Field Work Taking Dispatch on Location

Don’t play with ﬁ re: CDE Nation’s capital See ya in baby! gives hot tips goes full protocol The National Academies of Emergency Dispatch September/October 2008 THEJOURNAL OF EMERGENCY DISPATCH

Field Work Taking dispatch on location

THE JOURNAL | September/October 2008 1 PROTECT THEM ASK THE RIGHT QUESTIONS

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OnTrack IndustryInsider 44 | Making Changes. Pro- posal for Change shows who’s 9 Medical CDE. Action to 21 In The News. | | behind the evolution of MPDS take once the help in uniform comes onto the scene 46 | Frequently Asked BestPractices Questions. Motorcycle 12 | Fire CDE. Fighting fi res helmet removal instructions takes understanding the 39 | Triple Protocol. environment Unifi ed Communications YourSpace 16 Dispatch Workforce. Center in Washington, D.C., | adds police and fi re protocols 47 | Dispatch In Action. Younger generations not Dispatcher set sights on career keeping up with popula- 42 | Quality Improvement. since the second grade tion fueled by post-war baby Program is the tie that binds boomers protocol consistency and Move doesn’t diminish ability accuracy to help people 18 | Software Secrets. AQUA reports designed to pinpoint 49 | Dispatch Frontline. compliance issues Dispatchers pull together to coordinate fi ve-alarm fi re

The following U.S. patents may apply to portions of the MPDS depicted in this book: 5,857,966; 5,989,187; 6,004,266; 6,010,451; 6,053,864; 6,076,065; 6,078,894; 6,106,459; 6,607,481. FPDS and PPDS patents pending. Protocol-related terminology in this text is additionally copyrighted within each of the NAED’s discipline-speciﬁ c protocols. Original MPDS, FPDS, and PPDS copyrights established in September 1979, August 2000, and August 2001, respectively. Subsequent editions and supporting material copyrighted as issued.

THE JOURNAL | September/October 2008 3 J DEARREADER THEJOURNAL A Good Thing. OF EMERGENCY DISPATCH NATIONAL NAED JOURNAL STAFF ACADEMIES OF COMMUNICATIONS DIRECTOR Stories fuel the job EMERGENCY DISPATCH Kris Christensen Berg 139 East South Temple, Suite 200 MANAGING EDITOR Salt Lake City, UT 84111 USA Audrey Fraizer USA/Canada toll-free (800) 960-6236 Int’l/Local: (801) 359-6916 TECHNICAL EDITOR Fax: (801) 359-0996 Brett A. Patterson www.emergencydispatch.org ASSISTANT EDITORS [email protected] Heather Darata Audrey Fraizer, Managing Editor Benjamin H. Rose CREATIVE DIRECTOR INTERNATIONAL Kris Christensen Berg ACADEMIES OF Lee Workman EMERGENCY DISPATCH A good thing about this job accurate auditing. They call it a GRAPHIC DESIGNER AUSTRALASIA OFFICE Marialice Jones 011-61-3-9806-1772 is the information I pick up “review of the reviewers” and it WEB DESIGNER GERMAN OFFICE Erwin Bernales with each edition. has led to more consistent scor- 011-43-5337-66248 For this issue, I had the ing in line with standards of the ITALIAN OFFICE 011-39-011-513-2588 opportunity to learn about National Academies of Emer- CANADA OFFICE ACADEMY STAFF ® 1-514-910-1301 incident dispatch teams (IDTs) gency Dispatch (NAED). PRESIDENT U.K./EUROPE OFFICE Scott Freitag from the founders of the organi- I also had the good fortu- 011-44-0-117-934-9732 ASSOCIATE DIRECTORS-USA zation dedicated to promoting nate to meet, by phone, several Carlynn Page and supporting on-scene com- dispatchers featured in the BOARDS & COUNCILS Ross Rutschman ACCREDITATION BOARD CHAIR ASSOCIATE DIRECTOR-U.K. Beverley Logan munications. Although incident YourSpace section. Zachary Brian Dale ALLIANCE BOARD CHAIR ASSOCIATE DIRECTOR-AUSTRALASIA dispatch has been around, at Cannady, a dispatcher for the Peter Hamilton Keith Griffi ths least in concept, for 30 years or Albertville Police Department CERTIFICATION BOARD CHAIR ACADEMICS & STANDARDS ASSOCIATE Brett A. Patterson more, its value to the emergency (Ala.), is working the dream Jeff Clawson, MD CURRICULUM COUNCIL CHAIRS DIRECTOR OF CURRICULUM DESIGNER Larry E. Latimer, M. Ed. response community is taking job he has wanted since grade John Flores (Medical/EMD Board) Mike Thompson (Fire/EFD Board) INTERNATIONAL LIAISON on even greater meaning in the school. Haley Latimer kept Ric Focht (Police/EPD Board) Tudy Benson Susi Marsan (ETC) wake of major disasters such calm when calling 9-1-1 after MEMBERSHIP SERVICES MANAGER RESEARCH COUNCIL CHAIRS Arabella VanBeuge as the seasonal fi res destroying her mom suffered a tonic clonic Brett A. Patterson, Medical/EMD Mike Thompson, Fire/EFD California homes and wildlife. seizure. Haley was 12 years old STANDARDS COUNCIL CHAIRS Marie Leroux, Vicki Maguire (Medical/EMD) As explained by Bonnie at the time. Janet Jones, a dis- Gary Galasso (Fire/EFD) Maney, telecommunications patcher for the Sarasota County Eric Parry, Jaci Fox (Police/EPD) manager for the town of Palm 9-1-1 Communications Center COLLEGE OF FELLOWS Thera Bradshaw (CA) (Emeritus) Beach, Fla., Police Department (Fla.), fi nds her career satisfac- Geoff Cady (CA) CHAIR Steven M. Carlo (NY) and All-Risk IDT coordinator tion in helping others, just as Marc Gay Jeff Clawson, MD (UT) AUSTRALASIA/SOUTH AMERICA Phil Coco (CT) Rex Comerford (IL) for the state of Florida, incident she did when helping a father Frank Archer, MD (Australia) Brian Dale (UT) Andrew K. Bacon, MD (Australia) Chip Darius, MA (CT) dispatch teams “take some of in the birthing of his baby boy. Peter Lockie (New Zealand) Kate Dernocoeur (MI) Silvio Najt, MD (Argentina) Norm Dinerman, MD (ME) the workload off the communi- It’s not only the informa- Peter Pilon (Australia) Patricia J. Dukes, MICT (HI) cations centers.” They are at the tion that keeps the job alive; CANADA James V. Dunford, MD (CA) Drew Burgwin (Br. Columbia) Marc Eckstein, MD (CA) scene, providing command post it’s also the people involved in Nicole Cimon, MD (Québec) Gary Galasso (CA) Claude Desrosiers (Québec) Keith Griffi ths (CA) assistance by doing what they the stories. In past issues, we’ve Marty Friedberg, MD (Ontario) Jeffrey R. Grunow, MSN (UT) Marie Leroux, RN (Québec) Ed Jetter (OH) do best—radio traffic control, featured French toast breakfasts Paul Morck (Alberta) Alexander Kuehl, MD, MPH (NY)(Emeritus) Wayne Smith, MD (Québec) Jim Lake (MA) resource tracking, and multi- made in honor of CPR saves, Jim Lanier (FL) EUROPE Bill Leonard (AZ) tasking. The work gives them a the city of Haleyville (Ala.) André Baumann (Germany) Stephen L’Heureux (NH) Gianluca Ghiselli, MD (Italy) Vicki A. Maguire (MI) close-up view of the situations and its annual festivity to com- Bernhard Segall, MD (Austria) Sheila Malone (IN) Gernot Vergeiner (Austria) Susi Marsan (GA) they have handled from inside memorate the first ever 9-1-1 UNITED KINGDOM/IRELAND Robert L. Martin (DC) Trevor Baldwin (England) Dave Massengale (CA) the communications center. call made in the United States, Chris Carney, MD (England) Jim Meeks, PA-C (UT) Michael Delaney (Ireland) Shawna Mistretta (CO) During the same time I and dispatchers winning awards Louise Ganley (England) Gene Moffi tt (UT) Chris Hartley-Sharpe (England) Jerry L. Overton (VA) learned about IDT, I had the for helping others through the Andy Heward (England) James O. Page, JD (Emeritus,1936–2004) Stuart Ide (England) Rick W. Patrick (PA) opportunity to listen in on a unexpected crises. Things don’t Peter Keating (Ireland) Brett A. Patterson (FL) Ray Lunt (England) Paul E. Pepe, MD, MPH (TX) telephone conference among always end happily but there’s a Andy Newton (England) (Emeritus) Mikel A. Rothenberg, MD (OH) (1954–2006) Gwyn Pritchard (Wales) (Emeritus) Ross Rutschman (OR) (Emeritus) quality improvement (QI) coor- lot that dispatchers do by sim- John D. Scott, MD (England) Doug Smith-Lee (WA) Janette K. Turner (England) Paul Stiegler, MD (WI) dinators working out of three ply being there. Fred Thorp, MPA (KS) UNITED STATES Carl C. Van Cott (NC) provincial communications cen- I hope you enjoy reading Bill Auchterlonie (KS) Sheila Q. Wheeler, MSN (CA) Bob Bass, MD (MD) Arthur H. Yancey, II, MD, MPH (GA) ters under the British Columbia this issue as much as we enjoyed Christopher W. Bradford (FL) Tina Young (CO)

Ambulance Service (BCAS). putting it together. And, as The National Journal of Emergency Dispatch is the offi cial bimonthly publication of the National Academies of Emer- gency Dispatch (NAED), a non-profi t, standard-setting organization promoting safe and effective emergency dispatch These QIs are fanatical about always, please don’t hesitate services wo . Comprised of three allied academies for medical, fi re, and police dispatching, the NAED supports fi rst- responder-related research, unifi ed protocol application, legislation for emergency call-center regulation, and strengthen- their work and devote time each to contact us about the stories ing the emergency dispatch community through education, certifi cation, and accreditation. General NAED membership, which includes a Journal subscription, is available for $19 annually, $35 for two years, month to a collective review of shaping your days and life in the or $49 for three years. Non-member subscriptions are available for $25 annually. By meeting certain requirements, certi- J fi ed membership is provided for qualifi ed individual applicants. Accredited Center of Excellence status is also available a random call in the interest of communications center. to dispatch agencies that comply with academy standards. © 2008 NAED. All rights reserved.

4 THE JOURNAL | emergencydispatch.org J PRESIDENT’SMESSAGE Thirty Years and Growing. Protocol and profession mature into 21st century

more consistent with the Police and Fire grow. Stories in this issue of The Journal Scott Freitag, NAED President Priority Dispatch Systems™. show the many directions a dispatcher The communications center has been can take with his or her career. No longer more fully recognized as an integral part is the dispatcher confined to a job with- As you’ve probably heard by now, the of the pre-hospital care team over the past out any opportunity to move beyond that National Academies of Emergency Dis- several decades, and I believe protocol position. The dispatcher can carry the patch® (NAED) recently released ver- has a lot to do with that. The public has skills of emergency 9-1-1 communications sion 12 of the Medical Priority Dispatch acknowledged the importance of telecom- to the fi eld and participate at a level once System® (MPDS). This latest version munications professionals and has a higher reserved for fi refi ghters, police, paramed- provides major new innovations in EMD expectation of them when they make tele- ics, and other fi rst responders. There are that deliver the high-quality pre-hospital phone contact. The protocol gives the public opportunities within the centers to work patient care you come to expect from an edge. Calltakers trained in the use of pro- in training, quality assurance, and continu- the Academy. tocol are able to provide pre-hospital instruc- ing education programs. What you might not know is the amount of time and talent devoted to its development. A tremendous amount of The communications center volunteerism goes into a project of this magnitude and we have motivated and has been more fully recognized skillful experts from the industry who dedicated their time to make sure that the as an integral part of the protocol stays the best it can be. In fact, when you consider the detail that went pre-hospital care team over into version 12, it no doubt represents an investment of 100s of volunteer hours. the past several decades, In the formal round of action held in the Academy offi ces, the NAED’s 19-member and I believe protocol has a Medical Council of Standards considered 302 Proposals for Change over eight full lot to do with that. days of meetings. Additional Proposals involving High-Risk Pregnancy and Child- birth and for Transfer, Interfacility, and tions that help save lives and bring new ones Projections from the U.S Bureau of Palliative Care were considered at a later into the world. Protocol helps us know how Labor Statistics reinforce the future of com- series of meetings held by three specialty to do what’s best for those we serve. munications specialists choosing this route. focused subcommittees. At the time I was launching into my According to the bureau’s Occupational As anyone at these meetings will agree, career, Dr. Jeff Clawson said we were wit- Outlook Handbook (2008–2009), employ- the discussions are painstaking. Even what nessing the “Dawn of the Dispatch Decade” ment of dispatchers is expected to increase someone might think is a minor change can as municipal and public awareness recog- six percent over the 2006–2016 decade. take hours of consideration. For example, nized the increasing importance of EMD. Population growth and economic expan- the revision to the long-established Chief As he predicted, the 1990s did serve as a sion are expected to spur employment Complaint selection question, “What’s the template for the safe and efficient provi- growth for all types of dispatchers. The problem, tell me exactly what happened,” sion of EMS in the 21st century. Nearly a growing and aging population will increase involved evidence that has been mount- decade into the new century and the pro- demand for emergency services and stimu- ing over the years. Many felt the question tocol is stronger than ever and reaching late employment growth of police, fi re, and lacked clarity and encouraged the caller to countries we once only dreamed possible. medical dispatchers. report a “diagnosis” of the patient’s prob- In 2009, we will be celebrating 30 years of I have been involved in emergency medi- lem. Callers, eager for help to arrive, often protocol now used in communications cen- cal services and emergency dispatch for 20 started talking before waiting to hear the ters worldwide. I hope you will share in the years and have watched the profession and second part of the question, which meant celebration of the event. Watch The Journal protocol mature. I can only anticipate a the calltaker’s unnecessary repetition of for more information. bright future as the Academy continues in the question. The new wording, “Okay, Along the same lines, the role of the the forefront of emergency fi re, police, and tell me exactly what happened,” is also calltaker and dispatcher also continues to medical dispatch. J

THE JOURNAL | September/October 2008 5 J ASKDOC Dispatcher Discomfort. What to do about callers in public places

in this case, if the phone can be brought to Sharyn Pachnek Jeff Clawson, M.D. the patient or if someone can call back from Supervisor, EMD-Q a cell phone the patient can use? Boynton Beach 9-1-1, Police & Also, what do you do if you cannot get Fire-Rescue Communications Sharyn asks: a straight “yes” or “no” answer to the ques- Boynton Beach, Fla. We have just received our flip-chart tions? What is considered the best course cards for the Aspirin Diagnostic Tool and of action? Proceed or stop? There is no Sharyn: will be implementing them within the next guidance for “I don’t know.” We get that Thank you for your questions about few weeks. (Yes, we do have a sign-off from answer all the time with grown children the Aspirin Diagnostic Tool. In answer to our local medical control.) Do you have any calling for elderly parents who can’t tell us your questions: suggestions regarding the very personal and if mom or dad has a heart condition or not. Callers in public places: We suggest graphic questions? There is some discom- Which side do we risk erring on? the protocol be adhered to as is. While we fort among our dispatchers about that kind It would seem this is only to be used understand your EMDs’ concerns about of questioning being yelled from person to if the patient is alert, yet that is not on the public propriety, we have not received any feedback in this regard from probably a thousand or more centers actually using If someone possibly is having a the Tool since last June. If someone possibly is having a heart attack, political cor- heart attack, political correctness rectness should not be an issue. Speaking to the patient: We have dis- should not be an issue. couraged this in general because its use was often to disprove what the caller was telling us. In this case, it would not be bad, person in a public place. Believe it or not, flip-chart card anywhere. Shouldn’t it be? but if the phone is corded, the distance we still get many calls from corded phones, (I know it is mentioned on the “Special issue is still present. Having someone call especially from restaurants, bars, and other Update” circular that came with the cards.) back on a cell phone is an interesting idea places of business. If we could get a quick response to but that may mean another calltaker is We know it is counter-protocol to ask to these questions, it would be most appreci- now in the mix. Personally, I would not speak to the patient under normal circum- ated. We would like to implement as soon waste the effort to do this either. stances, but can an exception be considered as possible. “I don’t know” the answers issue: An unknown answer is to be considered “OK” to proceed. Since the only time ASA could be administered is if the caller and the patient are in the same vicinity, they most always know or can ask the patient. We have not heard that this has been a problem so far. Statistically, an unknown answer is highly likely to be a “good to proceed” situation. Alertness issue: The alertness requirement on the manual pull-out card is listed as a pre-question qualiﬁ er in the ﬁ rst ASA Dx Tool question #1: (Chest pain and alert >16)…” In the ProQA® software version, it is in the blue CEI header: “Select one for alert patient > 16: 1st-party or 2nd-party caller.” The second bulleted CEI under the PDIs includes the “alert” requirement also. Hope this helps and best of luck with the initiation of this process … Doc J

6 THE JOURNAL | emergencydispatch.org J BYTHEBOARD ReadersBoard

We are pleased to introduce you to news and current events by creating the Sharon Torongeau is the director of com- our Readers Board. The 11 members have Industry Insider section and brought the munications for the Noblesville Com- volunteered to assist The Journal’s editorial number of continuing education articles munications Department (Ind.). She has staff and board in generating stories and to two per issue. been in the 9-1-1 public safety dispatch story ideas that keep The Journal lively and The Journal has an audience of approx- profession relevant. As many long-time readers may imately 60,000 readers, and they are for 20 years, have noticed, The Journal has gone through predominantly members of the 9-1-1 the majority some substantial changes during the past emergency services dispatch profession. of those years year to better refl ect the interests of our This relatively wide range of readers with the city audience. We have added more stories extends from management and supervi- of Noblesville. about dispatchers at work—whether a sory positions to the calltakers and dis- She started her call was taken solo or an incident involved patchers who use the medical, fire, and dispatching multiple dispatchers and agencies—and police protocols on a daily basis. Our pub- career for a more articles about the tools of the trade lication also goes out to medical directors, small town in (protocol, quality assurance, and accredi- physician groups, and others involved in northern Indi- tation). We have increased the amount of providing emergency medical care. ana and later transferred to Noblesville. She started as a dispatcher, from there was selected as the assistant Central US director, and last year was promoted to director. The communications center dis- Bryon Schultz, NREMT-P, EMD-I, has Coni McCloughen is the 9-1-1 director patches police, fi re, and EMS for Nobles- served as the communications qual- for St. Joseph County Fire Dispatch in ville and neighboring Westfi eld. ity improvement supervisor for EMSA, South Bend, Ind., which is one of four Oklahoma’s dispatch centers in the county. She April Tarrant is the emergency communi- largest EMS started her dispatch career in 1986 as a cations director at the Johnson County agency, line dispatcher for a police, fi re, and EMS Central Dispatch Center in Warrensburg, since 1999. center in Elkhart County, Ind., where Mo. Tarrant Schultz is she was part of the Beta team testing a began her responsible computerized EMD program in 1987. career in for measur- She then spent 12 years in Elkhart City the medical ing per- Communications, later transferring to fi eld and six formance, St. Joseph County Fire Dispatch where years later conducting she initially changed her call audits, providing instruction and worked career path other quality improvement and train- in quality and joined ing activities relating to EMSA’s Tulsa assurance. the New- and Oklahoma City communications ton County Central Dispatch Center in centers. Schultz was instrumental in Neosho, Mo. She started as a dispatcher in EMSA becoming an Accredited Center of April 1997, and then worked as a supervi- Excellence (ACE) in 2000. He is a veteran sor and training coordinator until leaving regional EMD instructor and became an to be the director of Communications and EMD-Q instructor in 2005. Schultz has Emergency Management for the agency served on the Omega Standards Council near Kansas City, Mo. and actively works with NAED/PDC on multiple research projects. Schultz joined EMSA in 1993, working as a paramedic, dispatcher, communications training offi - cer, and communications supervisor.

