9-1-1; What Is Your Emergency?

Wednesday, July 31, 2013

Expert Advice: Too Many Questions?

Taken from Public Safety Communications Magazine, May 2013
Written by T.G. Mieure, an APCO Life Member from Illinois.  He has been involved in public safety for 40 years.

I was taking a 9-1-1 call, and the caller started yelling at me for asking too many questions.  How else can I get the information I need to dispatch the call?

"If the caller is uncooperative and refuses to answer questions, we always advise the responders that the caller is uncooperative.  This warns them that they may find more of the same behavior once on the scene."

"One of the greatest issues, in my opinion, is that the public doesn't recognize that help can take several forms.  They don't understand that there are different types or differing amounts of resources that are sent, depending upon the circumstances or that the response determination is based on so many different factors."

If you have the luxury of more than one telecommunicator working, then I would get just real basic information, relay it to my partner so they can get the proper  response on the way.  Start asking the follow-up questions and let the caller know help is on the way and you have to ask a few more questions.

What if you're the only telecommunicator working, what do you do?  I would again obtain basic information from the caller and send the appropriate response.  You let the caller know help is on the way and you are going to ask the caller a few more questions.

I've also found, if possible, letting the caller listen to you send out the call and responding units reply back reassures the caller that help is really on the way.  Then you can start asking the protocol questions.

You must also remember that the caller may not understand what is occurring.  This may be their first contact with 9-1-1 and/or your agency.  They think it is taking forever to get help on the way when, in fact, it is only a few seconds.  You, as the telecommunicator, are not seeing or experiencing what the caller is seeing.

Another avenue to use, but it is not as quick as the above examples, is that of 9-1-1 public education.  You can easily put together a 20-30 minute program for presentation to civic groups, citizens' police/fire academies, schools, etc.  This gives you a chance to review why we ask so many questions.  It would be great to create a Frequently Asked Question (FAQ) sheet as a handout for your presentation.  You could also do some role playing, with audience participants simulating some minor calls like a prowler, brush fire, etc.  Consider placing information on your agency's website with general guidelines on calltaking.

Illinois APCO has a website (www.il911info.org) to assist in 9-1-1 education.  IL-911Info is a joint venture between the Illinois APCO Chapter and the Illinois Chapter of NENA.  Their goal is to communicate with people of all ages on the most effective use of calling 9-1-1 in any emergency situation.  There are numerous brochures to use and handout material available from the website.

It seems like this type of problem occurs a lot during an emergency medical dispatch (EMD) call for service.  We all know there are more questions to ask for this type of call.  You, as a telecommunicator, should try to put yourself in the caller's shoes.  Then ask, what would you be feeling?  Remember, this could be your mother, father, etc. on the other end of the phone.

I'll give you an outlandish example.  A telecommunicator took an EMD call from a frantic female needing EMS for her father.  The caller became very irate to the point that she was going to come to the comm center and kick the telecommunicator's butt.  Once the ambulance was sent, she was still belligerent toward the telecommunicator and hung up.  She never came to the comm center.

This incident with this caller occurred two more times in about a six-month period.  The third time, there was discussion about having her arrested.  Instead, the supervisor invited her to the comm center and gave her a tour.  She was shown a set of the protocol cards, and the supervisor explained to her why we ask the questions.  During this tour, an EMD call came in and she saw how the telecommunicator handled the call using the protocol cards and dispatching the EMS unit.  She left with a positive attitude toward the comm center.

In conclusion, belligerent callers are typically frantic with worry and don't understand the system.  You should provide reassurance that help really is on the way and that the questions you're asking are not delaying the help they need.  Doing so will help you get the information you need to send the appropriate resources.

12-Hour Shifts: A Luxury or a Liability?

Taken from Public Safety Communications Magazine, May 2013
Written by Charles D. Carter, certified litigation specialist and 9-1-1 consultant with more than 30 years of public safety experience.

Twelve-hour shifts have become the norm for 9-1-1.  Employers and employees love it.  Given a choice, employees vote to keep it.  Why?  Shift Schedule Design says there are more days off, more weekends off and longer breaks between shifts; managers enjoy such benefits as better productivity, reduced absenteeism and lower turnover.

