Opening Game Against the San Francisco Bracelets Made Possible by the Paramedics in Giants When Sucker-Punched to the Ground Santa Clara County

Where’s Waldo? No Place Like Work Space Helmet & Bicycle S. Australia addresses A great center takes The two go together like rural routes listening to the floor fun and safety The National Academies of Emergency Dispatch September/October 2012 TheJournal JournalOf Emergency Dispatch

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g industry insider 11 | Latest news updates

g departments BestPractices 18 | FAQ The difference between trauma versus medical is not always clear-cut 19 | ACE Achievers Central Lane County, Ore., is model for how dispatching is done 21 | Navigator Rewind Mob mentality puts responders features at risk. 22 Shifting Gears OnTrack Quickly sending the RIGHT on-scene information to responding officers and updating | ™ Combine the challenges and the excitement it in real-time can help save lives. That’s what the Police Priority Dispatch System 30 | Fire CDE ® of a paramedic with the rush and freedom of does better than any other. When your team takes a 9-1-1 call using ProQA dispatch Watch out: Escalators can get you software, you can be confident that both your new and veteran dispatchers are doing it riding a motorcycle and what do you have? coming and going Well, a pretty sweet gig. RIGHT and that responding officers are receiving the information they need to protect 34 | Medical CDE themselves and the citizens around them. 26 Room With A View Tumble off bicycle can take fun | out of wind in your hair “Information is the reduction of uncertainty” Imagine that communications isn’t an YourSpace ProQA Dispatch Software—reducing uncertainty for over 30 years afterthought but the centerpiece of a multi- million-dollar public safety complex that 38 | Dispatch In Action is both a model of functionality and part 39 | Stork Stories architectural wonder. 40 | Unforgettable

800.363.9127 OnCover Austin-Travis County EMS Department 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; www.prioritydispatch.net 6,607,481; 7,106,835; 7,428,301; 7,645,234. The PPDS is protected by U.S. patent 7,436,937. FPDS patents are pending. Other U.S. and foreign patents pending. Protocol-related terminology in this text is additionally copyrighted within each of the NAED’s discipline-specific protocols. Original MPDS, FPDS, and PPDS copyrights established in September 1979, August 2000, and August 2001, respectively. Subsequent editions and supporting material copyrighted as issued. Portions of this periodical come from material previously copyrighted beginning in 1979 through the present. send the right information. at the right time. to the right people—every call. THE JOURNAL | September/October 2012 3

8.25x10.875 ProtectThemAd.indd 1 11/4/11 11:48 AM FAQ unforgettable

| | Kate Dernocoeur Kate EMD for the wrote frequently Kate from a on moving industry before an emergency as 25-year career earning services journalist, medical Western from (nonfiction) MFA her She in 2010. Michigan University Emergency Principles of co-authored as her brief stint and Dispatch Medical with a her left dispatcher of Vail Town a dispatchers. for good respect profound 40 rson Brett Patte Standards & Academics is Brett chair Council Research and associate involves training, the IAED. His role for quality curriculum, protocol standards, is research. He improvement, and of College NAED of the member a and Rules Fellows, Standards Council, in a career began Committee. Brett 1987. Prior in communications EMS IAED, the position with accepting a to in Pinellas spent 10 years working he Fla. County, 18 fire cde | standards of quality of standards | kop Kevin Pagen fire qualityand EMS both Kevin provides Americanfor and training assurance EMS LIFECOM Response’s Medical in Center Communications Fire & member ofleading a As Modesto, Calif. curriculumtasked with is their QIU, he management, and quality development, ACE. of their maintenance 9 Ronald Richard Mass., has Cambridge, from Ronald over 27 for dispatcher a fire been an active regional EFD is He years. Fire the NAED on serves and instructor of Standards. Council 30 Feature

| Police beat emergencydispatch.org | | Ryan Ford Ryan certified 9-1-1EMD is an Ryan foroperator radio and dispatcher EmergencyCounty Pinellas the Communications Center in Clearwater, atgraduate student Fla. He is also a Public Florida’s South of University the OriginallyAdministration program. inhis experience Pa., from Fleetwood, withbegan communications emergency in Philadelphia.American Red Cross the 22 Shawn Messinger Shawn consultant and a police is Shawn instructor Dispatch Police Emergency is a He Corp. Dispatch Priority for Okanogan for the deputy chief former where he Office Sheriff’s County 9-1-1 combined of a director the was this During communications center. the deployment of oversaw he time RMS countywide and new CAD a system, and 911 phone VoIP system, a and EMD of ProQA in deployments the of a commander also was Shawn EPD. team. multi-jurisdictional SWAT 8

ors THE JOURNAL

Contribut 4 The g dearreader JournalOf Emergency Dispatch National NAED JOUrnal Staff True To Their Academies of Communications | creative Director emergency dispatch Kris Christensen Berg Image 139 East South Temple, Suite 200 Managing Editor Salt Lake City, UT 84111 USA Audrey Fraizer USA/Canada toll-free (800) 960-6236 Int’l/Local: (801) 359-6916 Technical Editor Fax: (801) 359-0996 Brett A. Patterson Modesty comes www.emergencydispatch.org SENIOR EDITOR [email protected] James Thalman Assistant Editors with the job Heather Darata InterNational Cynthia Murray Academies of emergency dispatch Art director Lee Workman Audrey Fraizer, Managing Editor AUSTRALASIAN OFFICE 011-61-3-9806-1772 SENIOR Designer Chris Carr CanadIaN Office 1-514-910-1301 Graphic Designer A survey wasn’t necessary to in newspaper reporting. Make a Reeding Roberts EUROPEAN OFFICE 011-43-5337-66248 production manager satisfy a long-held belief among mistake in a daily and you’ll likely Jess Cook ITALIAN OFFICE The Journal’s editorial staff be holding the phone away from 011-39-011-1988-7151 web | multimedia manager Erwin Bernales Malaysian Office about dispatchers. your ear while the school board 011-603-2168-4798 Web Designer Jason Faga They are a modest bunch, member, mayor, council member, U.K. OFFICE 011-44-0-117-934-9732 almost to a fault. or other presumably slighted indi- Academy Staff President The proof came as a result of vidual lets loose on high volume. Boards & Councils Scott Freitag an error—and I’ll admit mine—in a Not so with this caller. She Accreditation Board Chair Associate Director | USA Brian Dale Carlynn Page story about two girls winning an was very polite and, true to form, Alliance Board Chair Associate Director | U.K. Keith Griffiths Beverley Logan award for their timely actions to asked us not to print her name to Certification Board Chair Associate Director | Australasia help their grandpa. Grandpa had keep the focus on the dispatcher. Pamela Stewart Peter Hamilton Curriculum Council Chairs Academics & Standards Associate fallen down in the house and after During a subsequent phone Victoria Maguire (Medical/EMD Board) Brett A. Patterson Mike Thompson (Fire/EFD Board) the girls went to check on the noise call, she gave me the name of Jaci Fox (Police/EPD Board) Administrator of Instructor Services Susi Marsan (ETC) Amber Kiker they heard, they did as grandma the dispatcher and I asked her if Research Council Chair Communications Director Brett A. Patterson Kris Christensen Berg had taught them. They called 9-1-1. the dispatcher—Heather Baker— Standards Council Chairs Director of european operations Marie Leroux (Medical/EMD) Tudy Benson Grandpa was transported to would be interested in setting the Gary Galasso (Fire/EFD) Tamra Wiggins (Police/EPD) international liaIson the hospital and the girls worked record straight. I asked her. I was Amelia Clawson MemberSHIP SERVICES manager on arts and crafts with a respond- not told. The story resulting from Arabella VanBeuge ing officer while waiting for their our interview is in the Your Space mom and grandma to arrive. section of this edition. College OF Fellows Thera Bradshaw (CA) (Emeritus) Geoff Cady (CA) Chair Steven M. Carlo (NY) The girls received an award Heather was happy to tell Marc Gay (Emeritus) Jeff Clawson, MD (UT) Australasia | South America Phil Coco (CT) from 9-1-1 for Kids during the her side of the story, meaning Frank Archer, MD (Australia) Brian Dale (UT) Andrew K. Bacon, MD (Australia) Chip Darius, MA (CT) Closing Luncheon of Navigator. the plight of the two girls as seen Peter Lockie (New Zealand) Kate Dernocoeur (MI) Peter Pilon (Australia) Norm Dinerman, MD (ME) The dispatcher answering the from her end of the line. It wasn’t Patricia J. Dukes, MICT (HI) Canada James V. Dunford, MD (CA) Drew Burgwin (Br. Columbia) Marc Eckstein, MD (CA) call was also welcomed on stage much different from how we Claude Desrosiers (Québec) John Flores (CA) Douglas Eyolfson, MD (Manitoba) Scott Freitag (UT) and together they—the girls, described the incident, except Martin Friedberg, MD (Ontario) Gary Galasso (CA) Marie Leroux, RN (Québec) (Emeritus) Keith Griffiths (CA) grandpa, dispatcher, and award for the part about which agency Mark Gay, (Québec) (Emeritus) Jeffrey R. Grunow, MSN (UT) Paul Morck (Alberta) Darren Judd (UT) sponsors—posed for a photo later handled the call. She wasn’t upset Wayne Smith, MD (Québec) Alexander Kuehl, MD, MPH (NY) (Emeritus) James Lake (SC) published along with the story about the mistake, and she wasn’t Europe James Lanier (FL) Andre Baumann (Germany) Bill Leonard (AZ) in the magazine. The picture hung up on the “me” omission Gianluca Ghiselli, MD (Italy) Stephen L’Heureux (NH) Jean-marc Labourey, MD (France) Victoria A. Maguire (MI) Jan de Nooij, MD (Netherlands) Sheila Malone (IN) focuses on the two girls. (her name being left out in the Gwyn Pritchard (Cyprus) (Emeritus) Susi Marsan (GA) Bernhard Segall, MD (Austria) Robert L. Martin (DC) When writing the story, I original article). In fact, she didn’t Gernot Vergeiner (Austria) Dave Massengale (CA) Christine Wägli (Switzerland) Jim Meeks, PA-C (UT) accidentally attributed the call to seem to care about that stuff. United Kingdom | Ireland Shawna Mistretta (CO) Trevor Baldwin (England) Gene Moffitt (UT) an agency that neither answered “It’s nice when 9-1-1 gets recog- Michael Delaney (Ireland) Jerry L. Overton (CA) Conrad Fivaz, MD (England) Eric Parry, ENP (TX) the call nor sent response. The nized for the good things,” she said. Louise Ganley (England) Rick W. Patrick (PA) James Gummett (England) Brett A. Patterson (FL) truth of the error arrived over “And it’s really nice when it’s your Chris Hartley-Sharpe (England) Paul E. Pepe, MD, MPH (TX) Andy Heward (England) Ross Rutschman (OR) (Emeritus) Stuart Ide (England) Joe Ryan, MD (NV) my phone several days after the center that receives the attention.” Peter Keating (Ireland) Doug Smith-Lee (WA) Ray Lunt (England) Tom Somers (CA) magazine was mailed. I was out Then she laughed. Andy Newton (England) (Emeritus) Paul Stiegler, MD (WI) John D. Scott, MD (England) Michael Thompson (SD) of the office so the caller left a “By the way, I wasn’t com - Janette K. Turner (England) Carl C. Van Cott (NC) Sheila Q. Wheeler, MSN (CA) message asking that I clarify that pletely left out of the story,” she United States Craig Whittington (NC) Bill Auchterlonie (KS) Arthur H. Yancey, II, MD, MPH (GA) Robert Bass, MD (MD) Tina Young (CO) it was Baltimore County 9-1-1 said. “That arm behind the two Christopher W. Bradford (FL) that took the call, rather than the girls in the photo—it’s mine.” The National Journal of Emergency Dispatch is the official bimonthly publication of the National Academies of Emer- agency named in the story. And much to my chagrin, the gency Dispatch (NAED), a non-profit, standard-setting organization promoting safe and effective emergency dispatch services worldwide. Comprised of three allied academies for medical, fire, and police dispatching, the NAED supports first- The person calling—and it hand at the end of the arm is hold- responder-related research, unified protocol application, legislation for emergency call-center regulation, and strengthen- ing the emergency dispatch community through education, certification, and accreditation. wasn’t the dispatcher—was very ing the certificate she received General NAED membership, which includes a Journal subscription, is available for $19 annually, $35 for two years, or $49 for three years. Non-member subscriptions are available for $25 annually. By meeting certain requirements, certi- cordial but not the cold kind of from the same organization; her fied membership is provided for qualified individual applicants. Accredited Center of Excellence status is also available g to dispatch agencies that comply with Academy standards. © 2012 NAED. All rights reserved. cordial reminiscent of my years name appears in bold type.

THE JOURNAL | September/October 2012 5 g President’sMessage Oh! Marvelous Me Boss’ Day isn’t about employee praise Scott Freitag, NAED President

uite honestly, Boss’ Day on Oct. 16 has I believe it was about teamwork. alism isn’t something we can always put into always been a bit confusing to me. From what I’ve learned, a boss looks for practice. Nothing is easier to fail than trying Q It’s a day dedicated to the one per- the same qualities in his employees as the to achieve perfection. son an employee might rather avoid on a reg- employees want in a boss. It’s a reciprocal ular basis, depending on the situation. Maybe deal. Most might say they like their boss and Lesson from the master the day’s project won’t come in on deadline. the boss his employees for reasons such as I like the description Chicago Tribune Maybe spending lunch together is not the integrity, clarity, honesty, sticking up for a fel- business writer Mary Schmich provided in employee’s idea of a good time. Maybe the low worker, and passion about what they’re her article about good bosses (Oct. 15, 2010), boss isn’t so interested in step- which can be applied to good ping out with subordinates. employees: [The boss] understands Plain and simple, Boss’ that power is fleeting and borrowed, Day can be an imposition for a fancy suit on loan. He doesn’t for- employees and the boss on an get that his real power comes not otherwise pleasant October from the realms above him but from day. The safest option might the rank-and-file, and the rank-and- mean following avoidance file trust his leadership. A good boss tactics: keep head down, eyes shares a view his employees embrace averted, and pretend the day and work together to achieve. doesn’t exist, at least on your The “he” is used generically. calendar. I think a lot of it has to do with the day’s expecta- View from the top tions. What is the message? Schmich’s take reminds me of Does a boss expect praise? the many lessons I learned as a kid Should staff be obligated to from a favorite author, Dr. Seuss. give it? Is this one way to win While some of his work was for favor with the person in the the sake of having fun, many of the presiding position? stories contain messages that can hit us right over the head. Remember How did this happen? Yertle the Turtle and Other Stories? A State Farm Insurance Though it contains three short sto- employee in Deerfield, Ill., regis- ries, it is mostly known for its first tered the holiday in 1958 with story, “Yertle the Turtle,” in which the United States Chamber Yertle (Oh! Marvelous Me), king of Commerce. Patricia Bays of the pond, stacks his subjects to Haroski wanted a day to show appreciation to doing. While skills are certainly important, build a throne that reaches higher than the her boss and other bosses, anticipating that set- the fit keeps the ship afloat. moon. The burp of the bottom turtle forces ting aside a day was a good thing to do. It obvi- A good boss sets the example and builds Yertle to fall into the mud, ending his rule. ously hit a chord since the day has been around confidence levels. Nobody is better than the I’ve always looked at the book as a for more than half a century. next guy; we all have something valuable to reminder in keeping perspective. No one is But what was her true motive? Maybe, offer. Good employees look to the boss for better than the next guy, no matter where she was the boss. Maybe, she was self- leadership and don’t undermine motives and they sit in the hierarchy, which doesn’t employed. Maybe, she wanted to create a direction; after all, that’s the reason that per- mean we can exist without our leaders. It team? In other words, was her point to thank son is boss. They’re not trying to climb over does mean, however, that we can have lunch the boss for keeping us employed, or are we one another to win favor and the prize in their with our boss on Oct. 16 without feeling it’s a thanking the boss for putting together a eye isn’t who gets the job once the boss retires. move to stack the deck in anyone’s favor. No team that makes it worthwhile to spend the The qualities may sound simple enough flattery necessary, although don’t expect the day away from home? unless you take human nature into play. Ide- boss to pick up the check. g

6 THE JOURNAL | emergencydispatch.org g askdoc Who Comes First? Order of resuscitation when mom and fetus suffer cardiac arrest Jeff Clawson, M.D.

