Stop Problems Before They Happen: The Importance of an effective quality assurance & improvement program

Taken from Public Safety Communications Magazine, November 2006
Written by Alicia Ihnken, training course instructor for APCO Institute


In a business full of acronyms, the letters QA/QI often send people running for the door.  Quality assurance and quality improvement (QA/QI) can be intimidating, boring, challenging or even frightening.  However, without such a program, a communications center, business or any entity that answers to another can get into deep trouble.  Unless administration is closely monitoring performance through QA/QI, managers may not be aware of performance issues affecting customer service and satisfaction, opening the door for liability concerns.  This article discusses the importance, purpose and common characteristics of an implementation ideas for a QA/QI program.

WHY QA/QI IS SO IMPORTANT
Do the same problems pop up time and time again in your comm center?  Is each and every calltaker and dispatcher where they need to be in terms of knowledge, skills and abilities?  Will the calltaker's actions hold up against public scrutiny should the call become newsworthy?  Does your agency perform emergency medical dispatch (EMD)?  If so, do you have policies in place to ensure adherence to program guidelines and procedures?  The answers to these questions will determine your need for a QA/QI program and underscore the importance of the program for ensuring the achievement of quality goals and objectives.

Without a formal QA/QI program, there is no system to document checks and balances, and there's no routine way to measure individual performance.  In agencies without a QA/QI program, problems are typically addressed only when someone complains or draws attention to short-comings.  This usually happens after the behavior has become entrenched in the offender.  With a comprehensive program in place, management - from frontline supervisors all the way to upper administration - has a better picture of how the operation is running, and errors and deficiencies in individual employee performance can be detected and corrected before they have a negative impact on agency operations.

The purpose of a QA/QI program is not to spy on the employee, but to enhance performance by identifying weaknesses as well as strengths.  When QA/QI is done properly, it can help the current employee and the trainee.  Good calls can be archived for training purposes and top performers rewarded for their efforts.  Bad calls can provide valuable feedback to the employee, trainers, supervisory staff and administration.

While conducting reviews, the evaluator can pick up on trends of acceptable and flawed methods and even gross deficiencies that may be overlooked because there was no corresponding complaint.  The information obtained can be used to revamp training methods and improve overall awareness.  If the program is successful, it can eliminate such excuses as "nobody told me" or "I didn't know we couldn't do it that way" because the program will emphasize continuing development and improvement.

A successful program is also a lifesaver (i.e., lawsuit-saver) when it comes to liability issues.  This works in favor not just of administration, but also of the line worker.  The line worker will have the tools, information and feedback required to perform at a higher standard.  Administration will have the proof that it's watching out for the success of its employees and the safety of the public.

WHAT SHOULD A QA/QI PROGRAM INCLUDE?
A QA/QI program should not be used for disciplinary actions.  It is a tool to ensure employees are following the policies and procedures that support the organization's mission.  Disciplinary actions should be left to complaints lodged and supervisor observations.  If the reviewer uncovers a problem, across-the-board remedial training should be the direct result.  If one employee has a problem area, others could very well have similar problems - or a less experienced employee may observe and learn the problem behavior - so no employee should be singled out during these training sessions.

A QA/QI program should be global in nature, while addressing specific policies and procedures on a continual basis.  Just as short-term solutions can lead to bigger long-term problems, long-term programs can prevent the need for short-term solutions.

Centers that follow EMD guidelines commonly conduct quarterly reviews, with parameters generally dictated by the medical director of the agency's program.  EMD guidelines should be followed stringently.

But what about the rest of the activity that goes on in the communications center?  First consider the main functions of the communications center.  Is it for only police, only fire/rescue or only EMS?  Is it a consolidated PSAP?  Is there a separate calltaking center?  What definitive areas exist for which guidelines can be established?  Are policies/procedures in place for each function of the comm center?  The structure and functions of your agency will determine the type of information to include in your QA/QI review.

Your QA/QI categories for review should be based on your policies and procedures.  No part of the QA/QI program should catch anyone by surprise.  It's not intended to "trap" anyone, but to provide an objective picture of what is really happening.  Encourage staff members to look at the whole process as a benefit to them and their professional development.  If there is to be any trapping, it should be focused on catching employees in the act of doing something right!  Categories for review can include fire radio procedure, police radio procedure, nonemergency calltaking, 9-1-1 calls, customer service - or any other area that has a defined policy.  The information for each will have similarities and differences.

A review schedule should include information on the types of calls to be pulled and a schedule of when the reviews will be conducted.  Methods for pulling calls for review can include completely random, only 9-1-1, only nonemergency, only traffic stops, only chest pain calls or combinations of these.

Once the areas to address have been determined and the policies and procdures put in place, the QA/QI reviews should be built around these elements.

The most important element in a QA/QI program is that everyone involved have a clear picture of its purpose and how to proceed.  All QA/QI programs must include proper planning, proper review and proper enforcement.

Proper planning consists of a comprehensive analysis of the organization's goals.  Without this, evaluation guidelines can't be created.  During this analysis, determine the expectations of the administration, responders and the public regarding the employees, the standards to which the employees will be held, the evaluation method (standard of measurement) and the overall review process.

Proper review ensures the overall effectiveness of the program.  Even though all reviews should point back to the overall mission of the center by reflecting the policies and procedures, it's not enough just to ask, "Were the policies and procedures followed?"  The reviews should be comprehensive, but at the same time not so tediously detailed that the reviewer gets bogged down in the form instead of focusing on the information being reviewed.  Consistency is key; therefore, a schedule of reviews must be set.

Proper enforcement is the "payoff."  If the appropriate steps are taken in the review process, the organization should have a clear picture of employee performance.  As a result, strengths and weaknesses will be clearly defined and action plans can be created and implemented.

To assist you in understanding the process, review the sample policy and procedure, compiled from various SOPs, and the sample QA/QI form based on the sample policy.  They both will be at the end of this article.

Practical Application
When creating your review form, carefullly analyze the categories/questions you're including.  Are they quantitative or qualitative?  Will the evaluator understand the questions and how they should be answered?  Is there room to write comments and observations?  There are as many sets of evaluation questions and styles as there are communications centers.  Some comm centers will share information with you in the name of public safety.  The APCO Institute has resources that may help you create the desired format, including Web seminars on how to develop and maintain a successful QA/QI program.  Build in the experience of others, and tap as many resources as you can.

Another important element in QA/QI program is the people and their understanding of the purpose and process.  Who should conduct reviews?  Who should be reviewed?  How should the reviews be conducted?  The answer to these questions depends on the structure of the communications center.  A large center may have an individual designated as the quality assurance officer; a smaller center may assign the task to shift supervisors or trainers.

Don't forget about self-evaluations.  It has been said that we are our own harshest critic.  Let some of that criticism take a positive form with self-evalutaions.  Give employees the appropriate time (i.e., 30 minutes or so) to review their work objectively and according to the guidelines set forth.  If this is presented in addition to supervisors and trainers conducting evaluations, it can soften the blow when mistakes occur.  What cannot be stressed enough is that this process should not be used for disciplinary actions.  Similar to the daily observational report (DOR), the QA/QI review may, however, be used for tracking performance and evaluating opportunities for improvement.  The moment it is used to discipline an employee, is the moment its effectiveness as an evaluation tool is lost.  Performance evaluations, complaints and other types of information should be enough to find problems requiring disciplinary actions without resorting to call reviews.