THE JOURNAL | September/October 2008 7 Melissa Bless- Eastern US ing is a training specialist Judy Capparelli is the EMD administra- with Harford tor for the Raleigh-Wake County 9-1-1 County Emer- Center in Raleigh, N.C. The position gency Opera- involves performing quality assurance for tions in Forest the center, which received its Accredited Hill, Md. She Center of Excellence (ACE) in EMD in is an ETC October 2007. She has been with Raleigh- instructor as maintains the fi re department records Wake since 1996, starting as a telecom- well as an EFD-Q, EMD-Q, and EPD-Q. management system and mobile building municator and serving in the positions of She works with her center’s training acad- survey/preplan system viewable on mobile supervisor emy and is responsible for the continuing CAD terminals. and training education program. Blessing has a degree coordina- in political science from Loyola College tor before in Baltimore, Md. She began her career in Western US assuming Harford County as a police dispatcher and her current cross-trained to fi re/EMS dispatching and Dave Brinton is a is a fi refi ghter/paramedic posi- calltaking. She transferred to the training with the Salt Lake City Fire Department tion. She division in 2002. where he’s worked received since 1994. Brinton her Emer- has been involved in gency Number Professional (ENP) certi- Southern US EMS for nearly 20 fi cation in 2003 and currently serves as years. He is respon- secretary for the North Carolina Chapter Mark Braswell sible for the Salt Lake of Public-Safety Communications is an assistant City Fire Depart- Offi cials (APCO). chief with the ment’s medical qual- Cy-Fair VFD, ity assurance program Tami Wiggins is the training and quality Houston, and is on the NAED® assurance supervisor for Harford County Texas, and has Curriculum Board- Emergency Operations in Forest Hill, been there for Medical. Brinton is an Md. She serves on the NAED Police 20 years. He instructor for EMD, Council of Standards as well as the Call oversees the EFD, EMD-Q, EFD-Q, and ProQA®. Processing Board. She is an ETC instruc- operations of tor and a quality assurance specialist in the communi- Shawn Pray has been with Deschutes EFD, EMD, and EPD. She was the driving cations center, County 9-1-1 (Oregon) for more than force behind her center becoming the fi rst IT, safety, and public information. The eight years. Currently, he serves as the Accredited Center of Excellence in EMD Cy-Fair VFD was the second agency to administrative supervisor and training (ACE) in Maryland. Wiggins is a member become an Accredited Center of Excel- coordinator for the agency. Pray attended of a local volunteer fi re department and lence (ACE) in EFD. Braswell is also a Navigator 2007 and from the information has been for captain with the Houston Fire Depart- gathered at the conference, Deschutes about 20 years. ment, working there for 15 years. He is County 9-1-1 started developing a quality She has been EMD certifi ed, an EMD-Q, an EFD-Q, improvement program. Deschutes County employed and an ETC instructor. He serves on the 9-1-1 Operations became a consolidated at Harford NAED Fire Council of Standards and the public safety dispatching agency in 1985, County since Rules Committee. taking 1994, begin- calls for ning as a police Michael O’Neil has been employed by the police, dispatch City of Boca Raton Fire Rescue Services fi re, and supervisor. In Department, of Florida, since 1979 and medical 2002, Wiggins is currently the division chief of com- service was transferred munications in a combined 9-1-1 primary assistance. to the training PSAP. O’Neil holds paramedic, fi re inspec- J division to oversee the training academy tor, hazardous materials technician, EMD, and quality assurance programs. and ED-Q certifi cations. His primary duties involve the technical aspect and the EMD and fi re related aspects of the dispatch center. He also designed and

8 THE JOURNAL | emergencydispatch.org J MEDICAL CDE J FIRE CDE J DISPATCH WORKFORCE J SOFTWARE SECRETS OnTrack J MEDICALCDE Arrival Interface. Action to take once the help in uniform comes onto the scene

her chest, right between the nipples; other hand on top of that hand • Depth: Push down fi rmly 2 inches (5 cm) • Frequency: Pump the chest hard and fast…at least twice per second • Release: Let the chest come all the way up between pumps Each parameter is vital to the proper compression and decompression of the heart muscle. Professor Douglas Cham- berlain, in his keynote address at Euro- Navigator 2007, spoke of the compression “pushing” the blood needed by the brain and the decompression “pulling” in blood for the heart; hence, “Let the chest come all the way up between pumps.” So, what happens when the untrained bystander sees someone in uniform? Typically, they stop what they are doing, expecting that someone with more training is about to take over. But how far away is that person in uniform? Is that responder going to immediately take over performing chest compressions? If that responder is a pressions, results in a dramatic decline in police offi cer, does he or she have the level By Michael Spath survival rates.” In March 2008, the Ameri- of training necessary to take over? EMDs can Heart Association’s journal Circula- often hear the responders walking into tion published an article about hands-only the room and/or approaching the caller In recent years, there have been many CPR, emphasizing the importance of with, “Hang up the phone.” The EMD is scientifi c studies (Yu et al., 2002; Sato et al. uninterrupted compressions to a patient’s left to wonder if there is going to be an 1997; 25:733) demonstrating the impor- chance of surviving. interruption in CPR. If so, what can the tance of uninterrupted cardiopulmonary Not only must the compressions be EMD do beforehand to minimize that resuscitation (CPR) in successful patient performed continuously (when appropri- interruption? resuscitation. Coronary perfusion pres- ate to do so), they also must be performed On a recent 9-1-1 call at the Sunnyvale sure drops rapidly when compressions are correctly. Medical Priority Dispatch Sys- Department of Public Safety (California), ® stopped, even for a short period of time tem (MPDS) versions 11.3 and 12.0 the patient had dropped to the ground (Berg et al., 2001; 104:2465). Brett Pat- provide the following parameters for the while playing tennis. The caller, in the terson, Council of Research chair for the performance of chest compressions on midst of being told how to perform chest National Academy®, wrote on the ED-Q an adult: compressions, interrupted the calltaker forum in November 2006, “Make no • Hand placement: heel of one hand on with, “The paramedics are here.” The caller mistake, stopping CPR, particularly com- the breastbone in the center of his/ was immediately asked, “Are they with

THE JOURNAL | September/October 2008 9 the patient?” The caller responded, “He’s users see the following instructions on the In every cardiac arrest response, there are walking onto the tennis courts now.” Iff AArrivalrrival IInterfacenterface papanel:nel: ootherther ffactorsactors worworthythy ooff sstudytudy ththatat can affect the caller stopped performing chest com-- pressions at that point, waiting for thee responder to cross the tennis courts, howw long would that interruption last? There’ss no way to know how long that interrup-- tion could last, yet it is absolutely vital too the patient’s chances of survival that CPRR continues uninterrupted until the para-- medics take over. As knowledge of cardiac arrest sur-- vival continues to progress, so does thee MPDS. The advent of the Compressionss 1st pathway in a majority of suspectedd cardiac arrest cases is an example of thatt progress. However, with the inclusion off so many additional PAI links, the previouss “Arrival Interface” has been sacrifi ced inn the cardset. There is a replacement foundd in ProQA®. The importance of continuingg MPDS® v12 in ProQA®, NAE-std. © 1979–2008 PDC. our efforts until the paramedics take over, however, has not diminished in any way. The importance of the Arrival Interface the length of the interruption in CPR: In fact, the aforementioned studies have The Arrival Interface remains an integral • Are the field responders properly reinforced the need to keep going until the part of cardiac arrest survivability. All EMDs trained to take over CPR? responders take over. are strongly encouraged to insert “Don’t stop The MPDS cardset still contains several until the paramedics (EMTs) take over for • How seamless is the transition instances of “Tell me when the paramedics you” as soon as it is appropriate to do so— from untrained bystander CPR to field responder CPR? (EMTs) are right with her/him, or if any- and to repeat it as necessary. As has been thing changes,” but the emphasis to keep shown in several studies, a compressions J Is it essentially detrimental the caller going until the medics can take to survival if the arriving over is now left to the EMD. responders say upon enter- “It seems to ing the room “Hang up the What is the Arrival Interface? telephone and tell me what In MPDS v11.0, Panel C-18 read, “When be that getting happened”? you hear the paramedics (EMTs) arrive, J Perhaps they should be trained don’t stop CPR (Mouth-to-Mouth) until ‘hands on chest’ to say, “Keep doing what the they take over from you.” as soon as dispatcher tells you until I’m “Is the door unlocked? (Send someone ready to take over for you” as a to open it now.)” better option. “Tell me when they’re with the patient.” possible, and • Does one field responder immedi- In the version 11.3 and 12.0 cardsets, that keeping ‘hands ately take over CPR while another panel has been overwritten by the plethora starts preparing the automated of instructions and links needed to accom- on chest’ as external defibrillator (AED)? Are modate several different CPR pathways. common tasks pre-assigned? Is Utilizing the benefi ts of computer technol- long as possible, everyone familiar with his or her ogy over paper, ProQA users can still fi nd the assigned duties? Arrival Interface in the Specifi c PAI Target gives the patient Tool and on specifi c panels in the pre-arrival The importance of making the tran- sequence. Those not using ProQA, however, the best chance sition from bystander CPR to field can and should continue to emphasize the responder CPR as seamless as possible importance of continuous compressions of survival.” cannot be understated. As Patterson wrote through appropriate enhancement when in his November 2006 post on the ED-Q the EMD suspects the caller may interrupt Brett Patterson forum, “It seems to be that following the compressions. QA personnel for all MPDS protocol and getting ‘hands on chest’ as users should be providing training and feed- interruption of only a few seconds can sig- soon as possible, and keeping ‘hands on back on the importance of uninterrupted nificantly reduce the patient’s chances of chest’ as long as possible, gives the patient compressions for cardiac arrest cases. ProQA surviving a cardiac arrest. the best chance of survival.” J

10 THE JOURNAL | emergencydispatch.org ✄ CDE Quiz Mail-In Answer Sheet CDE-Quiz G Medical Take this quiz for 1.0 CDE unit. Answer the test questions on this form. (A photo Answers to the CDE quiz are found in the article “Arrival Interface,” which starts on page 9. copied answer sheet is acceptable, but your answers must be original. Please do not enlarge.) 1. When advising compressions, how deep should EMDs advise callers to push down on an Within six weeks, you will receive notiﬁ cation of your adult’s chest? score and an explanation of any wrong answers. a. 1 inch (2 ½ cm) Once processed, a CDE acknowledgement will be b. 2 inches (5 cm) sent to you. (You must answer 8 of the 10 questions c. 3 inches (7 ½ cm) correctly to receive credit.) d. As deep as possible Clip and mail your completed answer sheet along with the $5 processing fee to: 2. When advising compressions, how frequently should EMDs advise callers to push down on The National Academies of Emergency Dispatch the chest? 139 East South Temple, Suite 200 a. at least once per second Salt Lake City, UT 84111 USA b. at least twice per second (800) 960-6236 US; (801) 359-6916 Intl. c. at least three times per second Attn: CDE Processing d. as fast as possible Please retain your CDE acknowledgement to be submitted to the Academy with your 3. When advising compressions, how far should EMDs advise callers to let the chest come up before application when you recertify. providing another compression? a. all the way up Name ______b. halfway up c. just far enough to make another compression possible Organization ______Address ______4. According to the article, what do untrained bystanders typically do when they see someone in uniform? City______St./Prov. ______a. continue what they are doing until they receive further instructions. b. stop what they are doing, expecting someone with more training to take over. Country______ZIP ______

5. The Arrival Interface helps EMDs minimize CPR interruptions when responders arrive by: Academy Cert. # ______a. advising callers “Don’t stop CPR until the paramedics take over for you.” Daytime Phone ( ) ______b. advising callers to “guide the responders directly to the patient.” c. directing callers to hand the phone to responders. E-mail: ______d. directing callers to tell responders exactly what happened. PRIMARY FUNCTION 6. The Arrival Interface was removed from the MPDS cardset because: ■ Public Safety Dispatcher (check all that apply) a. these instructions are no longer appropriate in the DLS environment. _____Medical _____Fire _____Police b. it is the responder’s job to make sure the caller continues CPR until they can take over. c. space was needed for the plethora of instructions and links needed to accommodate ■ Paramedic/EMT/Firefi ghter several different CPR pathways. ■ Comm. Center Supervisor/Manager d. only ProQA users are authorized to provide these instructions. ■ Training/QI Coordinator 7. ProQA users can still fi nd the Arrival Interface: ■ Instructor a. by using the Specifi c PAI Target Tool. ■ Comm. Center Director/Chief b. by using the Summary Tab. c. by clicking on the Additional Information menu option. ■ Medical Director ■ Commercial Vendor/Consultant 8. According to the article, cardset users can and should continue to use the Arrival Interface ■ instructions, even though they are no longer listed in the cardset. Other a. true b. false ANSWER SHEET G MEDICAL September/October Journal 2008 VOL. 10 NO. 5 (Arrival Interface) Please mark your answers in the appropriate box below. 9. According to the article, following the protocol and getting “hands on chest” as soon as possible, and keeping “hands on chest” as long as possible, gives the patient the best 1. ❏ A ❏ B ❏ C ❏ D chance of survival. a. true 2. ❏ A ❏ B ❏ C ❏ D b. false 3. ❏ A ❏ B ❏ C

10. A compressions interruption limited to 10 seconds or less generally has no signifi cant impact 4. ❏ A ❏ B on the patient’s chances of surviving a cardiac arrest. 5. ❏ A ❏ B ❏ C ❏ D a. true b. false 6. ❏ A ❏ B ❏ C ❏ D 7. ❏ A ❏ B ❏ C 8. ❏ A ❏ B ❏ ❏ To be considered for CDE credit, this answer sheet must be received no later than 10/31/09. A passing score is worth 1.0 CDE unit toward fulfi llment of the 9. A B Academy’s CDE requirements (up to 4 hours per year). Please mark your responses on the answer sheet located at right and mail it in with your processing fee to receive credit. Please retain your CDE certifi cate to be submitted to the Academy with your application when you recertify. 10. ❏ A ❏ B Expires 10/31/09

THE JOURNAL | September/October 2008 11 J FIRECDE Smoke Kills. Fighting ﬁ res takes understanding the environment

contains poisonous gases (such as carbon burned after making an emergency land- By Dave Brinton & Brian Dale monoxide, hydrogen cyanide, benzine, and ing in an East Texas pasture. Their bodies hydrogen chloride). It’s critical to get out of were found in the front of the cabin, just the aircraft without delay—if fi re or smoke outside the cockpit door. Cause of death An airplane crash in Salt Lake City, is present, you will generally have less than was smoke inhalation. Utah, 43 years ago killed 40 of the 90 two minutes to safely exit the plane. Several years ago, Salt Lake City Fire people onboard when passengers could Reaction at the time of the crash is the Department Battalion Chief Brian Dale not make it outside through the emer- key to survival. Crash investigators have wrote an article explaining structural fi res gency exits and died from smoke inhala- found time and time again that those who and why they are so deadly. This information. Within several days, five more died survive are those who are evacuated from tion, which can be applied to any type of from injuries suffered at impact, including the aircraft swiftly. They have an escape structural fi res including aircraft, is well burns and, also, respiratory problems again plan and do not stop to retrieve their per- worth repeating as we approach the 10th related to the smoke inside the cabin. sonal belongings. An escape plan means anniversary of the Academy’s® Fire Priority Smoke inhalation is the primary cause understanding the brace position, counting Dispatch System™ (FPDS) protocols. As of death in most aircraft accidents, and in the rows to their nearest emergency exit, Dale stated in the article (Fall 2003), the all cases an aircraft accident is considered and, yes, listening to the safety briefi ng. EFD holds the pivotal role of managing an entrapment situation until proven oth- In many cases, as firefighters will tell fi re incidents and decreasing the potential erwise. Most die because of their inability you, victims are often found near or next for loss of life prior to on-scene arrival of to escape the burning craft. That’s because to exits where, sometimes frozen in panic, trained fi re suppression personnel. the smoke and gases resulting from a fire they were overcome by the smoke. This is The FPDS protocols empower the in a confi ned space soon make the interior what happened in the 1986 death of Ricky EFD to intervene in life-threatening situ- atmosphere intolerable for humans. The Nelson, his fi ancé, and fi ve band members ations involving structure fi res by obtain- smoke inside the cabin is usually thick and when the plane they were traveling in ing necessary information from the caller,

12 THE JOURNAL | emergencydispatch.org dispatching the appropriate resources, and As available oxygen decreases, fi re enters fi cient fuel, causing a rapid expansion and providing life-saving directions to those the smoldering phase. The area still has blast of the fl ame and fi re gases. who are threatened. The FPDS enables a immense heat and fuel, but oxygen avail- From the onset of the incipient stage, certifi ed EFD to systematically and con- ability is limited. All that is needed to surge oxygen is being used in the burning process fi dently process emergency calls for con- back to a free-burn is the introduction of and poisonous gases are being produced fi rmed structure fi res. that missing piece. When a fi re has entered (carbon monoxide being the most preva- this stage and someone opens a door, intro- lent). For the person trapped in a structure Fire behavior ducing a fresh supply of oxygen, a danger- fi re, this causes severe diffi culty breathing, In order to understand how to better ous situation erupts. The fire can rapidly disorientation, and asphyxiation. Again, interact with this special environment, it enter a free-burn state, or cause a more most victims of structure fi res do not die is important to understand what you’re up serious condition known as a backdraft or because of the heat, but rather succumb to against. What is fi re? How does it behave? smoke explosion. A backdraft occurs when severe smoke inhalation. What should the role of the EFD and fi re- a fresh supply of oxygen enters a super- Disorientation from gases, combined fi ghters be in suppressing this force? heated atmosphere where there is still suf- with zero visibility from smoke and intoler- Simply put, fi re is the result of fuel inter- able heat, can easily transform what would acting with a heat source and oxygen in the be a simple walk to an exit, into a desperate correct amounts to form a chemical chain In many cases, crawl though a hellish maze of dead-ends reaction. These four elements are known as and ultimate suffocation. As stated previ- the “Fire Tetrahedron.” A fi re confi ned in as fi refi ghters ously, victims who have attempted but an enclosed space will have three distinct failed to escape from these conditions are phases: the incipient phase, the steady state will tell you, frequently found incredibly close to doors or free-burning phase, and the smoldering and windows. phase. These phases differ from those of a victims are fi re out in the open because the oxygen sup- Fire suppression ply is limited in a confi ned space. often found So how do suppression teams combat The incipient phase is marked by the this destructive force? Put the wet stuff on production of smoke, small increases in near or next to the red stuff is probably the most famous heat, and little or no visible flame. Once saying in the fire service relating to sup- ignition is made, fi re moves into the free- exits where, pression. Fire is an escalating emergency burn phase with a marked increase in tem- sometimes that spreads and grows until someone sup- perature, smoke, and radiant heat from the presses it, usually by applying water to the flame source; room temperatures rise to frozen in panic, heated environment. Remember the Fire near 1,200 degrees Fahrenheit at the ceiling Tetrahedron? To extinguish a fi re, one has and around 300 degrees Fahrenheit at the they were only to remove one or more of the four ele- fl oor level. Flames given off by an enclosed ments. While this sounds simple in theory, fi re are trapped within the structure, such overcome by it isn’t in practice. as the cabin of an airplane, and are unable There are three or four tasks that must to escape without ventilation. The result- the smoke. be completed in rapid succession to bring ing smoke and gases soon make any interior success. The fire must be attacked, the atmosphere intolerable for humans. structure must be searched for victims and One phenomenon seen during the free- burn phase is mushrooming. As fi re grows inside any given area, the heated gases and smoke rise to the ceiling, roll across its surface, and then begin to bank down lower and lower toward the fl oor. Visibility decreases to zero very quickly when this occurs, and all available oxygen is rapidly depleted. As the fire consumes more and more fuel, heat increases until everything in the room spontaneously ignites. This condition is known as “fl ashover” and usually occurs when the heat reaches around 1,000 degrees Fahrenheit. The chance of survival for anyone inside a room during a fl ashover is very low. Even a fi refi ghter in full turnout (protective gear) caught in this environment would be at extreme risk.

