INTERNATIONAL ACADEMIES OF EMERGENCY DISPATCH MAY | JUNE 2017
FIRST ACE STILL PROPER SUICIDE SAVING A LIFE 10 | GOING STRONG 32 | INTERVENTION 44 | AFTER HOURS
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prioritydispatch.net | 800.363.9127 • •• COLUMNS MAY • JUNE 2017 | VOL. 21 NO. 3
4 | contributors 5 | the skinny 6 | dear reader 7 | from the emd side 8 | ask doc 9 | research • •• SECTIONS BEST PRACTICES
10 | ace achievers 13 | center piece 15 | faq
ON TRACK
32 | police cde 36 | medical cde 40 | blast from the past
YOUR SPACE
43 | dispatch in action • •• FEATURES
CASE EXIT 17 | fast facts—NAVIGATOR
46 | after the accident 18 | NAVIGATOR 2017 Another amazing NAVIGATOR event inspired and educated. See what happened at this year’s conference in New Orleans.
26 | APPS FOR DISPATCH A handful of smartphone apps are now available to help comm. centers provide enhanced service to their callers.
COVER PHOTO BY JOSHUA BRASTED Follow IAED on social media.
The following U.S. patents may apply to portions of the MPDS or software depicted in this periodical: 5,857,966; 5,989,187; 6,004,266; 6,010,451; 6,053,864; 6,076,065; 6,078,894; 6,106,459; 6,607,481; 7,106,835; 7,428,301; 7,645,234. The PPDS is protected by U.S. patent 7,436,937. FPDS patents are pending. Other U.S. and foreign patents pending. Protocol-related terminology in this text is additionally copyrighted within each of the NAED’s discipline-specific protocols. Original MPDS, FPDS, and PPDS copyrights established in September 1979, August 2000, and August 2001, respectively. Subsequent editions and supporting material copyrighted as issued. Portions of this periodical come from material previously copyrighted beginning in 1979 through the present.
may / june 2017 | THE JOURNAL 3 ••• CONTRIBUTORS
Art is a software instructor Sherri is the training and and IAED™-certified ED-Q™ operations manager for Waukesha instructor for Priority Dispatch County Communications, Corp.™ He has been a fire and Wisconsin, USA, a combined EMS dispatcher for 18 years and dispatch center in southeastern works at Union County Regional Wisconsin, just west of Milwaukee, Communications in Westfield, a land where the beer runs freely New Jersey, USA. Art has been and locals proudly stack cheese involved in 911 telecommunicator on just about everything and call training and medical quality it great. You can contact Sherri assurance since 1999. at 262-446-5085 or by email at [email protected].
ART BRAUNSCHWEIGER SHERRI STIGLER 7 | FROM THE EMD SIDE 20 | NAVIGATOR
Bonnie has been a dispatcher Ryan is the Communications with Waukesha County Specialist for the 911 Wellness Communications, Waukesha, Foundation, a nonprofit working Wisconsin, USA, since 2010. to optimize the overall health She is an APCO-certified and well-being of emergency Communications Training dispatchers. Ryan is a former Officer, a member of the center’s Police Communications Operator quality assurance team, and and currently serves as an Adjunct an IAED™ ETC instructor. She Instructor at the Golden West enjoys working with and sharing College Criminal Justice Training her knowledge and expertise Center in Southern California. with people interested in the emergency services career. BONNIE DOUGLAS RYAN DEDMON 13 | CENTER PIECE 20 | NAVIGATOR
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4 THE JOURNAL | iaedjournal.org THE SKINNY •••
INTERNATIONAL INTERNATIONAL OFFICES ACADEMIES OF AUSTRALASIAN OFFICE EMERGENCY DISPATCH 011-61-3-9806-1772 110 South Regent Street, 8th Floor CANADIAN OFFICE Salt Lake City, UT 84111 USA 1-514-910-1301 USA/Canada toll-free: 800-960-6236 Intl/Local: 801-359-6916 EUROPEAN OFFICE Fax: 801-359-0996 011-43-5337-66248 www.emergencydispatch.org ITALIAN OFFICE [email protected] 011-39-011-1988-7151 MALAYSIAN OFFICE 011-603-2168-4798 U.K. OFFICE 011-44-0-117-934-9732 THE WHOLE ENCHILADA IAED JOURNAL STAFF CREATIVE DIRECTOR DIRECTOR OF ACADEMICS Lots of substance served up in this issue Kris Christensen Berg Isabel Gardett MANAGING EDITOR PRINT AND LICENSING ADMINISTRATOR Audrey Fraizer Jess Cook Heather Darata TECHNICAL EDITOR WEB DESIGNER Brett A. Patterson Dave Tyler SENIOR EDITOR INTERNATIONAL TRANSLATORS Josh McFadden Hien Cam Giuditta Easthope t’s hard to believe it’s already summer. We have a lot in store COPY EDITOR Veronika Fagerer Heather Darata Abbas Hamed for you this time around. In addition to our NAVIGATOR ASSISTANT EDITORS Lu Huan Audrey Gonzalez Michel Looyé Rebecca Tuft Marco Mora coverage, we have a feature that touches on four specific Sara Scott I SENIOR DESIGNER Zhang Shengdong smartphone apps. Bystander CPR offers step-by-step CPR Serina Nielson Carolyn Turcotte instructions and alerts users to the closest AED. GoodSAM alerts ACADEMY STAFF the closest volunteer responders registered with the app when PRESIDENT DIRECTOR OF INTERNATIONAL RELATIONS Jerry Overton Amelia Clawson there is a cardiac arrest. The volunteer responder accepting the ASSOCIATE DIRECTOR | U.K. ASSOCIATE DIRECTOR, MEMBER SERVICES Beverley Logan Arabella VanBeuge alert gets a map with the patient’s location and the location of ASSOCIATE DIRECTOR | AUSTRALASIA ASSOCIATE DIRECTOR, Peter Hamilton INSTRUCTOR SERVICES the closest AED and has access to the app’s tools, including a Bonni Stockman ACADEMICS & STANDARDS ASSOCIATE Brett A. Patterson ASSOCIATE DIRECTOR OF MEDICAL metronome and on-scene video streaming. Check out our feature CONTROL AND QUALITY PROCESSES ASSOCIATE DIRECTOR OF ACCREDITATION Brian A. Dale Kim Rigden to learn about the PulsePoint and FirstNet apps. People might think summer sunshine puts suicidal thoughts BOARDS & COUNCILS at bay, but it’s just not true. Suicide is the eighth-leading cause ACCREDITATION BOARD CHAIR COUNCIL OF STANDARDS CHAIRS Jerry Overton Brett A. Patterson (Medical/EMD) Gary Galasso (Fire/EFD) of death in the U.S., with 30,000 people dying each year. To ALLIANCE BOARD CHAIR Tamra Wiggins (Police/EPD) Keith Griffiths Michael Spath (ED-Q) learn about Crisis Intervention Training in addition to how the CERTIFICATION BOARD CHAIR Conrad Fivaz, MD (ECNS) Pamela Stewart CURRICULUM COUNCIL CHAIRS medical and police protocols are each used to handle suicide, read RESEARCH COUNCIL CHAIR Victoria Maguire (Medical/EMD Board) Marc Gay Mike Thompson (Fire/EFD Board) Jaci Fox (Police/EPD Board) the CDE articles in our OnTrack section and take the quizzes to Susi Marsan (ETC Board) Deanna Mateo-Mih (ED-Q Board) receive credit. Gigi Marshall (ECNS Board) If you’re in the mood for a cross-country trip, check COLLEGE OF FELLOWS out our Best Practices section to learn about Waukesha CHAIR UNITED STATES Marie Leroux Bill Auchterlonie (Kansas) County Communications (WCC), Wisconsin, USA, and the Robert Bass, MD (Maryland) AUSTRALASIA | SOUTH AMERICA Catherine L. Bishop (Michigan) Frank Archer, MD (Australia) Christopher W. Bradford (Florida) Albuquerque Fire Department (AFD) in New Mexico, USA. Andrew K. Bacon, MD (Australia) (Emeritus) Geoff Cady (California) Peter Lockie (New Zealand) Steven M. Carlo (New York) Peter Pilon (Australia) Jeff Clawson, MD (Utah) WCC provides emergency communication services for 21 fire/ Phil Coco (Connecticut) CANADA Chip Darius, MA (Connecticut) EMS agencies and 19 law enforcement agencies in the county. Drew Burgwin (Br. Columbia) Kate Dernocoeur (Michigan) Claude Desrosiers (Québec) Norm Dinerman, MD (Maine) ™ Douglas Eyolfson, MD (Manitoba) Patricia J. Dukes, MICT (Hawaii) AFD made history by becoming the first-ever IAED Accredited Martin Friedberg, MD (Ontario) James V. Dunford, MD (California) Marc Gay (Québec) (Emeritus) Conrad Fivaz, MD (Utah) Center of Excellence (ACE). Marie Leroux, RN (Québec) (Emeritus) Gary Galasso (Utah) Paul Morck (Alberta) Keith Griffiths (California) Wayne Smith, MD (Québec) Jeffrey R. Grunow, MSN (Utah) Your favorites are in here too—Ask Doc and FAQ. EUROPE Darren Judd (Utah) Alexander Kuehl, MD, MPH (New York) Make sure you don’t miss out on an amazing survival story André Baumann (Germany) (Emeritus) Jan de Nooij, MD (Netherlands) James Lake (South Carolina) Gianluca Ghiselli, MD (Italy) James Lanier (Florida) in our Your Space section. Miraculously, Jonathan Arteaga Jean-marc Labourey, MD (France) Stephen L’Heureux (New Hampshire) Harm van de Pas, MD (Netherlands) Victoria A. Maguire (Michigan) (Emeritus) lived to tell the tale after a 37,000-pound mobile home fell Bernhard Segall, MD (Austria) Sheila Malone (Indiana) Gernot Vergeiner (Austria) (Emeritus) Susi Marsan (Georgia) (Emeritus) Christine Wägli (Switzerland) Robert L. Martin (California) on him. Montgomery County Hospital District (Texas, USA) UNITED KINGDOM | IRELAND Dave Massengale (California) Trevor Baldwin (England) Jerry L. Overton (Utah) communication center EMD Danielle Williams answered the Tracey Barron (England) Eric Parry, ENP (Utah) Michael Delaney (Ireland) Rick W. Patrick (Pennsylvania) Louise Ganley (England) Brett A. Patterson (Florida) call. The two later had the chance to meet. Also inspiring is the James Gummett (England) (Emeritus) Paul E. Pepe, MD, MPH (Texas) Chris Hartley-Sharpe (England) Ross Rutschman (Oregon) (Emeritus) story of Anthony Bruno from Las Vegas Fire & Rescue, Nevada, Andy Heward (England) Joe Ryan, MD (Nevada) Stuart Ide (England) Doug Smith-Lee (Washington) Peter Keating (Ireland) Tom Somers (California) USA. On his way home after his shift had ended at 2 a.m., he Ray Lunt (England) Paul Stiegler, MD (Wisconsin) Andy Newton (England) (Emeritus) Michael Thompson (Utah) came across an emergency scene. After stopping at the scene, he Janette K. Turner (England) Carl C. Van Cott (North Carolina) Arthur H. Yancey, II, MD, MPH (Georgia) Tina Young (Colorado) heard a noise. His investigation led to a person in need of help, The Journal of Emergency Dispatch is the official bimonthly publication of the International Academies of Emergency Dispatch® (IAED™), a nonprofit, standard-setting organization promoting safe and effective emergency dispatch services about 100 yards away from the initial accident. Bruno has been worldwide. Comprised of three allied academies for medical, fire, and police dispatching, the IAED supports first-responder- related research, unified protocol application, legislation for emergency call-center regulation, and strengthening the emergency dispatch community through education, certification, and accreditation. recognized with several awards for his role in helping save the General IAED membership, which includes a Journal subscription, is available for $19 annually, $35 for two years, or $49 for three years. Non-member subscriptions are available for $25 annually. By meeting certain requirements, certified man’s life. J membership is provided for qualified individual applicants. Accredited Center of Excellence status is also available to dispatch agencies that comply with Academy standards. ©2017 IAED. All rights reserved.
may / june 2017 | THE JOURNAL 5 ••• dear reader
DOUBLE THE FUN NAVIGATOR, NTW highlight eventful week
Josh McFadden
ere at the Academy, we spend had provided during the week. It was emergency or to send a battalion emergency. months preparing to put on obvious that you take NTW seriously and That is a huge responsibility. Not everyone Ha memorable, educational, that you’re all part of a large group of like- can handle that responsibility. This is a enjoyable NAVIGATOR conference minded, hard-working professionals. special skill not everyone is built to do, but each year. We expend a great deal of My favorite part of promoting NTW if you are you must find it in yourself to time, energy, and resources to ensure it’s a on social media was when I posed this pick up the line and answer that call.” worthwhile week for you. open-ended question: “How do you — Patty Fernandez-Andres In years past, National Public Safety encourage someone to overcome the stress “Don't give up. The task of learning Telecommunicators Week (NTW) of the job and find success?” I asked our this job seems insurmountable, but it preceded NAVIGATOR. NTW gives followers to tell everyone what advice isn't. Take full advantage of the time you special acknowledgement and appreciation they would give a struggling dispatcher/ have with your trainer and learn as much to dispatchers and calltakers everywhere calltaker. The response was fantastic, and as you can from them; take the best of for their dedicated efforts as the first, first everyone who participated gave excellent each dispatcher you train with and put responders. It has been the perfect way to get advice. Here are some of the most those pieces together to be the best you ready for our annual conference. This year, insightful words of wisdom: can be. Most importantly, remember that however, NAVIGATOR we are all here for you!” was held a couple of weeks — Dawn Michele earlier than usual, placing “You will have good it at the same time as days and bad days—days NTW. This created some that you feel on top of the challenges on our end, as world because you know we tried to give appropriate you saved a life, and days recognition to each. It was when you just wish you also a unique experience to could go through the phone celebrate both important and do something to make a occasions simultaneously. difference. We all have the While a portion of days when the only thing our staff headed to New that helps is just being there, Orleans, Louisiana, USA, for and sometimes it is just to NAVIGATOR, April 12–14, listen and offer words of others remained behind to encouragement. But never take care of other duties. I had doubt for one second you the pleasure of promoting are not doing enough or you NTW on social media, and are not making a difference, it was enjoyable to see how because you are.” centers in the U.S. recognized This was one of the many thoughtful responses we got for our NTW Facebook campaign. — Lisa Howard the week. That was just a small Followers of our Facebook page sent “Each call that we take changes a life. sample of the wonderful responses us photos of themselves and their co- When a caller dials 911 it begins a chain of we received during NTW. It is a workers dressing up as superheroes or in events that in large part is controlled by pleasure to be involved in a small way crazy outfits. Others provided pictures you. That call creates a ripple effect. The in this profession and to hear so many of comm. center employees eating meals size of that effect is determined by you. inspiring stories and examples of together that local restaurants or stores You determine when to send a unit non- devotion and heroism. J
6 THE JOURNAL | iaedjournal.org from the emd side •••
MEET BROCK One victim’s legacy to the Medical Protocol
Art Braunschweiger
his column is dedicated to the that. I always give callers the instruction ProQA: one to access the Go To Specific young man in the photo. His name to get an AED if there’s one available.” PAIs button (“Target Tool”), one to Tis Brock Ruether. In May of 2012 Unfortunately, there usually isn’t; at highlight Protocol Z (AED Support), and he was a talented, athletic 16-year-old least, that’s what most of our callers a double-click on Panel Z4 – Place AED. living in Alberta, Canada, when he went say. Granted, not many people have And please, don’t just read this. Run a test to volleyball practice at his high school defibrillators in their homes. But think call and try it. one evening. During play, Brock collapsed about the places where from sudden cardiac arrest (SCA). CPR there are defibrillators. was started within a few minutes, but Large stores, office it didn’t save him. Sadly, the AED that complexes, movie could have saved his life was brought to theaters, and other high- his side and never used. occupancy buildings are Brock’s mom, Kim, now spends almost certain to have her time educating the public on SCA an AED mounted on the and the need for better AED access wall somewhere. Next and awareness in schools. (75 percent time you receive a call of SCA deaths in children occur on for a cardiac arrest from school grounds.) The statistics on SCA one of those places, and are sobering: nine out of 10 victims die, the caller says there’s including 7,000 to 10,000 children every no AED available, year in North America. Yet the chances remember Brock. Step of survival are nearly 100 percent if the out of the Protocol shock from an AED is administered for a moment and say within one minute of collapse. That “Sir, there should be a shock is arguably even more important defibrillator somewhere than CPR because SCA usually results in the building. Send from ventricular fibrillation, an erratic someone to go look for and ineffective beating of the heart that it.” That’s not freelancing; can only be corrected with an electrical it’s lifesaving. The shock from an AED—a defibrillator. caller may be in such Brock Ruether Brock’s death was the catalyst for tunnel vision because several changes in the Medical Priority of the patient’s collapse that they’re not Lastly, when you receive a call for Dispatch System™ Protocol. The AED thinking beyond the immediate area a patient in their early 20s or younger instructions have since been revised, and they’re calling from. Your prompt could who collapses with no outward cause, an AED dashboard has been added to literally mean the difference between a sudden cardiac arrest should be the first ProQA® medical. And in Version 13.0 positive outcome and a pronouncement thing you consider. Remember, too, that of the Protocol, to increase calltaker of death. breathing descriptions of “gasping,” “a little,” awareness of the vital need for the caller But what happens if you tell ProQA “barely,” and similar terms describe agonal to get and use an AED, Brock’s Law was there isn’t a defibrillator available, and respirations—not effective breathing. And added. It simply and directly states that as you’re doing compressions the caller remember Brock. Defibrillation is critical to “The presence of an AED does not ensure volunteers that someone showed up with survival. Get that AED to the patient’s side its use—the EMD does.” one? Would you know how to get to the and make sure it’s used without delay. J You might be thinking, “I know AED pathway? It only takes four clicks in
may / june 2017 | THE JOURNAL 7 ••• ask doc
‘CAN’T BREATHE’ OR ‘CAN’T BREATHE AT ALL’ Substance or Semantics?