Implementing a QA/QI Program in Your Agency
This is where the rubber meets the road.  Proper implementation of a program that can save you and your employees from liability and improve the overall performance of public safety telecommunicators is crucial to a successful operation.  First, make sure you have a well-defined mission with clear-set goals.  These goals should be reflected comprehensively in policy and procedure.  Only after you have these important pieces in place can a fair evaluation system be created.  The right people and proper training are also crucial to successful implementation.  Do you have individuals, either supervisors or line personnel, who have the capacity to motivate and support others?  Can they be, or have they been, trained in mentoring techniques?  Take a closer look at current employee potential and follow best practices when hiring.

Develop a tracking system that will hold employees accountable to the program.  Several methods can be used to track call reviews (e.g., paper in a notebook with dividers, paper in a filing cabinet), but by far the most space-saving method is electronic.  Example: Names, dates and case/run numbers can be documented in MS Office Excel for easy reference and tracking.  Results of call reviews can be e-mailed to the appropriate parties.  This process does not have to be cumbersome.

Develop your preferred method of tracking before the first call review is conducted, and make sure the evaluators are very familiar with the system you plan to use.  It helps to have one person assigned to monitor the activity and compile reports for administration.  If everyone knows who is doing what, it makes it easier to hold employees accountable to the program and their duties.  With the right elements in place, including people who understand the process, the program should run smoothly.

Once the program is developed and you have the right people in place, how do you proceed?  If none of the employees were in the planning stage of the program, inform them of the process.  Everyone who works for an organization should be well-versed in its mission and goals.  Let them know who will be doing the evaluating and for what purpose.

Designate training times to familiarize those involved with the entire process.  "Roll call" training is a tool often implemented when the opportunities for classroom or meeting time are scarce.

Inform everyone of how and when the process will be implemented beforehand.  Give them a chance to digest the process and the opportunity to ask questions.  Even if an employee will not be conducting a review, he or she will still be subject to review and should be familiar with the entire process.

Set up a schedule and post it in an accessible area.  If there are no deadlines or the reviews can be conducted whenever the employees desire, the reviews will most likely not be done.  Give the employees the time and the tools to proceed, and hold them accountable.  Monitor the process to ensure timely results.

Summary
A quality assurance/quality improvement program should not be scary, daunting or overbearing; instead, it should be enlightening, helpful and beneficial to the organization and its employees.  To ensure your program meets these objectives, be sure you:

• Establish a clear mission with supporting goals;
• Have policies and procedures that support the operation;
• Have quality, well-trained employees; and
• Hold employees as well as management accountable to your clearly established QA/QI guidelines and methods.

The time you take in advance to build a solid foundation will eliminate the need for quick fixes and short-term solution.


Sample Policy & Procedure:
Nonemergency Calltaking

Policy: The purpose of this policy is to address proper nonemergency call handling within the communications center.  The seven-digit phone number to the communications center is 555-2525.  This number allows local access to the communications center for the public, responders and other area agencies.  Calltakers shall hold to the mission of the communications center and be professional and polite when dealing with all customers including responders, co-workers and callers.  Technical telephone training that addresses the operational aspect of phone use is provided in the initial training phase before the calltaker graduates to the on-the-job training.  This training and its corresponding policy and procedure are addressed separately.

Procedure:

1. Nonemergency lines shall be answered within three or fewer rings.
2. All nonemergency calls shall be answered, "Anytown Police, how may I help you?"
3. If an emergency call comes in on a nonemergency line, it shall be handled following the policy addressing 9-1-1 emergency calls.
4. Calltakers shall remain alert and ready to handle any incoming call.
5. Calltakers shall speak clearly and distinctly at all times.
6. All calls for service within the service area shall be entered into CAD in a timely manner.
7. The calltaker shall make every effort to enter the correct nature/event code.
8. The calltaker shall verify the location, cross streets and business name, if applicable.
9. The calltaker shall attempt to obtain the name and phone number of the caller.
10. If the call is transferred to another department, no event record is required.
11. Calls not involving law enforcement or those not within the service area shall be referred to the appropriate agency or transferred, depending on the request.
12. Although calltakers are not expected to endure abusive callers, the calltaker is not permitted to use abusive language, and courtesy must be maintained.
13. It is appropriate in cases of abusive callers to refer the call to the supervisor.
14. Calls shall be handled in a business-like fashion, and the caller shall be advised of what to expect (e.g., a phone call from an officer, a visit, an appointment or whatever the case may require).
15. All nonemergency calls are subject to review.

Sample QA/QI Call Review Form Information

Nonemergency Calls for Service
Name:                                                  Review Date:
Reviewer:                                             Case/Run/Event#:
Time of Call:                                         Time of CAD entry:               (N/A)
Was the appropriate greeting used? (Y/N) If no, explain:

Was the appropriate nature code entered? (Y/N)

Was the location information verified? (Y/N)

If caller did not have an address or if the locations provided did not register in CAD, how did the calltaker proceed?

Did the calltaker ask for the name and phone number of the caller? (Y/N)

If the call was not within the scope of the service area, was the caller provided with information on how to obtain the requested help?  What was done? (N/A)

If the caller was abusive, how was the call handled? (N/A)

Was the calltaker professional and polite at all times? (Y/N) Explain:

Runaways: Treat Every Missing Child Report as if the Child is in Immediate Danger

Taken from Public Safety Communications Magazine, March 2012
Written by Sheila Hanna-Wiles, RPL, education and training administrator for APCO Institute


SCENARIO 1:  Fourteen-year-old Lisa leaves a note to her parents stating she doesn't like living with them anymore and will find somewhere else to live.  The parents last saw Lisa at 10 p.m. the night before and found the note at 6 a.m.  Lisa's parents call 9-1-1 immediately after discovering the note.  This is the conversation between Lisa's mother and the 9-1-1 calltaker:

Calltaker: 9-1-1, where is your emergency?

Mother:  123 Adams Road.  My daughter has run away.

Calltaker:  Ma'am how do you know your daughter ran away?

Mother:  Because she left a note that said whe didn't like living here anymore and was going to live somewhere else.

Calltaker:  Has she done this before?

Mother:  Yes, a couple of times but she has always come back home in a couple of hours.

Calltaker:  How long has she been gone this time?

Mother:  I don't know.  We saw her at 10 p.m. last night.

Calltaker:  OK, I'm sending an officer to take a report.

Both parties hung up.

The calltaker dispatches an officer to talk to Lisa's mother.  She advises the officer that the subject has a history of running away from home.  Feeling no urgency to get to the house to take the report, the officer decides to drop his radio off at the station for maintenance on his way to the call.

The officer takes the report and requests a BOLO (Be on the Lookout) be sent out to neighboring jurisdictions.  This request came approximately 1 1/2 hours after the original call was received.  The officer advises communications staff to enter the report into NCIC (National Crime Information Center) "when they get time."  The report is never entered into NCIC.

Approximately 30 minutes later, another officer in a neighboring town pulls a car over for speeding.  The officer runs the license of the driver and asks for identification of the passenger.  The passenger produces a school ID badge.  The officer runs both names through NCIC and both are clear.  The officer gives the driver a ticket for speeding and sends them on their way.

The next morning a report comes in of an abandoned vehicle in a local shopping center parking lot.  The officer runs the license plate through NCIC and finds out that this same vehicle was stopped the day before for speeding.  The officer looks in the vehicle and notices blood on the seats.  He forces the trunk open and finds the body of a deceased female.  The female is later identified as Lisa.

SCENARIO 2:  Twelve-year-old Bobby loves the computer that was given to him by his parents for Christmas.  Bobby has befriended several people on different website chat rooms.  One friend in particular, Claire, has become Bobby's favorite friend.  Monday evening, Bobby's parents go to his bedroom to tell him goodnight and find him missing.  Several items of clothing are missing, as well as the money he had saved for an upcoming school trip.  Bobby did not leave a note, nor has he made any references about being unhappy with his life at home.

