Hurts at Home. M.D. Collective. Elephant at Large. Domestic violence Doctors fall in behind Decisions are never strikes all centers dispatch protocol black and white The National Academies of Emergency Dispatch September/October 2009 THEJOURNALJOURNAL OF EMERGENCY DISPATCH

Wind Began to Switch and Dispatchers and Protocol...oh, my!

THE JOURNAL | September/October 2009 1 UPDATED INSIDETHEJOURNAL VERSION September/October 2009 | vol. 11 no. 5

4 | President’s Message 5 | Ask Doc 6 | Dear Reader 7 | Contributors 50 | Retro Space

20 | feature 28 | feature Fellowship and the Spin, Rattle, and Blow. Tornados Protocol. Medical showcase Mother Nature’s awesome directors rally in support of protocol and its benefi ts for power in frightening package of wind, pre-hospital care. rain, and debris. Fire Priority Dispatch System™ v.5 The most advanced Fire Dispatching System. Unleashed. Departments Highlights of v.5 ProQA® & cardsets: OnTrack BestPractices 44 | FAQ. What is the right • Incorporates the National Academies of path for the EMD to take? Emergency Dispatch’s™ newest fi re protocols 8 | Medical CDE. That snap, 38 | Navigator Rewind. You crackle, pop can be deadly can improve low morale at the • Faster dispatch points workplace 11 | Police CDE. Domestic • New Pre-Arrival Instructions YourSpace • New protocols violence is call common to 40 | Service Hotline. Right emergency communications thing isn’t always the easiest • More than 40 new determinant descriptors thing to do 46 | Refl ecting on 30 Years. Dispatch lands its well- 41 | ACE Achievers. East deserved space in EMS fold Midlands Ambulance Service is IndustryInsider world’s fi rst multi-center ACE 47 | The Way We Were. Dispatch careers move ahead 15 | In The News. 43 | The Art of Emergency at rate of technological speed Dispatch. Continuous 800-811-2248 reassurance keeps callers calm www.dispatchfaster.com

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; 7,428,301. 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. Ask the right questions. Get the right answers. Send the right information. 2 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 3 J PRESIDENT’SMESSAGE J ASKDOC Taken by Surprise. leaves MPDS Protocol 36 Pandemic/Epidemic/ an impression not soon forgotten Outbreak (Offi cially Enacted Triage)

Brian Dale and I were heading back to along the southeast side of the Capitol to response matrix (increasing triage). This wouldn’t surprise me if some fl u patients Scott Freitag, NAED President the city, traveling east on our way to the a residential area, called the Avenues, lift- Jeff Clawson, M.D. group of patients should represent about 30 had these symptoms. We will pass this con- downtown fi re station. I was the Salt Lake ing off the ground about a mile west of the to 35 percent of all patients statistically. cern along to the CBRN Committee for its A tornado sweeping through down- City Fire Department (SLCFD) EMS pro- University of Utah campus. Moments later, If the service is trying to identify who expert consideration. town Salt Lake City on Aug. 11, 1999, gram manager and Brian a SLCFD cap- the 9-1-1 calls started. What is the clinical basis for the selection might have symptoms, it should use the SRI Hopefully, the worst has passed for the put the city’s police-fi re communications tain. The weird looking clouds trailing us Police put together incident command of diffi culty breathing, chest pain, headache, Symptom checklist for evaluation of patients time being here in the . It’s late center on high alert with 28 separate area reminded me of the tornado skies I watched centers near the retailer show and a second and sick person as the symptoms triggering based on center policy. This is actually the fi rst winter Down Under. The U.K. has initiated agencies responding to the incident. The as a kid growing up in southern Illinois. But in the Avenues, the area of greatest residen- the initial selection of Protocol 36? device to be used and will generate informa- Protocol 36 countrywide for signifi cant call F2 rated tornado touched ground for 10 still, that was no cause for alarm until rain tial destruction. Brian and I hurried over to In working with the CBRN (Chemical, tion for responders on any suspect patient. pressure on the ambulance services. Round minutes, from 12:45 to 12:55 p.m., killing turned to hail and winds nearly pushed us the retailer show setup no more than a mile Biological, Radiological, Nuclear) Fast Track Protocol 36 is only used once there is a patient 2 will be fought in the fall and winter sea- one person at an outdoor retailer show and off the road. from the NAED offi ces. Committee under the Council of Standards, overload/decreased hospital capacity and tri- sons in the northern hemisphere. injuring more than 80 The damage left these Chief Complaints were considered age must begin (declining response by stages We have included an example of a others. Damages were in the tornado’s four- direct symptom mimics of presenting flu based on the local severity rating of 1 (suffi x hypothetical response plan for a declining estimated at $170 mile path was relatively patients and the most likely to capture the A), 2 (suffi x B), or 3 (suffi x C). response, based on increasing triage, using million. light compared to the majority of cases. It does not attempt to cap- Finally, abdominal pain and syncope the three suffi x levels in this protocol. Saying this was a destruction seen in ture all fl u patients, as Protocol 36 is designed have not been reported as H1N1 symp- Hope this helps clarify. Watching to see surprise is no exag- and other to be used only for initiating a declining toms by the CDC, WHO, etc., although it if pigs can fl y north again... Doc J geration. We don’t states making up Tor- think “tornado” in nado Alley. Homes and Utah when stormy businesses were dam- Hypothetical Response Plan (if Doc ruled the world...) strikes. Tor- aged and a downtown nados are extremely hotel was closed for CODE DETERMINANT DESCRIPTOR LEVEL 1 LEVEL 2 LEVEL 3 rare, so rare in fact several days for repairs. that there are no tor- The greatest devastation nado sirens in the city. occurred in Memory O-1 Flu symptoms only (cough, fever, chills or Flu Health Advisor Flu Health Advisor Self Home The tornado 10 years Grove, a park just out- sweats, sore throat, diarrhea, body aches, Quarantine ago even caught our side the city dedicated headache, etc.) meteorologists off to Utah war veterans. O-2 Chest pain < 35 with multiple Flu Health Advisor Flu Health Advisor Self Home guard. According to a Hundreds of trees were fl u symptoms Quarantine story in The Salt Lake uprooted.

Tribune, Larry Dunn, Path of Destruction Memory Grove, north of downtown Salt Lake City, received the brunt of the tornado’s force. The lunch hour sur- then the science oper- prise twister taught us a A-1 Chest pain > 35 with multiple Flu Health Advisor Flu Health Advisor Self Home ations offi cer for the weather service, knew Our closest cover was the parking garage few lessons. fl u symptoms Quarantine “something special” was heading our way. at the NAED offi ces. I tore up the four levels, Every responder had the best of inten- A-2 Chest pain < 35 with single fl u symptom Flu Health Advisor Flu Health Advisor Self Home But a tornado packing wind speeds of more screeching the car to a halt one fl oor below tions, though actions were not as coor- Quarantine than 115 miles per hour? No way. the top. Brian and I jumped out of the car dinated as we might have liked. Multiple A-3 Abnormal breathing with multiple Flu Health Advisor Flu Health Advisor Flu Heath Advisor People living in Salt Lake City at the and in a scene that I’ll never forget, we took command centers established by respond- fl u symptoms time can tell you exactly what they were turns running from our hiding spot behind ing agencies brought out our biggest prob- doing when the tornado hit. They’ll still a concrete post to see the full view of “that lem. As outside resources arrived to assist, talk about it for another decade, passing thing” churning up the city’s main street responders were on different frequencies, C-1 Chest pain >35 with single fl u symptom ALS COLD BLS Amb COLD Flu Health Advisor their stories onto grandkids. Larry Latimer, toward the state’s Capitol Building. We were making it diffi cult for them to communi- C-2 Abnormal breathing with single fl u ALS HOT ALS HOT BLS Amb HOT NAED director of curriculum design, was spellbound. We could feel the air pressure cate. Responders separated by only a few symptom or Asthma taking an afternoon stroll that put him building up in our lungs. We could hear trees blocks were acting in parallel. We now have at the center of things. Kris Berg, NAED ripping out by their roots and slamming onto a new radio system and a command system communications director, stood in awe the ground. I don’t remember the sound of structured to better meet the demands of D-1 INEFFECTIVE BREATHING with 1st Resp + ALS HOT ALS HOT 1st Responders HOT at her office window watching orange voices, only car horns and wind. major emergencies. We still don’t have tor- fl u symptoms sparks fl ying from the sub-station explo- Cory Lyman, who was then in charge of nado sirens and probably never will. D-2 Not alert with fl u symptoms 1st Resp + ALS HOT ALS HOT 1st Responders HOT sion two blocks away. Others will tell you communications, was on the ninth fl oor of Brian and I will never forget that day, and D-3 DIFFICULTY SPEAKING BETWEEN BREATHS 1st Resp + ALS HOT ALS HOT ALS HOT about pulling over to the side of the road the downtown operations center, tracking the same goes for hundreds of others in the with fl u symptoms and listening to the sound of the one-inch the tornado from a room packed with peo- Salt Lake Valley. If we’re lucky, the tornado diameter size hail bouncing off the sides ple watching the funnel cloud continuing in 10 years ago will be the same one we’re still D-4 CHANGING COLOR with fl u symptoms 1st Resp + ALS HOT ALS HOT ALS HOT of their SUVs. a northeast direction. He watched it swerve talking about in another 10 years. J

4 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 5 J DEARREADER THEJOURNAL CONTRIBUTORS OF EMERGENCY DISPATCH

Call it NATIONAL NAED JOURNAL STAFF ACADEMIES OF COMMUNICATIONS/CREATIVE DIRECTOR Serendipity 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 BRYON SCHULTZ Cynthia Harmon GREG SPENCER JACI FOX Audrey Fraizer, Managing Editor Benjamin H. Rose Bryon Schultz, NREMT-P, EMD-I, INTERNATIONAL GRAPHIC DESIGNER ACADEMIES OF Jess Cook Greg Spencer is the dispatch educa- Jaci Fox has spent 10 years as a has served as the communications EMERGENCY DISPATCH Marialice Jones tion adviser for the NAED. He is also police calltaker and seven years AUSTRALASIA OFFICE Mishael Ulibarri quality improvement supervisor for Lee Workman Perhaps you can blame Rich the office after spending 10 011-61-3-9806-1772 an instructional designer and techni- as a police dispatcher. She is EMD, EMSA since 1999. He is responsible GERMAN OFFICE WEB DESIGNER Saalsaa’s case of the swine flu days quarantined at home. “I 011-43-5337-66248 Erwin Bernales cal writer for Priority Dispatch Corp, EFD, and EPD certifi ed. She is also a for measuring performance, conduct- ITALIAN OFFICE where he is the primary author of the certifi ed quality assurance specialist. ing call audits, providing instruction, (H1N1) on chance, a mere twist had been traveling to a lot of 011-39-011-513-2588 EMD Advancement Series lessons. Jaci serves as the co-chairperson of of fate considering the amount countries on business, spending CANADA OFFICE ACADEMY STAFF and other quality improvement and of time he spends cooped up a lot of time with lots of people 1-514-910-1301 PRESIDENT MEDICAL CDE PAGE 8 the Police Council of Standards for training activities relating to EMSA’s Scott Freitag U.K./EUROPE OFFICE the IAED and as the quality assur- in airplanes. Or maybe, the real holed up on airplanes.” 011-44-0-117-934-9732 ASSOCIATE DIRECTORS-USA Tulsa and commu- Carlynn Page ance coordinator for Medicine Hat nications centers. He is a veteran problem has surfaced: Saalsaa A sore throat was Saalsaa’s Ross Rutschman puts too much of himself into first sign of trouble. From BOARDS & COUNCILS ASSOCIATE DIRECTOR-U.K. Regional 9-1-1 Communications in regional EMD instructor and became ACCREDITATION BOARD CHAIR Beverley Logan Brian Dale Alberta, Canada. an EMD-Q instructor in 2005. Bryon the job. there it was a fever he noticed ASSOCIATE DIRECTOR-AUSTRALASIA The former California- at the office while working ALLIANCE BOARD CHAIR Peter Hamilton POLICE CDE PAGE 11 joined EMSA in 1993, working as a Keith Griffi ths ACADEMICS & STANDARDS ASSOCIATE based firefighter and para- among a skeletal staff during CERTIFICATION BOARD CHAIR Brett A. Patterson paramedic, dispatcher, communica- Jeff Clawson, MD medic joined Priority Dispatch the Utah-specific July 24th DIRECTOR OF CURRICULUM DESIGNER tions training offi cer, and communi- CURRICULUM COUNCIL CHAIRS Larry E. Latimer, M. Ed. Corp.(PDC) 20 years ago holiday (commemorating the Vicki Maguire (Medical/EMD Board) cations supervisor. Mike Thompson (Fire/EFD Board) DIRECTOR OF EUROPEAN OPERATIONS when it was known as Medi- arrival of Mormon pioneers Bill Kinch (Police/EPD Board) Tudy Benson FEATURE PAGE 31 Susi Marsan (ETC) INTERNATIONAL LIAISON cal Priority Consultants Inc. to the Salt Lake Valley on July RESEARCH COUNCIL CHAIRS Amelia Clawson Brett A. Patterson, Medical/EMD MEMBERSHIP SERVICES MANAGER He moved from Sacramento 24, 1847). His physician gave Mike Thompson, Fire/EFD Arabella VanBeuge (which averages 16 days below a diagnosis of influenza, later STANDARDS COUNCIL CHAIRS Marie Leroux, Vicki Maguire (Medical/EMD) freezing) to Salt Lake City confirmed through a culture Gary Galasso (Fire/EFD) (with an average of 122 days as the H1N1 virus. He prom- Eric Parry, Jaci Fox (Police/EPD) below freezing) for the chal- ised the doctor he would stay COLLEGE OF FELLOWS Thera Bradshaw (CA) (Emeritus) lenge to automate the medical indoors, away from the rest Geoff Cady (CA) CHAIR Steven M. Carlo (NY) priority cardset months prior of the world, for 10 days. His Marc Gay Jeff Clawson, MD (UT) AUSTRALASIA/SOUTH AMERICA Phil Coco (CT) Rex Comerford (IL) to the establishment of the wife was out of town visiting Frank Archer, MD (Australia) Brian Dale (UT) Andrew K. Bacon, MD (Australia) Chip Darius, MA (CT) National Academies of Emer- family at the time. Peter Lockie (New Zealand) Kate Dernocoeur (MI) Silvio Najt, MD (Argentina) ® Norm Dinerman, MD (ME) gency Dispatch (NAED™). He “Neighbors came by drop- Peter Pilon (Australia) Patricia J. Dukes, MICT (HI) JIM AND SHARON LANIER KIMBERLY RIGDEN- BRETT PATTERSON was a fellow in concept before ping off pots of chicken soup,” CANADA James V. Dunford, MD (CA) BRISCALL Drew Burgwin (Br. Columbia) Marc Eckstein, MD (CA) Jim Lanier, ENP, is the division man- Brett Patterson is an Academics and there was an NAED College he said. “They’d ring the door- Nicole Cimon, MD (Québec) Gary Galasso (CA) Claude Desrosiers (Québec) Keith Griffi ths (CA) ager for the Manatee County Emer- Kim Rigden-Briscall is an emergency Standards associate for the NAED™. of Fellows, designing proto- bell and I’d wave at them from Marty Friedberg, MD (Ontario) Jeffrey R. Grunow, MSN (UT) Marie Leroux, RN (Québec) Ed Jetter (OH) gency Communications Center in service consultant with nearly 20 His role primarily involves training, col, implementing protocol, the window.” Paul Morck (Alberta) Alexander Kuehl, MD, MPH (NY)(Emeritus) Wayne Smith, MD (Québec) Jim Lake (MA) years of experience in dispatching. and, basically, serving as pro- There is irony in all of this, Jim Lanier (FL) Florida. He has been involved with curriculum, protocol standards, qual- EUROPE Bill Leonard (AZ) Prior to establishing KRB Consult- tocol’s chief architect during noted Eric Parry, Priority Dis- André Baumann (Germany) Stephen L’Heureux (NH) Public Safety since 1984. Jim is an ity improvement, and research. He is Gianluca Ghiselli, MD (Italy) Vicki A. Maguire (MI) ing, she worked 17 years for the Bernhard Segall, MD (Austria) Sheila Malone (IN) EMD, EFD, ED-Q Instructor, NAED a senior EMD instructor and a mem- two decades of tremendous patch Corp. police consultant. Gernot Vergeiner (Austria) Susi Marsan (GA) College of Fellows member, has British Columbia Ambulance Ser- ber of the NAED College of Fellows, company growth. “The 10 days in quarantine UNITED KINGDOM/IRELAND Robert L. Martin (DC) Trevor Baldwin (England) Dave Massengale (CA) served on various NAED boards, and vice as a dispatch quality improve- Standards Council, and Rules Com- Saalsaa, PDC executive vice allowed him to work on fine- Chris Carney, MD (England) Jim Meeks, PA-C (UT) Michael Delaney (Ireland) Shawna Mistretta (CO) is a regular contributor and board ment manager in the Performance mittee. Patterson became a para- president and Priority Solutions tuning the very Protocol that Louise Ganley (England) Gene Moffi tt (UT) Chris Hartley-Sharpe (England) Jerry L. Overton (VA) member of The Journal. Management Division, a paramedic medic in 1981 and began a career in Inc. chief technology officer, would be used internation- Andy Heward (England) James O. Page, JD (Emeritus,1936–2004) Stuart Ide (England) Rick W. Patrick (PA) Sharon Lanier, RN, a.k.a. “The Con- (1991-2004), and a critical incident EMS communications in 1987. Prior never looked back. He really ally for diagnosing a pandemic Peter Keating (Ireland) Brett A. Patterson (FL) Ray Lunt (England) Paul E. Pepe, MD, MPH (TX) fl ict Queen” is the ombudsman for a stress diffuser. She has been a certi- to accepting a position with the enjoys his work and the area situation.” Andy Newton (England) (Emeritus) Mikel A. Rothenberg, MD (OH) (1954–2006) Gwyn Pritchard (Wales) (Emeritus) Ross Rutschman (OR) (Emeritus) large acute care hospital in Ocala, fi ed ED-Q and EMD since 2006 and a NAED, he spent 10 years working in near downtown Salt Lake City Saalsaa was OK about lit- John D. Scott, MD (England) Doug Smith-Lee (WA) Janette K. Turner (England) Paul Stiegler, MD (WI) Fla. Sharon has a graduate degree presenter at both the Navigator and a public utility model EMS system in where he calls home. But a diag- erally testing his work first- Fred Thorp, MPA (KS) UNITED STATES Carl C. Van Cott (NC) in counseling in addition to mul- EuroNavigator conferences. Pinellas County, Fla. nosis of swine fl u while Saalsaa hand, making sure that the Bill Auchterlonie (KS) Sheila Q. Wheeler, MSN (CA) Bob Bass, MD (MD) Arthur H. Yancey, II, MD, MPH (GA) tiple professional certifi cations and THE ART OF EMERGENCY DISPATCH FAQ PAGE 44 was working behind the scenes symptoms listed actually Christopher W. Bradford (FL) Tina Young (CO) accolades for her work in the area PAGE 43 as chief architect of Protocol 36 matched the illness—at least 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 of dispute resolution and conflict (Pandemic Outbreaks)? That’s this once. services worldwide. 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 strength- management. just crazy. “I’m happy to test drive the fl u ening 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, SERVICE HOTLINE PAGE 40 “I had it coming,” said Saal- protocol but I’m giving the other 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 saa, on the day he returned to protocols a miss,” he said. to dispatch agencies that comply with academy standards. © 2009 NAED. All rights reserved.