Dr. Jeff Clawson, Brett Patterson
erhaps the most influential agents Additionally, there is field data to suggest Likewise, a same or similar of change for the MPDS® are the that most of these patients are not as sick INEFFECTIVE BREATHING term may Pactual users. From Proposals for as the “Can’t breathe at all” group. In fact, be used when it is obvious the patient is Change (PFC) to rapid input regarding many of them are reported to be 1st party not in severe distress, most commonly the newest beta version, users provide the callers speaking in full sentences, while when 1st party callers are involved. This real-life feedback so necessary for quality stating, “I can’t breathe.” is most likely when the 1st party patient protocol evolution. In response to this excellent feedback, states “I can’t breathe” but is otherwise Case in point: MPDS v13.0 the Academy’s Rules Group, a working speaking in complete sentences without contained changes to the ECHO-related, sub-group of the Council of Standards, obvious distress. Again, the goal here is INEFFECTIVE BREATHING section of is in the process of addressing this issue appropriate triage in the best interest of Case Entry. These changes were inspired by removing the parentheses from this the patient, not simple word matching by by PFCs that detailed actual cases where phrase and addressing the issue here, the EMD. EMDs did not select an ECHO code in print. The Academy owes a great deal because the caller’s description did not The intent of the INEFFECTIVE of gratitude to the EMDs and their EXACTLY match the quoted phrases in BREATHING section, and its link to the agencies who take the time and effort to this section of the Protocol. In other words, ECHO code, is to capture the most acutely provide the feedback so important to the the patient was actually in dire straits but, ill patients that can benefit from the evolution of the MPDS. In this case, the because the description did not match the immediate response of the closest available feedback is being used to “fast-track” this Protocol phrase exactly, the EMD did not trained responder who, in many cases, is change into ProQA® and make it available code the call as ECHO. not part of the standard EMS response to users as soon as possible, perhaps In reality, these phrases were taken team (e.g., HAZMAT units, ladder trucks, even by the time of this printing. In the from actual calls, which is why they are police, etc.). Patients with INEFFECTIVE meantime, EMDs and ED-Qs should placed as quotations. However, they were BREATHING, as the term strongly consider the phrase “Can’t breathe” with never meant to be exact or absolutes. So, suggests, are not breathing adequately discretion when it is offered alone or after considering the related PFCs, the to sustain life. And it is expected that without further clarification, meaning Council of Standards voted to make a while emergency callers have predictable it is no longer a mandatory, ECHO-level couple of changes to clear things up. First, tendencies in their descriptions of these phrase in and of itself. the phase “… or reasonable equivalents …” patients, there is bound to be some Brett A. Patterson was added to the directive at the beginning variation. Therefore, EMDs should be Academics & Standards Associate of the section, and this has worked out encouraged to consider not only the Chair, Medical Council of Standards very well. Additionally, to more directly caller’s vernacular, but also the scenario International Academies of address one of the PFCs, the phrase “Can’t and any additional clues it may provide. Emergency Dispatch® breathe at all” was changed to read “Can’t Certainly, if the caller describes a patient Special thanks to the Central breathe (at all).” using one of the listed terms, and there Communications Center for Alberta Health But while the intent of the later are no obvious circumstances to the Services in Edmonton, Alberta, Canada; the change was actually to allow more contrary, INEFFECTIVE BREATHING Toronto Paramedic Services Communications discrepancy on the part of the EMD, it must be assumed and the appropriate in Canada; the Alameda County EMS has apparently opened the gates a little code assigned. But if the exact term or Authority in San Leandro, California, USA; too wide. Several high-volume agencies phrase is not used, and the EMD strongly the Oakland Fire Department in California, have reported spikes in the number of suspects INEFFECTIVE BREATHING, USA; and the various IAED™ National Q ECHO-level calls and have provided caution must always err in the patient’s clients who submitted their concerns and data that links the complaint of “Can’t favor; 1st party callers offer direct, audible supportive data to facilitate this important breathe” alone to the volume increase. assessment of their breathing status. change in the MPDS. J
8 THE JOURNAL | iaedjournal.org research •••
CELEBRATION OF INNOVATION Conference explores advances in EMS and dispatch
Christopher Olola, Ph.D.
he halls were lined with row The results support related (non- with NAEMSP allowing researchers after row of intriguing research IAED) studies: A metronome for five minutes to explain their research, Tsummations presented on posters dispatchers to direct bystanders in leaving two minutes to field comments or and submitted from the finest researchers giving CPR is effective in helping questions from the people assembled at in prehospital care. This was a celebration bystanders achieve the correct your display. of innovation and genius in a health compression rate. As it turned out, our concerns went profession considered a significant link in The popular research poster exhibit unwarranted. Our research was well- the history of health care. serves several purposes, not the least of received, and we will carefully consider The event was part of the annual which is the venue to share innovation, the recommendations to improve National Association of EMS Physicians spark discussion, and encourage (metronome) protocol. We are confident (NAEMSP) conference, which was held networking among the many disciplines moving forward to the next step: writing in New Orleans, Louisiana, USA (Jan. under the EMS umbrella. The contest a paper for publication in a peer- 21–26). Educational sessions and research has also grown beyond posters highlighted response safety, expectation, resulting challenges unique to demographics in daily rounds to and geography, and contemporary assemble, view, and issues involving social media and take down posters in credentialing. There were several papers preparation for the on emergency dispatch. next scheduled group. The International Academies of Each day, conference Emergency Dispatch® (IAED™) research goers paraded along the team presented a summary explanation poster route, stopping signifying the first release of data from to hear a synopsis of the the Academy’s metronome study. A information organized metronome audio built into the Medical according to a standard Priority Dispatch System™ (MPDS®) research paper but ProQA® software signals the rescuer to do condensed to fit in a smaller space reviewed journal. We are also planning a chest compression at each click of the (a board). future research posters for conferences metered sound when providing CPR to a Standing in front of a research addressing public safety issues that victim of sudden cardiac arrest. poster to explain the research and benefit from the use of sound, time- The IAED research group conducted answer questions is little different tested, and internationally recognized the study in 2016 at four sites in Salt from standing in front of a classroom protocol systems. Lake City, Utah, USA, with each site audience, at least in terms of potential The research poster competition characterizing a different demographic unease. Both can be daunting. You complements the Academy’s goal to population (junior high, assisted living might ask yourself: Is data presented evaluate dispatch protocols through residential setting, community college, logically? What about visual appeal? an evidence-based process. It’s a stage and university). Participants were Did we catch spelling and grammatical allowing the Academy to showcase the randomly allocated to either of two errors and graphic blemishes? Did we importance of emergency dispatch to groups: standard instructions given by prepare an adequate summary? Will public safety and the power of protocol. EMDs over the phone (control group), our research generate discussion and We returned to our offices knowing and instructions complemented by questions? Will we leave our audience a our research lends to the vital link of the metronome audio over the phone take home message, perhaps stimulating understanding where we came from and (experimental group). further research? Time is a huge concern, where we go from here. J
may / june 2017 | THE JOURNAL 9 ••• BEST PRACTICES | ace achievers
Albuquerque Fire Department RIGHT THING TO DO First ACE was accomplished for the people
Audrey Fraizer
om Montoya helped write one and the ACE award in February 1993 like it firefighter,” said Chavez, now an for the Academy records nearly occurred in more recent times: Lt. Cosmes Academy Fire and Medical Protocol T24 years ago in his move from Madrid, supervisor; Lt. Randy Pennington, Instructor. “It was a place to mend before Denver, Colorado, USA, to Albuquerque, quality assurance; Capt. Jay Staeden, who going back in the field.” New Mexico, USA. was in charge of the Alarm Room; Assistant A growing recognition of what dispatch At the same time, he’s reluctant to Chief John Brown, who later became a fire actually does shifted perspectives, and by take any credit for the history-making chief in Texas; and Sharon Eberly, who the time Chavez was assigned to the Alarm first-ever Accredited Center of Excellence provided direct IT support and data analysis. Room years into the use of the Medical (ACE) achieved during his three-year “Those were the guys cementing the Priority Dispatch System™ (MPDS®), (1990–1993) tenure as chief of the changes in the Alarm Room,” Montoya said. dispatch was no longer second class. Albuquerque Fire Department (AFD). “This was all part of an EMS system change, “Dispatch was moving in a forward “I would like to take more credit,” said and there was a lot I needed to get done.” direction,” he said. “This was a promotion Montoya, who retired from firefighting in The Alarm Room, or communication and not a place for recovery.” 2008 and now lives in Denver. “I kind of center, is an assignment. AFD operates stood aside and let staff do their work.” on a four-year rotation, promoting and Gaining momentum The AFD Alarm Room is a fire assigning firefighters to a multitude of In 1990, two dispatchers working and medical ACE. In February 2017, department roles. Dispatch wasn’t always out of a converted storage room handled the center received its sixth medical a coveted position, explained Patrick 28,000 calls, with each medical and fire re-accreditation and in 2015, it was re- Chavez, who retired in 2012, following a response meriting the full cavalry: rescue accredited in fire for the third time. 25-year career with AFD. vehicle and pumper truck rushing to the Montoya recalls the names of people “For a long time, dispatch was the scene, lights-and-siren blaring. The Alarm involved both in protocol implementation dumping ground for a sick or injured Room was the communication hub for 19
10 THE JOURNAL | iaedjournal.org ace achievers
fire stations employing 500 firefighters/ to get them going and accepted by the said. “We did the ACE for the people. EMTs. Three paramedics in one vehicle other dispatchers.” We kept on working at it, and like Dr. went on each medical call. Some members of the local firefighters’ Clawson would tell us, ‘It was the right Montoya assigned Brown to oversee union expressed doubt about protocol. thing to do.’ This was about saving lives. dispatch changes, and a three-month study The then-newly elected International Helping people.” subsequently conducted in 1991 showed Association President Capt. Eddie Madrid retired in 2004, after a 20-year an ALS response necessary in 35 percent Varela wanted the system changed. The career at the AFD. His many promotions of the calls; firefighters trained as EMTs determination of ALS or BLS response included AFD Division Commander could sufficiently handle the remaining should be up to the crew, not dispatch. in charge of communications and 65 percent. Staeden had an advantage. As former emergency operations. After retiring, At the same time, Montoya had others union president, he persuaded them to he volunteered with the Rio Rancho in his department scope out potential give MPDS a chance. After all, a change Fire Department. protocol systems. The existing calltaking some perceived as political should not Chavez said Madrid understood the and dispatching system was “ad hoc,” and get in the way of improved procedure, distinction, the hallmark of ACE. Montoya wanted a measureable method as potentially better patient outcomes, and “Cosmes knew the importance of part of a long-term goal to improve patient widely accepted standards. protocol,” Chavez said. “He knew the value outcomes and response times. He also had trusted advocates on of being an ACE. We had the backing of a Several systems were vetted with his side. complete system and Academy research to the MPDS coming out on top because “I liked what protocol could do,” said support what we did.” of scripting, structure, and a constantly Madrid, who stayed 12 years in the Alarm The ACE designation also sent a hands- evolving approach to complement Room following his promotion from the off message to media looking for a story EMS best practices and research. Codes field (firefighter/EMT-B). “It made sense. critical of emergency communication. established to dispatch appropriate response were a clincher. “A serious call and you could pop a dispatch right away,” Montoya said. “Less serious calls and the dispatcher could spend more time on the call without affecting patient outcomes.” The Emergency Medical Authority, which had EMS oversight in Albuquerque and the county, approved reducing staffing on the rescue unit from three firefighters to two firefighter paramedics, with backup by a pumper truck, and implementing the new MPDS. Montoya left AFD in November 1993 for the Castlewood Fire Protection AFD Alarm Room District (now South Metro Fire District) in Centennial, Colorado, less than a year The biggest part was giving instructions “The press came after our dispatch after AFD achieved the world’s first ACE. over the phone before response got there. center twice and didn’t find anything,” he Montoya recalls Academy President Jeff Bleeding. Choking. Heart attack. We had said. “ACE and protocols help. We’re not Clawson, M.D., and Academy Curriculum our part, and we could make a difference.” the type of center news salivates over.” Director Scott Hauert presenting the Protocol remained in force. award at a press conference at AFD Station The ACE, Madrid said, was a Out of storage 1, where the two newly certified EMDs statement of quality, not a contest to In 1996, the two EMDs left their were mastering the use of the MPDS see which center would be first to the storage room for the new AFD fire/ v10.1 cardset. finish line. Madrid knew other centers EMS and police consolidated public Staeden, Montoya said, deserves a lot of using protocol had tried, or were trying, safety communications facility and the credit. but that didn’t pressure the AFD Alarm administrative building. The Fire “He was the one to run with the Room into achieving accreditation. Academy on the first floor eventually protocol,” Montoya said. “He fought hard “It’s not about playing a game,” he moved to a dedicated building next door,
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freeing both floors for the separate police The intuition gained from relying on the importance of our work and the and fire/EMS communication centers. voice and background has also helped. protocol system.” Today, AFD is one of the few dispatch Marrufo won’t ever forget the call from Chavez gives credit to the support from centers in the country staffed by uniform a woman who reported her daughter Dr. Clawson and the team behind AFD firefighters. In 2016, the 26 certified EMDs drowned in the bathtub. The mother Alarm Room’s continued peak performance. and EFDs dispatched 105,000 calls requiring sounded almost relaxed, composed, even “Doc has always been supportive of medical or fire response, a number expected as he gave instructions to get the two- us,” Chavez said. “Reps like Tim Martin to grow at least 10 percent in 2017. Four year-old girl out of the bathtub for CPR. and Chris Murdock [PDC™ client service shift supervisors review 30 calls each “Something wasn’t right,” he said. “The representatives] have taken the relationship month, with any overflow channeled to QA girl survived, but there was something to a new level. They are considered friends Supervisor Alejandro Marrufo, firefighter, off about the situation, the way the and members of our fire department EMT-B, EMD, EFD, EMD-Q®, EFD-Q™. mother behaved.” brotherhood and sisterhood.” Marrufo asked for the dispatch Marrufo relayed his suspicions to The AFD Alarm Room answers all assignment three years ago. He wanted police. Further investigation revealed emergency and non-emergency medical to test a new environment, off field, and the near drowning resulted from the and fire-related requests for service found the change to his liking. mother’s attempt to punish the child by in Albuquerque, and they work in “I get to see the situation from the start,” forcing her into a bath of ice water. conjunction with the Bernalillo County he said. “I have the ability to calm the caller “Those kind of calls stick with you,” he Emergency Communications Center to and situation before response arrives.” said. “They are meaningful. They prove provide service outside of city limits. J
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12 THE JOURNAL | iaedjournal.org center piece
Waukesha County Communications MORE THAN ‘JUST’ CO-WORKERS Waukesha County Communications excels in building community
Bonnie Douglas
n the world of dispatch centers, there assistant. The WCC team provides Bunch’ by any stretch of the imagination. is nothing that quite compares to a emergency communication services for There were hurdles for sure. We learned Iplace that is truly a “home” to its staff. 19 law enforcement agencies and 21 fire/ that with open minds and appreciative A place where family comes first, and EMS agencies in Waukesha County. attitudes, obstacles and challenges can the health of the organization depends In 2016, we answered 346,000 calls for be overcome.” upon the good and purposeful work service. We continue to grow. Consolidation is a challenge under of the family members. A place where the best of circumstances. Technology, the mission, vision, and values are daily The beginning human resource management, and the fare … along with the state’s famous WCC was formed in 2004 with ability to serve the respective law, fire, and cheese. Such is the culture at one of the consolidation of the Waukesha EMS partners efficiently and effectively Wisconsin’s consolidated emergency County Sheriff Department dispatch does not happen overnight. New and dispatch centers, Waukesha County center, the Lake Area Communication unaccustomed processes require open Communications (WCC). Services dispatch center, the Brookfield and respectful communication to create Waukesha County, in southeastern Police Department, and the majority a center determined to provide the best Wisconsin, USA, consists of 576 square of municipal fire departments in service to agencies and the public. miles and, according to the 2014 census, Waukesha County. a population of 395,118. WCC engages “It wasn’t easy those first few Keeping connected 35 emergency telecommunicators, eight years,” said Sherri Stigler, Training and Organizing police and fire/EMS telecommunicators in training, seven Operations Manager. “I always tell people protocol groups went a long way in supervisors, training and operations that it was like blending three families unifying WCC, and they continue to do manager, director, communication center together, each with their own way of so. Monthly meetings of fire, police, and specialist, and emergency preparedness doing things. It certainly wasn’t the ‘Brady EMS field leaders and WCC staff provide