Bobby's parents immediately called 9-1-1.  The following conversation takes place between Bobby's father and the 9-1-1 calltaker:

Calltaker:  9-1-1, where is your emergency?

Father:  100 Court Dr.  My son is missing.

Calltaker:  Sir, how do you know your son is missing?

Father:  Because some of his clothes are missing and the money he has been saving is also missing, and he should be in his bedroom getting ready for bed.  He was in his bedroom earlier.

Calltaker:  Has he done this before?

Father:  No.

Calltaker:  How long has he been gone?

Father:  I'm not sure, but less than two hours.

Calltaker:  OK, I am sending an officer to take a report.  In the meantime, can you give me a description of your son, what he was wearing?

Father:  (Gives description of son.  Clothing, age, etc.)

Calltaker:  Do you know where he could have run to?  Any close friends or family?

Father:  I can't think of any place in particular but he talked a lot about a girl he met on the Internet.  I believe her name is Claire.

Calltaker:  Do you know where Claire lives or do you have a phone number or last name for her?

Father:  I don't know where she lives, and I don't know her phone number or last name.  I thought I could find it on his computer, but I don't know his passwords to get into his computer.

Calltaker:  OK, do you have a recent picture of your son?  If so, please have it ready for the officer.

The officer arrives on scene.  Both parties hang up.

The officer takes the report and gets the picture of Bobby.  He immediately confirms that the case meets the AMBER Alert criteria and asks the comm center staff to put him into NCIC and issue an AMBER Alert.

For the next hour, the officer and Bobby's parents try to break into Bobby's computer and retrieve any information they can about "Claire."  Within two hours, the police locate a computer technician who can break passwords.  Just as the technician was able to get into Bobby's computer, the phone rings.  It's Bobby.

Bobby asks his parents to come and pick him up from a local convenience store.  After they pick him up, Bobby tells them the story of meeting Claire on the Internet and how she wanted to meet in person and how they could do fun things forever.  He says she told him that his parents would not like where she lived so he shouldn't tell them where he was going.

Claire had picked Bobby up at the same convenience store earlier.  She took him back to her house where they were suppose to "have fun."  Bobby noticed right off that she looked older than 16 years old, like she had told him in the chat room.

Claire began making sexual advances toward Bobby.  Bobby told her he didn't like what she was doing and it made him feel uncomfortable.  All of a sudden, Claire got angry and screamed for Bobby to get out of her house "now and never come back."  This is when he ran out the door and to the convenience store.  Bobby was able to take officers directly to Claire's house.  After officers made the arrest and did a background check on "Claire," they found out that she was a registered sex offender.

These two stories are not Lifetime movie plots; these are real scenarios that haunt our family, friends and community every day.  These are calls that are received in a comm center every day, somewhere.

A LITTLE UNDERSTANDING
Understanding the background of runaways and knowing the level of response that is needed "is unquestionable one of the most critical elements in the entire missing-child investigative process" and will assist in bringing these runaways back home safely, according to Steidel.  "Furthermore, it is recommended that law-enforcement agencies respond to every report of a missing child as if the child is in immediate danger."

A runaway is defined as a child who leaves home without permission and stays away overnight; a child 14 years old or younger (or older and mentally incompetent) who is away from home, chooses not to come home when expected to and stays away overnight; or a child 15 years old or older who is away from home, chooses not to come home and stays away two nights.

Another term you need to know is "thrownaways."  Although closely related to "runaways," thrownaways have different criteria.  Thrownaways are children who are asked or told to leave home by a parent or other household adult and no adequate alternative care has been arranged for the child, and the child is out of the household overnight.  Or it is when a child is away from home and is prevented from returning home by a parent or other household adult and adequate alternative care is not arranged.  Although not necessarily reported to authorities as missing, thrownaways frequently come to the attention of law enforcement.

SCOPE OF THE PROBLEM
Youth ages 15-17 years old make up two-thirds of the runaways/thrownaways.  According to the National Incidence Studies of Missing, Abducted, Runaway, and Thrownaway Children (NISMART) report findings in 1999, an estimated 1,682,900 youth had run away or been "thrown away."  Twenty-one percent were reported to authorities for purposes of locating the youth.  Seventy-one percent could have been endangered during their runaway/thrownaway episode by virtue of such factors as substance dependency, use of hard drugs, sexual or physical abuse, presence in a place where criminal activity was occurring or very young age (13 or younger).

This is not to say that every child runaway/thrownaway will end up in the worst situation.  Some have been found living with family members or close friends and doing well.

Why these children end up as runaway/thrownaways is almost as important as finding them.  Three things are needed in order for a child to run away: ability, willingness and opportunity.  Most kids have the ability and opportunity but need the willingness.  Willingness comes from many different factors or circumstances, such as stress, not wanting to get into trouble for something they did, a power struggle, substance abuse or not wanting to go to school.

Another reason that sparks the willingness to run away is dreaming of a better life outside the home.  The dream consists mostly of "no rules and I'm my own boss."

Some kids run away because of drug and alcohol abuse.  The kids are addicted or using more than their parents know about.  Usually, their goal is to be able to use it freely and not hide it.

Sadly, some kids run away because they are living in a home where they are criticized constantly.

If you take all these reasons and look closely, the bottom line reason is because these kids don't have good problem-solving skills.  Running away is the easiest fix to the problems.  They choose to run from the problem instead of looking for alternate options to fix the problem.

A TELECOMMUNICATOR'S IMPACT
The manner in which the initial call is handled by the public safety telecommunicator forms the foundation and direction of the overall response to the missing child.  The attitude a telecommunicator possesses during the onset of the call will manipulate the handling of the call.  As with any emergency call, a telecommunicator must treat each call as a new call regardless of how many times the person has called to report their child missing.  The telecommunicator is tasked with gathering the facts surrounding the incident and relaying those facts to the responders.  They must not pre-judge the call.

When taking calls for runaway/thrownaway children, one of the most important resources a telecommunicator should use to build a response toolbox is the Standard for Public Safety Telecommunicators when Responding to Calls of Missing, Abducted, and Sexually Exploited Children (APCO ANS 1.101.2-2010).  The response toolbox is a pre-incident planning and resource development project.

The goals for the initial intake of information are stated in the APCO ANS standard as:

1. Obtain and verify incident location along with callback and contact information.  Maintain control of the call.  Communicate the ability to help the caller.
2. Methodically and strategically obtain information through systematic inquiry to be captured in the agency's intake format.
3. Recognize the potential urgency of the missing child incident and immediately begin the proper notifications consistent with agency policy.
4. Perform all information entries and disseminations, both initial and update.  This includes mandatory entry of information about the missing child into the Federal Bureau of Investigations (FBI) National Crime Information Centers (NCIC) databases accurately, including vehicle if known.

These goals should remain at the forefront when developing a response toolbox.  The intake information must be gathered in a timely fashion and methodical manner.

The following questions are consistent with the APCO ANS 1.101.2-2010 standard.  After obtaining the location to send responders and the caller information, the next step is to narrow down the time frame.  Asking the following questions can assist in getting this information efficiently:

1. When did this happen?
2. Where was the child last seen?
3. Any special regional considerations, such as wildlife, weather or wilderness?
4. With whom was the child last seen?
5. Who last saw the child? (If the answers to questions 4 and 5 are the same, ensure this information is conveyed to investigative personnel.  Complete the background checks for investigative personnel as authorized.)
6. What mode of travel was the child using?
7. What was the direction of travel?
8. What suspicious circumstances, if any, were there?
9. What steps have been taken to locate the child?
10. Has this happened before?
11. What is the caller's relationship to the child?
12. What ideas or suspicions exist about where the child may have gone?
13. What notes, letters, or threats, if any, were located pertaining to this incident?