THE JOURNAL | September/October 2008 13 ventilated, and there must be a non-stop enter a burning structure, the interior attack time checks, and notifying utility companies, fl ow of water both into and out of the fi re team needs a supply of fresh air. This is the removes at least some of the burden from the truck supporting the suppression team responsibility of the ventilation crews (usu- IC in times of increased stress. inside. When done correctly, it is a well cho- ally truck companies), and the importance reographed art form. The Incident Com- of this task should not be underestimated. Conclusion mander (IC) on the scene assigns teams Besides making the air and visibility better Structure fi res are extremely dangerous into sectors identifi ed by task assignments for interior teams, proper ventilation may environments that need to be respected and (attack, ventilation, rescue, medical) or by improve the chances for survival of anyone dealt with using methods and procedures geography on the fire ground (east, west, trapped inside the structure. In the United proven to prevent future harm to life or interior, exterior, roof). States, the practice of Positive Ventilation property. This is why FPDS interrogation There is a tremendous amount of coor- Attack is becoming a commonplace proce- and instruction segments are written the way dination and communication necessary dure for interior operations. This involves they are. Fire and rescue environments are between the IC, the attack team, sector offi - considered escalating incidents and safety cers, and the communications center. Once issues are of primary concern at all times. on scene, the fi rst arriving engine company Lack of Since the introduction of the EFD sets up to make either an offensive attack, almost 10 years ago, more than 2,500 dis- which means going inside the structure, or approved patch personnel have been trained and cer- a defensive attack; this is done from the tified in the proper use of the Academy’s outside in cases where there is extreme protocols is FPDS protocols. Their use of Pre-Arrival danger. If an IC chooses a defensive attack, Instructions is as important in fi re incidents the structure will be written off as a total a signifi cant as they are in medical emergencies. In fact, loss. Operations are then designed to simply the NFPA standard 106 states, in part: contain the fi re and keep it from spreading dispatch “Pre-Arrival instructions or information, to uninvolved structures. when authorized by the authority having One of the common tools an IC uses to danger zone jurisdiction, might include law enforce- make this decision is the principle of Time, ment, fi re or medical protocols, hazardous Life, and Value (TLV). that can be materials recommendations, poison control Time: When did the fi re start and how has information, evacuation, safety and disaster the structure weakened? This is a vital initial easily avoided instructions. The purpose of these instruc- piece of combat information for responders. tions is to ensure improvement, rather than Life: Are there imminent life threats through EFD deterioration of the situation, and that the within or near the structure? Is someone training. service requester or victim is kept safe. The trapped without a viable exit? Part of the function of the public safety telecommu- response confi guration for aircraft incidents nicator might include the use of prede- is driven by the size of the aircraft involved. placing a fan at the attack team entry point termined questions, pre-arrival telephone This is expressed in the number of souls and ensuring an exit on the opposite side of instructions, and pre-assigned actions that (occupants) the aircraft is capable of car- the structure for heated gases and smoke. are an integral part of the responsibility to rying, including the crew, not the number One way that EFDs can decrease danger prioritize calls and assist in the stabilization actually on board. to interior crews is by clearing up any mis- of the incident. A pre-arrival reference sys- Value: Is it worth the risk of sending communication heard between the IC and tem should be a written, reproducible docu- an attack team inside? What is the value fi re ground crews as prescribed in the EFD ment in a uniform format based on current of saving the structure? If, upon arrival, course. With so many activities going on at guidelines and administrative protocols.” the structure is 75 percent involved, what the fi re ground you can see why one of the (NFPA 1061 A-2-4.2.1) is the risk-benefit ratio of an aggressive, important functions of an EFD is to be a Lack of approved protocols is a sig- interior attack? An IC rarely places the logistics coordinator. Dispatchers have a vital nifi cant dispatch danger zone that can be lives of a fi re company at risk by sending role in assisting the IC in completing his or easily avoided through EFD training in the them inside when any of these factors her objectives. Fire Priority Dispatch System. J are questionable. Helping the FPDS™ v4, NAE-std. © 2000–2008 PDC. Obviously, there are other consider- IC by making ations beyond TLV. However, this gives you phone, radio, or an idea of the kind of decisions that must pager notifica- be made quickly. One can also see the value tions, provid- of Key Questions the EFDs are trained to ing important ask when an aircraft emergency occurs. This is one of the reasons it is said that the EFD is the fi rst Incident Commander. If the decision is made to

14 THE JOURNAL | emergencydispatch.orgpatch.o ✄ CDE Quiz Mail-In Answer Sheet CDE-Quiz F Fire Take this quiz for 1.0 CDE unit. Answer the test questions on this form. (A photocopied Answers to the CDE quiz are found in the article “Smoke Kills,” which starts on page 12. answer sheet is acceptable, but your answers must be original. Please do not enlarge.) 1. Which of the following is not part of the Fire Tetrahedron? Within six weeks, you will receive notifi cation of your a. fuel source score and an explanation of any wrong answers. Once b. humidity levels processed, a CDE acknowledgement will be sent to c. chemical chain reaction you. (You must answer 8 of the 10 questions correctly d. heat source to receive credit.) Clip and mail your completed answer sheet 2. At least 50 percent of all fi re deaths are due to smoke inhalation. along with the $5 processing fee to: a. true The National Academies of Emergency Dispatch b. false 139 East South Temple, Suite 200 Salt Lake City, UT 84111 USA 3. Statistically, how much time do you have to safely exit an aircraft following a crash? (800) 960-6236 US; (801) 359-6916 Intl. a. no time (there’s nothing you can do once the plane goes down) Attn: CDE Processing b. 30 seconds Please retain your CDE acknowledgement c. two minutes to be submitted to the Academy with your d. since you should never leave a downed aircraft, the time is determined by the application when you recertify. arrival time of fi rst responders Name ______4. A condition where everything within a room spontaneously ignites is known as: Organization ______a. smoke explosion b. backdraft Address ______c. fl ashover d. free-burn City______St./Prov. ______

5. Which of the following is not indicative of the free-burn stage? Country______ZIP ______a. marked increase in heat Academy Cert. # ______b. heavy smoke conditions c. little or no fl ame conditions Daytime Phone ( ) ______d. mushrooming E-mail: ______6. During the smoldering stage, which one of the following elements is needed for the fi re to surge back to a free-burn? PRIMARY FUNCTION a. fuel ■ Public Safety Dispatcher (check all that apply) b. oxygen c. heat _____Medical _____Fire _____Police d. water ■ Paramedic/EMT/Firefi ghter ■ Comm. Center Supervisor/Manager 7. When an environment is in danger of a backdraft, which element is needed to complete the dangerous cycle? ■ Training/QI Coordinator a. a new source of oxygen ■ Instructor b. a stronger chemical reaction ■ c. a new source of fuel Comm. Center Director/Chief d. more heat ■ Medical Director ■ Commercial Vendor/Consultant 8. Which of the following describes a defensive attack? ■ Other a. an attack beginning on the outside, then moving inside. b. a process of using both master streams and interior headlines. c. a process where only chief offi cers work to suppress a fi re. ANSWER SHEET F FIRE d. a tactic where the fi re is attacked from the outside and the structure itself is considered September/October Journal 2008 VOL. 10 NO. 5 (Smoke Kills) a complete loss. Please mark your answers in the appropriate box below. 1. ❏ A ❏ B ❏ C ❏ D 9. All aircraft accidents are considered entrapment situations until proven otherwise. a. true 2. ❏ A ❏ B b. false 3. ❏ A ❏ B ❏ C ❏ D 10. The size of the aircraft involved is expressed in: 4. ❏ A ❏ B ❏ C ❏ D a. the type or series of commercial jet airliner (e.g., 727, 737, or 757) 5. ❏ A ❏ B ❏ C ❏ D b. gross weight of the aircraft c. the number of souls (occupants) the aircraft is capable of carrying 6. ❏ A ❏ B ❏ C ❏ D d. the number of occupants actually on board 7. ❏ A ❏ B ❏ C ❏ D 8. ❏ A ❏ B ❏ C ❏ D ❏ ❏ To be considered for CDE credit, this answer sheet must be received no later than 8/31/09. A passing score is worth 1.0 CDE unit toward fulfi llment of the 9. A B Academy’s CDE requirements (up to 4 hours per year). Please mark your responses on the answer sheet located at right and mail it in with your processing fee to receive credit. Please retain your CDE certifi cate to be submitted to the Academy with your application when you recertify. 10. ❏ A ❏ B ❏ C ❏ D Expires 10/31/09

THE JOURNAL | September/October 2008 15 J DISPATCHWORKFORCE Boom and Bust. Younger generations not keeping up with population fueled by post-war baby boomers

many occupations 10 to 15 years down the road,” Knold said. Future impact will differ depending on the occupation, as Knold indicates. Some, but not all the jobs, will be created by the need to replace those retiring. Others will be diffi cult to replace because of the education and experience level required or, conversely, the inability to fi nd employees for lower-paying jobs an educated workforce doesn’t want and, because of the economy and job market, won’t have to take. Lower-paying jobs could lose out in terms of fi nding workers, Knold said. There’s also job appeal and in the case of public service, the past generation may not share the same zeal as the post- war generation. “We’re not able to attract the younger tions nationally just can’t compete with the people into public service like we used to,” By Audrey Fraizer population numbers generated by the baby said Dave Beach, director of the Utah High- boomers. In fact, the Bureau of Labor Statis- way Safety. “It’s not to the extreme but there tics estimates that during the next 10 years, is a concern.” Mark Knold’s trees tell the story. there will be a 15 percent decline in workers Beach compares figures for the Utah The economist for the Utah Department ages 35 to 54, concurrent with a 25 percent Highway Patrol that 25 years ago would have of Workforce Services has a presentation increase in demand. attracted 1,500 to 2,000 applicants once the based on age and population that puts the “There’s a worker vacuum that’s start- call went out for anticipated openings. Now, baby boom generation into perspective. ing to happen in most of the United he said, they are lucky to get 100 people If you are in Utah, the shape of the tree for States,” Knold said. “The body count isn’t responding to their ads, a trend he attributes 2005 is enviable for employers in other states. strong enough.” to changes in the workforce and the shift- Utah is one of the few, if not only, states with ing attitudes about public service jobs. Even a high enough birth rate to replenish its num- Baby boomers departing among existing staff, he said, the attitudes bers from generation to generation. In fact, Welcome to the retirement phase of the have changed. the number of people between the ages of 25 baby boomers, a generation spurred by the and 29 represents the greatest percentage of return of soldiers from World War II during a “There’s a worker those available to the workforce, and, with- period of optimism and economic expansion out coincidence, they are most likely the ones that resulted in the tendency for people to vacuum that’s who are responsible for producing the largest have large families. This demographic bulge, segment of the state’s population (those up to which correlated with birth years between starting to the age of 4 years old). 1946 and 1964, swept through childhood, However, the same does not apply for the youth, young adulthood, middle age, and is happen in most rest of the country, at least that’s what the now looking at leaving the workforce. shape of the national tree for 2005 shows, of the United based on statistics from the U.S. Census Future impact depends on occupation Bureau. That tree bulges at the lines des- With the first wave of boomers turn- States.” Mark Knold ignating the ages between 40 and 49. The ing 62 this year, the anticipated high rate of lines below and the lines above diminish in retirement due to many factors—the retire- “In the old days overtime shifts were gob- comparison. Old age and associated mortal- ment programs offered as incentives to highly bled up,” Beach said. “Not any more. We have ity account for the lower numbers ascending skilled individuals or in occupations where trouble fi lling them.” the tree, while below the bulge it’s obvious age reduces performance (such as police work Beach said his department offers an incen- that Americans—except in Utah—are having or airline piloting)—could reach crisis propor- tive program that includes signing bonuses fewer children. tions in the early years of the next decade. and education incentives for employees of In other words, the younger genera- “It’s certainly going to be an issue for the communications center. The extras are

16 THE JOURNAL | emergencydispatch.org particularly helpful in a competitive market cies, like the federal and state government technologically savvy employee who no lon- climate, he said, especially since jobs in the agencies, that want to keep their senior execu- ger plans to spend 20 to 30 years in an agency, public sector often can’t compete against tives and managers—the ones who can afford which has historically been the case. Statistics traditionally higher paying jobs offered by to retire—or lure the top executives out of show workers between the ages of 18 and 38 private industry. retirement and back into the workforce? change jobs, although not careers, an average Another approach is developing an effec- “No one has the answers, although it’s of 10 times. tive advertising campaign that employs the obvious from discussions that this is an issue By the way, these are not statistics from types of mass information platforms fre- for many states, including Utah,” said Mau- the U.S. Department of Labor (DOL). The quented by younger job applicants. reen Henry, executive director of the Utah DOL has never published statistics about For example, the Richmond area in Vir- Commission on Aging. career change, according to an article in the ginia initiated a three-month multi-juris- A major emphasis is eliminating the bar- summer edition of the Occupational Outlook dictional campaign that attracted 4,500 riers to a senior workforce. Some companies Quarterly Online, but the department does applicants for 27 keep statistics on the num- dispatch positions at U.S. Population by Age and Sex: 2005 ber of times people change three communications employers or change occu- centers. According to 85+ pations while working for the local news reports, a 80-84 same employer. $289,400 grant from 75-79 For organizations that Virginia’s Wireless 70-74 have struggled to effectively E-911 Services Board 65-69 manage the workforce chal- was spent to blanket 60-64 lenges associated with gruel- the area with television 55-59 ing and emotionally draining and radio spots, bill- 50-54 work, as well as shrinking board ads, brochures, 45-49 pay and benefi ts, the emerg- a 30-minute television 40-44 ing employee shortage is program, and even especially alarming. It will 35-39 promotions on social demand a much better job 30-34 networking sites such of recruiting, retaining, and as Facebook, MySpace, 25-29 engaging younger workers, and YouTube. 20-24 Henry said. The results were 15-19 For public service, she so good that they’re 10-14 said it’s a perfect storm of hoping to spread it to 5-9 economic expectations, other localities in Vir- 0-4 aging, and attitudes about ginia and the rest of 15,000,000 10,000,000 5,000,000 0 5,000,000 10,000,000 15,000,000 working in government jobs. the country. “This is an immensely Baby Boomers Dominating the Labor Force Male Female Worker Vacuum complicated situation,” Already feeling the pinch that offer defi ned benefi t pension plans are Henry said. “We’re just beginning to develop Public sector careers are already expe- reviewing ways in which employees can con- good models that change the paradigm of riencing the effects of mass retirement, tinue working part-time without deferring both those planning to retire and those enter- especially in areas such as education, public receipt of the income. Part-time jobs allow ing the workforce.” administration, and criminal justice. the fl exibility many aging workers want, either Among the hardest hit will be federal through a limited number of days or hours Baby boom statistics and state agencies. According to the Bureau per week or according to a project-by-project Baby boomers number about 77 million of Labor Statistics, 50 percent of federal basis need with time off in between. people out of a population of 285 million. employees and 70 percent of federal senior Beach agrees it’s a complex issue, particu- They comprise about 60 percent of the U.S. managers will be eligible to retire by 2010. larly in occupations charged with protecting workforce between the ages of 25 and 64, The Government Accountability Office public safety. and their presence in the national economy estimated in 2003 that by 2007, 55 percent “These aren’t jobs that you can turn on is so powerful that the U.S. Bureau of Labor of senior executive service employees would and off,” he said. “It’s not like you can go and Statistics estimates that by 2008, the retire or leave offi ce. On the state and local home or wait for the next guy to show up year the first baby boomers begin to retire levels, police agencies will also have a lot of when you’re in the middle of a crisis.” en masse, the United States will face a skilled vacancies, according to the statistics, and labor shortage of about 10 million people. many have been experiencing diffi culties fi ll- The next generation This will signal the beginning of a 20-year ing the vacancies in their police departments, Employers will also have to consider transition until the youngest of the boomers established to cope with the infl ux of boom- how younger workers view their careers. reaches age 65 in 2029. By 2030, all surviving ers moving to the suburbs. The federal government will be increasingly boomers will be ages 66 to 84, representing So what about those industries and agen- competing with the private sector for the one in fi ve Americans. J

THE JOURNAL | September/October 2008 17 J SOFTWARESECRETS Falling in Line. AQUA reportsports designeddesigned to pinpoint compliance issues

This report doeses By Tamara Haislip not calculate or digestst any information. It isis a compilation of thee Have you ever wondered how the information stored inn reports in AQUA™ are calculated? This relation to each case.e. article explains that as well as the purpose of each report. Many of the reports make Determinant use of standard scoring, which is explained drift report at the end of the article. This report mea-- Note: Recently a few of AQUA’s reports have sures the accuracy off DeteDeter-rr- undergone name changes. If the report name has minant Levels. changed, the former name will be in parentheses • All Determinants after the new name. found in the GREENEN section are ideal, Case evaluation record meaning the calltakerker This report is a detailed look at the Emer- and reviewer agreed.d Note: Determinants ACROSS are fromfrom gency Dispatcher’s (ED’s) activity during each the CALLTAKER, and the determinants going • Determinants found in the PINK stage of the reviewed case; the compliance DOWN are from the REVIEWER. section are considered a RISK to sscoringcoring isis sub-totaledsub-totaled forfor eacheach stage.stage. ThisThis This report shows the accuracy with the patient, meaning the calltaker rereportport sshowshows tthehe totatotall pprotocolrotocol comcompliancepliance which calls are classiﬁ ed and dispatched. The selected a lower determinant than as wwellell as thethe customercustomer serviceservice report is grouped by calltaker, with the ﬁ nal was appropriate. The patient’s well- sscore.core. group consisting of all calls. Under-response being is at risk. and over-response amounts are accumulated • Determinants found in the YEL- for each possibility. Total response numbers LOW section are considered a are simply sums of their type. WASTE, meaning the calltaker selected a higher determinant Communications center protocol compli- than was appropriate. The extra ance (protocol compliance report) resources needed for a higher deter- This report shows the average level of minant are wasted. compliance to protocol for each ED in • Anything found in the GRAY area each section of the case review process. is an unknown determinant, or in This report shows the scores of cases simpler terms, either the assigned grouped by the calltaker who took the level was not entered or the reviewed calls. The weighted score is shown for each level was not entered in the case. calltaker. The standard scoring system is used.

Cause-EffectCa (protocol compliance summary)su This report shows cause and effect, mmeaning how segments in one part of the cacall [Case Entry (CE) or Key Questioning ((KQ)]K can impact other segments [Chief CoComplaint (CC) or Final Coding (FC)]. ThThe report also shows a trend and, in this cacase, when compliant with CE and KQ the cacalltaker is more often correct in the CC anand FC. This is the only other report that shshows customer service compliance. This report is grouped by calltaker and shshows five lines of information in each grgroup,o four of which are differentiated by:

18 THE JOURNAL | emergencydispatch.orgpatch.org • Perfect Case Entry, Perfect Key it provides case score details for each call- J Gives the percentages of Questions taker. The top line is the total compliance total cases • Less Than Perfect Case Entry, score for all cases listed. It displays one call- • Statistics shows all Chief Com- Perfect Key Questions taker per page. plaints broken down individually The standard scoring system is used. • Perfect Case Entry, Less Than and scored per segment Perfect Key Questions Shift/team protocol compliance J Gives the compliance levels • Less Than Perfect Case Entry, Less This report shows the average level of achieved in each section of each Than Perfect Key Questions performance/compliance grouped by team. CC and the total average score Each line represents a team. by center • Total Scores for Chief Complaint, The standard scoring system is applied J Final Coding and Customer Service Gives possible areas for to cases handled by each particular team. improvement This report provides a context that QI summary report explains factors that may cause a calltaker to Each line is computed with the standard The quality improvement (QI) summary lose focus during a call, and indicates the call- scoring system. The groups of numbers report is the most detailed report since it taker’s areas of strengths and weaknesses. between sections are as follows: shows the agency as a whole. Total Cases Reviewed: The number of Individual employee protocol compliance • Distribution shows the distribution cases reviewed in the time frame given for (employee protocol compliance) of determinants in percentages the report This report shows the average level of J Gives the percentages of Total Cases Entered: The number of compliance in all areas of the protocolprotocol,, aandnd reviewed cases cacases entered when call date is within the rrangea speciﬁ ed for the report

THE JOURNAL | September/October 2008 19 Note: The following must be done on each case evaluation record for it to show in this report: • Review completed check mark in customer service area • Assign a valid level in ﬁ nal coding J Reviewed For Period: Total cases entered /(# of days covered in report * calculated calls per day) • Call Volume: Enter annual call volume for the agency / 365 * # of days included in the report (* is multiplication) (/ is division)

ReviewerRe comparison This report compares the reviewers within the agency. It lists the sscoresc of the cases entered and reviewed in the date range covered by the rereport and is grouped by the reviewer. The standard scoring is used.