Disadvantages: Sitting at a terminal or work station for 12 hours straight can increase the likelihood of ergonomic problems; it's harder to cover absences; employees may find it easier to take on a second job; employees take longer to get back up to speed and to learn procedures and directions.  Managers can alleviate this by avoiding 12-hour work patterns that have long breaks; and training that must be done on the employees' days off.

Is working 12 consecutive hours in a fast-paced, high-stress, physically and mentally demanding environment a good idea?  Does it support the clear judgment, quick thinking and reflexes, and life-and-death decisions that we must make in the public safety environment?

The weight of evidence by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) strongly suggests that extended-duration work shifts significantly increase fatigue and impair performance and safety.  The JCAHO report refers to a study that demonstrated that physicians in training who work extended schedules:
  • Make 36% more serious medical errors;
  • Make five times as many serious diagnostic errors;
  • Have twice as many on-the-job attentional failures at night;
  • Double their risk of a motor vehicle crash when driving home;
  • Experience 1.5 to 2 standard deviation deterioration in performance;
  • Suffer performance commensurate with a blood alcohol level of 0.05-0.10%; and
  • Report making 300% more fatigue-related medical errors that lead to a patient's death.
There are also longer term health detriments due to shift work and chronic sleep deprivation.  Sleep deprivation and the circadian system affect metabolic processes, which may result in increased risk of cardiovascular disease, insulin resistance and diabetes.  Regular nightshift workers also have an increased risk of certain cancers, particularly breast cancer, when compared with non-shift workers.

A NIOSH study says, "Extra caution should be exercised when scheduling critical activities for extended work shifts, especially extended night shifts."

In spite of individual variability, tiredness increases anxiety scores, irritability and depression, and it deteriorates cognitive performances.  The concept of prophylactic rest considers that a subject cannot start work rested if he did not sleep at least five hours the previous night or 12 hours during the previous 48 hours.

Two recent studies funded by NIJ make important additions to this research effort.  The first study examines sleep disorders among law enforcement officers, and the second explores the impact of shift length on officer wellness.  The study focused on police officers, but could apply to 9-1-1 telecommunicators.  To illustrate, I have replaced the words "police officer" with the word "dispatcher."

One of the greatest dangers to dispatchers and their overall performance on the job is often overlooked--fatigue.  Dispatchers work demanding schedules characterized by long hours, frequent night shifts and substantial overtime.  Insufficient rest or irregular sleep patterns--coupled with the stress of the job--can lead to sleep deprivation and possibly sleep disorders.  The result can be severe fatigue that degrades cognition, reaction time and alertness, and impairs their ability to protect themselves and the communities they serve.

In summary, nurses, doctors and police officers who work extended shifts in a high-stress environment are more likely to suffer fatigue, which can effect their health and job performance, and the safety of those they serve.

Are dispatchers exempt from fatigue and health problems?  Hardly!  Where health and public safety are the issues, the public should not be placed at risk for the convenience of employers or employees.

Friday, July 26, 2013

Succession Planning: The Importance of Continuing Leadership Education

Taken from Public Safety Communications Magazine, July 2013
Written by John R. Brophy, director of quality assurance at Mobile Medical Response and the author of Leadership Essentials for Emergency Medical Services.  His experience spans 30 years and includes leadership development training at the local, regional, national and international levels.  He is a former fire department captain and Navy corpsman, and currently serves as the NAEMT liaison to APCO.

The development of leaders in an organization is vital to both its current and future success.  With the increasing rate of changes within the emergency communication field, and the ever growing focus on accountability of supervisors and managers, leadership competency will continue to play a central role in the success or failure of organizations and their leaders.

There are a number of ways leadership development can be accomplished, and no one "magic bullet" course or activity will provide what they need.  In many ways, leadership is a mindset.  It is not about title or position; it is about vision, communication and motivation.  To find the most success, leadership development programs must be multifaceted and ongoing.

Formal leadership courses are a great first step.  They provide core content and a foundation for the overall program, but these programs need to be meaningful and timely.  For example, if you promote a couple of people to supervisor positions and you have a leadership course that is required for all new supervisors, then it's important that they be scheduled for it promptly so that they are given the information and inspiration they need to begin their new role.  Some key elements should include providing them with insights on making the transition from "buddy to boss," which is often the most challenging of transitions in all of leadership, as well as discussions of ethics, interpersonal communications, leadership styles and other key elements that may be organization specific.

