/dispatch USA Cobb knew St. Joseph County was in the Christmas party. They produced a video, same position as Grady EMS had been eight highlighting what ACE means to the center 134 Guilford Metro 911; Greensboro, months earlier; that being brand new to the and individual dispatchers. N.C., USA ACE process, beginning the very first point McCloughen attributes their success to of the 20 needed for accreditation, and with the ones who made it happen. 140 Cape County Private Ambulance; the same aspiration to be “above and beyond” “This is a compliment to them, and Cape Girardeau, Mo., USA in their commitment to the public. they wear it like a badge of honor,” she The best approach was showing St. said. “They’re proud to say what they do 141 Metropolitan Area Joseph County Fire the Grady EMS ACE for the public.” Communications Center Author- binder—the point-by-point documentation Lockhart said the process wasn’t easy, ity; Centennial, Colo., USA for the 20 Points of Accreditation, a real although “rightfully meticulous,” considering page-turner for ACE aspirants. Since much the significance and what ACE represents for 142 Salt Lake City Department of of the information is not meant for eyes out- the public. Her advice to others in the run- Airports; Salt Lake City, Utah, USA side of Grady EMS, Cobb had legal draw up ning for ACE? a confidentiality statement. She also provided “Find a strong mentor,” she said. “Susi and suggestions for motivating personnel. Betsy were invaluable.” EFD Re-ACE “There are a lot of changes over a short Marsan said the offer to mentor still 4 Mecklenburg EMS Agency; period of time, and you have to make it a stands, although she is not quite sure where Charlotte, N.C., USA great experience for your center,” Cobb said. the offer will take them, or how many might “At Grady, we had moved into a new center take them up on it. 17 City of Hialeah Public Safety and had the new version 12.0 (MPDS) to get “We really didn’t know what we were get- Communications Division; up to speed. We made sure our people were ting into,” she said. “But it’s the right thing to Hialeah, Fla., USA involved from the start. Everybody had a part.” do. We’re here to help.” g

THE JOURNAL | November/December 2013 23 g FEATURE | Resiliency

24 THE JOURNAL | iaedjournal.org In Pursuit Of A Blueprint For 9-1-1 Wellness Resilience takes more than ignoring the stress

Jim Marshall

he history of our nation’s failure to care for our warriors The problem is real returning from war is hard to face. Even now we are play - In Roberta Troxell’s 2008 study of 497 Illinois telecom- ing a dangerous game of catch up—even as researchers have municators, 16.3% acknowledged symptoms consistent with finally begun connecting the dots between escalating rates Compassion Fatigue (CF) 2—a condition in which a person T 1 of service-related post-traumatic stress disorder (PTSD) and suicide. experiences struggles with traumatic stress symptoms and But in case you are assuming I am anti-military or a pessimist about burnout. In 2012, former dispatcher Heather Pierce and Northern to blather on critically, let me offer some assurance: I am not a pes- Illinois University researcher Michelle Lilly released widely simist or an extremist on a rant. In fact, I’ve been accused more than publicized findings from their study of telecommunicators, once of being a “psychotic optimist.” indicating significant heightened risk for PTSD among 9-1-1 But my dogged optimism and bent toward hopefulness is telecommunicators; in fact, as high as 9–10% of their subjects well founded—a gift from my courageous trauma clients. Over reported symptoms consistent with PTSD.3 the years as a mental health clinician, I have witnessed so many survivors fight their way through horrendous memories and rise The good news like a phoenix from the ashes. The point in bringing up our nation’s We are making progress in safeguarding our 9-1-1 pros’ resilience abysmal shortcoming in recognizing and treating our warriors’ in the face of traumatic stress, but we’ve only just begun and our PTSD is that we will repeat this failure in the 9-1-1 community if we long-term success will require stakeholders from all sectors to join don’t systematically evaluate and proactively address the impacts in building what I call a Blueprint for 9-1-1 Wellness in the Next of 9-1-1 stress on our front-line telecommunicators. Generation PSAP.

THE JOURNAL | November/December 2013 25 Let me offer in a nutshell the gains we’ve Next steps and how can we optimize this buffer? made so far, where we need to go from here, The IAED has guided a systematic (Reflect on each condition pertaining to and how you can help. evolution of dispatch from an this buffer.) In 2010, the National Emergency unstructured, medically uninformed • What is the status of Variable (A–D) Number Association (NENA) launched practice to a research-driven science. related to each condition, and how can the NENA Working Group on 911 Stress. 911WF is in the early stages of a similar we optimize that condition? NENA leaders joined by mental health task-contributing science to advance professionals and representatives from 9-1-1 resilience and wellness. The Model • Reflect on the interactions between APCO International, the APCO Institute, for Evaluation and Achievement of 9-1-1 specific stressors/buffers/variables: How the U.S. government, and the commercial Wellness (see Figure 1) is one of many do we need to factor for these? sector all chose to acknowledge and take tools providing a rigorous methodology With such a quick first immersion responsibility for facing the 9-1-1 stress risks to achieve this task. The model implies into The Model for Evaluation and revealed by Troxell, Pierce, and Lilly. The that by evaluating needs and ensuring Achievement of 9-1-1 Wellness, you might result was realized on Aug. 6, 2013, when the resources to address them, PSAP leaders feel as if you were pitched in a dump NENA Executive Board approved the new can empower telecommunicators to tank and then dangled over the edge of Standard on 9-1-1 Acute/Traumatic and assume full personal responsibility for the Grand Canyon by your belt loop. It’s Chronic Stress Management. their wellness. a lot to take in all at once without more The adoption of this standard is In Figure 1, we can see that there are explanation. But the model is introduced promising; it represents a major first step two pure stressors, two pure buffers, and as an example of one key tool offered by for the 9-1-1 industry toward fostering 9-1-1 four work “variables”—aspects of work 911WF to help 9-1-1 stakeholders carefully resilience, optimal well-being, and health- that can serve either as stressors or stress evaluate 9-1-1 stress. By joining together driven performance. Now our nation’s PSAP buffers depending on how they are shaped using such tools, we can build a Blueprint leaders must implement the standard and in relation to six conditions. To ensure for 911 Wellness that will ensure the that will require active and expert support. optimal well-being or “wellness,” we must health and performance of the very first Anticipating this need, the 911 Wellness systematically manage conditions by responder in the Next Generation PSAP. g Foundation (911WF) was established in countering stressors and optimizing buffers 2011. It is devoted exclusively to ensuring and variables. Sources the mental (and physical) health of our Planning effectively for optimal 9-1-1 1 U.S. Department of Veterans Affairs. http://www.ptsd.va.gov/ 9-1-1 professionals. Subject Matter Experts wellness also involves answering specific public/pages/ptsd-suicide.asp. Accessed Sept. 16, 2013. (SME) from 9-1-1 and the mental health questions. For example: 2 Troxell, R. (2008). Indirect Exposure to the Trauma of Others: The Experience of 9-1-1 Telecommunicators. http:// field joined together to advance resilience • What is the status of Condition 1 gradworks.umi.com/3335425.pdf. Accessed Sept. 9, 2013. research, education, policy, and intervention. pertaining to Stressor (A or B), and how 3 Pierce, H.A., & Lilly, M.M. (2012). Duty-related trauma exposure In support of the 911 Wellness Foundation’s can we optimize this condition to buffer in 911 telecommunicators: Considering the risk of Posttrau- ™ work, the IAED Board of Trustees has the stress? matic Stress Disorder. Journal of Traumatic Stress, 25, 211-215. established a formal alliance between the doi: 10.1002/jts.21687. This percentage was based on using a two agencies. • What is the status of Buffer (A or B) symptom cut-off score associated with PTSD in clinical samples.

26 THE JOURNAL | iaedjournal.org g FEATURE | Resiliency Plan B When the other stuff doesn’t work

Dr. Lori K. Gray

Dispatchers commonly ask me how to cope when healthy eating, restful sleep, exercise, and work-life balance aren’t enough to help. In other words, how can we persevere and thrive when our capacity for caring becomes overwhelmed or depleted? What do we do when the other stuff doesn’t work? Let’s break this down based on reasons why this happens.

Human suffering and cruelty We have the privilege of experiencing humanity at its truest level, at its finest and cruelest moments. We learn that there is no limit on what one human being can do to another, which is reflected in phrases like: “Only the good die young” and my favorite from policing—“No one is truly innocent.” patient who then survives) is not reasonable. The burden of caregiving The challenge of weighing the best- and The odds are too low and these calls are too It’s part of dispatchers’ character to help; worst-case scenario to arrive at a more “realis- infrequent to keep you going. A more reason- they want to contribute to the greater good. tic” perspective doesn’t work for us. able goal is to “increase the odds of survival As a result, dispatchers tend to care for others It is important to consider not just the to the best extent possible.” This is something before caring for themselves. When a group traumas but also the moments—the moments that we can achieve regardless of whether of people with these attributes works closely that are the reason why you do what you do there are positive/negative outcomes and together, we end up with people preferring to and that carry you through what you do, high-/low-acuity calls. deal with others’ problems rather than their regardless of whether it’s your best or worst own and caring for others to the point of deple- call. A violent crime in which a little girl and High frequency of low-acuity calls tion and sensitized to feeling devalued. We her parents survive but all other kids died Frequent low-acuity calls can be frustrat- need to realize and embrace that you can only and the girl says in a humble voice, “Thanks ing. We get conditioned to call frequency care for others in so far as you care for yourself. for helping me keep my mommy and daddy.” and acuity and may get bored when those We need to support each other in doing so. Or the elderly gentleman who found his thresholds aren’t met. Perspective works for It’s not “just a job” and we need to be wife deceased due to natural causes and asks, some—the view that you get paid the same mindful of that in how we care for ourselves “What do I do? She was my everything!” regardless of the call that you’re answering. and how we look out for each other. It’s not about a pat on the back. It’s about This doesn’t work for many or when you’ve aspiring to have the strength that those just taken the pediatric arrest and the next Perspective people had. We need to think not just about one is for a stubbed toe. Although that isn’t A father whose child died—an innocent the stressors but also the moments, and the an emergency by my standards, that person victim of a random crime—said something moments are much too easy to miss. is quite lucky not knowing the world as we that I will always remember. He dropped to know it: Where bad things happen to good his knees and then froze in utter disbelief for When the toolkit runs out people and life can end in the drop of a hat. what felt like forever until he looked up and Through my experiences working in said: “I made a mistake. I made a mistake. I inner-city Detroit with victims of torture Saturation assumed that my child would live a long life. and horrendous sexual assaults, I learned that We go through loops: stimulus overload I realize now that the only thing in life that we have to develop a comfort in being there (the initial catch-up as you sit down and get is guaranteed is death, not when. My mistake with people. This is how we help when our into the groove), stimulus max (on the ball was assuming when.” toolkit runs out. Never underestimate the and rolling with the information flow), and That father was absolutely correct. Life is comfort and security that you provide by stimulus saturation (hitting the wall men- too short to devalue your incredibly impor- being with someone at their worst moment. tally). Regular breaks are important. Sched- tant role, to lose sight of what truly matters We also need to ensure that our expec - ule a minimum of two consecutive weeks of to you personally and professionally, and to tations of ourselves are reasonable. Getting vacation time to spend your time catching up lose sight of the reasons why you show up a “save” (e.g., resuscitating a cardiac arrest rather than recuperating. each day to help others. g

