9-1-1; What Is Your Emergency?

Tuesday, May 21, 2013

From The Chair: The Chair Itself

Taken from 9-1-1 Magazine.com
Written by Paul D. Bagley, published author of fiction and non-fiction books, a retired police officer and emergency dispatcher.  He is the past president of New Hampshire Emergency Dispatchers Association, and he is editor and publisher of the association's monthly newsletter, "The NHEDA Broadcaster."

Okay, we've spent some time and ink describing what dispatching is all about.  We've talked about the level of stress that goes hand-in-hand with the job.  We've discussed the lack of appreciation or even recognition from those whom we serve and those whom we dispatch.  We've mentioned some of the emotions and the dynamics that are significant elements of an emergency telecommunications career.  We've even explored some of the medical issues that have become somewhat commonplace in our vocation.  What we haven't talked about in this column entitled "From The Chair," in any length, is the furniture; specifically: the chairs themselves!

In a recent column I mentioned how a colleague colorfully described the job of dispatching as a vocation where an inordinately high percentage of those of us in the profession are likely to be wearing king and queen sizes.  That being the case, why do so many of The Chiefs still insist upon buying disposable chairs for the dispatch center?  I had one chief so cheap that he not only bought several chairs at a time so he could get a bulk discount (each for under $50.00 from an office supply outlet), he bought them unassembled so he could save a little bit more money.  He would then put on a formal display of his lack of mechanical acumen or, worse, call upon one of us to either assist him or do the assembling ourselves.  Knowing that these "chairs" as he called them would soon self-destruct under the rigors of dispatch it was like asking inmates on death row to assemble their own electric chairs.

In the space of a single year that center chewed up all the toy seating The Chief purchased like a school of piranha chowing down on a full side of beef.  It's not that the telecommunicators are naturally destructive people - they're not.  It's that chairs are made of moving parts, and any machine with parts that move will experience wear and tear.  The cheaper the parts, the faster the machine deteriorates.  When a chair is occupied twenty-four hours a day, often by individuals who are above average in width, breadth and girth, it needs to be designed to handle the load.  Even "normal" sized dispatchers exert above-normal stresses upon a chair because when the fur flies and the proverbial spaghetti hits the fan there is no time for them to consciously think about how they are moving around behind those consoles.  Reaching for a reference manual, stretching to push the transmit button, or extending to grab a ringing telephone, one does not consider the furniture; they just act.  If the furniture isn't designed to go with the flow of the dispatcher it will literally crumble  under the pressure.

Chairs that can do the job properly are not cheap, and they certainly aren't found on sale at the local discount office supply store.  Good dispatch chairs are rated for twenty-four hour use, and they carry a maximum load assurance right on them; usually 500 pounds or greater.  The office supply chair that carries a weight rating above 250 pounds is rare, and "task" chairs are the worst of these.  The Chief thought he was doing us a favor by getting armless task chairs with mesh backs.  His logic was we wouldn't sweat so much having all that air movement around us.  Nonsense!  You can sweat just as much in a mesh chair as you can in a leather one.  As for mesh itself, that's kind of a personal thing.  Wool or nylon fabric, vinyl or leather coverings are personal variants that are a matter of taste and budget.

Task chairs - no matter what the brand or style - have a five-point base.  It is impossible to emphasize how useless these chairs are in a communications center environment.  Six-point bases are only a slight improvement.  The moment a full-sized dispatcher attempts to recline in these chairs in an unconscious effort to obtain something from behind them, or after enduring a busy spell and a good healthy stretch is long overdue, they will find themselves on the floor wondering why The Chief has it in for them.

The minimum number of points for the base of a dispatcher's chair is seven.  Seven or more casters on the floor allows for smooth movement across a tile, wooden or even carpeted floor without worry that the base will somehow slip out from under the occupant.  It's a stability issue, pure and simple.  The test of any dispatch chair should be for the largest member (or even potential member) of the staff to sit in the chair with the seat up as high as it will go.  Once in this position, the dispatcher then unlocks the back of the chair allowing it to recline rapidly.  If, upon reaching the full extent of the relining length, the chair remains squarely positioned on the floor, it's a keeper.  If said dispatcher winds up staring at the ceiling after the back of their head has come in sharp and sudden contact with the floor, it's a task chair and should be discarded from consideration immediately.

Chairs are like automobiles.  Manufacturers of both devote more time, better materials and more labor to the higher end of their product line.  Purchasing a car off the showroom floor you receive what is available.  Special ordering a car gets you exactly what you want.  Chairs are no different.  Without trying to offend animal-rights individuals regarding the use of leather in manufacturing, I will say that I have found cars and chairs that are crafted with leather tend to get more attention from the craftsmen than their fabric counterparts, and they tend to last longer under a variety of adverse conditions.  The material known as Naugahyde? might be considered a fairly reasonable substitute given its leather-like appearance and its long-wearing properties, and it usually runs a little cheaper than leather.

Oddly enough, one of the primary gripes of dispatchers has always been the furniture.  The radios and telephones don't need to be mounted in consoles they can sit atop an old wooden counter top that is three inches above a normal counter height.  The center can be cramped with barely enough room in it for changing your mind let alone changing a set of old reel-to-reel recording tapes because the department has yet to upgrade to digital logging technology.  But the chair in which that dispatcher sits must be suitable to the task at hand.  This rules out all of those bargain-basement specials that look so good on the glossy print circular from the office supply store, or those tiny little photos that show up on the store's website.

What The Chief needs to grasp is something fundamental to the workplace known as "dispatch:" the person seated in the communications center is the only priceless thing in the room.  Police chiefs don't think twice about providing comfort to their officers who patrol in cars.  The radios, light controls and laptop computers are routinely positioned to provide comfort and ease-of-use while on patrol.  Even climb into the cab of a modern fire truck or ambulance?  You'll find accoutrement's and comfort galore.  Yet, do the practitioners of law enforcement, firefighting, or emergency medical services often spend their entire working shift seated in those vehicles?  Of course they don't.  But dispatchers do.  Why should what is being sat in and where the work is being done be any less important for those in dispatch?  The answer is it shouldn't.

Why should what is being sat in and where the work is being done be any less important for those in dispatch?  The answer is it shouldn't.

One other thing The Chief needs to consider when buying chairs for dispatchers is that workplace nuisance known as workman's compensation.  Junk seating can more readily cause chronic lumbar and cervical maladies than the designer chairs.  For that matter, the cost of treating a head injury that comes from toppling over backwards in a chair that is insufficiently designed and not constructed for use in a dispatch facility must be factored in to the overall cost of the chair.  True, a good chair may well run into four figures.  The chair in which I sit when I compose this column cost me nearly $1,500.00, but it is a dispatching chair that any center would be proud to own.  I will have this chair for the remainder of my life, and my daughter will inherit it when I'm gone.  I've had it now for seven years, and maintenance consists merely of wiping it down once in a while.  Before I bought this chair, I also went through a bunch of the discount versions.

An old sale adage goes, "quality is never expensive."  There is also the old saying that, "a workman is worthy of his hire."  Simply put, this means that good stuff costs more.  While the initial cost factor might seem on the surface to be a good deal, if the goods fall apart after a very short service life and you have to replace them in very short order, did you really save anything?  And an eight or a ten year warranty usually tends to trump a sixty or a ninety-day one.

In the stage play, "Inherit the Wind" playwrights Jerome Lawrence and Robert Edwin Lee described a hobby horse named Golden Dancer that bedazzled the eyes of child with glitz and glitter.  The child wanted that toy above all else, and his father and mother scrimped and saved to buy it for him.  On Christmas morning there was Golden Dancer sitting in the living room awaiting the boy, and he jumped aboard for his first ride.  He had longed for that moment and dreamt of it often with all of his being.  But the wood from which it was made was rotten, the stirrups were made from cheap material and the whole thing fell apart the moment the boy began to rock.  The child's heart was wounded.  Like the glossy photo of an inexpensive office chair in a sales circular, it was all about show and no substance.

The Chief truly needs to be cautious when spending those tax dollars that were so hard to obtain and ask which is more expensive: the high-priced chair that's bought once and which carries no associated expenditures like workman's compensation claims and sick days, or the discount chair that must be purchased over and over again and risks staff injury and/or chronic illness.  Like Golden Dancer, the cost of buying The Chair may be higher than is readily apparent on any price tag.  And in this, another wise old saying applies: penny wise and pound foolish.  Money spent on something good today is an investment in piece of mind for the future.  Besides, the dispatcher is the most expensive element in emergency telecommunications and investing in a dispatcher's comfort and well being is never a frivolous expenditure - it's merely the right thing to do.

Saturday, May 11, 2013

What Use Our Work?

Taken from 9-1-1 Magazine.com 4-12-2013

Written by Barry Furey, PSAP Management columnist for 9-1-1 Magazine.  He has been involved in public safety for more than 40 years, having managed 9-1-1 centers in four states.  A life member of APCO International, he is the current director of the Raleigh-Wake County (NC) Emergency Communications Center. 

During the past few months, I became a fan of a British Series called Ripper Street which documents the comings and goings of a London Police Division in the wake of Jack the Ripper's crime spree.  There is considerable discord among the elements as to whether Jack has stopped his murderous ways, or if he bears the blame for any new injustices.  While sorting through the seemingly endless challenges faced by the constabulary, the inspector questions whether or not he and his staff are actually making a difference.  Hence, the title of the final episode of the season, and of this column; because this question is as valid today as it was in the 1890s...