Dr. Clawson: We have all but completed a review of most of our processes and policies. Within a previous draft the following was included: In the event that both mother and child suffer cardiac arrest prior to the arrival of the ambulance crew, Pre-Arrival Instructions (PAIs) must be relayed in the first instance to the newborn baby before the mother. Could you point me in the direction of any evidence base for this, if it remains a current recommendation? I have been through Chapter 8 of Principles of EMD and was not able to locate this directive. It may have been a locally-defined decision. Many thanks, Helen Rees Senior Nurse Practice & Service Development NHS Direct Wales potentially life-threatening defects, might Onward through the ethical fog. . . Welsh Ambulance Services NHS Trust warrant resuscitation of the mother. Dr. Clawson Helen: My suggestion is to develop an internal Brett: I have forwarded your question to Brett Pat- policy that considers various scenarios, but I am Wow, what a nightmare scenario to even terson, IAED Academies and Standards associate still going to defer to Dr. Clawson on this one. consider. I can’t really think of anything you and Research Council chair, for his clarification. Brett A. Patterson left out. The problem depends on what caused Dr. Clawson IAED Academics & Standards Associate mom to arrest and the gestational age/condi- Helen: Chair, Council of Research tion of the baby. That would determine who I have done a few ethical searches on this Helen: you resuscitated first. Is the baby a 30-week topic but there isn’t much available since I think Brett has covered the waterfront preemie that doesn’t have a high chance in healthcare providers generally have enough well on this by listing the variables that the field with a mom who is having a SVT staff to attempt resuscitation on both patients. might make either the mother or the baby arrhythmia-type of issue and just needs to be Most of the ethical literature is about when the best candidate for resuscitation. Another converted? Did mom get shot in the chest and to take the baby (crash C-section) or when to aspect to throw in, and there are many, is if spontaneously delivered a healthy baby at 39 discontinue life support for the mother. the mother bled out from a uterine tear, weeks? We had a baby in our unit whose par- However, in my opinion, one point is etc., and the baby is suffering a respiratory- ents got in a car accident on the way to the hos- clear—there are too many potential factors caused arrest—in this case the baby would pital. Mom didn’t put on her seatbelt because it to make a blanket statement, i.e., gestation come first, as the mother would likely be was too annoying while she was laboring. Mom of fetus, health of fetus, cause of maternal irretrievable outside of a hospital. was mostly brain dead on arrival and the baby arrest, time since maternal arrest, time since I don’t recall us (in Principles of EMD did fine after just a few days in intensive care. I delivery, etc. Different situations warrant textbook or at the Academy) ever taking just don’t know how to qualify this in an e-mail. different approaches. For example, trau - a position on this. This center must have This is definitely a “sit around the table with the matic arrest of the mother associated with made this one up locally. For the father, high risk team and talk about it” issue. head trauma and delivery of full-term fetus who could likely be the caller, this would Sorry not to be more help on this one. might suggest working the baby, while an be unbelievably hard to witness, much less, Robin Ayers unknown cause of maternal arrest, with handle. Really a “Bad Day at Blackrock” as Chair, High Risk Delivery Standards delivery of premature fetus with known we used to say. Committee g

THE JOURNAL | September/October 2012 7 g Policebeat Entertain The Initiative Contributions come from all levels Shawn Messinger

In my travels around the United States The reluctance to take action, or present ment called 9-1-1 using a TTY machine. No teaching Emergency Police Dispatch™ (EPD™) ideas, not only keeps people from engaging one at the center during the time of the call classes it never fails to amaze me how so many in their jobs, but it also robs the agency of could remember how the system worked telecommunications professionals feel that potentially valuable contributions. Some- and the instructions had been long mis - they have no influence on the environment times, it takes someone who is not at the top placed; the most senior calltaker on shift in which they work. Either directly with com- to recognize an opportunity or a better way couldn’t remember a single other TTY call ments or indirectly by their attitudes, they of doing things. The view from where dis - in the past 10 years. Dispatcher professionals, take the position of no control. They believe patchers sit provides a perspective unique to as we know, are resourceful. They like to help that nothing they do or say will change the management’s position. Good ideas shouldn’t people. The dispatchers on duty worked as daily routine in the communications center be left to fade into oblivion. a team, pooled their knowledge, and figured or their profession as a whole. Take this case, for example. out how to help the caller. Rather than addressing an issue, dispatch- During a recent EPD certification course The problem had been solved, at least for ers toss it aside, suggesting: “that’s just how we discussed the lack of a policy for testing the moment. things are here,” or “it’s always been this way,” the TTY system, which became an issue I asked if they had since put a TTY policy or my least favorite, “I’m just a dispatcher.” when an individual with a hearing impair- in place and whether they had updated others at the center about how it worked. Their answer was “no” and they made comments to the effect that they did not believe the “bosses” would get around to it. I suggested they try “leading from the bottom,” which is a way nonsupervisory people could foster positive change within the communications center. I asked if anyone had tested the TTY system despite the lack of a policy and if policy for testing and use had been drafted for a supervisor to review. The answer to both questions was “no.” I encouraged them to “lead from the bottom” and to test the TTY system as a general part of their work routine and to develop a sample policy. My suggestion was certainly not in support of insubordination or a dis- regard for the chain of command, but I do believe that waiting for “someone” to make a difference is the same as waiting for “no one.” Consider the importance of action in this case. Dispatchers offer a public service that makes a difference in the communities they serve. If the TTY fails to work, the public service falls short of the agency’s honored com- mitment and the community’s expectations. As the iconoclastic Donald H. McGannon said—“Leadership is an action, not a position,” —it’s up to the individual to make the difference. Leadership can come from any level in an organization, even the bottom. How can you lead from the bottom? g

8 THE JOURNAL | emergencydispatch.org g standardsOfQuality Get What You Can Continuing education is something to celebrate Kevin Pagenkop, ENP

uring a recent Internet surfing ses- the requirements for every sion, a newspaper article from Kan- Merit Badge available—132 Dsas caught my eye¹. The featured in total³. That’s more than six story involved a Boy Scout who had recently times what was required. received the prestige of successfully com- After reading this article, pleting the requirements to attain the rank I was left with a couple of of Eagle Scout, the Boy Scouts of America’s thoughts: What level of ser- highest advancement rank. Only 5% of Boy vice could we provide our Scouts ever complete the requirements callers if we applied more to become Eagle Scouts, but of those who than six times the effort accomplish this achievement, a large percent- required? What if we just age of them continue their service into adult- marginally exceeded the mini- hood as astronauts, career military officers, or mum requirements of our politicians². What made this specific story so jobs? What if “good” could be appealing was not just that the young man replaced by “great”? featured, Curry McWilliams, became an Certification and accrual Eagle Scout, but it was the manner in which of continuing education unit he completed the difficult requirements. hours is often regarded as For those not familiar with the Boy nothing more than the manda- Scouts of America, education is accrued tory application of effort simply to maintain highest level of professionalism from others? through the receipt of Merit Badges. The the means to receive a paycheck. This is often We need to hold everyone to that same ideal. subjects are learned through classes, self- more prevalent the further we advance in our Curry McWilliams is not an emergency study, or apprenticeship instruction. Once careers and begin to get cynical, frustrated, or telecommunicator and comparing the diffi- the applicable skills are successfully dem- burned-out. What once was new and exciting cult jobs we do each shift to a Boy Scout may onstrated or the required tasks completed becomes routine or boring. How does that strike some as insulting, but this young man (some of which take months to complete), then relate to the quality of service we are completed the training and earned Merit the Scout is presented with a small, circular providing? Do we find ourselves simply going Badges for Communications, Emergency patch that can then be sewn to a sash worn through the motions and working to meet the Preparedness, Fire Safety, First Aid, Lifesav- with his uniform. While the number of minimum requirements or standards? ing, Medicine, Public Health, Radio, Safety, patches worn is certainly a point of pride, Continuing education should be viewed and Traffic Safety. In fact, examining the Boy these patches are a physical representa - like Merit Badges and not simply a required Scouts of America in totality, the most often tion of the knowledge gained and correlate amount of training hours that we procrasti- earned Merit Badge since 1910 has been First to the number of years an individual has nate accruing. There are a variety of topics Aid, with almost 7 million Scouts completing been a Scout. Merit Badges are offered for and venues that range from improving exist- the requirements to wear the badge.² Perhaps a variety of subjects and are not necessarily ing skills, gaining new skills, or simply general these similarities are proof that when indi- specific to camping or the outdoors (sub - interest or entertainment. Taking the time viduals accept the responsibility to provide jects most associated with the Boy Scouts and making the effort to self-improve should service to their community, whether it’s as of America). There are badges for business, be celebrated. We may not sew our course a Boy Scout or as a Public Safety Dispatcher, architecture, computers, electronics, graphic certificates to our uniforms but we should “good” shouldn’t be “good enough.” g arts, welding, and chemistry, to name a few. work to create a culture where education is To rise to the rank of Eagle Scout requires valued. Whether or not the completion of ¹ “Scout grabs elite goal: all 132 merit badges”, Kansas City Star, June 17, 2012, Dawn Bormann the successful completion of 21 Merit Badges.³ additional education is undertaken toward Curry McWilliams’ amazing accomplishment career advancement or simply as an oppor- http://www.kansascity.com/2012/06/17/3663154/leaven- worth-teen-earns-all-132.html was that after he had earned the required 21 tunity to improve the quality of service pro- badges, he continued his self-education and vided, we should encourage one another to ² The Boys Scouts of America on-line, http://scouting.org did not stop taking classes and learning new continually apply ourselves and work toward ³ The Boy Scout Handbook, 12th Edition, the Boy Scouts of subjects until he had successfully completed mastering our trades. Don’t we expect the America

THE JOURNAL | September/October 2012 9

IndustryInsider Fundraisers contribute to raisers have surpassed $500,000 in donations in funds for AMR’s field paramedic’s care following to a college trust fund for Stow’s two children training officer. The Cali- tragic assault and to pay for his ongoing care. fornia Emergency Nurses AMR in California has raised thousands of Association (ENA) named For information Nearly 18 months ago, Paramedic Bryan dollars during several large-scale events held its scholarship after Stow to about how you can help, go to Stow made headlines when a violent assault over the past year, including a barbecue Santa provide a paramedic with www.support4 put him on the other side of emergency assis- Cruz AMR hosted one week after the attack an educational opportunity bryanstow.com tance. The then 42-year-old EMT with Santa that brought in $127,000. AMR communica- in nursing. Cruz AMR was leaving Dodger Stadium in tions centers have pitched in, collecting dona- Stow had been a paramedic going on six Los Angeles, Calif., following the March 31, tions at fundraisers and selling Bryan Stow years when the attack occurred. 2011, opening game against the San Francisco Bracelets made possible by the paramedics in Giants when sucker-punched to the ground Santa Clara County. NENA conference focuses by two fans from the opposing team. Hospital- “The dispatchers the bracelets in copious on future of 9-1-1 system ized in critical condition and suffering a trau- amounts, spreading support for Bryan across matic brain injury, he is now making progress the Bay Area and into the valley,” said AMR From the National Emergency Number although it is expected Stow will need lifetime Client Services Manager Jennifer Ceynowa. Association (NENA) assistance. “The fans are great and many know right away More than 750,000 calls are placed to The attack and Stow’s rehabilitation con- where the money is going.” 9-1-1 emergency services across the United tinues to draw national attention. In June Other events and private donations States and Canada every day, and thousands 2012, there was enough evidence presented in through several sponsoring organizations and of lives are impacted. But many local call court to bring two suspects to trial and fund- a website dedicated to Stow continue to bring centers are stretched to the limit by advances

career launch Program provides jump start for careers in dispatch and role-playing using 9-1-1 simulators. When they turn age 18, they can apply for dispatch programs at centers anywhere in the state. Blanke predicts a bright future for the certified students. “Telecommunication is a growing field with lots of opportunities, and the pro - gram gives them a good starting point for a career in law enforcement and public safety,” he said. “They can get a job right out of high school and since it’s shift work, go to college at the same time if that’s what they want to do.” Since 1990, New Jersey public safety telecommunicators are required to complete a Eleven law enforcement high school stu- Flemington. He retired in 2003 after nearly 40-hour basic communications course for dents attending Hunterdon County Poly- 30 years with the Somerville, N.J., Police certification through the state’s Office of tech Career Academy (N.J.) got a jump on Department to start the program and added Emergency Telecommunications Services. dispatch careers with certification through the ETC course in 2008 once he certified as Telecommunicators responsible for EMD the NAED’s™ Emergency Telecommunica- a NAED instructor. Blanke certified as an must also complete an eight-hour CPR cer- tor™ Course (ETC™). EMD while with the police force, although tification and a 32-hour EMD course. All Ret. Sgt. Larry Blanke is the sole instruc- he did not work in communications. telecommunicators in secondary PSAPs tak- tor for Law Enforcement and Criminal Inves- Blanke lectures the students in law ing calls or dispatching EMS are required to tigation at the career and technical school in enforcement and provides hands-on training maintain EMD and CPR certifications.g

THE JOURNAL | September/October 2012 11 in technology, heavy call volume, human lations of 50,001 earn 1 heartbeat for each 95 corridor, an area that covers one-third of resource and training issues, and inconsistent CPR training session and once reaching 90 the state’s population and two-thirds of the or inadequate funding. heartbeats (equivalent to 90 sessions) qualify state’s critical infrastructure, will be fully To address these and related issues, nearly for the same designation. operational by the end of 2012. The second 2,000 9-1-1 professionals and government phase will add Eastern Shore agencies, and leaders gathered June 9-14 at NENA 2012, the the entire project is expected to be com - National Emergency Number Association’s plete in 2016. Annual Conference & Expo in Long Beach, The Kent County Office of Emergency Ser- Calif. The conference featured general sessions vices uses the Police, Fire, and Medical Protocols. on issues facing 9-1-1, education and training sessions, networking opportunities, and an Emergency alert system exhibit hall showcasing products and services. provides another reason A California Issues Forum focused on to use a cell phone issues such as the Next Generation and Enhanced 9-1-1 projects being carried out in Starting June 18, the nation’s emergency many California counties; funding require- alert system started sending automatic alerts ments; progress in reducing wait times; and via cell phone about life-threatening weather, rural 9-1-1 challenges. national emergencies, and child abductions. “The nation’s 9-1-1 call centers provide The service is free and no sign up is nec- lifesaving service to all Americans,” said The program endorses the four critical essary; the system operates via cell tower NENA CEO Brian Fontes. “But they’re in steps in the American Heart Association’s and instantly reaches all phones within a need of more help. Our annual conference “chain of survival”: Early access to emergency tower’s reception area. The phone, which gives 9-1-1 decision makers and industry lead- care, Early CPR, Early defibrillation, and Early must be turned on to receive the alert, ers a chance to share information and tackle advance care. Maine Emergency Medical Ser- sounds the alarm and vibrates, even if it’s challenges ranging from next-generation vices, Maine Cardiovascular Health Program, been turned to mute. Users can opt out of technologies, to enhanced training for call and the Maine Center for Disease Control takers, to transparency and accountability in and Prevention started the program five years 9-1-1 funding.” ago and since then the HeartSafe designation has been awarded to 58 Emergency Medical HeartSafe designation Services, covering more than 266 cities with a puts communities in combined population of 838,799. survival mode The NAED™ EMD system has been used in Maine PSAPs since 2007, and the state is Neighborhood Watch programs around now looking at a comprehensive implemen- the country might keep your area safer from tation plan to include EFD and EPD systems. crime but what about a program in Maine Telecommunicators in every PSAP have been that could help members of your community trained in MPDS®, and most have recertified the Amber Alerts and weather messages, survive following a heart attack or stroke? at least once. but not national emergencies. And all you have to do is save up heart- The messages sent by the alert are limited beats to qualify. Project allows emergency to 90 characters and describe the emergency The program, called HeartSafe Com - staff statewide to and suggest action. munity, recognizes Emergency Medical Ser- communicate quickly Depending on reception, the cell phone vices throughout Maine that help improve automatically accounts for a change in the outcomes through community education, A new $349 million statewide interop- user’s location. If the user is driving and availability of CPR training and Automatic erable police radio system, called Maryland enters a county with an active weather warn- External Defibrillators (AEDs), pre-arrival FIRST, will allow government agencies from ing, the phone sounds the alarm, even if the emergency medical instructions provided by police to public works to communicate warning was issued before the driver crossed dispatchers, and advanced cardiac monitor- during large-scale emergencies like terrorist the county line. ing capabilities. Points (heartbeats) are given attacks and natural disasters, and help in situ- Of the 600 cell phone carriers in the based on several criteria (CPR training, AED ations like long-distance police chases, when nation, about 100—including all major carri- availability, ALS dispatch); the population size officers previously might have lost radio con- ers—have told the federal government they divided into six categories dictates the num- tact, according to an article posted on Mary- will broadcast the alert. ber of heartbeats required for the designation. land community news online. The alerts are being generated through a For example, service zone Category I with The Maryland Transportation Author- partnership of FEMA, the Federal Commu- populations of up to 2,500 residents earn five ity, Maryland State Police, and Kent nications Commission, the National Weather heartbeats for each CPR training session and County Office of Emergency Services are Service and cell phone carriers. According to once reaching 40 heartbeats (equivalent connected to Maryland FIRST now. The officials, the alert does not replace traditional to eight sessions) qualify for the Heartsafe entire first phase, which will provide cover- sources for emergency information, but is designation; service zone Category VI popu- age in central Maryland and the Interstate intended only to act as a bell ringer.