THE JOURNAL | November/December 2013 27 g FEATURE | Resiliency In The Stress Of Times Acknowledging stress is a step toward resiliency

Q & A with Jim Lanier

How did you become so invested in the lid on that nasty box of memories and experi- inherent risk of situations coming back to issue of 9-1-1 stress and resiliency? ences and move on to the next situation. mind—the classic “I want someone to hear Like many others 25-plus years ago, I came I never lost sight of my personal experi- this” as the caller commits suicide. This may from the old school of public safety stress ences with stress despite my good fortune change to a degree if live video is placed in management: Suck it up and move on. As a of promotion (OK, of being shoved) into the PSAP, but the majority of requests for field responder, 9-1-1 dispatcher, and calltaker, Public Safety Answering Point (PSAP) service will still be nonvisual. I got my fair share of mental bumps and management. I noticed that when employ- Another unique stressor is situations bruises and often gritted it out because it was ees exhibited behaviors that were out of when the telecommunicator is essentially all I knew how to do. I did not know the mani- the norm for them, there was a pattern handcuffed from being able to assist, even festations of the symptoms related to stress, there, and often, the culprit was stress though there is a dire need for intervention nor did my colleagues, nor our bosses. We did (which may be cumulative or specific- and the tools (International Academies of not talk about it because to talk about it was incident related, or even due to external Emergency Dispatch® protocols) are available to acknowlednge it. To acknowledge it meant challenges such as family stressors). for changing the outcome. For example, most to confront it, and it was easier not to confront of us have answered a call from a frantic par- something that scared us because we felt we What do you see as the stressors unique ent about an injured child, and then the par- had little control over it (which is difficult to the work of the telecommunicator? ent drops the phone and, consequently, is when your entire career is built around being The nonvisual environment is a unique unable to follow Pre-Arrival Instructions. able to control situations). stressor because the telecommunicator com- Lack of closure is another PSAP stressor. I went over the “burnout” cliff twice bines what is heard (or not heard) and what An intense call can result in emotional in my career and both times scratched and is said (or not said) into a mind’s eye visual of and mental baggage compounded by its clawed my way back to level ground. It’s in the situation. Mentally visualized traumatic unknown outcome. More than once, I and our DNA to put others first, so you keep the situations don’t always go away; there’s the other 9-1-1 telecommunicators have checked

28 THE JOURNAL | iaedjournal.org the newspaper’s obituary section to find out Done right, there are aspects of NG9-1-1 whether the cardiac arrest patient survived. From research, that could reduce stressors for the 9-1-1 tele- Exclusion, intentionally or not, from the we realized communicator. In any event, the industry public safety team is a stressor. While this has needs to welcome and integrate suggestions improved immensely, there are still occasions that burnout from front-line personnel and take advantage after a significant event when first respond- of the unique and exciting opportunity to ers are brought in for Critical Incident Stress is a symptom incorporate stress management and wellness Management and yet the 9-1-1 telecommuni- programs in the PSAP. cator taking the initial call is left out. of CF and that There is also a tendency for task satu - Where do you think the 9-1-1 industry ration combined with the lack of down - there are ways needs to go to fully address 9-1-1 stress time. Calltakers and dispatchers are often risks and ensure resilience of our front- so busy for extended periods of time that to intervene lines as we go forward? they keep pushing through until they are As the PSAP becomes more complex, so mentally spent. and assist the does the need to make sure that we are taking care of our personnel. The National Emer- What have you seen over the years person before gency Number Association (NENA) Stress supporting your concerns of stress in the Standard is an excellent place to start, and if PSAP? he or she hits the standard seems intimidating or a daunt- Outside of my own experiences with coming task, look for the proverbial low-hanging passion fatigue (CF) and burnout in the field the wall of fruit and see which portions you can imple- and in the PSAP, I saw fellow caregivers who ment now and strategize the next steps. were stellar and model employees go through burnout. The blueprint to strategically plan a spiral of decline in their attitudes to the our approach is very worthwhile. It is the point where they got terminated from or quit right thing to do and, in the long run, this a job that previously had been their dream job. The secret to resiliency is considering will make stress relief and resiliency part I had one co-worker who kept it bottled inside past intangibles compared to current tangi- of the 9-1-1 culture. This increase in well - until making the ultimate cry for help with bles relative to wellness and job satisfaction. ness will increase job satisfaction and have a self-inflicted GSW to the temple. In retro- We must acknowledge the good and create other benefits (a happier and healthier spect, several co-workers had noticed the mul- an environment of continued support and workforce which means less stress on 9-1-1 tiple cries for help along the way, but no one that it’s OK to ask for help before the situ - administrators). chose to acknowledge them (which goes back ation gets out of hand. For example, how to acknowledgement of what is being exhib- much time is unnecessarily spent supervis- You and your wife Sharon began presenting ited in someone else is acknowledging it in us, ing an employee who can do the job well at NAVIGATOR on the issue of compassion so keep the lid on it and ignore it). instead of mentoring and forming more of fatigue some 10 years ago. What experi- On the flip side, I have been in situa - a personal co-worker and coach relation - ence compelled you to address it? tions in which we’ve recognized early or late ship? Chain of command is important, but Sharon had recognized that when signs of burnout and CF and, because we I would offer that a chain of support and hospital caregivers were exhibiting prob- knew what to look for, we were able to get communication is critical to a healthy and lematic behaviors, there was often a root the individual appropriate assistance. Some resilient 9-1-1 workforce. cause related to the stress created (or com - bounced right back to the console while oth- pounded) by caring for others. Often these ers left the profession, although at least they Do you think that Next Generation 9-1-1 behaviors were rubber-stamped as “burn- left it healthier as opposed to those who com- will add to this stress? out.” She saw this not only at the hospital pounded the problem of being so burned Text messaging will bring stressors, not as a registered nurse and ombudsman, but out and fatigued that it caused them to quit only the nonvisual nature of the message, but also in ambulance/EMD dispatch center without having a psychological “Yellow Brick because of limited options to interpret unclear personnel also employed by the hospital. Road” to lead them back. messages. For example, a caller on the phone Ironically, it was a discussion of similar will have different voice inflections and tones behaviors (extreme outbursts of anger What is leadership’s role in fostering resil- contributing to communications, but with a after a frustrating 9-1-1 call) in two differ - ience among calltakers/dispatchers? text there are only words. “Please help me” via ent PSAPs that started the discussion of Our personnel are by far our most valu- texting does not tell us much. how CF has been recognized in the hospi - able resource, and to be an effective leader, Also, the industry must be wary of the tal setting, and many of the same stressors you have to take a holistic approach to temptation to assume that just because a and symptoms are present in the PSAP. employee support, which includes recog- technology (such as streaming video into From research, we realized that burnout nition of the impacts of stress inside and the PSAP) is available and “cutting edge,” is a symptom of CF and that there are ways outside the PSAP. A leader has the responsi- that it should be automatically integrated to intervene and assist the person before he bility to absorb (and prevent) as much stress into the PSAP without due diligence on or she hits the wall of burnout. Just as impor- as possible with an emphasis on colleagues’ the impact (operationally and mentally) to tantly, there is support available to bring indi- wellness and resiliency. front-line staff. viduals back from burnout. g

THE JOURNAL | November/December 2013 29 g FEATURE | NAVIGATOR

Navigating Dispatch Conferencing across the pond

Audrey Fraizer

30 THE JOURNAL | iaedjournal.org g FEATURE | Euro NAVIGATOR

Euro NAVIGATOR Waltz Conference keeps gaining steam

icture this for your evening out in Euro NAVIGATOR also celebrates the The final program blocks mirror the Lower Austria: achievement of centers processing calls interests of protocol research and noted Leave your hotel for a drive to and sending response using the MPDS® and comments from the prior year’s conference. Pthe restored 900-year-old abbey at FPDS®—PPDS® is now being introduced— The recent conference, held Sept. 11–13 in St. Melk, a Benedictine monastery beaming and honors front-line staff through the Pölten, Austria, highlighted management of over the Danube Valley and considered one Dispatcher of the Year Award. staff, protocol, and the universally hot topic of Europe’s greatest sights. Accept a glass of For example, the boat cruise not only of stress. A four-session block on the second champagne or a non-alcoholic beverage when signaled the start of Euro NAVIGATOR but day delved into the FPDS, which is picking you board a boat for a leisurely cruise down it also celebrated the 10th anniversary of 144 up steam in the European countries. the Danube River through the Wachau Notruf NÖ. The accredited and reaccredited A free (open floor) presentation Valley to the town of Krems. The day fading Center of Excellence played host to the scheduled on the final day allows time for into night pulls a shade over the vineyards cruise, featuring opening remarks by Jerry topics regarding concerns related to protocol although soft electric lighting from castles Overton, chair, IAED Emergency Clinical or center operations. and villages illuminates the sky and shore, Advice System Program, and Lower Austria enhancing the history and known beauty Governor Erwin Pröll. Behind the picture of the countryside. Austrian music plays “The governor spoke highly about the Austrian EMS Provider Gernot Vergeiner discreetly in the background. importance of protocol,” Benson said. “He is and Benson organized the structure three As your trip draws to a close, you are proud of what 144 Notruf NÖ is doing for years ago based on Vergeiner’s experience at surprised by a bold show of fireworks the population of Lower Austria.” the inter- and multi-disciplinary conferences streaming above the boat, the flash of color The Dispatcher of the Year Award went he attends in Europe. reflecting in the Danube River’s evening to Daniel Wegscheider, of Leitstelle Tirol, “The face-to-face exchanges and shorter darkness. You take the napkin from your lap Austria. Wegscheider is an EMD, EFD, and time slots [compared to conferences familiar and set it over the plate that held servings EFD-Q™ certified instructor. Wegscheider to most Americans] prove to be an effective from the Austrian-style food buffet. You started as a calltaker with Tyrol Leitstelle in way of engaging individuals and broadening depart from the boat with the past four May 2003. the dialogue,” Vergeiner said. “Networking hours forever etched in your memory but “Daniel practices what he preaches,” throughout the conference establishes the not without shaking the hands of dignitaries Benson said. “Literally. He follows the contacts with other countries and agencies.” accompanying you on the cruise. protocol verbatim and his voice was calm Vergeiner was an early proponent of the Does it get any better? and collected during the call submitted with MPDS in Austria, building his argument for Well, that depends. his nomination as he assisted in the delivery standardized protocol from the country’s For the 160 emergency center profession- of a baby.” ambulance man law of 2002, which created als attending Euro NAVIGATOR, the cruise Leitstelle Tirol was established through two tiers of ambulance response (rescue and was a great indicator of things to come. an agreement signed in September 2004 emergency). Similar to the ambulance plan, The opening of the sixth annual Euro between the Tyrol Center and the city of he wanted a national standard for calltaking NAVIGATOR conference heralded 23 Innsbruck. Leitstelle Tirol dispatches all and dispatching. sessions, Medical and Fire Instructor Tyrolean emergency services (except for In 2004, 144 Nortruf NÖ adopted the Recertification Workshops, and a police police) in northern and eastern Tyrol. MPDS and since then, the protocol has leadership seminar. It was the largest Euro expanded to a multitude of centers in several NAVIGATOR to date, quadrupling in European flair European countries, including Austria, size from the 40 people who attended the Euro NAVIGATOR is unique among Germany, and the Netherlands. New to the inaugural conference in 2008. the IAED’s conferences, of which there are conference in 2013 were representatives As the numbers grow, so does the now eight including U.S. NAVIGATOR. from the country of Georgia, located at enthusiasm, according to Tudy Benson, Sessions are divided into blocks, and the the crossroads of Western Asia and Eastern IAED™ director of European operations. accepted proposals are clustered around Europe. Georgia is a member of the Council “The rooms are always packed at Euro common topics and areas of interest. of Europe. NAVIGATOR,” she said. “It’s amazing. There Four sessions moderated by two chairs Benson is pleased with the advance of are no empty seats and during the breaks, are scheduled per block, and each block— protocol in Europe. there’s a ton of networking.” lasting about 80 minutes and held in the “The conference was a success,” she said. The “passion for protocol” doesn’t stop in same room—leaves time for discussion “We are certainly very happy with the way the classroom. between the speakers. things are going.” g