As April rolls around again, we spend time educating the public about 9-1-1 and honoring our brightest and best employees.  But, it seems to me that one thing we rarely do is sit back and take a long hard look at what it is that we really do, because absent of the speeches, proclamations, and news clips lies this measure.  And what we really do is pretty darn good.

In my little corner of the world we average about a dozen each of EMD (Emergency Medical Dispatch)-assisted births and cardiac saves every year.  The cardiac saves number is actually higher, but internally we only credit those cases where we institute active CPR on a non-responsive victim.  Now, there are centers that are larger and smaller than ours, but if you multiply all this by the assumed number of Public Safety Answering Points (PSAPs) in the United States (about 6,000) you'd get a pretty impressive number of people that we collectively bring into this world - and keep from leaving this world - in any given year.  Look at this globally, and then add in the suicides we've prevented, the fire and crime victims we've kept alive, and the lesser portions of help that we distribute on a daily basis and you've got a truly remarkable body of work.  All of this coming of course, from a group of people employed in what was recently recognized as one of the "ten most underpaid professions in America."

Now, it's really easy for folks in the trenches to miss out on their importance.  As I just said, they are generally underpaid for what they are asked to do, and often unrecognized.  And when they are recognized, they are not always given the true support they deserve from their co-workers.  In reality, even a doctor can't diagnose a problem over the phone in ninety seconds or less.  But, that is what they are expected to do every day.  There are also the little - and sometimes not so little - frustrations of dealing with first responders and the public who may not always be understanding of what it is really like to juggle limited resources to manage a seemingly unlimited number of calls.  No, Halle Berry does not work here.  And in a world where news is a series of sound bites, there is always the possibility of having your next call being repeated ad nauseam on not only the local stations, but worldwide on YouTube as well.  Still, as long as bad calls and not good calls are considered newsworthy, when you think about it, we're all doing our jobs.  And recently, doing our jobs means dealing with more active shooters, hostage takers, and straight-up crazies than ever before.

I don't know that I can add anything new to the discussion about stressful working conditions, short staffing, and the myriad of other maladies that infect our profession, save to say that in the end each and every one of us makes the world a better place.  And that honor, my friends, doesn't come with a plaque or a parade.  Often, it doesn't even come with a thank-you.  But as long as someone is sick, or hurting, or in trouble, you and your work both have purpose.  What good then our work?  Why, we're saving the world, one caller at a time.  Have a great Telecommunicators' Week.  You deserve it.

Friday, May 10, 2013

Quality Assurance? Are They Learning or Burning?

Taken from 9-1-1 Magazine.com 3-31-2013

Written by Sue Pivetta, President of Professional Pride, Inc. She has worked in emergency communications since 1989 as a college instructor, consultant, workshop leader and author. She teaches adult learning through her book and workshop The Exceptional Trainer. She can be contacted through her website at www.911trainer.com to receive monthly special offers or to join the Professional Pride e-mail group.

Although needed and necessary, Quality Assurance (QA) programs can create chaos in your Comm Center if not presented and managed in a way that acknowledges some realities.

You cannot put lipstick on a "perceived" pig and call it beautiful.  You must change the perception.  You cannot force people to put their defences down when they are feeling unsafe.  You can work to help them feel safe.  You cannot ask people to trust when they have no evidence they should.  Trust is destroyed quickly but built back slowly.

Here are five thoughts on a positive pro-active QA program at 9-1-1.

1. Build or Destroy?
Question: "Help...We just put in a quality assurance call review program.  We already have grief from the floor but now there is a resistance from the supervisors to use the call assessment protocol.  The feeling is this is too much to expect!  This so called tool won't help anything when we are so short staffed and there is no time and negativity already from mandatory OT."

You can use a tool, such as a hammer, to build or demolish.  Which is it?  It appears this new thing has not been sold to those affected as to its true intent.  Here the call assessment is viewed as a time and emotional burden.  Busy supervisors may be resisting not only the additional time burden but the emotional backlash of becoming the gotcha person.  There are already so many time and emotional strains on leaders when short staffed.  What can be done to help supervisors create this program to be a very good thing for their people?

2. Finding Middle Ground
During times of high stress (short staffing, mandatory OT) people who care about doing good work are often hyper sensitive to being able to do good work.  Administrators are likewise more sensitive to liability and errors and feel the need to remain cognizant of what is happening on the floor.  Where is the middle ground?

How can administration ensure quality without micromanaging and provide reasons to welcome the assessments?  Involve those affected before implementing the program.  If it's too late for that - call a "how's it going" meeting.  Acknowledge the feelings of being under a microscope, listen to their concerns and ask for suggestions on how to approach the need for Quality Assessments with trust and collaboration.  Ask "What would have to happen to make call assessments a positive force for our agency?"

3. Leading to Water
Most people care deeply about their co-workers and generally want everyone to receive credit for what they achieved.  Supervisors need is to protect their staff from further stress and hold things together.  This program could offer your agency an opportunity to fill real needs that may have been previously neglected - the need for valuing, positive attention and morale building.

The true intent of a QA program is to ensure a high level of service and compliance to procedures.  An aspect that is not sold enough is that good calls, great calls and consistent good work will also receive immediate "blue ribbon" recognition.  Begin or focus your program to find those good, great or consistent calls so you can set the mood and perception as this program is a very good thing.

4. Kill The Messenger?
Let's say you announce the new Quality Assurance program and you now experience an uproar.  As an administrator you may feel attacked and see those objecting as negative complainers.  Truth is your most important asset.  Killing messengers drives truth underground.  Additionally, you deliver a message of your own: "Tell me your truth at your peril."  Truth delivered encountering backlash feeds discontent and contributes to the death of trust.

It's all in the presentation!  Is it possible that commendations are in order but rarely sought out?  Could it be that call assessments could result in support for good work during hard times?  Could call assessments point out the true dangers of short staffing by bringing to light the consequences to the public or responders as well as the staff?  If your goal is to support your people, the choices you make in your presentation is more effective if you take into account the personal fears of those others while also finding the good in something perceived as bad and SELLING it.

5. Use The Indirect Route?
Generally the message "You need to change for the better!" is not well received if a person is under stress and feeling attacked, judged or under-appreciated.  However, there is a solution.  Let the person experience a "discovery" to create ownership.  Learning is defined as a "change" - no change will happen if there is no need to establish change.

When poor quality work is found - a discover and learning opportunity could be presented to the person needing the change.  Ask the person to review the work before any evaluative remarks are made by the supervisor.  Assuming your protocol and procedures are clear and direct about what should happen (and what didn't happen) in this call, let the person who took the call or dispatched the call evaluate the policy or procedure in reference to their own call.  Ask them to respond to the work and offer their own assessment.  In the event the person does not agree with the need for change or argues the circumstances to justify the behavior, supervisors may want to ask questions Columbo style.  "What do you think could have happened here that would have been more in line with procedures?"

Learn on Burn?
We all learn through our experience.  If our experience is somehow we are lesser by our mistakes, that is how we will view any and all assessments.  If we experienced problems are opportunities and can result in growth, we will welcome the opportunity to learn.  Learn or burn?  Let's be clear about the history of your agency as far as how evaluations have been approached.  Must you rewrite history?

If indeed some predecessor has burned your people with criticism, poor training, or micromanaging, you must indeed purge history - but unfortunately it cannot be re-written.  Here is how: acknowledge the mistakes of the past and create a new promise with those affected.  Have a meeting and talk about past injustices and offer to make this right with their help and guidance.  This may sound a bit like coddling your staff - but is the alternative of either making chaos or making peace.

Conclusion: you must sell the good, listen to fears, and acknowledge history.  1: Move the focus from individual assessments to the good of the whole by agreeing to search for positive patterns, celebrating success and attending to exposed needs. 2: Move the focus from "telling" to teaching by allowing the discovery to be owned by the person needing change.  With just a few minor changes you can and should transform your program from "flame thrower" to "warm blanket".

Thursday, May 9, 2013

From the Chair: "Scanner Land!"

Taken from 9-1-1 Magazine.com 3-9-2013

Written by Paul D. Bagley, published author of both fiction and non-fiction books, a retired police officer and emergency dispatcher.  He is the past president of New Hampshire Emergency Dispatchers Association, and he is editor and publisher of the association's monthly newsletter, "The NHEDA Broadcaster."

You just sat down to begin your shift.  The cluster of screens before you glow brightly, and the radio test revealed no problems.  Before long, you will handle the fire on Broadway, the domestic violence on State Street, and the fender bender at the mall.  And of course you will wonder if the hundreds, if not thousands, of people looking over your shoulder will approve of the way you're doing your job.  The latest installment of "From the Chair" takes an irreverent look at the love-hate relationship between dispatchers and their best friends and worst enemies - the residents of Scanner Land.

Hasbro recently made changes to its board game Monopoly(TM), and this started the gears turning in my head.  What if there was a board game made exclusively about and for dispatchers - you know, a game to be played on a board for when things are really boring in dispatch.  Like the game Candy Land(TM), we could call it Scanner Land!(TM).  The object of the game would be to move a player's piece around a board that represents a shift in dispatch.  A roll of the dice would determine how many squares one moves, and each square would represent a different type of emergency call the player would have to dispatch.  The key to winning the game would be to efficiently dispatch the most number of calls while conveying the least amount of information to the press, media, and all of the assorted scanner-junkies that inhabit the real "scanner land."