6 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 7 J MEDICAL CDE J POLICE CDE

formers. Electricity can be transmitted over trical activity, especially when skin is wet or personality changes, amnesia, and extreme long distances using high voltage power the patient is immersed in water. fatigue are common problems experienced lines. It can then be transformed to a safer Ventricular fi brillation, commonly called by lightning strike survivors. voltage before it is distributed for consumer V-fib, is the most common cause of sud- Cardiac and respiratory arrest are the use. In North America, standard wall sock- den death from an AC electrical accident. most likely causes of death in lightning OnTrack ets distribute electricity at 110–120 volts. V-fi b is an ineffective heart rhythm caused strike cases. Research shows that a patient’s In Europe and Australia, standard sockets by rapid, uncoordinated contraction of the heart may actually stop twice after being J MEDICALCDE distribute electricity at 220–240 volts. heart’s lower chambers, called ventricles. struck by lightning. The heart initially stops Alternating current is generally three Ironically, an electric shock from a defi bril- as the result of the electric shock. In most times more dangerous than direct current lator is required to correct this condition. cases the heart will start beating again on of the same voltage. Direct current tends to This shock is designed to temporarily stop its own just as it does after a defibrillator cause a single, large muscular contraction the heart, hopefully allowing it to restart on is used. However, lightning strike patients that often throws the patient away from the its own with a normal rhythm. often experience an accompanying respira- electrical source. Alternating current, on In the dispatch environment: “All elec- tory arrest that typically lasts much longer. the other hand, can generate a continuous trocution and lightning strike patients are Because the patient is not breathing, the muscle contraction, effectively “freezing” assumed to be in cardiac arrest until effec- heart quickly uses up the available oxygen the patient’s hand to the electrical source. tive breathing is physically verifi ed. [For this supply and stops beating again. Immediate reason, you should] stay on the line with the ventilation support may, therefore, improve How does electricity cause injury? caller until breathing can be safely verifi ed” the outcome in these cases. For this reason: Almost everyone has experienced (MPDS Protocol 15, Rule 1). “If cardiac arrest in an unconscious light- a minor electrical shock at one time or Electrical shocks can cause a wide range ning strike patient is confirmed, the CPR another. Minor shocks are usually more of medical problems including: burns, Ventilations 1st pathway should be selected startling than dangerous. However, even numbness, paralysis, muscle pain, bone for care” (MPDS Protocol 15, Rule 2). Electrocution and Lightning. That snap, low voltage, low amperage electricity can fractures, vision problems, hearing prob- It is important to recognize that lightning be dangerous under certain conditions. lems, headache, seizures, brain damage, poses significant scene safety concerns for crackle, pop can be deadly The severity of an electrical injury depends amnesia, nerve damage, kidney damage, car- bystanders and responders. The old myth that on a number of factors including: voltage, type diac arrhythmias, cardiac arrest, respiratory lightning never strikes the same place twice is number of deaths caused by lightning strikes circuit is capable of doing work such as of current (AC or DC), length of exposure, arrest, unconsciousness, and death. Survi- absolutely untrue. The conditions that caused By Greg Spencer is close to 1,500 annually, which is about 1% lighting your home or powering your com- degree of insulation and grounding, and path- vors often experience long-term, sometimes lightning to strike a specifi c location once are of the total natural and unnatural accidental puter. Electricity, however, is always looking way taken through the body. In general, high disabling, effects from an electrical injury. the same conditions that may cause lightning The ability to generate and control elec- deaths in the country (UKE AMPDS™ Proto- for an easy pathway to the ground. Unfor- voltage is more dangerous than low voltage, Electrical shocks can also cause second- to strike the same place again. Lightning can tricity is clearly one of mankind’s greatest col 15, Axiom 5). In Australia and New Zea- tunately, human beings sometimes become and long exposure times are more dangerous ary traumatic injuries. Violent muscle spasms strike 10 miles or more from the storm. Coin- achievements. Imagine life without electric- land, lightning accounts for approximately 13 that easy pathway. The human body is than short exposure times. Alternating cur- can cause bone fractures and other traumatic cidentally, thunder can generally be heard ity. Most of us use it every day to light our deaths per year. about 50 to 70 percent water, making it an rent is typically more dangerous than direct injuries. Additionally, “Electrocutions and from a distance of about 10 miles. This means homes, cook our food, and power the many excellent conductor. When electricity from current of the same voltage because of its lightning strikes occurring above the ground that when you hear thunder, you are already conveniences of modern life. Medical prac- What is electricity? an electric circuit travels through a person tendency to “freeze” the patient to the elec- may result in signifi cant falls, causing injuries in danger of a lightning strike. titioners rely on electricity-powered tech- Electricity can be defi ned as energy result- to reach the ground, the results can be dev- trical source, thereby increasing the length of that may be more serious than those incurred The safest place to be during a thunder- nology to diagnose illnesses and save lives. ing from the fl ow of electrons through a mate- astating and even deadly. exposure. Alternating current may also cause from the electrocution or lightning. Answer- storm is inside a substantial building or inside Unfortunately, when uncontrolled, elec- rial. Many materials such as wood, rubber, An electric circuit can contain direct or continuous contraction of the muscles used ing all Key Questions should ensure this is not a fully-enclosed, metal-topped vehicle. Open tricity can be deadly. In the United States, ceramic, and air contain tightly bound electrons alternating current. Direct current, often for breathing, making it impossible for the overlooked” (MPDS Protocol 15, Axiom 2). garages, covered patios, picnic pavilions, golf electrical injuries suffered in industrial that do not move easily. These materials, called referred to as DC, always fl ows in one direc- patient to breathe effectively. shelters, and tents provide protection against accidents and related incidents result in insulators, tend to restrict the fl ow of electric- tion. Batteries produce direct current. Elec- Electrical injuries, especially those caused How does lightning cause injury? the rain, but provide no protection against approximately 1,000 deaths every year. In ity. Other materials such as copper, aluminum, trons from a battery always fl ow from the by high-voltage, are often much worse than Lightning is second only to flooding lightning. When struck, substantial buildings comparison, lightning strikes are often unre- iron, and water contain electrons that can eas- negative to the positive terminal. they appear on the surface. An electric cur- as the leading storm-related killer in the with electrical wiring and/or metal plumb- ported or misreported making accurate sta- ily detach from their atoms and move around. The electricity that comes into our rent can cause deep burns and serious internal United States. Lightning is an extremely ing typically transfer current through the tistics diffi cult to achieve; however, estimates These materials, called conductors, allow elec- homes and workplaces from a power plant tissue damage and leave only minor marks on high-voltage, short duration, unidirectional wiring or plumbing to the ground, protect- suggest that lightning accounts for about 200 tricity to fl ow freely. An electrical wire is made is alternating current, often called AC. This the skin, especially in cases of prolonged con- electrical pulse. A bolt of lightning can mea- ing those inside. Fully enclosed vehicles simi- deaths in the United States per year. by surrounding a conductor, such as copper, means that the current periodically reverses tact. In the dispatch environment: “All electri- sure several million volts, but typically lasts larly transfer current through the metal car Worldwide fatalities from lightning strikes with an insulator, such as rubber, to control direction. The frequency at which the cur- cal burns are considered to be worse than they for only a fraction of a millisecond. body to the ground. People seeking shelter vary widely by country and region depending where the electricity should fl ow. rent reverses direction is measured in hertz look externally” (MPDS® Protocol 15, Rule This very short duration makes lightning inside a building or vehicle should stay away on geographic, meteorological, and socioeco- An electrical circuit is a pathway from the (number of cycles per second). In North 5). Remember that “hidden exit wounds and strike injuries quite different from other from hard-wired telephone or radio equip- nomic factors. The average annual number of negative terminal to the positive terminal of America, electricity from a standard wall internal injuries may complicate the patient’s high-voltage electrical injuries. Lightning ment, electrical wires, plumbing fi xtures, or deaths in the United Kingdom is 5, or 0.05 an electrical source. The number of electrons socket alternates direction 60 times a sec- status” (MPDS Protocol 15, Axiom 1). rarely causes substantial burns. Most burns metal components that may conduct electri- per million people. South Africa and India are moving through a circuit is called current, ond or 60 hertz. In Europe, standard sock- Currents that pass through the brain that do occur are caused by rainwater, cal current from a lightning strike. Lightning among the countries with the highest number and is measured in amps. The “force” push- ets alternate at 50 hertz. or heart are generally the most dangerous. sweat, or jewelry that becomes heated, not safety experts recommend that people fi nd of lightning-related deaths. In South Africa, ing electrons through the circuit is called Power companies prefer alternating Even relatively low voltage currents have by the lightning directly. safe shelter as soon as they hear thunder and the average number of lightning-related deaths voltage, and is measured in volts. current because its voltage can be changed the potential to cause cardiac or respiratory Lightning typically affects the brain and remain in that shelter for 30 minutes after is 6.3 per million people. In India, the average When controlled properly, an electric relatively easily using devices called trans- arrest by disrupting the body’s normal elec- nervous system. Long-term brain damage, the last clap of thunder is heard. J

8 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 9 ✄ J POLICECDE 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 “Electrocution and Lightning,” which starts on page 8. copied answer sheet is acceptable, but your answers must be original. Please do not enlarge.) Hurts at Home. Domestic violence Within six weeks, you will receive notifi cation of your score and an explanation of any wrong answers. Once processed, a CDE acknowledgement will be is call common to emergency communications 1. The “force” pushing electrons through the circuit is called: sent to you. (You must answer 8 of the 10 questions a. amps. correctly to receive credit.) b. circuit. Clip and mail your completed answer sheet Vital role c. current. along with the $5 processing fee to: d. voltage. Realizing these facts helps us understand The National Academies of Emergency Dispatch that the police calltaker has an important 139 East South Temple, Suite 200 2. The frequency at which alternating current reverses direction is measured in: role in a domestic violence call. The call- Salt Lake City, UT 84111 USA a. amps. (800) 960-6236 US; (801) 359-6916 Intl. taker is the fi rst link in the call for help. In b. hertz. Attn: CDE Processing essence, there is a zero-minute response c. volts. Please retain your CDE acknowledgement time to the incident. The police calltaker is d. watts. to be submitted to the Academy with your there to gather accurate, specifi c, and timely application when you recertify. 3. Alternating current is typically more dangerous than direct current of the same voltage information and provide direction before because: Name ______the offi cers get there. It is imperative to col- a. it is more likely to travel through the heart. lect the facts in order to accurately classify b. its voltage increases as it enters the body. Organization ______the incident and document the event. More c. it tends to “freeze” the patient to the electrical source, thereby increasing the length of exposure. Address ______importantly, the calltaker needs to respond d. it tends to cause a single large muscular contraction that often throws the patient away in a non-biased and professional, yet empa- from the electrical source. City______St./Prov. ______thetic way. It is common for the violence to be pre-existing. When the victim calls the 4. Surface burns are a good indication of the severity of an electrical injury. Country______ZIP ______fi rst time, this is often not the fi rst time the a. true Academy Cert. # ______b. false violence has occurred. Daytime Phone ( ) ______Domestic violence can be an extremely 5. Ventricular fi brillation is the most common cause of sudden death from an AC electrical dangerous incident for officers to attend. accident. E-mail: ______The propensity for violence exists because a. true Some reports indicate that more than half the situation is charged with emotion. Situ- b. false PRIMARY FUNCTION of all American women will experience ations escalate easily in these calls. As such, ■ By Jaci Fox Public Safety Dispatcher (check all that apply) some form of violence from spouses dur- it is again imperative that the information 6. Lightning rarely causes substantial burns. _____Medical _____Fire _____Police ing marriage.ii that goes out to the patrol unit attending is a. true ■ b. false Paramedic/EMT/Firefi ghter It is a sad reality, but domestic violence Statistics in Canada show that on aver- accurate and specifi c. Often in these calls, ■ Comm. Center Supervisor/Manager is more than a title of a newspaper article. It age, 33 incidents of domestic violence have the calltaker is not only gathering informa- 7. If cardiac arrest in an unconscious lightning strike patient is confi rmed, which CPR pathway ■ Training/QI Coordinator is more than statistics and terminology. It is occurred before the fi rst call or contact is tion, but is also providing calming state- should be followed? ■ Instructor something that we hear and deal with every made with the police. In fact, on average, a ments and safety instructions for the caller. a. Compressions 1st day in the communications center. On aver- Canadian woman will attempt to leave the A recording of the call and the information b. Ventilations 1st ■ Comm. Center Director/Chief age, domestic violence related situations home (on average) seven times before doing obtained may also be required as critical ■ Medical Director 8. Lightning never strikes the same place twice. account for about three to eight percent so successfully, and 80 percent of women in evidence to support the charge of domes- ■ Commercial Vendor/Consultant a. true of a center’s call volume. It shows itself in shelters have never had any police involve- tic assault (and other additional charges) b. false ■ Other the form of physical or mental abuse or vio- ment before.iii and further be needed for court processes. lence, sexual assault, threats, intimidation, Most of the statistics quoted in this Because of all these circumstances, we reit- 9. Thunder can generally be heard for a distance of about ______mile(s). ANSWER SHEET G MEDICAL or stalking complaints. Domestic violence article center around the female being the erate that the calltaker needs to be in con- a. 1 September/October Journal 2009 VOL. 11 NO. 5 (Electrocution and Lightning) is responsible for more injuries to women victim. It has been difficult to locate sta- trol of the call, and his or her competence b. 5 Please mark your answers in the appropriate box below. than any other reason, exceeding injuries tistics regarding male victims of domestic is paramount. c. 10 ❏ ❏ ❏ ❏ d. 20 1. A B C D due to rape, mugging, and traffi c accidents violence, as men are less likely to report 2. ❏ A ❏ B ❏ C ❏ D combined.i This is a frightening fact. domestic violence to the police. Protocol specifi cs 10. Covered patios, picnic pavilions, golf shelters, and tents generally provide adequate Domestic violence is not gender specifi c, Compare the raw numbers. In a seven- Let’s examine the specifi cs in the Police 3. ❏ A ❏ B ❏ C ❏ D protection against lightning. and it does not offer preference by ethnic- year period [2000–2006], 4,588 U.S. sol- Priority Dispatch System™ (PPDS™) call- a. true 4. ❏ A ❏ B ity, social standing, or age. The U.S. Depart- diers [in combat] and police officers [on taking process on Protocol 114, Domestic b. false 5. ❏ A ❏ B ment of Justice statistics in 2007 (Bureau of duty] were killed by hostiles or by accident, Disturbance/Violence. 6. ❏ A ❏ B Justice Statistics) illustrate that females age and more than 8,000 women—nearly twice The protocol defi nes domestic distur- ❏ ❏ 20 to 24 were at the greatest risk of nonfatal as many—were shot, stabbed, strangled, or bance as: Any disturbance where the par- 7. A B intimate partner violence. An intimate part- beaten to death by the intimate males in ties involved are in an intimate, family, or 8. ❏ A ❏ B ner could be considered a current or former their lives. In Canada, compared to the 101 cohabitational relationship (roommates), as 9. ❏ A ❏ B ❏ C ❏ D spouse, girlfriend, or boyfriend. Canadian soldiers and police offi cers killed, defi ned by applicable laws. In order to receive credit for this quiz you must be certifi ed in the specifi c discipline it is designated for. To be considered for CDE credit, this answer sheet must be received no later than 10/31/10. A passing score is worth 1.0 CDE unit toward fulfi llment of the Academy’s CDE requirements. Please ❏ ❏ The FBI reports that a woman is bat- more than 500 women—nearly fi ve times as After getting the address of the emer- mark your responses on the answer sheet located to the right and mail it in with your processing fee to receive credit. Please retain your CDE certifi cate to 10. A B Expires 10/31/10 iv be submitted to the Academy with your application when you recertify. tered every 12 seconds in the United States. many—met the same fate. gency, the phone number the caller is call-

10 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 11 Statistics from the National Coalition Against Domestic Violence (NCADV) CalltakingAdvice