THE JOURNAL | November/December 2013 31 g FEATURE | UK NAVIGATOR

The Perfect Environment UK NAVIGATOR offers something for everyone

all it the ideal dispatch venue to of Bristol, England. The three-day confer - Dinkel was selected from 29 nomina - learn, network, or refresh, but never ence, Sept. 17-19, highlighted each set of tions—11 of those from YAS—and all exem- can it be said that this is the place to protocol specifically—such as the police plifying the “very high standards” the judges kick back and put your feet up. and fire leader seminars—and broadly in look for in choosing the Dispatcher of the C ™ “The experience of UK NAVIGATOR addressing daily operations of managing Year, according to Louise Ganley, PDC clini- was motivating, rejuvenating, and informa- staff, setting policy, and getting the most cal support representative. tive,” said Antoinette Smith, quality assur- out of the protocols. “This was a really hard decision,” Ganley ance manager, London Ambulance Service And, of course, there were the awards. said. “It finally came down to the type of call, (LAS) NHS Trust. “I came away with a new and Fiona was brilliant in the way she han- zest and energy ready to find new ways of Awards dled a very difficult situation (see sidebar).” doing things and to test the skills and tech- Yorkshire Ambulance Service (YAS) The Bill Boehly Award is exclusive to UK niques l learned. The opportunity to commu- NHS Trust brought home three awards rec- NAVIGATOR and recognizes an individual nicate with other ED-Qs™ and EMDs from ognizing the center’s high standards of care: making significant contributions to the clini- other services was invaluable.” Accredited Center of Excellence (ACE) for cal assessment of the patient over the tele - Smith was among the 90 emergency each of their two Emergency Operations phone and/or policy development in the center professionals—from England, Centres (EOCs) in Wakefield and York; Dis- area of secondary triage of emergency callers. Scotland, Wales, Northern Ireland, Ire - patcher of the Year presented to EMD Fiona According to the nomination submitted land, Gibraltar, and the USA—attending Dinkel; and the Bill Boehly Clinician of the by Annette Strickland, YAS Clinical Hub UK NAVIGATOR in the Old Market area Year Award presented to Jan Matulewicz. team leader at the Wakefield EOC, for the

32 THE JOURNAL | iaedjournal.org think UK NAVIGATOR did that. We had an True EOC “It’s the perfect enthusiastic response.” Melissa Thiele gave a high thumbs-up to Ambassador environment to the dynamics of IAED Research & Studies Officer Tracey Barron’s “Ignite Your Staff Fiona Dinkel was the EMD answering have healthy Performance” session. the 9-9-9 call placed by a husband whose debate and In addition to the great “how-to” tips of wife was alerting him to the visible slippage motivation, such as serving cups of tea at of their baby’s umbilical cord through the pick up fresh, random, Thiele welcomed Barron’s refresh- birth canal during her early stages of active ing look at the supervisory positions, such labor (prolapsed cord). new ideas for as the job Thiele performs at East Midlands “The couple was home, and she had just Ambulance Service (EMAS) NHS Trust. gotten out of the shower,” said Louise Ganley, the dispatch “She motivated me to see not only my PDC™ clinical support representative. role as a calling, but to help inspire staff to “Fiona started giving instructions (PAIs) but center.” see their role not as a job, but as a calling,” they couldn’t relocate the baby.” – Susan Ozyer said Thiele, EMAS control training officer. According to the nomination submitted “Added to that, her talk reminded me to keep by Yorkshire Ambulance Service (YAS) an element of fun in all aspects of my life, Quality Auditor Linden Horwood, Dinkel’s past two years, Matulewicz has combined his not only in my role at EMAS.” call signified one of the “truly rare instances clinical adviser role with a project to improve Another favorite mentioned was Maxine whereby AMPDS™ directs the EMD to the care and clinical support to nursing home Davis’ “Changing the Emergency Dispatch ‘Clarify & Reassure’—only to repeat the staff and patients: Centre,” which broke down facility and staff- same panel.” He has attended meetings on his own ing proposals into “who” and “what” will be time to educate care home staff and develop affected. Davis took the team approach to Takes a team a direct access clinical advice service that her talk, dividing the audience into groups While still on the call and unbe- signposts care home staff to the appropriate to collectively tackle a practical example of knownst to the caller, Dinkel liaisoned with pathway to meet the needs of their patients. control room layout. her EMD supervisor and the supervisor This work has been proven to reduce the “The groups swapped sheets and added contacted the hospital’s midwifery unit. volume of 9-9-9 calls received from the care ideas to the existing lists,” Thiele said. “Over- Without any signs of nervousness, she used home following the training and education all, this gave me a very practical approach to her “outstanding protocol knowledge” to Matulewicz contributed to around the role problem solving.” navigate through the appropriate Protocol of the ambulance service. F: Childbirth – Delivery panels and the Matulewicz is currently conducting Networking midwife’s instructions, which duplicate an audit project for the YAS Clinical Hub Jason Beese, who co-presented “Does the positioning of a pregnant female (lay focusing on breathing diagnostics and One Glove Fit All?,” found the presentations her on her left side with a pillow wedged abdominal pain. thought provoking and—high on his list—the behind her lower back) already found The two centers comprising the YAS camaraderie superb. in Protocol C: Airway/Arrest/Choking were certified as an ACE in January 2013. “UK NAVIGATOR 2013 was a very (Unconscious) – Adult ≥ 8Yrs and the worthwhile experience,” said Beese, EMD Post-Dispatch Instructions (PDIs) of Proto- Sessions quality assurance auditor, South Western col 12: Convulsions/Seizures. The 12 one-hour sessions featured cus- Ambulance Service NHS Foundation Trust. Dinkel also incorporated instructions tomer service, emergency center nurse triage, “The opportunity to meet with colleagues from the midwife at the hospital; this evidence-based dispatching, the power of lis- and friends from other dispatch agencies enhancement to Protocol F was later submit- tening, leadership, and managing suicidal call- was invaluable.” ted to the Academy through the Proposal for ers. Longer sessions included the police and Susan Ozyer couldn’t be anymore effu- Change process. fire seminars, medical instructor workshops, sive about her three-day stay. Dinkel handed over patient care to the and EMD-Q® certification courses. “This was a fantastic opportunity to crew arriving on scene, providing them with There were favorites mentioned in the network with colleagues from all over an update. The baby was later delivered in mix, of course, although appeal often hinges the world,” said Ozyer, quality auditor, the hospital. on the individual’s reason for signing up for Wakefield Emergency Operations Centre, “She was amazing,” Ganley said. “Bril- the session. YAS. “It’s the perfect environment to have liant. She was able to calm the mother and “These are busy people taking at least healthy debate among other professionals father, which is so important when callers three days away from work, and they want and pick up fresh, new ideas for the dis - need to do what you are instructing.” to be absolutely sure they are using the time patch center.” Dinkel had few words to say when well,” said Beverley Logan, IAED™ accredita- And if it’s a person of few words you’d accepting the award. tion officer. “They want information that like to ask, there’s EMAS Control Training “She was really pleased,” Ganley said. is relevant and allows the time to provide Officer Jonathan Pearson. “She thanked everybody and said that the insight into a different view to the way “I found it enjoyable and we learned award was not only about her. It was about they might be handling various situations. I something,” he said. g her team.” g

THE JOURNAL | November/December 2013 33 g MEDICAL CDE g FIRE CDE OnTrack g MEDICALCDE Are You Completely Alert? MPDS pays close attention to challenge of consciousness

Unconsciousness is classified as one of Callers may describe what they see any num- Brett Patterson the nine time-life priority complaints in the ber of ways, so figuring out where the patient fits Medical Priority Dispatch System™ (MPDS) medically along this continuum can challenge and has a relatively high probability of being your calltaking skills and your knowledge of the Editor’s Note: This article is updated from a a true emergency that every calltaker/dis- protocol. This article will describe how to recog- 2009 CDE with the MPDS® guidelines for deter- patcher will answer sooner rather than later. nize and handle reports of unconsciousness and mining the patient’s level of consciousness and And it’s a challenge on both ends of the will include a few related changes in the upcom- providing corresponding instructions. telephone line. ing release of MPDS version 13.0.