12 THE JOURNAL | emergencydispatch.org The system is years in the making and • Participation is voluntary by cell phone post to operate during floods, toxic spills, mass- there are limitations: carriers casualty incidents, and other events demand- • Transmission of the alert depends on the • The alert won’t interrupt phone calls ing tri-county services. quality of the cell tower signal; areas with There would be no cost to Essex County, poor reception could curtail the message and according to preliminary talks, Clinton Book mobile could take County would insure and maintain the vehicle, • Alerts are done by county; some people exit to emergency route and Franklin County would convert it to the will receive warnings about threats that aren’t imminent for them A move that probably upset rural book- worms in the Clinton-Essex-Franklin counties (New York) Library System might just benefit in a way that makes up for the loss of the recently shelved bookmobile. The regional library system recently shelved the book mobile owing to hefty operational costs and instead of retiring the vehicle, command center, installing multiple-agency offered it to the same three counties for use radios, a conference table, and a satellite phone. as a mobile communications and command It might be possible to install existing surplus

Stressed out New study links 9-1-1 dispatchers to post-traumatic stress disorders

A study by researchers at Northern Illinois Psychology Professor Michelle Lilly, accord- ers from 24 states. The majority of the sample University (NIU) suggests that the on-the-job, ing to a NIU Today news release. Lilly said the was female and Caucasian, with an average age indirect exposure to trauma puts dispatchers findings published in theJournal of Traumatic of 38 and more than 11 years of service. at risk for developing symptoms of post-trau- Stress could contribute to enhanced preven- The dispatchers participating in the survey matic stress disorder (PTSD). In other words, tion and intervention efforts. were asked about the types of potentially trau- it doesn’t take being there to feel the pressure. Lilly conducted the study with her former matic calls they handle and the amount of emo- “The NIU study suggests that one does student, NIU research associate Heather Pierce, tional distress they experienced. They were also not need to be physically present during a who worked for more than a decade as an emer- asked to rate the types of calls that caused the traumatic event, or to even know the victim gency dispatcher in Chicago’s western suburbs. most distress and to remember the worst call of a trauma, in order for the event to cause For their study, the researchers analyzed the they had dealt with during their careers. significant mental health challenges,” said NIU responses of 171 on-the-job emergency dispatch- The most commonly identified worst calls were the unexpected injury or death of a child (16.4% of respondents), followed by suicidal callers (12.9%), shootings involving officers (9.9%), and calls involving the unexpected death of an adult (9.9%). Survey results showed that dispatch - ers experience high levels of “peritraumatic distress,” the strong emotions felt during a traumatic event. Participants reported experi- encing fear, helplessness, or horror in reaction to nearly one-third of the different types of potentially traumatic calls. A “moderate relation- ship” was found between Video available at www.niutoday. the dispatchers’ emotional info/2012/03/29/ response and PTSD symp- niu-psychology- study-links-9-1- tom severity, with 3.5% of 1-dispatchers- the survey participants with-post- reporting symptoms severe traumatic- stress-disorder- enough to qualify for a diag- symptoms/ nosis of PTSD. g

THE JOURNAL | September/October 2012 13 equipment, and generate additional funds spring, Gold Cross donated an ambulance to Scammers impersonate through grant application. Long-term plans for the program in an effort to assist students in 9-1-1 dispatchers maintenance include Department of Home- gaining practical experience in giving pre- land Security grants or in-kind services. hospital care to patients while inside the In the world of 9-1-1 and related phone back of a moving ambulance. scams, crooks and prison inmates are target- Future looks bright Gold Cross Ambulance President Mike ing homes and leaving residents with the bill. Moffitt noted the importance of students Crooks are targeting homes for pos - An aging population is working in favor of learning EMS skills with the latest equip - sible burglary by posing as 9-1-1 dispatchers careers in dispatch. According to the 2012/2013 ment, which will result in students receiving responding to emergency calls. According to Occupational Outlook Handbook, published the most comprehensive training needed to the way the scam works, residents receive by the U.S. Bureau of Labor Statistics, job open- make a seamless transition into the para - calls in the middle of the night from a sup- ings for police, fire, and ambulance dispatch are medic and EMT professions. posed 9-1-1 center asking about the numer- expected to grow by 12% from 2010 to 2020 “As an ambulance service provider, we end partly because of an older population “likely to up employing the paramedics and EMTs that mean more emergency calls; and, therefore, a are trained (at Dixie State), so it is in our best need for more dispatchers.” interest to make sure that they have the proper In rough numbers: Jobs 2010: 100,100; equipment to train with,” Moffitt said. “We look Employment Change 2010-2020: 11,700. In at this as a partnership with Dixie State College, 2010, the median pay was $35,370/year or and as they identify needs that they may have about $17/hour. for equipment and other devices, we will keep Occupations also looking good in the our eyes out for what we have in our system decade to come include registered nurses that we can retire and give a second life to.” (711,900 new jobs projected), retail sales (706,800 new jobs), postsecondary teachers CPR/AED awareness (305,700 new jobs), cashiers (250,200 new contests inspire action ous calls placed from the home. Once jobs), and receptionists (248,500 new jobs). everything is reported to be “OK,” the scam- Those on the decline include desktop pub- National CPR/AED Awareness Week— mer moves on to a list of questions, such as: lishers (15% decline), floral designers (9% June 1 through June 7—may have passed you How many people live in your home? Are decline), and air traffic controllers and food by this year, but the contests sponsored by you home alone now? Is there a security sys- service managers (3% decline). The highest the Sudden Cardiac Arrest (SCA) Founda- tem? If so, what company services it? paying jobs (more than $150,000/year) tion might leave you with enough inspira- Apparently, the scammer hopes that peo- include oral and maxillofacial surgeons, tion to enter next year’s event. ple awakened this way will be too groggy to orthodontists, dentists, and chief executives. The first contest, the People Saving realize that they haven’t called 9-1-1. People Awards, honored “ordinary” people The second in a seems-to-be-growing series Ambulance service donates who helped save the lives of SCA victims of “slammer scammer” telephone schemes cardiac monitors to college to increase awareness about the bystander hinges on fraudulent activation of a common EMS program assistance in sudden cardiac emergencies. feature on home telephone lines, call forward- Winning entries are posted on the SCA sur- ing. In previous “slammer scammer” telephone The donation of four portable cardiac vivor story page and the first place winner schemes, inmates called people at home and monitors by Gold Cross Ambulance in Salt received an AED. feigned an emergency to get them to push *72 Lake City, Utah, to Dixie State College’s (St. For the second contest, the SCA Founda- or other codes to turn on call forwarding to George, Utah) Emergency Medical Services tion partnered with the Citizen CPR Foun- a buddy’s number. The new ploy goes unno- program is the second significant donation dation (CCPRF) to choose the top video ticed until the phone bill arrives. in as many years that Gold Cross Ambu - helping to raise awareness about SCA, CPR, Investigators believe that the second lance has made to DSC’s EMS program. Last and AEDs. A panel of reviewers from both slammer scam starts with an accomplice out- organizations evaluated videos based on side the prison searching phone directories creativity, production quality, and overall for multiple numbers belonging to the same impact. After the conference, the top videos person. The accomplice then calls these num- were posted on the CCPRF website, the SCA bers, seeking fax or computer tones. website, the SCA Foundation Facebook page, The accomplice activates the number’s and the YouTube Channel. An AED was pre- call-forwarding feature to direct all calls to sented to the first place winner. a third number. The call is automatically The video contest is held twice a year. forwarded to the third number, where the According to the American Heart Asso- buddy answers and accepts the call. They ciation (AHA), less than 8% of the people talk as long as they want with the bill going who suffer sudden cardiac arrest outside to the registered line holder. In South Florida, of a hospital survive. For every minute that victims have included a federal judge and an defibrillation is delayed, the survival rate architect who designed one of the prisons drops 6–10%. from which the scam was originating. g

14 THE JOURNAL | emergencydispatch.org INTERNATIONAL NEWS Dutch 112 system transitioning to AMPDS

The Dutch emergency phone number mainland Europe to become a certified EMD matter of best practices.” system (112 ) will be looking and sounding and ED-Q™ and is responsible for introduc- Justice Minister Ivo Opstelten said con- different in the years to come. ing AMPDS in The Netherlands Society of solidation would actually improve quality. Fourteen of the Netherland’s 24 112 emer- Medical Directors Ambulance care and the The justice ministry intends to create a gency control centers will disappear in the next Dutch Healthcare System. single emergency control organization to five years as the result of a 50-million-euro bud- But like everything else, he said, imple- ensure that everybody immediately knows get cut and will coincide with the 10 regional mentation takes advocacy, honesty, and the who is responsible for the coordination of forces under the Regional Homeland Security ability to work well within the culture. emergency services. Organization. A majority of those in operation For example, no one in the Netherlands This should lead to improved coopera- following the consolidation will be answering accepts facts hands down. tion and a faster delivery of the right kind emergency calls using the Advanced Medical “We are a consensus society,” he said. of assistance at the right location. Priority Dispatch System™ (AMPDS™). “Nothing happens without complete discus- The Joint Dispatch Center of the Hol - sion of the facts presented.” Digital age pushes change lands-Midden region in Leiden was the Dr. Nooij, who has served on the Interna- to South Australia rural first public safety region to go live with tional Academies’ College of Fellows since address system the AMPDS in May 2011. The center serves 2009, anticipates a day when all calls in the 780,000 people and receives an average of 125 Netherlands will be triaged using AMPDS For dispatchers at SA Ambulance Service’s urgent calls a day for medical help. —a prediction that isn’t too far off consider- emergency operations center, it’s not only Jan de Nooij, M.D., medical director, ing the six other regions that have followed what’s in a property number but, also, how Regionale Ambulance service and Dispatch the lead of Hollands-Midden: Amsterdam- the number will make emergency responses Center Hollands-Midden since 2000, said the Amstelland, Rotterdam-Rijnmond, Zeeland, more efficient and the patient easier to find. AMPDS was an essential part of the public Noord-Holland Noord, Brabant Noord, and Why? safety region’s journey to become a better Midden West Brabant. Many rural properties in South Australia dispatch center. “EMS is the practice of medicine and are located on unnamed roads and without Dr. Nooij was the first medical director on EMD is integral to its success,” he said. “It’s a numbers. For time eternal, rural property

THE JOURNAL | September/October 2012 15 owners have relied on local knowledge and reference points to help emergency services (and other service providers such as livestock vets) find their property. “It’s simple really,” said Craig Westlake, SA Ambulance Service, general manager—Oper- ations and Systems. “The third house on the right past the large gum tree just as you go past Joe’s corner. Not that bad.” Westlake said outsiders—those unfamiliar with the “Joe’s corner” type of directions—are amazed when they hear how the information is relayed and the ability of local response to know just right where they are going. “When you consider that we service a geographical area of about 1 million km 2— but only a population of about 1.7 million, and 99% live on the coast—you can see that we have some fairly large rural areas to cover,” he said. Locating by reference point and familiarity, however, will soon be in the past for Southern Australia compliments of the digital age. Rural property that would have been difficult or impossible to find previously without physical geographic markers can now be put in a digital format that transfers information freely and gives instant access: plot and point. The rural property addressing system initiative started in 2010 is set up to attach numbers and street names to an estimated 55,000 rural property owners who have so far done without. All occupied rural prop- rural road numbers are a clear and logical courteous manner,” according to tips avail- erties, homes, and businesses will be on a way of finding properties, benefiting every- able on the South Australian government named road with a numbered address con- one in the community.” rural addressing website. “Stress the impor- sistent with national standards for Australia The addition of numbers and road names tance of displaying the road sign to the local and New Zealand (road number, road name, hasn’t won over everybody the system will community and service providers, including locality, and postal code). Adjustments to affect. Some like it; some don’t. Those taking the emergency services.” accommodate future rural landowners are the side of the government’s project cite the Despite Westlake’s familiarity with the built into the system. safety addresses will provide, particularly if area, he welcomes the rural addressing system. The number assigned to the property an emergency service responding to a medi- “When fully operational, the addressing is based on the distance of a property’s cal, police, or fire call isn’t familiar with the system will be fantastic,” he said. “But it will entrance from the start of a road. For exam- individual’s district. Those against it worry take some time for the community to get ple, if a property entrance on the right side about the intrusion. used to actually having an address.” of the road is located 1,240 meters from the Rural property owners notoriously In a project funded last year under the start of the road, the rural road number will protective of their privacy don’t see the Digital Regions Initiative National Partner- be 124. Odd numbers are on the left, and necessity of changing something that, for ship Agreement, the SA Ambulance Service even are on the right. all practical purposes, works. Local councils will provide high-speed mobile broadband State governments and local councils have endeavored to balance their concerns to ambulances across regional, rural, and managing the plan have stressed the ease of by designing a system that identifies only remote South Australia. a numbered system compared to the confu- the property, and not the owners. The com- According to the funding agreement, sion and time-consuming frustration of find- puterized database does not require the user the project will enable paramedics to access ing a property, particularly in an emergency, to enter the property owner’s name. It oper- details of an incident and critical patient without something more tangible than look- ates by street numbers and names. data in real time and improve interagency ing for a large gum tree. For holdouts, the government suggests tact. mobilization, communication with opera- According to a state government rural “If your neighbor isn’t displaying their tional centers, as well as increase paramedic addressing system campaign-style video: road sign it is recommended that you speak safety in remote areas and while operating “In an emergency, or for everyday business, to them in the first instance in a calm and in high-risk situations. g

16 THE JOURNAL | emergencydispatch.org Your newest trauma tool isn’t in here.

Seriously injured patients rely on you to give the best medical attention and care. To do that, you need knowledge, experience and the proper tools. That’s why the Centers for Disease Control and Prevention (CDC) has released the widely endorsed Field Triage Decision Scheme: The National Trauma Triage Protocol to help EMTs and paramedics choose the best transport destination for trauma patients. Designed in partnership with other leading organizations and experts in injury care, the Decision Scheme has been published in the prestigious MMWR Report & Recommendations. It’s a valuable tool that can help your EMS system save lives.