Almost one third example of KQ 6 would be, “Where is your 1 When processing these types of events, use of female homicide victims | son now?” That way, there is no accusation the information that you get from Case Entry reported in police records in the question, and the level of teamwork are killed by an intimate Questions. partner. between the calltaker and caller remains 2| Use the caller’s name often throughout the constant, which helps you process the call call process. When a caller becomes distraught more effi ciently. or distressed, using her name will catch her 4 Don’t judge the caller. Judging the caller is a attention and re-engage interrogation. | One in four serious dispatch danger zone. The victim is calling women will experience 3| If the caller indicates the name or relationship for assistance. Why the victim stays with a violent domestic violence in partner is not for us to judge or understand. her lifetime. to the suspect in Case Entry 4, use that name or noun (husband, wife, son, daughter, or Victims of domestic violence stay in relationships person’s name) instead of the word “suspect/ for numerous reasons, including lack of of domestic violence victims are women. person responsible.” Even though a caller emotional support, limited fi nancial means, guilt, 85% is asking for police assistance, she is still nowhere to turn, personal beliefs, shame, fear of being judged, or fear of the partner.v Some women cases of emotionally engaged with the accused. Most believe that the situation may improve or even domestic violence In 70 to 80 % Calling her husband/son/daughter “the are never reported of intimate partner homicides, no suspect” may sound accusatory, and suddenly change, or they believe violence is a normal part to the police. matter which partner was killed, the cooperative caller becomes defensive of a relationship. Studies show that more than the man physically abused the or disengaged with the calltaker. A more half of the women in domestic violence situations woman before the murder. effective way to handle those questions would stayed because they feared that they could not be to substitute the caller’s information. An support themselves and their children.vi

ing from, and the caller’s name, the next safety. That includes the safety of the caller or “Physical.” It does not offer “Both” as an KQ 5 (“How many people are involved?”) The answer to KQ 11 (“Is there a court It is a sad reality that domestic violence important step is to get a clear answer to and the offi cers. So, the fi rst KQs address option, as a domestic is consistently verbal is important so the correct number of order/restraining order in place?”) is also is so prevalent in our day-to-day opera- Case Entry Question 4, “Tell me exactly weapons. The information gathered is to before it becomes physical. resources are sent in response to the call. valuable to the offi cer. Often, people who tions. But with the use of PPDS Protocol what happened.” If the caller states that she fi nd out whether someone is being injured KQ 3 (“Are you in immediate danger?”) KQs 6, 7, and 8 deal with the suspect’s are on some sort of documentation to 114, Domestic Disturbance/Violence, you is “having a domestic” with her child, that is or whether there is the possibility of injury deals with the caller’s safety. If the caller location, description, and potential mode not be together are found to be breaching will feel confident that you are obtaining certainly not a clear answer. for the offi cers on their arrival to the call. answers “Yes” to this question, now is the of travel. Very specifi c description details those no-contact orders. It is very com- the most accurate information in the most A domestic can be many situations, If the answer to KQ 1 (“Were weapons right time to enter the Caller In Danger are obtained. mon for victims to call police asking to effi cient and resourceful method available from something as simple as having a ver- involved or mentioned?”) is “No,” the call- (CID) Protocol. In some serious domes- KQ 9 (“Are any children present?”) and drop charges. to police calltakers. J bal argument about a TV program to an taker then asks KQ 1a, “Does s/he have tics, you may need to remain in these Pre- KQ 9a (“I need to get each child’s age”) are Lastly, KQ 12 (“Is anyone injured or incident with someone chased around access to any weapons?” If the answer Arrival Instructions (PAIs) for the duration signifi cant pieces of information for a cou- sick?”) and KQ 12a (“How many?”) obtain the house with a machete. If it is not clear to KQ 1 or 1a is “Yes,” the calltaker asks of the call. It is important to note that these ple of reasons. Patrols responding to domes- information that may indicate assistance Sources what is going on at the incident, re-ask “What type?” then “Where are the weap- PAIs in the PPDS can act differently than tics need to know if there are adult children from EMS. i From the New Jersey Division of Criminal Case Entry Question 4 stating, “This is ons now?” the ones in the MPDS®. You may go into at the incident, because children are pro- The interrogation for Protocol 114, Justice—Handling a Domestic Violence very IMPORTANT, tell me exactly what The weapons questions are handled dif- the CID, ensure the safety of the caller, tective of their parents. Adult children can Domestic Disturbance/Violence, is a fre- Call http://www.njpdresources.org/dom- happened.” You will get more information ferently on this Chief Complaint Protocol and return to KQs very quickly. The CID make the arrest or detainment of either par- quently used protocol that a calltaker or violence/dv-dispatcher-stud.pdf about what is transpiring at the scene using compared to other protocols. Inside every instructions are to be used each and every ent or both extremely diffi cult. Additional dispatcher will use many times even during ii From the New Jersey Division of Criminal this technique. It is necessary that you get a residence there are countless items that can time the caller feels in imminent danger resources may be needed to efficiently one shift. Because of the frequency of this Justice—Handling a Domestic Violence good visual picture of what is occurring at be used as a weapon. These may include during the interrogation. deal with the parties on scene. If there are protocol’s use, calltakers and dispatchers Call http://www.njpdresources.org/dom- the scene and relay that information to the kitchen knives, plates, glasses, broom han- However, it is important to note that infants, toddlers, or school-age children, may become complacent when using this violence/dv-dispatcher-stud.pdf units en route. dles, and rolling pins. If the weapons are put you must reach the dispatch point before additional resources like Child and Family protocol, especially when calls are coming iii ARTAMI (The Alberta Threat Assessment away, or not mentioned, the calltaker must entering the CID sequence. It is critical that Protective Services or Victim Services may from the same victims/suspects. Becoming and Management Initiative) Key Questions still determine the location of the weapons you have the police dispatched to the call also be required for assistance. There is also complacent with these situations is a very iv The War on Women: Elly Armour, In the Key Questions (KQs), we will in the house. When the offi cer arrives, sus- before entering these instructions, as there the possibility of a barricade situation when serious dispatch danger zone. Even though Jane Hursham, and Criminal Domestic analyze the logical progression of the inter- pects may try to access those weapons to is no dispatch point in the CIDs. You may there are children involved. incidents may come in regularly from loca- Violence in Canadian Homes (2006) by rogation and provide the reasons for the use in the incident. The offi cers need to be stay in the Caller In Danger Protocol for KQ 10 (“Has anyone involved been tions/victims/suspects, each incident needs Brian Vallée order of the questions and the rationale advised of the location of weapons within many minutes; therefore, the police must using alcohol or drugs?”) provides use- to be dealt with individually, without bias v http://www.surewoman.com/dv/why_ behind wording. the residence. be dispatched fi rst. ful information to the police attending or prejudice. Domestic situations regularly women_stay.html As in all of the other PPDS Chief Com- In the calltaking software ProQA®, KQ KQ 4 (“Is anyone else in immediate the scene. People under the influence of increase in intensity or escalate without vi http://www.surewoman.com/dv/why_ plaint Protocols, the fi rst and most impor- 2 (“Was the disturbance physical or ver- danger?”) deals with the safety of any other drugs and/or alcohol can further compli- warning, so each call for help needs to be women_stay.html tant priority in the call process is scene bal?”) offers only two responses—“Verbal” person(s) on scene. cate the situation. taken seriously.

12 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 13 ✄ CDE Quiz Mail-In Answer Sheet CDE-Quiz ? Police 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 “Hurts at Home,” which starts on page 11. copied answer sheet is acceptable, but your answers must be original. Please do not enlarge.) 1. The protocol’s defi nition of domestic disturbance includes family members and roommates. Within six weeks, you will receive notifi cation of your a) true score and an explanation of any wrong answers. b) false Once processed, a CDE acknowledgement will be sent to you. (You must answer 8 of the 10 questions 2. What percentage of Canadian women have never been involved with police before they went to the correctly to receive credit.) IndustryInsider Women’s Shelter? Clip and mail your completed answer sheet a) 25 percent along with the $5 processing fee to: line, and website resources and print com- and that makes you want to reach out and b) 50 percent The National Academies of Emergency Dispatch munications. The emergency communica- get everyone on the same page.” c) 65 percent 139 East South Temple, Suite 200 tions center coordinates transport to Mayo Weiss said her motivation comes from d) 80 percent Salt Lake City, UT 84111 USA (800) 960-6236 US; (801) 359-6916 Intl. Clinic for employees who become critically the television news she watched about 3. When will the calltaker use the Caller In Danger Protocol during a domestic disturbance Attn: CDE Processing ill or are injured when away from home. Denise, who was dragged from her North interrogation? Please retain your CDE acknowledgement The Mayo Emergency Communications Port (Fla.) home and murdered in January a) if the answer to Key Question 3 is “Yes” to be submitted to the Academy with your ™ b) each and every time the caller feels in danger during the interrogation Center, an NAED Accredited Center of 2008. Her body was found three days later application when you recertify. c) only after the dispatch point in the call Excellence (ACE), dispatches: buried in a shallow grave not far from where d) all of the above Name ______• Gold Cross, advanced life support she lived with her husband Nathan and their two children. Not only was the crime 4. On average, how many incidents of violence occur before the victim calls for help the fi rst time? ground ambulance, from locations in Organization ______horrifi c, but her tragic death also indicates a) 3 Minnesota and western Wisconsin b) 13 Address ______the lack and disparity of training programs c) 33 • Gold Cross Plus, critical-care ground among dispatch agencies. d) none—the victim generally calls on the fi rst act of violence City______St./Prov. ______transport, from base in Mankato, “It doesn’t make sense for centers not to Live Well Dispatchers benefi t from Mayo health promotion. Minn., and Eau Claire, Wis. 5. Men are more likely to report domestic violence than women are. Country______ZIP ______have trained and certifi ed dispatchers, espe- a) true • Mayo One, the emergency medical cially considering the important job they b) false Academy Cert. # ______Mayo Clinic keeps helicopter based in Rochester, Minn.; do,” Weiss said. “Many agencies do [require Daytime Phone ( ) ______employees in good Eau Claire, Wis.; and Mankato, Minn. minimal standards] but it was Denise’s mis- 6. What is a dispatch danger zone that can occur during call processing in a domestic fortune to call one that did not.” disturbance/violence incident? hands of health • Mayo MedAir, the air ambulance that E-mail: ______The Lee family believes Denise might a) judging the caller fl ies worldwide b) staffi ng problems still be alive if local 9-1-1 call centers had PRIMARY FUNCTION c) becoming complacent with these types of calls The Mayo Clinic emergency communi- • Lukes One, an emergency medical properly handled the critical call Denise d) both a and c ■ Public Safety Dispatcher (check all that apply) e) none of the above cations dispatchers really know how to live, helicopter based in Duluth, Minn. placed while in the backseat of her captor’s _____Medical _____Fire _____Police and with a commitment that fl ows from the • Neonatal and pediatric specialty team car and a second call from a driver reporting 7. On average, how many times does the victim attempt to leave the residence before he or she suc- ■ Paramedic/EMT/Firefi ghter top down. transports, as determined by patient a frantic scene she witnessed in a car next to cessfully leaves? ■ Comm. Center Supervisor/Manager At least, that’s the assumption as mem- age/condition, by air and ground. hers on the Florida interstate. a) 1 b) 5 ■ Training/QI Coordinator ber recipients of the Best Employers for “The dispatcher’s job was to pass that c) 7 ■ Instructor Healthy Lifestyles Gold Award at the information along and she didn’t,” said d) 10 recent Leadership Summit sponsored by Schultz, a dispatcher at the same center as ■ Comm. Center Director/Chief Tragedy inspires the National Business Group’s Institute on Weiss. “She was complacent and did not 8. Why are the weapons questions handled differently on this protocol? ■ dispatchers’ voluntary help Medical Director the Costs and Health Effects of Obesity. live up to the reasons why she took the job a) Statistics show that many people are injured in domestic disturbance/violence incidents. ■ b) Weapons are available in every residence. The location of the weapons is a safety issue for Commercial Vendor/Consultant Now in its fi fth year, the award acknowl- in the fi rst place.” responding offi cers. ■ Other edges and rewards employers’ initiative to Safe to say that it takes working within Weiss and Schultz were quick to point c) In many states and provinces, guns are legal to have in residences. d) The abuser may have a criminal record. improve their workers’ health, productivity, a system to understand its fl aws. out that their center is an exception to the ANSWER SHEET ? POLICE and quality of life. Winners are honored in Just ask Nicole Weiss and Heidi Schultz. position they advocate. 9. According to the National Coalition Against Domestic Violence, what ratio of women will experience September/October Journal 2009 VOL. 11 NO. 5 (Hurts at Home) Please mark your answers in the appropriate box below. three categories with the gold going to orga- The two emer- domestic violence in their lifetime? nizations “creating cultural and environmen- gency communica- a) one in four women 1. ❏ A ❏ B b) one in two women tal changes that support employees who are tions professionals c) one in 10 women 2. ❏ A ❏ B ❏ C ❏ D committed to long-term behavior changes.” are major advo- d) one in 25 women 3. ❏ A ❏ B ❏ C ❏ D Mayo Clinic has made the winners’ list cates for the for its LiveWell program for as long as the Denise Amber Lee 10. Why is the police calltaker’s role vital in domestic disturbance calls? 4. ❏ A ❏ B ❏ C ❏ D award’s been around. LiveWell promotes Foundation, which a) Accurate, specifi c, and timely information is essential to responding offi cers. ❏ ❏ b) The calltaker is the fi rst link in the call for help. In essence, there is a zero-minute response time 5. A B health and wellness resources by coordinat- is pushing for fed- to the incident. ❏ ❏ ❏ ❏ ❏ ing existing resources within the LiveWell eral legislation c) The calltaker has access to critical instructions like the Caller In Danger (CID) Protocol. 6. A B C D E infrastructure to an employee’s individual mandating stan- d) both a and c 7. ❏ A ❏ B ❏ C ❏ D e) all of the above health situation. These include onsite pro- dards for dispatch training and certifi cation. “We adhere to standards because it’s a 8. ❏ A ❏ B ❏ C ❏ D grams such as the employee fitness facili- “Being in the profession you understand priority to us,” Weiss said. “I’m here because 9. ❏ A ❏ B ❏ C ❏ D ties, nutrition education, health fairs, the the issue,” said Weiss, supervisor, San Diego Denise’s story connected. Advocating for In order to receive credit for this quiz you must be certifi ed in the specifi c discipline it is designated for. To be considered for CDE credit, this answer sheet must be received no later than 10/31/10. A passing score is worth 1.0 CDE unit toward fulfi llment of the Academy’s CDE requirements. Please ❏ ❏ ❏ ❏ ❏ Employee Assistance Program, the Nicotine County (Calif.) Sheriffs’ Department com- her brings even more meaning to what we mark your responses on the answer sheet located to the right and mail it in with your processing fee to receive credit. Please retain your CDE certifi cate to 10. A B C D E Expires 10/31/10 be submitted to the Academy with your application when you recertify. Dependence Center, a 24-hour nurse help munications center. “You have a fi nger on it already do.”

14 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 15 County breaks ground for Receiving federal funding was like the up to improve emergency management and Durham center achieves Protocol covers high- cal order and the committee went from new center icing on the cake, allowing the county to preparedness with a focus on addressing “Big 3” ranking causes of death there,” said Eric Parry, PDC consultant. expand the planned 12,000 square foot identifi ed defi ciencies and needs. Dr. Jeff Clawson didn’t have the luxury modern dispatch center to include an addi- of user recommendations when he devel- Less than a year after receiving an tional 3,000 square foot EOC. The dedi- The Durham Emergency Communi- Statistics used to list the primary causes oped the original medical cardset fi rst used $899,422 grant for construction from the cated space will include an elected offi cials cations Center (DECC), N.C., achieved a of death in the United States take on an by the Salt Lake City Fire Department Federal Emergency Management Agency’s room with a teleconference monitor, a world’s fi rst distinction with the addition interesting spin when compared to fire, (SLCFD) communications center 30 years (FEMA) Emergency Operations Center media relations room, an operations room of a third major accreditation to its grow- police, and medical protocols. At least a ago. The emergency medical physician sat Grant Program, Deschutes County 9-1-l’s with a media wall featuring fl at screen TVs ing list of honors. DECC learned in early third of the top 15 causes are covered by down and drew up a list of medical com- (Ore.) new facility broke ground in July. and projectors for PowerPoint presenta- August that it had been granted accredita- instructions dispatchers provide every day. plaints based on his experience and the Receiving the award—the first grant tions, and a dorm room with bunks for tion by the Commission on Accreditation According to the statistics, based on coded disease classifications at that time Shawn Pray, Deschutes County 9-1-1 workers to get some rest during an emer- for Law Enforcement Agencies (CALEA). data collected in 2006, heart disease and common to the dispatch process. He placed administrative supervisor and training gency. Deschutes County is also looking The accreditation program required cancer top the list, together accounting the patient complaints into categories coordinator, applied for—came as a sur- into EOC incident command software. DECC to comply with state-of-the-art for almost half of all deaths (1,191,524 (Chief Complaints), adding to each category prise with so many other applicants vying “We definitely have a need for it (the standards in four basic areas: policy and combined total). Not far down the list are the relevant signs and symptoms necessary for a piece of the $14.5 million ultimately grant) so it was pretty exciting that we got procedure, administration, operations, stroke (137,119), accidents (unintentional to deduce the type of assistance required, divided among 22 agencies. it,” Pray said. “It was defi nitely a surprise, a and support services. This latest accredi- injuries) (121,599), influenza (56,326), including pre-hospital care instructions. “Somebody else called (Deschutes’ emer- good surprise.” tation puts DECC as the only center in suicide (33,300), and assault (18,573). “The whole idea was to identify priority gency manager) and said, ‘You lucky dog, you Deschutes County 9-1-1 serves an area the world with three major accreditations Four major mechanisms of injury in symptoms, not disease types or diagnoses,” got it,’” Pray recalled. “It was exciting to hear of 3,000 square miles and a population of to its name, according to James Soukup, 2006—motor vehicle traffic, poisoning, he said. “I wanted something the layperson that because it was pretty competitive.” 170,000. The EOC Grant Program was set- Breaking Ground Grant funds Deschutes’ building plan. DECC director. fi rearm, and fall—account for 74.6 percent could use. Protocol clears the deck to the In addition to the CALEA accredita- of all injury deaths. level of what is happening now.” SCHOLARSHIP tion, DECC is recognized as an Emergency So, where are we going with this? It’s Over time, the system has grown from Medical Dispatch Accredited Center of the connection between the statistics and the original 29 Chief Complaints to 37 (33 Scholarship leads to improvement Excellence (ACE) awarded by the National protocol’s development. The association is in the cardset, 37 with ProQA, and Protocol Academies of Emergency Dispatch® not coincidental. 36 is available online to download). in Mumbai’s ambulance service (NAED™) and the APCO Project 33 Cer- The National Academies of Emergency “They all started from a core modifi ed tifi cation for DECC’s training curriculum Dispatch® (NAED™) doesn’t go to the by frequency and clinical considerations,” gency services and the required Naresh Jain, and Manish Sacheti—and they from the Association of Public-Safety Com- centers responsible for putting this data said Brett Patterson, NAED Academics and thesis project in his chosen area of put together a plan to improve the coun- munications Offi cials-International. together; rather, the Academy goes to the Standards Associate. “We keep evolving.” scholarship prompted a call to the try’s ambulance service. Each contributed communications centers for the data to For those yearning London Ambulance Service (LAS) seed capital in the amount of $100,000 support both the development and revision for more about morbid- to, perhaps, replicate its process in USD. Mangal, who also received a Cheve- of fi re, police, and medical protocols and the ity (disease) and mor- More his native Mumbai. ning Gurukul Scholarship, contributed her associated Pre-Arrival Instructions. While tality (death), the data At The response was positive. Steve expertise in media relations and administra- the statistics relate to the number of deaths, is available through the www.cdc.gov/ Irving, executive officer at LAS, tion, also garnered through a visit to LAS. it’s protocol’s job to provide assistance to Vital Statistics Coop- nchs/fastats/ helped formulate a Memorandum of In 2005, two years after their initial responders (getting them the proper infor- erative Program of the homicide.htm Understanding (MOU) to facilitate investment, the group members launched 10 mation) and the patient (eg., cardiopulmo- Centers for Disease To access the the project. Mather was on his way. Advanced Life Support (ALS) ambulances as nary resuscitation for sudden cardiac arrest) Control and Prevention’s National Center for Health Mather spent hours each week part of their Dial 1298 for Ambulance pro- and allocate the proper resources. (CDC) National Cen- Statistics during a three-month period riding gram in Mumbai. Irving and Russell Smith “It’s very much a user-based process,” ter for Health Statistics Launched Steve Irving and Russell Smith from the London Ambulance Service attend the 2005 kickoff event. in ambulances, learning software from LAS attended the inaugural event. said Jay Dornseif, Priority Dispatch Corp. (NCHS). It is gathered applications and processes used in “[London Ambulance Service’s] sup- (PDC) consultant. “Their suggestions can from death certificates Shaffi Mather, of Mumbai, India, was the LAS control center, and studying train- port for the project with processes, proto- generate new protocols or changes to the completed by funeral directors, attending eager to visit London not for the Tower of ing regimes, protocol, and vehicle design. cols, and training helped us put the project existing ones.” For example, version 5 of physicians, medical examiners, and coroners London or Big Ben but rather to learn what He was introduced to the Medical Prior- together,” Mather said. “The MOU with the Fire Priority Dispatch System™ (FPDS™) and used to monitor and evaluate health a world-class ambulance system provided ity Dispatch System™ (MPDS®) LAS had LAS and the visit by Russell Smith and includes a new protocol addressing bomb status of the United States. in contrast to the service he had at home. implemented in 1999. Steve Irving gave us the foundation of threats and suspicious packages in response He wanted more than an ambulance service “I was fascinated by the effectiveness of credibility when we launched the service to centers needing a set of instructions in picking up the body of the deceased, as was MPDS (protocol) in providing help to indi- in Mumbai in 2005.” light of the anthrax scares. Turn to the Web for grant the most he could expect at the time. viduals in emergencies,” Mather said. “Most On Oct. 8, 2008, Mumbai’s 1298 DECC provides 24-hour, seven-days- The same goes for police protocol. A opportunities Mather studied his options and applied importantly, it helped me understand the Ambulance Access for All launched the a-week 9-1-1 access to citizens and user standards committee composed of law for and received in 2003 the Chevening need for protocols in dealing with emergen- MPDS for use in its network of fully agencies in and around Durham County. enforcement specialists compiled a list of Gurukul Scholarship in Leadership and cies. I wanted to have it in the control room equipped advanced and basic life support Services include emergency and non-emer- incidents based on the predominant types Did you miss the Grants.gov Webinar Excellence—a 12-week advanced leader- from day one but we could not afford it at ambulances. The installation of ProQA® gency requests as well as dispatch for police, of police calls received at communications series broadcast over the Internet in mid- ship program created for India’s future lead- that time.” software at the Mumbai communications fire, EMS, and other city/county support centers as the starting point for the future August? If so, don’t fret. Each program in ers by the London School of Economic and Mather returned to India, gathered four center control room is part of the “Dial agencies. On average, DECC receives 1,000 version of the protocol system. the ongoing series is recorded and made Political Science (LSE). His interest in emer- close friends—Ravi Krishna, Sweta Mangal, 1298 for Ambulance” initiative. J calls every 24 hours. “The call types were put into alphabeti- available to view on Grants.gov, an online