34 THE JOURNAL | iaedjournal.org Unconsciousness vs. fainting Unknown Problem (Person Down) to con- You must first understand the differ - tinue the interrogation (Case Entry Rule 8). ence between unconsciousness and fainting, which is a simple but important distinction. Choosing the right protocol for Unconsciousness is a persistent state, mean- unconsciousness ing the patient is still not awake while you When the caller reports medical uncon- process the call. Unconsciousness can result sciousness as the Chief Complaint during from several types of scenarios; however, this Case Entry, choosing the correct Chief Com- article will focus primarily on medical causes. plaint Protocol is generally straightforward. Fainting, called “syncope” in medical terms, In the absence of scene safety (especially haz- is a transient or fleeting state, meaning the ardous materials) and mechanism of injury patient “comes to” or wakes up rather quickly. concerns, your choice is typically between Fainting is generally less serious than uncon- Protocol 31 and Protocol 9: Cardiac or Respi- sciousness. However, fainting, near fainting, ratory Arrest/Death. or dizziness (in certain cases) may represent a The patient’s status of breathing deter- problem that requires medical evaluation. (See mines which one you choose. also Axiom 1 and the First Law of Fainting on If the patient is breathing effectively, Protocol 31: Unconscious/Fainting (Near).) you should go to Protocol 31. If the patient is not breathing effectively, you use Protocol The “conscious” and “breathing” questions 9, which will most likely result in an ECHO On Case Entry, also called “the primary response sent directly from Case Entry. interrogation,” you aren’t yet concerned Notice, however, that an ECHO Determi- about whether the patient has a decreased nant Code is also available on Protocol 31. level of consciousness or difficulty breathing. This is available for unconscious patients You want to find out if the patient is awake who meet INEFFECTIVE BREATHING at all and/or breathing at all so you can select criteria, but who are obviously alive from the appropriate Chief Complaint Protocol the caller’s description. In these cases, Proto- and begin a more detailed interrogation. col 9 is not appropriate, and Protocol 31 pro- MPDS® At this point, you need the caller to give v12.2, NAE-std. © 1979–2013 PDC. vides an appropriate response and fast track you a simple yes or no. That’s why Case to PAIs for this critically ill class of patients Entry Question 5 is worded as “Is s/he awake The AGONAL BREATHING Detec - who have a high likelihood of eventual car- (conscious)?” because the word “awake” is tor is also an important tool that can be diac arrest. commonly understood and solicits a clear used to monitor and evaluate the patient’s and decisive answer. If for some reason the breathing if the caller’s report of breathing Dizziness with a fall caller does not understand “Is s/he awake?” is questionable. Sometimes the caller may report that the you should then use the designated clarifier However, you should understand that patient felt dizzy or fainted and then fell. In and ask “Is s/he conscious?” you are not required to use the AGONAL this scenario, you might wonder whether Obtaining a clear answer is also necessary BREATHING Detector when the caller you should choose Protocol 31 to handle the with the next Case Entry Question: “Is s/he expresses UNCERTAIN BREATHING or fainting or Protocol 17: Falls to handle the breathing?” Breathing may be difficult for INEFFECTIVE BREATHING in an uncon- fall. A Rule on both Protocol 17 and Protocol callers to initially determine in unconscious scious patient (Case Entry Rule 3 in v13.0). 31 provides guidance on choosing the cor- patients; however, this information is neces- In fact, using this tool when it is unneces - rect Chief Complaint Protocol: “Ground- sary for you to send the correct response and sary only delays the treatment of a possible level falls caused by fainting, near fainting, provide appropriate Pre-Arrival Instructions cardiac arrest (an ECHO response) and the or dizziness should be handled on Protocol (PAIs) for the patient. delivery of critical Pre-Arrival Instructions. 31.” Additionally, Protocol 17 will shunt you For this reason, several descriptions that To put it quite simply, use the AGONAL to Protocol 31 if a medical cause of the fall is qualify as INEFFECTIVE BREATHING are BREATHING Detector when you are discovered during Key Questioning. listed on Case Entry for clear recognition. unsure, not when the caller is unsure. And Why go to Protocol 31 for this kind of Also, in MPDS v13.0 a new definition for never hesitate to start compressions. It’s far incident? The reason is because fainting, UNCERTAIN BREATHING has been added: better to start compressions on a patient who near fainting, and dizziness can indicate “A situation where a 2nd party caller is uncer- does not need them than to delay compres- underlying heart problems that can be the tain, unsure, indefinite, or ambiguous when sions for a patient who does. first and perhaps only sign of a heart attack asked if an unconscious patient is breathing.” In most cases, you are required to clearly or other serious heart problem requiring As indicated by Axiom 1 on Case Entry, determine the patient’s status of conscious- ALS care. if a 2nd party caller (who can actually observe ness and breathing before moving on from Although you might consider going the patient) is uncertain if the patient is Case Entry; however, if you are speaking to Protocol 17, there are usually no signifi - actually breathing, you should consider with a 3rd party caller who cannot go to the cant mechanism of injury concerns with a the patient to be NOT BREATHING until patient to personally verify his or her status, ground-level fall. In this case, the potential proven otherwise. you are directed to proceed to Protocol 32: for heart problems is more serious than the

THE JOURNAL | November/December 2013 35 this may not be initially observed or clearly reported by the caller. Sometimes the caller does not even notice Sometimes the caller does not the patient’s change in consciousness until you ask “Is s/he completely alert (respond- even notice the patient’s change ing appropriately)?” during Key Question interrogation. That’s why this Key Question in consciousness until you ask “Is is asked on the majority of the Chief Com- plaint Protocols in the MPDS. s/he completely alert (responding Changes in the patient’s level of con - sciousness can also be difficult for the caller appropriately)?”during Key to describe. Sometimes the patient seems to be between “fully alert” and “not at all alert.” Question interrogation. Because of this frequent caller confusion, obtaining a clear answer to “Is s/he com - pletely alert (responding appropriately)?” is especially important on this protocol. ground-level fall, and the Chief Complaint preceding it: “(Initially unconscious) Is s/he Determinant Code 26-C-1 “ALTERED is truly the fainting or dizziness, rather than still unconscious?” The alertness Key Ques- LEVEL OF CONSCIOUSNESS” and the the fall. tion is intended to determine if a conscious associated definition help the EMD identify patient has experienced any decrease in level patients who may be having a serious prob- Potential heart problems of consciousness to help you correctly triage lem even though the caller answers “yes” to Patients with fainting/near fainting or patients on Protocol 31. the alert question. This code should be used who have experienced dizziness prior to a Take special note of the clarifier. If the when any caller description indicates an ground-level fall must be carefully evalu - caller does not understand “Is s /he com- altered level of consciousness but the caller ated to determine if they are experiencing pletely alert?” you should then ask, “Is s/he still reports the patient to be “alert.” While a potential cardiac emergency. Protocol 31 responding appropriately?” As explained in the term “alert” is well understood by medi- offers Determinant Descriptors to classify Axiom 3 on Protocol 31, a responsible EMD cal professionals, it is not always understood patients in various levels of risk consider - can clarify this question in additional ways if in the same context by laypersons. ing cardiac history, age, changing color, and there is any trouble getting a useable answer If you’re dealing with a patient whose other indications of potential heart prob- from the caller (e.g., “able to talk normally,” normal state is not completely awake, lems, which gives agencies flexibility with “with it,” “making sense,” etc.). another Rule on Protocol 26 provides guid- response options. ance: “Patients who are normally not com- For these patients, the most critical fac- Dizziness without a fall pletely awake should be considered alert in tor is to distinguish between the patient Dizziness (a lay term for vertigo) by itself the dispatch environment.” These patients who has become fully alert and the patient is not likely to be a pre-hospital emergency are not alert due to chronic problems who remains unconscious or is not alert. The unless it has caused the patient to fall down, rather than acute problems that can be life unconscious or not alert patient will receive indicating a potential heart problem. In the threatening. a DELTA-level response while the fully alert absence of a ground-level fall or any identifi- In summary, your evaluation of a patient may receive a CHARLIE- or ALPHA- able priority symptom (abnormal breathing, patient’s level of consciousness ensures an level response. Just as important as your chest pain, decreased level of consciousness, appropriate response for patients who may response determination is your treatment or SEVERE hemorrhage), dizziness/vertigo be experiencing critical, time-sensitive emer- determination. Notice that unconscious is handled on Protocol 26: Sick Person (Spe- gencies. A decrease in level of consciousness patients or not alert patients with INEFFEC- cific Diagnosis) as an ALPHA-level NON- can be a sign of shock, which involves a lack TIVE BREATHING are linked directly to PRIORITY complaint (26-A-2). of perfusion in the brain. Just as impor - ABC-1. This is to ensure that they are breath- However, be aware that you must clearly tant to your identification of these signs ing effectively. If they are not, CPR is started. address the patient’s level of consciousness and symptoms is the treatment it prompts. If they are, their unprotected airways are while using Protocol 26 even when the caller Unconscious patients are not able to main- maintained and constantly monitored because seems to be reporting a straightforward “sick tain an adequate airway and are at serious of the serious risk of aspiration of vomit and person” call. Case review and outcome data risk of aspiration of gastric contents into the airway obstruction caused by uncontrolled have shown that a significant number of lungs and/or a blocked airway due to uncon- positioning of the head and neck. patients have been triaged as ALPHA using trolled positioning. An important Rule on Determining a conscious patient’s “alert- Protocol 26 when, in fact, it was clear upon Protocol 31 reinforces the DLS links to PAIs ness” on Protocol 31 depends upon the caller’s call review that an altered level of conscious- for unconscious patients: “The airway of response to Key Question 3: “(Conscious) Is ness was evident. These patients may be an unconscious patient must be constantly s/he completely alert (responding appropri- experiencing insulin shock, stroke, or a num- maintained.” Your vigilance in the evaluation, ately)?” This Key Question has a different ber of other critical problems. The only sign treatment, and monitoring of these patients, purpose from the consciousness question these patients may have of the need for ALS through compliant use of the MPDS, can lit- on Case Entry or even the Key Question care is an altered level of consciousness, but erally be lifesaving. g

36 THE JOURNAL | iaedjournal.org YOU MUST BE MEDICAL CERTIFIED TO TAKE THIS QUIZ. CDE Quiz Mail-In Answer Sheet CDE-Quiz Medical Answer the test questions on this form. (A photocopied answer Answers to the CDE quiz are found in the article “Are You Completely Alert?,” which starts on page 34. sheet is acceptable, but your answers must be original.) Take this quiz for 1.0 CDE unit. WE WILL NOT PROCESS ALTERED SIZES.