may / june 2017 | THE JOURNAL 13 ••• BEST PRACTICES | center piece
the conduit to address issues, including EMDs, and EFDs, and are taught basic Staff has been working with Wisconsin personnel and equipment updates, skills in geography, CAD system/record state legislators to raise awareness for public feedback, and problematic calls. The management systems navigation, customer safety communication minimum standards center stays connected and hears what is service, phone system operations, and center of education and training as well as #iam911 working and what is not. specific call types. It’s the dispatch floor to reclassify dispatchers to the status of where probationary telecommunicators protected safety telecommunicators. Recruiting and selection begin calltaking training with a CTO Recruiting qualified individuals as and progress through their training on Celebrating success telecommunicators is a never-ending the Teletype, five police dispatch radio We celebrate what we do, especially calls task. To assist with that initiative, channels, and one fire dispatch channel. involving dispatch-assisted CPR “saves” and WCC appointed a committee of Based on prior experience and skillset, the births. Family, media, and staff are invited to telecommunicators, led by a supervisor, process takes six to nine months. these celebrations—when a dispatcher is able responsible for advertising job to cradle a newborn she helped to deliver or opportunities, recruiting, assembling hug a cardiac arrest survivor. resources used to help in making “The level of trust “It does not get any more real for selections, and participating during the and cooperative dispatchers,” Stigler said. “These are the panel interview. The WCC hiring team reinforcing moments that soundly deliver is always on the lookout for potential spirit we see among the ‘this is why we do what we do’ message.” recruits at community and four-year our agencies and the college job fairs. We are family Applicants must take a typing test center is a testament Each new hire receives a WCC and a telecommunicator exam, and those to the commitment of Challenge Coin and signs the “WCC passing both tests are scheduled for a two- everyone who works Oath” describing our mission, vision, and hour “sit-in” with a telecommunicator value statement with an emphasis on and a one-hour written questionnaire or partners at WCC. core values: Family, Integrity, Respect, covering introductory knowledge We can be very proud Responsibility, Service, and Trust. typical of a first interview. Candidates As a family, we throw parties or proceed to a panel interview, representing of that.” potlucks to celebrate major life events communication center staff, human such as milestone birthdays, pending resources, and fire and law enforcement births, and weddings. WCC Director departments. The final hurdle is a Community Gary Bell also gets into the act; he recently background investigation by the WCC is more than “just” an baked a cake in the center’s kitchen to Waukesha County Sheriff’s Department, emergency dispatch center. celebrate a probationary employee’s and conditional offers are provided During the December holiday season, 30th birthday. pending successful completion of hearing staff donates non-perishable goods, Through trial and error, WCC and drug screenings. personal hygiene items, and money to discovered that focusing on hiring local nonprofit organizations. This past people complementing existing staff and Training holiday, a group of telecommunicators principles, offering comprehensive training, The WCC Training Team consists and supervisors baked and distributed providing community involvement of 12 communication training officers thousands of cookies to law enforcement opportunities, and establishing core values (CTOs), three training supervisors, departments and fire departments in provide the foundation for best serving and the training and operations Waukesha County. the public and the fire and police agencies manager. Each training team member The WCC leadership team created depending on what we do. is APCO CTO certified and, as part a Community Education Team (CET) “We are in such a better place now of the job, updates training materials that promotes positive community that we are established,” said Stigler, and takes adult learning training relations between dispatch and the who was hired in 2004 for a supervisory courses when not actively training a public and provides education about position. “The level of trust and probationary telecommunicator. the 911 system and emergency dispatch. cooperative spirit we see among our Training begins with six weeks in a The CET participates in several events agencies and the center is a testament to classroom. Probationary telecommunicators to forge better relationships with the the commitment of everyone who works certify as International Academies of community and law enforcement and or partners at WCC. We can be very Emergency Dispatch® (IAED™) ETCs, fire agencies. proud of that.” J
14 THE JOURNAL | iaedjournal.org faq
FALL OR PUSH? Protocol 30 handles both
Brett Patterson
Brett: traffic than for individual patient injuries. Hello Brett, We have had several recent cases where Specifically, ejection mechanism is related Please help us solve a long-standing people were thrown from a moving car. to the force of going through a windshield, issue within our call center. Is a parachutist They were not in an accident or anything— and auto versus pedestrian is related to the injury a traumatic injury or a fall? The just people thrown out of the car! My discrepancy in mass of one versus the other. jumper jumps out of the aircraft, doesn’t calltakers didn’t know how to properly Therefore, Protocol 30: Traumatic fall out, has a fully inflated parachute, code these incidents. All of the calltakers Injuries (Specific) is most appropriate for lands on ground but breaks an ankle, leg, used different protocols and Determinant a person falling or being pushed out of a etc. What is it? I say it’s a traumatic injury; Codes, such as Protocol 30: Traumatic vehicle, provided there are no significant my co-workers say it’s an EXTREME Injuries, or various codes on Protocol 29, i.e., traffic accident concerns, and the person fall, but like I said, he comes down at the Pedestrian struck or MVA with Ejection. wasn’t subsequently run over. Notably, regular rate of descent as other jumpers Could you provide me with clarification as there is a new Determinant Descriptor in but just doesn’t land right. to how we should properly code this? MPDS® v13.0 that addresses cases such as Thanks, Regards, this when the patient does not appear to be Juan Rodriguez Nicholas J Camisa MICP, NREMTP critically injured but the EMD is concerned Communications Officer EMS Supervisor, University Hospital- about the mechanism of injury: 30-D-5 Joint Communications Unit REMCS, Newark, New Jersey, USA “HIGH VELOCITY impact/MASS injury.” Fort Bragg, North Carolina, USA Thanks, Hi Nicholas: Brett A. Patterson Hi Juan: Protocol 29: Traffic/Transportation Academics & Standards Associate I love long-standing disputes! You are Incidents was designed more for Chair, Medical Council of Standards correct. This mechanism simply doesn’t mechanism of injury and scene safety issues International Academies of Emergency equate to the same forces involved with associated with motor vehicle crashes and Dispatch® an EXTREME fall, and the specific
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injury is the reason for the call. I’ve attached an article from Dr. Clawson that addresses issues such as this. I would also point out that Protocol 30, v13.0, has a new Determinant Descriptor (HIGH VELOCITY Impact/MASS Injury) for cases when the EMD is concerned about a high mechanism, but the body area injured doesn’t code high enough to satisfy the EMD. A similar code is also available on Protocol 29. Hope that helps to settle the debate! Brett
Juan: Protocol 30 would be the appropriate choice. There are a zillion things that cause injuries to people (all you need to do is think of an amusement park and the potential of accidents there). We don’t have a special protocol pathway for accidents involving falls from bicycles. The same goes for skiers. The spectrum of “Tour de France riders” through “kids on tricycles” cannot be jammed simply into a mechanism of injury format. Regarding velocity, we don’t assess on Protocol 30 how fast the boom on the forklift was going when it hit the worker in the back or the speed the skier was going in a downhill race, either. The Protocol does, however, provide information about the severity of the injury in terms of the body area symptoms. Some use MPDS Protocol may present in different ways, and affected in much more detail compared 25: Psychiatric/Abnormal Behavior/ the EMD needs to know “… exactly to Protocol 29. Suicide Attempt, while others use MPDS what happened” in order to select an As you’ve probably determined, even Protocol 26: Sick Person. appropriate protocol. if you go to Protocol 29, you basically end Which would be most appropriate? So, the answer to your question is up in the same Determinant Level based Thank you, to find out not what the caller thinks on what is known and what is not known Michelle Rossi is the underlying problem but rather about the patient’s priority symptoms CMED Telecommunicator, North what sign/symptoms/actions are and injuries. Central Connecticut EMS Council prompting the call. By far the best Hope that helps. Hartford, Connecticut, USA way to do this is to repeat Case Entry Onward through the “what-if” fog ... Question 3. Common to the anxiety Doc Hi Michelle: attack diagnosis are symptoms such When you think about it, a as rapid breathing (Protocol 6), racing Brett: complaint of “anxiety attack” is heart or palpitations (Protocol 19), chest My co-workers and I were having a actually a caller diagnosis rather than pain (Protocol 10), or simple anxiety/ discussion about which protocol to use a description of what has happened. nervousness (Protocol 26). for an anxiety attack. I wonder if you can It’s like saying the patient is drunk I hope this response helps to answer provide some clarification. or is having a heart attack. All of your question. It’s for a patient with no priority these conditions or caller diagnoses Brett J
16 THE JOURNAL | iaedjournal.org 3 32 sessions attendees
5 candy bars 2 handed out research posters
5 countries represented
2 e hibitors tracks speakers excellence | NAVIGATOR 2017 excellence
EXCELLENCE You’ll find it at NAVIGATOR
Audrey Fraizer
xcellence has a way of moving you to the next step Awards and beyond. NAVIGATOR attracts the dedicated—emergency E Excellence has a way of opening your eyes, letting you dispatchers, supervisors and center directors, and public safety see the best path to follow. experts—to a single source that celebrates the profession. The Excellence builds a foundation that benefits you and awards start on opening day and continue through the Closing everyone connecting to your world. Luncheon two days later. When each recipient accepts an And excellence was the theme this year at NAVIGATOR, award, it’s also a sure bet that the person will acknowledge held April 12–14, in the Big Easy. co-workers. “It’s what you do that makes the difference,” said Academy “I couldn’t have done it without my partners,” said President Jerry Overton during his Opening Session remarks Dispatcher of the Year Erin Berry, EMD, Loveland Police building up to this year’s Dispatcher of the Year Award. emergency communications, Loveland, Colorado, USA. Contrary to the nickname bequeathed upon New Orleans, Berry was honored for professional excellence exemplified Louisiana, USA, in the 1970s, however, excellence in emergency by her lifesaving efforts during a call that led to the revival of a communications is neither a slow nor easygoing way of life. Loveland High School student (read the DOY story on pg. 24 to “What you’re doing is everything but that,” Overton learn more). said. “You are committed 24/7 to making a difference. Your And NAVIGATOR awards were just getting started. excellence makes a difference in each and every call.” Jeff Cicillian, former Lake County Sheriff’s Department The distinction of being “extremely good” doesn’t work police officer and 911 center manager, Lake County, Illinois, independent of objectives. It also depends on where you choose USA, received the Instructor of the Year Award. Cicillian to concentrate professional efforts, and, as Overton pointed out, specializes in Emergency Police Dispatch and the Active at NAVIGATOR opportunity abounds, with choices packed Assailant Protocol. into every hour and bordered by some of the best networking in Sherri Stigler, Training and Operations Manager, Waukesha the industry. County Communications, Waukesha, Wisconsin, USA, won “NAVIGATOR is an eye-opener,” said Richard Lindfors, first place in the Research Poster Contest. Quality Improvement Manager, Richmond Ambulance Janice Warshauer, RN, Northwell Health Center for Authority, Richmond, Virginia, USA. “I get to see what other Emergency Medical Services, Syosset, New York, USA, received agencies from the rest of the world are doing. At the end of the the Bill Boehly Award for Clinical Support Desk (CSD) Clinician. day, we’re in the same business, with the same issues, and we’re Charles R. Goodwin, Lead Dispatcher, Natick Police here able to discuss them in a focused, nonworking atmosphere.” Department’s Public Safety Communications Center, Natick,
may / june 2017 | THE JOURNAL 19 excellence | NAVIGATOR 2017
LET THE GOOD TIMES ROLL This is my fourth NAVIGATOR, and it’s always so awesome, especially the First-time USA NAVIGATOR attendee Stephanie Dandonneau, people you get to meet. You realize Operations Chief, Groupe Alerte Santé Inc., Québec, Canada, said you’re not alone. NAVIGATOR is a she was impressed with all of the sessions she attended, and great time to focus on the issues and was especially interested in Kim Rigden’s stress management share ideas. presentation. Dandonneau said their personnel take turns attending Cindy Sparrow, 911 Communications, conferences, and NAVIGATOR in New Orleans, Louisiana, USA, was Red Deer Emergency Services, Alberta, Canada especially exciting for her. “This place is just beautiful,” she said. “I am meeting lots of people I was impressed with the ETC and learning, too.” Instructor manual someone from a Mindy Thomas, Manager, Queensland Ambulance Service, neighboring 911 jurisdiction showed Rockhampton, Australia, traveled all the way from the Land Down me, so I signed up for the instructor Under in order to breathe in the sights and sounds of NAVIGATOR, course at NAVIGATOR. We have a her first American conference. She said networking was a highlight, lot of new hires and want to give particularly when it came to discovering the universality of emergency them an overview of the profession dispatch issues, such as investing so much in training only to see the beyond policies and procedures. new person leave within a few years. The ETC course will provide a “We all have a difference in structure, yes, but I am finding out that great foundation. the challenges are the same,” she said. Laurel Strandberg, Lakewood Police The exquisiteness and excitement of New Orleans cuisine was fully Department, Lakewood, Colorado, USA enjoyed. Though some of us (myself included) did not venture past the safety of our accustomed palates, others were quite adventurous It’s amazing to be in a room with so as they feasted upon the likes of charbroiled oysters, spicy jambalaya, many agencies and open your mind and even alligator wings. I think it was just as much fun to watch their to what the rest of the emergency reactions during those first few bites! communications world is doing. Sherri Stigler, Training and Operations Manager Richard Lindfors, Richmond Ambulance Waukesha County Communications, Waukesha, Wisconsin, USA Authority, Richmond, Virginia, USA
I was pleased to see several breakout sessions that focused Dispatch is my career. I started on stress management, health, and wellness. Christine Bannister, as a volunteer firefighter, got into Supervisor, Waukesha County Communications, Wisconsin, USA, gave a dispatch, and have watched it evolve comprehensive overview of stress and healthy ways to manage it in her for the past 19 years. I liked the presentation, “Wellness For the First, First Responder.” Tami Wiggins, protocol from the start. It gives you Training and QA Manager, Harford County Department of Emergency something great to go by. Services, Maryland, USA, and Madeline Marks, Clinical Psychology Shawn Trainor, Montgomery County Hospital Program, University of Central Florida, USA, partnered for the session, District, Houston, Texas, USA “When Trauma Hits the Dispatch Center.” New sessions included a how-to in creating a 911 public education This is my second NAVIGATOR, and program, presented by Ben Bills, PIO, El Paso-Teller County 9-1-1 I definitely come for the training. I Authority, Colorado, USA, and Sasha Vargas-Fimiani, Public Educator, started out wanting to be a police Charleston County Consolidated 9-1-1 Center, South Carolina, USA. officer, changed into dispatch, and Both are pioneers in the industry using creative ways to engage their loved it. There’s so much about it that communities in the 911 system. I enjoy: the adrenaline rush, helping Ricardo Martinez, Founder, “Within the Trenches Podcast,” and people, and never having the same Creator of #IAM911, recorded several new episodes with guests for day twice. his podcast, recorded live from the Exhibit Hall. I had the honor of Angela Barnes, Dispatch OIC recording Episode #141. Gulfport Police, Gulfport, Mississippi, USA Ryan Dedmon, Founder, Operation 10-8 Anaheim, California, USA
20 THE JOURNAL | iaedjournal.org excellence