Not unlike the development of the original game of Monopoly(TM) by Parker Brothers, Scanner Land!(TM) can be based upon reality.  Nothing is more real than the calls that the average dispatcher encounters every day; calls that constitute the very need for dispatchers.

Most other vocations allow practitioners to do their work and be judged on the final output.  Dispatchers have an ever-present ear eavesdropping over their shoulders.  It listens to every transmission, and judges them constantly.  It often seems as though listeners are waiting to pounce upon any perceived mistake.

There is a very broad array of people who monitor radio scanners; radio receivers that sit atop their upright piano in the living room, are found nestled on their nightstand next to their bed, or who carry portable versions that are clipped to their belt.  Scanner people are everywhere!

What is truly amazing is the range of those who listen to their scanners religiously.  Listeners can be found in every socio-economic level, among all creeds, colors and genders.  Scanner people cut across every layer of our society.  To give you an idea of how some people think of their scanners, back in my early career I had been dispatching the evening shift for almost a year.  I was in uniform with my name tag displayed when I stopped by the store on the way home to purchase a gallon of milk.  A man came up to me while I was standing in line and asked if I was the same Paul Bagley who dispatched for the local police department.  I said I was.  He replied, "Oh, my wife and I love you...we listen to your show every night!"  My show?  When I was a DJ with a top-forty radio station I would have given everything to have fans like that.  But as a dispatcher of emergency services I found myself somewhat dumbfounded.  I discovered that some people actually consider what we do entertainment!

Another thing about scanner people - some can be downright rude about things.  If there is anything on earth that you don't know, all you have to do is admit it on the radio and someone in "scanner land" will call you up and let you know just how stupid you truly are.  I once admitted on the air that I didn't know what the term "cul-de-sac" meant.  Within seconds every phone line into dispatch lit up like a Christmas tree.  All kinds of people feeling quite superior with their own knowledge informed me as to the definition of the term.

"A cul-de-sac is a circle or a loop at the end of a dead end street," one snooty person stated before abruptly hanging up.  Had it been just one person calling I would have been delighted; but it was literally dozens!

Our radio repairman appeared in my center one night due to a frequency modulation problem reported by field personnel.  The repairman narrowed it down to the console microphone, and decided to test it.  He instructed me to key the microphone and say "ah" like I was at the doctor's office having my throat examined.  He told me to keep the mike open and hold that "ah" for as long as I could.  I pushed the floor pedal and did as asked for what seemed like minutes.  He had me repeat the exercise several times.  Before he was finished tweaking the system, the phone rang.  It was one of the many ambulance personnel whom I dispatched.  Since our center had only one dispatcher on duty at a time, he knew he would be talking with me when the phone was answered.

"It sounds like nodes," he barked.  "Take two aspirin and see the doctor in the morning."  He then hung up.  The radio guy made me perform the test two more times to my utter humiliation.  Fortunately, no one else called to diagnose what ailed me.

Back when "Smokey and the Bandit" was all the rage, the closest thing there was to a reality TV show was the nightly news.  Everyone with a citizen's band radio and a whip antenna on their four-wheel-drive pickup truck also had a scanner.  These guys would shadow some of my cops on calls, and often thwarted police activities by getting in the way.  Like my fans, they simply craved entertainment.  I found myself deliberately broadcasting false calls in order to draw them to the other side of town from the real location - my officers knew they were false by a code phrase that I included in the dispatch.  They would then stop by the station, or give me a call from a phone booth, to get the real information (there also were no cell phones or digital pagers back then).

It's not that I have anything against the public listening in - it's their right, and is protected by F.C.C. regulations, and various court decisions.  Of course there's nothing in the US Constitution that guarantees freedom of listening the way the First Amendment insures freedom of speech.  Listening to radio broadcasts is just one of those many unforeseen rights that were not enumerated in the Constitution by our founding fathers because radio had yet to be invented or even conceived.  And allowing the public to listen to dispatch activities is among the many initiatives that can be considered part of a transparent government.

I'll also agree that a scanner can be a very useful tool for people who aspire to becoming dispatchers.  By trainees listening in to the center where they work they can learn from their coworkers when they're not on duty.  New people hear how others dispatch, and acquire the rhythm of their center.  I often had my trainees carry a pocket scanner with them when off duty in order to get the gist of what the job was all about.

There is another up-side to "scanner land" - most of the people listening are basically good citizens who want to do right by their police department.  Not everyone listening is up to no good.  Good citizens often call in tips that help solve crimes or capture wanted suspects.  True, much of the volume of calls generated by scanners is frivolous, and oft times redundant.  But every now and then a nugget of information comes through that  makes all the junk calls worthwhile.  And of course, using scanner people for information is quicker than Wikipedia and just as reliable - after all, Wikipedia allows users to redefine things making it a reflection of public opinion.  Scanner-generated calls ultimately reflect public perception, so why not?

Citizens who listen to scanners, as well as the news media, have been stifled in some jurisdictions with the advent of encrypted transmit and receive communications.  As though digital laptop dispatching doesn't thwart listeners enough, encryption is considered by many police agencies to be the only effective method of protecting sensitive communications.  I spent many years as a law enforcement officer and all of it without encryption.  What I said and did was always on the record, as indeed all routine police matters should be.  True, the bad guys had the ability to listen in and maybe get tipped off to what we were doing.  But my experience was that bad guys had better things to do than listen to scanners; things for which I would ultimately arrest them.  In my state the commission of a crime while in possession of a police scanner begets you an enhanced penalty upon conviction.  As a result, I've never understood the need of encryption other than in tactical situations.

One nearby police agency decided it would be a great idea to encrypt all of their channels.  It cost them a small fortune!  Two weeks after the switch over to encrypted communications took place, a local high school kid built a descrambler in the electronics lab at the school with parts he purchased at Radio Shack!  His device enabled him to listen in on everything.  He became his own cottage industry, and built up a sizeable college fund selling his little homemade descramblers to anyone who wanted one.  Over the course of time, the police agency gave up playing hide-and-seek, and opted for clear channel transmissions on all but their tactical channel.

Those of us who occupy The Chair have learned to cope with the demons that inhabit "scanner land."  Like life itself, we've learned to accept the bad with the good, and recognize that for every jerk out there you can find dozens of good people who are merely keeping abreast of what's going on around them.  As I've always said, dispatching is simple - it's just not easy.  But to our loyal listeners we make it seem easy.  Maybe a board game like Scanner Land!(TM) is a good idea.  Maybe the public we serve would grow to better understand the complex world that emergency telecommunications has become by playing the role of a dispatcher.  Possibly they'd develop a better appreciation for what it's like to have to separate the life-threatening from the mundane each day.  Maybe they'd acquire an understanding of what working in a pressure cooker is all about.  Maybe, but I doubt it!  Working in The Chair is no game, and emergency dispatching certainly isn't something for amateurs.  We'll just have to be satisfied with business-as-usual when it comes to interacting with the residents of "scanner land."

From the Chair: Chaos and Staffing

Taken from 9-1-1 Magazine.com 10-12-2012

Written by Paul D. Bagley, published author of both fiction and non-fiction books, a retired police officer and emergency dispatcher.  He is the past president of New Hampshire Emergency Dispatchers Association, and he is editor and publisher of the association's monthly newsletter, "The NHEDA Broadcaster."

There are only two kinds of emergency telecommunicators: those who have experienced absolute chaos in the communications center, and those who have yet to experience total chaos in the communications center.  Regardless of how well staffed a center may be, there comes a time when all hell breaks loose and the proverbial spaghetti hits the fan.  It can occur during a normal business day.  It can happen in the middle of the night when absolutely nothing normally happens.  Virtually anytime disaster strikes.  When you glance down and see every single phone line blinking, you'll know you've arrived.

The test that accompanies Comm. Center chaos can be among the hardest challenges that ever faced by even the best trained and most experienced emergency telecommunicator.  Whether it is caused by a tornado touching down, a hurricane reaping widespread destruction, a psychotic gunman shooting everything and everybody in sight, or simply a bull moose walking down Main Street, when every line is ringing and every radio is chattering, the person in The Chair is placed under more pressure than anyone who has never endured dispatch could attempt to comprehend.

My test came after I'd been dispatching quite a while.  I thought I'd seen activity before that day, but it was nothing compared to the sheer volume of calls that were taken by me and the two young colleagues with whom I worked that day.  Our test was a flood of epic proportions: the second "hundred year flood" we'd seen in two years.  In the space of ten hours we each handled roughly 2,000 calls - that equates to roughly twenty seconds per call.  Most, thank heaven, were informational calls that made up the din of noise, but we had our share of true emergencies wedged in with all the unnecessary inquiries.  One woman was calling via her cellular phone from atop her car as her four-wheel drive vehicle was floating down a swollen river.

The Chief, who had absolutely no idea how to answer an emergency line or even use a radio, could only play gofer and get us lunch.  We were so swamped we didn't have time to utter to him what we wanted to eat.  Every phone line would light up the instant that we cleared the previous call.  Even if we'd had more qualified people in the room, I doubt we could have handled things any faster.  We were exploiting the far reaches of the available equipment and taxing the software to the max.

In some multi-agency/multi-community dispatch center where two or more people are working, the work load is often divided up: one will handle phones while the other handles radio.  In other places they divide the load by the color of the lights they are dispatching: one will handle blue lights (police calls), while the other(s) handle red and white lights (fire and ambulance).  Regardless of how the load is distributed, it always seems to go easier with others to help shoulder the burden.  The problem is, the moment the "big event" comes, that ideal division of labor, no matter how well-thought-out or how equally distributed, flies out the window.