1. Which of the following best describes the difference between unconsciousness and fainting? A CDE acknowledgement will be sent to you. (You must answer 8 of the 10 questions correctly to receive credit.) a. Unconsciousness is a persistent state; fainting is a transient state. b. Fainting is a persistent state; unconsciousness is a transient state. Clip and mail your completed answer sheet along with the $5 USD (must be U.S. currency) NON-REFUNDABLE 2. The purpose of Case Entry Question 5 “Is s/he awake (conscious)?” is to determine: processing fee to: a. if the patient is awake at all so you can select the correct Chief Complaint Protocol. The International Academies of Emergency Dispatch b. if the patient is in cardiac arrest. 110 South Regent Street, Suite 800 c. if the scene is safe for responders. Salt Lake City, UT 84111 USA d. if you should use the Aspirin Diagnostic and Instructions Tool. Attn: CDE Processing (800) 960-6236 US; (801) 359-6916 Intl. 3. Version 13.0 provides a new definition for which one of the following terms related to breathing in the Please retain your CDE acknowledgement unconscious patient? for future reference. a. INEFFECTIVE BREATHING b. AGONAL BREATHING Name ______c. UNCERTAIN BREATHING d. NOT BREATHING Organization______

4. As indicated by Axiom 1 on Case Entry, if a 2nd party caller (who can actually observe the patient) is uncertain Address______if the patient is actually breathing, you should consider the patient to be: a. NOT BREATHING until proven otherwise. City ______St./Prov.______b. a good candidate for the AGONAL BREATHING Detector. c. alert. Country ______ZIP______d. in a transient state. Academy Cert. #______5. You should use the AGONAL BREATHING Detector when you are unsure, not when the caller is unsure. a. true Daytime Phone ( )______b. false E-mail ______6. If the caller reports that the unconscious patient is breathing effectively, you should go to: a. Protocol 9: Cardiac or Respiratory Arrest/Death. PRIMARY FUNCTION b. Protocol 26: Sick Person (Specific Diagnosis). c. Protocol 31: Unconscious/Fainting (Near). Public Safety Dispatcher (check all that apply) d. Protocol 32: Unknown Problem (Person Down). _____Medical _____Fire _____Police

7. Ground-level falls caused by fainting, near fainting, or dizziness should be handled on: Paramedic/EMT/Firefighter a. Protocol 12: Convulsions/Seizures. Comm. Center Supervisor/Manager b. Protocol 17: Falls. c. Protocol 31: Unconscious/Fainting (Near). Training/QI Coordinator d. Protocol 32: Unknown Problem (Person Down). Instructor Comm. Center Director/Chief 8. Unconscious or not alert patients with fainting/near fainting or who have experienced dizziness prior to a ground-level fall will receive a(n): Medical Director a. ECHO-level response. Commercial Vendor/Consultant b. DELTA-level response. c. CHARLIE- or ALPHA-level response. Other

9. The lay term for vertigo is: ANSWER SHEET G MEDICAL a. conscious. November/December 2013 Journal “Are You Completely Alert?” b. alert. Please mark your answers in the appropriate box below. c. dizziness. d. syncope. 1. o A o B

10. Patients who are normally not completely awake should be considered alert in the dispatch environment. 2. o A o B o C o D a. true 3. o A o B o C o D b. false 4. o A o B o C o D 5. o A o B 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 9. o A o B o C o D

To be considered for CDE credit, this answer sheet must be received no later than 12/31/14. A passing score is worth 1.0 CDE unit toward fulfillment of 10. o A o B the Academy’s CDE requirements. Please mark your responses on the answer sheet located at right and mail it in with your processing fee to receive credit. Please retain your CDE letter for future reference. Expires 12/31/14

THE JOURNAL | November/December 2013 37 g FIRECDE The Firetrap Fire calls can get tricky in a hurry

ence, 100 were killed, 230 were injured, and trampled to death as the crowd of more than James Thalman and Jordan Sebresos 132 escaped unharmed. Most of the fatalities 500 people rushed away from sudden danger. were caused by smoke inhalation. Television footage of the incident showed The evening’s headliner rock band—Jack Adding mayhem to the incident, investiga- shirtless firefighters using sledge hammers Russell’s Great White—had barely cracked the tors were shocked to find out that the night- and axes to knock down an exterior wall to first chord at 11:07 p.m. on Feb. 20, 2003. Less club officials were not yet aware that security create an exit. Emergency dispatchers have than nine minutes later, The Station nightclub staff had blocked some emergency exits. since concluded that the combination of in West Warwick, R.I., was engulfed in flames. On Jan. 27, 2013, history repeated itself intensely dark smoke and the fast pace of the fire overwhelmed emergency responders. A club fire on Dec. 4, 1971, involving another rock ’n’ roll show was less deadly but was made legendary in the Deep Purple song Smoke on the Water. The lyrics tell the true story of the entertainment complex of the Montreux Casino in Switzerland going up in flames during a Frank Zappa and The Mothers of Invention concert. An audience member fired an emergency flare gun into the rattan-covered ceiling, i.e., “some stupid with a flare gun,” as the lyrics put it. The blaze burned down the entire complex, built in 1881. There were only a few injuries and no fatalities. Its billowing smoke spreading out over nearby Lake Geneva inspired the song that has kept the fire going in memory for more than 42 years.

Structural fire statistics Although residential structure fires outnumber nonresidential building fires, the potential number of victims escalates depending on factors that include the event, the building’s capacity (and actual atten - dance), access to emergency exits, and the origin of the fire (e. g., vehicle storage area or main venue). According to the Nonresidential Building Fires (2009–2011) report released by the U.S. Fire Administration1: • An estimated 86,500 nonresidential building fires are reported annually to United States fire departments, resulting in an estimated 85 deaths, 1,325 injuries, and $2.6 billion in property losses per year. An hour later, it had become the world’s with a vengeance when at least 200 people • Cooking is the leading cause of nonresi- fourth-deadliest nightclub fire. The first of a were killed in a nightclub fire at 2:30 a.m. dential building fires (29%); however, slew of fireworks brought in by the band to in the southern Brazil city of Santa Maria. most nonresidential building cooking add some visual dazzle to the reunion perfor- Once again, pyrotechnics and a confined fires are small, confined fires (97%). mance ignited flammable sound insulation space with an inadequate number of exits • Outside/special properties account for foam inside the walls and ceiling surround- contributed to the fatalities. The two main the highest percentage of nonresidential ing the stage. Of the 462 people in the audi- causes of death were asphyxiation and being building fires (21%), while storage build-

38 THE JOURNAL | iaedjournal.org hesitation. Unfortunately, part of handling to Case Entry to address building fire inci- these situations is recognizing that people dents involving prevention of escape. These aren’t always able to escape in time. How - situations are clearly very dire and require ever, the EFD’s role may have a crucial and early response initiation. even lifesaving impact in relaying the right When using this Determinant Code, the information, sending the right response, and EFD must indicate a suffix for the type of considering the immediate needs of the caller building/structure involved as this is crucial by providing lifesaving instructions. for sending the appropriate rescue resources The new version of the Fire Priority to the incident. Dispatch System™ (FPDS®)–version 6.0–has This new ECHO determinant allows the streamlined the caller interrogation process EFD to provide Post-Dispatch Instruction to send a more informed response and pro- (PDI)-a, initially bypass the Key Question vide lifesaving instructions earlier in the interrogation, and follow the DLS Link to pro- caller interrogation process. A few of these vide PAIs on B-1 “Trapped in building fire (1st impactful changes are described in this arti- party)” earlier than ever before. These instruc- 86,500 cle in relation to structure fires. tions have also been slightly modified to ask for nonresidential building information that will help responders locate ﬁres annually Caller Danger - Not Trapped the trapped person(s) quickly upon arrival: 85 In v6.0 of the FPDS a new “Caller Danger “Exactly where are you located?” and “What is deaths - Not Trapped” instruction was added to the the best entrance of the building to get to you?” Case Entry Protocol. This Pre-Arrival Instruc- As a result of these v6.0 changes, indi - 1,325 tion (PAI) is already on Panel B-2, but it has viduals trapped in a structure/building fire injuries been modified slightly and added on Case receive both a more immediate response and Entry for easier and earlier provision. instructions earlier to attempt to limit smoke ings account for the highest percentage of Though PAIs have not typically been pro- inhalation and make themselves known to nonresidential building fire deaths (29%). vided on Case Entry, this change resulted from responders trying to locate them. • Nonresidential building fires occur most a surprising number of cases where callers had In addition to this new ECHO determinant, frequently between 3 p.m. and 6 p.m. the ability to leave a dangerous situation (e.g., a the following list describes some of the other burning building or the site of a carbon mon- key changes to Protocol 69: Structure Fire. • Nonconfined nonresidential building oxide leak) but had not yet done so. • The new Key Question 5: “Where exactly fires most often start in vehicle storage Much of the data on these incidents has areas (9%). is the fire?” has been added to Protocol 69 been anecdotal but has revealed a need to to provide helpful location information • 56% of nonconfined nonresidential build- address these situations early in the protocol. for responders. ing fires extend beyond the room of ori- Just like other safety instructions, the new gin; the leading causes of these larger “Caller Danger - Not Trapped” Case Entry • Another new determinant, 69-D-11 fires are unintentional or careless actions PAI is designed to get the caller to safety as “Building/Structure over water,” was (19%), intentional actions (13%), and elec- soon as possible. added to allow agencies to differenti - trical malfunctions (12%). The calltakers will have to be aware of this ate the type of response or resources for new instruction and how to use it correctly. these incidents. • Misuse of material or product (32%) is For whatever reason, these callers have not yet the leading contributing factor in the • Four new suffixes were added: I, J, K, and left the dangerous situation, but they might ignition category of nonconfined non- F. The new I and J suffixes allow depart- just need someone to tell them to get out. residential building fires. ments to differentiate their responses and Calltakers must be sure to promptly resource allocation according to the pres- • Smoke alarms are not present in 52% of continue with the rest of the caller interro- ence of injuries. The new K and F suffixes the larger, nonconfined fires in occupied gation once they’ve given the “Caller danger were added to handle common first-party nonresidential buildings. not trapped” instruction. The goal is to get reports of LIGHT smoke and burned food. the caller out of danger without delaying the These new suffixes will help fire depart- Dispatcher’s duty response any further. ments better customize their responses. g Each of these nightclub fires illustrates If the caller is not able to stay on the line the need for an immediate pre-planned after leaving the area, the calltaker should Sources response. People trapped in a fire are dealing process the call based on the information 1 The Station Nightclub Fire; Wikipedia; http://en.wikipedia. with both life-threatening smoke and toxins obtained before the call terminated. org/wiki/The_Station_nightclub_fire; updated Sept. 28, 2013 (accessed Oct. 7, 2013) and, in cases of large gatherings, the added 2 Smoke on the Water; Wikipedia; http://en.wikipedia.org/ Trapped in building fire danger of panicked crowds stampeding for wiki/Smoke_on_the_Water; updated Sept. 2, 2013 (accessed the exits. Beyond these elements, fires can Though ideally it is best for a first-party Oct. 7, 2013) grow unbelievably fast and, at times, may caller to leave the premises of a building/ 3 U.S. Fire Administration, Statistical Reports: Nonresidential even lead to spontaneous combustion. structure fire, this may not be possible for all Structure Fires (2009-2011); http://www.usfa.fema.gov/ The dispatcher must be well prepared callers. In v6.0, a new ECHO determinant, statistics/reports/nonresidential_structures.shtm updated to handle every type of situation without 69-E-2 “Trapped in building fire,” was added June 13, 2013 (accessed September 24, 2013)

THE JOURNAL | November/December 2013 39 YOU MUST BE FIRE CERTIFIED TO TAKE THIS QUIZ. CDE Quiz Mail-In Answer Sheet CDE-Quiz Fire Answer the test questions on this form. (A photocopied answer Answers to the CDE quiz are found in the article “The Firetrap,” which starts on page 38. sheet is acceptable, but your answers must be original.) Take this quiz for 1.0 CDE unit. WE WILL NOT PROCESS ALTERED SIZES.