16 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 17 portal for fi nding and applying for all fed- The Department of Health and Human Calm before the storm peak period of August through October. The 1992 eral grant programs. A feature recently Services (HHS) is the managing partner of doesn’t mean quiet Atlantic hurricane season, for example, had a below- added to Grants.gov helps users apply for the cross-agency Grants. times ahead normal number of named storms and hurricanes. grants through the American Recovery gov website, which has The fi rst storm did not form until late August, when and Reinvestment Act (ARRA), the formal information about more More Hurricane Andrew hit southern Florida as a destruc- name of the $787 billion federal stimulus than 1,000 grant pro- At According to the August Atlantic hurri- tive Category 5 storm. program. grams involving all 26 www.grants.gov cane season outlook, emergency dispatchers The NOAA Climate Prediction Center, a divi- The Recovery Act was established to cre- federal grant-making in the hurricane belt may have a season of sion of the (NWS), pre- For opportuni- ate and save jobs, jump-start the economy, agencies. These agencies ties, resources, kicking back in their chairs. dicts a 50 percent probability and build the foundation for long-term award more than $500 upcoming Webi- OK, that’s an exaggeration, although the of a near-normal season, a 40 nars, and links More economic growth. The act includes mea- billion in grant funds National Oceanic and Atmospheric Admin- percent probability of a below- At sures to modernize infrastructure, enhance annually. The Recov- www.whitehouse. istration (NOAA) does expect a near- to normal season, and a 10 percent gov/recovery energy independence, expand educational ery Act featured on the below-normal Atlantic hurricane season as probability of an above-normal www.nhc.noaa. www.recovery. gov/ opportunities, increase access to health homepage of Grants.gov gov the calming effects of El Niño continue to season. Forecasters say there is care, provide tax relief, and protect those directs users to Recov- develop. a 70 percent chance of seven to For the full story, in greatest need. Smaller stimulus-funded ery Act opportunities, The calm start to this hurricane season, 11 named storms, of which three visit the NOAA website events so far approved include the hiring of resources, upcoming however, is not a reliable indicator of the to six could become hurricanes, three new emergency services dispatchers Webinars, and links to www.whitehouse. overall activity for the entire season, which including one to two major hur- in Lynchburg, Va. gov/recovery and www.recovery.gov. began June 1 and reaches its historical ricanes (category 3, 4, or 5). Bird’s Eye View The eyewall surrounding the eye is the most violent part of the hurricane.

PROTOCOL ANNOUNCEMENT ENTER TO WIN FPDS version 5 hot to go AN IPOD TOUCH DURING OUR 30 YEAR PROTOCOL CELEBRATION The existing train protocol has been divided into two protocols depending on the type of incident—derailments/colli- sions or fi res. VISIT THE PDC WEBSITE, take our SHORT In addition, a Pre-Arrival Instruction SURVEY and you’ll automatically be has been added for callers trapped in tun- eligible to win one nels. Locally-defined service calls added to Protocol 53 allow the agency to specify of 30 GREAT the reason for the call, such as killer bee PRIZES. swarms in Texas. “Fire departments needed a better way Winners will be to address these,” said Jay Dornseif, Priority notifi ed on Dispatch Corp. (PDC) fi re protocol consul- NOVEMBER 13 tant. “This allows them to track what kind of service calls they run and how often.” The FPDS, first released in fall 2000, contained 20 complaint types. The proto- col is scripted and designed like the Medi- cal Priority Dispatch System™ (MPDS®) and each complaint type typically features Ready to Roll FPDS version 5 features two new Chief Complaint protocols, bringing the total to 25. a “go now” DELTA response, demanding an immediate response with the right resour- 300 Years 1979 2009 ™ ™ Fire Priority Dispatch System (FPDS ) moving the dispatch points in Key Questions ces for elevator rescue, structure collapse, priority dispatch systems protocols® version 5, scheduled for release in October to a spot earlier in the sequence of interro- or aircraft emergency, to name a few. 30 Years of Meaningful Change 2009, includes several changes addressing gation. The two new protocols bring the In case of an emergency requiring FPDS, safety, clarity, and the ever-changing world FPDS total to 25. the dispatcher immediately goes to the fi re of emergencies and potential disaster. The new Chief Complaint protocol protocol before shunting to the MPDS for Among the added features are two new addressing bomb threats/suspicious packa- injuries that may have occurred. Chief Complaint protocols addressing train ges was designed to cover biological threats Check the Continuing Dispatch Edu- accidents and bomb threats, a rearrangement made through the mail in response to the cation article in the next issue of The www.prioritydispatch.net of safety questions from Case Entry to the distribution of Anthrax bacterium through Journal for a complete look at the latest individual protocols the questions affect, and the postal system that killed fi ve people. release of the fire protocol. J

18 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 19 of trained, certifi ed paramedics providing pre-hospital care was a fairly recent innovation and few were willing to accept the idea of sparing a paramedic because of what could be done over the phone before they arrived. “There were a lot of people who didn’t believe that lives could be saved because of actions taken at the dispatch center,” Dr. Fowler said. “I can’t emphasize enough how strongly I feel that Jeff was right all along. He led the way.” Some of those who did agree make up the most infl uential core of emergency medical physicians supporting protocol’s development and subsequent growth to international application. Most of them are members of the National Association of EMS Physicians (NAEMSP®), an organization that’s been around almost as long the MPDS. “The timing was perfect,” according to Norm Dinerman, M.D., Medical Director of Transport Medicine System in Maine. “Proto- col could give us the kind of reproducible evidence scientists and medical doctors look for in validating their work.” The NAEMSP and protocol came along during what Dr. Fowler Jeff Clawson, M.D., co-founder of the NAED and creator of the Priority Dispatch System calls a “heady time” in emergency medicine. The EMS Systems Act of 1973 focused only on specifi c components of the EMS system but in the 10 years after its passage without a process for integrating the pieces through one federal coordinating agency. 9-1-1 was in its infancy, shackled by telephone service boundaries out of sync with jurisdictional dispatch centers. Calls were being answered in other than the caller’s own community. CPR, defi brillation, and a rapid means to provide pre-hospital care were all in place, but without the management needed to develop local, regional, and state level programs.

collected from base station hospitals in Salt Communications centers outside of his By Audrey Fraizer Lake City showed that the paramedic units home state of Utah were only beginning to What constitutes the arriving at the scene were not always the catch wind of medical dispatch by the early ones closest to the scene. 1980s. For the most part, the idea that dis- dignity of a craft is that it With a little help from my friends. In other words, emergency dispatch was patchers could assist beyond answering calls Things don’t happen in a vacuum. Make nothing new but, at that time in the early and sending resources was all too radical; creates a fellowship, that your own breaks. Seize the bull and grab it 1980s, dispatchers had little to do with just about as extreme as the idea 10 years by the horns. determining or resolving the actual emer- earlier that ambulance “jockeys” could do it binds humans together, Paul Pepe, M.D., medical director, City of Dallas EMS and Dallas Metropolitan You can use any of those clichés and it gency. They answered the phone and con- more than what was called a scoop-and- BioTel EMS System would still apply to the history of the Pri- tacted either the private ambulance services drop at the medical center. and fashions for them a ority Dispatch Corp. (PDC) Systems. The or the fi re departments that were starting Some centers, maybe a handful, were Fire, Police, and Medical Protocols currently to take over some of the EMS operations. using some form of experience-based prior- common language. in use at more than 3,000 communications Similar to short order cooking, response ity dispatching of emergency resources but centers worldwide are there because Jeff was served in the order received. nothing with the sophistication of struc- Clawson, M.D., had an idea, was driven “Patients were suffering and people were tured calltaking and pre-arrival instructions “There was a lot to be done,” said Dr. Fowler, NAEMSP past to make it work, and possessed the good dying because we weren’t doing what was that Dr. Clawson were developing for pre- president (1992-1993). “This was 25 years ago. Pre-hospital care fortune of timing and the support of other appropriate,” Dr. Clawson said. “It was my hospital care. was novel, it was new.” emergency physicians. intent to change the system.” “Jeff brought it to the next level,” said The novelty and the group’s ability to predict the potential of There was no “reinventing the wheel” As fi re surgeon (medical adviser) to the Dr. Paul Pepe, medical director for the pre-hospital care united the physicians, Dr. Dinerman said. “The for Dr. Clawson. Emergency dispatch was Salt Lake City Fire Department in 1976, City of Dallas EMS and Dallas Metro- leaders in emergency medicine stepped forward to move it in the the redheaded stepchild of emergency med- Dr. Clawson was in the position to test his politan BioTel EMS System. “He delved right direction,” he said. “Jeff immediately impressed me. Here was ical services. ideas. He developed a system—the Medical into the area of dispatch life support with this thoughtful and modest physician, an individual who could “Many centers used a single page code Priority Dispatch System™ (MPDS®)—that a creative concept that could be applied refi ne, refocus, and reframe. Meeting him was a seminal event.” sheet,” said Dr. Clawson, who collected the based the ranking of its determinant codes across the board.” There was also a deep interest in collaboration, according to “one-pagers” for his “museum.” A code 99 on statistical clinical probabilities gathered That’s what makes protocol so revo- Joseph L. Ryan, M.D., Medical Director for Regional Emergency given to responders might mean a medical through systematic questioning by the lutionary, according to Ray Fowler, M.D., Medical Services Authority (REMSA) and Care Flight based in emergency requiring resuscitation, while a emergency dispatcher. The level of response FACEP, a physician specializing in Emer- Reno, Nev., and former Medical Director for Santa Clara County code 50 might convey a non-life threatening married to that code was left to the agency gency Medical Services (EMS) in Dallas, EMS in California and the Pinellas County EMS System in Florida. medical emergency. Ambulance run sheets and what works best for the community. Texas. Public and professional acceptance After all, the people stepping forward were primarily clinicians Norm Dinerman, M.D., medical director, Transport Medicine System, Maine

20 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 21 Unlike other physicians in the NAEMSP, Paul Stiegler, M.D, EMD was NAEMSP’s first position medical director for Dane County (Wis.) EMS and NAEMSP paper. In the past 25 years, the NAEMSP POSITION PAPER member, hasn’t know Dr. Clawson since the dawn of dispatch. The membership has published nearly 50 more two crossed paths 10 years ago during Dr. Stiegler’s fi rst NAEMSP position statements; a majority has been EMERGENCY MEDICAL DISPATCH meeting. Dr. Clawson was teaching the medical director’s course updated based on new fi ndings relevant to and Dr. Stiegler fi nished the course wanting to learn more about the subject, although none have been retired. Approved By The NAEMSP his protocol system. Membership is open to paramedics, nurses, Dr. Stiegler took the opportunity to discuss protocol with Dr. administrators, educators, and researchers Board Of Directors Clawson at an EMD class held later in Madison, Wis. They talked dedicated to pre-hospital care through their November 20, 2007 and Dr. Stiegler chose the MPDS over other protocol systems he long-standing support of resources that had reviewed for the EMS center. A friendship developed Dr. “connect, serve, and educate its members.” Stiegler was honored to accept a position on the National Acad- They publish the journal Prehospital Emer- POSITION STATEMENT emies of Emergency Dispatch® (NAED™) Medical Council of Stan- gency Care, hold an annual conference, offer The National Association of EMS Physicians believes that: dards. He is one of few doctors certifi ed as an EMD instructor. leadership courses, and conduct workshops “His work is wonderful,” said Dr. Stiegler, who had been eval- focused on the “how-to” of conducting emer- • Tested knowledge and demonstrated skills in the area of basic telecom- Ray Fowler, M.D., FACEP, physician specializing in Emergency Medical Services (EMS) in uating various protocol systems for use in the county’s commu- gency care research. munications should be requisite for all emergency telecommunicators. Dallas, Texas nications center. “Because of priority dispatch we were able to The founders keep in contact, Further training to the level of emergency medical dispatcher should be reconfi gure our ambulance dispatch. That was a big deal.” although many have stepped down required for all personnel who receive calls for medical assistance and/or The standardization found in protocol is vital to medicine. from NAEMSP board positions. Sev- dispatch those resources. Consistent application allows evidence-based decision making eral participate in the annual NAEMSP • Governments should approve statutes or regulations that require Emergency through data collection and longitudinal study. Patient outcomes National EMS Medical Directors Course Medical Dispatchers (EMDs) to be certified/licensed in accordance with and Practicum, a three-day workshop nationally accepted standards for emergency medical dispatch. that takes place next in Phoenix, Ariz., in 2010. They attend many of the same • The use of formal, medically approved EMD protocols should be required for “Because of priority EMS focus conferences where it’s almost the practice of emergency medical dispatching. In all EMS systems, prioritiza- the norm for one of them to receive an tion of calls to be dispatched should be an essential element. dispatch we were able award in honor of their work to improve • The provision of pre-arrival instructions should be a mandatory function of to reconfi gure our the EMS system. Two years ago, in Sep- every EMD in a center that interrogates callers and prioritizes medical calls. tember 2007, the U.S. Metropolitan EMS Pre-arrival instructions should take into account the dispatch-specific (i.e., ambulance dispatch.” Medical Directors Consortium (The nonvisual, nonpretrained caller) circumstances of providing standard basic Eagles) presented Dr. Clawson with the life support and/or advanced life support procedures and care to callers, prestigious Paul E. Pepe award. At Navi- known as dispatch life support. gator 2009, Dr. Clawson presented Dr. • The “medical service” in EMS begins when a public call is received at a public Paul Stiegler, M.D., can be studied over extended periods and in that way, physicians Pepe with the Academy’s Special Award medical director, Dane County (Wis.) EMS safety answering point or other agency that provides prehospital emergency can develop research evidence of interventions directed at long- of Preeminent Innovator in EMS. care in response to requests for unscheduled medical assistance. All centers term health status. Dr. Clawson and Dr. Pepe fi rst crossed servicing requests for medical assistance should have medical oversight by a trained in specialties vital to advancing the emerging public health “That’s what I found so fascinating when I read about Jeff’s stuff paths 25 years ago at the founding of the physician medical director, with knowledge at least to the level of a certified system; the fi eld was too new for anyone to go forward alone. in JEMS,” Dr. Ryan said. “Jeff applied evidence-based practices to NAEMSP, of which Dr. Pepe was the fi rst EMD, who is responsible for all medical aspects of the EMD program by “We did not have the expertise to practice emergency services the 9-1-1 system.” elected president (1987-1989). They have which these calls are processed. medicine, at least on our own,” said Dr. Ryan, a NAEMSP charter The article, published in February 1981, highlighted the remained good friends and share the same member. “No one did at that time. Getting together was very ben- medical protocol system and its application to lights-and-siren respect for EMS, particularly the dispatch • Quality improvement and risk management activities should include over- efi cial for sharing insights and overall fi nding solutions to the same response and patient transport. At that time, only about 100 profession Dr. Clawson brought to light. sight of call-taker compliance with protocols, including levels of protocol use problems we all were having.” public safety and private agency emergency call centers had Aside from the recognition, Dr. Claw- reliability and consistency. These are essential for effective, safe, and risk- The early NAEMSP position papers were authored by names trained and certified EMDs on staff using what was to become son acknowledges the reaffirmation of averse medical dispatch operations. still familiar to emergency medicine: Dr. Clawson; Dr. Ryan; known as the Medical Priority Dispatch System (MPDS). their work, the knowledge that NAEMSP • EMD medical directors should participate in the design, operation, and data Alexander Kuehl, M.D.; Peter A. Maningas, M.D.; and emergency Despite protocol’s limited use, the article “gave us a sense stayed on the right track, driving EMS into analysis of medical dispatch, and data-based programs for community injury responders including Fred Hurtado and Donald Sharpe. that we could send the right resources” based on a standardized the future. and disease surveillance, wherever these programs are possible to implement. A position paper they and others developed, approved by the approach to gathering information, Dr. Ryan said. “I was also It’s like a portion of a quote inscribed • Investigation of the need for, and the safety and potential effectiveness of, NAEMSP in November 1993, provided “20 sound rationale and intrigued by the potential of lay people to intervene before help on the award Dr. Clawson received at the expanded service options as an alternative to dispatching resources to the corresponding protocols and policies” to apply when determining arrived on the scene.” annual EMS State of the Sciences Con- scene should be a medical director responsibility. a lights-and-siren response and patient transport. A joint position Dr. Clawson had advanced his support of pre-hospital care ference—also known as the Gathering of statement issued in January 1993 by the National Association of and dispatch priority reference systems at an early meeting of the Eagles—two years ago in Irving, Texas: • Research designed to improve EMD should focus on the specific components State EMS Directors and the NAEMSP encouraged the concept NAEMSP, a viewpoint Dr. Fowler helped push through the group’s “What constitutes the dignity of a craft is of the process (e.g., interrogation questions, dispatch prioritization descrip- of comprehensive and integrated EMS system planning and imple- Standards Committee for formal inclusion in their library of emer- that it creates a fellowship, that it binds tors, post-dispatch instructions, pre-arrival instructions, and safety element mentation. Another joint paper, also endorsed by the American gency medicine position statements. The points raised in the state- humans together, and fashions for them a advisories) and/or their relationships. College of Emergency Physicians and approved in January 2005, ment included a recommendation to use a sound dispatch system common language.” supported establishment of a regular full-time position for EMS to establish a patient’s level of severity, which then determines the “That’s how I’ve seen our efforts,” Dr. These positions are revisions of those in the 1989 NAEMSP position paper: Emergency medical director in all states and U.S. territories. type and urgency of response. Clawson said. J medical dispatching. Prehosp Disaster Med. 1989;4(2):163–166. J

