9-1-1; What Is Your Emergency?

Tuesday, March 24, 2015

Recognition of Work Well Done: Nominate an Employee Who Has Gone Above and Beyond

Taken from Public Safety Communications Magazine, March 2015
Written by John W. Wright, communications analyst based in Riverside, Calif.  Reach him at rfanalyst@gmail.com.

As a communications center manager or shift supervisor, we are often recognized by our own departments when our division or shift does a great job.  Sometimes upper management notes the accomplishments of our hard-working employees, such as supporting the mission, handling a major incident or working through a crisis, as a sign of quality supervision in our own evaluations or commendations.  But these accolades are truly the result of dedicated teamwork by the professional telecommunicators who work for you.  Now don't get me wrong, good supervision is essential to leading a quality team, but when circumstances require everyone to step up, outstanding work by the members of your team is how this is accomplished.

I have always heard that a good manager leads by example, but a great manager also recognizes the hard work done by others.  So, when was the last time you formally recognized one of your employees, or team of employees, for a job well done?  As managers, we often make mention in an annual employee evaluation, or a memo for their personnel file, outstanding accomplishments.  But I suggest that all of us should be routinely finding additional opportunities to publicly (even if only within the department) recognize employees when they go above and beyond expectations in service to the department or the public.

As an example, my city's PSAP in Riverside, Calif., holds a week of recognition and celebration every year during National Public Safety Telecommunicators Week (NTPSTW), which takes place the second week in April, to recognize the hard work done by all of their PSAP professionals.  This is in addition to formal recognition throughout the year at department events.  Management routinely nominates employees to the CPRA's (APCOs Southern California Chapter's) annual telecommunicator awards, which recognize public safety communications professionals throughout Southern California.

I am extremely proud that these employees have received many well-deserved awards from CPRA over the past 20-plus years that the chapter has held this annual event during NPSTW.  The department has also nominated several employees for the annual APCO International Public Safety Communications Awards Program (PSAP) over the years, and some employees have been recognized at the International level with top awards for Telecommunicator of the Year and Communications Center Director of the Year.  I know that many, if not all, of our chapters hold events, annual awards or conferences where there is an opportunity to have the work of your employees publicly recognized.

While there are many opportunities to recognize your employees (such as those listed above), it will not happen if you do not take the time to be a great manager or supervisor.  I know it is a bit of extra work, and our typical workload always seems to be greater than the time you have to do it, but no one will ever know of their exceptional work without you taking a few minutes to write it up.  Nominations do not require you to write the next great American novel; just describe what they did and the results of their hard work.  I have had the wonderful opportunity to occasionally participate in evaluating some of the nominations submitted to the CPRA Chapter Awards Committee from PSAPs.  Many of the top winners were from nominations that were brief, but also clear and concise.  Although, with that said, I also would caution you to submit more than, "They do a great job and deserve this award."  Include a bit of explanation and details.  Filling out the nomination form completely is always essential.

For the PSAP awards, APCO has a very dedicated group of member volunteers who spend many long hours reviewing nominations each year to select those who will be recognized at the annual conference in August.  The APCO Awards Committee accepts nominations for Telecommunicator of the Year, Communications Center Director of the Year, Line Supervisor of the Year, Radio Frequency (RF)Technologist of the Year, Information Technologist of the Year, Trainer of the Year and Team of the Year.  Nominations are accepted between January 1 and April 1 each year and nominees, or their nominators, do not need to be members of APCO International to be nominated.

Additionally, APCO International has a Technology Leadership Awards Program designed to recognize PSAPs and other public safety communications agencies for their use of technological advancements.

Will you be just a good manager or supervisor, or a great one?  For more information on the awards program, visit www.apcointl.org/awards.

I wish to personally thank the members of the APCO Awards Committee and all those who recognize the dedication and hard work of professionals who serve in public safety communications.

Thursday, February 26, 2015

Tactical Dispatch: Understanding What a Tactical Dispatcher Is

Taken from Public Safety Communications Magazine, January 2015
Written by Rhonda Harper, MA, RPL, NREMT, is the 9-1-1 administrator for the Independence (MO) Police Department and an APCO Institute adjunct instructor.  Reach her at rharper@indepmo.org.

When discussing training and required skillsets, it is often asked just what, exactly, the difference is between a tactical dispatcher and a telecommunicator.  The best, though somewhat complicated answer, is that the purpose of the tactical dispatcher is to support specialized teams with accurate, efficient documentation of events during critical incidents.  The simpler answer is that the two positions actually do perform many of the same duties and hold the same responsibilities, just on a different level of criticality.

As with most elements of public safety communications, the difference depends on individual circumstances and the agency in which the dispatchers perform.  No matter where you go, the tactical dispatcher and the telecommunicator quickly gather information from the caller and a host of other available sources, then disseminate that information to units in the field.

The profession of public safety telecommunicator is constantly evolving, and there is no such thing as having too much knowledge. There is always some new technology or skill to be learned or shared with colleagues.  It is essential for telecommunicators to know every aspect of their jobs, as well as their agency's policies and procedures.  The daily practices of the telecommunicator must mirror the policies and procedures the agency has in place in order to minimize liability for the telecommunicator, the agency and any governing entities.

This general standard for all telecommunicators goes hand-in-hand with rising to the specialized skill level of a tactical dispatcher, though how the position of tactical dispatcher is utilized will vary from agency to agency.  For example, some agencies have the tactical dispatcher respond with the SWAT team for hostage situations or barricaded subjects in a specialized mobile command post, while other agencies will have the dispatcher run this position from a console.  This decision depends on the individual agency's available equipment, manpower, resources and needs.