1. What is the leading cause of nonresidential building fires? A CDE acknowledgement will be sent to you. (You must answer 8 of the 10 questions correctly to receive credit.) a. non-extinguished cigarettes b. cooking Clip and mail your completed answer sheet along with c. faulty outdoor lighting the $5 USD (must be U.S. currency) NON-REFUNDABLE d. shots from emergency flare guns processing fee to: The International Academies of Emergency Dispatch 2. Which type of facility accounts for the highest percentage of nonresidential building fire deaths? 110 South Regent Street, Suite 800 a. storage buildings Salt Lake City, UT 84111 USA b. outside and special properties Attn: CDE Processing c. malfunctioning elevators (800) 960-6236 US; (801) 359-6916 Intl. d. stairwells Please retain your CDE acknowledgement for future reference. 3. The new version 6.0 of the Fire Priority Dispatch System (FPDS) has streamlined the caller interrogation process to send a more informed response and: Name ______a. get the caller off the phone as soon as possible. b. handle the text messages (regarding the same incident) coming into the center. Organization______c. provide lifesaving instructions earlier in the caller interrogation process. d. alert EFDs that they might be receiving similar calls. Address______

4. In v6.0 of the FPDS, a new “Caller Danger – Not Trapped” instruction was added to: City ______St./Prov.______a. Key Questions. b. Determinant Descriptors. Country ______ZIP______c. Axioms. d. Case Entry Protocol. Academy Cert. #______

5. If the caller is not able to stay on the line after leaving the area, the calltaker should: Daytime Phone ( )______a. go on to the next call. b. process the call based on the information obtained before the call terminated. E-mail ______c. report that the individual is safely out of the building. d. terminate the response. PRIMARY FUNCTION 6. In version 6.0, what is the new ECHO determinant added to Case Entry to address building fire incidents Public Safety Dispatcher (check all that apply) involving prevention of escape? _____Medical _____Fire _____Police a. 67-E-1, Person on fire (outside) b. 69-E-1, Person on fire (inside) Paramedic/EMT/Firefighter c. 69-E-2, Trapped in building fire d. 72-E-1, Sinking vehicle Comm. Center Supervisor/Manager Training/QI Coordinator 7. The new Key Question 5: “Where exactly is the fire?” has been added to: Instructor a. Protocol 61: HAZMAT. b. Protocol 64: Marine/Boat Fire. Comm. Center Director/Chief c. Protocol 68: Smoke Investigation (Outside). Medical Director d. Protocol 69: Structure Fire. Commercial Vendor/Consultant 8. Which Determinant Code has been added to allow agencies to differentiate the type of response or resources Other for structure fires over water? a. 65-D-1 MUTUAL AID to incident (multiple units – HOT) b. 67-D-3 LARGE OUTSIDE fire ANSWER SHEET F FIRE c. 68-C-1 HEAVY smoke November/December 2013 Journal “The Firetrap” d. 69-D-11 Building/Structure over water Please mark your answers in the appropriate box below. 1. o A o B o C o D 9. The new I and J suffixes allow departments to: a. differentiate their responses and resource allocation according to the presence of injuries. 2. o A o B o C o D b. differentiate the type of structural fire. c. recognize the severity of the fire. 3. o A o B o C o D d. collect data on fire sources. 4. o A o B o C o D 10. The new K and F suffixes were added to handle common first-party reports of: 5. o A o B o C o D a. children playing with matches. o o o o b. high school bonfires. 6. A B C D c. LIGHT smoke and burned food. 7. o A o B o C o D d. nightclub pyrotechnics. 8. o A o B o C o D 9. o A o B o C o D

To be considered for CDE credit, this answer sheet must be received no later than 12/31/14. A passing score is worth 1.0 CDE unit toward fulfillment of 10. o A o B o C o D the Academy’s CDE requirements. Please mark your responses on the answer sheet located at right and mail it in with your processing fee to receive credit. Please retain your CDE letter for future reference. Expires 12/31/14

40 THE JOURNAL | iaedjournal.org g LAST CALL g STORK STORIES g CPR YourSpace g LASTCALL The Call That’s Hard To Make Dispatcher requests honor to give Last Call

Sgt. Johnson was on his way back to seven years and even if she hasn’t seen a face, the station following his shift. He never she can tell who it is by voice. left his car, and he never pulled out his “I’m on good terms with all the guys,” she service weapon. Although wounded, he said. “Derek was a work friend.” was able to drive away from the shooter She and Sgt. Johnson had met in person. and attempt what would be his final radio He was congenial. He liked to smile. He transmission before crashing into a tree came by VECC to meet the people helping two blocks away. Draper police officers to keep him safe on the streets. They worked and paramedics arriving on the scene, together on a street-mapping project. pulled Sgt. Johnson from the car, and pro- “He was so involved,” Whitney said. “If it vided CPR until he was airlifted to a local was a search and rescue, he’d be there. He did hospital. He never regained consciousness everything. He was awesome and wonderful and died that same morning. to work with.” The alleged shooter, a transient who She tells herself Sgt. Johnson died the lived in his car, turned the gun on himself way he would have wanted. He died the way and the person who was with him. They he had lived. He died protecting the commu- both survived. nity he served. Whitney had two requests when she Whitney was back at work for her next shift. heard the officer had died. “I like being here,” she said. “I like what I “I asked to go to the debriefing,” she said. do. I like knowing someone’s bad day might The call was never one Kris Whitney “I asked to do the Last Call.” be a little bit better because of the trust wanted to make until the day she took the Whitney started composing the final placed in us at the worst times.” radio transmission she had always dreaded. dispatch before her request was actually Sgt. Johnson was the first officer killed The voice came over the police radio just granted. She wanted to be ready—or at least in the line of duty since the Draper Police shy of 6 a.m., which was about the time Val- be ready to help the person who might be Department was created in 2003. His death ley Emergency Communications Center selected—and when she got the OK, she on Sept. 1, 2013, marks the 137 th officer in (VECC, located near Salt Lake City, Utah) talked to Sgt. Johnson’s fellow officers and Utah to be killed in the line of duty. dispatcher Whitney would normally sign off her co-workers at VECC. She attended his Whitney’s Last Call: her shift. It was a Sunday morning, and she funeral, leaving early before the other hun- “Draper 8.” Pause. was at a desk handling a channel different dreds of attendees formed the long proces- “Draper 8.” Pause. from the channel relaying a garbled message sion leading to the officer’s final resting place. “Draper Sierra 8. Sergeant Derek her co-dispatcher could not understand. She VECC Police Operations Manager Gigi Johnson.” was signaled over to help. Smith sat next to Whitney at the dispatch “We thank you for your dedication, loy- “I know their voices but I still couldn’t radio when she read the 42-second script. alty, and service to the citizens of Draper, tell who it was,” she said. “Neither of us Whitney was composed. She was profes - Utah, and the United States. You made the could. Then we heard the shots.” sional. She found it harder than she had people you served your family. You have On the other end of the transmission, thought it would be. She climbed inside the influenced many for your unending com- Draper Police Department Sgt. Derek John- dispatch bubble. passion, respect for all people, and service in son lay mortally wounded inside his police “There was nobody there but me,” Whit- many facets of law enforcement. All those SUV. He was the victim of a lone shooter who ney said. “It was my good-bye. It was what I you served will remember you. Your sacrifice had aimed a handgun at the officer when he wanted to tell him.” will never be forgotten.” steered his patrol vehicle over to approach a Whitney knows the officers. She has “Draper 8. Rest in peace.” car oddly parked on the side of the road. worked with them through dispatch for “10-42. End of watch.” g

THE JOURNAL | November/December 2013 41 g STORKSTORIES Long Time In Between Five years separate 9-1-1 deliveries

made it through the hiring process, and had plenty of hands on deck, with each is now an emergency medical dispatcher seeming to have an assigned role. The (EMD). With less than one year behind the cousin making the call relayed instructions scenes of response, she was able to do two to the new grandma, and they did not send things very few have done before her at the dad out to boil water. Johnson County E-911 Central Dispatch “He held her hand” until PAIs demanded (JoCo E-911). the use of his shoelace, Carson said. “He lost Carson helped in the delivery of a baby one to the baby.” boy and, with fellow EMD Samantha Hill, Three minutes after baby’s appearance, met the mom, dad, and baby on the very the ambulance arrived for transport. next day. Baby deliveries aren’t common for JoCo “We decided to take gifts to the hospital, E-911. Operations Manager Leigh Anne not knowing if we’d be able to meet them or Bowling said the last out-of-hospital deliv- not,” Carson said. “The parents were amaz- ery was close to five years ago, and during ing. They let us hold him.” that time the center has had its hands full Hospital staff had met the mother the with improvements, from reviving its use night before when, in the early stages of of the Medical Priority Dispatch System ™ labor, she was told to go home and return (MPDS®) to becoming its own entity in when contractions became more intense Johnson County, to building a new facility and frequent. Not long after 1 a.m., mom anticipated for opening in 2014. It also was Fifteen months ago Megan Carson was a went into active labor but it was already too updated to Next Generation 9-1-1 equipment stay-at-home mom raising her identical twin late for another dash to the delivery room. in step with a population boom brought on girls and not exactly sure what she wanted “Her cousin called and said the mom was by commuters moving to the county’s sub- to do once returning to the Johnson County crowning, and in the next three minutes the urbs, a 45-minute drive from Kansas City. (Mo.) workforce. baby was out,” said Carson, who provided More residents could even mean more But her mother knew best. Pre-Arrival Instructions (PAIs) while Hill babies for JoCo E-911, and that would be OK “I told my mom about the opening with dispatched the ambulance and EMD Michael by Carson. 9-1-1, and she convinced me to apply,” Carson Roomsburg took control of other calls com- “I did not know how much I would love said. “She figured if I could take care of twins, ing into the center. dispatch,” she said. “Everyone does an amaz- I’d have no trouble handling this job.” They weren’t the only ones in rush mode. ing job, and it’s something different happen- Carson followed her mother’s advice, Despite the makeshift facility, mom ing all the time.” g

“Storking” Up Extra pins honoring baby delivery came in handy

It was a good thing Quality Assurance bec, Canada. “These calls don’t occur that Coordinator Michel Courtois had the fore- often. Yes, we get calls for labor situations sight to order a few extra stork pins rather but most of the time the responders get than just the one to acknowledge the “great there before the baby is out.” job” dispatcher Jacynthe Sarazin did helping That was before the call Sarazin a caller through a quick delivery. answered on May 6; since then, three of the “I ordered a bunch of them and contacted extra pins have flown out of storage and the local paper,” said Courtois, of the The onto lapels during the same month. Laurentian and Lanaudière Center of Health “I have never seen anything like Jacynthe Sarazin Communication (CCS), in Blainville, Que- this,” Courtois said.