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Rethinking Our Stuff Break Out the Salsa! E The 100 Questions of Politics! Yuck or Yay? or Yay? Politics! Yuck T Jim Lanier, Sharon Lanier Jim Lanier, C L Carlynn Page, Scott Freitag, Communications Center Ron Two Bulls, John Ferraro Ron Two Dr. Clawson, Brett Patterson, Dr. Craig Whittington, Eric Parry E Appreciative Supervision A Death—Ask the Doc Live! Tami Wiggins, Melissa Blessing, Tami P When the Chips Are Down— P C C CLOSING LUNCH C

S O OPENING SESSION I ACE PRESENTATION A ACE PRESENTATION D & CCM GRADUATION DISPATCHER OF THE YEAR AWARD DISPATCHER

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26 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 27 Opening windows to equalize air pressure will save a roof, or even a home, from destruction by a tornado. Rip Theoretically, opening windows would stop the interior air pressure from intensifying, preventing total destruction to the house. However, most Roarin’ buildings vent this difference through normal openings in about three seconds, and the over- ornados rank among the most frightening and awesome pow- Tornados have picked up people and items, powering winds of a tornado are not likely to be T ers of Mother Nature, so it only carrying them long distances before setting affected by a thin layer of glass regardless. Better makes sense that protocol would be right them down without injury or harm. to stay away from the windows and seek shelter there with them. People and animals have been transported up to in the lowest central location of the home. “The assignment of resources is critical, a 1/4 mile or more without serious injury. Fragile especially in a severe weather situation,” items, such as sets of fi ne china or glassware, have said Brett Patterson, National Academies of been blown from houses and recovered, miles away, Emergency Dispatch® (NAED™) Academics without any damage. A tornado in Broken Bow, Tornados never strike big cities. and Standards associate. “You have to pri- Okla., carried a motel sign 30 miles and dropped it Some believe that the density of tall buildings is oritize resources, and that’s where protocol in Arkansas. However, given the quantity of airborne enough to deter a tornado. Not so. Big cities are is at its best.” debris, these occurrences are the exception rather hit less often because of their small geographi- Normally, as the following stories indi- than the norm. cal size relative to cities isolated in large plains. cate, the heaviest call volume comes before The probability of a violent tornado in the center and continues after the severe weather Highway overpasses of a big city is about once in a thousand years, moves through an area. It could be sound- are a safe place to unless you live in St. Louis, Mo., which has been ing the tornado siren that pushes people to hit by three intense tornados, the last occur- Tornados, like lightning, never strike twice. shelter if you’re on the phone, calling 9-1-1 to find out if the rence happening in 1927. warning is “for real,” or fear over what may Tell that to Guy, Ark. A church building in the city the road when you see has been hit three times by three separate torna- a tornado coming. be following a sudden downpour of rain. After the storm passes, people want help. dos during three different years. Also, Cordell, Kan., A tornado can drive a Many motorists leave their Victims might be trapped, an electrical experienced a tornado hit every May 20 for three con- straw through a tele- cars to seek cover under hazard may exist, or someone could call to secutive years: 1916, 1917, and 1918. phone pole. overpasses, sometimes report the odor from a potential gas leak. The forces inside a tornado leading to fatal destruction. It doesn’t matter the type of situation are incredible but still poor- In actuality, wind speeds when protocol’s involved, according to Jim ly understood. They are cer- may be higher under an Lanier, Emergency Communications Cen- tainly strong enough to turn overpass and could be ter (ECC) division manager at Manatee otherwise harmless items fi lled with fl ying debris, the County Public Safety in Bradenton, Fla. into deadly missiles. cause of most fatalities in tornados. “The protocol assists by providing the appropriate call processing tools no matter what presents after the tornado passes,” he said. Lanier directs a center all too familiar with disastrous weather conditions. The Deadly Spring Season in Florida, from February through April, is characterized by powerful tornados attributed to the jet

Page 30 Page 32 Page 34 Page 35 Page 36 BY AUDREY FRAIZER HEATHER DARATA Twist and Touch. The Fast Track. Run for Cover. Larry Meets Early Warning. CYNTHIA HARMON F5 tornado takes infamous spot in Thrill of the chase propels storms Tornado touches ground for the Tornado. House lost but son’s alert may have ILLUSTRATED BY Oklahoma history into big business 23 minutes Walk in the park takes a turn saved their lives JESS COOK to the wild side

28 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 29 stream. Manatee County’s subtropical loca- Twist and Touch. F5 tornado takes south then turned north, striking parts driven through her neck and jaw. Room to Blow. tion and long coastline makes the area par- of Tinker Air Force Base as an F4 and “It was big, mean, and ugly,” Eng- ticularly susceptible to the cyclone winds of infamous spot in Oklahoma history fi nally lifting over Midwest City. land said. Tornados are way of tornados, hurricanes, and tropical storms. Once the worst was over, calls for The tornado was the last offi cial F5 Manatee County’s historical area-adjusted he F5 tornado touching down in crete foundations, shredded cars, crushed help fl ooded the EMSA-Oklahoma City to hit the United States as measured life in Oklahoma tornado activity is slightly above Florida’s Oklahoma City, Okla., on May 3, buildings, and carried street signs miles away communications center. Field respond- by the old Fujita (F) scale rating, which state average. It is 2.6 times above the over- T 1999, never went away, at least in from their designated intersections. ers not on duty were called in to help, was designed prior to the introduc- all U.S. average. the minds of those witnessing the devasta- “This thing just kept producing torna- though most had already responded on tion of the pulse-Doppler technique, a By Bryon Schultz In the event of a severe weather warn- tion fi rst hand. dos,” England said. “They were everywhere. their own initiative. Medics traveled to highly specialized form of the Doppler ing, the county’s Comprehensive Emer- KWTV-Oklahoma City Director of No one really anticipated it would be as bad gency Management Plan places the ECC Meteorology Gary England remembers that as it was.” scar Hammerstein knew exactly what he in charge of notifying personnel who have day as if it was yesterday instead of 10 years By the end of the day, the F5 tornado “It was a savage storm. It was a was writing about when he composed a primary emergency response and/or ago. The weather, sunny and humid in the had resulted in the death of approximately O “Oklahoma,” a song that’s not only the recovery tasking. The center maintains and morning, deteriorated by mid-afternoon to 36 people; it’s estimated that 675 were horrifi c thing. It was absolutely state’s anthem but, also, recognition for the state updates notification and alerting proce- a high-risk warning; severe weather, includ- injured, many critically. Some, captivated by with “Plen’y of air and plen’y of room,” a place per- dures, as required. ing the possibility of strong damaging winds, the live video feed, hesitated fi nding shel- unbelievable.” fect for one of nature’s most deadly forces. Lanier cites all three protocols— was blowing their way. ter until the tornado came through despite -Gary England Tornados are common in Oklahoma, and if you MPDS®, PPDS™, and FPDS™—for their Mel Spruill, an Emergency Medical Ser- warnings to seek cover immediately. Nearly work in public safety it doesn’t take long before you severe weather importance. Firefi ghters are vices Authority-Oklahoma City EMD and 8,000 homes and businesses were damaged experience a tornado fi rst hand or fi nd yourself work- first in to assess damages and get people a native Oklahoman, remembers watching or destroyed, with estimates running close smaller areas in the suburbs to provide radar. The EF Scale, operational since ing with someone who has. out, likely followed by police officers to the system coming through. to $1.2 billion. Five deaths, 100 injuries, and mutual aid and triage patients. Feb. 1, 2007, assigns a tornado a “rat- EMSA-Tulsa Shift Lead Melissa Hudson said paying maintain order, direct traffi c, and, later, dis- “You can feel something in the air,” she heavy property damage was reported in the Paramedic Jim Cochrane, now an ing” based on estimated wind speeds close attention to weather conditions is the fi rst step to courage looting. said. “It’s almost like the air is electrically Wichita, Kan. metro area. It was the largest EMSA-Oklahoma City EMD, and and related damage based on a list of successfully manage a tornado from the communica- The protocols Lanier’s center may use charged. It’s hard to describe what the feel- in a series of 140 tornados hitting Kansas, his field partner Terry Grimm were Damage Indicators and Degrees of tions center. Since their work is done indoors, they keep tabs on the weather by monitoring local TV channels include FPDS Protocols 54 (Confined ing is. You just know you’re going to get Texas, and Tennessee during a three-day dispatched to the south part of Okla- Damage. From that, a rating (from EF0 and the Internet and remain in constant contact with the Space/Structure Collapse), Protocol 53 something and it’s going to be big.” event ending May 6. homa City on the border between to EF5) is assigned. National Weather Service. Watching the local stations (Citizen Assist/Service Call), Protocol 55 From late afternoon until midnight “It was a savage storm,” England said. Oklahoma City and Moore. They England credits technology and works best for EMSA because local meteorologists do (Electrical Hazards), Protocol 58 (Extrica- multiple supercell thunderstorms pro- “It was a horrific thing. It was absolutely dug victims out from the rubble continuous surveillance for the rela- not hesitate to interrupt programming for severe weath- tion/Entrapped (Machinery, Vehicle)), and duced a total of 60 tornados in the KWTV unbelievable.” of an apartment complex, finding tively low death count. Warnings er. Once they get word, preparation is key. Protocol 60 (Gas Leak/Gas Odor). broadcast area, more than that area typi- The F5 tornado touched down just a three-day-old infant, her mother, were issued well in advance of the “Even before a storm is on top of us, we are pre- The PPDS Protocols that apply include cally experiences in a year. The granddaddy southwest of Amber, Okla., headed north- and grandmother, all still alive inside tornado’s arrival, and the Oklahoma paring,” said Shift Lead Chad Moser, who has been Protocol 107 (Assist Other Agencies), 111 of them all, a F5 traveling over a 40-mile east, parallel to Oklahoma Interstate 44, the bathtub where they had gone for City broadcast media, keeping up- through his share of severe weather. (Damage/Vandalism/Mischief), Protocol path on the ground, recorded winds of 301 moments after another tornado had passed cover. Other people, caught outdoors to-the-second track of the storm by The communications center goes into auto drive 124 (Officer Needs Assistance), and Pro- miles per hour. over the airport in Chickasha. The storm or trapped inside, were found impaled radar, trackers, and helicopter, inter- once conditions indicate severe weather is on the tocol 131 (Traffic/Transportation Acci- The F5 storm was so massive storm track- continued northeast, destroying the com- by debris swept up in the deadly winds rupted programming to provide con- way: all non-emergency transfers are stopped and dent (Crash)). ers couldn’t capture the entire image in their munity of Bridge Creek before crossing or crushed from the weight of falling stant updates. management stays on the alert. Since on duty ambu- In addition to calls requiring the assis- cameras’ viewfinders. Winds yanked grass the Canadian River and into far southern objects. England remembers hearing “There was blanket coverage,” he said. lances are not kept in a station, but are instead posted tance of medical protocols, there is MPDS and trees out by the roots, ripped up con- Oklahoma City. The tornado continued about a woman who had a 2x4 board “Everyone knew it was coming.” J throughout the cities in parking lots of convenience Protocol 22 (Inaccessible Incident/Other stores, gas stations, or other public buildings, when Entrapments (non-vehicle)) for situations a tornado warning has been issued, every EMS crew- involving prevention of escape in which member potentially in the path of the tornado is sent there is an increased threat of injury, illness, to a fi re station or hospital. or death to a victim. The Sinking Vehicle From there, it’s a waiting game for the com- (1st Party) Protocol added to MPDS v.12, munications center until the tornado has passed. and also found in the PPDS and FPDS, As soon as the tornado has gone through an area, they contact crews to assess damages. Sometimes provides life-saving instructions before the damage is limited to a few downed trees while arrival of responders. other times tornados leave an area looking like a Dispatchers accustomed to using proto- bomb went off. col on every call also add the extra advan- Communications centers in Tulsa and Oklahoma tage of auto drive—getting to the core of City are built to withstand the storms. Tulsa’s 9-1-1 the situation without wasting minutes pre- center is rated to withstand an EF4; Oklahoma City’s cious to response. 9-1-1 center was built to withstand an EF5. “The protocol has become second “It is vital that our communications centers remain nature to our people,” said Bryon Schultz, operational during and after a natural disaster such as a quality improvement supervisor for EMSA tornado,” said Cathy Smith, EMSA-Tulsa communica- (Okla.). “They don’t have to make it up as tions manager. “Our employees know that the building they go along. It’s there every day for every is safe, which allows them to focus on their job to help emergency call.” J those that have been affected by the storm.” J

30 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 31 He owns and operates Extreme Chase Tours geography and climate. The area extends from ers the inside scoop. They’re at the scene and makes his home inside Tornado Alley in north-central Texas through Oklahoma, Kan- and, if possible to do so safely, taking videos Mannford, Okla., outside Tulsa. sas, and Nebraska into the Dakotas. Here, dry of the storm’s performance for both news Alone, he takes his weather-battered air from America’s West meets warm, moist broadcasts and further study. Many of the pickup close to the weather, so near in fact air fl owing north from the Gulf of Mexico. trackers come from the University of Okla- that an EF2 tornado in 2005 shoved his Florida is another area known for tornados homa (UO) School of Meteorology, which truck over on its side. The close call and both early in the year and later when hurri- is housed in the National Weather Center. the subsequent video earned him an Emmy canes spawn twisters. A third tornado hotbed Ground “truthing” is a hobby or some- nomination for spot news. is Dixie Alley, running from Texas northeast thing meteorology students do for the He doesn’t take the same chances on to Alabama, then skipping over the southern experience, England said, and not a viable tour. Sure, there’s a risk about chasing any Appalachians to North Carolina. means for putting food on the table. Like storm, but the real adventure is more than But no matter where you are based England and Dean, the trackers look for- what his group has paid to chase. it’s the same kind of excitement for those ward to tornado season. They are like kids “A tornado is in a candy shop, icing on the cake grabbing all they and that’s what can in a limited people want,” he amount of time. said. “But there’s They never get more to it. A lot enough, no matter more to it.” how many times Dean craves they go back. the electricity Their best in the air, the work of ground knowledge from truths is done his radar that a when nobody else The Fast Track. Thrill of the tornado is near. is out there; the He watches the small tornados chase propels storms into big business fields of farm that don’t regis- country with ter on the radar anny Dean talks at a fast clip, his brick, and glass spiraling up into the sky. road on Highway 51 in Kansas was the big- wheat stalks blo- but they happen voice raising and lowering to the “I was petrifi ed,” he said. “So was my sis- gest, baddest, and darkest cloud he had ever wing and chang- to come across L tempo of his story. ter. But that event sparked an interest in me seen or thought he would see. ing their shade during “maybe Yes, he remembers the day, exactly. It like nothing ever had before.” “From that day, everything changed,” he like a hand does it could happen” was two days before his seventh birthday Shortly after, Dean started building said. “This was unbelievable.” rubbed back and trips into the in June 1964. model weather forecasting stations. He The video he made during the violent forth against gold countryside or

Yes, he remembers where he was, studied electronic telecommunications Andover, Kan., tornado outbreak earned velvet. He con- Toppling a Town The photo depicts the magnitude of devastation in Murphysboro, Ill., following the 1925 Tri-state tornado. on their way to whom he was with, and where they were in college since being out there riding the him $600 from the local news station stantly glances at the big storm that going: on their way to and an opening into a his tourists, monitoring facial expressions with the DNA for storm watching in their does register. These are the tornados visit dad in Dalhart, in career where pay is low racing between dread and awe at the sight of genetic makeup. eluding the commercial chasers in a busi- the Texas Panhandle; “Then BOOM, there it was. The on the list of why he the column extending from a thunderstorm “How do I explain it?” asked Gary Eng- ness particularly popular since the 1996 his mom’s hands were gets up each morning. to the ground. Sometimes, the tornado may land, director of meteorology for KWTV in release of the movie Twister, a disaster pressed to the steering biggest, ugliest black cloud I’d “Weather is more appear nearly transparent until picking up Oklahoma City, Okla. “Think about what- film centering on rival data-collecting wheel and they peered than my passion,” dust and debris along its pathway. ever you really like, whatever drives you, teams. out into the hail and ever seen. Right there. Like he said. “It’s my “I’ve been chasing for 19 years and still and that’s how we feel about the weather.” “Their greatest danger is the amount of traf- rain whipping hori- life. Everything I do get the same goose bumps I did as a kid,” he England, who has been at the station fi c out there,” England said. “We get so many zontally against the car. a snake slithering across the revolves around the said. “This is the beauty and power of Mother since 1972, has never chased a tornado vehicles lined up, it starts to look like a train.” They were in the core weather.” Nature I get to show and teach.” from inside a vehicle. The closest he ever England doesn’t question why the tor- of a storm. countryside.” Dean chases storms Dean puts a capital “t” on the Teaching. came to that is the one that buzzed over nado chasing business exists, nor does he “Then BOOM, there –Lanny Dean for a living—all kinds: It’s not just him in a storm supped-up SUV the TV station several years back. But with poke fun at the reason people from all it was,” Dean said. “The tornados, hurricanes, driving along a road in Oklahoma, Texas, today’s technology and the zeal of the sta- around the world spend lots of money at biggest, ugliest black fl oods, you name it, he or South Dakota looking at a giant weather tion’s storm trackers, England doesn’t have the chance to sit in pursuit of a tornado. cloud I’d ever seen. chases. He takes two cell dropping monster size hail on his wind- to be there to feel the power behind nature’s “I remember telling my daddy this is Right there. Like a snake slithering across storms was where he wanted to be. On national weather forecasts each day and even shield. He exists in the moment, one with most destructive force of energy. what I wanted to be, just like Harry Volk- the countryside.” April 26, 1991, he took one perilous step when taking his twins fishing he keeps his the weather and land, and that’s where he “I can see everything from right where I man [popular meteorologist featured on Dean was awestruck. Frightened, closer. He got into his car, a 1976 Malibu, eyes on the sky, not the red and white bob- takes his passengers. am,” he said. “I don’t need to go out in one. stations in Oklahoma, then Chicago] thrilled, and frozen all at the same time. and drove to the area of a reported massive bers. Dean and his wife held off their wed- “They love it,” he said. “There’s no bet- We have people eager to do that for me.” was,” he said. “Weather is very thrilling, “Look, it’s hit a house,” he remembers his tornado outbreak. ding date to the day of a storm, hoping for a ter feeling than that.” England relies on the ground truth— and when you get close to the big storm, mom saying as they watched chunks of wood, He was stoked. There, not far from the crackle of thunder to exhilarate the nuptial. Tornado Alley is a unique combination of storm trackers—to give him and his view- it’s also a little terrifying.” J

32 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 33 Run for Cover. Tornado touches ground for 23 minutes