Get a free copy of the Field Triage Decision Scheme: The National Trauma Triage Protocol, the MMWR and other free resources at www.cdc.gov/FieldTriage g fAQ g ACE g Navigator Rewind BestPractices g FAQ Trauma or Sick? Answer not always clear-cut

Brett: Thank you for your prompt response. Your answer has cleared up the controversy our center was having regarding Trauma vs. Sick or Medical. We now have a better under- standing between the two. Angela

Brett: I have a calltaker who gave flawless DLS Instructions for CPR; however, on Panel 12 (CPR Compressions), the caller hesitated. Specifically, the calltaker was on Panel 12 when the caller said, “I need to call my mom, too.” The calltaker replied, “You can do that when the paramedics arrive,” and continued flawlessly with instructions. The caller then injury complaints we sometimes receive, i.e., stated, “He’s not doing anything; he’s not By Brett A. Patterson patient was lifting something, or even standing breathing; he’s not doing nothing.” At this up out of bed, and heard a pop in the knee or point, the calltaker asked if the caller wanted Brett: hip followed by pain. In such cases, the “exter- to continue CPR, and the caller said, “No, We had a debate whether to triage an nal force” is not very apparent because it is grav- because he is not breathing. He’s not doing incident as trauma or sick, using this sce - ity, weight bearing or, in your case, movement. anything.” The calltaker replied, “We are nario as an example: A female is brushing her While using Protocol 26: Sick Person doing CPR because he is not breathing, that’s teeth. Her jaw locks up. What would your (Specific Diagnosis) to rule out priority why we are doing it. Do you want to con - recommend? symptoms would not be a bad choice in tinue CPR?” The caller answered, “Yes.” The Angela D. Thomas, EMD your scenario, it sounds more like a trau - calltaker resumed giving CPR instructions. Fulton County Emergency matic injury affecting the joints of the jaw. We are unsure how to grade these types Communications Center While this would triage out to a 30-B-1 (Trau- of comments. The calltaker did not ask if Atlanta, Ga., USA matic Injuries) because the jaw is part of the the caller wanted to perform CPR but, head, and Protocol 26 would likely come out rather, if she wanted to continue. Is this a Angela: as ALPHA if no difficulty breathing, I still critical deviation, freelance question? What As you have discovered, the difference believe Protocol 30: Traumatic Injuries (Spe- do you recommend? between what is termed “trauma” versus cific) is the best choice considering that this Melody A. BonAmi “medical” is not always clear-cut! is an actual injury. With a more severe injury Manatee County Public Safety Dispatch definitions are designed to get to the jaw, the BRAVO response is appropri- Bradenton, Fla., United States us to the right protocol; specifically, with ate because the head is involved. In this case, trauma, protocol helps us to consider impor- it is simply a slight over-triage, which the Melody: tant factors such as the mechanism of injury MPDS ® often does in the interest of erring on From your further description, it sounds and safety. On some calls, however, these the side of the patient’s safety. like the EMD had the best of intentions concerns are very minor and using a medical Brett A. Patterson but simply used the wrong words. The call- protocol is not a problem. IAED Academics & Standards Associate taker explained that CPR was being done Your scenario is a lot like other spontaneous Research Council Chair BECAUSE the patient was not breathing,

18 THE JOURNAL | emergencydispatch.org and to explain to callers not to expect imme- This is not about freelancing, since with the EMD and discussing better ways diate results is completely appropriate, i.e., enhancement was necessary in this case to handle such cases in the future, i.e., addressing the “Nothing’s working!” phe - due to the caller’s reluctance. It has more calming techniques and reassurance with- nomenon. However, this should not have to do about the content of what was said, out asking permission. been followed by the direct question, since and this is best addressed with education Brett A. Patterson it counters a primary Academy position rather than performance deductions. I rec- IAED Academics & Standards Associate about not asking the caller’s permission. ommend a review of the above principles Research Council Chair g

g ACE Getting Out Of Its Own Way Central Lane County Achieves ACE

he is not only told what to do next, he clearly believes that’s exactly what’s going to happen. The call is a watershed moment for Cen- tral Lane Communications; not only did it occur at almost the same time that the center decided to go for ACE status—which it achieved this past April officially at this year’s Navigator conference in Baltimore—it is the documented proof that the center is a model for how dispatching is done, not just in central Oregon but throughout the Northwest. “Cassie did nothing short of a phenome- nal job, as anyone who hears that call can tell,” Communications Supervisor Cynthia Alte- mus told The Journal in July. “We play that call whenever we get a chance for all kinds— public and public safety—of audiences. Every time, people will come up after—men included—and say, ‘When I have a baby, I’m calling you guys no matter what’s going on.’” Altemus takes that as the high praise that it’s intended to be. The center has set a stan-

On Stage Christy Gaston (left of award) and Cynthia Altemus (holding award) are flanked by Academy representatives as they dard of the can-do, no-matter-what first, first accept Central Lane Communications’ ACE at Navigator 2012. responders. It’s not something they say. It’s mother’s pelvic bone. The father only knows what they do, and they do communications By James Thalman this because Ezell has come to the guided for public safety agencies and cover a region of conclusion through the Medical Priority Dis- about 300,000 people in Lane County. They EUGENE, Ore.—There’s a famous 9-1-1 call patch System™ (MPDS®) post-dispatch inter- are part of a new unified rural fire department. from four years ago in which a young father rogation that the infant’s body is blocking his They handle calls—police, fire, and medical— is two levels into panic mode beholding his entrance to his life on Earth. for the twin cities of Eugene/Springfield and pain-riven wife in the midst of a breech birth By following the prompts on Protocol F: are part of discussions of a plan in the works of their son. The situation could have been Childbirth–Delivery Panel 6, Ezell knows to join the Eugene and Springfield fire depart- become infamous had it not been for the quick that after three hard contractions and still no ments. It’s such a sure thing that the fire chief’s pivot and good hands of veteran Central Lane birth she must switch to Panel 16, 17, and ulti- business card says Springfield on one side and Communications dispatcher Cassie Ezell. mately 18, all the while reassuring the father: Eugene on the other. The about-to-be dad is completely beside “I’ve done this before; listen very carefully, and The unification is made possible under a himself—a condition the dispatcher’s supervi- I’ll tell you what to do next.” new Oregon Revised Statute provision that sor and more than one listener calls “pretty The mood of the situation seems to flip allows public safety departments of similar much a basket case.” He comes all but unrav- immediately, and the change is palpable, even size or approximate regional connection eled when his new son starts to present but over the phone. The father’s demeanor turns to join forces to get the most out of public his tiny shoulder becomes lodged behind the from intense anxiety to clear-headed calm as funding. That has made for a lot of territorial

THE JOURNAL | September/October 2012 19 reconfiguring, not to mention some retool- from our police and medical agencies, mean- we worried about trying to get it, the more it ing of attitudes about who is responsible to ing they backed us and really never had a seemed to come to us. It’s like we got out of whom and for what exactly. discouraging word about our performance. our own way, and things just kind of started “It’s pretty much a day-at-a-time thing But somehow, we just didn’t quite bring the to flow and fall into place.” for us,” Altemus said. “We’re the designated energy into the right focus.” New in the mix—although mostly inter- PSAP and the generic one when people aren’t From the outside looking in, it’s no nally to the fire and rescue in the area—is the sure. If we don’t handle a jurisdiction exactly, wonder drawing the bull’s eye was kind unification of Lane County Fire District No. we know who does and will get the caller of a moving target. The center covers a 1 and Lane Rural Fire/Rescue. The official into the right hands.” region of about 270 square miles, including start date of the unified service was July 1, The 9-1-1 breech baby call isn’t just a Eugene proper, providing emergency medi- but things have been humming organization- trust-promoting illustration that Central cal dispatching in addition to routing other ally for a good year. Lane knows what to do in some big-time emergency calls for Lane Rural Fire/Rescue, Lane Fire Chief Chris Heppel said on hours of need, the incident is a metaphor— which just blended two rural fire districts KKNU-FM’s Community Forum hosted achieving ACE designation was its own kind under one administrative umbrella. by long-time journalist and public safety of difficult birth. Knowing which calls were to be handled agency advocate Tracy Berry that the com- “It was a goal of management, but and which are hand-offs is an abiding chore munications center has a lot to deal with, it wasn’t a shared goal within the cen - itself, and with fire districts and other public but fortunately the new and improved ter somehow, if that makes sense,” Alte - safety agencies taking advantage of a state fire and rescue approach has become just mus said. “I think other comm. centers revised statute to get the most out of public another part of the job at Central Lane. will know what I mean; those who have funds by joining forces, dispatching became “Continuity and consistency are part and decided to become an ACE will under - a moving target within a moving target for parcel to all aspects of emergency services,” stand anyway. It was as if the harder we the communications center. Not to mention, Heppel said. “We’ve got both in our commu- tried or the more we focused on it, the every city’s public service and safety agency nications center, no matter how agencies are more difficult it seemed to get.” has either moved into new buildings or are organized or reorganized from within.” ACE designation wasn’t just the natural about to by this fall. Altemus said the support of the responder order of things that some centers report. “Externally, let’s just say we’ve had about agencies is a huge plus. “We know it’s not that “Our level of expertise was high enough, but every challenge, and going after an ACE got way in a lot of places,” she said. “I always like to we didn’t quite have all the pieces in place,” put aside a few times the past four years,” say, partly tongue-in-cheek: “You guys do the Altemus said. “We had incredible support Altemus said. “Somehow though, the less germs and we’ll do the rest.” g

20 THE JOURNAL | emergencydispatch.org g NavigatorRewind No Bees Involved Swarming presents police officer safety issue

By Audrey Fraizer

The violence of mob actions depicted in written word and video makes you nauseous. An overwhelming feeling of dread watching the tension build pushes the more sensitive or, at least, the more street naïve observers further down in their chairs. In one scene, a mob of at least 50 angry female teenagers in New York City carry knives, blades, and guns, challenging a girl with a heart problem to come out of her house to face the consequences of a “he said, she said” quarrel, shouting, “We’re gonna punch you in the chest. We’re gonna fix your heart condition.” Two officers arriving at the scene are Shutterstock.com / Theresasc75 knocked down and “banged up” pretty badly before they’re able to call for back-up assis- trend in violence against police officers and Fire Safety, City of Edmonton Community tance. Firefighters from the nearby New York medical crews responding to scenes of mob Standards Branch, and the Alberta Gaming City Fire Department Engine Company 138 rule and reports of disorderly conduct fueled and Liquor Commission, oversees the safety blast the violent mob with their high-powered by the use of social media channels and text of the hospitality industry—bars, nightclubs, water cannon. Nine are arrested. messages to attract larger numbers to the events, and after-hours clubs—and monitors A mob of 50 to 70 people from a small incendiary situations. the impact these businesses have on their town in Saskatchewan, Canada, surround According to numbers provided at the surrounding communities. a police truck and ambulance, pelting cans, Navigator 2012 session “Swarming: An Offi- The PSCT plays multiple roles within bottles, and debris at emergency responders cer Safety Issue,” more than 60,000 police Edmonton, Ashmore said. and curse Royal Canadian Mounted Police officers worldwide are attacked each year, The team selects premises for joint (RCMP), blaming them for injuries to a par- either by lone assailants or the actions of agency attendance and inspection based on tier who crashed his ATV into a ditch dur- escalating mob disturbances at sporting a number of factors including past history ing a police drunk and disorderly pursuit. events, labor disputes, parties, and other and special events. They provide guidelines Mob members on ATVs and cars follow the gatherings triggering civil unrest. While and standards for establishments involved in ambulance to the hospital, banging on the swarming—the unexpected gathering of the sale and service of alcohol and support doors to get to the people barricaded inside. large numbers of people in particular public local strategies that help reduce crime (sur- A RCMP vehicle is set on fire and an ambu- locales—doesn’t necessarily lead to violence, veillance, reinforcement, and access control). lance is severely damaged. someone causing a disturbance within a They enforce municipal and provincial ordi- An Edmonton (Canada) police officer crowd can trigger antisocial behavior. Vio- nances, such as the Edmonton Public Places responding to a fight at the Oil City Road- lence can erupt spontaneously and grows Bylaw that regulates smoking, fighting, uri- house is punched and kicked in a “terrify - out of crowd dynamics. nating, and defecating in a public place, dan- ing” downtown swarming that leaves him “Mobs make everyone vulnerable,” said gerous actions, weapons (capable of firing bleeding and bruised; earlier that same year, Edmonton Police Service Sgt. Joan Ashmore. projectiles), bullying, and handbills. a second Edmonton police officer is beaten “People get caught up in the moment, emo- The team also protects those in the ser- unconscious by hoodlums near a high school. tions take over.” vice of protecting others, according to co- A violent mob in Alice Springs, Austra- Real and potential events like these— presenter Tracy Ward, a sergeant with more lia, throws rocks and swings logs at police assaults on police and mob violence—in than 20 years experience with the Edmonton attempting to place a “very drunk” couple Edmonton’s burgeoning entertainment dis- Police Service, with the last nine years as a into protective custody. Tasers used against trict several years ago led to the creation of calltaker and dispatcher. the crowd prove ineffective and police are the Edmonton Public Safety Compliance “The mood has changed,” she said. “Uni- forced to release the man and woman they Team (PSCT), as part of the city’s Respon - forms no longer command respect. The mob had taken into custody. sible Hospitality Edmonton (RHE) initia- mentality can be like something out of the The incidents, which occurred between tive. The multi-agency PSCT, consisting of book Lord of the Flies. Mob rule means impos- 2009 and 2012, demonstrate an alarming the Edmonton Police Service, Edmonton ing what the mob wants.” g

THE JOURNAL | September/October 2012 21 g feature | Motorcycle Paramedics

They’re the practical way to travel in heavily congested urban areas and cost less than sending an ambulance or adding another ambulance to the fleet. During the past two decades, motorcycle paramedics Shifting have proven their worth in emergency medical response in South America, Eastern and Western Europe, Australia, Asia, and Africa. Since 2000, the São Paulo (Brazil) Fire Department Gears has operated Honda motorcycle ambulances in a first responder role to offset the delay of traditional ambu - lances caused by horrific traffic congestion. Always Motorcycles bring deployed in two-man teams, the lead vehicle carries a first-aid kit and IV fluids, and the rear vehicle carries more advanced equipment such as an automated external fast response defibrillator and suction devices. By getting there before ambulances, the moto-medics (as they are called in Brazil) can triage the patients and analyze what can be done. to medical In America, motorcycle rescue units (MRUs) are picking up momentum. Miami-Dade (Fla.) Fire Rescue (MDFR) pioneered a fleet of 10 Harley Davidson motor- emergencies cycles in 2006. Others like Austin-Travis County (Texas) EMS (ATCEMS) and City of Pittsburgh (Penn.) EMS are Ryan Ford making inroads in a trend that could be taking root. The ability of the MDFR Motorcycle Emergency Response ombine the challenges and the excitement of a Team (MERT) to move through traffic reduces response paramedic with the rush and freedom of riding a time for immediate life-threatening calls to less than Cmotorcycle and what do you have? three minutes. Well, a pretty sweet gig in my opinion. So what are the odds you’ll see motorcycles added to Paramedics, especially those in urban settings, are con- your local EMS fleet soon? What role will they play in the stantly trying to find new ways to reach the patient in less Medical Priority Dispatch System™ (MPDS)?® time. Putting paramedics on motorcycles is one way that appears to be working. With drastically reduced response Austin’s pieces fall into place times, paramedics arriving on this highly mobile mode of Commander Kurt Brown and Division Chief Jason emergency transportation may make a difference when Martin led the effort to get ATCEMS on two wheels. response times matter to the survival of the patient—such They approached Austin’s Greater Area Crime Commis- as in cases of cardiac arrest and resuscitation—and provide sion (GACC) for assistance in lining up grants and dona- a highly mobile and rapid extra set of hands for back up tions for the initial fleet of motorcycles. The Austin Police to ambulance crews. Department then welcomed paramedics to train with their Their use in emergencies, however, is far from new, police motorcycle teams and even modified parts of their according to Summa Health System EMS Director (Akron, training program to be more applicable to the different Ohio) Francis Mencl, M.D., M.S., FACEP, FAAEM, in his pre- operational demands of the paramedic riders. sentation “Alternative Vehicles: Motorcycles in EMS,” given “We were lucky,” said Eric Jakubauskas, ATCEMS at the EMS Safety Summit 2012 sponsored by the Trans- Operations division chief. “It took a few years, but the portation Research Board of the National Research Council. pieces eventually fell into place.” In fact, it’s more like a revival of the life-saving strategy The first EMS motorcycle response unit—two paramed- on two wheels. ics on donated BMW G 650’s dual-purpose motorcycles Paramedic motorcycles have been around since the fully equipped with sirens, lights, and standard ALS medi- early 1900s and were commonly used during WWI. cal equipment—was deployed with great success at the

22 THE JOURNAL | emergencydispatch.org Whatever Comes Our Way The ability of motorcycle rescue teams to maneuver through traffic and monitor special events reduces response time for life-threatening incidents. THE JOURNAL | September/October 2012 23 Head Out On The Highway Whether on highway duty or at special events, motorcycle rescue units act as a force multiplier.