Once this information is obtained and relayed to the responders, the next part of questioning will center on the child.  Examples of questions to ask are: the child's name, sex, race, age, height, weight, hair color, etc.  The child's clothing description is also gathered at this time.

Finding out about the child's medical condition is another very important element.  Ask the caller if the child has any medical conditions or if the child is taking any medications, and if they are, when the next dose is needed.

The next part of questioning should focus on the suspect/companion.  The preliminary questions are similar to those asked about the child: name, sex, race, age, medical status, etc.  Another important piece of information to gather is the relationship between the child and this person.  Do they know each other?  Are they related?

If the child's mode of travel was in a vehicle, then you should obtain the vehicle's description.  The easiest way to get a vehicle description is to use the acronym CYMBALS: color; year; make/model; body style; additional description (dents, rust, damage); license plate; and state.

MAKE A DIFFERENCE
SCENARIO 1 RECAP:  The officer arrives at Lisa's parents' home to deliver the news.  "I'm very sorry.  We did all that we could," says the officer.  The hurt and grief Lisa's parents feel at the news of their daughter is indescribable.

Could the telecommunicator and/or officer have made a difference in the outcome?  Yes.

One very important element that was missed in the process was getting the information into NCIC immediately.  Had the information been put into NCIC, then the traffic stop officer would have received a "hit" on Lisa's name.  The telecommunicator and officer pre-judged the call based on the history.  The prejudgment prevailed when the telecommunicator advised the officer of the history, although the history was not relevant to this episode.  And the officer prejudged by making a stop on his way to the call as though time was not an issue.

We know the telecommunicator did not ask enough pertinent questions to help locate Lisa.  She didn't get a description of Lisa, did not ask if she could be accompanied by anyone or obtain her mode of travel.  All of these are examples of information that could have been put in a BOLO immediately.

DIFFERENCE MEANS LIFE OR DEATH
SCENARIO 2 RECAP:  After the investigator questions Bobby and as he released him to his parents, he said, "We're done questioning Bobby.  You may take him home.  We did everything we could to make sure this moment happened."

Now, it's time for the investigator to question Claire.  "We know your intent was to sexually assault Bobby.  So why did you let him leave?" asks the investigator. 

Claire responds, "The television had an AMBER Alert scroll at the bottom of the screen, and it stated that Bobby could possibly be with me.  I knew it was only a matter of time before you guys would find me.  So I let him go.  We could have had a good time if you would have stayed out of it, and Bobby would have cooperated."

The NCIC entry and the AMBER Alert notification were the key differences in sparing Bobby's life.  The telecommunicator asked several pertinent questions prior to the arrival of the officer, including the possibility of a suspect/companion.  This allowed the information to be gathered and broadcast faster to other responders.  The telecommunicator advised the caller what to do prior to the officer's arrival because she knew the process.  When the officer requested the entry into NCIC and that an AMBER Alert be issued, the telecommunicator knew exactly what had to be done.

One part of this story that can make a difference between life and death is to educate the community about NetSmartz (www.netsmartz.org).  This is an Internet safety resource from the National Center for Missing & Exploited Children and the Boys and Girls Clubs of America that uses the latest technology to create high-impace educational activities for kids of any age group.  The goal of NetSmartz is to extend the safety awareness of children and empower them to make responsible decisions online and in real life.

IT'S YOUR MOVE
A missing child is a paren't worst nightmare.  When their child is missing, they expect public safety responders to do everything they can to locate their child.  Are you and your agency prepared to do everything you can to help that parent find their missing child?

Every 9-1-1 center should have policies and procedures in place on how to handle these types of calls.  In addition, every staff member should be trained on these policies and procedures.  Every call that is received about a missing child should be checked for quality assurance.  Contact information should be readily available to every telecommunicator.

Adopting APCO ANS 1.101.2-2010 as the minimum standard for your agency in handling these types of calls is a good start to implementing and creating a response toolbox.

It's the Law: Strategies for Testifying in Court

Taken from Public Safety Communications Magazine, September 2012
Radiohead Column


DEAR RADIOHEAD,
Do you know any resources for telecommunicators who have to testify in court?

Sincerely, Ms. Scale O'Justice

DEAR MS. SCALE O'JUSTICE,
I couldn't pass up the opportunity to comment on this topic.  A few years ago, a friend of mine taught a class for telecommunicators that dealt with testifying in court.  So, with his permissioin, I will note some things that may help.

In this era of criminal and civil cases, public safety telecommunicators are being served subpoenas to testify at trial.  You may also receive a subpoena to give a deposition.  Testifying is not a part of training for public safety telecommunicators, but in the aftermath of several highly publicized trials in which telecommunicators testified, it's clear that they are as likely to be called to testify as police officers.  You may even be subpoenaed to testify against your agency or co-workers.

Criminal and civil trials have a lot of similarities and are conducted under the same court rules and procedures.  The difference is in the type of case brought before the court.

Criminal cases involve criminal acts (e.g., burglary, theft) that we associate with possible jail time.  A criminal trial occurs when the state charges the defendant with a violation of a law in the penal code.  In a criminal trial, the evidence has to demonstrate guilt beyond a reasonable doubt for the jury to find the defendant guilty.

A civil trial involves a claim by one party (e.g., a person, the state, a business) that the defendant caused them damage.  The determination of guilt in a civil trial is based on the preponderance of the evidence.  One found guilty cannot go to jail; compensation is usually monetary.

Let's say you've been served a subpoena.  It may direct you to appear at a law office to give a deposition or may direct you to appear in court to give trial testimony.

The prosecutor or civil attorney must have knowledge of all facts that may arise from the testimony of witnesses for the prosecution or defense.  If you're not sure your attorney understands a concept or topic you'll be testifying about, be sure to discuss it with them.  You know your job, and part of the education process is to show the attorney they can count on you and your testimony.

Tips for testifying:
Behave professionally -- on and off the witness stand.  This can influence the jurors, and you never know who's sizing you up.

Before the trial starts, familiarize yourself with the witness stand and the path you need to get to it.  This will allow you to walk confidently and directly to the stand.

Dress professionally -- and conservatively.  If you have a uniform, wear it; the uniform enhances your credibility.  Avoid flashy colors, and wear minimal jewelry.

When you're sworn in, look at the judge or jury and clearly say "I do."

Sit up straight, and look at the questioning attorney.  When answering the question, make eye contact with the judge or jury, whichever applies.  Answer all questions clearly and loudly enough for the judge and jury to hear you.  Do not nod.  The court clerk or judge will ask you to answer audibly, and it could appear you're unsure about your answers.  If the question is about distance or time and your answer is only an estimate, be sure you say so.

If you are asked whether you have talked to anyone about this case and you have, admit it.  There's nothing improper in discussing the facts of the case with attorneys, police officers or investigators prior to trial.

If a question cannot be truthfully answered with a yes or no, you have a right to explain the answer.

Keep your hands in your lap and away from your mouth.

If you need to ask the judge a question, address them as "your honor," and wait until the judge gives you permission to speak.

Listen carefully to the question asked, and make sure you understand it before answering.  If either attorney objects, stop talking, let the judge rule on the objection and then continue.  If you're not sure how the judge ruled, let them know.