at least not in comparison to her customer service. “That was phenomenal, off the charts,” he said. “The caller was responding. They had made a connection.” Entertainment hit a high note with the eagerly anticipated The Big Easy Attendee Party held Wednesday evening at Generations Hall, and the ACE Reception, held Thursday at Mardi Gras World. Getting to the events was half the fun. The second line parade on Wednesday was a tribute to New Orleans in the name of emergency dispatch. A costumed group and brass band, considered the parade’s “main line,” were followed by a large group Academy Associate Director of Medical Control Brian Dale draws a roomful. of revelers (NAVIGATOR attendees), known as the “second line,” starting Massachusetts, USA, was recognized provided insight into Austrian EMS at the Hilton New Orleans Riverside, by the National Center for Missing and innovations that they have helped develop. overlooking the Mississippi River, down Exploited Children (NCMEC). James Gummett and Zerena Duhaney, the famous and fabled streets of the Eric Parry, PSAP Implementations both in Quality Assurance for the London French Quarter. Generations Hall was at Next Generation Advanced 911 Ambulance Service NHS Trust, U.K., built in the early 1820s as a sugar refinery Inc. (NGA911), Salt Lake City, Utah, explained how their large communication and has since been renovated to depict the USA, received the Dr. Jeff Clawson center shares the QA load. history of New Orleans jazz. Leadership Award. A special guest appearance by a The drive to Mardi Gras World First-time ACEs totaled 23 medical, young lady and her family accentuated introduced ACE attendees to the tastes of five fire, and three police agencies. Forty- the positive effect of emergency New Orleans, from hurricanes (and not the eight agencies were re-accredited. communications when you might least type known for winds exceeding 150 mph) expect it (which is the nature of the to Cajun, Creole, and French cuisine, and True intentions business). Emily Cox proved “The Power everything in between. Mardi Gras World NAVIGATOR offers the premier of Protocol to Save Lives, Change Lives, gives a backstage look at the 300,000-square- educational and networking venue. and Make Friends” in a final day session foot float-making warehouse. New Orleans drew 1,320 attendees. The given by Kim Rigden, IAED™ Associate Of course, nobody goes to 113 sessions spread over the three days Director of Accreditation, and Michael NAVIGATOR overlooking those they included 16 tracks presented by new and Spath, Manager, Communications, left back at the comm. center, especially veteran speakers (169 total). A total of Sunnyvale Department of Public Safety, when the week happens to coincide with 42 exhibitors lined up in rows inside the California, USA. In 2007, Rigden coached National Public Safety Telecommunicators coliseum-sized exhibit hall. Emily’s grandmother Cynthia Cox in CPR Week (NTW) (April 10–14, 2017). NTW, A global tone reverberated after then-7-year-old Emily was shocked celebrated in honor of the very people throughout the three days, with in a home accident. The Cox family lived attending NAVIGATOR, is often the most attendees from 15 countries (including within the 911 region covered by the anticipated week of the year, featuring the USA and Canada) and a dedicated British Columbia Ambulance Service, dress-down days, games and prizes, daily international track. where Rigden worked as an EMD. drawings, and food provided by just about Sonia Bounouh, Training/QI Manager, “I knew I made a difference that every branch of local public service. Communications, Hamad Medical day,” said Rigden, who introduced Emily “Sure, I’m missing the celebrations Corporation, Doha, Qatar, described and Cynthia to the standing room only with co-workers,” said Melissa Trcka, the impact of protocol updates on her presentation. “We all are a helping hand Training Coordinator and Quality staff. Siegfried Weinert and Dr. Susanne when people need it most.” Assurance Officer, Vicksburg Warren Ottendorfer, Special Projects Manager Spath, who later Q’d the call at 911, Vicksburg, Mississippi, USA. “But and Medical Director, respectively, 144 Rigden’s request, admitted Rigden’s that’s OK because this is very important Notruf Niederoesterreich, Lower Austria, protocol compliance wasn’t perfect, for our agency.” J
may / june 2017 | THE JOURNAL 21 awards | NAVIGATOR 2017
IAED President Jerry Overton, left, and IAED Co-Founder Jeff Clawson, M.D., right, present the Leadership Award to Eric Parry. CROWD-PLEASERS Awards recognize Emergency Dispatch advocates
Audrey Fraizer
hen it comes to awards, Director, PSAP Implementations at Next And that’s where Dr. Clawson said he NAVIGATOR produces Generation Advanced 911 Inc. (NGA911), made his mistake. Wtop-notch results. This a company based in Los Angeles, “I should have known him a lot year, the IAED™ saluted leadership in California, USA. “I truly don’t know what earlier than I did,” he said. “His work has the emergency dispatch profession and to say. It’s such an honor. I never thought helped changed the course of dispatch in contributions to research. in a million years I’d get this award.” the world.” Parry was introduced to protocol Parry became one of the first Dr. Jeff Clawson Leadership Award through his 24-year career with the Royal Emergency Police Dispatch (EPD) There’s something about the Dr. Jeff J. Canadian Mounted Police (RCMP) instructors and comprehensive Clawson Leadership Award that leaves the where his focus gradually shifted from implementation specialists for the recipient speechless. police work in the field to overseeing the Academy and PDC. He literally wrote At least, the reaction seems to be operations of police dispatch centers. He the book on 911 management training: the norm in the years Dr. Clawson was a Priority Dispatch Corp.™ Emergency Number Professional—the has announced his selection at (PDC™) Police Consultant for nearly “must-read” textbook for National NAVIGATOR’s Closing Luncheon, and eight years and was instrumental in Emergency Number Association this year was no different. developing the Police Priority (NENA) certification course and “I’m stunned,” said Eric Parry, Dispatch System™ (PPDS®). designation. He is past Chair of the EPD
22 THE JOURNAL | iaedjournal.org awards
Council of Standards. Dr. Clawson has USA, said after receiving the Dispatcher of the local hospital EMS coordinator and ER often referred to him as “the Michael the Year Award at NAVIGATOR. physician (also their medical director), in Jordan” of police dispatching. “If you want to know how it order to assist in developing changes to a “He has helped the Police Protocol sometimes feels to be a dispatcher, open a specialized report that would now include to become what it is today,” Dr. book, read partway, and then slam it shut,” time stamps for initial call to 911, dispatch Clawson said. she said. “You never know the outcome.” of medical units, and also hands-on-chest In many cases, being left speechless is times for dispatch-assisted bystander CPR. not that unusual for the award recipient, These completed reports provide a short and Parry is no exception. Parry is a NAVIGATOR is about patient summary as well as X-ray images familiar face and voice in an emergency learning to improve of the affected artery both pre- and post- services career spanning 47 years in the stent placement. The hospital coordinator U.S. and Canada. on so many levels— sends copies of the reports directly to the Following more than 30 years Next Generation 911, communication center, where they are then combined with the RCMP and PDC, shared with the dispatchers who took the he was far from leaving the emergency technology, adult initial call. They are also displayed on the communication profession. learning, training, center’s EMD bulletin board, where they Parry was Program Manager for the and keeping up with are viewed by all staff. State of Utah 911 Program and then Stigler said Emergency Dispatchers Manager of the 911 Division, Utah changes in protocol. have welcomed knowing more of the Communications Authority. He is a My agency is an ACE, narrative, and she would like to expand charter employee of the nearly year-old the outcome program to cover other NGA911. He is on the Denise Amber and that holds us to a medical emergencies. Lee Foundation board and Chair of the higher standard. “It is amazing for our folks to have the NENA Education Advisory Board. opportunity to see how they can impact Kristy Moore, Training Coordinator Through it all, Parry said he has one Kern County Fire Department the entire chain of survival in a very person at the top of his list to thank. Bakersfield, California, USA tangible way,” Stigler said. “Ultimately, “My wife [Joanne] is my cheerleader when dispatchers know ‘the rest of the and has been for all these years,” he said. story,’ it creates a deeper understanding of He gave the $500 honorarium that goes Stigler’s research is working to keep the why we do what we do … and that ‘buy- with the award to the American Cancer book open. She was able to connect with in’ is invaluable.” J Association in honor of Joanne’s sister who recently struggled with breast cancer.
Poster contest Sherri Stigler’s concern for dispatchers led her to first place in the Academy’s fifth annual Research Poster contest. Stigler, Training and Operations Manager, Waukesha County Communications, Wisconsin, USA, focused her research on patient outcome and providing emergency dispatchers with the rest of the story. “We seldom learn what happens to the patient after we hand over the call,” she said. While keeping to the background is part and parcel to the profession, not knowing the outcome of a medical emergency can be downright irksome. It’s like Erin Berry, EMD, Loveland Police Department, Loveland, Colorado, IAED Director of Academics Isabel Gardett, left, congratulates Sherri Stigler for her winning Research Poster.
may / june 2017 | THE JOURNAL 23 dispatcher of the year | NAVIGATOR 2017
Berry had the opportunity to meet Zander’s family. Shortly after the event, nearly 20 people who had helped save his life were honored at the Thompson School District Board of Education meeting. Zander was unable to attend; he was still recovering at the hospital. While at that time the family declined to talk about the incident, Dirk was ready to address the audience at NAVIGATOR. “Sept. 13 [2016] might have been the worst day of our lives, but because of Erin, it turned out to be the best,” he said from the stage. “The hardest part wasn’t the call telling us what had happened, the drive to the hospital, watching the helicopter take off for the children’s hospital in Denver, or waiting. The hardest part for us was how Erin Berry accepts the DOY award among peers and the family she assisted. we could say thank you for saving our son’s life. Thank you for all you do. Thank you for everything you continue to do.” HAPPY REUNION This was the second time in three Wouldn’t have happened without Erin and Protocol years that Loveland Police Department dispatchers have assisted in saving the life Audrey Fraizer of a high school student. In 2014, Tommy Lucero, then a freshman at Thompson Valley High School, collapsed on the rin Berry figured something “There are so many dispatchers from baseball field after running at a team was up when she recognized a different agencies, and they all do an practice. Coaches were able to revive him Efamily she had a met at the police incredible job.” following CPR PAIs over the phone and department in Loveland, Colorado, Berry was recognized for her using the AED at the school. USA, sitting in the front row at the professional abilities exemplified by her “Tommy and I are friends for life,” NAVIGATOR Opening Session. first in the EMS chain of survival effort Berry said. Berry was among 40 dispatchers that led to the teen’s complete recovery. Since then, the Lucero family and nominated for the Dispatcher of the Zander, who was 16 at the time, collapsed McKee Medical Center Foundation Year award, and Loveland Police Chief while running laps on the practice officials have worked to increase the Robert Ticer had insisted she attend track east of the high school. He wasn’t number of AED units inside schools and the conference held in New Orleans, breathing, and he was turning blue. in the community. The Loveland Police Louisiana, USA. Tyler Royse, a member of the Crimson Department and emergency dispatch Not that she would have turned down Regiment percussion section, and are members of the “Heart Safe City,” the invitation, and, yes, she did catch on Loveland High School Resource Police designated by the American Red Cross. to the possibility of receiving the award Officer Bruce Boroski, performed CPR Berry has been with Loveland Police when 17-year-old Zander Kunselman and while others rushed to retrieve the AED dispatch for a total of seven years. his father, Dirk, and mother, Shaudin, inside the high school. Ticer was sworn in as Loveland Police walked into the ballroom. Then, the call After the first shock, Zander’s pulse Chief in June 2016, appealing to the from September 2016 was broadcast returned just at paramedics arrived to type of leader staff wanted, engaged and to the nearly 1,400 communicators in the field. present, which is just what he was doing the audience. Berry closed the call, congratulating at NAVIGATOR. But to be named Dispatcher of the team on the “really great job” they did “Erin is a perfect example of what we the Year? for their friend. Zander spent two weeks do for our community,” he said. “I’ve got a “I am truly honored,” said Berry, in recovery. great department, and I really want them following the award presentation. NAVIGATOR wasn’t the first time to know that I’m here for them.” J
24 THE JOURNAL | iaedjournal.org comm. center tour
on Bourbon Street. EMS and fire set up similar bare-bones answering points. On Sept. 26, one month after Katrina, the Orleans Parish Communication District (OPCD), established in 1982, co-located the three public safety agencies in one room at the Hyatt Regency Hotel, next to the Superdome. This was the first time fire, police, and EMS were co-located, Ireland said. “It had been talked about for years,” she said. “Katrina brought it home. We needed consolidated or, at least, co- located communities.” Three months later, on Dec. 16, OPCD moved operations to temporary facilities at its current location (near Canal Street and City Park Avenue). Seven double- Operations Director Shinar Haynes and Debbi Doucette, Woodland Park PD. wide modular buildings formed one large room. Construction of the 25,000-square- foot dedicated emergency operations WELCOME NAVIGATOR facility spanned three years (2009–2012). OPCD opens doors to six NAVIGATOR tours over three days Consolidation of police, fire, and EMS telecommunicators into OPCD personnel Audrey Fraizer was completed in April 2016. To avoid the shutdown Katrina caused, OPCD was built on a site not flooded f you think people have forgotten Katrina, place. She wasn’t home; she was out in the aftermath of Katrina plus raised think again. The hurricane that devastated of state visiting her son. The story another 5 feet for added protection. Steel- INew Orleans, Louisiana, USA, and its of her frantic efforts to return and reinforced concrete walls can withstand people is as fresh today as it was on Aug. 29, the subsequent residency on a cruise winds greater than 155 mph (Category 5 2005, when Katrina made landfall and the ship temporarily housing EMS would hurricane). The building is blast proof and next morning when the levees collapsed. take up a volume of words. Suffice it ballistic resistant. Scars from the monster storm and to say, disregard images of luxurious OPCD provides the CAD system, compromised levees still weigh heavily on accommodations on a ship built for telephone customer premises equipment, the most damaged parts of the city and in oceanic adventure, Ireland said. electronic mapping (GIS) system, audio the hearts of residents forced to flee and “This was five months living out of a logging of the telephone and radio systems, those who stayed behind. Ultimately, 80 suitcase in a small room and sharing meals and an uninterruptible power supply (UPS) percent of New Orleans and large portions with others similarly stranded,” she said. for the entire E9-1-1 building, backed up of nearby parishes became flooded, and the “Each morning, we’d leave the boat and go by dual generators with eight days of full floodwaters did not recede for weeks. to work.” operations without resupply. Emergency Barbara Ireland doesn’t skip a beat Hurricane Katrina changed everything well water produces 80 gallons per minute, when asked about Katrina. about communications. Katrina flooded and an on-site sewage treatment plant, “This affected everything about both E911 call centers and all E911 independent of city sewage services, can our routines, our worlds,” said Ireland, switching equipment. No E911 or regular process 15,000 gallons per day. who was named Deputy Chief of telephone service was available. On Sept. More than a decade after Katrina, Communications for New Orleans 15, the New Orleans Police Department people, their communities, and commerce Emergency Medical Services (NOEMS) established a rudimentary 911 center are still recovering. The emotional toll shortly after Hurricane Katrina. She has with the assistance of the FBI using 10 lingers, Ireland said. worked in New Orleans EMS for 32 years. single telephones with calls distributed “The trauma of being part of When the storm hit and the levees in round robin (circular hunt group) on something causing others so much pain broke, Ireland was in the worst possible the first floor of the Royal Sonesta Hotel stays with you,” she said. J
may / june 2017 | THE JOURNAL 25 • FEATURE | apps for dispatch HAPPENING APPS Smartphones can extend chance of survival
Audrey Fraizer
26 THE JOURNAL | iaedjournal.org apps for dispatch | FEATURE •
hile there’s not a boatload of apps available exclusively to emergency communication Wcenters, we found some great apps made for mobile devices to complement the goals of first HAPPENING APPS responders behind the headset. GoodSAM Smartphones can extend chance of survival London Ambulance Service (LAS), NHS Trust, U.K., is not about to skip a beat when it comes to phone apps Audrey Fraizer to increase survival rates for patients of cardiac arrest. The “shockingly easy” campaign, which made its debut in 2013, aims to increase public access to automated external defibrillators (AEDs), while a partnership between LAS and the U.K.-based GoodSAM (SAM stands for Smart Phone Activated Medics) organization alerts clinically trained ambulance staff and the public to life-threatening emergency calls, including cardiac arrests. Public members must possess basic life- support skills trained to an LAS standard. As part of the shockingly easy campaign, LAS offers an accreditation program that includes advice, automatic alerts, and debriefings in using the AED in a cardiac emergency. The automatic alerting system informs the accredited organization when a medical emergency occurs and verifies that someone with life-support skills has been informed; the call also alerts the organization to the arrival of ambulance crews. In 2015, 88 bystanders gave electric shocks to people experiencing cardiac arrest, and almost three-quarters of these patients were alive when they arrived at the hospital; more than half of that number recovered and were later discharged. There are about 2,600 defibrillators available across London. The app provides voluntary help to cardiac arrest patients across London. If the control room receives a 999 call about someone in cardiac arrest, an alert goes to the three nearest volunteer responders registered to the GoodSAM app. The app does not replace ambulance response, and it depends on clinically trained ambulance staff and members of the public trained to an LAS standard of basic life support. The volunteer accepting the alert receives a map showing the patient’s location and the closest AED. If the volunteer does not accept the alert or the alert goes unanswered, the alert defaults to the next volunteer. Unanswered alerts are diverted within 20 seconds. Co-founded by prehospital and IT specialists, the GoodSAM app allows users to send a distress signal to the three nearest medically trained Good Samaritans, and in the LAS system, at the same time the call automatically dials 999 (the U.K.’s three-digit emergency number).