ExemplaryEx performance This report generates individual forms for each case that has a score eequalq to or higher than the level set for high performance. This score is agency specific and is set in case list maintenance ssettings.et

NoncompliantNo performance This report generates individual forms for each case that has a score eequalq to, or lower than, the level set for minimum performance. The score is also agency-speciﬁ c and is set in the case list maintenance settings.se

TrendsTr The trends report prints out the information seen on the trends screen wwhenh you launch AQUA.

StandardSt scoring The total for each line is the average of the Case Entry, Chief Com- pplaint,l Key Questions, Final Coding, if no Pre-Arrival Instructions (PAIs) or Post-Dispatch Instructions (PDIs) exist; otherwise, the combined PAI/ PDI score is computed into the average. Case Entry, Chief Complaint, Key Questions, Final Coding, and Cus- tomer Service are all averages.

PAIsPA and PDIs are weighted Since no case will have both PAIs and PDIs, a single score is needed fofor both. Also, not all cases will have either PAIs or PDIs, so the calcula- titiono is done using the number of cases that actually has this component. ScScoring calculations are completed in the following way: • Determine the count of cases with PAIs and calculate the average PAI score for them • Determine the count of cases with PDIs and calculate the average PDI score for them • Calculate the ratio of PAIs and PDIs to the total number of cases with those values • Multiply each score by its ratio of the whole and add the two together; the result will be a valid percentage score at or below 100

NOTE: If the report includes no cases with PAIs or PDIs, the report’s calcula- titiono will not count those columns. J

20 THE JOURNAL | emergencydispatch.org IndustryInsider Multi-story buildings tional stops were made and, if that was the with the caller whether it’s through infl uence vertical response case, another 54 seconds was usually added the aptitude to speak a language other to the response time. than English when needed, use a tone The authors conclude that measuring of voice that de-escalates a crisis situ- Never mind the delays in emergency variables such as building height provides a ation, or to ask the questions in a way response due to traffic snarls and packed more meaningful representation of the EMS that both calms the caller and provides sidewalks; the height of a building may be response (from dispatch to on-the-scene) the necessary response; one student a bigger obstacle when it comes to timely than simply measuring time based on call said good communication meant never arrival getting in the way of reaching a assignment to arrival exclusive of the fac- diminishing the importance of any call patient’s side. tors urban living brings to the puzzle. no matter past experiences, such as a According to a study published in Aca- The study was conducted from July plethora of alarms from the same busi- demic Emergency Medicine (14:772-778), the 2001 to December 2003 using calls to ness or private establishment. time from dispatch to arrival on-scene and the New York City 9-1-1 system for EMS • Ability to get the details, including to the patient for high-priority call types assistance requiring a priority 1, 2, or 3 ALS asking the caller how she or he would varied by place, all other factors being equal: response. A total of four of the 32 primary like to be addressed (Ma’am, Mrs., Ms., The median on-scene to patient interval was New York City Fire Department stations Mr., or fi rst name), the exact name of 2.8 minutes for residential buildings, 2.7 were sampled with an estimated 51 of the an apartment complex or mobile home minutes for offi ce complexes, 1.3 minutes 598 paramedics observed. park, and the address plus additional for private homes (less than four stories), identifying information to get respond- and 0.5 minutes for outdoor calls. ers to the right location. Specifi cally, for offi ce, apartment, or medi- Dispatchers describe • Ability to put aside any biases—for cal buildings 10 stories or higher, the on-scene skills they value example, slurred speech may be an to patient interval was 3.5 minutes, com- indicator of a disability but even if pared with 2.3 minutes for buildings three a diffi culty in speaking is related to to 10 stories in height. When the patient was Have you ever asked your dispatchers drugs or alcohol, the dispatcher has on the fi rst or second story of a building 10 about the skills that make them proud to be a responsibility to give the highest stories or taller, the interval from on-scene to part of the communications center team? standard of care and attention without patient was 2.8 minutes; for the third through Well, the instructional coordinator for judging the person at the other end of ninth fl oors, the interval was 3.1 minutes, and Public Safety Training Consultants, Kevin the call. for the tenth fl oor or higher, the interval was Willett, did at a recent public safety train- 3.3 minutes. When an elevator was necessary ing class he held, which attracted more than An irksome issue is the “just a dispatcher” for reaching the patient, the median interval 40 dispatchers from all over northern and label students said they sometimes hear for all types of buildings— central Utah, Nevada, and Wyoming. around their police and fi re departments or from approaching the elevator This is a partial listing of what the dis- from people in the business. But that’s chang- at ground level to stepping out of the patchers told him: ing, Willett said. “Look for a person at Apple elevator—was 51 sec- • Ability to mine data so police have a [Inc.] who has saved a life, and you probably onds, unless addi- possible status check on occupants of wouldn’t fi nd one,” he said. “There’s nothing a pulled over car, and the same goes for like this. People can see that.” investigating addresses and providing a “heads up” about what police could encounter at Play it safe with the scene; getting the informa- children and cell phones tion is like being an artist, according to one student. “You’re painting A recommendation from a March 2008 a picture of what the study based on more than 110,000 inter- offi cer might be views with prepaid and other cell phone walking into.” users could save parents the embarrassment • Ability to of learning their children are spending sum- communicate mer vacation placing prank calls to 9-1-1.

THE JOURNAL | September/October 2008 21 According to study author Nicholas less phones have been reported in the last and dispatch period, MPDS quickly identi- P. Sullivan and David Aylward, director 18 months in Tennessee, Illinois, Arkansas, fi es the medical factors involved in the emer- and founder of COMCARE Emergency Idaho, and Wisconsin. gency incident.” Response Alliance, parents should teach COMCARE is a nonprofi t educational The Emergency Medical Center (First their children how to access the 9-1-1 sys- and advocacy group of organizations repre- Aid Station) Branch of the Chinese Hospital tem using a cell phone in case of an emer- senting emergency responders nationwide. Association is an exclusive national profes- gency while, at the same time, warning sional organization for Chinese emergency them that calling the number erroneously practitioners/administrators. It is a non- is a serious mistake because it could jeop- China’s emergency profi t, grass-roots-based organization formed ardize the help someone in an actual crisis medical offi cials endorse by 26 emergency medical centers around may need. Their pointers: use of MPDS China on a voluntary basis under the direct • Explain that “emergency” for 9-1-1 leadership of the Ministry of Civil Adminis- means threat to body or life—“afraid tration and Ministry of Health, in addition you will be hurt” The Emergency Medical Center (First to the Chinese Hospital Association. It was Aid Station) Branch of the Chinese Hospital offi cially founded in Qingdao in April 2002 • Don’t assume that because you know Association has endorsed the use of the Medi- with its organizational secretarial department how 9-1-1 works that your child also cal Priority Dispatch System® (MPDS) for use set at the Beijing Emergency Center. understands the concept in its affi liated emergency medical centers. The Emergency Medical Center (First • Don’t assume a child who knows how According to the announcement issued Aid Station) Branch of the Chinese Hospital to dial 9-1-1 on a landline will know in July 2008 by the organization, China’s Association stated that the MPDS is appli- how to do the same thing on a cell national 1-2-0 emergency telephone call cable in pre-hospital emergencies for several phone, which requires the extra “call” volume and pre-hospital emergency work- reasons, including: or “send” button stage load trends are increasing every year and the • MPDS can improve the accuracy level Sullivan and Aylward said parents who sooner the country uses MPDS, the faster it of on-scene patient evaluation teach their children how to use cell phones will advance in the quality of pre-hospital responsibly in emergency situations may response to patients. • Before the arrival of an ambulance, the be able to avoid the public humiliation “MPDS resolves pre-hospital problems MPDS telephone life support system can correctly and promptly help to and even prosecution that can result from quickly by obtaining the patient’s on-scene stabilize the medical condition of the “prank” 9-1-1 calls placed on cell phones information, using this information to deter- on-scene patient by youths. In one case currently under mine the condition based upon scientific investigation in Salt Lake City, Utah, a judgment to make the most appropriate • MPDS treatment of the classifi cation 14-year-old was arrested after placing response,” the announcement states. “At the system greatly enhances the effi cient more than 1,500 bogus wireless 9-1-1 same time, MPDS provides standardization utilization of emergency resources and calls from cell phones. Similar incidents to the dispatchers to ensure quality service. enables the patient to obtain the most involving preteens and teens abusing wire- In fact, during the telephone interrogation effective treatment

22 THE JOURNAL | emergencydispatch.org RN ASSISTANCE • The use of MPDS in the country can greatly accelerate the work of pre-hospital emergencies and reach the speed Tele-nurse program and level of international standards directs 9-1-1 callers In conclusion, the announcement states, “Our branch believes that the intro- to the right resources duction of MPDS is entirely feasible and practical; therefore, the branch encourages Most people know 9-1-1 is the number services. And, the caller can say “no” when the introduction of MPDS into the emer- to call in case of a medical emergency, but asked if RN assistance is preferred and gency center. It is hoped that the full use oftentimes the calls placed are for con- instead have an ambulance dispatched to of pre-hospital emergency treatment will ditions—like a nosebleed or scrape from the specifi ed location. continuously promote the development an accidental fall—that don’t warrant an “At any time, the nurse can deter- of China’s emergency industry.” ambulance trip to the hospital. mine that the patient does need immedi- MPDS is used in 3,000 communica- That’s why four years ago the Rich- ate transport, and an ambulance is sent,” tions centers around the world, includ- mond Ambulance Authority (RAA) Baker said. ing centers in the United States, Canada, (Virginia) introduced a pilot tele-nurse The 18-month pilot program RAA Europe, United Kingdom, Africa, Australia, program at its communications center. initiated four years ago required dispatch and New Zealand. The service, known as the Community to send an ambulance on each call, no Health Access Program (CHAP), went matter whether the patient was subse- live in 2006. quently transferred to the nurse on duty Stress of helping “Many calls we receive are for a non- or elected to stay on the line with the dis- survivors of rolled vehicle emergency,” said Lee Ann Baker, chief patcher. Each call was tracked to determine is part of the job administrative offi cer for the RAA. “This the outcome. was a way to get the right resources to Baker said they found no adverse out- a person without always having to send comes during the pilot, which prompted The stress of responding to a crisis an ambulance.” them to go live with the program in 2006. doesn’t seem to be an issue among the From March 2006 to March 2007, RAA emergency dispatchers honored at the What it takes processed more than 400 calls through annual emergency services awards cer- The CHAP process involves an initial CHAP. Over the two years since the pro- emony sponsored by the Utah Bureau screening by a dispatcher who goes through gram went live, RAA has saved 750 ambu- of Emergency Medical Services, Utah the Medical Priority Dispatch System® lance trips without any negative impact on Department of Health. (MPDS) protocol. If, from the caller’s patient care. At least, the stress doesn’t hit them answers, the dispatcher determines the “We’ve never had a transferred call that until the event is over on their end and medical situation is for a low-acuity situ- turned out to be an actual emergency,” the dispatcher has a moment to refl ect ation (an Omega-level call), the dispatcher Baker said. on what just happened. asks the caller if he or she would like to Two other EMS systems—East Anglia “Our job is responding to whatever consult a nurse. If the patient answers “yes,” Ambulances Trust in England and the call we get,” said Camille Critchlow, the call is transferred to the registered nurse Ambulance Service of New South Wales a dispatcher for the Tooele County (RN) working the daily 12-hour shift at the Sydney Operation in Wales—successfully Sheriff’s Offi ce in northern Utah, along RAA communications center. tested and implemented their own ver- the south shores of the Great Salt Lake. The RN goes through a separate set of sions of the CHAP program during the “There are some calls that get to you questions using Priority Solutions Inte- same time frame as the RAA pilot pro- more than others and when that hap- grated Access Management (PSIAM) soft- gram. There are now over 25 sites world- pens, Heather [her co-worker] and I talk ware that integrates triage algorithms with wide with the CHAP system in place. about it. But generally you let it go. You emergency medical calltaking. The soft- The good attention the CHAP program have to. You can’t take the job home.” ware helps the nurse gather information has received over the past two years may The award their agency received from the caller, which is used to decide the be one reason that the Houston, Texas, for Outstanding Dispatch Agency Per- course of action. The patient may be pro- city council recently approved a $6.8 mil- formance recognized the dispatchers’ vided with self-help direction or the nurse lion, five-year contract with Healthcare efforts in response to a horrifi c rollover may connect the patient to the appropriate Alliance to provide registered nurses 24 traffic accident off Utah’s Interstate 80 community health care provider. hours a day for fi rst-aid advice and medical that involved a family of seven. Accord- If the caller needs a ride to a facility referrals to 9-1-1 callers. ing to the award, Critchlow and Heather other than an emergency room, RAA “They haven’t contacted us, but the Prescott “stayed locked on to the 9-1-1 provides alternative transportation to the program seems very similar to ours,” Baker calls gathering victims’ conditions and facility and back. said. witness scene descriptions until the fi rst Switching the call to the RN, however, The RAA is an NAED Accredited Cen- unit arrived on scene.” does not in any way pre-empt ambulance ter of Excellence (ACE). J

THE JOURNAL | September/October 2008 23 Critchlow and Prescott have had their we were a little fortunate in this event The Tooele County Sheriff’s Office share of tough calls. Critchlow, a dispatcher because the hospital did call us with dispatches emergency services for 46 for three years, said this incident, which updates about how they were doing. That individual agencies, covering 7,000 square occurred in September 2007, was particu- doesn’t happen very often.” miles of Tooele County. The once pre- larly difficult because five of the victims The awards were among several predominantly county has experienced phe- were children. Two people were killed. sented in cooperation with the Sandy nomenal population growth over the past “It was intense, especially because of City Fire Department during the 2008 decade, from 26,672 to 40,735 residents, the kids involved,” Critchlow said. “But National EMS Week. or roughly a 53 percent increase. J

TIMELY ADVICE Aspirin Diagnostic is frequently used over-the-phone advice

During the past several months, the people ﬁ nding where they put the aspirin,” identified using Protocol 19. The tool is Manatee County 911 dispatchers have she said. “They put down the phone to look designed for use after asking all Key Ques- advised the use of aspirin among many and sometimes forget to come back since, tions and initiating dispatch. callers, especially since chest pain is one of by that time, help has arrived. We’re having Typically, it is used prior to the provi- the most common complaints the center good results.” sion of Post-Dispatch Instructions (PDIs). receives from callers. Manatee County 911 dispatcher John However, if certain PDIs appear to take “We use it all the time,” said Laura Lid- Mercer said callers are delighted to receive precedence in an unstable patient, those dell, Manatee County Emergency Com- the information, especially a 2nd-party PDIs should be provided first. Cardset munications Center training coordinator. caller worried about the person—often users will ﬁ nd the Aspirin Diagnostic and “It’s one more thing we can do before the a husband or wife—suffering from the Instruction Tool on a double-sided pullout ambulance gets there and one less thing chest pain. card that slides out from behind Protocol the paramedics have to do once they arrive. “Getting the aspirin puts them into the 10. ProQA® users can activate the tool by They can concentrate on what else needs action,” he said. “The callers are glad to have clicking on the Aspirin Diagnostic button to be done.” something they can do before the ambu- on the toolbar or beneath the DLS Links Liddell trained the dispatchers on the lance arrives.” on Protocol 10 or Protocol 19. use of the Aspirin Diagnostic in March, The Aspirin Diagnostic and Instruction The NAED does not sanction the use soon after the National Academies of Tool should be used for all non-allergic alert of the Aspirin Diagnostic and Instruction Emergency Dispatch® (NAED) issued the patientspgpg over the age of 16 presenting with Tool without local authorization. J instruction tool. She said the dispatchersspatchers non-traumatic chestchest pain, includingincluding thosethose had little trouble learning the additionddition to MPDS® v12, NAE-std. © 1979–2008 PDC. their Medical Priority Dispatch BH System® (MPDS) protocol and IAGNOSTIC AND INSTRUCTIONS ASA ASPIRIN D g J POST-DISPATCH INSTRUCTIONS actually enjoy the ability to give (ambulance)( to help y a. I’mIm sending the paparamedicsrame DIAGNOSTIC QUESTIONS to aspirin,aspirin, or tell you exexactlyactly whwhatat to the advice to people making Is s/he allergic StStayay on ththee lineline and I’llI’ll tell you 1. (Chest pain and alert 16) defibrillator (AED) a emergency calls in response to bad reaction to it before? + Not alert) If there is a ever had a s –––––––––––––– – J bb. ( 1 +1 Not alert) we need it later. asppiirriin iinnsttructProtectedionsn by U.S. Patents 5,857,966; 5,989,187; 6,004,266; 6,010,451;get it 6,053,864;now in 6,076,065; case 6,078,894;we need 6,106,459; it later. 6,607,4 the pain and discomfort they fear — Do not proceed with aspirin instructions someonesomeone to get it Yes Aspirin-Containingmaterial in Medications ested ana d AlA ert) Remi bloodod or coffee ground material (Patient(Patient memmedicationdication rerequestedequq and Alert) may be an indication of a heart 2. (No) Has s/he vomited c. instructed for these For AMI early treatment purposes,do the what her/hisDo NOTdoctordoctor Use has These instructed Medications the last 24 hours? following medications J attack. asppiirriin innstructions ––––––– — Do not proceed with aspirincommonly instructions known brand names)(listed by their For AMI early treatment purposes, th “The protocol is awesome,”” Yes s in thethe last following medications blackck or bloobloodydyas stoolstoolsaspirin ARE the her/his conditiioon 3. (No) Has s/he passed : ✱ same thecommonly line with known calle brandr if her/his and generic(listed condition by names) their she said. “Before this protocol, wee • Alka-Seltzer • Ecotrin StayStay on the line with caller 24 hours? J orNOT is woworseningrsening. n instructions ––––––– unstable the same as aspirin onn Ta weren’t able to tell people anythingg not proceed with aspirinasppiirri (dissolveinstructions in water first) administeredin Diagnostic & IInstructionnsandtructi should T Yes — Do • Empirin ✱ UtilizeUtilize ththee AAspirinspir Diagnostic: pn about what to take. Now, we’ree any aspirin• Anacin •or Excedrin Bufferin MeMedicaldical ContControlrol anandd ththee p Does anyone there have any aspirin or Bufferin authorauthorizedized•by Advil localocal (ibuprofen)l 4. (No) • Ascriptin (only if • Motrin able to give the advice and callerss ? (Ask them now.)w.) aspirin based;and another 16 yeyears• Alevears olold d. (ibupro available • Asperbuf –––––––––––––– J (naproxen) • Nalfon have the opportunity to help them-m- proceed wiwiththh aspirinaassppirrin instructions variety contains • Celebrex (fenopr No — Do not • Aspergum R(celecoxib) unless: or four babybaby (low-dose) ✱ •Link Feldene to X-1 unless:• Naprosyn (nap selves while help is on the way.” one adult aspirin/Bufferinin/Bufferin• Bayer or • Goody’s Powder acetaminophen)DLS (piroxicam) – 5. (Yes) Get ththem.em. • Indocin andand Not• Orudisalert–––––––alert–––– (ketopro––– tell me whenn you hahave•ve BC Powder • Halfprin INEFFECTIVEINEFFECTIVE BRBREATHINGEAATHING(indomethacin) If there is any hesitancy overer aspirins and • Midol • Tylenol (acetami typee do you• Bufferinhavehave?? • Measurin (acetaminophen) the protocol, it’s on the part of thehe 6. (Not obvious) Which • Vioxx (rofecoxib • Doan’s pills • St. Joseph Limitations Warning caller, but not because the advice is • Easprin • Vanquish These recommendations represent the ONSS coming from someone other thann a ADMINISTRATION INSTRUCTIONS ASA Aspirin Administration w. current best practice aspirin/Bufferin right now.no er/him toLocalchewchew Medical oneone adultadult Control aspirin/Bufferin must authorize and approved by the Academy’sapproach asCouncil defin physician, Liddell said. (Adult ASA – 325mg) Tell her/him to aspirins rightright now.now. the EMD’s evaluationto chew and four baby (low-dose) Standards “One of the biggest problems is SA – 8811mgm ) TeTellll her/him to ()X regarding the (Baby or Adult low-dose ASA – 81mg)of aspirin in patients presentingadministration heart-saving early administratipotential life- a che t i ith i f 24 THE JOURNAL | emergencydispatch.org THE PREMIER EDUCATIONAL CONFERENCE FOR POLICE, FIRE, AND MEDICAL DISPATCH

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30Years 888.725.5853 WWW.EMERGENCYDISPATCH.ORG 1979 2009 protocolspriority dispatch systems® 30 Years of Meaningful Change SCHEDULE AT A GLANCE | NAVIGATOR 2009 | LAS VEGAS, NEVADA | APRIL 29–MAY 1 Topics and speakers are subject to change. Visit www.emergencydispatch.org for the latest updates. Tuesday, April 28

Opening Exhibit Hall 6:00 PM–8:00 PM Gala Reception 6:00 p.m.–8:00 P.M.