In Pieces The EF3 tornado ripped apart homes and businesses. Blow Out About 4,000 volunteers came to help clean up. Miraculous Everyone lived to tell about the 2007 tornado. time between phones and radios. Residents minor injuries such as broken ribs or abra- panee’s rescue, forcing a massive shutdown of asked if there was a tornado. People trapped sions from fl ying glass. local roads. The highways were a parking lot in buildings needed assistance getting out Assistance arrived from outside the city for more than eight miles each way. and many were concerned over the odor of in the form of law enforcement offi cers and Schmucker, overwhelmed by offers to gas. Miraculously, there were few injuries volunteer organizations. Forty ambulances help, also credits the resourcefulness of his and no deaths. were ready when daylight came. Eighty community. Neighbors were helping neigh- “They [the dispatchers] knew what to pieces of apparatus, brought over from sur- bors and progress could be seen less than 24 do,” Schumucker said. “Some didn’t want rounding agencies, awaited crews to begin hours after the tornado touched down. to take a break and I had to force them the job of clean up. The Red Cross and “By Friday afternoon barns and homes to leave.” Salvation Army served meals to emergency were coming down; by Saturday morning Outside the center was chaos of an workers and volunteers. new ones were up,” Schmucker said. entirely different sort. Debris in a path start- “I was just amazed at how quickly every- What insurance didn’t cover, the residents Still Standing The Nappanee Police Department knows it can count on its dispatchers (left to right: Deb Miller, Supervisor Tod Schmucker, Stacey Ford, Lisa Benner, Don Truex, Sherm Yoder ). ing less than a mile away led to a town hit one dropped everything and came to Nap- tried to, raising $700,000 from the sale of hen an evening tornado training storm. Two factors—rapid development alert, at 10:18 p.m. on Oct. 18, the tornado hard. Hundreds of houses and businesses panee to help,” Ford said. T-shirts, sweatshirts, a DVD with pictures of session was canceled for Oct. 18, and wind speeds of 60 mph—set it apart was on the ground. were damaged or destroyed. Concrete News reports about a civilian clean up the aftermath, and donations. Several tornado W 2007, nobody at the Nappanee from the average nine tornadoes sweeping “Fifty seconds later I have an offi cer yell- fl oors were all that remained of some fast day prompted 4,000 volunteers from other sirens were also purchased for expanded cov- (Ind.) Police Department 911 commu- the 37 counties in the center’s watch area. ing into the radio that he’s been hit (while food restaurants. Several callers reported areas and surrounding states to come to Nap- erage in case of future events. J nications center knew that within hours “It was moving like crazy,” Sabones in his car) by debris from the tornado,” they’d experience the real thing—in the said. Schmucker said. form of an Enhanced Fujita 3 (EF3) tor- The NWS issued a special message Nappanee Mayor Larry Thompson nado wrecking havoc on the ground for that included the phrase “This isn’t your was in his car headed to the command Larry Meets the Tornado. 23 minutes. normal thing,” catching Nappanee Police center, located behind the dispatch center, Tod Schmucker, Nappanee commu- Department EMD Stacey Ford’s atten- when the tornado siren sounded. While Walk in the park takes a turn to the wild side nications center supervisor, remembers tion. By the time the tornado warning he “knew that this was the real deal” not his pager going off at about 10 p.m., sev- came across around 10:15 p.m. she had until he reached the command center did n afternoon walk to a World War road and I thought, ‘those are hurricane- era in hand. He recorded the tornado’s path eral hours after training was canceled. already issued a weather watch for two he know how close they were. The tornado I memorial park close to down- force winds!’” Latimer said, noting the rare of destruction, snapping photos of more Schmucker, a trained veered to the east less than A town Salt Lake City, Utah, usually chance of something of that magnitude hap- than 500 downed trees and capturing the weather spotter who “Fifty seconds later I have an a mile away from where he brought few surprises to Larry Latimer, pening on this side of the Rockies. images of shattered windows, crushed cars, was home at the time, stood. except on the day the NAED director of The rain stopped. The winds died. Larry and toppled buildings. As he later learned, went outside, looked offi cer yelling into the radio that Dispatchers, who had curriculum design came within a door left the complex, quickly returning to his this twister was among the most notable up at the sky and back received pages to report to width of disaster. offi ce literally dripping wet from his close tornados to hit west of the Great Plains in down across the hori- he’s been hit by debris from the the center, were at their sta- Latimer remembers leaving the offi ce on encounter with disaster. the 20th century. zon. Moments later, the tions prior to touch down Aug. 11, 1999, thinking the stormy sky over- “Did you see the tornado?” people According to the National Weather Ser- power was out; the sky tornado.” answering calls from resi- head would bring nothing more than the asked. Larry’s drenched clothing was answer vice, the F2 tornado caused $170 million in was black. Schmucker -Tod Schmucker dents hopeful that the siren usual cloudburst common to the summer enough. “Is that what it was?” he countered. damages during its 14-minute run. Three was in the car and on his was only a test. During the weather pattern. A sudden outburst of rain Larry had seen a tornado from the inside hundred buildings were affected, including 34 way to work. 23 minutes of ground time, hastened his steps, but it was the hail blowing looking out. He put off drying out long homes that were completely destroyed. One Fifteen miles away at the National storms—the first fizzled. After the tor- the lines were almost still. sideways into his face that forced him to run enough to call ETC Board of Curriculum person was killed when a tent collapsed at an Weather Service (NWS) Forecast Offi ce in nado warning was issued, Ford activated “I do remember dispatch being kind of for cover. He took shelter in the vestibule of Chair Susi Marsan, also known as “The outdoor retailers convention and another 80 Northern Indiana employees were keeping the tornado siren, on the OK of the Nap- eerie,” Schmucker said. an apartment complex, throwing his weight Disaster Queen.” people were injured, some severely. a close eye on the radar sweeps for signs of panee police and fire chiefs, something After the tornado passed, residents against the door while watching the storm “Susi,” Larry teased. “You must be in Thinking back on his encounter, Larry severe weather. Mike Sabones, NWS North- that hadn’t happened in the six years jammed the phone lines. Dispatchers stayed from a window, eye level in the only structure downtown Salt Lake City.” shrugs his shoulders and smiles. ern Indiana Offi ce meteorologist in charge, she’d been with the center. the next eight hours consoling residents, saving him from the destruction. Larry repeated the route the next day, “I always seem to fi nd myself in the mid- remembers the EF3 tornado-producing Less than a minute after sirens gave the coordinating assistance, and juggling their “I watched as trees fell down across the this time with his usually ever-present cam- dle of things,” he said. J

34 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 35 Early Warning. House lost but son’s alert may have saved their lives

Shambles Jennie Irwin, her husband Troy, and 5-year-old son Joe took shelter in the basement of their house in Williamson County, Tenn., when a tornado from the Super Tuesday outbreak made a direct hit on their house Feb. 5, 2008, leaving total devastation behind. ennie Irwin didn’t think for a sec- “‘I’m pretty sure that tornado hit us,’” ning through Jennie’s mind all night was the ond that the tornado warning for Jennie recalled Troy saying. thought, “My house is gone.” J Williamson County (Tenn.) on Once the noise stopped, Troy crept Those at the center put a 9-1-1 Cares Feb. 5, 2008, would be any different from upstairs. The news he brought back wasn’t activation into place. People donated past warnings that had left her, her family, what they wanted to hear. Most of their clothes, toys, and gift cards. and her possessions unscathed. house was gone. Jennie asked him if he was They moved to a house not far from Boy, was she wrong! serious and he replied that he was. where they had been living. One year Storm clouds gathering outside were The Irwin home was almost a total loss. later, Irwin says she doesn’t experience scaring 5-year-old Joe, and he begged for The roof was gone except for a small section many lingering effects from the tornado. his parents to change from their evening over the master bedroom and bathroom. The sound of a train increases her pulse pajamas in order to run for cover. Jennie, Robes hung from the hooks. Although the rate and her son’s baby book is the one the 9-1-1 geo-coding coordinator for the kitchen was damaged, the dishes sat in cup- possession she does miss that can never Williamson County communications cen- boards where they’d been placed after din- be replaced. ter, and her husband Troy, headed toward ner had been cleared away. “That bothered me that I lost that,” the basement for shelter just in case their Most of their possessions were Irwin said. “I still think about that.” son’s forecast panned out. destroyed. Glass and pink insulation caked Jennie doesn’t like to dwell on the event, In minutes the power went out and they their clothes and heavy rain had drenched preferring to think about the people, many heard the high pitch whistle of a tornado. everything. Irwin’s brother-in-law and of them strangers, who reached out to help From their position in the basement, they nephew got stranded with them after com- her family. heard furniture thumping upstairs, blinds ing to help. A place to stay for the night “People were so nice it made it easier to fl apping, and screeching winds forcing them dwindled to one—go on foot to a neighbor’s bear,” Irwin said. “They were really generous to put their hands over their ears. house that had suffered less damage. Run- when they found out what happened.” J

Shattered Insulation and glass littered the house. Rocking Alone Joe’s baby book wasn’t found after the storm. Wiped Out The house was a total loss after the tornado hit.

36 THE JOURNAL | emergencydispatch.org THETHE JOURNAL | September/OctoberSeptember/October 2009 37 J NAVIGATOR REWIND J SERVICE HOTLINE J ACE ACHIEVERS J THE ART OF EMERGENCY DISPATCH J FAQ at nearly half the top pick of percentages play a big part in keeping the troops happy, The result is the overall reduction in nega- include minimal esprit de corps, absence of according to MATCom (Wasilla, Alaska) tive attitudes and behavior.” training or scheduling that doesn’t permit public safety dispatchers Carol Hayes and Quality assurance that supports ongoing opportunity for training, and a hiring process Trish Robinson. individual improvement builds self-confi - excluding telecommunicator participation. “Navigator offers a wonderful oppor- dence and self-esteem, which inevitably Low morale is a matter of self-esteem tunity for training and we’re lucky it was results in people feeling better about them- BestPractices and workplace perception, said Banks, who our turn in the rotation,” said Robinson, a selves, increases job satisfaction, and ulti- was an active member of the NENA Educa- senior calltaker. mately makes for happier employees. tion Advisory Board up until she assumed A center’s inability to send dispatch- her responsibilities as the Canadian Direc- ers to faraway places shouldn’t curtail the Engage in the moment tor on the NENA Executive Committee. means to lift your employees’ spirits, Banks Lots of people come to work, or spend “You take away that sense of belonging said. Team building doesn’t have to be bor- their lives, preoccupied with past events or or undercut self-confi dence and you’ll have ing; it can be as quick and easy as playing worried about future disasters. Negativ- a low morale issue on your hands,” she said. games designed to improve calltaking and ity may be the result of bad experiences “People want to be treated fairly and with dispatching expertise or passing around or low expectations to reduce disappoint- respect for the work they do.” a plate of cookies or (for the more health ment. In the communications center, the A decline in morale can also be related to conscious) vegetables and fruit. constant stress of a real or impending crisis change at the workplace, said Joanne Flem- Many centers, for example, celebrate can leave an employee always preparing for ing, who arrived two days prior to Naviga- National Public Safety Telecommunica- the worst (defensive pessimist) or looking tor’s offi cial opening to attend Banks’ class. tor week, an annual observance of emer- at the world through dark-colored glasses For example, her communications center gency communications’ “unsung heroes” (card-carrying pessimist). That attitude can in Alberta, Canada, was part of a massive dispatch consolidation cutting the number of call centers from 32 to three. “A change to the positive is not an “As you can imagine, it was overwhelming for us,” said Fleming, a dispatcher/calltaker easy transition. It takes continuous going on six years. “I volunteered to come here so I could get some ideas for what our baby steps to move forward.” supervisors can do to get us back on track.” –Nancy Banks Fleming was not a member of her center’s negativity basket, at least from all appearances at the back table where she sat with Mesquite held during the second week of April. make a person the brunt of gossip. (Nev.) Police Department Commander Clar- Not only does the dispatch holiday offer What can you do to help people find issa Larson and Morrow County 9-1-1 (Ohio) an atmosphere of appreciation but it also comfort in the present moment? Supervisor Teresa Staley. The three public ser- opens the door to creativity (for the self- “You can lead by example,” Banks said. J NAVIGATORREWIND vice specialists met that morning, developing motivated) and team building through a Don’t be the one promoting the negative. a friendship that will undoubtedly go beyond break in the routine. Try to keep a smile on your face and, most of Bad Attitude Buster. their day in the classroom. A week dedicated to a “feel good” all, be sincere in your approach to cowork- You can “We have the same issue,” said Larson, who approach doesn’t dismiss the other 51 ers. Ask the individual what may be causing improve low morale at the workplace has been in the law enforcement profession for weeks. Banks recommended ongoing posi- the problem and offer suggestions for posi- 22 years. “In jobs as serious as ours, you have tive reinforcement such as the occasional tive change. If talk among coworkers turns the Communications Center,” presented as orchestrate following a day-long seminar to develop an out, a sense of humor, because if potluck, dress down day, popping infl ated ugly, force a change in conversation. Stand By Audrey Fraizer part of Navigator’s pre-conference package about overcoming the workplace obstacles. you don’t, things can get really sour.” balloons for prizes, remembering birthdays up against communication—spoken and and sponsored by the National Emergency “A change to the positive is not an easy and job anniversaries, and recognizing hon- observed—that you won’t tolerate. After all, Number Association (NENA). transition,” Banks said. “It takes continuous Taking the high road orary performance with awards. just because one worker is miserable doesn’t So, you’re having trouble keeping attitudes The class, developed by ENP Patty baby steps to move forward.” Considering the positive attitude drains “The satisfaction given from commend- mean the rest have to follow suit. positive among your staff at the communica- Cross of the Denco Area 9-1-1 District cited in the NCTCOG survey, it shouldn’t ing a good job is often wasted when we save Supervisors who bring attention to the tions center? (Texas) and ENP Sherry Decker of the Road to ruin be surprising what the same survey found it up for an annual blowout with nothing moment and energy to the workplace infl u- Join the club. North Central Texas Council of Govern- What contributes to the low morale works to improve morale. Just as the lack in between,” Banks said. “Saying thank you ence others to do the same, she said. A posi- “We all have the exact same problem and ments (NCTCOG), focused on identifying precipitating negativity in the communi- of appreciation and training opportunities even once in a while is big.” tive attitude rubbing off on individuals and it’s certainly not restricted to our profession,” potential reasons for bad attitudes and, of cations center? hinder job satisfaction, offering apprecia- In addition to saying thank you, giving dis- teams can lead to accomplishing tasks more said Nancy Banks, supervisor of Communi- course, ways to affect the positive in people According to a NCTCOG survey com- tion and training tend to bolster good feel- patchers regular quality assurance (QA) feed- quickly, solving problems more effectively, cations Training for Peel Regional Police in and situations behind them. pleted by dispatchers in preparation for the ings among workers. Working as a team also back relating to job performance also reduces and even enjoying the process more than Ontario, Canada. “But in our case, we have the Situations don’t always turn out the ongoing course, the lack of appreciation by scored high as a negative attitude breaker negativity, according to Eric Parry, chair of the you might expect. added stress of working in close quarters while way we would like, Banks cautioned. A management and co-workers is by far the along with somewhere to advance for the NENA Education Advisory Board. “It takes work, although it’s certainly dealing with personal crisis. That’s tiring.” notable and lasting change in morale takes heaviest trigger fi nger when it comes to the self-motivated. “Negativity is endemic to centers with- not impossible, teaching people to see Banks made her comments during the a concerted effort, rather than a one-time cynicism or apathy common among dis- Training at the workplace or the chance out a system of QA,” Parry said. “Those that the sunny side,” Banks said. “We’re in this all-day seminar “Overcoming Negativity in fi x energized supervisors and trainers may satisfied workers. Morale busters running to attend conferences such as Navigator do QA engage a totally different dynamic. together.” J

38 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 39 J SERVICEHOTLINE J ACEACHIEVERS negativity and nobody, including you, does Shooting an Elephant. anything about it except try to ignore it Double Indemnity. even though they are not providing care to Right thing isn’t always the easiest thing to do our customers in need, this is potentially as East Midlands Ambulance Service harmful as the direct method. The direct or indirect methods may be quick and less is world’s fi rst multi-center ACE painful to us, but are they the best way to proceed? Think about it. OK, now let’s try and bring this full circle. Orwell shot and killed the grazing, now docile (he was chillin’) elephant as the crowds grew. He could explain/rationalize his actions logically. Many might say he did what was right at that moment, and the law would most likely support his actions in the name of public safety (though I am sure the elephant’s owner would disagree!). Does Orwell believe he made the right decision? We will never know, especially because the writer is quite dead and currently unavail- able for questioning. What if Orwell had done nothing except watch and wait? Would he be viewed as a coward or very wise if nothing further hap- pened before the handler arrived and took the elephant away? In retrospect those are valid questions, but the least painful way Times Two The East Midlands Ambulance Service was the fi rst in the world to receive multi-control center accreditation earlier this year. out of this for Orwell was to shoot the elephant so the crowd would be shown he Setting the stage was “in control” and he wouldn’t have to By Heather Darata Derbyshire Ambulance Service factor is the local population was not very Secondly, we have the same responsibil- deal with any ramifi cations if the elephant became the fi rst in the U.K. in 1993 to use By Jim and Sharon Lanier fond of the occupying government and was ity and accountability to do the right thing had later caused more trouble. Orwell’s the Medical Priority Dispatch System™. curious to see what the foreign authority no matter where we are positioned in the rationale was that he was: “seemingly the If Robin Hood and his Merry Men (MPDS®) (Advanced MPDS in the U.K.). figure was going to do (would Orwell do chain of command. When the rubber meets leading actor of the piece.” In actuality he were living in Sherwood Forest today in In 1999, Derbyshire merged with Leic- George Orwell wrote an autobiographi- something foolish or cowardly). Also, once the road—when you have to make a deci- realized afterward that he was “an absurd Nottinghamshire, England, and needed to estershire and Nottingham to become the cal essay in 1931 titled “Shooting an Ele- the news started that the elephant might be sion on your own without the support of puppet pushed to and fro.” call 999 for an ambulance, they’d reach East Midlands Ambulance Service, bring- phant.” The essay includes his experience shot, huge crowds started to appear and fol- someone else, when the elephant is in the When you face your next proverbial an EMD with the East Midlands Ambu- ing the protocol along with it. EMAS as a Colonial British police offi cer stationed lowed Orwell to the fi eld. Many in the crowd fi eld and the onlookers are watching you— elephant we hope you reflect: Should I lance Service (EMAS) NHS Trust— achieved ACE status Sept. 20, 2006. The in Burma who is presented with a dilemma. were looking forward to the meat that the how do we choose to do what is ethically approach it cautiously to see if it really is the world’s fi rst multi-control center to same year, EMAS merged with Lincoln- An elephant has broken loose from his elephant would provide if it was shot. right given all the factors? “crazy” and thus a menace? Do I have the receive accreditation. shire and Northamptonshire; EMAS kept chains, the handler is 12 hours away, and OK, we can hear your inner monologue How do we react when presented with a full story? Am I reacting in a rational or EMAS serves six counties—Notting- its name. On May 22, 2009, the two ambu- the elephant has since rambled into town saying, “Shooting Elephants? Jim and Sha- diffi cult situation? Usually we want the situ- emotional manner? Was Dumbo based hamshire, Derbyshire, Leicestershire, lance control centers for the East Midlands and caused all kinds of mischief, including ron have tipped this month; those falls off ation to be resolved quickly. How? Well, we on a real story? What does my gut say? Lincolnshire, Northamptonshire, and Rut- received accreditation—something no one property destruction and a citizen’s death. the horses years ago and the nights out can “fi x” the issue by the “directly or indi- What is the ethical and empathic thing to land—that make up 6,425 square miles else in the world had achieved. The elephant eventually wanders out of with the PDC sales staff are catching up to rectly ignoring the other factors method.” do (whether or not it is what the “crowd” and are home to 4.8 million people. EMAS town, goes out into the fi elds, and is grazing them.” Though those things may be true, we This is also known as DOIITOFM (please wants me to do)? headquarters are located in Nottingham- The journey contently like a huge gray cow, not bother- have some points to make! What raised our do not try to steal our made up acronyms Orwell’s fi nal sentence of the essay is: “I shire. Each year the trust receives 500,000 The conviction behind the ACE ing anyone. So, here is Orwell’s problem: interest was the ethical dilemma he faced here under penalty of phony law). An often wondered whether any of the others emergency 999 calls for medical help from stamp of approval never wavered, pro- Does he leave the elephant alone as long and what really facilitated or infl uenced his example of a direct method would be to grasped that I had done it solely to avoid callers who speak languages including Eng- pelling the teams assigned to the task to as it just hangs out where it isn’t doing any decision and thought-making process. hang up on a caller who is giving you a bad looking a fool.” If we strive to make decisions lish, Gujarati, Chinese, and Polish. Patient keep the momentum going. additional harm and wait for the handler to First, let’s explore this from a leadership time even though he or she is cursing at you based purely on the servant’s heart mentality, Transport Service (PTS) and volunteer “Our main driver in having both our return? Or does he shoot the elephant for perspective. In the essay, the mob was very only because he or she is so overwhelmed then the most telling sentence of our individ- ambulance car drivers provide care and centers accredited was the reassurance its earlier naughty deeds because it could curious how Orwell would handle the situ- by the situation. ual professional essays (professional careers) transport on more than 5,000 journeys that when the general public dialed 999 cause a problem later? ation since he was the foreign policeman Indirectly ignoring the other factors can be: “I often wondered whether any of the to and from routine appointments each within the East Midlands region they To further illustrate the problem, there with the gun (leader) and was supposed to method is to simply stick your head in others grasped that I did it (superior and self- day. And if that wasn’t enough, the trust received the highest quality of service are factors to consider. For one, elephants have had the designated infl uence and con- the sand (or the toilet) and not do any- less customer service) solely because it was operates two ambulance control centers— possible in both clinical outcome and were the equivalents of bulldozers or trac- trol. But in the situation, who actually had thing about it. For example, if you have a the right thing to do, though not always the Nottingham and Lincoln—also accepted customer service,” said Ben Holdaway, tors, valuable and hard to come by. Another the control? co-worker who is a spewing fountain of easiest thing to do.” J into the ACE fold. EMAS General Manager—Control and