Austin Marathon in February 2009. In the crowds attending one event, cover great spring of 2011, ATCEMS added a highway spans of area in another, and even go off program, which focuses MRU response to road for patients that may be in more remote, accidents and any other medical emergencies inaccessible locations. along the heavily congested I-35. During highway operations, MRU teams When on highway duty, MRU teams wait are CTECC tracked with the automatic at their staging points for three hours in the vehicle locator built into each motorcycle. morning and three hours in the afternoon Motorcycles are manually placed on the call during rush hour times; the units average and dispatched in tandem with the first ambu- about five calls per shift. MRUs regularly lance due for that location. Austin’s MRUs arrive in enough time to assess the patient can downgrade incoming units although they and either downgrade incoming units or never handle the situation independently. prepare the patient for ambulance transport. “Whether used on highway duty or at Advantages special events, they act as a force multi - Advantages of motorcycle EMS include plier (to borrow a military term),” Chief mobility, speed, and the lower operating cost Jakubauskas said. “Their presence enhances of motorcycles compared to ambulances. A our current operations and provides a better motorcycle can ride the shoulder or weave in service to citizens.” between vehicles to reach a traffic crash minutes before an eight-foot wide ambulance is Heavy Metal Thunder The Austin-Travis County EMS motorcycle Dispatch application able to make its way through heavy traffic. rescue units come fully equipped with lights, Emergency motorcycle response offers The patient receives help faster. sirens, and ALS medical emergency kits. dispatch flexibility in responding to calls that Chief Jakubauskas estimates ATCEMS have a low likelihood of patient transport. motorcycle units arrive on scene to high - This makes patient triage through MPDS way incidents an average of 1 minute before an ideal tool for determining whether to dis- the ambulance. The time saved is typically patch a MRU, ambulance, or both. Motor - greater during special events like the Austin cycles are especially well-suited for many Marathon. Dr. Mencl, in his presentation at ALPHA- and OMEGA-level calls when the EMS Safety Summit, showed Australian transport is unlikely. In lieu of dispatching motorcycle EMS response times are an aver- an ambulance, a single paramedic on a motor- age 4.5 minutes below the average response cycle can assess the patient, render care, and time for an ambulance crew. According to secure a patient refusal for transport far Dr. Mencl, during the same talk, motorcycle more efficiently than an ambulance crew. response was less than three minutes for life- Motorcycle units responding to “lighter threatening calls compared to six to eight duty” also leaves ambulances available for minutes with an ambulance. more urgent calls. A study published in the American Jour- ATCEMS is dispatched through a central nal of Emergency Medicine (A method to agency, Combined Transportation and Emer- reduce response times in prehospital care: the gency Communications Center (CTECC), motorcycle experience, 1998 Nov;16(7):711-3) which classifies them as ALS units without the arrived at similar results. “During rush hours obvious transport capabilities. The paramedic [in Taipei, Taiwan, a densely populated urban the hourly operational cost of dispatching a rider has the tools, equipment, and supplies area], the response times of the BLS motor- MRU was 61% less than an ambulance (Naks- necessary to handle triage and many less severe cycle and ALS ambulance were 4.9+/-3.0 tad et al, 2009). The authors of a study pub- injuries. If transport is needed, motorcycle minutes and 6.3+/-3.4 minutes, respectively, lished in the Scandinavian Journal of Trauma, paramedics attempt to stabilize the patient in and in non-rush hours, 4.2+/-2.1 minutes and Resuscitation & Emergency Medicine (2009 anticipation of the emergency vehicle’s arrival. 5.1+/-2.5 minutes, respectively. Using motor- 17(1):9) concluded that ambulance use was At special events, CTECC notifies the cycles to transport EMTs to the emergency avoided in 23.5% of all motorcycle responses. designated commander who coordinates scene significantly reduced response time Treat and release is more likely to occur when the movement of special units reserved for compared with a standard ambulance in a the motorcycle medic responded irrespective the event (motorcycle, bicycle, ATV, ambu- congested urban setting.” of complaint, except for the elderly who are lance). The versatility of motorcycles is a Sending a MRU costs less than ambulance more likely to be transported irrespective of definite asset since they can navigate thick response. A study in Oslo, Norway, revealed response mode, according to Dr. Mencl.

24 THE JOURNAL | emergencydispatch.org must keep up with or even exceed the speed limit in the course of duty,” he said. Even so, Chief Jakubauskas stresses safety equipment and sound training as the most important elements in planning a MRU program. Motorcycle paramedics require advanced safety training and ATCEMS follows the typi- cal training regime police riders receive: 80 hours (2 weeks) of initial training followed by regular refresher courses. Austin is the first city to send a paramedic to certify as a motorcycle instructor, which eliminates the need to outsource training and allows ATCEMS to cater its training specifically to the needs of its EMS motorcycle operations.

Predictions Chief Jakubauskas estimates 10 to 12 agencies have approached him for information and ideas about how to start similar programs. He stresses the importance of networking, finding grants or donations to help cover initial costs, and making safety and training the program’s centerpiece. Over- all, he is optimistic about the future of his department’s EMS motorcycle program and believes other cities will soon follow. Whether a MRU will be coming to your town any time soon depends on three factors. The first two are climate and population density. If you’re reading this article from a dispatch center in a large southern city, your odds of see- ing MRUs implemented are much greater than, say, a small town in Maine. There’s a role for them in northern cities, but they’re limited by inclement winter weather. Areas with a larger population typically have greater problems with traffic congestion, which is where the most utility is found with a motorcycle unit. The third factor is culture. Misconceptions serious due to a broken femur. ATCEMS has A MRU program requires leadership Since responder safety is paramount in had three minor incidents and no injuries willing to risk the investment of money EMS, some skeptics may be quick to dismiss in the past three years of operations. Two and personnel. It also requires advocates motorcycles units because of perceived risks. accidents were merely scratched paint but within the department with enough clout The accident rate, however, is lower than one recorded nonetheless. to champion the program. However, as might expect. According to a 2008 report in Chief Jakubauskas attributes lower Chief Jakubauskas pointed out, it’s yet to Portugal by Kiefe & Soares-Oliveira, only 12 operating speeds to relatively minor acci - be seen if this trend will take hold in the MRU paramedics were involved in traffic accidents when they do occur. “A paramedic United States like it has internationally. dents over the course of 30 months and 3,626 will likely be operating a motorcycle If a few more cities can soon follow the calls. Each accident involved just the MRU through crowds at a special event or con - lead of Austin, Miami, and Pittsburg, others and only three paramedics were injured. Of gested traffic at a much lower speed in may indeed find their center dispatching this those three, only one injury was considered comparison to a police motorcycle unit that latest addition to the EMS fleet.g

THE JOURNAL | September/October 2012 25 g feature | Salt Lake City Public Safety Complex

High And Wide Space and floor-to-ceiling light are showcased in the new Salt Lake City Public Safety Complex 26 THE JOURNAL | emergencydispatch.org magine, if you can, a dispatching center that is nearly 8,000 square feet and the view from the console Iincludes floor-to-ceiling, 180-degree, glare-proof views of the outside world. The break area features a dispatchers-only deck. There aren’t private offices for the bosses Room because the best space is designed and used for the com- fort of the folks at the consoles. The access to the electronics is a floor below, so when things go kaput, the center can operate seamlessly without supervisors blowing a fuse. With Imagine that communications isn’t an afterthought but the centerpiece—even the showpiece—of a multi- million-dollar public safety complex that is both a model of functionality and part architectural wonder. Its structure is broad-beamed steel welded to pillars sunk 50 feet A View below double-rebar concrete, and the frame is nestled into a series of giant shock absorbers designed to absorb the worst earthquake like a car’s front wheel hitting a pothole. What makes a good And, the building is so energy efficient it leaves no carbon footprint whatsoever. In your dreams? Pie in the sky? Nope. Everything dispatch center great anyone could think of that any dispatcher could want is included in the new Salt Lake City Public Safety Complex, James Thalman which, when it opens in the spring of 2013, will go by the ten-code moniker “10-19” as its location. They don’t want to brag about it, but the architect and becue beef under a steel skeleton stairway. “It seems the public safety facilities managers involved with its con- so simple. Yet, most 9-1-1 centers fail in providing the cept, design, and construction simply can’t help it. They’re basics such as environmental control, glare, ergonomics, as proud as new papas and came close to handing out cigars and noise. Sheesh!” at the steel topping ceremony this past July. McClaren points out that his company’s surveys and As the ceremonial final steel girder was hoisted into those by several communications centers show that mov- place on July 13, perhaps the biggest smile in the crowd ing people into a better workplace environment dramati- of city dignitaries and the group of bustling steelworkers cally reduces turnover. Give dispatchers room, a view, and momentarily milling on the ground floor was found under as much control over their own spaces and replacement James L. McClaren’s hardhat. McClaren is the principal rates drop from 30% annually to almost zero, he said. architect of the complex and is the M of MWL (McClaren, “We spent a lot of time watching dispatchers at work, and Wilson & Lawrie, Inc.) of Phoenix, Ariz. for people who are the key factors in the course of lessening “This is a center by which all other emergency com - the severity of a situation to outright saving lives through munications operations will be measured,” McClaren said what they communicate, we listened,” McClaren said. as the 1,500-pound piece of steel rose to the southwest They also heard what dispatchers didn’t say—rubbing corner of the complex where it was ceremoniously bolted their necks constantly, rubbing their elbows, shifting their into place atop the four-story structure. His statement was weight in chairs. “They were caught in an ergonomic hell, more matter-of-fact than boasting; his company has a pedi- tethered to their own space, often literally. Dispatchers gree of public safety projects that ranges from huge FBI need to be separate with their own space to move and to data centers to county PSAPs, but this is the one he talks decompress after a high-stress incident that has taken total about everywhere he goes. concentration to handle,” he said. “In a way, they need to be “As design professionals, the least we can do is treat able to climb into their own cocoon and stay there.” dispatchers with respect, while creating environments The dispatching center couldn’t be described in any that are humane,” McClaren said over a lunch of bar - terms as closed off or cocoon-like in appearance, but

THE JOURNAL | September/October 2012 27 The Centerpiece The third-floor dispatching center is shown here both aspects are there and attended to in just above the white solar panels over the entryway. their way, building planners said.

Eloquent, not elegant Basically, if it has anything to do with emergency dispatching, it’s been factored into the structure and array of services on the building’s third-floor plan that included a series of often marathon-length meetings. Salt Lake City Police Sgt. Scott Teer - link, head of departmental facilities man - agement, along with Deputy Chief Tim Doubt, department logistics bureau manager, have been at it full time for more than three years, putting every necessity and operational amenity into the $125 million building, from determining the best use of the 172,000 square feet on the interior to the four floors—two above ground and one below 143,000 square feet of secure parking. The single motivating principle of the entire structure, the element that makes it both eloquent and elegant, is the capacity to communicate and work together in times of crisis, McClaren said. “Communication is what it’s all about in any emergency, and too often the crisis is manifolded by lack of interaction among the responding agencies at the command center level. This addresses that abiding knot in the system by just getting rid of it altogether.” The idea is to have everybody work together but not interrupt each other, Teer- link told The Journal during a guided tour of the building’s third floor emergency operations center. “The walls that both literally and figuratively separate communications in the [existing] cramped building retract for big emergencies in the new complex. Those in the command center and all personnel having anything to do with communications, whether internal at the command center or externally to provide updates to the public Sgt. Scott Teerlink through the news media, are in a few seconds literally working together.” “We drew the line at what functions best,” what each agency needs a kind of moving and most say. That’s how it should be because Doubt said. “There were elements we had to target within a moving target. they’re the ones who are at the stations, at the cut back and amenities that could have been To avoid that double conundrum, Doubt consoles day in and day out.” nicer, but as far as the form meeting the func- said, “We used exactly the opposite tactic to And they were more than willing to say tion of dispatchers and what they do, this is as what is the normal approach in building new what’s what, McClaren said, noting that in good as it gets. We keep reviewing and look- space—at the first and regularly along the way, the dispatching portion of the third floor, ing for things we have missed, but so far, we we met with employees and not with the space for supervisors and private meetings haven’t come across anything.” bosses. We had input from the supervisors are located at the center of the operation, not Public safety is a particularly nettlesome but often simply told them, ‘No, you can’t around the outside, which is customary for building process because departments tend have that corner for an office,’ or ‘No, you an agency in most public buildings. to reorganize and organize again constantly, can’t have your own printer.’ The employees “This is no minor achievement, and I’m McClaren said. That makes pegging exactly do the work, so they’ve had the most input quite sure it will contribute to the flow of

28 THE JOURNAL | emergencydispatch.org like the one we just finished in Buffalo, That’s a problem, not just in volume, he N.Y., this will not be just the emergency added. “I was just in a meeting with a dozen response center. It can monitor everything public safety personnel and there wasn’t one from purse snatching to a commuter-aggra- laptop in the room; it was all e-pad devices,” vating pothole.” he said. “The public we serve can’t wait to The big picture, along with views from buy the next new device, but they are prac- the dispatching “crow’s nest” of the flagship tically obsolete the moment you buy them. building, includes a stunning element that no That’s a difficult reality for folks trying to get public safety complex should be without: a the most public service and safety out of a floor-to-ceiling JumboTron-type video board single centralized location.” in the center of the third floor that displays But that’s also all the more reason to have the in real time picture-in-picture exactly what’s flow of emergency information coming into a happening out there. A communications single clearinghouse-type center, he added. supervisor or individual dispatcher with a particularly difficult situation—a fire at a refinery A zero-sum building or a crime scene in which the relative risk to Another type of energy—energy emis - rescuers isn’t clear—can be reviewed and dis- sions—is worthy of note in a profile describ- cussed at the moment, foregoing the usual ing the ideal communications center. control center briefings to those in charge. The structure is the first public building Some centers have projection rooms for in the country to be a “net zero energy emis- such live broadcasts and deliberations, but sions” building. That means it will produce they have an inherent glare problem in which at least as much emissions-free renewable details can be washed out in daylight or are energy as it uses. Heat and electricity will too thin to facilitate educated evaluations at be produced by panels located on the roof night. The four individual panels at the new in combination with the building’s canopy complex can create panoramic video picture that also provides shaded walk and sitting windows that can be sectioned off and moni- areas for the public. tored in one place from inside the center. Along with using all natural light “It’s basically the real life representation available during the day, louvers will be of an incident with the goal that everybody placed over the windows to help direct involved can see everything they need to natural sunlight and create lighting inside. instantaneously,” Teerlink said. “Again, it’s all The lights within the work stations of the about function; that is the backbone of the building will turn off automatically to save building and the work that goes on inside it.” energy when there is enough natural light in Keeping the flow of information flow- the room, thanks to the level of occupancy ing is a less noticeable element that is no and daylight sensors. less important to Kevin B. Miller, principal Water will be heated by the solar panels architect of the local firm—GSBS Archi - for the sinks and locker rooms. Radiant tubes tects—overseeing the project from the home are seated in the floor to heat and cool the base in Salt Lake City. building, a design element that Miller points “This is a building that has to last 50 out as far more efficient than the standard years,” Miller told The Journal from a blue- forced-air systems commonly used in public James L. McClaren print festooned office area located in a and private businesses, commercial buildings,

Photo by Christopher Barr Christopher by Photo nearby former bank building that pro - and residences in the Mountain West. vides its own picture windows on the proj- There was a time when—barely a genera- information that most agencies in older build- ect’s progress. Looking across the next five tion ago—that the dispatching center was a ings and new ones that didn’t maintain the decades, Miller brings up the past 15 years. pseudo-convalescent center for hurt officers employees-first concept didn’t have,” McClaren “Back then, when there was a traffic acci- or post-surgery mending, McClaren said,, not- said. “That fact is, and I learned this from my dent, the center would get maybe one or ing that his own father became a dispatcher father who was a San Diego police officer hurt two calls,” he said. “Now dispatchers report after being hurt on the job as a police offi - on the job so he became a dispatcher, they are that getting 500 calls is routine on even cer. “Dispatching has been part of my life all the first, first responders, as you at the NAED™ the most minor fender-benders. Given the my life. That connection is the heart of this have so eloquently demonstrated. course of information technology, that’s a state-of-the-art building..” g “This is the definitive ‘fusion center’ of drop in the bucket compared to what’s com- communications,” he continued. “It will ing. We all get enamored with technology, More about the Public Safety Complex be able to fuse all the media in all its itera - but we have tried to keep central the idea at www.naedjournal.org tions in one, synergy-enhancing place. Just that it’s people who do the work.”

THE JOURNAL | September/October 2012 29 g Fire CDE g Medical CDE OnTrack g fireCDE Up The Down Staircase Escalators can get you coming and going

We take for granted our daily use of the personal and professional duties, and a visit By Ronald Richard estimated 35,000 escalators in the United to the mall wouldn’t be as inviting without States, each serving an average of 12,000 the motor-driven carrier ferrying shoppers Editor’s Note: The March/April 2012 issue of people per year and, collectively, providing from one floor to another. Although a sta - The Journal featured FPDS® Protocol 56: Eleva- trips to 105 billion passengers per year.1 tionary stairway may be built alongside a tor/Escalator Rescue. In this installment, we will People living and working in high-rise movable stairway, leg power is the likely review the Escalator portion of this dual Chief buildings probably use these mass movers loser to engine power in a survey of com - Complaint Protocol. thousands of times while performing their parative use.