7:30 AM–8:30 AM Wednesday, April 29 Registration and Continental Breakfast

Opening Welcome 30Years Opening 8:30 AM–10:30 AM 1979 2009 30 Year Protocol priority dispatch systems® Session protocols Celebration KeyNote 30 Years of Meaningful Change

10:30 AM–10:45 AM Coffee Service

10:30 AM–12:30 PM Exclusive Exhibit Hall Hours

11:30 AM–12:30 PM Box Lunch in the Exhibit Hall

MANAGEMENT EXHIBIT HALL LEADERSHIP & OPERATIONS SPECIAL INTEREST MEDICALFIRE POLICE

The Employee: Bullying in the Through the Looking Glass New Science – Chapter Two Major Incidents and the Catching the Bad Guy – From Hire to Leader Communications Center Telecommunication Specialists Keeping the Caller Safe 12:45 PM–2:00 PM Jim Lanier, Sharon Lanier Dr. Jeff Clawson, Brett Patterson that Handle Them Bill Kinch Jim Lake Michael Spath Hall Hours Dave Brinton Open 26 Hours in a Day: Time TBA Turning the Science into an Art Form Customer Sevice – Beyond the Score NFPA 1221 – Call Processing Fighting Crime and/or Evil 10:30 a.m.–4:00 p.m. 2:15 PM–3:30 PM Management for Today TBA Charlotte Hughlett, Tina Young Tammy Spath Standards Jaci Fox, Harley Kesler, Eric Parry Exclusive Hours Ron Two Bulls, John Ferraro Jay Dornseif 10:30 a.m.–12:30 p.m. 3:30 PM–3:45 PM Box Lunch Coffee Service 11:30 a.m.–12:30 p.m. Appreciative Inquiry Communications Create a Training Program that Low Acuity Calls – Omega Version 5 Fire Implementing EPD: Secrets to Success 3:45 PM–5:00 PM David Nelson Center Stafﬁng Deals You a Full House and Beyond Gary Galasso, Mike Thompson Jim Lake Melissa Blessing, Tami Wiggins Greg Scott Bill Kinch, Eric Parry, Michael Spath, Ross Williams

Attendee 5:30 PM–7:30 PM Pool Party Thursday, April 30 7:30 AM–8:30 AM Registration and Continental Breakfast Dispatcher of the KeyNote 8:30 AM–10:00 AM YEAR 2009 ACE RECIPIENTS Speaker

10:00 AM–10:15 AM Coffee Service

EXHIBIT HALL LEADERSHIP MANAGEMENT & OPERATIONS SPECIAL INTEREST CDEQUALITY IMPROVEMENT TECHNOLOGY

TBA Why Do You Keep Asking Me Forgiving: The Art of CDE – To Boldly Go Where no Chip ‘n Dale’s EMD Review ProQA 5: Police Version 4 Hall Hours All These Questions? 10:15 AM–11:30 AM Dr. Jeff Clawson Learning to Let Go Instructor Has Gone Before Chip Hlavacek, Brian Dale Eric Parry Open Grant Rinaca, Nadine Boulanger, Chris Bradford Tracey Barron, Louise Ganley 10:00 a.m.–2:00 p.m. Lori Daubert 11:30 AM–12:30 PM Exclusive Hours & Box Lunch Picnic Lunch in the Exhibit Hall 11:30 a.m.–12:30 p.m. Coaching Skills What Q Can Do For You Critical Incident Stress and the Game Show CDE – Making CDE The New QI CAD Integration 12:45 PM–2:00 PM Last chance to visit this David Nelson Emergency Dispatcher Motivating While Educational year’s exhibitors! Michael Spath, Tammy Spath Brian Dale Ron McDaniel, Chip Hlavacek Kim Rigden Ron Two Bulls, John Ferraro

Miffbusting 101 – Dealing CCM Course Take a Break Continuing Education How to Score Multi-Agency ProQA Tips and Tricks 2:15 PM–3:30 PM With Conﬂict Thomas Somers, Samantha Paul Robert Hodges Tips and Tricks Calls Chip Hlavacek, Tammy Haislip Jim Lanier, Sharon Lanier Christina Baum, Alice Valle Brian Dale

3:30 PM–3:45 PM Coffee Service

Appreciative Supervision Missing and Exploited Children EMD Behavior Thinking Outside the Box Quality Assurance AQUA Tips and Tricks Roundtable Discussion 3:45 PM–5:00 PM David Nelson National Standards Tracey Barron, Louise Ganley for CDE Chip Hlavacek, Tammy Haislip NCMEC Chris Bradford Kim Rigden, Jaci Fox, Michael Spath, Dave Brinton Friday, may 1 7:30 AM–8:00 AM Registration and Continental Breakfast

LEADERSHIP MANAGEMENT SPECIAL INTEREST MEDICALFIRE POLICE & OPERATIONS

I Dub Thee Supervisor LA Commuter and Successfully Training Legal Trends in Emergency Hazmat Verify or Clarify 8:00 AM–9:15 AM Robert Hodges Freight Train Crash Lateral Hires Medical Dispatch Dave Brinton Jaci Fox, Colleen Bachewich, Thomas Somers Tammy Spath Dr. Jeff Clawson, Fred Hurtado Tami Wiggins

EFD Accuracy – Looking at Trials and Tribulations of Department of Transportation – Somebody Answer That Phone! Psychology of a 911 Call TBA Dispatch Accuracy Compared Examining Operational 9:30 AM–10:45 AM The National 911 Ofﬁce Michael Spath Kim Rigden TBA to Fire Reports Communications Centers Laurie Flaherty Jay Dornseif TBA Fire It Up! (or Down): Redeﬁning the Purpose of TBA Shaping Student Performance Maryland’s Pandemic Flu Using the FPDS for Better Terrorism: Dispatching 11:00 AM–12:15 PM 911 and EMS TBA Louise Ganley, Tracey Barron Preparedeness Plan Resource Allocation into Harm’s Way Fred Hurtado Greg Scott, Dr. Richard Alcorta Lisa Kalmbach Bob Pastuala

Dr. Jeff Clawson Closing 1:00 PM–2:30 PM Leadership Award Lunch

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What could be more important than protecting our children?

Announcing 9-1-1 COMMUNICATION Helping to PROTECT OUR CHILDREN CENTER BEST PRACTICES IN CASES OF is as easy as 1-2-3! MISSING CHILDREN NCMECʼs 9-1-1 Communication Center Best A missing child is a critically important and high 1. Download Practices in Cases of Missing Children document from profile event that can rip the fabric of your agency www.missingkids.com/911 and community if not handled correctly. In terms of urgency, use of resources and potential impact 2. Request a copy of the Public Safety Telecommunicator on the community, a missing child requires a level Checklist for Missing Children. of readiness akin to a disaster. This joint initiative of 3. Apply to attend NCMECʼs CEO Overview Course in NAED, APCO, NENA, National AMBER Alert and the Alexandria, Virginia. National Center for Missing & Exploited Children (NCMEC) was created to:

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invited to apply to attend the two-day oveview course · Develop and endorse best practices held at the National Headquarters of NCMEC in · Develop tools for handling incidents of Alexandria, VA. Courses are conducted approximately missing and abducted children every six weeks at no cost to participants.

For more information, visit www.missingkids.com/911 or email [email protected] Dispatch Moves Off Center Dispatch teams and mobile units take the art of communications into the ﬁ eld

30 THE JOURNAL | emergencydispatch.org BY AUDREY FRAIZER

Photographs courtesy of Randall Larson; St. Croix County 9-1-1 Communications Center; River Falls, Wisconsin, Ambulance; and Metro Nashville Offi ce of Emergency Communications Center Page 32 Into the Field. Incident dispatch teams arrive on the scene to assist directly during The increasing use of incident dispatch teams and mobile dis- emergency patch units are taking emergency communications centers to a new level of involvement. Page 35 And for very good reasons. Built to Command. Dispatchers going to the fi eld to assist in a major incident take the stress off the central communications center; they can con- Mobile units used in Wisconsin let centrate on the fi re or other emergency leaving those at the center dispatchers get to the heart of an the ability to stay focused on the other 9-1-1 calls coming in. An emergency added bonus is the experience the dispatchers bring to the scene. As Randall Larson, San Jose Fire Department Communications shift supervisor, said, the career dispatchers staffi ng mobile units Page 37 during major incidents make better and more intuitive commu- Dispatch on Wheels. nications personnel than line personnel pulled off the incident Metro Nashville ECC responds to staff these positions. In turn, the line personnel are in the fi eld responding to the emergency. in a bus built for emergencies The idea of sending dispatchers to a major incident goes back a good 30 years, but it wasn’t until the last decade that it began to gel on a larger scale, thanks to the efforts of a group that has since gone on to organize the National Incidence Dispatcher Associa- tion (NIDA). Incident dispatchers provide on-scene emergency communications support to field operations. These specially trained safety dispatchers are integrated into the scene—such as a major fi re or police standoff—to coordinate communications using the same skills they’ve developed in their centers (hearing and repeating accurately, managing multiple resources, and tracking personnel involved at the scene). Mobile dispatch units also bring the team closer to the incident. The dispatchers and incident supervisors of Metro Nash- ville Field Incident Response Situation Team, or FIRST, take command from a 40-foot bus in response to HAZMAT and rescue operations as well as to situations requiring crowd control. Mark Hutchison, a FIRST team member and a fi re instructor for the National Academies of Emergency Dispatch® (NAED) said the bus gives them full access to whatever they need. “If it can be done at the center, it can be done here,” he said. The same goes for the vehicles used by emergency agencies in Wisconsin, as described in related stories you’ll read in the following feature section. These centers away from the home base provide a close up and personal approach for dispatchers to assist where their skills may be needed most.

THE JOURNAL | September/October 2008 31 Into the Field. Incident dispatch teams arrive on the scene to assist directly during emergency

California burning ty’s mobile unit was set up for operations at “They take some of the workload of The Summit Fire in the Santa Cruz the Christmas Hill Park base camp not long the incident off the communications Mountains, Calif., burned some 4,270 acres after the fi rst call about the fi re was received center,” explained Bonnie Maney, tele- and destroyed 31 homes when it roared by San Jose Fire dispatchers. communications manager for the town of across the summit along ridgelines and deep The team was ready, said Santa Clara Palm Beach, Fla., Police Department and into steep mountain valleys during the last Communications Center Chief Dispatcher All-Risk IDT coordinator for the state of week of May. Curtis Darnell. “Two of our dispatchers Florida. “They are on the scene, allowing Local televised news reports compared getting their ROSS training drove down the incident commander to truly manage the area burned—approximately 1.5 miles to help and were drafted into the incident the situation while IDT handles the com- east to west by fi ve miles north to south— from the start.” munications traffic.” to the campus of UC Berkeley, but 18 times ROSS, or the Resource Ordering and larger. Videos of the fi re captured by ama- Status System, is a Web-based data system IDT takes hold teur photographers and posted on YouTube developed by the National Wildlife Coordi- The idea of sending dispatchers to a show smoke and fl ames billowing from the nating Group for managing wildfi res. major incident goes back a good 30 years, but ridge tops, giving the viewer only a sense it wasn’t until the last decade that incident of what must have been sleepless nights of On-scene communicators dispatch began to gel on a larger scale. worry for the hundreds of residents des- Incident Dispatch Teams (IDTs) pro- Don Stabler, who retired two years ago perately hoping that fi refi ghters would beat vide an on-scene emergency communica- from the Contra Costa County Fire Depart- back the fi re before it reached their homes. tions support group to field operations, ment as a senior fi re dispatcher, remembers It was this scene that must have played in including fi refi ghting and law enforcement; the day in 1970 when he volunteered on his the minds of incident dispatchers from the the specially-trained public safety dispatch- off-duty day to assist in the fi eld on a major Santa Clara County Communications Cen- ers are integrated into the scene to release fire. The fire chief, who was the incident ter and San Jose Fire Department (SJFD) ground units for tactical operations and pro- commander at the scene, handed Stabler responding on duty to the Santa Clara Coun- vide command post assistance to an already a pad of paper and radio and left the dis- ty’s Mobile Communication Unit. The coun- overburdened incident commander. patcher in charge of communications traffi c

32 THE JOURNAL | emergencydispatch.org at the command post established at a base in the midst of an escalating, major wild- cations, a mobile repeater, generator, radio camp not far from a border of smoke and fire, those skills have been shown to be battery chargers, and other tools to support fl ames. He answered calls and coordinated extremely valuable,” Larson said. “They tactical communications, resource account- emergency response. can release field units to go back and do ability, and incident documentation. “This gave him the ability to do other what they do best—fighting fires and The unit is brought out any time a things while I handled the job I did on a staffing command positions.” situation demands direct contact between daily basis,” Stabler said. Over the years, the concept has become incident command and dispatch, including Over the last three decades, Stabler has much more recognized, both within the wildfi re control and major holiday or politi- responded to more wildfires than he can fire service and also in law enforcement, cal events, such as Fourth of July celebra- count, along with other major disasters like where tactical dispatchers have been used tions and anti-war demonstrations. the fl ooding that can result from brush loss for almost as many years to support SWAT “There’s everything we need,” Darnell in the aftermath of a wildfire. Although and hostage negotiation team tactical com- said. “The mobile van duplicates everything technically retired from public service, Sta- mand posts, Larson said. that we can do at the center.” bler is the communications offi cer for the SJFD Dispatch Shift Supervisor Traci Cordelia Fire District in Solano County, Jackson was one of those ears and voices IDT energizes Calif., and is still very active in incident assigned to the command post supporting Darnell has pushed for an IDT program dispatch. By July, he had responded to four the Summit Fire fi ght. She said IDT gives in Santa Clara County because of advan- major fi res in the 2008 California fi re season the advantage of total dispatcher dedication tages that make it a “win-win” situation for as part of an IDT team, including a 10-day to a major incident. his dispatchers, the communications center stint at the operations center set-up at the “The dispatchers are there from the as a whole, and the overall handling of Cali- Konocti Conservation Camp to fight the beginning to the end,” she said. “We can fornia’s wildfi res. This year has been one of Walker fi re, which destroyed nearly 15,000 handle the situation from a remote location, the worst fi re seasons since the state began acres in a mostly wildland area. and we get it done without bogging down keeping records. As of mid-July, fi res in the “By all means, IDT helps,” Stabler said. operations at headquarters.” state had consumed almost 840,000 acres “The workload is taken off the in national forests as well as state, comm. center because we can get at “By all means, IDT private, and local lands, according least 90 percent of the work done to a story posted by International on the fi eld.” helps. The workload is Fire Fighting News (July 15, 2008). “IDT energizes the dispatcher,” Wildfi re beginnings taken off the comm. Darnell said. “It gives them a close Incident dispatch grew out of up view that they don’t get in the the need to train dispatchers to center because we can comm. center. To be there in the staff overhead communications incident and to have the great unit positions during major wild- get at least 90 percent visual appraisal is a great opportu- fi res in California, said Randall Lar- nity. The dispatcher is devoted to son, SJFD Communications shift of the work done on the that incident.” supervisor and director of its IDT The job, however, isn’t open to since the inception in 1992. fi eld.” Don Stabler just anyone. Standardized train- As Larson explained, histori- ing for Santa Clara County’s IDT cally, line personnel were pulled off the Dispatch on wheels dispatchers includes a 24-hour state fire fire line to staff administrative positions When called into the fi eld to dispatch a marshall’s office certified ICS (Incident in mobile communications units during major event, IDTs generally work a 10- to Command System), a 24-hour Incident major fi re incidents. They were not trained 12-hour shift. The mobile unit serving as Dispatcher course developed by the Cali- dispatchers. As incidents increasingly their workstation for the extended period fornia Fire Chiefs Association-Communi- depended on specialized communications they are in the fi eld depends on the incident cations Section, and additional training in support, it was recognized that trained dis- location. For example, incident dispatchers local resource management provided by the patchers, who do that job every day in their from both SJFD and Santa Clara County dispatcher’s agency. communications centers, would be ideal to assigned to the Summit Fire used the Santa Each member of California incident staff the mobile communications unit. Clara mobile unit because of the fi re’s prox- dispatch teams must be certifi ed as a Radio Among the other skills needed for imity to the county line. It was a jurisdic- Operator (RADO), Incident Dispatcher the job, dispatchers can multi-task, hear tional decision. (INDI), and Status/Check-In Recorder and repeat accurately, manage multiple The Santa Clara County unit is a former (SCKN) within the state of California mutual resources and conversations, anticipate the sheriff’s department prisoner transport bus aid system. Local agencies like San Jose, which needs of field units, and track resources that was extensively overhauled to provide regularly deploy IDTs on local incidents, and personnel. an enclosed work area for the dispatchers, also have a qualifying IDT selection exam. “Civilian dispatchers who dispatch incident commander, and support staff. The Requirements, however, vary by state and few for a living simply make better and more unit is equipped with three radio positions, states outside of California and Florida have intuitive communications personnel, and computer workstations, cellular communi- as of yet formalized IDT standards.