40 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 41 J THEARTOFEMERGENCYDISPATCH Communications. “The Emergency individuals, Hilary Yates, control training 2. Set up a realistic timetable. Medical Dispatcher (EMD) is the fi rst per- manager, worked with Beverley Logan, Don’t underestimate exactly how long Silence Not Always Golden. Continuous son you will speak to when requesting an International Academies of Emergency it takes. Make sure everything is time ambulance and it is imperative that they Dispatch® (IAED™) national accreditation realistic when compiling the portfolio. reassurance keeps callers calm act in an efficient and effective manner; offi cer, during the process. through the accreditation process we have “I worked closely with Beverley and let 3. Don’t go it alone. been able to guarantee this.” the Academy help me in getting everybody Involve staff, particularly those whose The process was challenging, espe- on board with what we were trying to achieve jobs revolve around the use of protocol cially since EMAS has many other ambu- and sorting everything before we set off with and quality assurance. Achieving and lance targets it must meet. For example, the accreditation process,” Yates said. maintaining ACE takes buy-in and that all NHS ambulance means keeping the services must respond channels of communi- to 75 percent of Cat- cation open. Beyond egory A emergency that, there is no faster calls (the most serious way to reach burn-out I let her talk and explain to me all the needed to do something and since the doing and life threatening than handling a proj- By Kimberly Rigden-Briscall reasons why she couldn’t do anything to couldn’t involve arguing with me she gave including heart attack, ect of this size without help me: no debate, no demands—just me my replacement pen. Very effective, but difficulty breathing, plenty of assistance. polite silence. She kept talking for a while is silence always golden? or serious traffi c acci- 4. Use Academy This is a picture of my favorite pen. I’m as I silently smiled at her. And then she said, In the realm of emergency communica- dent victims) within resources. one of those people who really likes a good “Let me look and see if we have another one. tions silence is often described as “dead air.” eight minutes. Within pen; one that looks great, has a comfortable I wouldn’t normally do this. . .” Her voice There are many reasons for “dead air” during Don’t be shy. The 19 minutes 95 percent weight, and pushes down hard on the paper trailed off as she walked down the aisle to a 9-1-1 call: inputting information into the Academy exists to of all Category B calls for seemingly fl awless penmanship. the pen case. She did in fact have one of my computer, fi guring out what to code the call, strengthen emergency must be responded to. So imagine my distress when I took my precious pens in stock. She handed it to me computer problems, using your mute switch communications; its “The process [ACE] favorite pen out of my purse to make a few and said, “If this happens again, I won’t be to talk to someone else in the dispatch cen- staff can provide the was very long and notes only to find the shaft was cracked, able to do anything for you.” ter, and actually dispatching the crew. Yet if expertise necessary to demanding in terms of rendering the pen unusable. I was forced Then I spoke. I said, “Thank you very the dispatcher doesn’t explain why there is achieve your goal plus the number of staff and to use a pen offered by the sponsors of the much” and off I went out of the store and silence then dead air is, well, deadly. moral support during resources required,” lecture I was attending. This didn’t make on with the rest of my day suitably prepared When a 9-1-1 caller is confronted with those times when you Holdaway said. “With me happy at all. Now, I’d only had my to properly write down anything that struck silence, it makes him or her very nervous… will need it. all the other perfor- beloved pen for about three months. While my fancy. even fearful. Think about it: this person is mance indicators the Linked Lincoln control staff is proud to be part of the world’s fi rst multi-control center accreditation awarded in May. Sweet success it didn’t break the bank to pur- already in a high stress situ- trust has to achieve Holdaway, Yates, chase this pen, it was considered ation that, in her opinion, this was a huge challenge for EMAS, espe- Logan regularly visited EMAS, gave advice, and their control team were delighted an investment. So I took myself Silence is not so great when requires emergency help. cially with the signifi cant amount of staff kept in contact, met with the training team, when they heard about the award: EMAS to the lovely stationary store in Once she has dialed 9-1- we have recruited and trained over the last and provided feedback. Yates helped in pri- had achieved the world’s fi rst multi-control town to discuss my faulty pen the person calling 9-1-1 for 1, she wants an immedi- 18 months. Having a dedicated team helped oritizing tasks and together they led EMAS center accreditation. with those who sold it to me. I ate response. Part of that is us with this.” across the fi nish line a year after diving into “Everybody was pleased,” Yates said. explained how I had bought this help is already upset and having the dispatcher talk EMAS also found itself facing a logisti- the process, receiving ACE recognition for “We’ve had a really long year working with pen three months ago (and how to her. What does a 9-1-1 cal issue because of a headquarters reassign- both centers. the teams across both sites but it has all I loved it) and that when I took anxious and needs someone caller do with silence? She ment during the accreditation process. The Academy also trained EMDs to be been worth it.” it out of my purse that morning fi lls it with her voice. If she “We’ve moved from our old control dedicated AMPDS mentors—their role Two presentations took place—one at it was broken. else to take charge. is calm enough, it might be room to a brand new control center and revolves around the support of new control each control center—in recognition of the The sales lady made “tsk- a simple question, “are you trust headquarters as well,” Holdaway said. staff to ensure high standards of service are feat. The first presentation took place at ing” noises and asked if I had my still there?” If she is more “That was a big achievement.” developed and maintained. Nottingham—HQ for EMAS—June 19, receipt. “For a pen?” I thought anxious she may start ram- Not only was moving an issue, but they 2009, and the second at the Lincoln control to myself. I replied that I didn’t. I also reit- This experience got me thinking. The bling about what is happening. If she is were also using a new telephony system Been there, made it through center on July 14, 2009. Logan attended the erated that I’d only had this pen for three technique of keeping silent is really effective really scared she may even start to yell and [provides voice communication over dis- If your center is interested in becoming Lincoln control center event and couldn’t months and that I loved it. The sales lady in all sorts of conversations. It puts pressure swear or employ any manner of attention- tances] and working toward upgrading their an ACE, EMAS offers the following advice say enough about EMAS’ achievement. started talking about how doubtful it was on the other person; he or she feels like he or getting techniques. In short, the caller takes digital radio system. about the process: “I am extremely proud of the East that she could do anything for me without she has to keep talking to offer a solution or control of the call; and once the caller has “We’ve got quite a lot that was going on,” Midlands Ambulance Service NHS the receipt and that even if I had the receipt an answer. Some interviewers use this tech- control, the wrestling match begins. Holdaway said. 1. Prepare and gather Trust and especially pleased to present the most likely scenario was that it would be nique to get a person to spill—to say exactly So, while silence is a great technique Dedicate the time to do things this award,” Logan said. “Every member sent back to the manufacturer who would what he or she didn’t want to say. I used it to when we want people to talk themselves Support is key to success right. EMAS spent two days a week of staff has shown commitment to ensur- probably not be able to fix it nor replace get the person to do exactly what she didn’t into what we want them to do, it is not Despite an obviously full plate, receiv- for three months going through ing professional patient care provisions it. It was at this point of the conversation want to do. The sales lady may have been so great when the person calling 9-1-1 for ing ACE status for both centers was high on the application and gathering the are their main priority—they are all an where I employed a technique I have been ready for me to complain and argue, but she help is already upset and anxious and needs the priority list. Instead of trying to shoul- information. important part of the world’s first multi- working on with great success. didn’t know what to do with silence. Because someone else to take charge. Since there are der the task solely among several EMAS control room accreditation.” J I-didn’t-say-a-thing. she was the representative of the shop, she legitimate and unavoidable reasons for an

42 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 43 emergency dispatcher to stop talking to carefully. If the trauma patient has ineffec- I believe a universal instruction should a caller, how does the dispatcher avoid the tive breathing, we protect life over limb and be included on how to get a patient off the deadly silence? The simplest techniques are open the airway. bed and onto the floor, for example “get often the most effective. I like to use the Medical patients do not have the same behind the patient and hold under the arms “Pre-Emptive Strike”; to avoid increasing traumatic risks associated with neck move- and lower to the fl oor (if 2 people, get the the caller’s anxiety level and to keep her ment so we always open the airway of the 2nd person to hold the legs).” The instruc- from taking over the call during necessary unconscious medical patient. This not only tion could be used like the “reassurance” periods of silence, prepare the caller for the keeps the airway open, it literally forces the and “clear vomit” tabs. gap in conversation. Let her know what is caller to monitor the patient by keeping Regards, going on. “I am going to update the crew. them hands-on. Gabrielle Nicholls You will hear a few clicks. I will be right Complaints of alcohol intoxication Quality Support Coordinator back. Don’t hang up. I will still be able to should be handled based on the actual com- Western Operations Centre hear you.” “I am entering your information plaint, i.e., “can’t wake him up, he’s beating Ambulance Service of NSW into the computer. You will hear me typing. his mother, she’s vomiting,” etc., not the Australia Don’t hang up, I’ll be right back.” diagnosis of intoxication. Find out exactly Emergency dispatchers work with life what happened rather than accept the diag- Gabrielle: and death situations every day and while nosis of intoxication. Your question has been considered these situations are a routine part of the Remember that Protocols ABC are for several times by the Academy’s Council of job, nothing about a 9-1-1 call is routine for airway as well as arrest. The single most Standards. Here are several points for you the person making the call. Remember that important intervention an EMD can pro- to consider: while it’s obvious to the dispatcher that she vide is airway maintenance. An unconscious There is no real danger to the patient needs a few seconds to type, it isn’t obvious patient, no matter what the cause, is unable when you consider the risk-to-benefi t ratio; to the stressed-out caller! The dispatcher to protect their airway because of the lack of the patient is effectively dead, and the risk needs to explain what she is doing. This a gag refl ex. Additionally, the airway may be of serious injury from a fall from the bed or will go a long way in reassuring the caller closed off when the patient’s head becomes chair is minimal. that her call is being taken seriously and fl exed forward. When providing the head- The patient’s position and situation, that she is being helped. If the dispatcher tilt, the EMD opens the airway, provides as well as the caller’s ability, varies from forgets to prepare the caller for the silence initial evaluation of breathing, maintains an call to call, making standard instructions and she starts to freak out, a simple, “I am open airway, enables the caller to constantly difficult. In reality, some callers simply still here. Help is coming. I just need a few monitor the patient, and keeps the caller in do not have the strength to move the seconds to update the crew” will usually a perfect position to quickly turn the head patient, and a specific instruction may be bring the caller back down. It takes more to the side if the patient vomits. problematic. work to reassure and calm a caller when she While it seems fi ne to leave such “breath- Providing specific instruction carries is escalating than it does to explain what is to the PAI Arrest/Airway pathway. The ing effectively” patients on their side, his- some liability risk that relates to potential J happening while she is still calm. It is always FAQ EMD didn’t think this seemed correct tory has shown that such patients are often rescuer injury. This is one of the reasons we better to prepare the caller for the dead air since the patient was breathing fi ne—only left alone and deteriorate. Remember, the leave some instructions open for the caller, with a reason for the silence. Unconscious but Breathing. unconscious due to alcohol. The patient only way the EMD can monitor the patient e.g., “Cool the burn for up to 10 minutes Using the Pre-Emptive Strike to reduce had been rolled onto his side due to vomit- is through the eyes of the caller, and the with water.” the caller’s anxiety and keep her from trying What is the right path for the ing, and the EMD thought the PAI Arrest/ head-tilt effectively enables this in the DLS While we regularly receive questions to take control of the call is a very effec- Airway instructions for laying the patient environment. about not having a specifi c instruction, once tive advanced call management technique. EMD to take? fl at on their back, opening the airway, and Hope this helps. EMDs understand that the risk of injury is A calm and helpful caller is less stressful monitoring seemed to be inconsistent Brett A. Patterson low and that time-to-compressions is criti- for the emergency dispatcher to deal with. Let me explain. We had a patient with the later DLS instructions for when Academics & Standards Associate cal, their hesitance generally goes away and Emergency dispatching is a high stress job By Brett Patterson who was very drunk and unconscious. a patient is “less awake” and vomiting. NAED they work quite well with callers to get the so any chance to reduce the stress load is a Per prior articles and documentation What is the correct pathway/instruc- job done. good thing. regarding patients and alcohol over- tions for the above scenario? Brett: With all that said, we are currently As I get ready to put down my favor- Brett: doses, EMDs select either Protocol 26 or Annie M. LaFleur, Supervisor I am from the NSW Ambulance Service working on version 12.1 and welcome any ite pen, I want to leave you with one last In MPDS version 12, a DLS link for Protocol 31 based on the patient’s level Anne Mioduski, EMD Coordinator (Australia), and I wanted to get some advice Proposals for Change on this matter for thought. Silence isn’t always golden, but “Unconscious and Effective breathing” was of consciousness. In this case, Protocol Weld County Regional Comm. Center from you on how we should instruct call- consideration. If you have signifi cant docu- there is a well-known rule: “Do unto others added for patients who are still unconscious 31 was selected since the patient was Greeley, Colo. ers to get a patient onto the floor to start mentation of the problem, and can recom- as you would have them do unto you.” How after Key Questions, but they’re not having unconscious at the time of the call. The CPR. I have several issues relating to this mend a reasonable and effective solution, would you want your mom, your spouse, any trouble breathing. The link takes EMDs problem arose when the EMD finished Annie: problem. First, the safety of the patient; please submit a Proposal for Change (PFC) your friend, or yourself treated if you had to to the X-3 card, which is basically a “monitor Key Questions and the patient was still The “Unconscious and Effective breath- second, that the protocol does not provide for consideration. I can assure you that it call 9-1-1? That is how dispatchers should and hang out until help arrives or anything unconscious but was breathing normally. ing” DLS Link was added to specifi c trauma calltakers with an instruction to the often will be considered very seriously. strive to treat everyone who calls 9-1-1; changes” card. The link is found on several Because the DLS link for “Unconscious protocols and relates to the new head-tilt asked question; and finally, how to audit Hope this helps. the caller is somebody’s parent, spouse, or protocols (3, 4, 14, 17, 22, 29, and 30); how- and Effective breathing” is not located Rule. If the unconscious trauma patient is calls in which calltakers have to ad-lib these Brett A. Patterson friend. Better call management techniques ever, it’s NOT on the Unconscious card, Pro- on Protocol 31, the EMD selected the breathing effectively, we do not risk mov- instructions in order to proceed with the Academics & Standards Associate make better dispatchers. J tocol 31, and I’m wondering why that is. regular “Unconscious” link, which goes ing the neck, but rather monitor the patient CPR protocol. NAED J