42 THE JOURNAL | iaedjournal.org Jessy Demers-Huot and Jessyca Latour

Cathie Savignac

On May 18, Jessy Demers-Huot, a dis - Latour received the most ominous call with patcher for five years, merited the second the caller reporting the baby’s arrival while The caller pin on a call that Courtois rates an 11 on a the mother was in a filled bathtub. scale of 10, with one being the easiest and 10 “She was not able to get out, and the water reported the the hardest. was not draining fast enough,” Courtois said. “The patient was yelling and swear - “The baby came out but was not breathing.” baby’s arrival ing at each contraction, and the caller was Latour provided Pre-Arrival Instructions distracted and disturbed by what was hap- and in a matter of seconds, she heard the while mother pening around her,” Courtois said. “This baby crying and her work was done. made it very difficult for [Demers-Huot] to “The caller started showing the baby to was in a filled concentrate.” the family’s other children, forgetting she Within eight minutes from when was still on the line,” Courtois said. “Everyone bathtub. Demers-Huot answered the call, the baby was doing OK when the responders arrived was out and ready to meet responders arriv- on scene soon after.” ing nearly 13 minutes later. Courtois was understandably surprised Sarazin had her hands full not only with Cathie Savignac, a dispatcher for 11 by the month’s events. the expectant mother and the friend mak- years, had much less time to make good on “I was really not expecting what May was ing the call, but, also, with the father insist- earning the third pin. The call she answered going to bring,” he said. ing that they hang up and that he drive his at 7:35 a.m. on May 24 was from a panicked The Laurentian and Lanaudière Cen - wife to the hospital. Sarazin, a dispatcher for mom who had undoubtedly hoped the ter of Health Communication (CCS) is not quite three years, was able to persuade baby would wait until her husband was the most recent addition to the 10 centers him differently, although that didn’t make home from taking their other children to operated by the Corporation of Partners the call any easier. a friend’s house. for Health Communications in Quebec. “It was difficult for [Sarazin] to get the No such luck. Mom was going solo on The 950-square-meter facility was com - information,” Courtois said. “The caller this one. pleted in 2011 and fully operational in became greatly distressed every time the “The baby arrived seven minutes from early 2012. patient had a contraction.” the start of the call, and responders got there The CCS is a non-profit organization Six minutes after the call came in, the a few minutes after,” Courtois said. “It took a created to receive, prioritize, manage, and baby’s head was crowning and visible to couple more minutes before dad was back.” dispatch 9-1-1 calls. Each center in the orga- the caller. Six minutes after that, mom was With little time to spare, Jessyca Latour nization uses the Medical Priority Dispatch handed her newborn at just about the same made it four deliveries before the end of System™ (MPDS®) and its dispatchers/call- time an ambulance pulled up to the home. May. A relative newcomer to the center, takers are certified EMDs.g

THE JOURNAL | November/December 2013 43 g CPR Direction Determinant SCA influences career choice

A chain of events spinning a normal Sat- urday into an altogether different direction helped 19-year-old Sadie Hockenberry dis- cover a potential career path. Of course, her mother, Marie Dodson, and stepdad, Dan Dodson, certainly would have preferred a jumping point far less dra- matic than the sudden cardiac arrest Sadie suffered in July. “This is not the wake-up call I would have wanted for her,” Marie Dodson said. Sadie was upstairs in her bedroom on July 27 when her mother decided to give her daughter the rundown of Saturday errands before driving away. They chatted for a few Gary Eichelberger Cumberland County Commissioner, Jimmy Brandt Dispatcher, Gary Dressler 9-1-1 QA Manager, Eric Harne Dispatcher, and Jim Hertzler Cumberland County Commissioner minutes, and Sadie mentioned she would be working that evening at her part-time job, the first to arrive at the rural home, and is returning (as of this writing). prepping a restaurant’s salad bar. Brandt said he would stay on the line until “We’re absolutely amazed that she’s back “Sadie wasn’t sure about what to do after EMS got there. Twelve minutes later, Dan home recovering,” Marie Dodson said. “If I high school,” Marie Dodson said. “This was Dodson turned Sadie’s care over to paramed- hadn’t gone upstairs to talk, if Dan hadn’t OK for now.” ics from Cumberland Goodwill EMS. Brandt been home, and if we didn’t have someone No sooner had Marie Dodson turned to cleared the line and went on to his next call. giving CPR instructions, she wouldn’t be leave when she heard a “thump” from where Marie and Dan Dodson left the room here. Everything fell into place. Everyone Sadie had been sitting up in bed. Her head while responders used a defibrillator to shock was where they were supposed to be.” had hit the bedstead. Her face was ashen and Sadie’s heart. Six minutes later, her heart was Brandt said this is the first time during his her eyes were rolling to the back of her head. beating without assistance. Her pulse was 11 years with Cumberland County 9-1-1 that Marie Dodson ran for her husband who was coming back. She was airlifted in critical con- he knew “for sure” it was a save and the first downstairs waiting to get on their way. dition to Milton S. Hershey Medical Center time he was credited for a save. Dan Dodson knows CPR. He learned the in Hershey, Pa. “You like to think you’ve helped along the technique years ago in scouting and the con- Twenty-four hours later, Sadie was sit- way, but most of the time it doesn’t happen struction company where he’s a crane operator ting up in a chair in her hospital room. She this way,” he said. “You don’t find out the out- requires CPR certification. Despite the back- was no longer hooked to a ventilator, she come or it’s too late to help by the time the ground in CPR, however, he was understand- was breathing on her own, and her heart person is found and the call to 9-1-1 is made.” ably hesitant when it came to his stepdaughter. was beating normally. She was home by the Marie Dodson said Sadie seems to be tak- “He didn’t want to accidentally injure next weekend with explicit instructions to ing it all in stride. her,” Marie Dodson said. rest for the next six weeks. “I’m more nervous than she is,” Sadie’s She called 9-1-1. “Tell that to a 19-year-old,” her mother mother said. “I was in her room, sitting at the Cumberland County (Pa.) Department said. “She can’t understand why she has to edge of her bed, and she sneezed. I jumped, of Public Safety Dispatcher II Jimmy Brandt take it easy. She feels fine and wants to get thinking something was wrong.” said Sadie’s condition went downhill fast moving again.” The emergency has put Sadie in the direc- from the moment he answered the phone Extensive heart tests haven’t revealed a tion of a career in emergency response. She call. Her lips had turned blue. She wasn’t con- reason why Sadie went into sudden cardiac has met the EMTs and paramedics involved in scious, and she had stopped breathing. There arrest. There is no family history to fall back her emergency care, and they showed her the was no pulse. He told them to take her out on since Sadie was adopted as a three-day-old equipment they used to revive her heart. Sadie of the bed and lay her on the floor. This time, baby and arrived without a family medical plans to go on a ride-along with Cumberland- Dan Dodson didn’t hesitate to provide CPR history; blood was drawn for DNA testing. Goodwill paramedics and looks forward to compressions, according to Brandt’s instruc- For safety’s sake, her physician recom - meeting Brandt and his team of co-workers in tions that he relayed to Marie Dodson. mended the pacemaker Sadie will likely the comm center. “He needed someone to get him going,” carry close to her heart for the rest of her “I always believe things happen for a rea- she said. “I was certainly frantic but he kept life. She has no obvious physical or cognitive son,” Marie Dodson said. “This could have giving her compressions.” side effects, despite an estimated 18 minutes been God’s way of telling her this is where The fire department response crew was without a heartbeat. Her short-term memory she needs to be.” g