If the other attorney asks a question you find objectionable, pause before answering and give your attorney time to object.  Avoid looking at your attorney when answering questions.  This looks like you're asking for help and the jurors might interpret this as a damaging question, even though your answer makes sense.

Avoid being combative and don't lose your temper.  Let attorneys get as nasty as they want.  They are likely trying to bait you.  Stay cool, and answer questions.

Don't be offended if you're told not to listen to testimony given by other witnesses.  No one wants your testimony altered by others' testimony.  In fact, you may be asked to leave the courtroom so you can't hear other witnesses' testimony.

If you make a mistake, admit it.  There could be bigger consequences if people think you are lying than if they think you made a mistake.

There are many other factors to consider when testifying, such as subpoenas, legal definitions, depositions, dirty lawyer techniques, sequence of events in a trial, etc.  Discuss procedures with your agency's attorney and/or the District/State Attorney.

Editor's note:  The opinions expressed herein are those of the columnist and do not necessarily reflect the views of APCO International.

More Than Just 9-1-1: Specialization in the Field of Public Safety Dispatching & Reliability

Taken from Public Safety Communications Magazine, September 2010
Written by Christopher Blake Carver, MPA - Mr. Carver has 17 years of experience in public safety communications.


Sometimes lost in the use of the term 9-1-1 dispatcher or communications technician is the reality that, within many agencies or communities, the role of a telecommunicator requires a significantly greater degree of specialization.  The degree may be based on workload, number of agencies dispatched for, telecommunicator skills and other operational realities.  These specializations, although essential, contribute to the complexity of the job of a telecommunicator and serve to highlight the often opposing skill sets they require.

This summary of these specializations is intended to serve as a guide for those new to the field or those who may be involved with communications from a consulting or political prospective, without a thorough, on-the-platform knowledge of what makes up a telecommunicator's daily workload.  For the communications manager or supervisor, this list is intended to identify possible ways to improve workflow and agency affectiveness -- especially during times of heightened activity.

BY GEOGRAPHIC AREA
One of the first areas in which specialization occurs for telecommunicators is by area the telecommunicator is responsible for.  In many cases, a dispatcher may be hired by one town and dispatch all of the agencies in that one community (police, fire, EMS).  These single-dispatcher environments remain a relatively common occurrence in the U.S.

Specialization by geographic area may also occur in a larger center, in which one telecommuicator may be assigned to cover services for one particular area on a regular basis for a special-event-related geographic area for a shorter duration.  Many new CAD systems also allow the user to create temporary areas for dispatching, such as an area affected by a storm.

There are many positives to this approach -- especially if all the responders have interoperable radios, can use compatible radio procedures and are empowered to share information.  Having a single dispatcher (or single dispatch group) manage a disaster-stricken area will ensure effective sharing of information and improve the effectiveness of the response.

BY AGENCY
The second tier of specialization is in assigning telecommunicators to be responsible for certain agencies -- and this is often the first level of growth in public safety communications centers.  Having one telecommunicator dedicated to fire/EMS and another to the police function is a logical step in workload management.  At this point, it's also required to point out that this is the first point of identification of the different skill-sets required to dispatch fire/EMS apparatus vs. dispatching police units.  Training for telecommunicators should acknowledge these differences in approach and ensure that telecommunicators who will be undertaking both roles are aware of and able to adjust to both sides of the floor.

BY ROLES & RESPONSIBILITIES
Given the distinct differences in fire/EMS and police dispatching, the functions by role are also related to the overall agency function that a given telecommunicator is assigned to.  Based on the size of population served, agency policies and preference, and workload, the functions of telecommunicators in the communications center may be organized along what role they are playing in the dispatching flow-chart.  It should be noted that one telecommunicator may serve the same role for different agencies in the center (i.e., there may be one records dispatcher for multiple agency radio dispatchers or one fire-ground dispatcher for the various primary fire/EMS agencies that are dispatched in one center).  It may also be possible for one telecommunicator to handle specific roles during non-peak periods of activity and that roles by expanded during periods of high activity.  During a storm, for example all of the roles may be filled by specific telecommunicators, while at 3 a.m., one telecommunicator may have two or three roles.

In most cases, however, telecommunicators should not be responsible for handling more than one or two channels at the same time -- and only more than one channel or talk group if the channels are not that active and the dispatcher isn't busy with other tasks or responsibilities.  Expecting one tactical dispatcher to monitor two or three fireground channels is a potentially very unsafe practice and could result in degraded fireground or incident safety -- particularly if your agency requires the dispatcher to monitor every fireground transmission.  A good rule of thumb is to limit the number of potential channels or talk groups that units can operate on to the total number of dispatchers on shift in the communications center.

ROLES FOR FIRE/EMS DISPATCHING

• 9-1-1/phone answering and alarm processing -- Self-explanatory, but needs to be identified, especially if your agency provides emergency medical dispatch and associated pre-arrival instructions
• Incident assignment/response coverage -- Fire/EMS dispatchers (often separate from calltakers) are responsible for ensuring the appropriate response is sent to incidents and adequate fire protection is maintained in the event of a serious incident or period of high activity.
• Dispatch/communications with units out of quarters -- One dispatcher will need to be available to communicate with units that are not in quarters to not only ensure they are responding to calls, but also to respond to messages from those units, such as changes in status, reports of emergencies they witness or other messages.
• Dispatch to in-quarters units/firehouse alerting -- Although this process can often be automated with such products as Locution, in many agencies alerting to firehouse PAs or intercoms remains a dispatcher function.
• Notifications dispatcher -- Many incidents will result in units on scene requesting the response of another agency (e.g., electric company, gas company, police) or notification to a hospital, such as with a cardiac arrest patient.
• Incident dispatcher -- In departments where dispatcher are required to monitor fireground communications to receive requests and information from the incident commander and to relay messages from the communications center to the scene, this is a critical function that requires a dedicated dispatcher.  Often, these dispatchers are an essential element of safety on the fire or emergency scene - monitoring for emergency buttons being depressed (the ID of the potentially in-trouble unit is displayed on most modern radio consoles) - and ensuring timely reports on member accountability (PAR).  Incident dispatchers also enter in narrative descriptions of the event, acess building information from available sources and confer with the incident assignment dispatcher should additional resources be required.

ROLES IN POLICE DISPATCHING

• Calltaking dispatcher -- Often, the 9-1-1 element of the communications center and in many agencies the same calltaker for police, fire and EMS incidents.
• Assignment/radio dispatcher -- Most agencies are divided into geographic areas, where one dispatcher serves as the radio and assignment dispatcher for the given area.
• Records/leads dispatcher -- Many larger agencies utilize a separate channel and dedicated dispatcher to handle more involved requests for criminal records checks, report numbers or other functions that would overload the main dispatch channel if done there.
• Tow dispatcher -- Some very large agencies have dedicated dispatchers to manage requests for tow trucks and/or other outside agencies.
• "Back-channel" dispatcher -- Some larger police agencies staff an extra dispatcher on a non-primary channel to manage other requests, handle tactical incidents or other functions, such as special events.

CONCLUSIONS
Understanding  the manner in which job functions in the 9-1-1 center can be organized facilitates not only a greater understanding of the complexity of the role of the public safety communications professional, but also serves as a potential roadmap to the operational and training needs inherent in the operation of 9-1-1 centers.  Regardless of the size of a 9-1-1 center -- or the number of agencies served, these basic roles and functions are what telecommunicators across the U.S. do every day -- whether they are alone in a small town police department radio room -- or sharing those functions with hundreds of other telecommunicators in a footfall field size 9-1-1 center in a major American city.