may / june 2017 | THE JOURNAL 27 • FEATURE | apps for dispatch
BUYER BEWARE Not all apps work realistically
mergency preparedness has hitched its wagon to the still- Erising app star. App enthusiasts on the market to enhance their readiness have a stack of apps to chose from, with a majority of these products developed by a third-party rather than the traditional emergency communication system. The app developer might GoodSAM app promise faster connectivity to a communication center or better location tracking, or request personal information that Registered responders—such as doctors, nurses, can be input into the app’s program for relay to the emergency and paramedics—within a specified radius can communication center in tandem with the caller’s connection. proceed to the emergency prior to the arrival of an ambulance. The bystander can continue Sales points to provide information to the Emergency Because location accuracy is a big concern, many apps Dispatcher, who can also convey instructions promise to determine your location more accurately than the for CPR. current emergency services system. There is no guarantee Built-in tools include a “Life Detector” that will happen. Wireless phones are mobile; they are not that provides readings of the patient’s pulse associated with a fixed location or address the same way as and respiratory rate, a metronome for CPR a landline. A cell site might provide a general indication to the timing, and instant on-scene video streaming. caller’s whereabouts but at this point not as accurately as a GoodSAM Pro is an advanced version that fixed line. gives ambulance services the ability to dispatch The Federal Communications Commission (FCC) requires registered responders or co-responders to calls wireless carriers to provide more precise location information other than cardiac arrest. to PSAPs at either a county-based or PSAP-based geographic The LAS has stressed the benefit of level; however, technology is still in the works. In addition, an additional resource to the emergency standards apply to outdoor measurements only, as indoor use ambulance response, which is deployed poses unique obstacles. as normal to a patient in cardiac arrest. As far as efficiency, it might be faster and wiser to call the GoodSAM does not replace response; it three-digit emergency number from your cellphone than to supplements services already available with rely on an intermediary to make the connection for you. Most the intent of getting volunteers with the right smartphones require only a swipe and a tap to activate, even if life-support training skills on the scene as the phone is locked. soon as possible. Other apps connect callers to a call center, not a PSAP, and The app is available in several countries, the call is answered by an operator who asks questions and and nearly 18,000 people have downloaded routes the caller to the PSAP. The liaison is not necessary since the GoodSAM app launched in June 2014, this is the way most emergency communication centers work, according to GoodSAM Project Director particularly if using the Medical, Police, or Fire Priority Dispatch Deepti Bal. System™ (PDS™). The EMD, EPD, or EFD asks questions that According to the American Heart determine the appropriate response and provides Pre-Arrival Association, almost 90 percent of people and Post-Dispatch Instructions. In addition, it’s not such a good who suffer out-of-hospital cardiac arrest die. idea to share personal information without reading a privacy Survival depends on getting help as soon policy and looking into the security platform in place to protect as possible, and it is estimated that CPR, your information. J especially if performed in the first few minutes of cardiac arrest, can double or triple a person’s chance of survival.
28 THE JOURNAL | iaedjournal.org apps for dispatch | FEATURE •
PulsePoint begins to occur well before then. The users within a specific radius of the An ambulance, with full lights-and- relatively low number of bystanders patient’s location and where to find the siren, pulling into a plaza where Richard providing CPR and retrieving an closest AED. Price was eating lunch alerted the former AED, however, keep the number While there was a boom of apps, San Ramon Valley Fire Protection of deaths related to out-of-hospital that wasn’t necessarily a blessing for District (SRVFPD), California, USA, SCA distressingly high. Fewer than 9 Price’s technology. Thousands of apps chief of an impending medical problem. percent survive. face identity crisis, getting lost among And, also, to a solution to assist in That got Price thinking. There had other apps. People scroll through the top sudden cardiac arrest (SCA) survivability. to be a way to connect CPR-trained 10, maybe, before moving on. To test “The victim was next door,” said Price, bystanders and AEDs to victims of SCA. the market, the SRVFPD piloted the who despite his position as fire chief He looked around. He knew an increasing software-as-a-service pre-arrival app. The did not receive pages for medical calls. number of people depended on their software, PulsePoint, attracted attention. “I rushed over knowing each moment smartphones but not typically to make In a little over six years, 900,000-plus lost was decreasing the patient’s ability phone calls. Many were glued to their residents and off-duty EMS personnel in to survive. Response time is the biggest phones, looking at a new work email, a 2,000 communities across 28 states have obstacle we face.” new Facebook notification, a YouTube downloaded the app. Activations exceed The patient died despite over- video, podcasts, or online banking. 35,000, and of those, at least one-third the-phone CPR instructions an EMD There was always a reason to check were SCA emergencies. provided to a bystander before the your smartphone. So, why not include a Price retired from SRVFPD in ambulance crew arrived. lifesaving app? Having the potential to 2012 after a 33-year career with the Price believes a missing element could save a life could be as easy as viewing a fire service. He is founder/president have changed the outcome. text message. of the PulsePoint Foundation, a 501(c) “If I had heard, or if someone else Price sat down with an IT team (3) nonprofit corporation based in close by had been notified, that could from Northern Kentucky University the San Francisco Bay Area. The have made all the difference in saving (USA), and together, along with other foundation provides a suite of mobile the man’s life,” he said at the time of the members of the SRVFPD, developed a apps to support public safety agencies incident. “Time is critical.” CPR notification alert. When an SCA to improve SCA survival rates through A victim of SCA has about 10 occurred in a public place and 911 better bystander performance and minutes to live, although brain damage was contacted, the app would notify AED access. The money the foundation raises goes back into development. Innovations include building an extensive cloud-based registry of AEDs. Locations are precisely mapped according to community data verified by public agencies. Through work with the International Academies of Emergency Dispatch® (IAED™), the foundation plans to connect the registry to 911 centers for automatic retrieval of information. “That saves the calltaker from asking if an AED is available,” Price said. “The calltaker will automatically know the closest AED.” They “gamified” the app to further engage and motivate people and developed various ways agencies can trigger PulsePoint activations, such as sending alerts based on keywords indicative of SCA. PulsePoint app
may / june 2017 | THE JOURNAL 29 • FEATURE | apps for dispatch
The foundation has partnered with connected to emergency the IAED and Priority Dispatch Corp.™ communications, the app (PDC™) to incorporate PulsePoint does link the user to an AED with ProQA® software. The process closest to the situation in queries a third-party agency when, the city’s five boroughs. during the call, MPDS® Determinant Administered through Descriptors categorize and prioritize the FDNY CPR mobile the emergency situations based upon unit, the program includes caller interrogation and the presence a workshop introducing or likelihood of priority symptoms and the app and provides threat to life. The software will display compressions-only CPR the locations of AEDs within a specific training. The workshop proximity of the incident (the radius is required prior to is yet to be determined by the IAED downloading the app, and FirstNet app Medical Council of Standards). The since the app was created in third-party agency will also have the 2013, more than 40,000 people have gone a 25-year agreement with AT&T to ability to notify a qualified responder to through the program. build a nationwide wireless broadband assist or perform the defibrillation. The training and app really took off network that will enable data sharing The same prompt would apply to when New York became one of now 42 across disciplines and jurisdictions and ECHO response initiated at Case Entry, states to mandate CPR for high school give priority to first responders sending and the new ProQA feature will tie into graduation, according to Lt. Jose Borrero, voice or text messages, images, video, the existing system that tracks AED a career FDNY paramedic who directs the and location information in real-time device usage. CPR mobile unit. during an emergency over a dedicated Price is dedicated to PulsePoint and New York’s law mandates instruction LTE network. AT&T will build, operate, his motivation is simple. in hands-only CPR and the use of an AED and maintain the network, which will “It’s vital to decrease the time it takes for senior high school students prior to cover all states, five U.S. territories, and a family member or other bystander to graduation. The law went into effect the District of Columbia. The rollout will initiate CPR,” he said. “If someone is down Oct. 7, 2015, and is part of a broader state begin later this year. for eight minutes, without help, none of education law requiring each school to FirstNet, an independent arm of the it matters.” have at least one operable AED and staff Department of Commerce, took its first volunteers trained and certified in CPR major step in achieving interoperability Bystander CPR and AED use. through a test lab that opened Nov. A nonprofit association affiliated with “I know from experience the 9, 2016, in Boulder, Colorado, USA. the New York Fire Department (FDNY) importance of giving CPR as soon as According to the FirstNet website, the offers an app that gives bystanders step- possible,” Borrero said. “The more people lab conducts “validation and verification by-step CPR instructions. Although not trained, the more people saved. The app testing for the network, services, and gives a quick refresher to features, and aids future research and how it’s done effectively.” development related to public safety Note: Visit broadband technologies.”1 Testing is http://bit.ly/14f225j to see projected to cut the time in field testing states where CPR training and actual deployment of FirstNet is mandatory for high services and applications. school graduation. FirstNet also allows access to developers for testing apps that would FirstNet complement interoperability and The First Responder cybersecurity on FirstNet’s network. J Network Authority (FirstNet) was signed into Source law Feb. 22, 2012, to provide a 1. “FirstNet Marks Major Milestone with Opening of Test Lab.” First Responder Network Authority. 2016; single interoperable platform Nov. 9. http://firstnet.gov/news/firstnet-marks-major- for emergency and public milestone-opening-test-lab (accessed Jan. 17, 2017). safety communications. In This app gives bystanders step-by-step CPR instructions. March, FirstNet announced
30 THE JOURNAL | iaedjournal.org The Premier Educational Conference for Police, Fire, and Medical Dispatch 18 Aria Resort and Casino Las Vegas, Nevada April 24–26, 2018
For general conference info visit navigatorconference.org or call Nikele Schwendiman at 888.725.5853 SEE YOU THERE! ••• ON TRACK | police cde
FEARING THE WORST Understanding goes a long way
Audrey Fraizer
n a Sunday, in March 2016, from the weapon, he picked it up, rearmed Intervention (CIT) program in 2007 in a 16-year-old male called the himself, and started walking toward an answer to an increasing number of 911 calls OAlachua County Combined occupied apartment complex.”1 and incidents involving people exhibiting Communications Center (CCC) and told A report issued by Alachua County serious mental illness. the 911 telecommunicator that he was Grand Jury found the shooting death lawful, As explained by Lt. Mark Morais, walking around an apartment complex but likely “avoidable.” Recommendations Durham Police Department, Assistant (Gainesville, Florida, USA) and planning included increased training in interacting District Uniform Police Commander, to kill himself using the M16 rifle he was with the mentally ill.2 CIT puts law enforcement in partnership carrying. He did not stay on the line. In The recommendation emphasized with mental health and consumer spite of multiple call-back attempts by something Jim Lanier had long believed advocacy groups, families, and individuals CCC, he did not pick up. necessary at every stage of an incident with a common goal to connect people Police arriving on scene ordered him potentially involving mental health issues. in a mental health crisis to appropriate to drop the gun. He did but then picked “We needed to explore what else we services rather than the criminal it up. Fearing the worst, law enforcement could do for the caller, calltakers, and justice system. A primary objective opened fire, killing the teen who had been officers,” said Lanier, Technical Services is decreasing the use of force in law holding a toy replica of the weapon. Division Manager, Alachua County Sheriff’s enforcement confrontations. Lt. Brandon Kutner, speaking on behalf Office. “If you don’t understand what is “Jails are not equipped to handle of the Alachua County Sheriff’s Office, happening with the caller, you can’t establish people with serious mental illness,” defended their actions. “Deputies gave the level of assistance necessary to help.” said Morais, who was instrumental verbal commands to drop the weapon, in integrating two federal grants that which he initially did,” Kutner said, adding Crisis Intervention Training helped design the current Mental Health “as we tried to establish a rapport with the The Durham Police Department Outreach Program (MHOP) that now individual, to try to get him to move away (North Carolina, USA) established a Crisis exists in Durham. “CIT gives police more
32 THE JOURNAL | iaedjournal.org police cde
options, ways to work with an individual, “We needed something to get to the MENTAL and de-escalate the incident.” next level of empathy and trust with the ILLNESS CIT nationwide is the genesis of caller,” said Lanier, a longtime proponent training curriculum developed by of the police, fire, and medical protocol Memphis (Tennessee, USA) police in 1987 systems. “We wanted to put more focus he Centers for Disease to address public outrage over the fatal on the behavioral perspective [in a non- TControl and Prevention shooting of a knife-wielding male with visual setting].” (CDC) provides the following severe mental illness. The “Memphis Model” In July 2016, the Alachua County definition and statistics includes sections covering clinical issues, CCC, with the support of Sheriff Sadie regarding mental illness: post-traumatic stress disorder, de-escalation Darnell, took the lead even before “collectively all diagnosable strategies, and lists of community resources. receiving Alachua County Grand Jury’s mental disorders” or While extensive training, certification, recommendations by initiating a project “health conditions that are and overall goals are standard, public where each telecommunicator would characterized by alterations agencies are encouraged to develop a attend a three-day certification class in thinking, mood, or behavior model that reflects their community. (Emergency Mental Health Dispatch (or some combination thereof) This includes advocacy groups, such as (EMHD)) that builds on CIT with an associated with distress and/or local chapters of the National Alliance on emphasis on the 911 telecommunicator. impaired functioning.” Mental Illness (NAMI); individuals and Facilitated by Jim Marshall, Director, Depression is the most family members; and mental health care 911 Training Institute, the course targets common type of mental and treatment professionals. optimal emergency response based illness, affecting more than “Partnerships are vital in making on understanding behavioral factors 26 percent of the U.S. adult this work,” he said. “You have to get a contributing to a mental health crisis. population. It has been commitment at the start for CIT to be Marshall said the certification course estimated that by the year most effective.” fills the gap between the initial call and 2020, depression will be According to the Memphis Model, an police intervention and disposition. the second-leading cause emphasis on emergency communications is “We’re providing real-time crisis of disability throughout the essential: Emergency dispatchers are a critical intervention from the beginning with world, trailing only ischemic link in the CIT program and may include the intent of getting help for that heart disease.4 calltakers, dispatchers, and 911 operators. The person,” Marshall said. “[Through the The definition stands in success of CIT depends on their familiarity course] dispatchers develop a greater contrast to the CDC definition with the CIT program, knowledge of understanding and compassion for people for mental health: “a state how to recognize a CIT call involving a in a mental health crisis.” of well-being in which the behavioral crisis event, and knowing the The course provides information individual realizes his or her appropriate questions to ask to better assist on 19 conditions that can affect mental own abilities, can cope with the responding officer. It’s recommended health, such as schizophrenia and severe the normal stresses of life, that dispatchers receive training courses depression. Dispatchers (EMHD) do not can work productively and (a minimum of 8–16 hours) in CIT and diagnose the behavior or predict outcomes. fruitfully, and is able to make additional advanced in-service training.3 “They optimize cooperation using our a contribution to his or her Alachua County’s telecommunicators call-managing objectives,” Marshall said. “We community.”5 J are required to take CIT. are bringing the same awareness to mental Lanier said CIT training was extremely illness, at the same level as science, as the look beyond assumptions and at the human beneficial for telecommunicators, Medical Protocol did for helping people at being experiencing a crisis. The outcome but he also wanted a program risk and safeguarding the scene for response.” might not be what we desire, but at least designed specifically for emergency Lanier said the course puts dispatchers dispatchers have the confidence they did all communications personnel that would at ease in calls involving people in mental they could to manage the call.” provide further guidance and tools health crisis situations. for effective mental health crisis call “From my own experience, I know The need is there management. With the proper training, there’s a feeling of helplessness when An estimated 7 percent of police the 911 telecommunicator has a greater answering these calls,” said Lanier, who has contacts in jurisdictions with 100,000 or chance to de-escalate the incident and the worked in emergency communications for more people involve the mentally ill. A danger to the caller, bystanders, and public more than 20 years. “It’s easy to judge the three-city study found that 92 percent of safety responders. caller, but this training helps the dispatcher patrol officers had at least one encounter
may / june 2017 | THE JOURNAL 33 police cde
does not occur during the call, the EPD first get responders on the way to provide would stay with Protocol 121 in cases of protection and assistance for the caller. abnormal behavior as defined by protocol. In PPDS, an ECHO determinant was added as a send point on Case Entry for Protocol 121 a CALLER IN IMMINENT DANGER Protocol 121 is split in two, with Key discovered at the onset of the call. This Questions meant for suspect callers and early send point allows the EPD to initiate not suspect callers. The questions are a 100-E-1 response, provide PDI-a, and similar in both sequences, although their go immediately to the Caller In Danger arrangement differs. Protocol, bypassing the Chief Complaint and A suspect is first asked, “Is anyone else addressing the caller’s safety first. CALLER there with you?” If the answer is “yes” and IN IMMINENT DANGER is defined as: the suspect hands the phone to the other “A situation that places the caller in individual present, the EPD transfers to the immediate danger of death or serious injury with a mentally ill person in crisis in the not suspect sequence of the Protocol. If no that does not involve a sinking vehicle, previous month, and officers averaged six one else is present or the caller refuses to vehicle in floodwater, stuck accelerator, such encounters per month.6 hand over the phone, the EPD continues ACTIVE ASSAILANT (SHOOTER), bomb According to NAMI, each year 2 with the suspect line of interrogation. found, suspicious package, bomb threat, million jail bookings involve a person A non-suspect caller is first asked, “Is mental disorder (suspect caller), or suicidal with mental illness. Approximately 15 s/he violent?” and the second question, person/attempted suicide (suspect caller).” percent of men and 30 percent of women “Were weapons involved or mentioned?” Principles of Emergency Medical in local jails have a serious mental illness, Key Questions continue with the EPD Dispatch cautions the EMD to carefully and 1 in 4 people killed in officer-involved gathering information about the suspect attend “to the hazards that can occur in these shootings had a serious mental illness.7 (where the person is now and a description). cases.” In many cases, police coverage during Surveys have found that a majority of If the caller does not know whether the these situations is standard policy.9 J Americans believe that people with mental person who needs help is violent, according illness are more likely to act violently and to Rule 2, the EPD should “consider Sources more likely to commit violent crimes. the person to be violent.” Post-Dispatch 1. Wiener-Bronner D. “Police killed a 16-year-old who had nd rd called to say he might kill himself. He was holding a toy Other research has suggested that the Instruction c directs the 2 or 3 party gun.” Fusion News. 2016; March 22. http://fusion.net/ opposite is true. caller, “If it’s safe to do so, observe her/him story/283280/police-shooting-robert-dentmond-florida/ According to the U.S. Department of continuously. (Beware of being attacked.)” (accessed Jan. 17, 2017). 2. Pyche TJ. “Grand Jury: Robert Dentmond Shooting Lawful, Health and Human Services, only 3 percent When the caller is in danger, the EPD But Avoidable.” WUFT-FM. 2016; Oct. 16. http://www. to 5 percent of violent acts can be attributed provides instructions on Protocol C: Caller wuft.org/news/2016/10/06/grand-jury-robert-dentmond- to individuals living with a serious mental In Danger (CID) to guide the caller to a safer shooting-lawful-but-avoidable/ (accessed Jan. 19, 2017). 3. Dupont R, Cochran S, Pillsbury S. “Crisis Intervention Team illness and, in fact, people with severe place. If the caller cannot take the phone Core Elements.” The University of Memphis, School of mental illnesses are over 10 times more with him or her while getting to safety, the Urban Affairs and Public Policy. 2007; September. http://cit. likely to be victims of violent crime than EPD instructs the caller to call back from a memphis.edu/pdf/CoreElements.pdf (accessed Jan. 23, 2017). 8 4. “Mental Health Basics.” Centers for Disease Control the general population. safe location and instructs the caller to set and Prevention. 2013; Oct. 4. https://www.cdc.gov/ the phone down without hanging up. If the mentalhealth/basics.htm (accessed Jan. 23, 2017). Police Protocol caller cannot speak freely, nor communicate 5. See note 4. Police Priority Dispatch System™ otherwise, the EPD will stay on the line 6. Cordner G. “The Problem of People with Mental Illness.” Center for Problem-Oriented Policing. 2006. http:// ® (PPDS ) Protocol 121: Mental Disorder as long as necessary. If the caller is able to www.popcenter.org/problems/mental_illness/print/ (Behavioral Problems) applies to “any speak freely, the EPD returns to the main (accessed Jan. 19, 2017). incident involving an individual who interrogation sequence and continues to 7. “Law Enforcement and Mental Health.” National Alliance on Mental Illness. 2015; Oct. 1. https://www. appears to lack essential reasoning faculties obtain critical information for the incident. nami.org/Get-Involved/Law-Enforcement-and-Mental- or exhibits bizarre, possibly mentally related The CID Protocol may be accessed Health (accessed Jan. 23, 2017). behavior.” Causes for the abnormal behavior at any point in the interrogation when 8. “Mental Health Myths and Facts.” U.S. Department of Health and Human Services. https://www. include drug abuse and excited delirium. circumstances or caller statements indicate mentalhealth.gov/basics/myths-facts/index.html The EPD would shunt to PPDS Protocol that the caller is in immediate danger; (accessed Jan. 23, 2017). 127: Suicidal Person/Attempted Suicide however, it is important to note that the 9. Clawson J, Dernocoeur K, Murray C. Principles of Emergency Dispatch. Sixth edition. International if and when, during the call, the caller CID Protocol should not be used until after Academies of Emergency Dispatch; Salt Lake City, mentions the possibility of suicide. If that dispatch has been initiated. It is essential to Utah. 2015.