Knowing some of the tricks of the trade in advance can serve as an enormous help in dealing with a deluge.  Take Danvers, Massachusetts; a reasonably small community just outside of Boston.  The combined PSAP/dispatch center was staffed by just two people when a propane storage tank exploded rocking the entire community.  Virtually everyone either called the PSAP to report the obvious, were phoning in their observations of the explosion itself, or they were reporting actual associated emergencies (i.e.: fires, structural damage, injuries, etc.).  Every incoming phone line was jammed to the point where neither telecommunicator on duty could place an outgoing call to get assistance.  They say necessity is the mother of invention - how true!  One of them remembered they actually had an open outgoing line available that the public hadn't yet accessed: our dedicated FAX line.  From the handset on the FAX machine they were able to call for additional personnel to assist with dispatching, and to alert the various agencies in order to actually get responders to handle those bonafide emergencies.

Chaos invariably is the result of call volume overwhelming the staffing level.  Few chaotic cycles are predictable; they always seem to be front-loaded arriving C.O.D.  Unfortunately by the time additional staffing does arrive the crisis has usually passed.  When that explosion does occur, or that tornado touches down, or that crazed gunman opens fire, our brothers and sisters seated in The Chair will handle more work in five to ten minutes than most people outside of our profession handle in a week.  It is demanding and almost debilitating because of the level of concentration that must be brought to bear.  The problem with people other than dispatchers is that they often lack the ability to achieve that same level of intensity in their focus, or to sustain it for the time needed to accomplish a mission such as the expectations for those in The Chair.

This brings into sharp relief another element that contributes to emergency communications chaos: public unawareness.  When I say "public", I'm not just talking about John Q. Citizen out there who, for the most part, is oblivious to anything in the world except his own narrow range of interests.  I'm including anyone and everyone who does not sit in The Chair.  Chiefs, captains, lieutenants, sergeants, firefighters, EMTs; you name it!  If they haven't dispatched, they have no - I repeat - NO knowledge of what we do or how we do it.  Having someone sit in communications during a shift to watch us stare at the console and answer the occasional radio or telephone call does nothing to further that person's comprehension.  They will never fully grasp the impact of absolute chaos, even if they witness it, because they won't have the responsibility of sorting out that chaos that goes along with the job.  Making those split-second decisions that may well mean the difference between life and death is easy to watch, but few are equipped to deal with it.

What constitutes chaos naturally depends upon the communications center involved.  I've alluded in the past to places where a single radio frequency and two telephone lines constituted the heart and soul of a community's emergency dispatch.  When both of those lines are ringing off the hook and that single radio channel is abuzz with multiple field personnel demanding a plethora of dispatcher actions, true chaos exists.  In the communications center where there are dozens of phone lines and radio frequencies that are controlled by multiple telecommunicators, chaos is simply a matter of load.  Call volume is usually the single measure used by the bean counters in our profession to establish and maintain staffing.  But the volume of calls alone does not reflect the nature of those calls; their intensity, their gist or even their duration.  Anyone who has endured the rigors of the chaotic center from The Chair knows all too well that these latter elements are the real issues and should be the means by which decisions about staffing need to be made.  But, emergency dispatching is almost exclusively a government function, and government rarely employs subjective analysis when it comes to the allocation of precious public resources like tax dollars, unless, of course, it is the Department of Defense of Homeland Security.

Far too many centers, solely because of budgetary constraints, staff their Chair(s) with a single dispatcher during what are perceived as "slow times."  While this makes fine fiscal sense when it comes to rationalizing annual operating budgets, it could actually mean life or death.  Imagine if you will a lone dispatcher at the console in the middle of the night.  He or she is eating their supper at the console because there is no alternative.  Suddenly, in the middle of chomping down a Chicken McNugget, the emergency line rings and the caller on the line has an actual emergency.  The problem is: that McNugget got gulped too fast and is now blocking the windpipe of that lone dispatcher.  Breathing is barely sufficient for life-support, and talking is out of the question.  The caller is left without anyone to respond to their emergency, and the dispatcher is in crisis themselves because they are choking to death and no one is around to help them.

This situation has occurred far too many times throughout the country to be tolerated.  One such dispatcher in Matthews, Virginia who was choking and unable to speak continued using her head and kept toning the local ambulance.  Tone after tone went out with no associated verbal announcement.  After a while, a sheriff's deputy and an ambulance volunteer realized that something was amiss and responded to the dispatch center.  They were able to rescue the dispatcher just in time.  Had there been another dispatcher working in those wee hours the episode would never have occurred.

A minimum of two people behind consoles twenty-four hours a day should be the standard everywhere.  One center where I once labored served some forty thousand people.  Imagine that entire collection of tax payers being placed in mortal jeopardy by a single Chicken McNugget.

There's a saying in the sales industry that quality is never expensive.  Having two dispatchers on duty throughout the night might seem like an expensive extravagance, until one of them starts choking or has a heart attack.  Imagine your sole telecommunicator being involuntarily incapacitated and without help.  How many calls will have been missed during his or her unconsciousness or even post mortem?  What will be the price that center will have to pay in answer to lawsuits levied against it for failing to adequately staff?  Currently, this hasn't become a commonplace legal argument in wrongful death or civil liability suits.  But soon, it may.  The public has an uncanny way of deciding what the standard of care should be, and it seldom lets anyone in local government know what that standard is until after the fact.  Acting preemptively to fight this argument is the only way to avoid it and to minimize the summary judgments made in courts of law by impressionable juries.

Having at least two people in The Chair around the clock not only decreases the level of dispatcher stress because of the reduced or shared load, it helps insure that someone is always there on duty and awake to save a dispatcher that is afflicted with an ailment or disabled through an accident.  It's just good common sense.  Having more than one dispatcher on watch helps foster camaraderie, provides training opportunities, and helps maintain standards by having a second opinion available in determining if actions are in line with established protocols.  This practice also helps communications personnel deal with absolute chaos when it does occur, which is the very essence of dispatch.  After all, emergency telecommunicators are those individuals in our society that everyone else depends upon to eliminate chaos from their lives.  When everyone else is losing their head, those in The Chair must remain level-headed and ready to solve all the problems.  And, as the old saying goes, two heads are invariably better than one...especially in the midst of chaos...when seconds count and lives are on the line.

Wednesday, May 8, 2013

From the Chair: 9-1-1 Mobility

Taken from 9-1-1 Magazine.com - 7-29-2012

Written by Paul D. Bagley, published author of fiction and non-fiction books, a retired police officer and emergency dispatcher.  He is the past president of New Hampshire Emergency Dispatchers Association, and he is editor and publisher of the association's monthly newsletter, "The NHEDA Broadcaster."

There is a tidal wave of change coming for the emergency telecommunications industry that is known simply as NG9-1-1.  It's all about mobility now.  Modern emergency telecommunications began with a simple idea a few decades back and developed into a national standard three-digit number known as 9-1-1.  Next came E9-1-1; the E stood for Enhanced.  The primary difference with the enhanced version was the cooperation of the telephone industry in providing Automatic Number and Automatic Location Information (ANI/ALI) data for the caller's phone number and location identification.  Then the wireless telephone industry got involved with all kinds of phased-in additions to E9-1-1 where tracking geographic location of the caller was to be accomplished (this one is more or less still in the "what if" stage).  While many locations may easily get a firm fix on latitude and longitude, altitude is still somewhat problematic.  A ten-story building with a footprint that is one hundred feet square has one hundred-thousand square feet of floor space, and each ten-thousand square foot must be searched one at a time to find a cellular caller.  Imagine that problem in a taller building; say 100+ floors, with a footprint the size of a city block that has an emergency "somewhere" inside.  Triangulation may narrow the search a little, but it will still require a toilsome effort by responders to find a caller who is incapable of verbalizing their specific location or who is using a phone that has ceased to function properly.  Enter NG9-1-1, or Next Generation 9-1-1.

The gurus in the high-tech industries have been busying themselves trying to solve some of the known problems, while simultaneously finding new and creative ways by which citizens - you know, those creature-like individuals who call us demanding help? - can access emergency services.  Let's see: we began by reducing seven-digit dialing down to three, and the public still programs 9-1-1 into their speed-dialers so the dog could step on the phone and call us.  We added in automatic number and location identification in case the caller is unable to speak their problem so we at least know where to send someone.  We incorporated access for cellular technology because the United States is such a mobile society and mobility is cherished above all other things.  We've even evolved to the point where we can track a caller's whereabouts through GPS.  Now the government movers and shakers want 9-1-1 to become accessible through Facebook and Twitter?  They want callers to be able to "text" their call-for-service, or even fax it to us?  What will Congress do next: require telepathic connectivity capability?  Those with the power lack the knowledge; those with the knowledge lack the power - and so it is in emergency dispatch.

Aside from the obvious increase in butt-dials to be encountered from all the kids with their jeans hanging down below their underwear, implementation of all these new emerging technologies will be time-consuming, difficult, and costly.  Regulators at the national, state, and local levels will have a hand in dictating what ultimately evolves into the set of tasks that dispatchers will have to perform in order to make NG9-1-1 a reality.  Some, but few, dispatchers will be polled for their ideas during the current design phase; fewer will be consulted during the regulatory stage.  One thing will be certain - dispatchers will have to become more technologically savvy in order to provide our "mobile" public with the emergency connectivity they require.