Using these understandings to develop a scalable model based on workload, agency requirements, staffing and other factors permits local community leaders and 9-1-1 managers to ensure that their 9-1-1 center meets the demands of its customers both on normal days and during peak periods.  Fortunately, new CAD systems and modern radio systems support these types of configurations, as well as allowing certain processes -- such as notifications and firehouse alerting -- to be automated, freeing up personnel to perform the valuable tasks of incident monitoring, ensuring effective response coverage and further improving the ability of communications centers and their personnel to perform the essential parts of their jobs that are beyond 9-1-1.

From The Editor's Desk

Taken from Dispatch Monthly Magazine, Volume 20.5
Written by Gary Allen, Editor of Dispatch Monthly Magazine


You may recall the "good old days" when communications centers had the luxury of simply answering the telephone and radioing information to field units.  Then along came cellular phones, and it hasn't been the same since.  The public safety communications industry has been on a faster and faster treadmill, trying to catch up with all the technology being invented.  It hasn't been easy.

Before the nation's comm centers could equip themselves with Phase II gear for cellular 911, along comes VoIP telephony.  And then New York City's mayor Bloomberg announced he wants a 911 system capable of handling text, photos and video.

I'm certainly happy that APCO and NENA are tackling the high-level, legislative and funding issues related to rolling out all this technology.  There's enough Washington (DC) activity to keep both organizations busy every day.  But back home, where the 911 calls are being answered, there is still work to be done.

Lately, the news is swarming with stories from all points of the country about delayed response times, missed incidents and other human errors leading to injury and death.  Perhaps it's just the law of averages that these incidents are appearing now.  But it certainly deserves a look.

The challenge of a comm center, after hiring the right people and training them adequately, is to establish a set of procedures and policies that maximize the public's safety.  First, you must recognize those situations that require a procedure and policy, so that when it occurs the dispatchers will handle it as the agency requires.  Second, within each situation you must recognize every possibility, so that no odd occurence will not be handled ad hoc.  Lastly, you must be supervising and auditing the performance of the dispatchers to insure that all of procedures and policies are being followed.

Several recent incidents seem to be focused on the very narrow portion of dispatching related to a dispatcher's discretion when handling telephone calls: the calltaker decides that the call was made accidentally, that the caller doesn't have an emergency, and then doesn't send anyone to investigate.  Many of these calls were made from cellular phones.  These situations should be an area of particular focus for managers and directors to insure the center's procedures provide enough guidance for their employees to successfully handle these types of calls.

I look forward to seeing negative stories disappear from the news radar screens, and to the resulting lawsuits.  But it's going to take some work at individual centers before that will happen.

9-1-1: Making a Difference

Taken from Public Safety Communications Magazine, August 2010, APCO Bulletin > Association News & Notes > Standards


The public safety communications community makes a difference every day.  We answer calls from people who need assistance, and we give support and provide information to protect the responders providing that help.  9-1-1 makes a difference every hour of every day.  Public safety communications professionals, at all levels and assignments, follow procedures on a daily basis to perform our duties.  How are those procedures developed?  They are developed by individuals, like you, who perform the duties or have knowledge and experience in the community.  One method is to develop consensus standards, but to get consensus standards, a balanced group of people need to provide that consensus.

APCO Standards Committee:  APCO has taken a lead in the public safety communications community by becoming an American National Standards Institute (ANSI)-Accredited Standards Developer (ASD).  The APCO Standards Development Committee's (SDC) scope is: APCO International will serve as a conduit to develop standards that will focus on public safety communications, including, but not limited to, training and professional development, professional qualifications, education, performance programs, technology, systems, operations and other related issues.

The SDC has three subcommittees that focus on specific areas:

• Training, which develops training and competencies standards;
• Operations, which develops operational standards; and
• Technical, which develops technical and equipment standards.

The SDC and its subcommittees have three member categories:

• Producer (i.e., a producer of public safety communications equipment, products, processes, systems or services);
• User (i.e., those who use public safety communications equipment, products, processes, systems or services); and
• General interest (i.e., all others, including, but not limited to, professional associations and societies and regulatory agencies).

What can you do?  Participate; join a committee.  One great way to get involved is to help develop and approve standards.  The SDC is currently expanding and looking for members to help facilitate important standards for the public safety communications community.  A diverse knowledge base and individual experience benefits standards by addressing the needs of and providing insight from all stakeholders.  Your input in developing and reviewing candidate standards can prove invaluable regardless of your background.  This participation allows you to be proactive.  Not only will you understand what standards are being developed, but you will have input into the changes in the industry.

To participate in APCO Standards activities, go to www.apcostandards.org or e-mail standards@apcointl.org for more information.  Members are selected from applications based on the positions open and the applicant's background to ensure balance and lack of dominance.  There are opportunities to join SDC committees and provide subject matter expertise.

Call to action: If you can't join the committee, you can still participate.  As new standards are prepared, the candidates are announced in a Call to Action.  These are for proposals for APCO standards and standards from other organizations that may affect the public safety community.  When these notices are published, look into the standards that affect you and provide feedback.  This feedback can be potential changes or a different way to accomplish the same actions.  It can be as simple as a comment that the proposed standard is a good solution to its issue.

Learn, act and connect with your leaders.  We need your help to develop and approve standards that enhance public safety communications.

~ QUESTIONS? E-mail standards@apcointl.org.

Challenges of Mobile Alarm Devices

Taken from Public Safety Communications Magazine, August 2010
Written by Kathy McMahon, APCO Technical Services Manager


Devices designed to automatically signal for help have been available for years.  Many of them are programmed to dial a private call center or alarm company that in turn notifies the appropriate PSAP that emergency response is needed.  Some devices dial 9-1-1 directly.  But until recently, these auto-dial devices or alarms primarily reported only a fixed, registered location for the person needing assistance.

The increasing use of wireless phones and developing wireless technologies provide unique opportunities, allowing mobile alarm devices to automatically dial 9-1-1 when activated by a user or an authorized third party.  Prior to opening a voice connection to a caller, many of these devices provide the calltaker with a recorded message indicating a potential emergency.  Calltakers receiving these alarms are presented with an ANI/ALI screen  representative of the wireless Phase 1 or wireless Phase 2 call.  In some cases, direct contact with the individual in need is enabled, and the calltaker can ascertain incident details directly.  In other cases, calltakers receive a recorded message with instructions to contact a private call center for more details.

Applications are also being developed that will notify citizens if a device fixed to a person under their authority moves outside of a specific geographic zone and to enable a wireless device to call 9-1-1 in cases of the theft of high-risk cargo.

Developing applications that increase the probability that an endangered person or high-risk collateral can be found more quickly has the potential to positively affect public safety and decrease the time it takes to resolve such incidents.  However, the ability of PSAPs to effectively react to these notifications is still uncertain.  In cases in which direct contact is made with a victim and details of an emergency are obtained, the challenges are less.  Scenarios in which direct contact isn't possible make it more difficult for a calltaker to determine the best way to respond.  Open-line wireless calls aren't new to 9-1-1, but many have been attributed to accidental dialing.  If a PSAP can't confirm details from a wireless call's open line, the options for identifying and locating the caller are limited.

Implementing mobile alarm device technologies has the potential to significantly increase the number of calls in which PSAPs won't have direct contact with callers.  These challenges are coupled with the fact that wireless technologies don't offer pinpoint location accuracy for these devices.  The extended amount of time it takes to manage these calls can affect the PSAPs calltaking capability and answering time efficiency.