30 THE JOURNAL | emergencydispatch.org How an escalator works becomes stuck in the brush guard (the area The odds that a person will die from an The heart of the escalator is a micro - between the track and support structure escalator accident in the United States are processor-controlled motor that turns the of the elevator), often resulting in a foot or 1 in 10,440,000 but when accidents occur, main drive shaft. The drive shaft powers hand injury from the step scraper at the top they disproportionately strike two groups: the chain that rotates the steps in sync with or bottom of the escalator. Finger entrap - children five years old and under and adults another chain that rotates the handrail; this ment and comb plate entrapment can also 65 years and older.6 handrail is a rubber conveyer belt looped occur, especially with children. According to a retrospective study of around a series of wheels. The steps are escalator-related injuries among children in 7 wedge-shaped risers that move along this The Consumer Product Safety the United States: continuous conveyer in an upright position, Commission (CPSC) reported the There were an estimated 26,000 esca - collapsing on each other at the top and bot- following escalator deaths and lator-related injuries among those aged 0 2 tom of the escalator. injury statistics from 1992 to to 19 years old in the United States during The mechanics behind the continu - 2003, in the United States5: 1990–2002, yielding an average of 2,000 of ously rotating stairs of an escalator is simi - these injuries annually. The mean age was 6.5 lar to pumping a bicycle: a pair of chains is years at the time of injury, and 53.4% of the looped around two pairs of gears powered patients were male. by a motor (similar to legs pumping) con - 24 The most common mechanism of stantly moving in one direction. The result nonwork-related escalator deaths, injury for all age groups was a fall, account- is a smooth and rhythmic rotation. an average of two deaths per year ing for 13,000 (51.0%) injuries. Entrapment However, if the chain snags, the gears accounted for 29.3% of all injuries and crunch, or the power stalls, the escalator 36.5% of injuries among children who were comes to a halt while the riders’ momentum younger than 5 years old. continues. This can cause riders to stumble For children 5 years old and up and or fall. The escalator’s motor also continues 8 adults, injuries to the leg accounted for 27.7% to run whether something is entrapped deaths were the result of clothing of all injuries; among these, lacerations were or blocking the chain’s movement, which being caught at the top or bottom of most frequently reported. Among children forces the chain to continue its rotation for- the escalator or between the stairs younger than 5 years old, the hand was the ward. In a malfunction or incident, it may and the side wall of the escalator most common injury site (40.6%), with hand be necessary to bring an escalator to a com- injuries frequently occurring as a result of plete stop by shutting off the power with an entrapment (72.4%). “emergency escape” button found, in most A retrospective study of escalator-related cases, at the top and/or bottom of each unit, 16 injuries among older adults (mean age 80.1 mounted low or even below belt level. deaths were the result of falls, years) using data from the National Elec - some involving major head trauma tronic Injury Surveillance System of the Escalator injuries U.S. Consumer Product Safety Commis - Escalators provide a quick method of sion, showed a slip, trip, or fall (84.9%) was transporting a large population between the most common injury.8 Of the 6,000 escalator injuries floors with speeds varying from about 90 Recent reports collaborating statistics per year, falls accounted for feet per minute to 180 feet per minute; an include the following scenarios. average escalator moving 145 feet per min- In March 2012, the New York Times ute can carry more than 10,000 people an 75% reported that an 88-year-old woman died hour, far above the capacity of an elevator in after she fell down an escalator at the Linden- the same time frame due to waiting periods hurst station of the Long Island Rail Road. 3 between the elevator’s trips. Of the total number of According to preliminary investigation and Although the nicknamed “moving stair- escalator injuries per year, autopsy, the woman choked to death when case” is generally a smooth Point A to Point B entrapment accounted for her clothes got entangled in the escalator’s venture, accidents can happen at either point treads. The Metropolitan Transportation or in between. These accidents can be caused 20% Authority had hoped to replace the escala- by defects associated with escalators, includ- tor that had received some complaints of ing: missing teeth on the escalator track, loose malfunction, though it had passed inspection or missing screws, broken or missing steps, after a minor repair in February, a month pre- excessive space between the steps and the vious to the incident.9 escalator sides, and general malfunction.4 0–5 In June 2012, a large retail furniture out- However, the majority of escalator Age in which children were let in Milton Keynes, England, was fined incidents begin with a trip or fall, which more frequently involved in when a two-year-old boy had two fingers sev- sometimes leads to entrapment. Escalator “caught-in” injuries, which ered on the store’s moving walkway. The tod- tend to be more serious incidents can also occur when a shoelace dler was holding his father’s hand when he or piece of fabric gets caught in the teeth stumbled and fell. The left hand he extended of the escalator or when a foot or hand to stop his fall became trapped between the

THE JOURNAL | September/October 2012 31 machine’s skirting and tread, severing two (PDIs) including how to turn off the esca - precautions to keep the victim from falling fingers. An investigation into the incident lator, if necessary, by pushing the emer - into the pit while being rescued. revealed that the gap between the skirting gency shut-off switch (button) at the top and tread was larger than the legal limit of and/or bottom of the escalator. If possible, Code and regulations 4 mm and posed a potential safety hazard.10 the caller (or calltaker—if in direct contact In the United States and Canada, new An escalator accident can also be the with the trapped individuals) should main- escalators must abide by the American result of inattention or inappropriate rider- tain verbal contact with the trapped people Society of Mechanical Engineers’ (ASME) ship. In June 2011, an 18-year-old intoxicated and assure them that help is on the way. A17.1 standards that cover the safe design, male, using a subway escalator in Cambridge, The EFD should also advise the caller to construction, installation, operation, inspec- Mass., fell over when he tried to sit on the contact building management. tion, testing, maintenance, alteration, and hand strap for the ride to the fourth-floor repair of transporting machinery including level exit. The youth fell over 20 feet, land- escalators, elevators, dumbwaiters, moving ing on his upper body.11 The call was coded walkways, etc. Old/historic escalators must 17-D-5 LONG FALL. The fall was the result The dispatcher conform to the safety guidelines of ASME of negligence of the rider who was using the A17.3, adhering to a minimum requirement escalator improperly. and caller should that will provide a reasonable degree of determine a clear safety for the general public. Most states Escalator 9-1-1 require permits for escalator installation Handling an emergency call for an esca- meeting point or alteration and new or altered equipment lator rescue differs slightly from an elevator must be inspected prior to opening for rescue. The calltaker still needs information for emergency public use. Some states shutdown escala - about the number of people trapped and/ tors when property owners fail to adhere or injured, the location of the escalator, and crews. to regular maintenance inspections. g the best entrance to get to the escalator; however, because an escalator is more of an “open Sources air” mode of travel, there is usually less caller 1 “Escalators.” Consumerwatch.com. 2012; Feb 24. www. consumerwatch.com/workplacepublic/escalators (accessed guesswork involved. The concluding Key Questions request June 15, 2012). Passenger safety issues are prioritized as information about the escalator’s location 2 Harris T. “How Escalators Work.” howstuffworks.com. the initial Key Questions of Fire Priority Dis- and the best entrance for responders to http://science.howstuffworks.com/transport/engines- ™ ® patch System (FPDS) Protocol 56: Elevator/ access the escalator. Together, the dispatcher equipment/escalator.htm (accessed June 20, 2012). Escalator Rescue. Escalator Key Questions 1 and caller should determine a specific, clear 3 See note 2. and 2 begin by asking whether persons are meeting point for emergency crews. 4 See note 1. still trapped, whether the escalator has been 5 See note 1. turned off, and whether anyone is injured Escalator extrication 6 (how many). Based on the responses to these The first step to rescuing a trapped indi- Remington, A. “Accidents & Death/Transportation Ac- cidents.” Book of Odds. www.bookofodds.com/Accidents- first two Key Questions, the EFD should be vidual is to stop the escalator, which will not Death/Transportation-Accidents/Articles/A0045-How- able to determine the appropriate Determi- stall or stop until the emergency shut-off Risky-Is-an-Escalator-Ride (accessed June 18, 2012). nant Code, whether 56-D-1 “ENTRAPMENT switch has been activated. The EFD should 7 McGeehan J, Shields BJ, Wilkins JR 3rd, Ferketich AK, Smith (escalator) with injuries,” 56-B-2 “Caught give the instruction to push the button GA. Pediatrics. 2006 Aug; 118(2):e279-85. “Escalator-related (escalator) with no injuries,” or an OMEGA at the top and/or bottom of the escalator injuries among children in the United States, 1990-2002.” http://www.ncbi.nlm.nih.gov/pubmed/16882773 (accessed code, if applicable, “Escalator incident– as part of the PDIs, before response even June 22, 2012). not caught (with or without injuries).” An arrives on scene. However, if for whatever 8 O’Neil J, Steele GK, Huisingh C, Smith GA., Accid Anal ENTRAPMENT, as defined on Protocol 56, is reason the emergency shut-off switch does Prev. 2008 Mar;40(2):527-33. Epub 2007 Sep 10. “Escalator- “a situation involving prevention of escape in not respond, responders may attempt to related injuries among older adults in the United States, 1991- which there is an increased threat of injury, kick the brush skirt to stop the escalator. 2005.” http://www.ncbi.nlm.nih.gov/pubmed/18329403 illness, or death to a person.” In rarer situa - This should not be attempted by callers or (accessed June 22, 2012). tions, the EFD may select 56-B-3 “Unknown bystanders. Once the escalator is stopped, 9 Haughney C, Pereira I. “Death on Escalator M.T.A. Had Once Hoped to Replace.” New York Times. 2012; March 14. http:// situation (investigation)” for a third-party it’s time for response to act. www.nytimes.com/2012/03/15/nyregion/woman-88-dies- caller who is not aware of the situation and Removing the injured individual from on-escalator-at-lirr-station.html (accessed July 7, 2012). unable to see the escalator and its occupants. the escalator involves closing off the upper 10 Reilly, J. “’I looked down and saw his index and middle However, if a known incident has and lower landings. Responders will deter- fingers were missing’: Father’s horror as toddler son gets hand occurred and the caller is unsure of a mine the approach necessary to extricate trapped in Ikea escalator.” Daily Mail. 2012; June 3. http:// patient’s status, Rule 3 instructs the calltaker the victim. For example, if the patient’s www.dailymail.co.uk/news/article-2153998/I-looked-saw- index-middle-fingers-missing-Fathers-horror-toddler-son-gets- that: “All persons caught in an escalator with hand or foot is stuck in the brush guard, hand-trapped-Ikea-escalator.html (accessed July 7, 2012). unknown injuries are considered injured responders will place heavy-duty spread - 11 “Next time take the lift: Drunken teen falls 20ft over until proven otherwise. Such incidents ers between the exposed track and support side of escalator after trying to ride it sidesaddle.” Daily should be coded as 56-D-1.” structure to extricate the victim. If it’s the Mail. 2011, June 29. http://www.dailymail.co.uk/news/ After initiating dispatch, the EFD step scraper trapping the victim, respond- article-2009065/Shane-OMalley-survives-escalator-fall-Cam- bridge-Massachusetts-caught-tape.html (accessed July 7, 2012). should give Post-Dispatch Instructions ers will remove the pit cover, taking extra

32 THE JOURNAL | emergencydispatch.org 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 “Up The Down Staircase,” which starts on page 30. 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 estimated average number of people each escalator in the United States transports each year? A CDE acknowledgement will be sent to you. (You must answer 8 of the 10 questions correctly to receive credit.) a. 12,000 b. 35,000 Clip and mail your completed answer sheet along with the c. 1.5 million $5 NON-REFUNDABLE processing fee to: d. 105 billion The National Academies of Emergency Dispatch 139 East South Temple, Suite 200 2. The mechanics behind the continuously rotating stairs of an escalator is similar to what mechanical device? Salt Lake City, UT 84111 USA a. Jaws of Life Attn: CDE Processing b. come along (800) 960-6236 US; (801) 359-6916 Intl. c. wench Please retain your CDE acknowledgement d. bicycle for future reference.

3. Escalator speeds vary: Name ______a. from about 1 mile per hour to 2 miles per hour. b. from about 90 feet per minute to 180 feet per minute. Organization______c. depending on the time of day. d. depending on the number of people in transit. Address______

4. From 1992 to 2003, the Consumer Product Safety Commission (CPSC) reported that more deaths were City ______St./Prov.______caused by clothing getting stuck in an escalator compared to falls on an escalator. a. true Country ______ZIP______b. false Academy Cert. #______5. According to statistics, the most common injury site among children younger than 5 years old is the ______: Daytime Phone ( )______a. leg. b. knee. E-mail ______c. hand. d. elbow. Primary Function 6. According to statistics, the most frequent cause of injury among older adults is ______: Public Safety Dispatcher (check all that apply) a. a finger entrapment. _____Medical _____Fire _____Police b. a comb plate entrapment. c. a clothing grab. Paramedic/EMT/Firefighter d. a slip, trip, or fall. Comm. Center Supervisor/Manager

7. Because an escalator is more of an “open air” mode of travel, there is usually more caller guesswork involved. Training/QI Coordinator a. true Instructor b. false Comm. Center Director/Chief 8. The initial Key Questions on Protocol 56 address: Medical Director a. passenger safety. Commercial Vendor/Consultant b. escalator location. c. escalator’s on/off switch. Other d. building management. ANSWER SHEET FIRE 9. All persons caught in an escalator with unknown injuries are considered injured until proven otherwise. Such F incidents should be coded as: Sept/Oct Journal 2012 “Up The Down Staircase” Please mark your answers in the appropriate box below. a. 58-B-2. b. 56-B-2. 1. o A o B o C o D c. 56-D-1. d. 62-D-1. 2. o A o B o C o D 3. o A o B o C o D 10. After initiating dispatch, the EFD should give Post-Dispatch Instructions (PDIs) including how to turn off the escalator, if necessary, by pushing the emergency shut-off switch (button) at the top and/or bottom o o of the escalator. 4. A B a. true 5. o A o B o C o D b. false 6. o A o B o C o D 7. o A o B 8. o A o B o C o D 9. o A o B o C o D 10. o A o B To be considered for CDE credit, this answer sheet must be received no later than 10/31/13. A passing score is worth 1.0 CDE unit toward fulfillment of the Academy’s CDE requirements. Please mark your responses on the answer sheet located at right and mail it in with your processing fee to receive credit. Please retain your CDE letter for future reference. Expires 10/31/13

THE JOURNAL | September/October 2012 33 g medicalCDE Wind In Your Hair Might feel good until rider takes a tumble

tective headgear for auto racing, motorcycling, onto various steel test anvils. An accelerome- By Audrey Fraizer and Cynthia Murray equestrian sports, bicycling, skiing, rollerblad- ter is placed inside the helmet to measure the ing, skateboarding, snowboarding, and karting. peak G-force of the impact. If the peak accel- A tumble over his bicycle’s handlebars But the reason goes beyond the com - eration imparted to the head form exceeds nearly 50 years ago was enough of a lesson in pany he represents. a certain threshold value (around 300 Gs, safety for Snell Memorial Foundation Execu- “Pete’s accident was survivable,” said depending on standard and test type), the tive Director Ed Becker. Becker, who, prior to joining Snell in 1989, helmet is rejected. The manufacturer goes “I landed on my lower face and messed worked for the Naval Biodynamics Labora- back to the drawing board or markets the up my teeth,” said Becker, who now crash- tory in New Orleans, La., studying human helmet minus the Snell seal of approval.1 tests commercially developed helmets for response to crash impact acceleration. “The Becker said testing doesn’t reproduce the standard-setting company established in helmet he was wearing failed to protect his real-life situations. No humans or animals 1959, following the death of auto racer Wil- head when the car flipped over.” are used in the experiments, so there’s no liam “Pete” Snell. “I remember my mother cry- Given the chance today, the helmets that guarantee that a human’s head will respond ing while my father cleaned up my face. It have been approved through Snell Memo- in the exact same way as the artificial head was just a few years ago that I finally repaired rial Foundation’s multi-faceted helmet test- form. Snell’s testing is strictly a measurement the last of the damages with a dental implant ing procedures could have prevented the of how a helmet should react in an incident to replace a broken front tooth.” tragedy. Impact testing carried out in their to protect the wearer’s brain and skull. Becker was lucky. Although not wearing a accredited facility in California involves “We call ourselves helmet critics,” he said. helmet at the time of his accident, the founda- positioning the helmet on a metal head form “We don’t design them. We test helmets for tion’s senior employee is a firm advocate of pro- (test dummy) and dropping it in a guided fall energy management.”