Okay, NG9-1-1 is coming.  The expense to update half a million PSAPs and dispatch centers across the country will eventually be found, and additional funds needed to train personnel to deal with all this new technology will somehow blossom forth from the many branches of the always-bountiful tree of tax revenues.  I believe this is where someone usually inserts the line, "When pigs fly!"

Whether we like it or not, both the bodies of human knowledge and technology grow faster than any one person can assimilate them.  The inevitability of it all doesn't make that fact any easier to accept.  But big changes are coming and we need to prepare for them, if for no other reason than to make our own lives easier.  Dispatchers will rise to the challenge as we always have.  They will embrace the new technologies even though they will have little input into their development and implementation.  Some of the changes will make a dispatcher's life easier.  Others will tax their intellectual prowess and emotional wellbeing to the max.  But while the planners and the programmers are busily addressing the demands of our mobile society, what are they doing to insure that PSAPs and dispatchers have those same capabilities?

PSAPs and Emergency Communication Centers (ECCs) are almost always in fixed locations.  The only time anyone thinks of dispatchers taking the field is when there is a major incident brewing that requires an on-scene dispatcher presence to help sort through the chaos.  That on-scene presence is seldom for accommodating the ECC, but rather the incident commander.  Incident command trailers and vehicles, since the inception of the oxymoron "Homeland Security," have sprouted like mushrooms across the country.  Thousands of units have been purchased with grant money from DHS and they are outfitted with cutting-edge technologies that aren't available back at the home PSAP.  Satellite telecommunication, IP-based connections and microwave make these units self-sustaining, provided they're connected to a power source or a generator.  Plug it in and go!

When the World Trade Center came crashing down in 2001, so too did the New York City emergency operations center.  Since most PSAPs are located in public buildings they are just as vulnerable to destruction as was New York over a decade ago.  The real purpose in all the DHS grants is to provide communications in the event of a similar disaster.  Terrorists are not the only things that create disasters.  Given the breadth of climatic changes that we've seen over that same decade, it takes little imagination to envision weather becoming a principle factor in many disasters.  Would a dispatch center be any better off if it were destroyed by flood, tornado, or hurricane rather than a terrorist act?  How about an earthquake or a devastating fire?  As General George S. Patton once observed, "Fixed fortifications are monuments to the stupidity of man."  At a time when the technological world is gearing everything toward mobility in accessibility, why does the emergency telecommunications industry still cling to the outdated brick-and-mortar concept?  Did we learn nothing from 9/11?  It took the Murrah Federal Building bombing for us to start considering interoperability.  When are we going to start grasping the significance of General Patton's observation?

A pragmatic look at today's PSAPs suggests that tradition is the primary reason that mobility hasn't been considered a strong motivation thus far.  Twisted-pair, CAT5, CAT6, and even fiber optic cabling for connectivity with callers has been the fundamental logistic that previously restricted communications centers to fixed locations.  But the days of hardwire connectivity being essential to PSAP operations are over.  Mobility can exist at the receiving end of emergency calls just as easily as it can at the initiating end.  The big question is, "why."  Why would a PSAP want to be mobile?

Well, there is the obvious issue of getting out of harm's way.  When the flood water or the tornado is about to wipe out the PSAP you've got to find a place and a method for handling the ensuing emergency calls from all those tweeters and cell callers after it has struck.  If the PSAP isn't there anymore, the show must still go on and an alternative method and location must be found.  Why not make operations mobile in the first place in order to avoid the additional chaos that comes from having everything go down for any length of time?

Now I'm not suggesting that the motivation for mobility need be along the lines of Yasser Arafat's standard; "never a night in the same place."  I'm a pessimist, but not to that extent, and I'm certainly not paranoid.  However, being functionally mobile with all operations would mean that stealth could be added into the mix if and when it ever became necessary.  The only downside to moving around a lot is that your relief needs to know where you are in order to be able to relieve you.

Since dispatcher wants and needs are routinely at the bottom of any list of things to be considered by planners or by management, I suggest that greater efficiency might be found outside the confines of a single room.  Emergency telecommunications could evolve into a model that is closely parallel to that employed by many private companies all over the country - numerous workers telecommute and labor from home saving commuting costs at a time when those costs are through the roof.  Employees work longer hours and often prove more productive beyond the walls of an office building.  Face it; with a properly equipped laptop and a headset, dispatching can be done virtually anywhere.  Certainly security is a concern, and employee work product would have to be closely monitored for seamlessness and efficiency.  But the argument that it is technologically impossible has disappeared, opening up new avenues for a dispatching cadre that could include people with an array of walking disabilities that preempt them from doing the job outside of their own domicile.  It's a heck of a lot easier and cheaper to comply with the Americans with Disabilities Act by letting people work in their own homes than it is to accommodate a variety of disabilities by retrofitting a single workplace.  And make no mistake about it; there is a significant portion of our population who can handle well the emotional rigors of dispatch if mobility in communications can overcome and accommodate their immobility.

Regardless of whether emergency PSAPs become mobile in our lifetime, the sheer number of new technologies being thrust upon our industry can, at times, be overwhelming.  Attend a conference or a trade show and you will immediately be assaulted by a corps of vendors who all vie for your attention with their latest offerings.  CADs that do everything but make coffee, logging systems that will recover the missing eighteen minutes of the Nixon tapes, and radios that will transmit and receive to and from the far side of the Moon are just the openers.  Bells and whistles abound when it comes to software and hardware and judicious shoppers will closely assess need versus what is being offered.  While NG9-1-1 is coming at us at full speed, we need to be wary of what is actually being offered under the guise of NG9-1-1 to insure that what we get is what we need.  For as we keep General Patton's thoughts in mind, we need also to be mindful of his comrade in arms, General Omar Bradley.  I've quoted him before in this column, but his observation is appropriate to this discussion as well: "If we continue to develop our technology without wisdom or prudence, our servant may prove to be our executioner."

Failure should not be included in any emergency telecommunicator's options box because our job is about life and death.  If our technology fails, we fail.  More important; if we fail to plan properly, our technology fails and we fail.  Redundancy and mobility should be key ingredients in all future planning of PSAP operations, and proper PSAP planning should include the valuable input of the people who actually sity in The Chair.

Quality Is Job 9-1-1

Taken from 9-1-1 Magazine.com 2-12-2012

Written by Barry Furey, involved in public safety for more than 40 years, having managed 9-1-1 centers in four states.  A life member of APCO International, at this writing he was director of the Raleigh-Wake County (NC) Emergency Communications Center.

With all the hoopla over the Super Bowl car commercials - especially the one starring Clint Eastwood - it may be fitting to start this piece with a reference to one from seasons past.  In the early 1980s, Ford Motor Company penned the slogan "QJ1" - which stood for Quality is Job One.  That seemed reasonable then, and still seems reasonable now.  After all, if you are going to do something, you might as well do it right.  That axiom certainly applies to 9-1-1.

That being said, the state of quality control within our industry truly requires a case-by-case study.  Some states have standards; others do not.  Some agencies train; others do not.  You get the point.  Realistically then, quality must begin at home.  But what do we mean by quality?  What do we measure and how often do we measure it?  And, more importantly, what do we do with the results?

For starters, let's consider the fact that we're not even really sure what to call the process.  Is it quality assurance or quality improvement?  The first suggests that good service is essentially a lock.  After all, you're assuring it, aren't you?  On the other hand, the latter implies that you've already got quality, but you're going to make things even better.  Maybe it really doesn't matter in the end as long as something is done that both monitors - and hopefully improves - levels of service.

If you are utilizing a protocol-based call taking and dispatching methodology such as Emergency Medical Dispatching (EMD) or its fire and police variants EFD and EPD, chances are you have some sort of review mechanism built it.  After all, if you are committing to a scripted process it makes sense that its proper use has to be validated.  If not, you have nothing but a false sense of security.  Typically, methodology and guidelines for review are provided by the vendor.  But, in order for a quality assurance/improvement to work, it has to encompass more than one area.  For example, unless you are an EMS-only PSAP, emergency medical calls will make up only a portion of your Center's call volume.  Unless you use a protocol for every service you support, something is going to fall through the cracks.  Even when protocols are routinely used, the measurements called for may not cover every aspect of good customer service.  Where they are not used - or used for only one service - a majority of your calls may pass without review.  This is certainly not a strategy for success.

If, indeed, you are truly interested in quality, then a system that allows for the monitoring of both telephone calls (inbound and outbound) along with radio transmissions, CAD entries, and all other forms of communication (such as Mobile Data Terminals) is in order.  I include the latter because I've known several situations where such electronic traffic could be considered less than professional.  With  Freedom of Information requests flying about, you'll be glad you thought about looking there first.

In beginning the process, it's reasonable to take some guidance from those systems that have already been put in place.  Typically, 5% or less of a dispatcher's calls are actually reviewed.  Still, this provides a reasonable sample.  Another consideration is the assurance of random monitoring.  After all, having a less than fairly uniform comparison of all employees is also less than fair.  There are a number of software suites out there - some provided as part of logging recorder packages, and others as third party stand-alone programs - that can help you both create a valid call selection and grade your reviews.  The more flexibility a program offers, the better; especially when it comes to creating a list of key elements and a means for weighing each category.  What you look for is up to you, but it should at minimum include controlling the call, obtaining the correct information, documenting this information, adherence to procedure, disposition of the call (dispatch, relay, etc.) and professional demeanor.