In addition, marketing for mobile alarm devices, if not executed carefully, could mislead customers into believing that help will be on the way once their device is activated -- even if they are unable to provide further details.  Technologies that require PSAPs to contact a third-party call center for more information require additional steps by the calltaker that may not result in determining the individual's exact location.  It's critical to couple the deployment of such technologies with a strategy to manage the public's expectations of how the technology benefits them.

Many years ago there was a commercial on TV that showed a group of children who were unsure about a new cereal.  Their answer to the problem: "Let's get Mikey.  He will eat it; he eats anything."  Unfortunately, Mikey doesn't work at 9-1-1.  PSAPs are still expected to incorporate these technologies into their operations even though they may be uncomfortable with them.  Vendors deploying new solutions, such as mobile alarm or alerting devices, are encouraged to work with associations, such as APCO, and local PSAPs to better understand how these 9-1-1 calls are handled and how their technology may affect comm center.

'Had This Been a Real Emergency....' Disaster Exercises in the Comm Center

Taken from Public Safety Communications Magazine, August 2010
Written by Bob Smith, APCO International's Director of Strategic Development.


East Coast to West Coast to Gulf Coast, hurricane season is upon us.  To prepare, many public safety agencies reviewed, evaluated and updated their disaster response plans and procedures, policies, resource lists and inventories, and personnel were quizzed on new and revised policies.

The best way to evaluate preparedness is to conduct a disaster exercise.  FEMA defines an exercise as "a focused practice activity that places the participants in a simulated situation requiring them to function in the capacity that would be expected of them in a real event.  It's purpose is to promote preparedness by testing policies and plans and training personnel."

Exercises evaluate and improve an agency's disaster response by providing an opportunity for "dry runs" or simulations related to specific disaster types.  Exercises allow all responders to proceed through actual response steps - in real time or simulation - in a controlled environment.  They also provide agencies the opportunity to monitor and evaluate their response, the response of others and the effectiveness of their tools, resources and procedures.

Disaster exercises range in format and complexity.  FEMA recognizes several formats, the most common of which are drills, tabletop and full-scale exercises.

Drills are coordinated, supervised exercises used to test a single specific operation or function.  In a drill, there's no attempt to coordinate organizations or fully activate an emergency operations center (EOC).  A drill serves to practice a single component of an agency's response plan and assist in preparations for more complex exercises.

Tabletop exercises are a facilitated analysis of an emergency situation in an informal, stress-free environment.  A tabletop exercise is designed to elicit constructive discussion as participants examine and resolve problems based on existing operational plans and identify where those plans need to be refined.  There is minimal attempt at simulaton:  Equipment isn't used, resources aren't deployed, and time pressures aren't introduced.

Full-scale exercises simulate a real event as closely as possible.  This type of exercise is designed to evaluate the operational capability of public safety systems in a highly stressful environment that simulates actual response conditions.  It requires the mobilization and movement of emergency personnel, equipment and resources and should test and evaluate most public safety functions.

A jurisdiction's public safety and emergency management agencies may conduct disaster exercises regularly, but it's not uncommon for the comm center's role to be minimized or even absent.  When the comm center is involved, the role may be nothing more than receiving the first simulated 9-1-1 call, dispatching the appropriate resources and possibly monitoring radio traffic as warranted.  This lack of participation is unfortunate.  It doesn't gauge the center's preparedness and causes a significant gap in preparedness.

So how do we address this lack of involvement?

Comm center managers must develop and maintain a quality professional relationship with local field agencies and emergency management officials.  Educating these responders and officials to the comm center's role and importance to disaster response operations before, during and after an event encourages the inclusion of the center and its personnel in exercises.

Comm center employees can play  many roles in a disaster exercise, both in and out of the radio room.  They can be used to staff EOCs or to initiate and staff an on-scene Incident Command Post (ICP).

They can also serve as evaluators to gauge and audit specific portions of on-scene operations and compare actions or inactions to exercise objectives, thus establishing a benchmarking process to gauge an exercise's success or failure.  Comm center employees require little explanation of field-level operations due to their familiarity with aspects of field-level response.

They can also monitor and evaluate on-scene radio communications and accountability policies during an exercise.

If the comm center isn't invited to participate in local disaster exercises, it falls to management to ensure policies and procedures are tested regularly.  While a jurisdiction conducts a larger disaster exercise, the comm center can incorporate facets of its own disaster preparedness.  Example:  During a large-scale, mass casualty incident-based exercise, a comm center can drill on its policies for notifying local hospitals.  For a hazmat exercise, the center can practice initiating a mass notification system simply by simulating the initiation of a notice or launching an actual system test.  Or the center can review its procedures for activating a secondary PSAP or transferring calls to a backup agency.

The bottom line:  Whether participating in a jurisdictional disaster exercise or conducting an internal drill, the comm center must establish a formal process for testing and evaluating its preparedness.  As the hub of all public safety and emergency management response, failure to ensure the comm center is prepared can cause a domino effect, hampering operations at all levels during an event.

The Four Stages of Cold-Water Immersion

Taken from On Scene, The Journal of U.S. Coast Guard Search and Rescue, Fall 2006, pg. 13
Written by RADM Alan Steinman, USPHS (Ret) and Gordon Giesbrecht, Ph.D.


Falling into cold water can be life-threating.  There are four stages of cold-water survival, and each presents the survivor with a different challenge.  The stages are: 1) cold-shock; 2) functional disability; 3) hypothermia; and 4) post-rescue collapse.  It is important to understand the risks of each stage in order to be properly prepared to survive a cold-water emergency.

Stage 1: Cold-shock (0-2 minutes): Sudden immersion in cold water causes an immediate fall in skin temperature which triggers several body reflexes.  These reflexes are collectively known as the "cold-shock" response, and they last for just the first few minutes after falling in.  The cold-shock responses are: 1) instantaneous gasping for air; 2) sudden increase in breathing rate; 3) sudden increase in heart rate; 4) sudden increase in blood pressure; and 4) dramatic decrease in breath-holding time.  If your head is underwater and the cold-shock reflex causes you to gasp and inhale (and simultaneously decreases your ability to hold your breath), you may breathe in water and drown.  This has happened often enough in the past that the Coast Guard had a term for it: "sudden drowning syndrome."  It's one reason why a personal flotation device (PFD) can be life-saving -- it helps keep your head out of the water during the first few minutes the cold-shock reflexes are active.

The increase in blood pressure and heart rate from sudden immersion into cold water can also be fatal.  These rapid changes in the cardiovascular system can trigger irregular heart beats or even cardiac arrest in susceptible individuals.  But even aside from the potential for cardiac arrest, the irregular heart beats and rapid breathing rate can be incapacitating for someone struggling to keep his head above the waves.  This is yet another good reason why a PFD can be life-saving in this situation:  it helps you stay afloat until your heart rate, blood pressure and breathing rate return to more normal levels when the cold-shock reflexes diminish.

Sudden immersion in cold water also drastically reduces your ability to hold your breath.  For the average person who can hold his breath for 60 seconds in air, breath-holding time is reduced to 20-25 seconds or less when submerged in water colder than about 50 degrees Farenheit.  This would obviously be a problem for someone trying to escape from a submerged automobile, vessel or aircraft.  Finally, the rapid breathing that occurs during the first few minutes of cold-water immersion can lead to a drop in blood levels of carbon dioxide with subsequent mental confusion or even unconsciousness; both can significantly increase your chances of drowning, particularly if you're not wearing a PFD.