Often, new supervisors are promoted, assigned to work alongside a "seasoned" supervisor and considered trained.  While this approach does train them to do the job, it often doesn't provide them with the insights they need to begin to grow as a leader in their new job.  Providing some core material on what the organization expects, as well as what they should expect as they transition and take the next step in their career, will probide them with the insights they need to grow as a leader and, when well-executed, will send a message that their success is important to the organization.

To truly develop its leaders, an organization must further invest by providing ongoing activities and support.  With limited budgets, leadership development and other programs are often put on the chopping block.  In order to save them, the middle and upper leadership teams must creatively balance cost and benefit.  These key personnel  need the mindset that leadership development is not just a nice perk, but is actually a must have and is an investment in the future of the organization.

Through a commitment to the importance of leadership development and the application of some creative thought and collaboration, a lot of leadership development can be built into the daily, weekly and monthly routines with very little extra cost.  But for organizations to succeed in creating a leadership development program, they must first recognize and then accept that they have a leadership deficit.  If it is accepted that the deficit is actually an opportunity in the making, then an organization can achieve great things.  I recall working for an organization that invested in leadership development.  As the foundational event, we had a two-day leadership retreat away from the office.  When we returned, staff feedback was positive.  Our transformation from managers to leaders was underway, and it was palpable.

After a couple of months though, we started showing signs of our preleadership retreat selves and quickly realized we needed a "maintenance plan."  Conducting a leadership retreat every few months would be costly and time consuming, so that was clearly not the answer.  Instead, we implemented a monthly management meeting that provided opportunities to do more than just report on past, current and future events.  We began building leadership development activities into each of the meetings.  By taking the time we were already spending on management reporting and better utilizing the time by including some form of leadership activity each month, we had our "maintenance plan" underway at little additional expense.

Another inexpensive activity that can keep the leadership fire burning is what I call a "mini book club."  Find an article that focuses on a leadership topic and send it to your leadership team.  Granted, some will read it and some won't, but putting it out there and taking the "if you build it they will come" approach will engage many and send the message to all that leadership is important to you and the organization.  Over time, more will begin to read what you send, and as they do they will expand their minds and begin to anticipate the next article.  I turned this strategy into a "mini book club" by using a conference call we already had scheduled for on-duty supervisors and managers every Friday and extending the call five to ten minutes.  Depending on the topic, sometimes everyone was very engaged and the call would last an extra 15 minutes or more.  Members of the team had input on the topic and, over time, they began to take turns selecting the articles and facilitating the discussion.

Rotating the facilitation of the call and of meetings is another no-cost leadership development activity.  Supplying supervisors and junior managers with developmental activities builds their communication and organizational skills and provides them with opportunities to be the driver in the organization's journey to the future, rather than just a passenger.  Assigning collateral duties is yet another way of achieving leadership development and getting work done simultaneously.  Perhaps one of your supervisors could be the lead on  your quality assurance (QA) process, another could be responsible for facilitating maintenance and repairs of communications center equipment, a third could run certain reports, and so on.  By giving them ownership of their duties, you can keep them engaged while still making  sure that the work gets done in a timely and cost-efficient manner.

Relevant and timely feedback is vital in leadership development and succession planning.  Current and aspiring leaders need to be encouraged when they succeed and coached when opportunities for improvement exist.  There are many ways to do this, including involving their supervisor in their development.  If you think about the most effective calltaking QA processes, supervisor provided feedback is something that is clearly validated as an effective tool.  With timely and relevant feedback, calltaker proficiency and the scores that measure them improve and solidify.  The feedback is meaningful and can be applied to leadership development.  Make sure to avoid pointing out only weaknesses; be sure to point out successes too.  Say thank you, and call them out in a positive way at a meeting or send a hand written note when their performance deserves extra recognition.

Some organizations use 360 degree evaluations, mentoring and other activities that invest in their leaders and their development.  These are all great tools and should be part of the overall leadership development package that is available to your people.  Combining a 360 degree program with a mentoring or coaching program can provide great value because it identifies strengths and weaknesses in the eyes of the people around the leader and also pairs them with a mentor or coach who will help them solidify the positive, as well as improve on weaknesses.  Further, being a mentor or coach allows leadership development in addition to helping a peer or subordinate.  That's leveraging value!

Leadership development needs to be woven into the fabric of everyday activities to be the most effective.  It is often the most cost effective as well, so it becomes a value-added activity and not another expense that is headed for the cost-saving chopping block.