Aside from the mechanics of QA/QI there are the personnel issues to consider.  I recently became part of an online discussion regarding whether or not observations from a regularly performed review could or should be used to initiate a disciplinary action.  While I strongly maintain that management must assure employees that such reviews are not witch hunts (and must make sure that they are not,) it is also my belief that you can't ignore a problem if you find it.  While some discretion may be applied, serious issues need to be addressed.  Sometimes observations may lead to more training or other options, but there are clearly cases where discipline is suggested.  After all, if you don't fix what's broken, you are neither assuring nor improving quality.  And isn't that what you started out to do in the first place?

Protocol Use in Emergency Dispatch: An Evolving Standard of Care

Taken from 9-1-1 Magazine.com, 5-13-11, originally published in April, 2008 issue

Written by Brett Patterson, Academics and Standards Associate of the National Academies of Emergency Dispatch (NAED).  Involved in training, curriculum, protocol standards, quality improvement, and research.  He is a senior EMD instructor, a member of the NAED College of Fellows, Standards Council, and Rules Committee, and also serves as Curriculum Board Editor and Research Council Chairman for the NAED.  He became a paramedic in 1981 and began a career in EMS communications in 1987.  Prior to accepting a position with NAED, he spent ten years working in a public utility model EMS system in Pinellas County, Florida.

Protocols have become an integral part of modern day, emergency dispatch operations.  Protocols reduce variance, ensure a continuity of care, reduce liability, standardize response decisions, and provide a basis for performance measurement and quality improvement efforts.  It's not wonder that protocol use has become a rapidly growing standard in a discipline that has, historically, been fraught with inconsistencies in call receipt, processing, interrogation, instruction, and dispatch.

Before the use of protocols in the United States, emergency dispatching involved little more than an individuals interpretation of a complaint, perhaps some ad-libbed questioning to satisfy the dispatcher's curiosity, and the subsequent dispatch of a generalized resource that was left to interpret second-hand, subjective information and fend for themselves.  Mistakes were common because, in the non-visual environment of dispatch, unwritten, vague and varied procedures were forgotten, overlooked, or simply omitted by well-meaning individuals with little or no training.  Quality improvement efforts were either non-existent or in vain because without a standard in which to measure, the best efforts were simply reactionary, occurring only after a mistake was realized.  As a result, addresses and callback numbers went unverified, caller interrogations were incomplete and inconsistent, pre-arrival instructions were ad-libbed or non-existent, and resource allocations were often either wasteful or inadequate.  Concurrently, lawsuits became commonplace, perhaps becoming the saving grace of emergency dispatch, sparking the move to standardize dispatch methods in the same way field operations had years earlier, through the use of well thought out, pre approved protocols.

Although there are many benefits of protocol use in emergency dispatch, the driving force behind their proliferation in EMS involved resource allocation and pre arrival instruction.  While police departments had been using protocols, or at least guidelines, to sort calls according to priority for years, EMS agencies were still fighting turf wars by establishing political and jurisdictional boundaries that often resulted in a reluctance to respond the closest ambulance to an emergency.  Jeffery Clawson, considered by many to be the Father of Emergency Medical Dispatch, became frustrated by the response policies and associated political complications in his hometown of Salt Lake City, Utah in the late 1970s.  When he took action by speaking out and writing letters, he was eventually asked to take a more proactive role by becoming the city's Fire Surgeon.  Dr. Clawson then concentrated on developing protocols to standardize how EMS resources were deployed as related to type (ALS vs. BLS), priority, and location.  The rest, as they say, was history.

The discovery of pre arrival instructions was the next motivating factor in the development of emergency dispatch protocols.  Pre arrival instructions began with well-intentioned field practitioners working or visiting in communication centers.  When a call came in that was perceived as needing immediate attention, these paramedics, EMTs, or CPR certified individuals would provide ad-libbed instructions, before the arrival of responders.  However, because these professionals were trained to assess and treat patients in a visual setting, they often missed important clues to the patients condition due to a lack of non-visual interrogation skills and standardized questioning.  They also provided instructions that were difficult to understand or interpret.  Even so, anecdotal successes were well received and celebrated by communities and professionals alike.  Eventually, as such instructions became a public expectation in a few communities, efforts to standardize and adopt pre arrival instruction methods gained momentum.  As success stories became abundant, the media became more and more interested in the new phenomenon.  In addition to the local news celebrations, television shows, most notably Emergency and then Rescue 9-1-1, played an important role in making pre arrival instructions not only a national, public expectation, but also a standard of care in the industry.

Toward a Consistent Standard of Care
As public expectation evolved the standard of care in emergency dispatch, a duty to act was established in local courts.  This was a very important development because, due to the very fragmented and inconsistent way EMS has developed in the US (town, city, or county based vs. state or national delivery), only a relative few agencies had actually adopted formal protocols for emergency dispatch.  Even so, and probably because of national television coverage, even the smallest of communities had the best of expectations.  These expectations, coupled with the growing national standard of care, prompted lawsuits when pre arrival instructions were not provided in some communities.  Ironically, it was fear of liability that kept many of these agencies from providing the kind of help that their communities actually expected.  Eventually, however, as the growing number of lawsuits clearly involved omission rather than commission, more and more EMS agencies got the message and implemented pre arrival protocols.

While public expectation played a very important role in this evolving standard, written standards and expert opinions concurrently helped to cement it.  In 1983, Utah became the first state to require the use of dispatch protocols and established a curriculum for the certification of dispatchers.  Shortly thereafter, the US Department of Transportation issued a curriculum and a sample protocol for training.  In 1988, the National Academy of Emergency Dispatch was formed and began certifying dispatchers and developing national standards.  Today, the National Academies of Emergency Dispatch (NAED) has evolved to incorporate police and fire protocol standards into their mission.

In 1989, the emergency medical community got involved when the National Association of EMS Physicians (NAEMSP) issued a position paper on the subject.  This paper laid an important foundation for the implementation of emergency medical dispatch protocols because it recommended the elements considered most important in their construction: "The functions of emergency medical dispatching must include the use of predetermined questions, pre-arrival telephone instructions, and pre-assigned response levels and modes.  The EMD must understand the philosophy and psychology of interrogation and telephone interventions, and be expert in dispatch life support.  Minimum training levels must be established, standardized, and all EMDs must be certified by governmental authority."

In 1990, the Americal Society for Testing and Materials (ASTM) published Standard Practice for Emergency Medical Dispatching.  This document defined the functions of emergency medical dispatch including dispatch prioritization and the provision of pre arrival instruction.  It also recommended dispatch-specific medical training and the use of an Emergency Medical Dispatch Priority Reference System (a protocol) to ask key questions about patient condition and incident type, to determine the necessity for and provide pre arrival instruction, and to select predetermined response levels based on information obtained.

Today, it is estimated that more than 90 percent of EMS agencies have implemented the use of some sort of protocol or guideline to provide pre arrival instructions, although this percentage is estimated to be less in agencies controlled by police or fire departments.  The problem is that due to a lack of continuing dispatch education and formal quality improvement programs, compliance to protocol is often poor.  These factors severely limit the effectiveness of protocol use through the introduction of variance and subjective decision-making.  The same problems exist when guidelines are used instead of protocols, as methods are open to interpretation and difficult to measure due to their subjectivity.

Protocols & Quality Improvement
Ironically, protocol compliance issues are often compounded by well-intentioned efforts to improve compliance.  Quality improvement programs are relatively new to emergency services and, unfortunately, are not well evolved.  Too many agencies interpret quality improvement as a simple check and discipline routine that is often more destructive than productive.  When such big-stick methods are employed, dispatchers become frustrated and, eventually, robotic in their actions, because they perceive their agency's goal for them as nothing more than reading a protocol without incorporating human thought, judgment, or feeling.  This inappropriate practice then becomes, on the surface, a standard argument against protocol use with opponents citing that protocols limit, rather than enhance, the natural abilities of good employees.  This could not be further from the truth.

The components of a sound, quality improvement program are too complex to be detailed in this article.  Quality improvement is a philosophy of continuous improvement that must be adopted by the entire agency.  It involves careful attention to initial employee selection, orientation and training, statistically sound processes for randomized call review and analysis, appropriate group vs. individual feedback based on statistical evidence, and continuing dispatch education that is specific to the needs discovered during case review.  When implemented and manage appropriately, quality improvement programs are far more positive in nature than negative and employees actually look forward to feedback, rather than despising it.  When this happens, the protocol becomes an indispensable tool that calltakers rely upon for guidance; a tool that omits guesswork and actually allows individuals to think about a call holistically and incorporate human judgment without being limited by the strain of ad-libbing questions and instructions on a case-by-case basis.  Protocols do not limit decision-making.  When managed appropriately, they actually enhance it.

As national and international standards have developed, more governmental authorities have begun to mandate the use of dispatch protocols and formal training and certification for dispatchers through legislation.  Although extremely varied from state to state, this initiative is clearly on the move.  In Delaware, not only are dispatch protocols mandatory, NAED Accreditation is a requirement of all EMS communication centers.  This process incorporates fundamental quality improvement efforts to make protocol use optimal.  In Massachusetts, a move is in process to require Emergency Telecommunicator Certification and to provide funding for emergency medical protocol software (ProQA) implementation statewide.  Maryland is considering funding the implementation of both fire and police protocols statewide, in addition to the currently funded medical programs.