44 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 45 J THEWAYWEWERE J REFLECTING ON 30 YEARS J THE WAY WE WERE ing count or stumbling over his English Life in the Fast Lane. pronunciation somewhere between 1 and 30, then calling out “30!” when he Dispatch careers move ahead at rate gets to the end of the cycle. In between those cycles of chest compressions, the of technological speed infant’s lungs can be heard inflating with YourSpace each breath. Field responders having diffi culty fi nd- ing their way around the apartment com- plex can be heard on the tape a few minutes J REFLECTINGON30YEARS before they arrive “at the patient.” A delay during the search was not time Taking Flight. Dispatch lands wasted, Spath said. “Connie was there the entire time, pro- its well-deserved space in EMS fold viding instructions to the distraught par- ents,” he said. Thirty years ago minimum wage “There were no cell phones,” said Barry Times sure have changed. The debut of The infant survived. earners were pulling in $2.90 an hour and Furey, director, Wake County 911 Center in the Medical Priority Dispatch System™ in Carson said protocol isn’t the only the Bee Gees were rocking the Top 40 pop Raleigh, N.C. “First responders kept change 1979 at the Salt Lake City Fire Department change she has tempered since beginning charts along with Billy Joel and Kenny for the pay phone in their trauma boxes in Communications Center along with her dispatching career in 1987. But, it’s the Rogers. The body of Nazi concentration case someone needed to make a call.” advances in on scene patient care have now she prefers because of the protocol. camp doctor and medical experimenter Oh, the horrors! revolutionized the profession. Dispatchers, “We’ve moved from the Model T,” she Josef Mengele was secretly buried in Communications centers of decades calltakers, and communications centers said. “Protocol makes sense. It protects peo- another man’s grave after the “Angel of past lacked the luxury of technology: multi- have jumped into the EMS fold. Connie Carson ple. If everybody relied on universal ques- Death” accidentally drowned in Bertioga, screen computer-aided dispatch, text and A comparison to the past is mind- Connie Carson, Sunnyvale Department of “It was a tough adjustment,” she said. tions, we wouldn’t have all the problems Brazil. Neptune became the outermost video transmitting capacity, and electronic boggling, said Doug Horton, who recently Public Safety, California “There were many times I wished my head you hear about.” planet as Pluto moved closer because of data storage. No-frills dispatching was the retired as a major in the Spartanburg Connie Carson wanted to put her foot was an Etch A Sketch so I could shake their highly elliptical orbits and, today, norm with hourly pay for most places (S.C.) Public Safety Department. down or, at least, her headphones. There things around to lose what I had done. It’s maintains that position thanks to Pluto’s barely topping the federally mandated “Definitely not the same place where I was “no way” she was going to trade her much easier to learn than unlearn.” ouster as a planet. President Jimmy Carter minimum. Emergency dispatching was not started my career.” way of answering 9-1-1 calls for a protocol Fortunately, she’s a trooper true to her legalized home brewing. considered a “career” choice but, more often, The stories in the following section system that had logged only 10 more years profession, said Michael Spath, a senior Search a timeline for any year and you’re a piggyback position added to a list of tasks describe the state of communications in than the time she had spent handling emer- public safety dispatcher at the Sunnyvale sure to find facts like these, memorable belonging to a proficient typist. Not a lot celebration of protocol’s 30th anniversary, gencies over the phone and radio. center and a National Academies of Emer- events faded by time, simply forgotten, or for of people stuck around, preferring to grab from a time the cell phone wasn’t even a After all, the calltaker/dispatcher for gency Dispatch® (NAED™) certifi ed quality the younger generations, merely prehistoric the fi rst opening at the local, county, or glimmer in the eye of its maker. J the Sunnyvale Department of Public Safety improvement instructor. events that would chill the imagination. state fire or law enforcement agency. (Calif.) knew what the job required and had “Connie conscientiously took on the a 14-year track record to prove it. identifi ed training needs and as typical of Well, rules are rules. Carson had no most emergency dispatchers I know, down- choice but to conform, if it’s the job she played every attempt at positive reinforce- wanted to keep and it was. She crossed ment and recognition,” he said. her fingers; maybe the medical protocol Carson’s stubborn persistence paid off Barry Furey couldn’t make the jump from the counter and has shown its colors more than once in to the frying pan once things got hopping. the eight years since the MPDS was intro- Barry Furey, Wake County 911 Center, No such luck, Carson soon discovered. duced at Sunnyvale. One call, which she North Carolina The Medical Priority Dispatch System™ answered several years into the transition, Barry Furey is the “go to” guy at the (MPDS®) stood up to its claims of patient particularly stands out, Spath said. Wake County 911 Center in Raleigh, N.C. care and resource allocation. So, what did “She saved a life,” he said. For one thing, it only makes sense since that mean for Carson? She not only con- And in that peculiar trait among dis- he is the director of a center that last year formed but, also, became a believer in a patchers, Carson wasn’t the one shining the received close to 850,000 calls. For another, process that outperformed even her tough apple. It was Spath, for her. he has been in the emergency services busi- standards. “She’s great,” he said. “The call is a striking ness going on 40 years. “I was very resistant until I started seeing example of how protocol can save a life.” It’s not been a period where time has stood the results,” she said. “With those, I backed The call, now part of the DLS scoring still. Far from it, Furey said. “We’ve gone from off my position.” portion of the EMD-Q course, involves manual references to reference manuals. When Changing heart was actually the second infant cardiopulmonary resuscitation I started in public service there wasn’t anything step in Carson’s conversion. She fi rst had to (CPR). For those who haven’t heard the close to the system we have now.” let go of her free-form ways to a structured call, the infant’s father performs mul- Furey remembers the days when dis- formula, which was no easy task. tiple cycles of chest compressions, los- patch was a desk job assigned as light

46 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 47 duty or even as punishment. Those in California, the news was a welcome har- from the consolidated Spartanburg County a 1960s Batman, played by Adam West, in Vanesse takes a lot of pride in what they assigned copied down basic information binger of what could happen to dispatch Communications/911 Department in the a video commemorating his contributions were able to accomplish during his tenure the caller provided and sent it along for nationwide. upstate region of South Carolina also recalls to public service. as communications director, but as far as someone else to solve. Typed messages “That’s what Bob and I thought, any- the clack of the teletypewriter in the back- “I had a wonderful career,” he said. missing the job? were sent point-to-point using a Tele- way,” said Myers when her former husband, ground and the voices of some of the cen- “There’s never a day I didn’t enjoy coming “Not yet,” he said. “It was one of those type machine. The “database” of license Bob Mills, a Stockton (Calif.) Fire Depart- ter’s most frequent callers. to work.” 24 hour a day jobs with a lot of night calls. plates was a sheet of microfilm already ment fi refi ghter/paramedic, caught wind of “Not everyone was calling because of I had fun but it also gave me lots of head- outdated by the time it reached the cen- the innovation. an emergency,” said Horton, who recently aches. It’s time to move on.” ter; a software upgrade meant a new pen He attended an EMD course Dr. Claw- retired as a major in the Spartanburg Public Vanesse is perhaps proudest of the or sharpened pencil. son was teaching and first introductions Safety Department. “We might be the only county’s 9-1-1 system that he worked Jump ahead four decades and to the turned into a friendship revolving around ones they knew to call for any reason. After hard to develop. He was not only the top center where Furey works. Few would rec- Audrey Myers improving emergency dispatch. Mills mar- awhile, we’d recognize their voices.” administrator but, also, a virtual one-man ognize the profession in comparison. Or, in the case of Audrey Myers, typ- ried Audrey and instead of going dining and Voice recognition had its good and band for many years in charge of testing, Consumer electronics drive require- ing was the skill helping to put food on the dancing like other young couples, they’d bad days. While sometimes knowing who training, and fi nding funds to support and ments for text and video transmitting capac- table while awaiting word on the career she spend their evenings debating and designing was calling—without asking for a name enhance the system. ity. Multi-screen computer-aided dispatch was hoping to start. protocol to complement the system evolv- or address—was an asset in pre-Enhanced The three-digit emergency call num- (CAD) is the norm. Increasing emergency “I took a test for law enforcement and ing two states away. 9-1-1 days, there was also the occasional ber put into effect in 1982 brought basic call volumes include a high volume of calls was placed on the waiting list,” she said. “A “It’s all he could talk about,” Myers said. although mostly accidental mistake in emergency services to two-thirds of the new to this generation of dispatchers—non- typing job in San Joaquin County opened “He wanted to do something to improve the speaking. Some so casual but brash, Hor- county’s residents. In 1989, a county ref- English language calls, emergency medical so I took that.” way we did things. This was very important ton said, that students still listen to them in erendum Vanesse pushed to get on the calls, and wireless calls. The use of medical Myers never received an offer to patrol to him.” training classes as indicators of what not to ballot added a 75-cent surcharge to pay protocol takes training and quality assur- the streets of northern California, although The Stockton Department—a joint say to the panicked caller. Vic and Ellen Vanesse for an enhanced 9-1-1 service. In 2004, ance. Even the public’s perception of dis- that’s an omission she has yet to regret. The police and fi re center until 1985—became It’s like the time Horton candidly told a Vic Vanesse, Vermilion County 911 the wireless Phase 2 system was brought patch has changed. administrative job soon led to an opening the model dispatch center for California, frequent caller his choice for keeping an ine- Communications Center, Illinois online. The county now has two dedi- “Most people can’t remember a time in the communications center and that’s Myers said. The people working inside the briated spouse from entering the house. Vic Vanesse is a tough guy to track cated 9-1-1 trunks for cellular phones, without 9-1-1,” he said. “They expect a where she’s stayed since 1979. center became a second family to Audrey, “Fortunately, he survived,” Horton said. down now that he’s retired as director of instead of using the sheriff’s office num- lot more. We’re no longer the ‘Jack Webb’ “Things clicked,” said Myers, dispatcher Bob, and their two children. Mills has since “It was the wrong thing to tell her but I the Vermilion County 911 Communica- ber and rolling it over. of communications asking just the facts supervisor at the Stockton Fire Dept. Com- retired from the department. never thought she’d take me seriously.” tions Center in Danville, Ill. It’s not that he The state of today’s communications is ma’am.” munications Division (Calif.). “I don’t think “It’s been a great career,” Myers said. “I Aside from the occasional misstep, was any easier to fi nd during his 33 years at a far cry from when Vanesse accepted the Dispatchers in training for Wake I could find the same satisfaction in any couldn’t have wished for more.” Horton looks back fondly on his days in County 911 attend a three-month academy other job.” And, what about the Fire Priority Dis- dispatch and the rather unconventional to learn the varying procedures among the Myers entered the world of dispatch patch System™ (FPDS™) the department has way of doing things, at least compared more than 40 agencies they service. They at a time when EMS was growing dramati- since introduced? to today’s standards. Trustees from the “This has become a career, both answer simulated emergency telephone cally through the allocation of federal funds “I’ve adjusted,” Myers said. “I like it. It’s South Carolina prison in Columbia calls and radio transmissions and operate to develop local and regional EMS pro- a good system. It’s really gotten better over would take down plate information dur- rewarding and trying. Public safety the CAD. Another six months is devoted grams. The Emergency Medical Services the years since we fi rst heard about it.” ing third shift for first and second shift to practical calltaking and dispatch training Act of 1973 led to coordinated systems communications workers to find in the dispatchers are truly the fi rst, fi rst on the fl oor under the direct supervision of of resources able to provide immediate tag book and callers rarely received con- a training offi cer. response and medical care although the sistent instructions for similar emergen- responders.” Furey said it’s human nature to wish for impact on dispatch was, for the most part, cies. Multitasking was the ability to listen –Vic Vanesse things now from the past and, for the most years in the making. and write at the same time. part, he believes the technical and system Myers recalls radios that were heavy “To go into a comm. center today is changes have worked wonders for saving and often limited to two channels. In mind-boggling,” Horton said. “Defi nitely not lives and protecting property. The chal- small towns and even some large cities, the same place where I started my career.” the center but, at least, you’d have a good post in 1976, fresh from a 10-year stretch lenge ahead comes down to people; nation- an answering service paged the ambulance Horton worked in dispatch four years, chance of catching him at the Public Safety as a radio technician and dispatcher for the ally 9-1-1 centers lose about one out of fi ve provider after receiving a call on a 7-digit 1972-1976, until coaxed into joining Building where he started the management Illinois State Police. Calls were printed on of their employees every year. number. Only police had a real dispatch the police force. The chief didn’t have position in 1976. cards and passed back and forth among the “It’s a tough job with few accolades,” he and the line was often one shared by dis- to twist his arm too hard since that had Not anymore. consoles for record-keeping. A 30-button said. “Dispatchers are always on the spot. patchers and police officers; a break in the been Horton’s goal since the second grade Vanesse has traded a good life in public telephone line complemented the numbers Not many are willing to take a job where officers’ radio chatter opened up the line when a friend’s dad, who was an officer, service for projects he rarely had enough listed in the phone book to report a fire, Doug Horton you can’t make one mistake.” for dispatch. brought in a bullet and handcuffs for a time for in the past. He and his wife Ellen police, or medical emergency. A calendar The job was nonetheless exciting. Doug Horton, Spartanburg County show-and-tell session. His early ambition have been very busy preparing for the available from the county carried the same Audrey Myers, Stockton Fire Dept. “I was in the middle of everything that Communications/911 Dept., culminated into 38 years of public service Lincoln Park Historic District House and numbers for easier access. Communications Division, California was happening,” she said. South Carolina he felt miserable leaving when he retired Garden Walk, which included getting their Another major change is the attitude Thirty years ago, emergency dispatching The beginning of her career coincided Doug Horton still remembers the seven in June 2009. own home ready for the big event. There toward the 9-1-1 profession. “This has was not considered a “career” choice but, with the first installation of the medical digit numbers callers would dial nearly 40 Horton wasn’t the only one from the are also personal interests keeping him busy become a career, both rewarding and try- more often, a piggyback position added to a dispatch system Jeff Clawson, M.D., had years ago for requesting police, fire, and department feeling the loss. Organizers of a like spending time with family and reading a ing,” he said. “Public safety dispatchers are list of tasks assigned to a profi cient typist. developed. Word of the system spread and rescue assistance. The former dispatcher farewell reception superimposed his face on book from cover to cover in one sitting. truly the fi rst, fi rst responders.” J

48 THE JOURNAL | emergencydispatch.org THE JOURNAL | September/October 2009 49 there, including Luke, Karsten, and their the mountain was slow and diffi cult. The natural. He was a fabulous EMT when he friend Ryan Jaussi. boys—Ryan, Karstan, and Luke—couldn’t ran with us. Very, very dedicated to helping The wall is a 1/2 mile from the Mer- get close to the rock because of a four-foot others.” rell home, easily within eyeshot, reminding overhang. Randy wound up standing on a The young man his scoutmaster remem- Luke daily of its paint faded by wind, sun, ledge 50 feet above the road weighting the bered as the smiling kid always on top of the and age. To Luke, refi nishing the memorial rope during each repel. A storm blew in on highest place in the neighborhood and the RetroSpace seemed the perfect project for his Eagle the third day, and hands stiff from cold and EMT “everybody loved” died Oct. 9, 2004. Scout award, and, true to character, once wind made it diffi cult to work the ropes and Six years after completing what Lou-Ann Luke had his mind made up, there was no maneuver the rollers and brushes. An acci- calls “probably the most dangerous project reining him in. dental paint spill would ruin the whole rock in Eagle Scout history,” Luke was killed in Not in Name Only. Scholarship “This was something Luke wanted to face. A fall would result in certain death. a climbing accident not far from his home. do,” Randy said. “It was scary,” said Lou-Ann, who anx- An anchor failed and he fell 70 feet. Lou- commemorates emergency services natural Luke was 17 at the time, in high school, iously waited below, on the side of the Ann, Randy, and Ivan were among the fi rst and the year—1998—was exactly 100 road, supplied with hot chocolate and to arrive on the scene. years after L.O. Voight, a German immi- sandwiches for the boys. “A white knuckle Hundreds of people attended the on climbing ropes, and a climbing wall once grant to the area, had been paid $50 to experience.” wake, held inside the Merrell home. More anchored to the family room wall mimicked hang from a single rope to paint the words The project took five days, instead of than 1,000 attended the funeral. Since the routes followed on real rock. Their yard “Remember the Maine” on the sandstone three, and on the last day the boys added accident his three brothers seldom climb, remains a paradise of rock, hills, and trails wall. A twist in the rope except for maybe parallel to Ashley Dry Fork Creek. whirling him in circles Ivan, an EMT I Their father Randy, of Merrell hiking nearly ended the job in and member of the boot fame, and their mother Lou-Ann, an tragedy. He didn’t go county search and EMT I for Gold Cross Ambulance, may back up a second day. rescue team. With have winced at the stories their boys—Jer- Nearly 50 years later, the boys grown, the emy, Karstan, Luke, and Ivan—told them in 1944, Earl Goodrich trampoline, climbing weeks and maybe months after their lat- decided to paint a flag rope, and climbing est escapade, but they were stories almost and the words “Pearl wall are gone. Lou- expected from the choices made. Harbor” on the wall Ann still works as “We wanted it that way,” Lou-Ann said. from a 16-foot-by-2- an EMT I for Gold Their lives revolved around the boys, foot platform fastened Cross Ambulance encouraging their sons’ potentials only the to chains secured to and Randy continues Utah outdoors and their long family his- three stakes at the top to make his world- tory in the Uinta Basin could accommo- of the cliff. Work in famous boots and date. The boys piled one adventure on top construction accus- teach bootmaking of another, leaving neighbors in the close- tomed him to heights from an office on Tight-Knit Family knit town of Vernal shaking their heads in and, just to be sure, he Ivan, Randy, and Lou-Ann Merrell stick to the land of adventure and, for them, heartbreak. their property. Gold disbelief or maybe awe, especially when it tested the pulley system Cross Ambulance came to Luke. by piling 300 pounds of rock on the plat- their names to the wall below Goodrich’s funds a scholarship at the local high school “Some people don’t have fear,” said form and hauling it up the wall. His one lettering to the left side of the fl ag (as seen for students interested in pursuing EMS Becky Decall, a family friend for many regret was the blue fi eld of stars painted at from the road). They had repositioned the careers, including those looking to a future years. “Luke was one of them. There the right corner instead of the left as flag blue fi eld based on a document local histo- in emergency dispatch. wasn’t anything he wouldn’t try. He always protocol requires, an error, Goodrich later rian Doris Burton dug up indicating Goo- The scholarship, however, is more than pushed the limits and his brothers weren’t admitted, he wouldn’t mind someone else drich’s regret for the error. a memorial in Luke’s name only. far behind.” changing. No one was injured. No paint was “The minute I started working with The Decall family home is on the main Luke got the OKs he needed from the spilled. Luke, I said to myself, ‘this kid will make road visitors can take into Ashley National Uintah Duchesne County Commission Eleven years later, the wall is a backdrop it,’” Gurr said. “We wanted the scholarship Forest and the world famous rock art pan- and the Eagle Scout Board. Local compa- for a park across the road. There is plenty for people showing his same potential.” Writing’s on the Wall A century of climbers and daredevils leave their marks commemorating U.S. Naval history. els along the McConkie Ranch Petroglyph nies donated paint, rollers, paint screens, of space for picnics, and people driving or Not a day goes by when the fam- caves, and slinging climbing ropes down Trail. En route to the woods are miles of buckets, and supplies. He set a date in mid- biking along the park’s perimeter might ily doesn’t feel the pain and silence of By Audrey Fraizer along the pitched cliffs literally outside sandstone walls, including a 376-foot cliff October for a project estimated to take notice a memorial placed fi ve years ago by Luke’s absence. But they also like telling their front door. on the west side, not far from the McConkie no more than three days. His friend Ryan Luke’s friends and coworkers at Gold Cross stories about a son who knew no limits; Step inside their home and you’ll see an Ranch, notable not only for its sheer drop repelled down the cliff the day before to Ambulance. Luke was a perfect fi t at Gold the son who by age 25 had crammed The Merrell brothers had childhoods extension of activities complementing the but, also, the large American flag painted video the descent and place bolts for two Cross: an EMT extraordinaire, according more into his life than someone usually anyone with even an ounce of Huck Finn landscape. A railing framing the balcony midway up and down the face. Sixteen-foot ropes that would be used to pull them into to his EMT instructor Tracy Gurr, an IA does by age 75. in their blood would envy. Born and raised outside bedroom doors on the second fl oor letters spelling “Remember the Maine” and the wall. (intermediate advanced) at Gold Cross. “He lived on the edge all the time,” in the rural northeastern corner of Utah, served as a vault for a trampoline at the cen- “Pearl Harbor” are painted in black to the The going was tough, even for these sea- “We have EMTs who do this for the pay- Randy said. “When anyone said something the boys spent an idyllic youth roaming ter of a Great Room below. A hook from left and below. In smaller black letters there soned climbers. Carrying $4,000 worth of check and others who do this because it’s couldn’t be done, you could be certain he’d desert canyons, running rivers, exploring a two-story ceiling provided practice time are the names of the people who put them equipment and paint up the steep side of truly their calling,” Gurr said. “Luke was a be the one doing it.” J

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