34 THE JOURNAL | emergencydispatch.org Physics of brain injury forces are blunted and redirected by the hel- Traumatic brain injury (TBI), a form met’s reinforcements, according to the Snell According to national statistics of acquired brain injury, generally occurs Memorial Foundation. from the Snell Memorial when the skull collides with an object (or the “Of course speed, force, and other factors Foundation5: ground), causing bleeding and damage to the play into the impact,” said Debby Gerhardstein, impacted cells or piercing the skull and tear- executive director of the ThinkFirst National ing brain tissue. The rapid deceleration the Injury Prevention Foundation, which provides brain experiences when going from motion evidence-based programs that aim to prevent to no motion can also cause sheering of the brain, spinal, and other traumatic injuries. “The vessels between the brain and skull. helmet can only do so much.” In a sudden stop or slowing down, the protective layers beneath the skull help sup- Acknowledging the risk ply the force required to stop the brain’s TBI accounts for more than 50% of motion, normally preventing the brain from bicycle fatalities among children and youth colliding with the hard interior surface of below the age of 20 each year in the United Every year the estimated number the skull. However, these protective layers States, according to “The Facts Hurt: A State- of bicycling head injuries requiring are not enough to prevent damage in inci - by-State Injury Prevention Policy Report,” hospitalization exceeds the total dents of extreme force. As the body comes released May 2012 by the nonprofit organiza- of all head injury cases related to to a sudden stop, the brain is still moving and tion Trust for America’s Health. Nearly 63% baseball, football, skateboards, can strike the skull, causing irreparable dam- of deaths to children are caused by a head kick scooters, horseback riding, age to the cells and tissues that make up the injury resulting from a collision between snowboarding, ice hockey, in-line brain’s structures. bikes and cars, according to the same report. skating, and lacrosse. The results can be devastating. However, these deaths and injuries have Symptoms of a TBI can be mild, mod - been widely proven as preventable. A fre - erate, or severe depending on the extent of quently cited study from the New England the damage to the brain. Disabilities result- Journal of Medicine found that helmet use ing from a TBI depend upon the severity reduced the risk of head injury by 85% and of the injury, the location of the injury, and the risk of brain injury by as much as 88%.4 the age and general health of the individual. Despite the evidence, only 21 states and Some common disabilities include problems Washington, D.C., currently require chil- with cognition, sensory processing, com - dren and youth (generally 16 years of age or munication, and behavior or mental health younger) to wear bicycle helmets. Only the (depression, anxiety, personality changes, and Virgin Islands requires all bicyclists to wear $2.3 billion aggression). More serious head injuries may helmets when riding. Estimated indirect costs for injuries 2 result in a stupor, coma, or vegetative state. States and localities with helmet laws to unhelmeted cyclists issue fines for violating requirements. For An ounce of prevention example, Maine issues a warning for first One way to decrease the force of impact offenders under the age of 16, and $25 fines 95% when a bicyclist hits his or her head in a fall for second and subsequent violations. Viola- of bicyclists killed in 2006 is to increase the amount of time it takes for tion of the law in North Carolina carries a reportedly were not wearing helmets the impact to take place. That’s the mechan- $10 fine, which may be waived with proof ics behind quality bicycle helmet design. of helmet purchase. In an accident, the head pushes against All University of Florida employees who the helmet’s sturdy lining material that then ride their personal or UF-owned motorcy- compresses, lengthening the time the head cles, scooters, bicycles, or Segway personal and brain take to come to rest, avoiding sud- transporters for UF business purposes are den impact with the hard inner surface of required to wear a protective helmet that the cranium and thereby reducing the dam- complies with specific appropriate safety age. The brain may still make contact with standards. Violations can result in a suspen- the inside of the skull, but the force of the sion of riding privileges. 3 impact is reduced. 2/3 of those who died A helmet also provides a larger surface Not the end-all for brain injury that absorbs a large portion of the impact While helmets do absorb some of the and 1/8 of those injured energy that would otherwise go to the head. force of an impact, they can only go so far in in bicycle crashes suffered This also includes greater protection from preventing brain injuries. Concussions some- brain injuries rocks or sharp surfaces that must penetrate times do occur in sports in which helmets are a thick protective liner before reaching the worn. Also, helmets cannot protect against wearer’s skull inside the helmet. Instead of whiplash, a fast jerking of the head, which slicing straight through flesh and bone, the can cause concussions as well.

THE JOURNAL | September/October 2012 35 Becker, who hasn’t ridden much since Protocol 30 is also the appropriate choice happened and then address the conscious- the accident of his youth, believes bicyclists when handling persons injured in a fall while ness and breathing status of the patient. If should wear helmets for their own protec- rollerblading, skateboarding, or participating the patient is not alert with INEFFECTIVE tion, although he’s hesitant to demand man- in a wide variety of other activities that result breathing, the EMD should protect life over datory helmet laws. in traumatic injuries. limb and instruct the caller to open the air- “You can’t go around twisting arms,” he However, if the incident involves a way, as directed. said. “It’s my job to give sound advice to peo- cyclist, motorcyclist, or pedestrian in a col- If the patient is breathing and PAIs are ple who want to save their lives.” lision with an automobile, Protocol 29: not necessary, the EMD may enhance the Much like a seatbelt, however, a helmet Traffic/Transportation Incidents is the PDIs by encouraging the patient not to move is not the panacea to avoid injury from an appropriate choice to address scene safety and instructing the caller to stabilize the accident. Yet, if injury does occur, the safety patient’s head and neck in the position found factor and prompt care can soften the blow. in case of spinal injury (Rule 2 on Protocol Friends and fellow cyclists were doubt- “It’s my job to 30). Bystanders should be warned not to ful Lane Phillips would be able to take care move an accident victim before emergency of himself following an accident in October give sound personnel arrive at the scene (Protocol 30 2006 when he was found unconscious lying PDI-b). In many cases, moving the patient can on the side of the road. His bicycle, a few advice to people increase the severity of the injuries, though feet away, was badly damaged. Apparently, occasionally bystanders may deem it neces- no one stayed at the scene following the inci- who want to sary due to impending danger. dent. No one has come forward to confess or save their lives.” Good Samaritan laws prevent bystand- describe what happened to the well-known ers from being sued if they end up caus - South Carolina cyclist. ing further injury to the patients in an Phillips, who never goes without wearing —Ed Becker effort to help them. However, the dis - a helmet while cycling, was in a coma for two patcher should not advise bystanders to weeks and spent six months in the hospital. issues and the potential need to block off act against safety precautions nor do these Few thought he would be able to return to traffic. The EMD should document the laws create an obligation to help victims his mechanic’s job at Outspokin Bicycles in nature of the incident and the number of of an accident. Columbia, S.C., but Phillips fooled every - injured persons during Case Entry before For example, a bystander has no obliga- one. He not only returned to his job, but he even beginning Key Questions on Protocol tion to move an injured bicyclist out of the is again cycling and often takes his story on 29. High mechanism incidents may include way of traffic, but if the bystander chooses the road as an advocate for biking safety. The multiple patients and evidence to suggest to do so without dispatcher consent and accident is a fuzzy memory. serious injuries. cracks one of the patient’s ribs in the process, “It’s been a real miracle,” said Outspokin Traumatic injuries may also be the result a Good Samaritan law would prevent the Owner Brian Curran. “An off-duty EMT hap- of an extreme or long fall, such as being patient from suing the bystander for caus- pened to come by and that’s what saved Lane.” thrown off a large horse or falling from a ing that additional injury. great height while hiking, repelling, cliff div- Protection for a Good Samaritan ends Protocol ing, or rock climbing; these cases are handled when professional medical assistance arrives. Today, if a cyclist took a spill similar to on Protocol 17: Falls. As stated in Rule 2, “The Good Samaritan laws will not protect him or Becker’s flight over the handlebars, calltakers distance of the fall is a key factor in deter - her from liability for interfering with profes- would use Protocol 30: Traumatic Injuries mining response.” sional treatment efforts. g (Specific) to handle the emergency. A traumatic injury may also include a pen- The Academy does not offer a special etrating object, which is handled on Protocol 27: Sources protocol pathway for accidents involving Stab/Gunshot Wound/Penetrating Trauma. 1 Helmet Testing. Snell Memorial Foundation. http://www. smf.org/testing falls from bicycles, as discussed in an “Ask Patients with penetrating trauma may be han- 2 The Doc” column published several years dled with BLS units if necessary since trans- “Traumatic Brain Injury Information Page.” National Institute of Neurological Disorders and Stroke. 2012; June 14. ago in The Journal of Emergency Dispatch. This porting the patient immediately is preferable http://www.ninds.nih.gov/disorders/tbi/tbi.htm (accessed is due to varied speeds and surroundings over waiting for paramedics; this is especially July 3, 2012). and a large spectrum of riders—from Tour vital for patients afflicted with CENTRAL 3 “Nova scienceNOW: Brain Trauma.”. NOVA Teachers. de France cyclists to kids on tricycles, which wounds who may require operative interven- 2008. http://www.pbs.org/wgbh/nova/teachers/activi- cannot be jammed simply into a mechanism- tion and trauma center care. As applicable in ties/0306_01_nsn.html (accessed May 30, 2012). of-injury format. all cases of TRAUMA, EMDs should not pro- 4 Thompson, R.S.; Rivara, F.P.; and Thompson, D.C. 1989. A Protocol 30 asks for the status of the vide instructions for controlling bleeding (X-5) case-control study of the effectiveness of bicycle safety helmets. New England Journal of Medicine 320:1361-67. http:// patient (whether unconscious, in arrest, or through direct pressure on the wound if there www.nejm.org/doi/full/10.1056/NEJM198905253202101 completely alert) and what part of the body is evidence of visible fractured bone or foreign (accessed July 3, 2012). was injured. These indicators of the patient’s objects (Rule 4 on Protocol 27). 5 “Use Your Head and Wear a Helmet.” Snell Memorial Foun- condition and severity of injury are used to dation. http://www.smf.org/ssec/smfbikebroch09.pdf prioritize the response.6 Most commonly, Bystander care (accessed May 25, 2012). bicycle accidents result in head, neck, back, As always, the first priority in handling 6 Clawson, Jeff, M.D. Summer 2007. Bicycle and Rider at and spinal injuries. trauma patients is to find out exactly what Odds. The Journal of Emergency Dispatch. 2007. v9 n3:5.

36 THE JOURNAL | emergencydispatch.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 “Wind In Your Hair,” 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. As the body comes to a sudden stop, the brain: A CDE acknowledgement will be sent to you. (You must answer 8 of the 10 questions correctly to receive credit.) a. is still moving. b. comes to a stop. Clip and mail your completed answer sheet along with the $5 NON-REFUNDABLE processing fee to: 2. Disabilities resulting from a traumatic brain injury (TBI) depend upon the: The National Academies of Emergency Dispatch a. severity of the injury. 139 East South Temple, Suite 200 b. location of the injury. Salt Lake City, UT 84111 USA c. age and general health of the individual. Attn: CDE Processing d. all of the above (800) 960-6236 US; (801) 359-6916 Intl. Please retain your CDE acknowledgement 3. One way to decrease the force of impact when a bicyclist hits his or her head in a fall is to increase the for future reference. amount of time it takes for the impact to take place. a. true Name ______b. false Organization______4. helmet use can reduce head injury by ____%. a. 10 Address______b. 25 c. 50 City ______St./Prov.______d. 85 Country ______ZIP______5. Currently, what are the U.S. statistics regarding requirements for children and youth (generally 16 years of age or younger) to wear bicycle helmets? Academy Cert. #______a. No state has a mandatory requirement for wearing bicycle helmets. b. Every state has a mandatory requirement for children and youth to wear bicycle helmets. Daytime Phone ( )______c. Only 21 states and Washington, D.C., require children and youth to wear bicycle helmets. d. Close to 75% of all states and Washington, D.C., require bicycle helmets for children, youth, and adults. E-mail ______

6. Today, if a cyclist took a spill similar to Ed Becker’s flight over the handlebars, which Chief Complaint Protocol would calltakers use to handle the emergency? Primary Function a. 17: Falls Public Safety Dispatcher (check all that apply) b. 27: Stab/Gunshot/Penetrating Trauma c. 29: Traffic/Transportation Incidents _____Medical _____Fire _____Police d. 30: Traumatic Injuries (Specific) Paramedic/EMT/Firefighter Comm. Center Supervisor/Manager 7. Which protocol would be the appropriate choice when handling a call involving an accident between an auto and a bicycle? Training/QI Coordinator a. 17: Falls Instructor b. 27: Stab/Gunshot/Penetrating Trauma c. 29: Traffic/Transportation Incidents Comm. Center Director/Chief d. 30: Traumatic Injuries (Specific) Medical Director

8. When handling an accident between an auto and a bicycle, the EMD should document the nature of the Commercial Vendor/Consultant incident and the number of injured persons during Case Entry before even beginning Key Questions on Protocol 29: Traffic/Transportation Incidents. Other a. true b. false ANSWER SHEET G MEDICAL Sept/Oct Journal 2012 “Wind In Your Hair” 9. if the patient is breathing and PAIs are not necessary, PDIs may be enhanced by encouraging the patient: Please mark your answers in the appropriate box below. a. not to move. o o b. to move. 1. A B 2. o A o B o C o D 10. in many cases, moving the patient can increase the severity of the injuries, though occasionally bystanders may deem it necessary due to impending danger. 3. o A o B a. true o o o o b. false 4. A B C D 5. o A o B o C o D 6. o A o B o C o D 7. o A o B o C o D 8. o A o B 9. o A o B 10. o A o B To be considered for CDE credit, this answer sheet must be received no later than 10/31/13. A passing score is worth 1.0 CDE unit toward fulfillment of the Academy’s CDE requirements. Please mark your responses on the answer sheet located at right and mail it in with your processing fee to receive credit. Please retain your CDE letter for future reference. Expires 10/31/13

THE JOURNAL | September/October 2012 37 g dispatch in action g stork stories g unforgettable YourSpace g dispatchinaction A Family Affair Dispatcher follows parents’ footsteps

Emily, took over from there, providing Baker with all the right information. “They did a great job,” Baker said. “They told me what happened and followed my instructions. They unlocked the door to let the police in. I wish every caller could be like them.” An ambulance rushed “Poppy” to the hospital and later transported him to Shock Trauma. He was home two weeks later. The call that undoubtedly helped save their grandfather’s life has received local and national attention. In May, Baltimore County Executive Kevin Kamenetz honored the two girls and Baker and the trio also received recog- nition from the National 9-1-1 Education Coali- tion. In April, 9-1-1 for Kids presented them with hero awards at the Navigator conference. Baker said the attention has been exciting. The center was recognized for doing something good and she was able to meet someone she assisted over the phone. “Nice to put a face to the names,” Baker said. This is not the first time Baker has been noticed for her work. In 2008, she was named Baltimore County 9-1-1 Operator of the Year for her persistence in pinpointing a domestic vio- Going For The Gold 9-1-1 For Kids honored EMD Heather Baker and sisters Riley and Emily for actions to save the girls’ “Poppy.” lence situation. A misdirected Voice over Internet Protocol (VoIP) call came in from For Heather Baker, emergency dispatch- here and it was something she enjoyed. She Texas and Baker, in Baltimore, was able to ing is a family affair. never complained.” give police the information needed through The 35-year-old EMD from Baltimore Baker decided to give dispatch a shot and, the area’s communications center. She has County (Md.) 9-1-1 started in the profession like her mom, found the job to her liking. No also assisted in the delivery of babies and pro- 14 years ago and her mother, Catherine “Kitty” day’s ever the same and she prefers staying vided CPR instructions to bystanders calling Rizza, has been the voice behind response at behind the scenes to the medical, fire, and in for cardiac arrest patients. the same center since 1986. Her father, Ralph police responders she sends to emergencies. “We’re a very busy center,” she said. Rizza, also had invested 14 years in dispatch “We never get to meet the people we help, Baltimore County 9-1-1 receives more prior to his death in January 2006. but that hasn’t really bothered me,” she said. than 2,000 calls a day. In February, the Despite the combined 28 years of 9-1-1 “It’s all part of the job.” county announced work was complete on a during much of her childhood, Baker didn’t Baker’s under-the-radar experience $57.6 million overhaul of the county’s pub- grow up planning a career in dispatch. changed in March when 4-year-old Riley Stun- lic safety radio system and $18.5 million in “I wasn’t sure what I wanted to do,” she kel called 9-1-1 to report that her grandfather upgrades to the county’s 9-1-1 center in the said. “But mom had always been working “Poppy” had collapsed. Riley’s 6-year-old sister, Circuit Court Building. g

38 THE JOURNAL | emergencydispatch.org g storkstories Perfect Performance Baby delivery in harmony with constant protocol practice