Although protocol-related legislation is in effect or in the process of being adopted in several states, it is nearly as varied as the delivery systems it is being designed to improve.  In an attempt to help states adopt consistent legislation that promotes protocol use, the NAED has created generic, model legislation for consideration by state lawmakers.  This model can be downloaded at www.emergencydispatch.org under the Document Downloads link.

Internationally, the standardized use of emergency dispatch protocols has evolved very quickly.  With few exceptions, nearly all of the United Kingdom uses the Medical Priority Dispatch System to interrogate callers, allocate a specific response by priority, and provide pre arrival instructions.  The same system is used in Dublin and Belfast, Ireland; Edinburg, Scotland; Berlin, Germany; Innsbruck and Vienna, Austria; Turin, Italy; and all of the major cities of Australia, New Zealand, and Canada.

Protocol use in emergency dispatch has evolved from basic guidelines to sophisticated, software-based programs that benefit communication centers all over the world.  It is no surprise that agencies reaping the efficiency and effectiveness associated with modern-day protocols are the ones with sound, quality improvement programs.  Protocol implementation is a process that involves careful consideration not only to the protocol itself, but also to initial training and certification, statistically sound compliance measurement and feedback methods, appropriate employee interactions and involvement, and continuing dispatch education that relates to dispatch system performance and allows for concurrent recertification.  When implemented and maintained appropriately, and with the full support and buy-in of management, dispatch protocols provide a stable platform from which emergency dispatchers can provide consistent, pre approved help to those in need that meets and exceeds an evolving, standard of care.

Saturday, May 4, 2013

Heads-Up on Dispatcher Headgear

Taken from 9-1-1 Magazine.com (Originally published in July, 2006)

Written by Barry Furey, involved in public safety for more than 40 years, having managed 9-1-1 centers in four states.  A life member of APCO International, at the time the article was written he was Director of the Raleigh-Wake County, NC Emergency Communications Center

Perhaps no piece of communications equipment is less costly but more important than the headset.  Where telephone or radio transmissions must be clearly made and received, particularly in busy environments like communications centers, headsets offer obvious options over conventional speakers and desk microphones.  By placing both the microphone and speaker closer to the telecommunicator's mouth and ears respectively, headsets help to cut down background noise and improve the quality of both the transmit and receive audio.

Over the years, headsets have evolved to keep pace with other technologies.  There are now specialized devices that are designed for specialized applications.  While headsets used in the PSAP tend to be lighter weight and designed for comfortable wearing over long periods of time, bulkier models that more resemble ear protectors seen on the firing range are now appearing on the fireground.  Many departments, rightfully concerned about the background noise of sirens and diesel engines, are mandating their use on apparatus.

Both are a far cry from the first headset, developed almost a century ago.  As far as users go, public safety personnel are relative newcomers to the field, with aviators, and predictably, telephone operators, being among the first.  Since their inception, improvements in electronics have allowed for the miniaturization of many components, with the combination of science and user preference helping to drive the movement toward lighter weight models.  However, change has also come about as a result of health related concerns.  During the 1970s and 1980s, in the ear models were extremely popular.  Considerable discussion arose as to whether these devices increased the chances of ear infections and/or provided additional risk of hearing damage from loud noises when compared to other styles.  This style is still available, but there are now many more choices.

Today, headsets can be categorized into several different types.  Monaural, or single speaker styles, are commonly used in facilities where the telephone and radio must both be answered, or where the ability to monitor internal communications is required.  Binaural devices use two speakers.  The type of microphone used creates an additional division.  Noise canceling mics are designed for use in high ambient noise situations.  The little plastic disk on the end of the speaking tube with which we are all familiar is not indicative of a noise canceling microphone.

Since we are living in a wireless world, it should come as no surprise that wireless headsets have made inroads into PSAPs.  Offering similar conveniences to cordless telephones, wireless headsets allow greater freedom of motion, since the user is not tethered by a cord.  And, since cord replacement tends to be a recurring process for conventional headsets, this maintenance issue is eliminated.

Still, this choice does not come without its drawbacks.  Wireless devices tend to cost two to three times more than standard headsets and battery life and replacement can be issues.  You should be prepared to buy a new battery annually.  Cost is about $25.  Although this isn't exorbitant, and should be weighed against the replacement cost of cords, it can add up for larger agencies and multiple users.

Another concern is that of crosstalk and interference, which can happen anytime you add another radio to the mix, because essentially wireless headsets are two-way radios.  One reader, commenting on these devices stated that, "We purchased 5 of them and they worked fine for about a year but then we had to start sending the bases back to be serviced because the dispatchers were getting interference on the headsets and some of them were hearing each other's phone calls and radio traffic."  While it is not known how widespread this problem is, and the headset vendor was able to fix the problem through factory service, buyers should be aware that this issue could potentially exist.  However, with Bluetooth wireless technology headsets now available look for more innovation in these products in the future.

While we may be living in a wireless world, we are certainly not living in a homogeneous one, and the PSAP is most certainly a melting pot of diverse technologies.  To this end, the headset chosen will have to operate effectively in a potential mix of analog, digital, and increasingly VOIP worlds.  The latter will become of increasing concern as CPE (Customer Premise Equipment) uses IP from end-to-end.

The headset must also interface properly, where required, with the radio system in order to provide complete console audio.  This interface is normally a component of the integrated console electronics, but an amplifier box may be required in order to properly control headset volume.  These amplifiers come in several shapes and sizes ranging from "black boxes" to in-line models and offer multiple features.  Some serve as adapters to interface with computers through USB (Universal Serial Buss) ports, while others are designed to support functions of ACD (Automatic Call Distribution) systems.  Knowing what you want your headsets to do is important.

Getting your basic design down right also matters.  For corded devices, having a long enough cord to allow for free movement of the user is critical.  Most of us have seen cords that were literally pulled out of the plug from stretching.  A supply of extra cord segments, speaking tubes, and spare ear cushions will also go a long way to keeping those headsets you have in service.

Regardless of the type of headset used, however, there are some health, safety and maintenance concerns.  Surprisingly, while little information seems to be posted in the United States, warnings come from the website of the Australian Council of Trade Unions, an organization representing workers in some call centers.  One topic of concern raised by this group is the phenomenon of "acoustic shock" which occurs as the result of an extremely loud noise.  This can be prevented by the installation of volume limiting devices in-line.  And while many agencies have taken to using common plugs, sharing of the headset itself is not recommended.  The ACTU lists several suggestions for headset cleaning and maintenance, but the mail recommendation is not the share headsets.

Regardless of your need, there are now sufficient designs and sufficient manufacturers to provide you with severale viable choices.  Because, after all, your headsets should be a good fit.

The Day I Went From Dispatcher to a First Responder

Taken from 9-1-1 Magazine.com (Originally published Jan/Feb 2008 issue)

Written by Mary Hay Davis, freelance writer who has worked as a police dispatcher for San Diego PD for the past 21 years (as of the publishing of this article). She is married, with two children, living in a small community east of San Diego.  Her hobbies include photography and interior design, as well as coaching youth sports.

If you work as a dispatcher long enough, you inevitably face one of our occupation's worst type of calls: the death of a child.  Any death call can be traumatic, especially if it comes on the heels of something you have recently experienced yourself, such as the death of a parent.  But almost all dispatchers I know agree that the call they dread handling and that weighs on them the most heavily afterwards is a call where a child dies.

I have handled such calls numerous times, and they are no easier today than they were 21 years ago when I started dispatching.  Over the years, the disturbances and the domestic violence and the fatal traffic collisions have become a blur of memories and words on my screen.  And yet I can recall vividly every call I have ever worked involving the death of a child, even before I had children of my own.  And I can hear in my mind the sobs coming over the radio of parents who have learned their child's fate when the patrol officer on scene advised "11-44," our radio code for fatality.

As bad as all of these experiences have been, they were still remote and indirect - something I experienced vicariously in a supporting role to the officers in the field who were directly involved.  That is, until four years ago when I learned firsthand exactly what occurs on the other end of the radio and the emotional toll it takes, not only on the victims but on everyone at the scene.  The insight that came from the events that day helped me become a better dispatcher to the community I serve.

It was a beautiful sunny afternoon in May - one of those rare days where my husband, a canine officer, and I actually had an afternoon off together.  Our kids were inside playing, while my husband and I enjoyed a beverage on our patio outside.  Suddenly, screams pierced the air, breaking the day's tranquility.

The screams continued and got louder, and my husband and I started running up the street toward the source.  As we ran, our next-door neighbor pointed to the neighbor one more house down, and we heard wailing coming from the yard.  My husband was several steps ahead of me, and he raced up their driveway.  I had just turned a curve to where I could see what was going on - that the resident was holding the limp and lifeless body of a three-year-old child in her arms.  My husband wrenched the boy out of her grip and immediately began CPR.  When I got down the driveway, I wrested the phone away from her other hand and took over the 9-1-1 call.  I tried to talk to the dispatcher, but there was still so much screaming and sobbing that it was hard to communicate.  The dispatcher calmly got the information from me as to what condition the child was in on a moment-to-moment basis and kept assuring me that help was on the way.

In hindsight, it was very surreal, and I experienced the exact same time-space continuum that so many of our callers do: "What is taking you so long to get here? It's been 10 minutes!" when, in fact, it was only three or four.  Seeing the lifeless body and the child's blue face and lips twisted my perception of reality and slowed every single moment into almost a freeze-frame sensation.  As I knelt over the boy's body, on the opposite side of my husband, who had paused to check for a pulse, I heard it - a gurgling sucking sound that produced a voluminous amount of water and some vomit.  And then came a sound we didn't think we would hear - a huge gasp.  At that moment, time stood still as I wondered whether there would be another.  And then it came...and another...and another.  After spitting up some more water and vomit, the boy started taking more breaths, and then started crying.  At that point, both the boy's mother and the resident started sobbing in the faintest of hopes that this tragedy might have a good outcome.  And while the boy was indeed breathing for now, we had no idea what the outcome would be.