34 THE JOURNAL | iaedjournal.org POLICE CDE QUIZ | ?
YOU MUST BE POLICE CERTIFIED TO TAKE THIS QUIZ CDE Quiz Mail-In Answer Sheet Answer the test questions on this form. (A photocopied answer sheet Answers to this quiz are found in the article “Fearing The Worst,” which starts on page 32. is acceptable, but your answers must be original.) WE WILL NOT Take this quiz for 1.0 CDE unit. PROCESS ALTERED SIZES. A CDE acknowledgement will be sent to you. (You must answer 8 of the 10 questions correctly to receive credit.) 1. A primary objective of CIT is: a. apprehending a suspect of a violent crime. Clip and mail your completed answer sheet along with the $5 USD b. decreasing the use of force in law enforcement confrontations. (U.S. currency) NON-REFUNDABLE processing fee to: c. encouraging neighborhood watch programs. The International Academies of Emergency Dispatch d. tracking repeat domestic violence offenses. 110 Regent Street, 8th Floor Salt Lake City, UT 84111 USA 2. The success of CIT depends on an Emergency Dispatcher’s: Attn: CDE Processing a. familiarity with the CIT program. (800) 960-6236 US; (801) 359-6916 Intl. b. knowledge of how to recognize a CIT call involving a behavioral crisis event. c. knowing the appropriate questions to ask in order to ascertain information from the Please retain your CDE acknowledgement for future reference. caller that will help the responding CIT Officer. Name ______d. all of the above Organization ______3. What is the estimated percent of police contacts involving the mentally ill in jurisdictions with 100,000 or more people? Address ______a. 1 percent b. 7 percent City ______St./Prov.______c. 20 percent d. 33 percent Country ______ZIP______
4. How many people killed in officer-involved shootings have a serious mental illness? Academy Cert. #______a. 1 in 4 b. 2 in 3 Daytime Phone ( )______c. 4 in 7 E-mail ______5. People with severe mental illnesses are more than 10 times more likely to be victims of violent crime than the general population. a. true PRIMARY FUNCTION b. false Public Safety Dispatcher (check all that apply) 6. On Protocol 121, a suspect is first asked: _____Medical _____Fire _____Police a. “Are you feeling violent?” b. “Do you have any weapons?” Paramedic/EMT/Firefighter c. “Is anyone else there with you?” Comm. Center Supervisor/Manager d. “Are you under medical care?” Training/QI Coordinator 7. On Protocol 121, a non-suspect caller is first asked: Instructor a. “Where’s the person now?” b. “Is s/he violent?” Comm. Center Director/Chief c. “Are you or anyone else in immediate danger?” Medical Director d. “Does anyone need medical attention?” Commercial Vendor/Consultant 8. If the caller does not know whether the person who needs help is violent, Rule 2 tells the EPD Other to consider the person to be ______. a. harmless b. violent ANSWER SHEET ? POLICE May/June 2017 Journal “Fearing The Worst” 9. The CID Protocol should not be used until: Please mark your answers in the appropriate box below. a. response is on scene. b. the suspect actually harms someone. 1. o A o B o C o D c. after dispatch has been initiated. d. the caller can make positive identification of the suspect. 2. o A o B o C o D 3. o A o B o C o D 10. An ECHO determinant was added in the PPDS as a send point for a CALLER IN IMMINENT DANGER discovered at the onset of the call during which step in the protocol process? 4. o A o B o C a. Case Entry b. Key Questions 5. o A o B c. Post-Dispatch Instructions 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 o C o D
To be considered for CDE credit, this answer sheet must be received no later than 06/30/18. A passing score is worth 1.0 10. o A o B o C CDE unit toward fulfillment of the Academy’s CDE requirements. Please mark your responses on the answer sheet located at right and mail it in with your processing fee to receive credit. Please retain your CDE letter for future reference. Expires 06/30/18 may / june 2017 | THE JOURNAL 35 ••• ON TRACK | medical cde
PROCEED WITH CAUTION Addressing psychiatric issues requires careful intervention
Josh McFadden
nder no circumstances should the while PPDS Protocol 127 is titled People who attempt suicide are prone phrase “I’m going to kill myself” Suicidal Person/Attempted Suicide. to try it again. As many as 40 percent of Unot be taken seriously. It’s no Unfortunately, these behaviors and people who ultimately commit suicide doubt a genuine topic of concern when tendencies are prevalent across had been unsuccessful in previous someone calls 911 with this threat. the world. attempts. People are 100 times more Whether from a first- or second- likely to attempt suicide again within a party caller, when a suicide attempt has Numbers don’t lie year of the previous attempt.3 Suicide been announced or attempted, quick, A quick look at recent statistics rates rise with age as well. Suicide rates decisive, and effective action is needed. from Mental Health America reveals are highest in older people, with 40 Is it any wonder that hotlines have been startling information about suicide and percent of suicide victims over the age of established around the world where mental health. Perhaps most alarming 60. After age 75, the suicide rate is three people struggling with suicidal thoughts is that suicide is the eighth-leading times higher than the U.S. average. After can receive support and reassurance? But cause of death in the United States. In age 80, white males in the U.S. are six when the situations escalate, you, the fact, suicide accounts for more than times more likely to commit suicide than dispatcher, play a critical role in ensuring 1 percent of all deaths in the country. the average person.4 the safety and well-being of the suicidal Each year, 30,000 Americans die by As for determining what leads person and any bystanders. suicide. That number could be much people to commit suicide, alcohol and Both the Medical Priority Dispatch higher considering unsuccessful suicide other substance abuse is a major factor. System™ (MPDS®) and Police Priority attempts in the U.S. are around half About 20 percent of all suicides involve Dispatch System™ (PPDS®) address a million annually.1 The American people who have alcohol dependency. suicide attempts. MPDS Protocol Foundation for Suicide Prevention In addition, those who commit suicide 25 combines Suicide Attempt with reports that men die from suicide 3.5 often suffer from a mental disorder. Psychiatric and Abnormal Behavior, times more often than women.2 Depression is the most common among
36 THE JOURNAL | iaedjournal.org medical cde
these, as 70 percent of victims suffered Talking to someone threatening Marshall also highly recommended a from this illness.5 suicide isn’t something one should take direct approach to the call. Understanding the methods by lightly. Establishing rapport with a “Now is not the time to indirectly ask which people take their own lives is suicidal caller is important, but Marshall about intent,” he said. “While you may be important for dispatchers. According said effectively handing the call requires afraid that asking, ‘Are you thinking of to the Centers for Disease Control and rigorous training through a course killing yourself?’ will increase the risk, the Prevention, most men commit suicide supported by research-driven processes research doesn’t support this. You can ask with firearms (59 percent). For women, for assessing the caller’s risk. the question. A caller is apt to feel more the most common method is poisoning.6 understood if asked directly.” The CDC also reported that in 2013, 494,169 people in the United States were People who attempt The Protocol in action treated in emergency departments for suicide are prone to Protocol 25: Psychiatric/Abnormal self-inflicted wounds.7 Behavior/Suicide Attempt focuses on try it again. As many the type of medical assistance the caller Warning signs as 40 percent of or victim needs in the event of a suicide Research indicates a number of attempt. However, as opposed to the risk factors for suicide. Some of these people who ultimately PPDS, different methods of an intended common signs to look out for include commit suicide had suicide attempt may shunt to a different the following: been unsuccessful in protocol in order to handle the incident •• Verbal suicide threats such as, “You’d appropriately. Protocol 25 shunts to be better off without me” or “Maybe I previous attempts. three other MPDS Protocols, when won’t be around” appropriate: Protocol 8 if the person is •• Expressions of hopelessness threatening suicide by carbon monoxide, and helplessness “Managing suicide calls takes inhalation, HAZMAT, or other toxic •• Previous suicide attempts knowledge of the science behind mental substances; Protocol 23 if the person is •• Daring or risk-taking behavior health issues and a conscious process on attempting a suicide by OVERDOSE; •• Personality changes the part of the dispatcher to manage (his and Protocol 27 if the person has a stab or •• Depression or her) stress response,” he said. gunshot wound. •• Giving away prized possessions Recognizing the physiological Key Questions 1 and 2 are critical. •• Lack of interest in future plans impact, such as “gut reaction,” can They ask, “Is s/he violent?” and “Does turn the “I can’t get close to this caller” s/he have a weapon?” The answers to Uncomfortable issues ambivalence into “I can do this.” It’s these questions will help the dispatcher Even though data clearly shows a matter of the dispatcher balancing code the call with the appropriate suffix, suicide is a significant problem and the empathy with detachment. In other thus allocating appropriate resources number of people attempting suicide words, the dispatcher can assist the caller and alerting responders to potential is increasing, it’s not a topic that gets while, at the same time, manage his or danger. Violent people may include those a lot of attention and focus during her own well-being. That ability to push who are refusing help or entry, or those dispatcher training courses. According toward a connection, rather than over- exhibiting frantic, irrational behavior. to statistics from Public Safety Training distancing for the sake of self-protection, Police should be notified in these cases, Consultants (PSTC), suicide is discussed can provide a buffer to keep the person and the appropriate suffix should be for less than 30 minutes in most POST- from falling off a cliff. assigned. When weapons are involved, approved dispatch academies. For “Yes, the dispatcher’s primary job include the W Problem Suffix in the every one successful suicide, there are is to ensure the safety of the caller Determinant Descriptor. If the person 50 other people calling 911 or suicide and all those on scene, but equally is violent and has weapons, use Problem prevention hotlines before or during a important is building a life bridge of Suffix B. suicide attempt. empathy,” Marshall said. “By doing that, This protocol makes special note “People don’t want to talk about you’re showing the caller you can listen to teach dispatchers to keep first-party things that stress them, especially in carefully. You’re trying to help the person callers on the line if they are violent professions where stressful situations choose life, instead of death, as a solution or suicidal. In fact, Rule 3 is specific in happen all the time,” said Jim Marshall, a while waiting for the field responders to instructing that “1st party callers who mental health clinician and 911 Training arrive. They know they are truly being are THREATENING SUICIDE should Institute Director. heard and cared about.” be kept on the line until responders
may / june 2017 | THE JOURNAL 37 medical cde
arrive.” Not only does staying on If it has been determined that a the line keep the dispatcher and hanging, strangulation, or suffocation responders informed, but it may suicide attempt has occurred and the also help to prevent further action person is completely alert (as learned by the caller through constant, from Key Question 5), the dispatcher empathetic interaction. must ask whether the victim is having In addition, it is crucial for difficulty breathing. A Not alert TH the dispatcher to understand the victim always gets a Determinant SUICIDE IS THE 8 difference between a “suicide Descriptor of 25-D-1; a victim that LEADING CAUSE OF DEATH attempt” and a “suicide threat.” is alert without difficulty breathing IN THE U.S. Protocol 25 defines THREATENING in a near hanging, strangulation, or SUICIDE as: “Persons who are suffocation is assigned 25-B-5. EACH YEAR, 30,000 AMERICANS DIE threatening to commit suicide but Chemical Suicide is defined as BY SUICIDE have not yet done anything to harm “suicide by inhaling poisonous vapors themselves.” In this case, the call that can be created from a mixture MEN DIE BY SUICIDE would be given the Determinant of household chemicals.” The Code 25-B-3. Conversely, a suicide definition also explains that: “Often, MORE OFTEN THAN WOMEN attempt is an act toward ending life patients will tape window and door that has been committed. seams shut and post warning notes PEOPLE ARE 100 Protocol answer options for to prevent harm to others, such as TIMES MORE LIKELY TO suicide attempt include jumpers; ‘Danger,’ ‘Toxic Gas,’ or ‘Call 911.’ ATTEMPT SUICIDE AGAIN cut/laceration; near hanging, The immediate area also frequently WITHIN A YEAR OF THE strangulation, or suffocation; and smells of rotten eggs or sulfur, but PREVIOUS ATTEMPT chemical suicide, OVERDOSE, and Emergency Dispatchers should stab or gunshot wound, the latter not rely on this indicator alone as a 40 PERCENT OF SUICIDE VICTIMS ARE OVER THE three appropriately shunted to more warning signal.” AGE OF 60 specific protocols. For obvious safety and In Key Question 4, the dispatcher response concerns, Case Entry AFTER AGE 80, WHITE asks, “Is this a suicide attempt?” If the Rule 6 instructs: “If the complaint MALES ARE SIX TIMES caller says it isn’t, the dispatcher must description involves hazardous MORE LIKELY TO COMMIT ask the follow-up question, “Is s/he materials (toxic substances) SUICIDE THAN THE AVERAGE PERSON thinking about committing suicide?” that pose a threat to bystanders If a suicide has been attempted by or responders, go to Protocol 8.” cut/laceration, the dispatcher must However, if the dispatcher initially FOR WOMEN, ask where the person is cut and selects Protocol 25, the fail-safe shunt THE MOST COMMON if there is any SERIOUS bleeding to Protocol 8 will ensure appropriate METHOD OF SUICIDE IS (spurting or pouring). Key Question 5 coding and instruction for Chemical POISONING asks whether the person is completely Suicide cases. J alert. If the hemorrhage is dangerous and the caller is alert, the call must Sources be coded as 25-D-2. DANGEROUS 1. “Suicide.” Mental Health America. http://www. mentalhealthamerica.net/suicide (accessed Feb. Hemorrhage is defined as occurring in 2, 2017). the areas of the armpit, groin, or neck. 2. “Suicide Statistics.” American Foundation for SERIOUS Hemorrhage and MINOR Suicide Prevention. https://afsp.org/about- Hemorrhage get separate, BRAVO- suicide/suicide-statistics/ (accessed Feb. 2, 2017). 3. See note 1. level codes. SERIOUS Hemorrhage 4. See note 1. is uncontrolled bleeding (spurting or 5. See note 1. pouring) from any area or anytime 6. “Web-based Injury Statistics Query and Reporting a caller reports “serious” bleeding. System.” Centers for Disease Control and Prevention (CDC). 2017; Jan. 12. http://www.cdc. MINOR Hemorrhage is controlled or gov/injury/wisqars/index.html. insignificant external bleeding from 7. See note 6. any area.