Little did a neighbor know what was in store when flagged down during her morning walk on May 21, 2011. It wasn’t to borrow a cup of sugar. “I can’t believe we just delivered a baby,” she cried into the phone 15 minutes later to EMD William “Bill” Trimmer, senior telecommunicator, Nash County (N.C.) Emergency Services, 9-1-1 Division. “Oh Lord.” In the quarter hour drama beginning at 10:36 a.m., a neighbor deftly switched directions to deliver a healthy baby boy on the living room couch in a home she wasn’t the least bit familiar with. She scrambled for towels, a shoelace, and blankets while, at the same time, holding her neighbor’s other child and delivering a baby. “The neighbor got a little excited when she realized the baby was coming,” Trimmer said. “But other than that, she did a really good job.” The neighbor wasn’t the only one gar - nering praise that day. “The call was one of a kind,” said Mark Reavis, Nash County 9-1-1 Division QA and training officer. “Bill navigated perfectly and the outcome was a live child.” Although Reavis wasn’t in the room during the call, Trimmer’s immediate supervisor knew a perfect call when he heard one. He rushed the tape back to Reavis’ office and Reavis lost no time critiquing the call using AQUA ® quality assurance software. “He scored a perfect 100,” Reavis said. “It’s rare that anyone scores a perfect 100. Bill followed the protocol and each and every instruction verbatim.” Trimmer is used to scoring on the high side. Overall, the center scored 98.13% for the Flawless Call EMD Bill Trimmer helps to delivery a healthy baby boy and, in the process, nets 100% compliance. 1,000 calls Reavis reviewed during the six- month period between Jan. 1, 2012, and June Sometimes, the protocols are so auto - carriage, it isn’t often a full delivery takes 12, 2012. In 2011, Trimmer had inched over matic that he finds himself asking the Case place before paramedics arrive on scene and the bar, coming in first of 30 full- and part- Entry and Key Questions when he’s the the May 21 arrival was Trimmer’s first-ever time division members. His score: 99.66%. guy on the other end of the radio respond - over-the-phone delivery. The score is hardly an accident. Reavis ing to incidents while working his part- Aside from a potentially threatening holds a four-hour CDE class each month, time firefighting job. emergency during delivery—the umbilical and it’s a class no one even thinks of skip - “People deserve the best we can do, and cord was wrapped loosely around the baby’s ping or calling in sick to avoid. Trimmer that’s what we give them,” Trimmer said. neck but quickly removed—Trimmer said studies the protocols—fire, police, and “We’re ready for their call.” the call went exactly the way anyone would medical—outside of class like someone on a Fortunately, Trimmer practices all want. And he didn’t ask for a review like he weight loss diet might count calories. the protocols, and not just the protocols sometimes does to make sure he’s on track. “It’s all the time,” Trimmer said. “The referred to on a more frequent basis. While “Bill does an incredible job,” Reavis said. “I shift critiques each other’s calls and we prac- the division does receive calls requiring wanted to make sure he was recognized for tice when we have the time.” Protocol 24: Pregnancy/Childbirth/Mis- an outstanding performance.” g

THE JOURNAL | September/October 2012 39 Calm During The Storm Dispatcher keeps dad focused on delivery

through anything like this before,” the caller tells Leonard. “It’s real crazy right now. She’s not listening to me.” A minute later and the baby’s head crowns. “Oh my God,” the overwhelmed dad says. “It’s a head. Oh dude. Oh man. She is coming out.” Leonard agrees the situation is overwhelming. “It’s a little scary,” he said. “But I need you to pay attention. Sir, I need you to listen to me because I will tell you what to do.” Two minutes and 30 seconds later, the baby is wrapped in a blanket and the caller has used a shoelace to tie off the umbilical cord. “They were transported without further delay,” said Sarah Harrison, the center’s training officer and public information officer.

Maryland’s Finest Derrick Leonard, fourth from the right, stands among others honored by the Maryland Institute for EMS Systems. “Derrick did a fabulous job.” Leonard credits the protocol—Queen EMD Derrick Leonard had a lot on his “I need you all to get out here real quick, Anne’s uses all three—and the extensive and line during the last hour of his 24-hour shift as soon as you can,” the caller tells Leonard. “I ongoing training required and ability to mul- at the Queen Anne’s County Department of don’t know what’s going on. Her water broke.” titask for getting him through the first full Emergency Services in Centreville, Md. The next almost 12 minutes shortly after delivery he’s handled over the phone. He The early morning caller was stressed, the 6 a.m. on Nov. 6, 2011, were a ride on the Wild was also relieved “big time” when he heard person the caller was trying to help wasn’t Mouse roller coaster, at least for the caller and the baby let out a first cry. cooperating to the extent the caller wanted, mom. She wails, pushes, and rolls on her side “I knew the paramedics would be there and a third party involved could have cared and on her back again. The caller alternately soon but I didn’t know it (the delivery) less about anyone else’s issue. nearly loses his grip, asks mom questions she would happen so fast,” he said. “I had the pro- “I had a tough time trying to calm him can’t answer, and attempts to calm her while tocols and did the best that I could.” [the caller] down,” said Leonard, who has Leonard repeats Pre-Arrival Instructions Leonard was honored with the EMD Pro- been with the center going on six years. (PAIs) and reassures dad that he can do this. vider of the Year Award given to him by the “He was frustrated and really needed extra “You’re doing good, you’re doing fine,” Maryland Institute for Emergency Medical reassurance.” Leonard tells the caller four minutes into the Services Systems at the annual EMS award Leonard wasn’t exaggerating. Although call and still minutes away from the actual ceremony held in May 2012. But he certainly the couple had been sent home from the delivery. “There’s nothing you have to do doesn’t revel in the glory. hospital earlier that day for a case of Braxton right now but keep her calm.” “It was great to receive the award and Hicks, it took Leonard less than a second to Six minutes and two seconds into the bring a life into the world,” he said. “But realize that there was nothing false about the call and dad can hardly hear Leonard over the call shows only a small portion of what labor this time. the cries of pain and fear. “I’ve never been everyone here does every day.” g

g unforgettable The Next Breath Desperation haunts near choking survival victim

Editor’s Note: Kate Dernocoeur is no One minute you’re in the kitchen, at ber for tomorrow. You don’t really notice. stranger to dangerous and frightening situa - maybe 9:00, 9:30 p.m., after you get home You pop open the fridge looking for tions, but this story, she said, reflects her most from school, famished. The under-coun - something, anything, to eat. Something frightening experience, ever. Her survival wasn’t ter TV is on while the water heats for tea. quick, to tide you over ’til morning. You see a sure thing for several minutes, and she evokes Your thoughts are maybe on the events of the leftover couscous still in the cooking pan, that desperation in her story. the day, maybe what you need to remem - yeah, that’d be good. You reach for a fork and

40 THE JOURNAL | emergencydispatch.org take a bite. You’re just doing what you always do, grabbing a bite before heading upstairs. One minute, it’s all everyday, no big deal. Then you realize something is not right. Suddenly, nothing matters—not the TV, not the fact that you’ve been lazy about your diet lately, not the inbox of e-mails upstairs. What suddenly matters is this: You can’t breathe. This has a name. It is an airway obstruction. You have a full airway obstruction. What the heck? From a quick, casual bite of couscous? One minute you’re going for a forkful of the stuff, and the next, you can neither breathe out nor breathe in. You try. You cannot. The breeziness of two moments ago has died abruptly. The altered world threatens you as surely as a snake coiled and rattling—except you can’t even make a sound. With breathing comes so much: shouting joy for a beautiful day, speaking one’s mind, and whispering, “I love you” to a sleeping child.

Without it, you feel like you are looking Breathing Lessons Kate Dernocoeur describes the pain of near choking and the joy of coming back for air during an otherwise at the kitchen through the wrong end of ordinary day. the binoculars. Without it, the lights are too moment was over. You departed quickly. over the sink, drooling. There’s a chance this bright, the TV too loud, the degree of instant Now, there’s not even a pip of a squeak. might not go well. desperation too shocking. Nothing. The silence in the house impresses You step back, dizzy. Position the hand You know the dynamics here; you’ve you, the way it tries to smother the din in again, habit entrenched from training. Maybe studied airways, opened many in your years your head shouting, “Help, Help!” the in-and-up angle wasn’t quite right. Maybe as a paramedic. It’s the first, most important You are alone. You are oddly concerned you didn’t give it enough oomph. But that thing in the flowchart of resuscitation: A-B- about the housemate finding you dead. This first time was surprisingly painful. Never Cs. Airway, Breathing, Circulation. doesn’t seem very fair, after all. One minute you mind. Do it again! You have to get that cham- This patient—YOU—does not have an air- were just doing your everyday life. The next pagne cork thing going. way. God! thing, your life may only have a minute left. You ram into the counter again, hard, A flood of neon-lit thoughts pour in. Can You’ve got to do something. Your body really, really hard, and it really, really you make it over to the neighbor’s condo? throbs with adrenalin. You are sheened with hurts. You kinda collapse at the knees to What if they aren’t home? If you go out sweat. The room is raging hot, vividly bright. achieve that drop angle, so the lungs have there, you’ll only have enough residual to Your mind races. There is only one thing to to compress. try knocking on one door along the row. Can try, and you might only have one chance. “Uh!” There it is again, a sort-of grunt. you risk the energy to try? Would they even How many times have you practiced the You’ll take it. The drool is overwhelming. know what is wrong, what to do? It’s January logarithm? Thousands? You lean over the sink, spit, spit again, and out there, bitter cold. If you collapse on the Open the airway. I’m trying. Got to get a you tentatively try inhaling. Not too fast, sidewalk, you won’t be found in time. breath. Got to get a breath. There’s no airway. easy does it. Alarm pulses through you still, How can this be happening? Heimlich yourself, go ahead. You’ve read but you’re hearing the high-pitched evidence Can you move any air? You pull, hard, the stories. It’s Reader’s Digest stuff, but people of full-obstruction-turned-partial. Maybe, with your belly. It’s like sucking on a plastic have done it; they’ve saved their own lives. just maybe, this could end better than you water bottle; your ribcage collapses in, but no You eye the kitchen counter. Oddly, you were beginning to imagine. air moves. You press out, but nothing! recall installing it in the fall, admiring its You lean, spitting over the sink. The The memory of that time you had a bad pretty pattern. You step back from it, black image of a filled balloon, opening pinched— moment choking on—of all things—a rasp- stars beginning to dance across the scene. You that sound—comes to mind. You draw in berry at a restaurant comes up. That was a place your right hand near the xyphoid and with careful urgency. Please don’t close off partial obstruction, and the effort required drop heavily against the edge of the brown again, please God let me breathe. Yes. Oxy- to move air created a high-pitched squeak imitation-granite counter. gen. Your heart is a drum accompanying the that silenced the rest of the tables. People “Uh!” A primal-sounding thing. A half- discord. Your belly sucks air, pulling hard, turned to watch, wondering “What in the breath of stale air expelled. Good! Air out managing to deliver, little by little, some world?” Your friend was preparing to come means air in. Doesn’t it? blessed relief. You manage a few throat- around behind you to try the Heimlich But no. You try inhaling until your rib- clearing coughs. The lifeline is the size of maneuver when you finally—finally!—man- cage aches. Nope. Nothing. The only sounds a cocktail straw, but it’s enough for now. aged to suck in enough air to cough, once, are the TV and a strange buzzing in your Head bowed, still drooling, you breathe. You twice, maybe three times, and then the ears. Your muteness feels appalling. You lean breathe. You breathe. g

THE JOURNAL | September/October 2012 41 g retrospace EMS Triage It’s about time, it’s about place, and it’s about protocol Audrey Fraizer

f a call came in from a 13-year-old girl calmly reporting a teenage boy trying to Ibreak into her house, how would you dispatch the incident? 1. A disturbance or nuisance call 2. A stalking or harassment call Without more information, you might classify the call as either of the above and unwittingly jeopardize the safety of the caller by sending an ALPHA (whenever) or BRAVO (when available) response. Of course, in this era of emergency dispatch, the calltaker would ask several more appropriate questions. In the case of a suspected disturbance/nuisance classification (Police Protocol 113), a “yes” to Key Question 5 could make the difference between life and death in situations like these. It’s a question that could have saved the life of a 13-year- old girl police found dead 40 minutes after she made this very call. The call had been classified as a “routine juvenile disturbance.” It was a simple human error made in the interest of appropriate resource allocation, in the judgment of James E. George, M.D., J.D., in a three-page article that comprised the major editorial content of a 1981 edition of the EMT Legal Bulletin. Dr. George, senior editor for the Bul- letin, did not lay sole fault on either the the evolving science of emergency medical A third component missing from the dispatcher or responding officers. In his dispatching, he had a keen—almost prescient, list was perhaps the most important. While opinion, the tragic outcome of the break-in predictive—idea of how to reduce a dispatch- dispatchers often engaged in some form of was a consequence of an ineffective EMS er’s risk of medical and legal liability. And it evaluation of incoming calls, most centers triage process that, ultimately, left the door wasn’t a question of “if” but “when.” practiced a sort of flying-by-the-seat-of-their- wide open for error, and the dispatcher According to Dr. George, “Where serious pants system to calltaking. Few had clearly potentially liable for negligence. risks can be reasonably anticipated the law articulated written policy in support of tele- Errors may stem from several sources, requires that precaution be taken.” His advice phone screening of emergency calls, coupled Dr. George stated in the article: “The dis - regarding the minimal safeguards to prevent with sound guidelines and protocols that, patchers may underestimate the urgency of or reduce error of the kind resulting in the according to Dr. George, “would provide a a situation or err in gathering or recording death of the 13-year-old girl included: ray of legal light in an otherwise murky area essential information. Should harm result to • Confirmation of the caller’s address and of heavy potential liability.” a patient because of a dispatching error, the phone number At the same time, Dr. George stated, dispatcher as well as his employer may be “Dispatchers had to avoid the appearance held liable for negligence.” • Tape-recording calls and responses to of responding to or categorizing emergency Dr. George was a prolific writer on all make sure that the information written calls in a haphazard or arbitrary manner.” things medico-legal. Although he had no down by the dispatcher is the informa- Dispatchers needed “reasonable guidelines” direct training, education, or experience in tion actually received that would, among other goals, provide a

42 THE JOURNAL | emergencydispatch.org Woodbury, N.J., as well as president of Team Health East, also in Woodbury. While he and Dr. Clawson haven’t crossed paths for years, he still remembers the intensity and enthusiasm Dr. Clawson brought to all matters relating to emer - gency medical dispatch. “He introduced an interesting concept,” Dr. George said. “Many years back, we would run into each other at conferences and it was about the same time we started to hear good stories about the work he was doing. His system for emergency dispatching made perfect sense to me.” The Salt Lake City ordinance has remained on the books and has since been revised: 11.04.130: EMERGENCY SERVICES; UNLAWFUL TO REQUEST SERVICE WHEN: “Any person who shall request the city fire department emergency medical system to respond unnecessarily, falsely, capri- ciously or for nonemergency situations shall be guilty of a misdemeanor.

B. For the purpose of this section, nonemergency situations shall be the following: alcohol intoxication, minor lacerations, structure to respond based on fact and not tions, hives without difficulty breathing, minor contusions and sprains, minor gut reaction. The ideal system would also dis- non life-threatening overdoses, and many illnesses, insect and animal bites not courage unnecessary calls and curb the abuse other minor situations. deemed emergencies, rashes, skin disor- of the EMS system. This ordinance was viewed as one way to ders, hives without dyspnea (difficulty A unique example of such a system solve the “uncomfortable dilemma” facing of breathing), home delivery to avoid existed in Salt Lake City, according to Dr. EMS—providing prompt and appropriate doctor and hospital services, venereal George. The Salt Lake City Fire Depart - care in the face of rising costs and demands— disease, patients seeking nonemergency ment communications center was the first and curtail abuse by callers demanding ser- transportation, forehead and scalp lacer- in the world to use the Priority Dispatch vices for nonurgent situations. ations only, cold syndrome, sore throat, System™ for emergency triage and the Salt “I applauded what Salt Lake was doing,” earache, hiccough, nervousness, anxiety, Lake City Council was a forerunner in Dr. George said. “The city and Jeff’s protocol toothache, minor bruises, nonlife threat- led to tremendous strides in EMS.” controlling emergency triage by ordinance. ening overdoses, nonlife threatening Callers could be fined up to $299 or spend Dr. George had been practicing emer - self-inflicted injuries. (1987 Code: prior up to six months in jail for requesting gency medicine for close to 12 years when code § 14-2-8.1)” emergency medical services when no real he wrote the article. Thirty-two years later, emergency existed. For example, the ordi- he maintains his medical and legal licenses A class C misdemeanor conviction can nance defined nonemergency situations to and serves as chairman of Emergency Medi- result in 90 days in jail and up to $1,500 in include alcohol intoxication, minor lacera- cine at Underwood Memorial Hospital in fines and surcharge.g

THE JOURNAL | September/October 2012 43 THE PREMIER EDUCATIONAL CONFERENCE FOR POLICE, FIRE, AND MEDICAL DISPATCH

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44 THE JOURNAL | emergencydispatch.org