THE JOURNAL | September/October 2008 33 National Standards the need to clarify the difference between an “I wanted to make sure that if found It’s the inconsistency in standards IDT dispatcher, who goes out into the fi eld, again in that situation, I’d be with someone despite the growing use of IDT that and the dispatcher on a Telecommunicator who could work alongside me,” he said. prompted Dave Larton to establish the Emergency Response Taskforce (TERT) Ini- “This is not a slight against the person who National Incident Dispatcher Association, tiative team, who offers relief during a major was sent, but these situations require some- Inc. (NIDA). incident from inside the walls of the partner- one with the right background.” Larton, Coastal Region Auxiliary Com- ing communications center. munications Service (ACS) offi cer for the There is a need for both—TERT and Look to the future Communications and Technology Develop- IDT—and the latter does offer the advan- Stabler believes the need for IDT will grow ment Branch of Governor’s Offi ce of Emer- tage of putting a communications profes- nationally, especially if the size of California’s gency Services, Calif., recruited long-time sional on the field as opposed to pulling operation can be used as a yardstick. incident dispatch advocates Maney, Stabler, firefighters off the line to staff the com- Over the 15 years SJFD has been Larson, and tactical dispatch trainer Tammy munications position during a major wild- involved with incident dispatch, the team Smith. Over the past two years since fire incident. IDTs can also be deployed has responded to more than 300 emergency NIDA’s founding, they’ve consolidated their through the TERT requesting process. incidents within the city limits, including resources and standardized IDT training not “You get one of those large fi res and it’s major fi res, both structural and wildland; only for the fi re dispatcher but also for law a huge responsibility,” Berdan said. “Com- mass casualty incidents; hazardous mate- enforcement offi cials and medical dispatch- munications can be a nightmare without rials situations; and special events such as ers trained and certifi ed to respond in the the unique skills of a dispatcher.” the San Jose Grand Prix and countywide fi eld. Chuck Berdan, dispatch manager for mutual aid wildland and high rise drills. the Alameda County Regional Emergency IDT by fi re Since San Jose Fire and neighboring Communications Center (California), cur- Berdan knows about these types of Mountain Fire established the Fire Dept. rently serves as NIDA’s president. nightmares. The dispatcher many refer to Incident Dispatcher Team in 1992, the Larton said IDT helps to coordinate as the “grandfather of IDT” got his incident team has served as a model for similar incident command using the teams throughout the Bay Area. skills and talent inherent to the Fire departments in Sunnyvale, Palo dispatcher’s job. “We can handle the Alto, San Mateo County, Napa, and “Dispatchers have been working Contra Costa County are among on having people play well together situation from a remote agencies that have established for a long, long time, and that’s local response IDTs. While these where IDT goes,” he said. location, and we get it and other IDTs continue to sup- Maney said developing mini- port local incidents, more than two mum standards is a primary goal done without bogging dozen incident dispatchers have behind NIDA. deployed as mutual aid overhead “Dispatchers are known to rise down operations at resources to California’s 2008 fi re to the occasion, but we wanted to season—so far. There is also some create something that teaches them headquarters.” Traci Jackson state recognition, although the fed- a specialty,” she said. “We want them eral government has yet to give its to be able to apply the skills no mat- full support to an offi cial position. ter where they are called to go.” dispatch baptism by fi re in 1990 when left As Larson explained, within the Maney’s interest in incident dispatch alone in the operations van at the site of a national wildfire environment, the Inci- stems from her experience in the profession, major wildfi re. A fi refi ghter who had been dent Command System (ICS) position of including receiving emergency 9-1-1 calls assigned along with Berdan was called back RADO (Radio Operator) has traditionally from people seeking help related to any of to his agency to work in that role. referred to the incident dispatcher. In Cal- Florida’s catastrophic hurricanes. Similar to “I was the only one there and the fire ifornia an incident dispatcher does more IDT programs in California, the dispatchers grew to huge proportions,” Berdan said. “At than just “operate” the “radio.” They are receive intensive specialty training for inci- one point I had a radio in each hand. Those charged with managing communications dents that are never considered short-term were some pretty intense days.” on incident command and tactical chan- assignments once out in the fi eld. Berdan was sent help during the eight nels, assisting with resource accountability, “Not every dispatcher can do this,” she days he spent at the fire site, which even- and documentation. said. “They handle stand-offs, hurricanes, tually scorched 80,000 acres. The assistant “We’re recognizing an ICS position high-rise structure fi res, school shootings, sent, however, was not trained in incident called INDI—Incident Dispatcher—as a and brush fires. They are called in when command and Berdan wound up in the higher level of qualifi cation than RADO,” he needed, at any time an incident commander position of a dispatch trainer. The experi- said. “But this is not yet recognized nation- believes they will be of benefi t.” ence led him to write some of the fi rst IDT ally within the federal ICS structure.” Berdan looks to the NIDA for raising fire training material that has since been Crews got the Summit Fire under con- educational awareness about the importance expanded for use by other disciplines that trol during the Memorial Day weekend of dispatch in the fi eld. For example, there is can incorporate the IDT concept. after cooler and moist weather gave fire-

34 THE JOURNAL | emergencydispatch.org fighters a strong handle on stopping the blaze. The eight days it took to battle the Built to Command. Mobile units fi re, sparked, offi cials believe, by someone clearing brush, involved more than 2,600 used in Wisconsin let dispatchers fi refi ghters at a cost of $11.2 million. Jackson said it was a thrill to be part of get to the heart of an emergency the incident team. St. Croix County The upgrade was made possible through “It’s like being in the dispatch center but The St. Croix County’s (Wisconsin) the support of Charlie Mehls. with the ability to dedicate our time to the mobile command center has come a long “Charlie was the chairman of my plan- situation,” she said. “We’re doing exactly way since the days it traveled to emergen- ning committee at the time and worked what we do best.” cies looking like a glorifi ed delivery truck. very hard to make this vehicle a reality,” Larson believes IDT participation will “The truck had side doors that slid Swetlik said. “It was eventually purchased continue to grow due to the complexity open,” said Casey Swetlik, director of the in conjunction with the St. Croix County and actual size of incidents. St. Croix County 9-1-1 Communications Emergency Management offi ce.” “The ongoing recognition of the incident Center. “But it had the ability to take com- The mobile unit is equipped with every- dispatcher as a part of the incident manage- munications out of the center and that’s thing a dispatcher needs on the road. There ment team, as well as the understanding of what we wanted.” is a link to the central CAD system, which the need for a professional dispatcher, as The “delivery truck” version was a gives dispatchers the ability to maintain opposed to somebody who can just talk on 1982 Chevy Stepvan-20, which has since communications during a large-scale emer- a radio, is encouraging incident communi- been replaced. The current unit, a specially gency. They are equipped with 11 multi- cations unit leaders and agencies to call for designed, 30-foot recreational vehicle built channel mobile radios, dozens of portable certifi ed/qualifi ed incident dispatchers to by Winnebago’s commercial division, has radios, a dispatching and paging console, cel- staff their comm. units,” he said. all the amenities of the county’s permanent lular and satellite phones, maps, a television dispatch center and it’s used for much of to keep up with news and weather reports, Stabler agrees the same reasons as its predecessor. and basic offi ce equipment. The vehicle’s “IDT will spread,” he said. “In a bad “The dispatch pressure from a large power comes from a large generator. burn year like this one, you need someone event could cripple a center,” Swetlik said. Steve Bahneman, St. Croix County’s there around the clock. Dispatchers from “The mobile unit takes some of that pres- technical lead communicator, takes care of all over are signing up for training.” J sure off.” the maintenance and design layout.

THE JOURNAL | September/October 2008 35 A major benefi t of having the unit is the Wisconsin averages 21 confi rmed tornado help on multiple levels. It is a mobile com- mobility it provides, allowing dispatchers to touchdowns each year. In 2005, Wisconsin mand unit, a treatment facility with the get into the heart of an emergency or other- had a record 62 tornadoes reported, includ- potential to carry all supplies necessary to wise tense situation. ing 27 that occurred on August 18. respond to a mass casualty incident. A gen- In the late 1980s, for example, the unit erator powering the unit can run on three came in handy when it was deployed to River Falls types of fuel. protect Native Americans over spearfi sh- A community disaster resulted in a “We try to get as much use out of it as ing rights. According to information from fi nancial outpouring to fund the city’s disas- we can,” Rixmann said. the Wisconsin Historical Society, ten- ter relief trailer, according to River Falls, The trailer is called out about two times sions boiled over in 1989 when the United Wis., Ambulance Director Jeff Rixmann. a month, and most of these trips are related States Supreme Court upheld a to the mobile command center lower court decision that gave the function and crowd control. For Ojibwe rights to hunt and fi sh off- example, the trailer is on scene for reservation without regulation by big events like the local River Falls the state of Wisconsin. Confron- Days, a huge celebration held each tations between the Ojibwe and year in July, and for football training anti-spearfi shing protesters became camps and other activities. increasingly violent, and places The treatment facility function where the Ojibwe launched their comes in handy at the same events. boats became prime targets for There are two cots paramedics and many of the attacks. EMTs use to administer medical help That’s when the mobile com- as well as medical supplies, a defi bril- mand unit started making its mark, lator, and enough oxygen bottles to explained Swetlik, who has been keep 20 people breathing. It can also with the county since 1988. serve as a rehab center for fi refi ghters “We’d take the van to different reporting to intense fires including counties to keep the Native Amer- multiple structure scenes. icans safe,” he said. “The extra The 20-foot Haulmark trailer, presence curbed the attacks and similar to the type used for haul- the spearfishing could continue ing racing cars, has room enough to without incidence.” serve as a temporary tactical head- Spearfishing is still allowed, but the “We threw it out there and told it like it quarters for SWAT teams and as a mini- controversy has since died down. Now it’s was,” Rixmann said. “We did not have the police headquarters for offi cers responding more likely to see the mobile command capability of responding to a crisis of any to any major situation. The space accom- center deployed in support of SWAT call- magnitude. The money poured in.” modates two dispatch stations, and a third outs, special events, or large-scale emer- The crisis prompting the fall 2001 is in the planning stages. gencies such as the F-2 tornado that ripped purchase of the disaster relief trailer was Rixmann said the mobile dispatch sta- through the city of Hammond in 2005 and the straight-line winds that did heavy tion has almost the same amenities as the the tornado that knocked the power out in damage to buildings on the University of permanent communications center, with the city of New Richmond in 2007 during Wisconsin-River Falls campus. No one was a few exceptions such as the lack of data- a particularly heavy mining capabili- tornado season. “The dispatch pressure from a large ties for tagging Both times, the license plates. mobile command event could cripple a center. The “But if we unit parked in a need that, local centralized safe area mobile unit takes some of that law enforcement doubled as a dis- has their laptops,” patch center and as pressure off.” Casey Swetlik he said. “Basi- a headquarters for cally, the trailer firefighters. Once provides a scaled- again, the goal was safety. The fi refi ghters killed, but the destruction showed the city down version of dispatch to provide us with went door-to-door checking residences for needed a better way to respond rather than exactly what we need.” damages and gas leaks. solely from the indoors of the communica- Rixmann doesn’t hesitate when asked if Swetlik said mobile command units are tions center. the disaster relief trailer was worth the cost. not uncommon in the state, and a major The fully equipped emergency com- “Defi nitely,” he said. “There’s no doubt rationale is the number of tornadoes that munications and supply trailer, purchased it prepares emergency services in River Falls touchdown in the state each year. Accord- mostly through community donations and to better respond to any disaster that comes ing to National Weather Service statistics, some state and federal funding, provides our way.” J

36 THE JOURNAL | emergencydispatch.org Dispatch on Wheels. Metro Nashville ECC responds in a bus built for emergencies

It’s not unusual for dispatchers from major event might require a dedicated dis- police, and medical incidents ECC FIRST the Metro Nashville Offi ce of Emergency patch team. dispatchers handle. Communications Center (ECC) to arrive at “We have full access to whatever we There are seven workstations with pro- a police or fi re situation ready to take their need,” said Mark Hutchison, a FIRST team grammable 800 MHz radios, cell phones, place in the Metro mobile emergency opera- member of the Metro Nashville ECC and a laptop connections, and electronic devices tions center (EOC-2). fi re instructor for the National Academies that hold business contact information. The EOC-2, which can also be found of Emergency Dispatch® (NAED). “If it can There is a Doppler radar onboard, as well at large spectator events like Titan foot- be done at the center, it can be done here.” as satellite television (for keeping up with ball games, is the location of choice for the The bus is actually under the jurisdic- the local and national news reporting sur- center’s Field Incident Response Situation tion of the Emergency Operations Center rounding a particular event), a VCR, video Team, or FIRST. The team of dispatchers (EOC) of the Mayor’s Offi ce of Emergency cam, portable radio battery chargers, and a and incident supervisors takes their seats in Management (OEM). The EOC is the pri- conference room. the rough and ready mobile control center mary center for coordinating resources at The people working inside the bus, that was retrieved several years ago from a major disasters (severe weather, terrorism whether they are from the ECC or another city salvage yard. alerts, and other developing situations) Metro public safety department, are even The EOC-2 is the best way to go when so its bus features everything found in a more impressive. it comes to face-to-face contact, either for disaster-ready communications center. The The Metro Nashville FIRST dispatch emergency purposes or anytime when a bus is also well-suited for all the major fi re, team is trained in the Federal Emergency

THE JOURNAL | September/October 2008 37 Management Agency’s (FEMA) Incident the Metro Nashville area and even for inci- great source for relieving their stress.” Command System and the National Inci- dents that cross county and state borders. Their response to Macon County may dent Management System (NIMS). Since They have responded to dispatch during result in a state initiative for a Telecom- their operations are extending into tacti- major apartment fires, in search of miss- municator Emergency Response Taskforce cal response, they (TERT). States are eligible to receive involved with training to learn nego- “We have full access to whatever we TERT train teams tiating skills when of 9-1-1 dispatch- assigned to SWAT call- need. If it can be done at the center, ers and calltakers outs. Each member that can be mobi- documents informa- it can be done here.” Mark Hutchison lized quickly and tion, keeps a running deployed to assist log of the events that communications occur during a particular situation, and ing children, and recently they turned up centers during disasters. At least 20 states runs the radio. in neighboring Macon County, northeast either have a TERT program in place or are of Nashville, following a tornado in the in the planning phase. Where it started first state-approved assistance incident. Hutchison said the state TERT initiative The event that gave rise to incident According to news reports, the is a goal along with educating the public and deployment happened four years ago when county suffered the heaviest public offi cials about what their emergency an 18-wheeler overturned on a main thor- death toll from the doz- offi ces can do for people in Tennessee. oughfare in downtown ens of tornadoes that tore “There is so much potential and now it’s Nashville, subsequently across five southern just a matter of showing people what we creating a logistics states—Tennessee, can do given the right resources,” he said. nightmare for public Kentucky, Missis- The Metro Nashville ECC is the PSAP services. The traf- sippi, Alabama, for Davidson County, which has a popu- fi c snarl from the and Arkan- lation of nearly 610,000 people residing accident made it sas—on in a 526 square mile area. It is a consoli- close to impossible Feb. 5, dated center providing police, fire, and for emergency 2008. medical response to 9-1-1 callers. Accord- vehicles to reach ing to information available on its Web the scene of site recordkeeping and statistical report the truck have shown that the 9-1-1 calls are being accident, not answered a full eight seconds faster than to mention before. The compliance levels for emer- the other gency medical dispatch have risen to just emergencies over 95 percent. The ECC affecting has maintained the citizens standard acquired in the by NFD Com- busy munica- city tions as an that Accred- day. ited Cen- ter of Excel- This was “We lence a perfect storm for went (ACE) introducing incident management, Hutchi- up there to through son said. relieve the the “The event showed us how much bet- dispatchers,” National ter it would be to handle something this big Hutchison said. Acad- from the site,” he said. “There is so much “My thought emies of face-to-face communication involved, and was let’s get them Emergency it just makes it easier to have a dedicated home. As it turned Dispatch. dispatcher on-site.” out, we gave them The error rate Since then, they have used the FIRST much needed breaks and for the ECC is group many times for emergencies within talked to them. We were a below 1 percent. J

38 THE JOURNAL | emergencydispatch.org J TRIPLE PROTOCOL J QUALITY IMPROVEMENT J MAKING CHANGES J FREQUENTLY ASKED QUESTIONS BestPractices

J TRIPLEPROTOCOL Only Way To Go. Uniﬁ ed Communications Center in Washington, D.C., adds police and ﬁ re protocols to enhance response to massive call volume

It’s clearly an understatement to say violence in April 2008 had the dispatchers fi ed Communications (OUC), expect the Washington, D.C., is a unique city when it and calltakers who work out of the Unifi ed increase in call volume. Unfortunately, calls comes to emergency preparations. Not only Communications Center (UCC) located involving violence are probably impossible is it the nation’s capital, which is a tremen- in Anacostia D.C., busier than usual. The to escape for any individual at a center that dous public safety responsibility consid- mood on the streets in April was an indica- receives over a million 9-1-1 calls each year. ering the national security issues, but the tion of hectic days to come during a season In fact, the chance of answering a call in district also serves a vast commuting pub- already on overload due to extended day- response to a murder, rape, multiple-build- lic intent on getting to work everyday and light hours, warmer temperatures, children ing fi re, or robbery is every bit as anticipated tourists visiting the sights many are able to home on break from schools, street festivals, as the demands made by the people who see only once in a lifetime. citizen marches, elections, and the usually place the calls asking for immediate fire, At the level of emergency operations, the high numbers of tourists. police, or medical assistance. summer months always bring an increased “They don’t want us to be asking a lot call volume to the district’s relatively new Asking the questions of questions,” said Universal Call Taker and altogether state-of the-art communi- The dispatchers and calltakers, who (UCT) Erica Morris, who has been han- cations center. For example, the spate of work in the center under the Offi ce of Uni- dling police, fire, and emergency medical

THE JOURNAL | September/October 2008 39 calls in Washington, D.C., for the past 16 “Now we need to focus on the quality By the Millions years. “They can get really irritated with us and integrity of the information of the call,” when we do.” Quintana said. Their experience with caller impatience, and the knowledge that it’s a reaction that State-of-the-art center The Unified Communications Cen- will probably never change, is a major reason The OUC was the office established ter handles more than 3.5 million calls some dispatchers and calltakers in one of in 2004 to provide state-of-the art public a year. It integrates emergency call the nation’s busiest emergency call centers safety services and fi rst-class customer ser- centers for police, fire, rescue, and are resisting the addition of the Fire™ and vices to supporting agencies (see list that emergency responders, with most Police Priority Dispatch Systems™ (FPDS, accompanies story). In addition to the esti- emergency calls being answered in less PPDS) to their long-time use of the Medical mated 1 million 9-1-1 calls answered on than one second. Priority Dispatch System® (MPDS). an annual basis, the center also receives on The dispatchers and calltakers who “I can see the sense of asking the medi- average another 2.5 million calls from the work at the Unified Communications cal questions,” Morris said. “But in police, Mayors’ Citywide Call Center, also known Center provide emergency services for we already know what to ask. The ques- as 3-1-1. 580,000 residents and 2 million visitors tions are second nature and we don’t want The 3-1-1 calls involve city services and to the district plus several government the format [of structured protocol] slowing informational calls along with police reports agencies. The services they provide us down.” that can be taken over the phone. They do include: But it is the structure of the protocol, a not require a response from the police. consistency in the information gathered, and Travis Dupree, special assistant to the • 9-1-1 calls that require response the subsequent response that has prompted director, said police and fi re protocols are a from Police, Fire, and Emergen- the decision to stretch beyond the MPDS, welcome addition to OUC operations and cy Medical Services OUC Director Janice Quintana said. are in line with the center’s cutting-edge • 3-1-1 Mayor’s Citywide Center “The structure takes the judgment out call center technology built to replace an for calls that require city ser- of the questions they need to ask,” she said. aging operations center that was housed in vices, information, and police “It makes their job easier and we know we the basement of a building in downtown reports that can be made over are responding appropriately and with the Washington, D.C. the phone right information for our responders.” “We can guarantee to the public that This is not a matter of answering calls we will be asking the same questions for The 9-1-1 lines are answered so more quickly as they come in, Quintana the same situation every single time,” rapidly, the caller rarely even hears a explained, since, according to statistics, the said Dupree, who started his profession ring tone. The district answers over 96 center has already achieved a formidable as a calltaker in the Mayor’s Call Center percent of emergency calls in under goal of answering 95 percent of calls within (Washington, D.C.). “You’ve followed pro- five seconds, with most calls being fi ve seconds at an average answering speed tocol and handled the situation to the best answered in less than a second. of one second. of your ability.”