Eventually, the first responders showed up and took over the boy's care.  I turned my attention to the mother, who spoke only Spanish.  I tried to calm her and offer what little support anyone can during a crisis like that.  After a few minutes, they loaded the boy into the ambulance to take him to a staging location to be airlifted to Children's Hospital.  I drove the mother there to be with him; then, as he was flown away, I took her to the hospital.  I stayed a few hours until we found out the child's condition - that he was one of the few lucky ones and would survive.  Not only did he make it, he had absolutely no brain damage.  He was kept overnight for observation and then released the next day - a day he spent at the San Diego Zoo with his parents celebrating all that could have been lost.

It took me a few days to process all that had occurred that afternoon.  How a series of congruent, fortunate events - us being home and outside, and our middle neighbors being out to relay the screams for help - all came into alignment to give us crucial seconds that allowed for the resuscitation and revival of this boy.

While my husband and I took great satisfaction in the happy outcome, it dawned on me shortly afterwards that this was almost routine for him, and that he had handled incidents like this throughout his career as a first responder.  For me, it was a life-changing event - not only personally but professionally.

Never had I witnessed something this traumatic in person, let alone responded to it as a rescuer.  Hearing screams on the other end of the phone as a dispatcher is just part of a day's work for me.  But on that day, hearing the desperate screams and shrill sirens in person as they pierced the air gave me a profound and heartfelt new respect for what our caller's experience.

Through the years, it is easy for dispatchers to become complacent and see the callers' names on the screen as just words and letters.  You go into emotional survival mode, detaching yourself in order to stay sane amid the chaos.  But this experience that jolted me so personally four years ago has stayed with me professionally.  Every name on my screen represents flesh and blood and emotions that make up that person and all his of her humanity - a human being that needs my assistance at that moment.

Our neighbors have since moved, and we lost track of the little boy.  But I still think of him and his blue lips and how, for those interminable 10 minutes, his whole future depended on a roll of the cosmic dice - survival or death.  Even though our experience had a happy outcome, I relive it every time I get a death call, such as the call about the drowning of an 18-month-old girl in a backyard pool a couple of years ago.  This little girl was not so fortunate.  Although transported, she succumbed - her blue lips never again to turn pink, her mother never to hear the words, "She's gonna be okay." Never to take another trip to the zoo, or graduate high school, or marry and raise a family.  I think of all the things that little girl will never experience, and I think of all the anguish her family will continue to endure.  And even more sadly, I know that there will contine to be more calls just as tragic.

The little boy in my story has a name: Diego.  Four years ago he, too, was just a name on some dispatcher's screen, a mere statistic in the 9-1-1 center's answer times and the field unit's response times.  I promised myself that day that I would never forget the near death of this child.  But Diego's legacy to me is not just in the happy ending we experienced as his lips drew the breath of life back in.  His legacy lives on in every call I dispatch.  While I know that, yes, some victims will live and some will die, no longer are they just names on my screen.  Each is an individual, a person with a family and a future.  And I will dispatch accordingly.  For Diego.

What's On Your Desktop? Monitors, Maps, and Manuals That Shape Our World

Taken from 9-1-1 Magazine.com Magazine (Originally published in Nov/Dec 2006 issue)

Written by Barry Furey, involved in public safety for more than 40 years, having managed 9-1-1 centers in four states,  He is a life member of APCO International, and Director of the Raleigh-Wake County, NC Emergency Communications Center at the time the article was published.

A current television commercial asks, "What's in your wallet?"  For thousands of telecommunicators, a more pertinent question is, "What's on your desktop?"  The answer to the first question is a well known credit-card.  The answer to the second is not so easy.  In fact, there is no single correct answer.

The tools of the 21st Century telecommunicator are as diverse as the duties he or she performs.  Chances are good that some form on Computer Aided Dispatch graces the work space; however the size of the community served plays a major role in whether or not automation is used.  According to a 1999 survey performed by the Bureau of Justice Statistics, 100% of municipalities serving 250,000 or more residents were computerized, while only 18% of towns with less than 2,500 people had gone digital.  These smaller communities still rely on the tried and true paper and pen method, although dispatch cards are also common sights in larger facilities; albeit as a backup for the times when CAD goes down.

Since about three-quarters of US counties have Phase I enhanced wireless 9-1-1 service, and about one-half have Phase II, some form of geo-location device is now also normally present.  In the simplest form, this is an ALI (Automatic Location Information) display that can receive latitude and longitude, and a paper map.  Increasingly, it is a map-driven CAD or integrated computer and telephone system that can import wireless ALI and auto-populate a screen with the approximate location of the caller.

And, since an increasing amount of our activities are computerized, a wide range of programs -- not all specifically designed for public safety -- can also often be found.  Emergency Medical Dispatch is performed by many agencies, but it cannot be performed without the proper guidance.  EMD may exist as a stand-alone computer program, as a program interfaced to CAD, or as a manual card system.  Also entering the scene are similar guidelines for fire and law enforcement.  While many of these are produced specifically for this purpose, others are home-grown.  Decision-tree and expert-tutor type software can be modified to assist dispatchers in the call screening process.

Electronic versions of the old standby blue book and city directory also exist, providing cross-reference telephone information.  Of course, a desktop connected to the Internet truly opens up a world of possibilities.  National white and yellow pages are available online, lessening the need for ever having to dial directory assistance.  Reverse look ups by number or address can also be obtained.  Other popular resources are Geographic Information System sites.  Primarily operated by local government agencies, many provide residence ownership information, and some even provide photos and plot plans.  GIS web pages often have available layers for features such as topography and utilities.  If these features are not present on the CAD map, they can be readily accessed for use in emergencies.  These are valuable assets in managing a wide variety of calls.

Even commercial based map sites can be of benefit if there is no map associated with CAD, or if no CAD is present.  Although the data may not always be completely current, they can often offer a cost effective way of finding an address and even response directions; particularly if a local response team or fire department is traveling to an incident in an unfamiliar area or adjoining jurisdiction.  Though not strictly a mapping resource, traffic cameras operated by local and state departments of transportation, and even local television stations can be of benefit in getting the picture when it comes to handling major accidents and weather emergencies.  The ability for telecommunicators to obtain real-time views of accident scenes or to visually check the status of evacuation routes can be counted among the many benefits.

Many former "paper" resources, such as hazardous materials guides, are now also readily available via the Web.  And, when it comes to education and training, Internet resources are almost unlimited.  With the current focus on NIMS, FEMA produced online training is a popular destination for surfing telecommunicators.  Several associations, institutes of higher education, and private vendors have an extensive array of classes, including recognized degree and certificate programs, designed for and directed to public safety personnel that can be completed via Internet.

Of course, access to the Web does not come without risk, and stringent security precautions must be taken.  NCIC and SCIC regulations must also be considered.  Short of full-blown access, agencies may provide a limited gateway to selected, approved sites, restrict the Web to a dedicated machine, or may establish an internal intranet.  Intranets provide a localized means of accessing information using web-based technology.  They are an increasingly common means of organizing the storage of forms, SOPs, and other documents used in daily operations.  The use of hypertext and links, for example, can provide an easy means of searching large policy manuals through the use of keywords.

Regardless of how it is reached, weather-related information and weather maps also rate high on the dispatcher's toolkit.  From a TV station's Doppler radar feed to subscription forecast services, having advanced warning on serious storms can provide public safety with time to prepare.  As we continue to add these tools to the desktop, however, we can also see changes in the desktop itself.  Monitors, by necessity, have gotten larger in order to display an ever increasing amount of information.  Perhaps, a more correct statement is that monitors have gotten wider, because the use of flat panels by many agencies has actually reduced their depth.  The surfaces on which they are mounted may also now rise and fall, depending upon whether the operator chooses to stand or sit.  And, somewhere on these surfaces may also be found environmental controls that set temperature and airflow.

As is the case with many industries, some non-standard issue equipment can commonly be found.  Many telecommunicators maintain personal notebooks and cheat-sheets to use as references, when required.  And very few will be found without some sort of personal stash of snacks, sundries, and Sudafed nearby.  This may be decidedly low-tech, but imperative.

Perhaps the most important control room technology is not technology at all, but rather, the people who use it.  A perfect and very recent example of this is Tammy Rogers of Central Communications in Bentonville, Arkansas, who spent forty-eight hours tracking down a wireless 9-1-1 hang-up.  According to the Benton County Daily Record, dispatcher Toni Brandon answered a call from a juvenile, apparently in distress, reporting that she had been shot.  A non-initialized handset was used, and no location could be obtained before the caller was disconnected.

Over the course of the next two days, Ms. Rogers showed a mix of ingenuity and uncommon tenacity.  Using both law enforcement and cellular carrier resources, and a myriad of desktop tools, she was finally able to determine that the telephone had been given to a child as a toy, and that the call was -- fortunately -- not an actual emergency.

Given the skills demonstrated by dispatcher Rogers in the case, and by many other telecommunicators on a daily basis, the most critical question may not be, "What's on your desktop?"  Better we should be asking, "Who's sitting in your chair?"