38 THE JOURNAL | iaedjournal.org MEDICAL CDE QUIZ | G
YOU MUST BE MEDICAL CERTIFIED TO TAKE THIS QUIZ CDE Quiz Mail-In Answer Sheet Answer the test questions on this form. (A photocopied answer sheet Answers to this quiz are found in the article “Proceed With Caution,” which starts on page 36. is acceptable, but your answers must be original.) WE WILL NOT Take this quiz for 1.0 CDE unit. PROCESS ALTERED SIZES. A CDE acknowledgement will be sent to you. (You must answer 8 of the 10 questions correctly to receive credit.) 1. How many Americans die by suicide each year? a. 10,000 Clip and mail your completed answer sheet along with the $5 USD b. 20,000 (U.S. currency) NON-REFUNDABLE processing fee to: c. 30,000 The International Academies of Emergency Dispatch d. 40,000 110 Regent Street, 8th Floor 2. About _____ percent of all suicide victims in the U.S had alcohol dependency issues. Salt Lake City, UT 84111 USA a. 20 Attn: CDE Processing b. 30 (800) 960-6236 US; (801) 359-6916 Intl. c. 50 Please retain your CDE acknowledgement for future reference. d. 70 Name ______3. In 2013, approximately 600,000 people in the U.S. were admitted to emergency departments because of self-inflicted wounds. Organization ______a. true b. false Address ______
4. Which of the following is a common sign of someone contemplating suicide? City ______St./Prov.______a. giving away prized possessions b. watching sad movies Country ______ZIP______c. talking about a loved one who has passed away d. overeating Academy Cert. #______
5. There is no established training course for helping assess a caller’s risk for suicide. Daytime Phone ( )______a. true b. false E-mail ______
6. Protocol 25 shunts to the following three protocols in the MPDS: PRIMARY FUNCTION a. Protocol 8, Protocol 11, Protocol 26 b. Protocol 17, Protocol 23, Protocol 27 Public Safety Dispatcher (check all that apply) c. Protocol 9, Protocol 23, Protocol 32 _____Medical _____Fire _____Police d. Protocol 8, Protocol 23, Protocol 27 Paramedic/EMT/Firefighter 7. Suffix B is used if the person ______. Comm. Center Supervisor/Manager a. is violent b. has weapons Training/QI Coordinator c. is violent and has weapons Instructor d. is belligerent on the phone Comm. Center Director/Chief 8. According to Protocol 25, what is the definition of THREATENING SUICIDE? Medical Director a. Persons who are threatening to kill themselves and have already inflicted harm. b. Persons who are threatening to commit suicide but have not yet done anything to Commercial Vendor/Consultant harm themselves. c. Persons who refuse to speak on the phone to the dispatcher. Other d. Persons who have attempted suicide in the past. ANSWER SHEET G MEDICAL 9. What defines DANGEROUS Hemorrhage? May/June 2017 Journal “Proceed With Caution” a. Uncontrolled bleeding from any area Please mark your answers in the appropriate box below. b. Spurting or pouring bleeding from the head c. Bleeding from the legs or stomach 1. o A o B o C o D d. Bleeding from the armpit, groin, or neck 2. o A o B o C o D 10. What Determinant Code will a Not alert victim always receive? a. 25-D-1 3. o A o B b. 25-D-2 4. o A o B o C o D c. 25-D-3 d. 25-B-3 5. o A o B 6. o A o B o C o D 7. o A o B o C o D 8. o A o B o C o D 9. o A o B o C o D
To be considered for CDE credit, this answer sheet must be received no later than 06/30/18. A passing score is worth 1.0 10. o A o B o C o D CDE unit toward fulfillment of the Academy’s CDE requirements. Please mark your responses on the answer sheet located at right and mail it in with your processing fee to receive credit. Please retain your CDE letter for future reference. Expires 06/30/18 may / june 2017 | THE JOURNAL 39 ••• BLAST FROM THE PAST
FAILURE TO DISPATCH: A CIVIL RIGHTS VIOLATION?
from Emergency Medical Technician Legal Bulletin | James E. George, MD, JD, Editor | Spring 1988, Vol. 12, No. 2
rrors in EMS dispatching can However, the use of reasonable 1987), illustrates what can happen when result in tragic consequences. common sense may not always be emergency personnel fail to follow EDispatching errors may stem from enough to defend against a charge of procedures and protocol designed to several sources. The dispatchers may negligence. Courts have sometimes found reduce the risk of error. This case is underestimate the urgency of a situation the customary practice of as particular particularly interesting in that it is a civil or may err in gathering or recording industry to be unnecessarily risky. Modern rights case, not the usual negligence suit. essential information. Should harm result courts are reluctant to permit industries The Archie Case to an ill or injured person because of a to set their own uncontrolled standards. According to the facts contained in dispatching error, the dispatcher as well as Consequently, meeting the standard the opinion of the Court, the following his employer risk liability for negligence. of other ordinary and prudent EMS persons played a part in this case: Negligence has been defined as the dispatchers may not insulate an EMS Rena DeLacey, deceased (the suit failure to exercise that degree of care which dispatcher from potential liability if the was brought by the administrator of a person of ordinary reasonable prudence EMS system standard is itself inadequate. the estate); would exercise under the same or similar EMS systems must develop reasonable Les Hiles, a person in the community and circumstances. For example, conduct which procedures to minimize the risks inherent a friend of the deceased; falls below the standard established for the in dispatching. Where serious risks can be George Giese, a dispatcher for the protection of others against unreasonable reasonably anticipated, the law requires Racine Fire Department on duty during risk of harm is considered negligent that precaution be taken. the incident; conduct. The dispatcher’s responses A recent case in federal court, Archie Ronald Chiapete, Racine Fire Chief who and skill must be as good as those of any v. City of Racine, 627 F. Supp 766 (E.D. was responsible for rescue services. prudent, competent dispatcher acting Wis 1986), and on appeal Archie v. On May 27, 1984, at 7:19 a.m., the under the same or similar circumstances. City of Racine, 826 F.2d 480 (7th Cir. following call was made:
40 THE JOURNAL | iaedjournal.org blast from the past
Giese: Fire Department, Giese. breathe into that. That will slow your DeLacey dead in her apartment. He Hiles: Hi. Say, this is Les Hiles, and we breathing down. told the investigating police officers of have a lady that’s really, ahh, I don’t know, Rena: Okay, thank you. his calls to the rescue squad, but police I’m not a doctor, hyperventilating. She Giese: Okay, bye. were unable to find any record of them. can’t hardly breathe, and I said, well, let’s Rena: Bye. Testimony by the investigating officers go down to the emergency ward. Say’s, “I The taped conversation clearly shows at trial indicated that the lack of records can’t walk,” Ahh, so I says, well, I thought that the woman was in distress and that made them suspicious that the situation I could call rescue squad together, okay. Hiles was anxious to get help for her. had been inappropriately handled. The 818 College Avenue. Almost eight hours later, still on coroner, following the autopsy, listed the Giese: What’s the address? May 27, Hiles again called the Racine cause of death as respiratory failure due to Hiles: 818 College Avenue. I’ll meet you Fire Department. bilateral vesicular pulmonary emphysema, in front. Giese: Fire Department, Giese. with superimposed broncho-pneumonia. Giese: What’s the problem with her? Hiles: Hi, this is Les Hiles, Giese. At trial, Chief Chiapete testified that Hiles: She just don’t-just breathing like, Giese: Yeah. he would have sent the rescue squad to you know, she just can’t get her breath Hiles: Listen, this, this lady, ah, my little DeLacey, but could understand how one or nothing. black girl friend, I, I, called before and could reach a different conclusion. The Giese: How old is she? tried the paper bag. She’s still hyper-how department’s official response was the Hiles: Ah, excuse me. Rena, how old are do you say that word, hyperventilating? following press release: you? Forty-three. Giese: M’hm. “Addressing the specific incident of Giese: Let me talk to her, please. Hiles: But she sat here for six hours. I May 27, 1984 my conversation with Pvt. Hiles: Okay. Come here, come here. mean, did, and I asked, “Did you ever do Giese indicated to me that he came to the Wants to talk to you. She ain’t big this before?” She said, (slurred words) conclusion, based on the conversation enough. Four hours don’t people—(Makes only once in a while. But it scares me, you with Ms. DeLacey and Mr. Hiles, that an sound of a person breathing very hard). know, me. emergency situation did not exist. My See, I’m, Les Hiles you know and I could Giese: Well, if she’s hyperventilating, review of the tapes of those conversations be the best act in the world but- just, just have her do what I told you to indicates that his conclusion is not entirely Giese: Let me talk to her. Put her on do. She’s going to have to breathe into unwarranted. It is my view that, Pvt. Giese the phone. that bag. made a judgment call based on his present Hiles: She’s coming. She ever gets here. I Hiles: Yeah, but. analysis of the conversations with the know what’s wrong with her. Giese: Over her nose and her mouth and calling parties. I believe that his decision was Rena: Hello. then slow her breathing down. honestly made and without any intent on Giese: Hi, what’s, what’s, what’s Hiles: Listen to me now. Is there anything his part to refuse service or harm any person. the problem? do with the heart? In view of my analysis of the situation, Rena: Hyperthermia. Giese: No. it is my present intention not to impose Giese: Hyper what? Hiles: It isn’t going to beat the heart out? disciplinary action on Pvt. Giese. Rena: Thermia. Having a hard Giese: No. Viewing the entire situation from time breathing. Hiles: Cause I know…like my chest the perspective of hindsight, however, Giese: Have you ever had this when…I’m talking. You know who I am. I believe that it may have been better trouble before? Les Hiles. judgment if Pvt. Giese had dispatched Rena: Once, once. Giese: M’hm. the rescue unit. Hindsight is, of course, Giese: Why don’t you slow down just a Hiles: The swimmer? Okay, what I always perfect, and it is difficult to say little bit and relax? thought, my God, man, maybe it’ll wear what any individual would or would not Rena: And stay in my own apartment? her heart out. do at the time an incident arises. Giese: Just relax and don’t breathe like Giese: No. At present my department does not you’re breathing. Hiles: No? Okay. Say, what’s your have a written policy with respect to the Rena: Okay. first name? discretion of dispatchers, and that matter is Giese: Do me a favor. Giese: George. presently under review by Assistant Chief Rena: Yes. Hiles: Ok, thanks a lot. Jeffrey Peterson who recently assumed the Giese: Get, get a little paper bag. Giese: Okay. duties of the department training officer. Rena: A little what? Hiles: Thank you very much. The department naturally regrets Giese: A paper bag. Giese: Yeah. the unfortunate death of Rena DeLacey Rena: Paper bag. Hiles: Bye. but cannot assume responsibility for it. Giese: And put it over your mouth and Early on May 28, 1984, Hiles found At worse, the department can be faulted
may / june 2017 | THE JOURNAL 41 blast from the past
for an error of judgment which we protective services undertaken by the The Court of Appeals also noted believe is understandable in view of the state. If he does this in a way that deprives that in advising DeLacey to “breathe circumstances, and must be judged from a person of life or property, that person’s into a bag,” Giese deliberately assumed the perspective of the thousands of calls constitutional rights have been violated. control over DeLacey’s physical received by our department each year, A finding of such a deprivation welfare. This could create the “special and the great number of persons who depends on the totality of the relationship” that was alleged during are helped by our rescue service. We circumstances. It is not enough that the the original trial. It was perfectly have never refused and never will refuse dispatcher was a municipal employee, he forseeable and reasonable for DeLacey to send our rescue units in known must have exercised his state power in and Hiles to rely on advice given by emergency situations. an arbitrary and abusive manner. There Giese. Thus, a violation of DeLacey’s Why wasn’t the rescue squad sent to must be a deliberate misuse of state rights could be found under a special Rena DeLacey? Was it because she was power resulting in an infringement of a relationship theory. black? Was it because the dispatcher constitutionally protected right. At the time of this writing, we are didn’t believe Hiles? Or didn’t he think a In the Court’s analysis, the dispatcher unaware of any further actions by the real emergency existed? had a duty to send an ambulance if one District Court. The trial court found that race had was available. So, if his failure to send Commentary nothing to do with the dispatcher’s one was reckless or arbitrary such that The DeLacey case points out the failure to respond. There was no doubt it caused DeLacey’s death, a violation importance of taking all rescue calls that his response to DeLacey’s calls was of her constitutional rights occurred. seriously. The Court of Appeals specifically inappropriate, but it was not found to Giese knew the situation was serious, noted that because there were two calls, be racially motivated. The judgment yet he advised DeLacey to breathe into a Giese had no excuse not to send the of the dispatcher was not at issue here. paper bag and refused to send the rescue rescue squad. Plaintiffs raised a violation of civil rights, squad. With the second telephone call, What kind of safeguards might so the court had to decide if the failure Giese knew his “unsolicited medical prevent or reduce error of the kind to provide rescue services to DeLacey advice” didn’t work. Thus, his continued reported here? At a minimum, violated a constitutional duty owed to her. refusal to send an ambulance could EMS dispatchers should confirm all To prove a violation of DeLacey’s be found to raise an ordinary act of information given to them by the caller. rights, it must be shown that rescue squad negligence into a violation of DeLacey’s In addition, the practice of tape policies allowed this incident to happen. constitutional rights. The fact that he recording calls and responses is an A single incident will not support such never refused to send an ambulance excellent method of instantly assuring a claim, there must be a pattern of before this incident, only strengthens that the information written down by the incidents. Since this was not the case here, this argument. dispatcher is the information received. the Fire Chief and the City of Racine The District Court’s findings were Finally, dispatchers and complaint were dropped from the case. enough to show that Giese exercised state writers should be trained and retrained Regarding the dispatcher, the power in a reckless and arbitrary manner in proper procedures to be followed and plaintiffs also charged that there was a in twice refusing to send the ambulance. communication skills. “special relationship” between Racine and But, the record was not sufficient to Generally, the four basic questions to its citizens since it decided to provide say that as a matter of law there was an be asked are: (1) What is the problem?; (2) emergency services. But, the court found actionable abuse of power, so the Court of Where?; (3) Who is involved?; (4) When that providing such services does not Appeals sent the case back to the District did it happen? create a special relationship between the Court. The District Court must now The dispatchers must be able to city and its citizens. Thus, the dispatcher’s determine if Giese’s actions cross the line ask appropriate questions and provide failure to send the rescue squad, while from tort to constitutional violation. To appropriate answers in a manner that is wrong, did not violate DeLacey’s find this, it must be shown that Giese had readily understandable by even the most constitutional rights. reason to foresee the risk to DeLacey if distraught or uneducated caller. The Court of Appeals disagreed. It rescue services were withheld, and that While a dispatcher may advise the found that the dispatcher’s conduct could he deliberately and consciously imposed caller to put pressure on a bleeding have amounted to a violation of DeLacey’s this risk on her. In addition, Giese’s failure wound until an ambulance arrives, rights on a theory of abuse of state power. to act must have been for reasons other such advice should never be given as a To prevail, on this theory, plaintiffs must than honest error or mistaken judgment. substitute for sending emergency aid. show that Giese was acting in his official Finally, if there was an abuse of power, Providing appropriate answers, however, capacity (not disputed here), and that it must have caused DeLacey’s suffering should not include medical advice of the he was under a duty to disperse those and death. kind given in the DeLacey case. J
42 THE JOURNAL | iaedjournal.org dispatch in action | YOUR SPACE •••