Just turned 2 The UCC facility, which opened in August 2006 on 12 acres in southeast Washington, D.C., is home to the OUC and the D.C. Homeland Security and Emer- gency Management Agency (HSEMA). The agencies coordinate the activities of several federal and city agencies and work together out of a bomb-resistant 127,000-square- foot, $116 million facility that took nearly eight years to complete, from blueprints to construction. In the event of a regional emergency, the building has its own power and food/water/air supplies to serve as the regional and control center supporting federal agencies, including the Homeland Defense Department and municipalities in Virginia and Maryland. Calltakers and dispatchers using a uni- ﬁ ed voice and data communications system

Capital Apprehension Universal Call Taker Erica Morris said her 16 years of experience hasn’t convinced her that callers will in high-tech workstations are divided into appreciate the questions she will be asking once the nation’s busiest communications center adds police and ﬁ re protocols to its system. sections, depending on whether they’re

40 THE JOURNAL | emergencydispatch.org answering calls for emergency or city ser- ing Congress (WBC) Craftsmanship Award tocol benefi ts the public calling in since it vices situations. Desks are adjustable to for the construction of the Call Floor ceil- assures them of a more positive experience allow calltakers and dispatchers more free- ing system and the Construction Manage- despite the critical nature of the call. dom of movement to stand and converse ment Association of America (CMAA), “People call in about a situation they during a fi re, police, or medical emergency. National Capitol Chapter, Project Achieve- haven’t encountered before,” he said. “We The airport concourse-style building ment Award for 2006 in the category for get one chance to do it right for the indi- with its huge picture windows offers a projects with construction valued from $50 vidual callers, and I believe we can better comfortable respite from former quarters to $100 million. do that with protocol.” downtown. The interior high walls pro- It’s a remarkably appealing facility. The downside of introducing new provide the perfect stage for the two-story tall But glamour and architectural awards tocols, he said, includes the training that projected video screens that feature news, aside, the primary purpose of a unified will be required and the reluctance on the data, and messages designed to give a pat center remains: more effective answering, part of some of the calltakers and dispatchers to embrace the use of protocol in the “The structure takes the busy urban center. Time for training judgment out of the questions Training is another complicated issue. Since certification in each protocol they need to ask. It makes requires three days in a classroom, inde- pendent of the workweek and overall job their job easier and we know training, the OUC is faced with finding both the extra time to hold the classes and we are responding appropriately the money to pay for the hours outside of the regular workweek. Academy® certifi ca- and with the right information tion is valid for two years unless revoked or suspended and renewal depends upon for our responders.” Janice Quintana accumulating a specific number of credits to meet continuing dispatch education (CDE) requirements. on the back to the people on the phones responding, and providing customer service “We face the same challenges in training and radios. to emergency and city service calls. that any 9-1-1 center does,” Quintana said. The video screens are a feature the dis- This is what Quintana has devoted her “How do you find the time in a 24-hour patchers and calltakers particularly enjoy, career to achieving. Prior to directing OUC, operation that handles emergencies? But said Janie Scruggs, a UCT calltaker for the Quintana served as the operations manager it’s important, so we’ll get it done.” past fi ve years. for the Mayor’s Citywide Call Center that, “We’re in the center for 10-hour shifts during her tenure, handled more than four Challenged to change and it helps to know what’s going on out- million calls. She developed a quality assur- The reluctance of changing the way they side of here and about the incidents we’re ance (QA) program that she brought with answer calls, however, may be the biggest sending response to,” she said. her to the OUC. challenge. It’s like Quintana said. Some peo- The messages broadcast overhead on Kenneth Mallory, operations manager ple don’t like a lot of change in their daily the big screens offer the thanks they sel- for 9-1-1, called the UCC QA program routines. The veterans in police and fire dom hear for their jobs and help dispel any “magnanimous.” Supervisors are required communications are used to a structured bad feelings that may surface from negative to monitor calls and the radio weekly to system although one that is distinct from news coverage: “Thanks for saving lives. A provide coaching and feedback and to make the style of the PDS. fi ve-alarm blaze, the biggest we’ve had in 30 needs assessments for additional training, if Edward Washington, an assistant watch years, and no one was hurt because every- required, based on their fi ndings. commander, agrees. He said some worry the one did a great job.” “That’s quite a task in an agency our change and the challenges of asking ques- To accommodate employee breaks in an size and with the workload expected of our tions could disrupt their service. area with far fewer features than the down- supervisors,” said Mallory, who started his “It’s not that I don’t welcome a chal- town location, the facility also has a food emergency communications career in 1984. lenge but I’m looking at whether the service area, a gymnasium, a visitor/media “But we get it done. For us, it means a better police and fi re protocols will help in a fast- address center, an administrative area, quiet quality of calltaking and dispatching.” paced environment of a big city center like room, and an 11,000-square-foot childcare Mallory fi nds protocol the responsible ours,” he said. “I guess we’ll fi nd out as the development center. way to answer calls. He said the informa- situation unfolds.” tion gathered in the structured format UCC is working to make the full tran- Effective response and quality assurance means the responders will go to the scene sition to fi re and police protocols in fi scal The UCC has won several awards, better prepared to help and with a better year 2009. Stayed tuned to The Journal for including the prestigious Washington Build- sense of scene safety. He also believes pro- a progress report. J

THE JOURNAL | September/October 2008 41 J QUALITYIMPROVEMENT Settling the Score. Quality improvement program is a tie that binds protocol consistency and accuracy

Represents geographic range Compliance to protocol By Audrey Fraizer The EMD-Qs from the geographically The fi rst conference call, made about spread BCAS centers in Vancouver, Vic- two years ago, took more than two hours. toria, and Kamloops talked and decided They listened to the selected call as a group The seven quality improvement (QI) to meet over the phone once a month and reviewed it for compliance to protocol coordinators working out of three pro- to review and score one call, the same from the beginning—Case Entry through vincial communications centers under call, and post the scores for that call on Post-Dispatch Instructions. They looked the British Columbia Ambulance Service a spreadsheet that would be distributed at the spreadsheet, debated their scores, (BCAS) are QI fanatics. They are passion- among the EMD-Qs. They could then and gave reasons for applying the numbers. ate about their jobs and guaranteeing the compare the scores and discuss the differ- By the end of the conference, they hadn’t highest standards of call response for a ences in scoring at each level of the stan- reached a consensus on all the points but combined call volume that reaches nearly 1 million calls each year. The very drive they have for their jobs, “Our goal was to apply the however, drove them into a quandary. The scores from audits of similar calls scoring standards as reviewed by the specialists at the separate centers were inconsistent despite the use homogenously as possible. of the same set of scoring standards issued by the National Academies of Emergency We wanted to gain common Dispatch® (NAED). No one could put a fi nger on the reason. ground in the application of “We didn’t know what was wrong,” said scoring standards without Jeff McNeill, Quality Improvement coordinator for the Lower Mainland Region Com- diluting them.” Jeff McNeill munication Centre in Vancouver. “There was one center functioning better than the others in the use of the MPDS® protocol dards during a conference call scheduled decided to go ahead and schedule the same based on their scores from the audits.” for the same month. The call selection auditing process for the next month. and the subsequent creation of a wav fi le The next call didn’t go any more New concept in review would be rotated among the EMD-Qs and smoothly. They compared, reviewed, and It was 2006 when McNeill recognized the calls selected would be at random. debated, and still couldn’t agree on an that the centers were not uniformly apply- The provincial cross audit would not interpretation of scoring applications that ing the NAED scoring standards, so he affect the dispatchers who had taken the would bring their numbers any closer. subsequently brokered the concept of a calls and provided the emergency or non- “We all had our opinions,” Rigden said. “review the reviewers” teleconference. emergency assistance. This was meant The need for this monthly meeting is as an educational experience that would Bring in the experts obvious from the daily discussions EMD- get the EMD-Qs on the same page in the Someone suggested they call in the Qs now have at their centers, explained application of the scoring standards and, experts and since May they’ve spoken with Kim Rigden, Quality Improvement man- in the long run, assist the EMDs in their NAED call-processing luminaries includ- ager in the Performance Management calltaking process. ing NAED Call Processing Board Chair Division of BCAS. For example, the three “Our goal was to apply the scoring Brian Dale, Call Processing Board Co-chair EMD-Qs in Rigden’s offi ce spend a good standards as homogenously as possible,” Michael Spath, and NAED Academics and portion of their days in a shared offi ce talk- McNeill said. “We wanted to gain com- Standards Associate Brett Patterson. ing about the calls they reviewed among mon ground in the application of scoring That made all the difference. the 500,000 that come into the center standards without diluting them.” “They could cut through and fi nd the annually. When a question comes up, they After all, McNeill explained, the scor- nuggets,” Rigden said. “They could offer call the EMD-Qs at the two other centers ing standards take the EMD-Q to the heart their advice from their own experience and in the BCAS system. of protocol. He describes them as a sort of from the perspective of the Academy.” “We all want to do this well but didn’t screwdriver for improvement. Patterson said it takes someone from out- understand why we were having differ- “They tighten what you are doing,” he side of the EMD-Qs directly involved in the ences in the ways we scored the calls,” said. “This is what I call pure scrutiny at process to help evaluate what’s going right or Rigden said. the EMD-Q level.” wrong based on the scoring standards.

42 THE JOURNAL | emergencydispatch.org “We’re able to sit back and listen,” he said. “And since we work directly with the Cross Audit Scores Academy, we can bring in the thinking behind each of the standards and help others understand the protocol’s rationale.” May 2007 Greater consensus 100.0% The monthly call audit results are now coming within a six-point spread. There is greater consensus in their interpretation 80.0% of the details in the scoring standards and group members pat themselves on the back 60.0% for being the “biggest QI nerds ever.” 61.4% “It’s been a success,” said Gord Con- 57.6% 40.0% 50.4% rad, Quality Improvement coordinator 46.0% 46.2% for BCAS in Vancouver. “This process is 41.6% an auditing of the auditors and we all go 20.0% away with a better understanding of the scoring standards.” 0.0% Conrad said the process challenges the A B C D E F assumptions of EMD-Qs, who can lose their objectivity when applying the scoring standards in isolation of their cross auditing discussions. “It happens,” he said. “You develop a September 2007 method, and that can preclude looking at 100.0% the calls any differently.” Conrad and McNeill said they look 80.0% forward to the monthly conference call. 88.0% 90.0% 85.0% Conrad said he’ll go in on his day off to make the meeting and McNeill has yet to 60.0% 72.0% miss one.

40.0% Not about numbers McNeill said the audits are not about 20.0% the numbers; in fact, he says it’s much more no data no data than comparing individual outcomes. available available “I hate that,” he said. “This is all about 0.0% protocol and decisions that can help A B C D E F improve patient care. The measurement provides for the creation of procedures and guidelines and the front-end delivery of education.” November 2007 100.0% The provincial EMD-Qs are so enthused about the process that they are extending an invitation to be in on a conference call 80.0% and, perhaps, use their model for a similar program at communications centers 60.0% outside British Columbia. For more infor- 61.0% mation, you’re welcome to contact Jeff 57.0% 56.0% 40.0% 55.0% McNeill at [email protected]. 55.0% BCAS employs about 1,100 full-time 20.0% paramedic and dispatch personnel, 2,200 no data part-time staff, and 100 management and available support personnel. The provincial call 0.0% volume is about 1 million calls annually, A B C D E F ranking the BCAS as one of the largest ambulance services in North America. J

THE JOURNAL | September/October 2008 43 J MAKINGCHANGES User-Driven Process. Proposal for Change shows who’s behind the evolution of MPDS

but also because PFCs received from LAS explained that during pregnancy, the By Brett Patterson are almost always accompanied by sup- growing fetus displaces abdominal organs porting data. and can place abnormal pressure on the heart’s major vessels, namely the inferior Often, changes made to the ppolice,,, ﬁ re, Supportingpp g research and documentation vena cava. This added pressurep could slow or medical protocols are fueledeled bbyy user- ThisThis PFC concerneconcernedd tthehe ppositioningositioning blbloodood rereturnturn ttoo ththee submitted Proposals for Changenge (PFCs). ooff an unconscious, pregnant patient. In Take a look at the evolutionution ooff ththee hhisis introductionintroduction,, Heward Medical Priority Dispatchch System (MPDS®). It goes through ann interesting, but sometimes misunderstood, process that incorporates clinical ﬁ eld and dispatch research, expert consensus, and user input to create a medical dispatch standard of care that iss recognized worldwide. Whilee clinical research, interpretedd by special Academy® councilsls that are made up of expertsts in fields such as resuscitationon and obstetrics, drives most ooff the purely clinical standards,ds, in terms of volume, suggestionsons from users provide the major-jor- ity of functional MPDS changes.nges. This article will illustrate tthishis user-driven process by detailingailing a Proposal for Change requestquest received by the Academy fromom an MPDS user.

Multiple case examples PFC 1026 was received inn Janu-Janu- ary 2007 from Andy Hewardd ofof thethe London Ambulance Servicee (LAS). The sheer volume of EMSMS cacallslls received by the LAS (about 3 mimillionllion calls per year) provides multipletiple case examples even with regard too relatively rare occurrences in emergencygency ddis-is- patch that serve as an excellentllent studystudy population for the Academy.y. AdditionAddition-- ally, the LAS, in cooperationon withwith thethe National Health Services (NHS)NHS) ofof tthehe UK, devotes a full-time staffaff to study- ing clinical outcomes fromm a dispatchdispatch perspective in an effort to improve thethe efficiency and effectiveness ooff its service. The call volume and effort iiss vavaluableluable ttoo the Academy not only becauseuse tthehe LAS is able and willing to providee study data,

44 THE JOURNAL | emergencydispatch.orgydispatch.org heart and cause a drop in blood pressure, practices of resuscitation and obstetrics. Protocol experts decide resulting in collapse. Heward provided These councils are made up of subject Armed with this information, and with supporting research material showing experts that work with protocol experts guidance from the obstetric expertise on the Council, the protocol experts of the Council made two specifi c changes for ver- Suggestions from users sion 12 of the MPDS. First, changes were made to the airway panel of the adult CPR provide the majority of sequence by adding the qualifi ed instruction: “(3rd TRIMESTER) Lay her on her functional MPDS changes. left side and wedge a pillow behind her lower back.” From this point on, the pregnant patient is managed in essentially the that this sort of spontaneous hypotension to construct DLS-specific, Pre-Arrival same manner as other patients enabling occurs in about 10 percent of pregnancies. Instructions. These special councils are complete, hands-on airway control, but in He also pointed out that pregnant patients called together when new science emerges a slightly tilted position. To reinforce this who collapse for other reasons might be that needs protocol consideration or when encountered lying on their backs, which a signifi cant number of related PFCs are exacerbates this potentially serious medi- received that need special consideration. Rules cal condition. This PFC from LAS was forwarded to the 1. An unconscious, pregnant patient in her 3rd TRIMESTER should be placed on her Heward went on to explain that the Special Obstetrics Council, along with left side with a pillow or like object MPDS treats all unconscious patients in several other childbirth/delivery PFCs, wedged behind her lower back. Airway the supine (lying down, face up) position. for review in February of this year. and CPR instructions should then be He provided supportive documentation A very important Rule of ccompletedompleted in thisthis position.position. 2. Whe Whenn ccrowningrowning (top(top of baby’baby’ss head is vvisible) to suggest pregnant patients in their third the MPDS states: “The airwayay DULT 8 YRS and/or pushing iiss presenpresent,t, tturnurn ttoo PPAI trimester would be better off on their left of an unconscious patient mustst 2 Check Airway Listen carefully Childbirth–DeliveryChildbirth–Delivery sesequencequence “Check“Che side and that a tilt of even 15 degrees may be constantly maintained.”” .Crowning”Crowning” (F-4)(F-4) sincesince bibirthrth is 2 (Not breathing) IMMINEIMMINENTLay NT. be sufficient to relieve pressure on the This is vital for several reasons,s, on the her/him flat on her/his ground3.andP Presentationrese removentation ooff tthehe ccord,ordback, hands,hands, feet,fee vena cava. most notably because patientss (Breathing) any pillows. Layorher/him buttocksbuttocks flat firfirstst (BREECHBREECH) is a ddireire are unable to reject foreignn and remove any on her/his back rd pprehospitalpillowsrehosp.ital emeremergencygency. OftenOften thethe onlyo Logged into Academy database (3 TRIMESTER) matter in the airway, namelyy wedge a pillow cchancehLayanceher fforonor hersusurvivalrviv al ooff ththee babbaby•y is aat the behind her lowerleft back. side and As are all PFCs, once received by vomitus, while unconscious. Kneel next to her/himhhospital.osp andita l. (See(See alalsoso PPAIAI CChildbirth–Deliveryhildbirth–Delivery sequencesequencelook “E“Evaluatevaluate BREECHBREECH” F-20.F-20.)) the Academy, this one was logged into The head-tilt method, which food or vomit in the mouth for . 4. PregnantPregnant ppatientsatients who hhaveave “• ” a database and copies were sent out is performed with the patient • illnessillnes Is there anything Yes a to the Rules Group of the Council of in the supine position, is as intheth thee primarypr mouth?imary complaintcomplaint15 shouldshould be 5 handledhandled on ProtocolProtocoNl 2626 unlessunless thethe Standards. The Medical Council of the preferred dispatch methodod of airway problem concerns vaginal bleeding, Standards is an international, volun- control because it is easily described in labor, MISCARRIAGE, or waters broken. teer body of people with wide ranges the non-visual environment and it liter- MPDS® v12, NAE-std. © 1979–2008 PDC. of clinical and communications center ally forces the bystander to monitor the expertise responsible for the evolu- patient’s airway and breathing status. new instruction, a Rule was created for tion of the MPDS. The Rules Group These important considerations had to Protocol 24 that states: “An unconscious, places an initial rating on incoming be weighed from a risk-benefi t standpoint; pregnant patient in her 3rd TRIMESTER PFCs that helps guide them to the the circulatory risks and airway benefi ts should be placed on her left side with a pil- most effective action. In this case, associated with placing an unconscious, low or like object wedged behind her lower the Rules Group recommended, third-trimester patient on her back, versus back. Airway and CPR instructions should and the Readers of the Council of the circulatory benefi ts and airway risks then be completed in this position.” Standards agreed, that the Acad- associated with turning her on her side. Protocol evolution is essential to emy’s Special Obstetrics Council The difficult task of considering this maintaining the clinical and operational should consider this request. dilemma was made easier because Heward standards of DLS. This process is made included specific references to related possible by the volunteers of the Academy Consideration by special research with his PFC. The research sug- Councils and by the hundreds of Priority councils gested that airways maneuvers, as well Dispatch Systems™ users that take the time The Academy utilizes spe- as CPR, could be effectively performed and effort to submit PFCs that benefi t not cial councils when protocol with the pregnant patient tilted slightly only their own agencies, but thousands of evolution needs to consider to one side. The research also suggested other PDS users and millions of patients specifi c clinical standards. This that such maneuvers could be enhanced worldwide. The Academy would like to practice is particularly impor- if the patient had a stabilizing object specifi cally thank Andy, the LAS, and the tant when dealing with the placed behind her to help maintain NHS for their dedication to improving dis- advanced EMD pre-arrival her position. patch services in the UK and abroad. J

THE JOURNAL | September/October 2008 45 J FREQUENTLYASKEDQUESTIONS

Control Bleeding. What should To the NAED: We met with our physician advisor we do when rules collide? regarding the aspirin protocol. He had these questions: How does this affect calls To the NAED: bleed excessively, and the risk of further in which 1) the patient is an asthmatic who We recently had a call with a compound injury through pressure outweighs the is sensitive to aspirin and having chest pain fracture with severe bleeding. As I was doing benefi t of direct pressure. In reality, such 2) the patient is already on blood thinners? my quality assurance on the call, I noticed injuries are treated with different bleeding Anne Mioduski, EMD Coordinator the calltaker did not go through the Pre- control methods in the fi eld or hospital and Weld County Regional Arrival Instructions (PAIs) for control bleed- such methods are simply not appropriate or Communications ing. I have inquired why and was told that practical in the DLS environment. Greeley, Colo. under one of the tabs dealing with bleeding Unfortunately, because of the clinical control, there is a Direct Pressure Rule and risks and practical limitations of DLS, not Anne: a Bleeding Control Rule. According to the every patient condition can be effectively The Academy’s Council of Standards Direct Pressure Rule, “Direct pressure on treated in the non-visual environment. is made up of physicians from around the the wound should be avoided in the pres- Because of this, and other reasons, the world as well as nurses, paramedics, and ence of visible fractured bone or foreign MPDS® protocols must be developed to communications experts. When additional objects.” The Bleeding Control Rule states, handle the majority of cases safely and clinical expertise is needed, as was the case “Adequate control of almost all bleeding is may not address some rare, complex situ- with the aspirin protocol, other opinions simple if enough pressure is applied to the ations that are best handled by on-scene are sought. We had very strong agreement right place.” personnel. I am forwarding your question between the physicians on the council, exter- When talking with her, she said it looks to Dr. Clawson to see if he has anything nal cardiologists, and hematologists, with like a catch-22 situation. My question: else to add. regard to ASA administration for patients Where should we go with this? Brett A. Patterson over the age of 16 with symptoms of MI. This e-mail has also been courtesy copied NAED® Academics & Standards The only contraindications were age under to my EMS Director, EMS Training Offi cer, 16 (risk of Reye’s syndrome versus unlikely and EMS Medical Director. Ronnie: cardiac event), known aspirin allergy, or Someone help! I completely agree with Brett’s explana- active bleeding. Thanks again, tion. I wish there was a simple answer to The hematologists advised us that aspi- Ronnie D. Barefoot, EMD-Q this issue but, unfortunately, there isn’t. We rin “thins” the blood differently than blood Training Offi cer are generally fortunate that these types of thinners such as Warfarin. In short, blood Pasquotank—Camden—Elizabeth City injuries do not result in the patient bleeding thinners work by suppressing chemical Central Communications Center out, and the trauma involved often causes a clotting factors and aspirin inhibits plate- Elizabeth City, N.C. retraction and refl exive closure of the arter- lets. We have been advised that the ben- ies damaged. efits of taking a single dose of aspirin far Ronnie: I hope this helps somewhat. outweigh any risk associated with taking Your EMD is right in Best regards, Doc aspirin with blood thinners. Additionally, that such a situation patients who take aspirin on a regular basis poses somewhat of a develop a tolerance and will not be harmed dilemma. by taking an additional dose. The DLS Rule con- With regard to sensitivity in asthma cerning direct pressure patients, this only occurs in three to five when visible bone or a percent of asthma patients, and known foreign object is pres- sensitivity is only discovered after a severe ent was added after reaction to aspirin, such as an asthma attack. repeated concerns from Patients with a known sensitivity to aspirin users about EMDs pro- should not take aspirin, as is advised in the viding such instruction, protocol. If the asthma patient is not aware most often when bleed- of any allergy, the single adult dose should be ing was actually minor, given, as the benefi ts associated with aspirin which, potentially, may administration in the presence of MI out- cause additional nerve, weigh the risk of severe, adverse reaction in tissue, or vascular dam- these patients. age, not to mention MPDS® v12 in ProQA®, NAE-std. © 1979–2008 PDC. Please contact me with any additional excessive pain. EMD protocol questions or comments. Generally speaking, Brett A. Patterson open fractures don’t NAED® Academics & Standards J