44 THE JOURNAL | iaedjournal.org Bystander CPR Scores Bystander CPR

Cumberland County 9-1-1 Sudden cardiac arrest is not an isolated event. makes two saves According to the American Heart Association (AHA), nearly 383,000 out-of-hospital sudden cardiac arrests occur annually, and 88% of cardiac arrests occur at home. Considering the estimated 344,700 people in the U.S. that each year While effective bystander CPR provided immediately after suffer from a sudden cardiac arrest (SCA) at their homes, and the 8% who cardiac arrest can double or triple a victim’s chance of survival, actually survive, Cumberland County (Pa.) Department of Public Safety only 32% of cardiac arrest victims get CPR from a bystander. is doing a great job of improving the statistics. Less than 8% of people who suffer from cardiac arrest outside In July, with only three days between incidents, Dispatchers Eric Harne of the hospital survive. and Jimmy Brandt gave Pre-Arrival Instructions (PAIs) to callers, which And there is a difference between a heart attack and sudden resulted in the resuscitation of two patients in cardiac arrest. cardiac arrest. A sudden cardiac arrest occurs when electrical On July 23, Harne took a 9-1-1 call reporting a 50-year-old in cardiac impulses in the heart become rapid or chaotic, which cause the arrest. His story follows. Four days later, on July 27, Brandt took a 9-1-1 call heart to suddenly stop beating. A heart attack occurs when the reporting a 19-year-old female in cardiac arrest. That story is published on blood supply to part of the heart muscle is blocked. the previous page. A heart attack may cause cardiac arrest. On Aug. 8, both received Life-Saver Awards from the Cumberland County Board of Commissioners. AHA bystander recommendations1 Staff Development Manager Gary S. Dressler was deservedly proud 2010 (New): If a bystander is not trained in CPR, the of Harne and Brandt, although he’s quick to point out that the same goes bystander should provide Hands-OnlyTM (compressions-only) for everyone at the center. CPR for the adult victim who suddenly collapses, with an “They all do a great job,” he said. “It all goes to show the power of EMD emphasis to “push hard and fast” on the center of the chest, and the PAIs.” or follow the directions of the EMS dispatcher. The rescuer During the early morning hours of July 23, Harne took the call from a should continue Hands-Only CPR until an AED arrives and is woman who reported her husband might be having a seizure. Because of ready for use or EMS providers or other responders take over sounds in the background, Harne thought otherwise. care of the victim. “I could hear agonal breathing in the background,” he said. “He was in All trained lay rescuers should, at a minimum, provide chest cardiac arrest.” compressions for victims of cardiac arrest. In addition, if the Harne started CPR PAIs, drawing the caller into a focused response that trained lay rescuer is able to perform rescue breaths, compressions lowered her audible anxiety. Her husband’s pulse had returned by the time and breaths should be provided in a ratio of 30 compressions to 2 EMTs arrived on scene, and he had regained consciousness and was speaking breaths. The rescuer should continue CPR until an AED arrives prior to the ambulance reaching the hospital. and is ready for use or EMS providers take over care of the victim. The credit, Harne said, goes to the caller. “She was the one doing the heavy lifting,” he said. “We’re advice Academy position and counsel.” The following information stating the Academy’s posi - Harne said a Zen-like quality often develops from instructions relayed tion on CPR was published in the March/April 2013 issue in a calming voice to a bystander providing repetitive CPR compressions. of The Journal. The ability to focus on the moment, he said, tends to ease the stress and Mouth-to-mouth resuscitation worry accompanying the caller’s natural reaction to a medical emergency. Regarding mouth-to-mouth instructions for trauma “They’re looking to you for help and you have to remain calm for patients, this is the current standard of care—plain and simple. them,” Harne said. “You don’t want them worrying about what might The AHA recommendation states it is “reasonable” for EMDs to happen tomorrow. There’s only right now.” provide a compressions-only pathway for adult arrest victims of Since MPDS® was in place when Harne started at the center 15 years probable cardiac origin. Respiratory and traumatic origins are ago, he knows no other way to answer callers and dispatch response. But still treated with compressions and ventilations. he also said it takes more than the one person answering the phone. Additionally, the incidence of contracting an infectious “We have a team,” he said. “You’re always happy to be the person who disease through rescue breathing is extremely low. However, answers when everything works out, but it’s never only that one person.” one can respect the rescuer’s concern. We are only obligated Harne and Brandt come from non-medical backgrounds. Harne had been to offer the current standard of care instructions; rescuers in private industry looking for a change. Brandt was a mechanic at a paper are free to refuse mouth-to-mouth in such circumstances, and company and a volunteer at the local fire department; he had been interested they often do when blood is on the victim’s mouth, especially in emergency response since he was a kid. if the victim is a stranger. This is why we have a “Refused Both said they find the 9-1-1 profession satisfying, although it’s not the M-T-M” pathway. g type of job for everyone. “You have to figure out if you’re made of that kind of material, and the Sources only way to find out is by trying,” Harne said. “Some people come in and 1 Highlights of the 2010 American Heart Association: Guidelines for CPR and ECC: find it’s not for them. Dispatch is a high-stress job, and you have to accept www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ ucm_317350.pdf that. You can’t take the stress home.” g

THE JOURNAL | November/December 2013 45 g RETROSPACE Moving City Hall Progress and finances get in the way of Haleyville history

Audrey Fraizer

“I was busy and pretty much a wall - flower,” she said. “I didn’t get involved.” Taylor, however, fondly remembers the “Old Haleyville,” the place where she grew up, went to high school, raised children, and admired the city’s Christmas tree decorated for “everyone to see” in the downtown square. “It was actually more of a triangle,” she said. Over the years, Taylor said she has watched her memories torn down, one by one, and replaced by businesses she doesn’t necessarily chalk up to progress. Gone are the family-owned hardware stores, barber- shops, five-and-dimes, movie theater, and grocery stores. “The town went wet to attract more business,” she said. “But I don’t think a tattoo parlor or saloon are the types of business we wanted to come here.” Taylor said city hall is one of few vestiges of Haleyville’s past. One other is the town’s first brick commercial building, a depart - ment store that Haleyville residents Dr. Joe Teal and his wife, Judy, bought in 1999 and spent thousands to renovate. The building is registered with the Alabama Historical t’s tough fighting city hall, especially when preservation. The register does not restrict Commission (since 2004) and the National the building’s falling apart and there isn’t the rights of private property owners in the Historical Commission (since 2009). Ithe money to fix it. use, development, or sale of the property. “That’s a whole story in itself,” Taylor said. At stake is the Haleyville, Ala., city hall The building is scheduled to be demol- “He had his own struggles with city hall and where the first 9-1-1 call was made in 1968. ished by early 2014 should the city close on had to go out of town for help, but he got it.” The building, at that time less than a decade a lucrative deal to sell the property to a com- Taylor has followed Dr. Teal’s lead. The old, was in its prime. Architect Martin J. mercial developer. city hall building has state recognition, but Lide, who had his firm in Birmingham, Ala., Haleyville resident Valeria Taylor is sadly, she said, there is little time remaining was contracted for the design and, similar to inflexible in her view against the sale, and if to secure the national recognition. much of his work, its actual construction has there’s one battle she’ll fight to the finish, it’s By September’s end, Mayor Ken Sunseri received attention among mid-20th century protecting Haleyville’s claim to 9-1-1 history. and his five city council members will know preservationists. “City hall is a grand-looking place,” Taylor whether the site will be sold. A developer The Haleyville City Hall was listed in the said. “It’s the one real value to history left in this offered an amount—in excess of $1 million— Alabama Historical Commission’s Register town, and there’s the sign out front ‘Where it that far exceeds anything the city might of Landmarks and Heritage on Aug. 12, 2013. all began.’ What other town can say that?” expect from other commercial developers. Eligibility included the age of the property— Taylor, who is 73, has lived her entire life “This is a once-in-a-lifetime opportunity at least 40 years old—and its association with in the town made famous by the first 9-1-1 for us,” Sunseri said. an event of state significance. call placed in the country. She doesn’t recall The council agreed. If all goes as antici- Listing in the state register is an honorary what she was doing at the time, and she can’t pated, city offices would have six months to designation and exists to bring attention to recall much local reaction to the event. She vacate and the building would be torn down and promote the property’s historical signifi- was married with two sons and a practicing in early 2014, and its replacement would be cance and, thereby, encourage its long-term social worker for the state of Alabama. built downtown.

46 THE JOURNAL | iaedjournal.org Sunseri appreciates Taylor’s concern. He water and police departments, dispatch (the Sunseri said there’s no intention of anni- moved to Haleyville in 1974, and his father- county handles 9-1-1 calls), courts, mayor’s hilating history. The historic red phone on in-law, James Whitt, was Haleyville mayor at office, and council staff. display in city hall would stay in Haleyville the time the first-ever 9-1-1 call was placed on The room where the call was placed is the where he said it belongs. Feb. 16, 1968, by Alabama Legislature Speaker office for the magistrate, and the room where “The phone’s what’s significant and not of the House Rankin Fite from Haleyville the call was received is a storage closet. Sun- where the call was made,” he said. “We’d keep City Hall to U.S. Rep. Tom Bevill, who seri doesn’t recall people asking for tours of the phone and put it on display in the new answered in a different room at city hall. the two rooms, and there is public access in building. I don’t think the town would miss the Taylor finds irony in the history. the city hall lobby to the relics of the call— current city hall, and we’d still have the history.” “Don’t you think it’s strange that the son- phone, plaques, and a written history. The architect, who is 95 and lives in Texas in-law of the mayor who was there when it And if the sale doesn’t go through? close to his son, also an architect, said he was started wants the building torn down?” she “We lose out,” Sunseri said. “We stay here delighted to learn the first call was made in asked. “You’d think he’d be the first person and make the repairs, but we’d have to do it the building he designed. Lide hadn’t known who’d want to save it.” in stages. It would cost us hundreds of thou- that fact until Sept. 10, 2013, when his son, Sunseri says it comes down to practicality. sands of dollars we don’t have. A new roof also named Martin, talked to him about the “I understand why she wants to preserve would be $300,000 alone.” city hall building he designed and its uncer- the building,” Sunseri said. “But sometimes Building woes don’t impress Taylor, and tain future. emotion and logic don’t meet in the same place.” neither does the money the city stands to At the same time, he doesn’t find the The building turns 60 in two years, and it make if sold. She heard about the potential building architecturally significant, which is started showing its age a long time ago, Sun- sale in May at a city council meeting she not to dismiss the historical significance. seri said. The air conditioning unit, dating to attended on an unrelated matter. “It was a design that I did, that I was 1959, hasn’t kept most offices at peak com- “I thought council members were making proud of, and it may rightly have historical fort for a good decade. To replace the unit, a joke about selling city hall,” she said. “Come significance to some people in Haleyville,” he said, would take cutting a hole in the roof. to find out they were serious.” he said. “But, I personally do not regard the “The roof needs to be replaced anyway,” Taylor immediately got on a campaign architectural design of the building as hav- he said. to save city hall. Her daughter-in-law took ing historical architectural significance at a The plumbing’s bad—a drainage pipe photos that Taylor posted on a website broader societal level.” makes it impossible to reconfigure for dis- (savethehomeof911.com) targeted to stop the As far as preserving the building, Lide is ability accessibility—and the original wiring demolition. She designed T-shirts displaying non-committal. is still in use. Because of a shortage of cop - the message and circulated petitions in town “I want the people of Haleyville to decide per in the 1950s, due to World War II, alumi- and online. Taylor promoted the annual 9-1-1 how they are best served in this case,” he said. num filled the urgent requirement to find a festival honoring all police, fire, and emer- “I don’t think that the building’s architect has replacement. As often happens when there gency personnel. any relevant standing in this local matter.” is an urgent need for something, there was Dr. Teal, who has joined the fight, is a chi- Taylor has no intention of giving up. a lack of due diligence such as appropriate ropractor practicing in Georgia, and he and “Everyone wants to have one thing that’s testing by the labs of the day. his wife own land in Haleyville. He has plied always there,” she said. “If it goes away, we “We’re skeptical about the wiring,” Sun- Sunseri and city council with questions relat- lose a last connection to a place that’s been seri said. ing to the cost of repairing the city hall build- home to a lot of people.” Although Haleyville is a small town ing, taxes, and if money is uncertain, “is it Sunseri said it’s a tough situation. (pop. 4,172 in 7.4 square miles) with a pro - wise to invest in a new city hall at this time?” “You can’t please everybody,” he said. portionate number of public service offi - “Sorry to sound so negative, but in addi- “And it’s my belief and the council’s cials, Sunseri said the city hall building is tion to optimists and pessimists, there are also belief that we’re doing the best we can for overcrowded and largely obsolete for the realists,” he said. Haleyville.” g

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