Magnolia Towing. Peter Baty maneuvered his wrecker to lift the home to facilitate EMS rescue. Arteaga had a pulse. Events took yet another turn. Arteaga’s heart stopped. This time, Magnolia Volunteer Fire Department arrived and responders started CPR immediately. Moments later, a third team arrived on scene. MCHD paramedics determined the impact had crushed Arteaga’s lungs. They performed a simple thoracostomy. In a simple thoracostomy a gloved finger is inserted into an incision to relieve tension in injured lungs. The technique is performed on patients with traumatic cardiac arrest with known or suspected injury to the chest and/or abdomen. Arteaga’s lungs reinflated, and in seconds he had a pulse. He was in a coma for 10 days and was able to recognize friends Dispatchers, firefighters, sheriff’s deputies, and even a towing company combined to help save Jonathan Arteaga’s life. and family within six weeks. Physical therapy started while he was in the hospital continues during his at-home recovery. EMS IN TANDEM The people involved in saving his life Cohesive actions save young man’s life met the Arteaga family in a ceremony honoring the instinctive and phenomenal Audrey Fraizer EMS chain of survival. Arteaga was there with them. He can’t remember anything from that day, and the same goes for eople suffering a cardiac arrest Montgomery County Hospital events prior to the accident. secondary to a traumatic event District (MCHD) communication center “People there told me what happened,” Phave a slim margin of survival. EMD Danielle Williams answered the he said. “My family talks about things before People experiencing a cardiac arrest call. She had been there less than one year. the accident and there’s a month that’s lost.” secondary to a traumatic event and “I knew there would be difficult calls Williams shook his hand and they with their body folded in half beneath a but nothing like this,” Williams said. “A talked briefly about how well Arteaga mobile trailer might have half of a slim house was on top of a human being. This was recovering. chance of survival, at best. was really beyond what you’d expect.” “This is something I will never forget— Considering that’s what happened to The accident prompted the use of the call, Montgomery County Hospital Jonathan Arteaga, the circle of responders MPDS® Protocol 22: Inaccessible Incident/ bringing everyone together, and meeting helping him survive the crisis performed Other Entrapments (Non-Traffic). PDIs Jonathan,” Williams said. “Without everyone nothing short of a miracle in incredibly include “Do not attempt to rescue her/ doing their job so well, the results for rapid succession. him,” and while this may be a given Jonathan could have been much different.” The then 19-year-old Arteaga was considering the situation, the Arteaga By March, Arteaga was walking with prepping to move a mobile home, which family was eager to do anything to help. the aid of leg braces. He is gratified for the is a routine operation for Arteaga’s Response was on its way. people involved in saving his life. Mobile Home Service, in Conroe, Texas “I had to tell them not to remove the “There were so many,” he said. “I will (USA). Sometimes unexpected things unit,” she said. “They had to wait.” always be grateful for what they did to happen, as they did on Feb. 24, 2016. A Within minutes of the 911 call, help me.” jack holding the house gave way. The Montgomery County Sheriff Deputies Editor’s Note: Julie Martineau, PIO, 37,000-pound mobile home fell on top of Brad Crandell and Kenneth Morris Montgomery County Hospital District, Arteaga, pinning his knees to his chest. arrived on scene. They contacted contributed to this story. J
may / june 2017 | THE JOURNAL 43 ••• YOUR SPACE | dispatch in action
Dispatcher Anthony Bruno was recently recognized for his lifesaving heroics. NEVER OFF THE CLOCK Las Vegas dispatcher responds to emergencies on and off the phone
Josh McFadden
ike all dispatchers, Anthony Bruno the phones, he was headed home for an injured animal off in the distance. has dedicated his career to helping some much-needed rest. Not long into his Initially, he disregarded the noise and Lpeople. Bruno works long and late commute home, Bruno saw a technical was about the drive away, but a “gut hours answering frantic phone calls from rescue truck enter the freeway; its bright feeling” urged him to investigate. Bruno people who are experiencing the most lights signaled that an emergency was ventured off into the darkness of a frightful moments of their lives. nearby. Next, Bruno saw a helicopter deserted field and came upon the Ford, So naturally, the Communication getting ready to land on the freeway. As upside down with someone trapped Specialist with Las Vegas Fire & he approached the scene of an accident, inside, about 100 yards away from the Rescue, Las Vegas, Nevada, USA, came Bruno stopped his car a safe distance original accident. to the rescue even when the headset away and stepped out of his truck to “Help me!” the person pleaded. was off and he was away from the watch the crews do their work. Bruno spoke to the 20-year-old man— communication center. A Nissan had rear-ended a Ford, who later was determined to have been In March 2016, Bruno’s instinctive sending both cars off the road; the Ford trapped for an hour and two minutes— actions helped save a man’s life. In the flipped several times and landed far and reassured him that help would be several months following this heroic from view. Calls to 911 had reported on the way. Bruno ran up the road to intervention, he has been showered with only one car was involved, so paramedics where a Nevada Highway Patrolman awards and recognition. weren’t aware of the second vehicle. was helping with the aftermath of The incident happened when Bruno The responders did their work and left the accident. wasn’t even on duty. the scene. “I felt terrified and alone,” Bruno had clocked out from the Fire Bruno prepared to get back into Bruno recalled. Alarm Office, as it is locally called, at 2 his truck to leave, but he heard a After summoning help, the officer a.m. After another challenging day on whimpering noise or the sound of joined him at the scene, and the officer
44 THE JOURNAL | iaedjournal.org dispatch in action
called dispatch. Bruno was used to being The long list of accolades came as a “As a kid, I used to come by and on the headset, hearing people desperately surprise to the humble Bruno. visit where I now currently work,” plea for rescue to come. In an odd twist, “I wasn’t expecting it,” he said he said. “I tried six times to be a fire he began to have the same feelings that regarding the employee of the year department dispatcher.” so many callers have when they’re on the award, in particular. “I was shocked. [City Each time a job came up at Las Vegas phone waiting for help to arrive. representatives] came and surprised me Fire & Rescue, Bruno didn’t just apply, “The first thing that went through with the award.” he was the first applicant each time, my mind was, ‘What’s taking so long?’” he Though grateful for the submitting his application at 12:01 a.m. said. “It’s a different feeling to be in [the acknowledgement, Bruno shies away the day the job came open. caller’s] shoes. Imagine being a loved one from the limelight and dismisses the His persistence paid off, and the sixth of a victim. I was a complete stranger, and notion that he is a hero. In his mind, he time was the charm. I was so worried about “I was so glad I got the guy. It’s a difficult accepted,” he said. feeling to describe. Bruno has thrived I’m used to callers under the headset, just getting frustrated as he was Johnny-on- as they wait. Now, the-spot as a bystander I feel comfortable in the wee hours in saying, ‘I know it March 2016. One of seems like a long his secrets of success is time.’ I experienced a positive attitude and it first-hand on the a genuine appreciation other side.” for his work. Help did come, “I love my job and the man survived. with a passion,” he Those who arrived said. “I love what I do, on scene said without and I love coming to Bruno’s timely, work. I have the best brave efforts, the co-workers; we’re victim wouldn’t have the definition of a survived the accident. team. We talk about In recognition of the worst every day. his actions, in July We bounce ideas 2016, the city of Las off each other at Vegas named him work. At work I have employee of the true friends.” month. In January Bruno said 2017, at a ceremony dispatching isn’t for held during a city council meeting, he was only doing what anyone else would everyone. After all, you’re talking to was selected among the city’s other do and was simply performing a duty people on the worst days of their lives— 11 employees of the month in 2016 as that spilled over from his everyday work helping them give CPR to a loved one, employee of the year. as a dispatcher. comforting them when a family member The recognition kept coming for this “It felt good to be honored, but I has committed suicide, or assisting with veteran dispatcher. don’t look for recognition,” he said. “I’m any number of terrible events. Yet, Bruno The Las Vegas Fire Department not a hero. Heroes are the guys that cut said the profession is rewarding and named him employee of the month for the person out of the car. I don’t look at that he wouldn’t trade his experiences April 2016. Plus, he received the Everyday myself as a celebrity.” for anything. Hero Award from the American Red Helping people is second nature for And whether a call for help comes Cross in October 2016 at a ceremony at Bruno. Since graduating from high school while he’s got a headset on or whether he the Paris Hotel on the Las Vegas Strip. He in 2005, he has spent all his working time as sees a need away from the console, you even got to have lunch with the Las Vegas a dispatcher. But it was with Las Vegas Fire can be certain that Bruno will always be City Council. & Rescue where he always wanted to be. ready to jump in and lend a hand. J
may / june 2017 | THE JOURNAL 45 ••• case exit
for nearly four months, until Aug. 1, 1988. Martha and Charles Frieburg spent every day at their daughter’s bedside. They participated in her therapy sessions, learning how to help Sharron regain at least some of her skills. They brought her home from the hospital after the insurance company would not cover any further care because of a policy clause prohibiting extended treatment when a patient has recovered as much as the company’s doctors think is likely. Sharron was never expected to fully recover from the physical and cognitive trauma. And she never did. “The accident changed everything,” Linda said. “It set a new course for the family.” Sharron is now 47 years old (as of January 2017). She lives at home with Sharron Rose (left) her mother. Charles died in 2005. Linda moved close to her family home, along with her four sons, to assume some of AFTER THE ACCIDENT the tasks Sharron’s daily life requires. Unnecessary ambulance collision changes teen’s future instantly She had hoped to give her mother respite, and she does, but Sharron grows Audrey Fraizer increasingly agitated when her mother is out of her sight, even if it’s a walk to the garage outside. harron Rose Frieburg’s photo in their friends spent a good part of their They seldom talk about the accident. the 1988 Saybrook-Arrowsmith time away from the scrutiny of parents “I don’t at all unless I have to,” Martha S(Illinois, USA) High School hanging out at the neighborhood park, said. “It brings back all the sadness and yearbook is a trip down memory lane. driving aimlessly around town, going to tears that lie deep down in me.” Her hair is cut shoulder length, with movies, dating, and looking forward to Sharron can walk a short distance bangs bobbed above her eyebrows. She high school graduation. Sharron was an unassisted. Her gait is unsteady and she wears no makeup. Her smile is genuine, honor student and a cheerleader. College tends to stumble. The family prefers although soft because either she was was a summer away. to bring a wheelchair to grocery shop, taken by surprise or shies away from But Sharron never made it to attend services at Saybrook Christian photos that might reveal the braces on college. Her life took a dramatic turn on Church, where their father was a deacon, her teeth. She is 18 years old. March 26, 1988, at the exact moment and visit friends and family. Sharron’s “She was everything but shy,” said her her boyfriend, Mark, drove his pickup eyes don’t focus. Paralysis on her left side younger sister Linda Renee Frieburg. “She through a green traffic signal at an makes dressing and personal grooming was a ton of fun to be around. She liked intersection on their way to a movie. difficult. Because braces severely lacerated to sing. She was in jazz dance. She was Their vehicle was broadsided by a her tongue during the accident, she has funny—outgoing. She got straight A’s.” Bloomington City Fire Department trouble enunciating words. The Frieburgs live in Saybrook, ambulance moving at a high speed Martha said Sharron can say “yes” a small, rural town, and part of the through a red traffic signal, without and “no.” She more often relies on Bloomington–Normal metropolitan area lights-and-siren, and transporting a patient hand gestures. in east-central Illinois. The population with a sprained ankle to the hospital. “She has lots of her own signs,” Linda holds steady at close to 700 residents, and Mark sustained minor injuries. said. “Most of the time we understand like teens anywhere, Sharron, Linda, and Sharron was in a coma in the hospital what she wants.”
46 THE JOURNAL | iaedjournal.org case exit •••
Due to face and throat paralysis, Martha lives one day at a time. fatalities, rollovers, lawsuits, and horrible Martha said administering the Heimlich “At the age of 70, my biggest concern outcomes. Then there was Sharron maneuver is nearly an everyday occurrence is the concern of every parent caring for Rose. Her story caught my eye: In in the home. Sharron has no short-term severely disabled children,” Martha said. Bloomington, Illinois, nearly $5 million memory, although her long-term memory “What happens to Sharron after I am gone?” and the quality of life of a talented, provides glimpses into her past. In 1989, the city of Bloomington beautiful 18-year old girl, Sharron Rose reached a monetary settlement. The Frieburg, were lost because of a “sprained funds cover Sharron’s ongoing medical ankle” run. and therapeutic expenses and costs In 1983, Salt Lake City’s Fleet associated with her 24-hour care, housing, Management department reported and other necessities of daily living. that the EMVA rate had dropped 78 The Bloomington Fire Department percent in that city as a result of the changed its policies on using red MPDS®, and it was estimated that the lights and siren after the accident number of EMS vehicles traveling Salt involving Sharron. Lake City streets with RLS was safely “In the past, we ran hot all the time,” reduced by 50 percent through the use said Alan Otto, Chief of the Bloomington of the system. Were any Sharron Roses Fire Department (in a Feb. 4, 1997, article saved by these changes? I guess we will exploring the overuse of red lights never know. and siren published in the Cincinnati Enquirer). “Now, we’re down to 60 or Statistics 70 percent.” U.S. Fire Administration firefighter Sharron Rose fatality statistics over the years reveal Related article that vehicle-related deaths account for There are good times, Linda said. She The following article written by Jeff 25 percent of all fire service fatalities. loves to make Sharron laugh and take Clawson, M.D., was published in JEMS According to the National Law her places in the town where the family (“Running ‘Hot’ and the case of Sharron Enforcement Officer’s Fund, for the has lived for generations. Martha and Rose,” July 1991). period of 2002 through 2011, 39 percent Linda frequently retell Sharron family The use of RLS [Red-lights-and-sirens] of law enforcement officer fatalities were stories from before the accident. She is not without significant hazard. It has vehicle-related. enjoys those, said Linda, who is eight been estimated, for example, that as many Source: “Emergency Vehicle Safety years younger than Sharron. Martha as 12,000 emergency-medical-vehicle Initiative.” 2014; February. https://www.usfa. acknowledges her older daughter’s sense accidents (EMVAs) occur each year in fema.gov/downloads/pdf/publications/ of humor, despite her severe challenges. the United States and Canada as a direct fa_336.pdf (accessed Feb. 21, 2017) They love her unconditionally. result of RLS use. In addition, because According to the National Highway “On her worst days, we try to focus of what we call the “wake effect” of Traffic Safety Administration (NHTSA), on how far she has come,” Linda said. “I emergency units disrupting, confusing, between 1992–2011, there were: would never want to lose my sister. We and startling other drivers, up to five •• an annual estimated mean of 4,500 love her, but there are also days we can’t times as many accidents are caused motor vehicle traffic crashes involving help think about what might have been.” by units responding RLS that don’t an ambulance. Linda went through a tough period physically involve the emergency vehicle •• an annual mean of 29 fatal ambulance after the accident. She was angry. She itself. Does the number 75,000 get your crashes and 33 fatalities. sunk deep into depression. She withdrew. attention? It should, if you, too, believe •• an estimated annual mean of 1,500 It was like she had lost her best friend, that the prime rule of emergency medical injury crashes involving an ambulance and, in a way, she said she had. Poetry dispatch as for medicine itself should be, and 2,600 injured persons (ambulance and journal writing is therapy for her as “First, do no harm.” occupants and occupants of all other well as the company of her sons and their In 1989, I subscribed to a national vehicles involved). families. Saybrook is where she will stay. newspaper clipping service, and for Source: “The NHTSA and “I made a decision, and this is where one year, I received so many articles of Ambulance Crashes.” 2014; I should be,” Linda said. “All we can do is EMVAs that I couldn’t fit them all into April. https://www.ems.gov/pdf/ keep pushing forward and doing what we a cabinet drawer. And these were just GroundAmbulanceCrashesPresentation. can do for Sharron.” the ones that made the news, such as pdf (accessed Feb. 21, 2017) J
may / june 2017 | THE JOURNAL 47 Annals of Emergency Dispatch & Response
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