Stage 2: Functional Disability (2-30 minutes):  If you survive the cold-shock reflexes after falling overboard, cold water can still affect you in other ways.  It is much harder to swim in cold water than it is in warm water.  Your muscles get cold, making it harder to use your arms and legs to stay afloat.  And cold water is a bit more vicous than is warm water, requiring you to work harder to swim or stay afloat.  Your hands get cold quickly and you lose manual dexterity and grip strength.  This can affect your ability to grasp a rescue line or life ring or even to help pull yourself back aboard your vessel.  Both swimming failuer and loss of manual dexterity can occur during the first 30 minutes after falling into cold water.  Again, a PFD would be life-saving during this period, as it would dramatically decrease your need to swim to keep your head up.

Stage 3: Hypothermia (>30 minutes):  Hypothermia is a decrease in the body's core temperature (i.e., a drop in the temperature of the body's vital organs below 95 degrees Farenheit) resulting from excessive heat loss to the cold water.  Hypothermia is not really a threat until you have been immersed in cold water for at least 30 minutes.  The body cools relatively slowly, even in extremely cold water.  When the body's temperature falls to around 86-90 degrees Farenheit, you will lose consciousness and likely drown.  But even in ice-water, this could take an hour or more to occur.  In warmer water, the timeto unconsciousness could be much longer, depending on your body size and weight (large and/or obese people survive much longer than small, skinny people), your clothing, your state of health, the sea-state, and particularly on whether you're wearing a PFD or some other means of flotation.  But without a PFD or supplemental flotation, unconsciousness in the water usually means immediate drowning.  Survival times for the average sized person wearing an insulated worksuit with inherent buoyancy (e.g., and insulated exposure coverall and medium-weight undergarments - not a survival suit) in 45 degree Farenheit water, even in heavy seas, could be as long as 5-8 hours.  For the same person wearing a survival suit, properly donned before entering the water, the survival time could be as long as 36 hours!

Stage 4: Post-Rescue Collapse (>30 minutes):  A survivor is still at significant risk even after removal from the water.  Significant levels of hypothermia can slow the body's normal defenses against a sudden drop in blood pressure.  This can occur when the survivor is removed from the water, particularly if he/she is rescued in a vertical posture and not promptly placed in a horizontal posture in the rescue vessel or aircraft.  The hypothermic heart and arteries cannot adjust fast enough to the drop in blood pressure, which may cause loss of consciousness, irregular heart beats or even cardiac arrest.  Furthermore, the body's core temperature continues to fall even after a survivor is removed from the water, a phenomenon known as "afterdrop."  If the afterdrop lowers the heart temperature too far (e.g., below avout 77 degrees Farenheit), cardiac arrest may occur.  Finally, metabolic changes in the body caused by prolonged immersion hypothermia can contribute to potentially fatal cardiovascular effects even after a survivor is rescued.  For all of the above reasons, rescuers should be particularly mindful of the ABC's of first aid, handle a hypothermic victim gently, begin gentle rewarming efforts in the rescue vehicle, and transport the survivor to a site of definitive medical care.

Drowning Doesn't Look Like Drowning

Taken from On Scene, The Journal of U.S. Coast Guard Search and Rescue, Fall 2006, pg. 14
Excerpts also taken from a blog whose writer I cannot remember the name of.


The new captain jumped from the deck, fully dressed, and sprinted through the water.  A former lifeguard, he kept his eyes on his victim as he headed straight for the couple swimming between their anchored boat and the beach.  "I think he thinks you're drowning," the husband said to his wife.  They had been splashing each other and she had screamed but now they were just standing, neck-deep on the sand bar.  "We're fine, what is he doing?" she asked, a little annoyed.  "We're fine!" the husband yelled, waving him off, but his captain kept swimming hard.  "Move!" he barked as he sprinted between the stunned owners.  Directly behind them, not even ten feet away, their nine-year-old daughter was drowning.  Safely above the surface in the arms of the captain, she burst into tears, "Daddy!"

How did this captain know - from fifty feet away - what the father couldn't recognize from just ten?  Drowning is not the violent, splashing, call for help that most people expect.  The captain was trained to recognize drowning by experts and years of experience.  The father, on the other hand, had learned what drowning looks like by watching television.  If you spend time on or near the water (hint: that's all of us) then you should make sure that you know what to look for whenever people enter the water.  Until she cried a tearful, "Daddy," she hadn't made a sound.  As a former Coast Guard rescue swimmer, I wasn't surprised at all by this story.  Drowning is almost always a deceptively quiet event.  The waving, splashing, and yelling that television prepares us to look for, is rarely seen in real life.

The Instinctive Drowning Response - so named by Francesco A. Pia, Ph.D., is what people do to avoid actual or perceived suffocation in the water.  And it does not look like most people expect.  Most people assume that a drowning person will splash, yell, and wave for help; and why wouldn't they?  That's what we see on television.  Without training, we are conditioned first to think of drowning as a violent struggle that is noisy and physical.  It is not.  To get an idea of just how quiet and undramatic from the surface drowning can be, consider this: It is the number two cause of accidental death in children, age 15 and under (just behind vehicle accidents) - of the approximately 750 children who will drown next year, about 375 of them will do so within 25 yards of a parent or other adult.  In ten percent of those drownings, the adult will actually watch them do it, having no idea it is happening.  Parents - children playing in the water make noise.  When they get quiet, you get to them and find out why.

This is not to say that a person in the water that is shouting and waving is fine and doesn't need assistance.  They are in what is known as aquatic distress.  They are not yet drowning, but realize that they are in trouble and still have the mental capacity (and lung capacity) to call for help.  Not always present before the instinctive drowning response, aquatic distress doesn't last long - but unlike true drowning, these victims can still assist in their own rescue.  They can grab lifelines, throw rings, etc.

Characteristics of the Instinctive Drowning Response:

1. Except in rare circumstances, drowning people are physiologically unable to call out for help.  The respiratory system was designed for breathing.   Speech is the secondary, or overlaid, function.  Breathing must be fulfilled, before speech occurs.
2. Drowning people's mouths alternately sink below and reappear above the surface of the water.  The mouths of drowning people are not above the surface of the water long enough for them to exhale, inhale, and call out for help.  When the drowning people's mouths are above the surface, they exhale and inhale quickly as their mouths start to sink below the surface of the water.
3. Drowning people cannot wave for help.  Nature instinctively forces them to extend their arms laterally and press down on the water's surface.  Pressing down on the surface of the water, permits drowning people to leverage their bodies so they can lift their mouths out of the water to breathe.
4. Throughout the Instinctive Drowning Response, drowning people cannot voluntarily control their arm movements.  Physicologically, drowning people who are struggling on the surface of the water cannot stop drowning and perform voluntary movements such as waving for help, moving toward a rescuer, or reaching out for a piece of rescue equipment.
5. From beginning to end of the Instinctive Drowning Response, people's bodies remain upright in the water with no evidence of a supporting kick.  Unless rescued by a trained lifeguard, these drowning people can only struggle on the surface of the water from 20 to 60 seconds before submersion occurs.

Look for these other signs of drowning when persons are in the water:

• Head low in the water, mouth at water level
• Head tilted back with mouth open
• Eyes glassy and empty, unable to focus
• Eyes closed
• Hair over forehead or eyes
• Not using legs - Vertical
• Hyperventilating or gasping
• Trying to swim in a particular direction but not making headway
• Trying to roll over on the back
• Appear to be climbing an invisible ladder

So, if someone is in the water and everything looks OK - don't be too sure.  Sometimes the most common indication that someone is drowning is that they don't look like they're drowning.  They may just look like they are treading water.  One way to be sure?  Ask them, "Are you alright?"  If they can answer at all - they probably are.  If they return a blank stare, you may have less than 30 seconds to get to them.

http://youtu.be/X1mVcSUttx4

http://youtu.be/RE8ly9BsU_M