46 THE JOURNAL | emergencydispatch.org J DISPATCH IN ACTION J DISPATCH FRONTLINE YourSpace

J DISPATCHINACTION Living the Dream. Dispatcher set sights on career while in second grade

which gave him more to talk about when he made his frequent visits to their respective city departments. Lacks said Cannady would come in to observe what they did and—without getting into privacy issues, of course—talk about what was happening in a city that has experienced tremendous population growth over the past several years. Before the city got so large, Cannady would go on community patrols with his friend Richard Rutledge, a police captain who died from cancer several years ago, soon after his retirement from the police The goal to become what he is today Fifteen years later, Cannady is living his department. The police badge Rutledge started when 22-year-old Zachary Cannady childhood dream. The fact that Cannady gave Cannady is one of the dispatcher’s was in the second grade. cannot walk and uses a wheelchair because most prized possessions. Randy Amos, the Albertville, Ala., Police of the paralyzing effects of spina bifida, a That badge, along with the one he Department chief, took an afternoon in neural tube disorder, hasn’t made a speck of received from a former firefighter who 1993 to discuss police work and maybe a difference in his plans. worked for a city in Tennessee, is mounted in few things about the local CrimeStoppers Cannady is a dispatcher for the Albert- shadow boxes hanging at the Cannady home. program to a young audience at a good age ville Police Department, working the The badges on display are the highlight of his to infl uence in the right direction. morning shift five days a week under the public service collectibles that also include Although not at the usual age to make direction of his long-time friend and men- 679 patches from fire, law enforcement, tough decisions beyond what to trade from tor Scott Lacks, the department’s commu- and EMS agencies from places as far away his lunchbox at noon, Cannady was inspired nications supervisor. He says Cannady’s a as Egypt and Queen Island in western Aus- by the words of the then police chief. He model employee. tralia. Cannady catalogs and fi les the patches knew his future means of a livelihood lay in “We’re lucky,” Lacks said. “You certainly in specially marked boxes as they arrive in the public service sector. can’t complain any time you fi nd someone the mail. “I liked what he said about what police who’s so dedicated to what he does.” Cannady fi nds it fortunate that he found did,” Cannady said. “Something clicked.” Not only does Cannady have a passion his professional calling at such an early age. For some hard to put a fi nger on it reason, for the work he does while on the job but he Lacks, who has been in emergency com- he was sold on the profession. also tunes in to what’s going on after hours munications for 16 years, is grateful every- As the years went on, Cannady and with a police scanner he turns off only when thing has worked out so well for everyone Amos became friends and Cannady later he’s ready to call it a day. involved. Modifying the height of the fi le cab- befriended current Police Chief Benny Wom- “The scanner keeps me in the flow of inets in the communications center was the ack. His zeal for public service prompted things,” Cannady said. “It gives me an edge only accommodation Cannady required. regular trips to various public safety agencies on the public.” “I’ve never met anyone quite like Zac,” with the encouragement of his parents and The hand-held model he takes wher- he said. “For years he’s told me this is what grandparents, who would drive him to the ever he goes is a fi xture dating back to high he wanted to do. I am glad we were able to departments after school, over weekends, school. He’s always used it to track the make it happen. He’s someone who’s living and during summer breaks. goings on of police, fi re, and EMS workers, the dream.” J

THE JOURNAL | September/October 2008 47 J DISPATCHINACTION

Change in Venue. tie around the umbilical cord. The Laynes’ Move to newborn son Trevor was wrapped in a blan- communications center from ket and ready along with mom and dad to greet paramedics at the door. hospital doesn’t diminish ability “Dad did a great job,” Jones said. Layne said he didn’t remember the exact to help people in an emergency instructions Jones gave him; after all, he was busy delivering the baby and not taking mental notes for later reference. “You never know what’s going to come “Janet gave me the knowledge about over the other end of the phone,” she said. what do to and I followed through,” he That anticipation fuels her enthusiasm said. “It was not so much the process for dispatch, and the ability to help a father that worried me but hearing the baby cry in the birthing of a baby boy in May satisﬁ es once he was delivered. That’s the part her need to help. I remember.” “This was the last thing he probably The Laynes and Jones received plenty expected,” Jones said about the call she of publicity once their story went live answered during the early morning hours on the air. Things quieted down after a on May 27. “His wife had told him that few days and now life is back to normal, she was ready to go to the hospital but except for having a new baby in the home. knew that they weren’t going to make As Layne said, they had their 15 minutes it. She told him why and that’s when he worth of fame and he’s just glad Jones had called 9-1-1.” the instructions to help him through what According to a local newspaper’s cover- needed to be done. age of the event, Andrew Layne’s wife Dina Jones credits the use of the protocol for was having contractions early that morning, keeping the situation in order. two weeks before her due date. She woke “I can deliver a baby in person, but over her husband shortly before 4 a.m. and told the phone it’s different,” she said. “The him the time had arrived, although, as it protocols were priceless. I was able to see Place Change Janet Jones switched from taking care of soon became apparent, it was coming too what he was going through, from what he emergencies in a hospital to answering emergency calls from the Sarasota County 9-1-1 Communications Center. quickly for a drive to the hospital. said over the phone, and keep him going Layne told Jones, “My wife is pregnant step by step.” A longing to make a change in her life and says she can’t make it to the hospital The best part, she admits, was hearing without giving up the ability to help people and she wants me to call the ambulance.” baby Trevor cry, his way of announcing convinced Janet Jones that switching to a Jones told him she was dispatching an entry into the world. job in dispatch would be a good thing. ambulance and, in the meantime, she would “To me, that meant the baby was safe,” After all, the 43-year-old former para- be asking him some questions. She made she said. “That’s when I started crying. I medic/tech had spent 20 years working in the Sarasota Memorial Hospital (Florida) emergency room and didn’t want to lose the “The protocols were priceless. direct patient care she enjoyed, though she did feel a change in venue was in order. I was able to see what he was “It was time,” said Jones, who moved her public service career to the Sarasota County going through, from what he said 9-1-1 Communications Center two years over the phone, and keep him ago. “I knew dispatch would give me the type of contact I was used to, not hands-on, going step by step.” but direct and immediate all the same.” Jones has no regrets about the decision, and the job is in many ways similar it through Case Entry and when Andrew was so happy for the family. It was a very to what she left behind at the hospital. She made it obvious the baby was on its way, she joyous moment.” still helps patients experiencing cardiac and was ready to give the childbirth Pre-Arrival OB/GYN calls to the Sarasota County respiratory failure, among other medical cri- Instructions (PAIs). 9-1-1 Communications Center are not all ses, and she also gets her share of trauma Jones walked the couple through the that common. Of the 20,000 calls to 9-1-1 common to larger cities and particular to delivery process during the 10 minutes before during the first six months of 2008, only the water sports that attract tourists to the emergency crews arrived, all the way through 166 calls involved assistance for childbirth city off the southwest coast of Florida. the part where Andrew used his shoelace to and related medical issues. J

48 THE JOURNAL | emergencydispatch.org J DISPATCHFRONTLINE Fire Leaves Nothing Behind. Dispatchers pull together to coordinate fi ve-alarm response Robinson said. “That takes the pressure off the main center.” More than 100 fi refi ghters, coordinated by four telecommunicators operating out of the RICU, worked through the day and night before the fi re was extinguished. The building was destroyed, reduced to charred debris. The investigation into the deaths of the two firefighters and cause of the five- alarm fi re lasted for weeks. The City of Salisbury mourned the death of two of its fi refi ghters, Victor Isler, 40, and Justin Moore, 19. Robinson said the outpouring was tremendous. So Salis- bury colleagues could grieve, fire crews from neighboring jurisdictions manned the Salisbury Fire Department the week following the fi re and during a memorial service held for the two men. City police volunteers escorted the out-of-town fi refi ghters to the incidents as they occurred. The telecommunicators remained Rob Robinson didn’t want to take any tiple jurisdictions. Two hours later, shortly involved throughout the fi re and its after- attention away from the fi refi ghters respond- after 9 a.m., fl ames burst through the roof. math. For their work, the entire Rowan ing to an incident that cost two lives, but he A mayday was called and a count following County Telecommunications Department wanted to make sure his telecommunicators the evacuation of fi refi ghters from inside the was honored with the annual 911/Telecom- were noticed for their outstanding work. building showed not all were present. municator of the Year Award at the Rowan “Even though we lost people, and it was The anticipated bad situation happened. County Fire and Rescue Association’s very hard on them, my team did an out- The fi re had spread from the offi ces. Two annual awards banquet in June. Robinson, standing job,” said Robinson, Rowan County City of Salisbury fi refi ghters died, trapped who accepted the award on behalf of his (N.C.) emergency dispatch telecommunica- inside the building while trying to protect 24 full-time and 10 part-time telecommu- tions director. “They did exactly what they the warehouse. nicators the center employs, said the honor are trained to do.” “It was devastating for everyone,” Rob- acknowledges a team he calls incredible. The fi re, which by the day’s end would inson said. “Telecommunicators from other “Their sheer teamwork and dedication kill two fi refi ghters and destroy the family- centers called in to ask if they could help. were amazing,” he said. “We always wish we owned business, was called into the Rowan My team said no. They started the call and could do more to prevent something like County emergency dispatch center on the they wanted to fi nish it.” this from happening, but you lose people early morning of Friday, March 7, 2008. The The mayday call signaled it was time to sometimes. It happens in this business. fi rst call, at 6:57 a.m., was from a passerby send the Rowan Incident Command Unit They did an incredible job at communica- reporting smoke coming from the Salisbury (RICU) to the scene of the blaze. The RICU tions, continuing their work and making Millwork building; the next, a few minutes has four fully functional console positions sure everyone else got out okay.” later, was from workers arriving to their to relieve the call load in the communica- The fi re was Robinson’s second and third jobs. There was a fire inside the building tions center during large-scale incidents. line of duty deaths in a communications and, from what telecommunicators knew It also has five laptop computers; an 800 career spanning 24 years. With fi ve years to about the business, it could develop into a MHz-radio system, with interoperability go until retirement, Robinson hopes the past bad situation. The wood and lacquer used at capabilities on UHF, VHF, and low band; two deaths will be his last from a call made the plant in making laminate cabinets, mold- and personal conveniences for extended to the communications center. ing and other products would be fueling the stays, such as a microwave, coffee maker, “Nothing hits home as strongly as a fi re in a building that has stood in the same and refrigerator. On the road since 2005, radio transmission from a police offi cer or location for more than a century. it’s the pride of the communications center, fi refi ghter or paramedic in trouble,” he said. Rowan County dispatched City of Salis- which operates and maintains the vehicle. “It’s hard losing one of your own, someone bury firefighters and once they arrived, it “The telecommunicators at the scene who you may have been talking to on the was soon evident the fi re would take mul- can handle everything about the situation,” same day or day before.” J

THE JOURNAL | September/October 2008 49 J LASTPAGEFIRST Baby on the Way. Pre-Arrival Instructions help in the safe delivery of the unexpected

and it’s a fi rst for me to attend something like this,” Fox said. “Most of the time we don’t even know the outcome of our calls. We’re very fortunate that Dad wanted to meet us.” Fox said the event drew attention to the life saving—and in this case life giving— aspect of emergency communications. Few people are aware of the good things that can happen when calling 9-1-1 in an emergency and most don’t know about the Medical Pri- ority Dispatch System® (MPDS) protocol they use in response to the police, fi re, and medical calls that come into the center. The birth of baby Grace Le’Rain was MetroSafe’s chance to show-off its work. According to a story in the Courier- Journal (June 29, 2008, by Joseph Gerth), a newspaper published in Louisville, Grace Grace Le’Rain Purvis was the center of Le’Rain decided to make her debut before attention at a recent gathering in the Bon her parents had the chance to make a sec- Air Regional Library on Del Rio Place in ond trip to the hospital. The fi rst trip, two Louisville, Ky. The PAIs were hours earlier that morning on June 7, had The little girl, barely one month old, Hockman and Purvis returning home in wasn’t there for the books and she couldn’t developed anticipation of another six- to seven-hour possibly have known what all the hoopla wait until delivery. was about. Her parents, Domonique Hock- for that exact Things obviously didn’t work out that man and Charles Purvis, however, will be reason: to way. Hockman’s water broke at home in telling the story about why she was there the bathroom. She shouted a sleeping Pur- for years to come. maintain the vis awake. He grabbed some towels, rushed Grace Le’Rain was born before anyone in to help, and wound up calling 9-1-1 expected, at home under the guidance of calm while when he found Hockman on the fl oor of EMD Marty Wagner, who relayed the child- the bathroom. He could see the top of the birth and delivery instructions to Purvis giving and baby’s head. over the telephone. Dad was so grateful for Wagner told the Courier-Journal that Wagner’s help that he asked to meet the dis- practicing Purvis handled the situation like a charm. patcher that night. He was great, said Wagner, who came The request was plain impractical. life-saving to MetroSafe two years ago from a job in “They were on the way to the hospital,” retail sales. “I get people who scream bloody said Sherrie Whitford, quality improve- medical murder because they broke a toenail or ment supervisor of Louisville MetroSafe, something. He was calm and he listened to an emergency communications center that instructions. instructions.” coordinates police, fi re, and EMD services Purvis credited Wagner for guiding in Louisville and surrounding communities. him along and said he was the reason calm “The paramedics were obviously more con- deputy director of Louisville MetroSafe. prevailed at their home that night. cerned about getting mom and baby to the “It was a very rewarding experience.” Wagner took Purvis through the Pre- hospital safely.” Grace Le’Rain met her admirers at the Arrival Instructions (PAIs) for Childbirth- Purvis’ persistence eventually resulted in library looking delightful dressed in a new Delivery (PAI F), and in less than four the event at the library shared by the family blue jumper and a pink hair bow. Fox called minutes Hockman was holding her new and the emergency communications staff. the occasion “really cool” since it’s not often daughter. Grace Le’Rain was there to greet “Everyone had a great opportunity to dispatchers get to meet the people they try EMS crews, wrapped in the soft towels her see the great things that can happen when to assist via phone and radio contact. father had collected once alerted to her someone calls 9-1-1,” said Debbie Fox, “I’ve been in this business for 28 years imminent arrival.

50 THE JOURNAL | emergencydispatch.org A birth over the phone is certainly an The PAIs, similar to the protocol in gen- “Although [the instructions] may seem event to remember, and this is the second eral, have gone through many revisions over rather invasive, there are times that if some- such call Wagner has taken since beginning the years. thing isn’t done very quickly, the mother or his job in dispatch. In the case of childbirth and delivery baby could die,” he said. “We had to do some- Fox and Whitford complimented Wag- (PAI F), the 1990 revision of the MPDS thing. Without them, there wasn’t much ner on the call. gave dispatchers specific instructions to more the dispatcher could do but reassure “I’ve been doing this a long time and can follow when faced with a breech presen- the mother until help arrived at the door.” recognize a good call when it happens,” Fox tation or when the baby arrives with one Other general principles surrounding said. “Marty kept his cool. Dad said he was or more loops of umbilical cord wrapped childbirth are also found in the PAIs. For the one who should get the credit.” around the neck (nuchal cord). The v11.2 example, if the baby has been delivered, The PAIs were developed for that exact revision represented a major change to the caller must dry the baby and keep it reason: to maintain calm while giving and PAI F with the addition of instructions for warm (Purvis had towels ready for Grace practicing life-saving medical instructions. high-risk childbirth complications, includ- La’Rain). If ambulance time is lengthy, the Although there are literally thousands of ing frank breech delivery, footling breech, EMD can also warn people at the scene to cases involving effective telephone-directed arm or hand presentation, shoulder dysto- expect delivery of the placenta within about formal care, the number of times the PAIs cia, ruptured umbilical cord, and amniotic 20 minutes of the baby’s birth. have been used successfully is up to any- sac deliveries. The number of PAI F panels PAIs were developed for good reason. one’s guess. doubled, from 18 to 36. Just ask baby Grace (but give her a few “Globally that’s hard to determine,” Brett Patterson, academics and stan- years). With the MPDS initially developed said Greg Scott, a Priority Dispatch Corp.™ dards associate for the National Academies 30 years ago, through the third edition in (PDC) consultant. “We don’t have a way to of Emergency Dispatch® (NAED), said the 1981 with 29 cards, to version 10 with 32 gather that type of data and we often only instructions derived from the knowledge cards, and on to the current version 12.0 hear of their effectiveness when something base of emergency and non-emergency with 33 cards (there are 34 protocols in really good happens, like in the case of the physicians and nurses help in the high-risk ProQA®), it can be seen as a system that Purvis baby birth.” situations that jeopardize the outcome. keeps on giving. J CONTRIBUTORS

MICHAEL SPATH DAVE BRINTON BRIAN DALE TAMARA HAISLIP BRETT PATTERSON began 9-1-1 dispatching is a firefighter/paramedic is an Academy-certiﬁ ed EMD travels frequently for Priority is an Academics and Stan- more than 16 years ago. He with the Salt Lake City Fire and EFD instructor and a bat- Dispatch Corp.™ in her role dards Associate for the is the senior public safety Department where he’s talion chief over emergency as a trainer for both ProQA® NAED®. His role primarily dispatcher at the Sunnyvale worked since 1994. Brinton medical services at the Salt and AQUA™ emergency dis- involves training, curriculum, Department of Public Safety has been involved in EMS for Lake City Fire Department, an patch software systems. In protocol standards, quality in Sunnyvale, Calif. Spath is nearly 20 years. He is respon- Accredited Center of Excel- the past year, her teaching improvement, and research. a NAED®-certified quality- sible for the Salt Lake City lence. He is also the depart- schedule has put her in the He is a senior EMD instruc- improvement instructor for Fire Department’s medical ment’s safety ofﬁ cer. Dale is classrooms of at least 1,000 tor and a member of the police, fire, and medical quality assurance program a consultant, a member of the dispatchers. NAED College of Fellows, protocols. He co-chairs the and is on the NAED® Curric- NAED® Council of Standards Standards Council, and NAED Call Processing board ulum Board-Medical. Brinton and College of Fellows, and a SOFTWARE SECRETS PAGE 18 Rules Committee. Patterson and is a member of the Q is an instructor for EMD, EFD, frequent speaker at Naviga- became a paramedic in 1981 Standards Task Force. Spath EMD-Q, EFD-Q, and ProQA®. tor. He is also the Academy’s® and began a career in EMS and his wife Tammy own Board of Accreditation Chair. communications in 1987. and operate EDQ911, a qual- FIRE CDE PAGE 12 Prior to accepting a posi- ity management consulting FIRE CDE PAGE 12 tion with the NAED, he spent service. 10 years working in a public utility model EMS system in MEDICAL CDE PAGE 9 Pinellas County, Fla.

MAKING CHANGES PAGE 44

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