There continue to be misconceptions of the 9-1-1 emergency number system by the general public.  It is often believed (and the media plays a part in exacerbating this problem) that when an individual calls 9-1-1 for help, they are speaking to a member of the specific profession that is needed.  For example, if someone calls for a medical emergency, they assume they are talking to a medically trained professional such as a paramedic or EMT.  And when people call 9-1-1 to report a fire, they often believe they are talking to a firefighter.  Or if they call to report a crime, they believe they are speaking to a law enforcement officer.

What the general public doesn't realize is that, in many jurisdictions, they are actually speaking to a civilian who is specially trained to take their calls for service and assign units to help when the caller so desperately seeks assistance.  Telecommunicators possess a set of skills and personality traits unique to their profession that aren't always shared by field officers, firefighters or paramedics.  Among those skills is an innate ability to multitask -- managing multiple incidents and sources of information at the same time, all while listening and accurately repeating complex information in a concise and efficient manner.  Having a skilled tactical dispatcher on duty during heightened incidents is critical because it frees up officers to resume tactical field roles.

Duties & Responsibilities
The desire alone to become a tactical dispatcher is unfortunately not enough to pass the skill level or qualifications necessary to perform this duty.  Each agency has its own process in which tactical dispatchers are chosen, however the first step for every agency is to decide what duties and responsibilities will be the domain of the tactical dispatcher.  The next step is to look at the qualities and characteristics needed for an individual to become a tactical dispatcher.  Again, each agency is different and will have different requirements.

The tactical dispatcher must be proficient not only in their daily duties, but also in the specialized knowledge required by their agency, and they must possess a will to continually seek out more knowledge.  Working in this capacity, the tactical dispatcher must understand the "why" behind the "what" of their jobs.  If something goes wrong, the tactical dispatcher must find a work-around.  The primary duty of any telecommunicator is to protect their responders and the public.  This task is especially crucial during heightened situations when a tactical response is needed.

Not everyone can make it as a dispatcher.  There continues to be a shortage of experienced and dedicated telecommunicators in agencies nationwide because of this fact.  Failing to pass the training program doesn't necessarily reflect poorly on the person, it simply means it takes a very special type of person to be able to do this job.

The general daily duties of a telecommunicator include gathering information, prioritizing needs based on the response level required and resources available, then recording and documenting all communications.  This, in a nutshell, is what the telecommunicator does.  To expand further, the telecommunicator also completes requests from field responders and runs warrant checks, license plates, articles and vehicles through the National Crime Information Center (NCIC) while keeping responders up to date and disseminating information quickly, efficiently and accurately.

These tasks are typically performed within a dispatch center, often with other employees working nearby.  Depending on the agency's preferences and resources, the tactical dispatcher may work from within the comm center at a console or on scene, typically from a response unit specially designed for radio capabilities.  When the tactical dispatcher is based in a specialized response unit, it is imperative the individual chosen for this position is able to work around any problems or unexpected situations, as there will not be assistance available from a nearby co-worker or supervisor.

Specific qualifications for the tactical dispatcher position will vary depending on the individual agency.  Below is a list of common requirements.

  • The dispatcher may be required to be on the job for a predetermined number of years prior to being given the opportunity to apply.
  • Must be able to monitor and complete multiple tasks at once without missing any radio traffic or information.
  • Must adhere to policies and standard operating procedures as set forth by the agency.
  • Must have proficient knowledge of the jurisdiction.
  • Must be able to problem-solve as a situation progresses.
  • Must be able to document and relay information to field units in a timely and accurate manner.
  • Must be able to remain calm under intense pressure and for long periods of time.
  • Must be able to utilize technological equipment effectively.
There is not just one type of incident in which a tactical dispatcher may be needed.  This specialized skill can be utilized during several critical incidents such as active shooter situations; hostage or barricaded subject incidents; natural, manmade or terrorist disasters; or even planned events such as parades, holiday festivities or carnival events.

As telecommunicators, we always hope for the best and plan for the worst.  Even in our day-to-day professional activities, breaks are considered a luxury and our call loads dictate how we plan our days.  Depending upon the situation, it can be difficult to even take a short bathroom break, and forget a smoke break if there is no one to relieve you.

The tactical dispatcher is subject to call-outs and must be available when they are needed. There is no rhyme or reason as to when incidents occur, but when situations go downhill they often go in a quick sliding fashion.  Therefore it is best to have more than one tactical dispatcher in each agency.  Depending upon the size of your agency, you may consider one-eighth of your staff, with a minimum of two tactical dispatchers.  For the smaller agencies, one-third may be considered to account for sickness or vacations.

The skills required of a tactical dispatcher should be specifically planned out and tested prior to an incident occurring.  It is never optimal to do trial by error, on the fly of under pressure.  The dispatchers should be included in the planning process for responding to tactical events.  This is especially essential if there is no one else available with a background in dispatch to ensure all needs are adequately met.  If those planning out the needs of the tactical dispatcher do not  have a background in communications, it can lead to potential issues when a real-life scenario does arise.

Unexpected events, or incidents in which a tactical dispatcher is needed, can quickly become overwhelming and draining to the dispatcher, especially when they are alone without backup.  This is another reason to have more than one telecommunicator trained in tactical dispatch.  This is not unlike Incident Command System (ICS) activation or the incident commander position.  The role of the tactical dispatcher may change depending on the relief staff available.

Let's face it: the role of the dispatcher has not been around for that long.  AT&T enacted 9-1-1 as the national number to be used in an emergency in 1968.  It wasn't until 1999 that Congress passed the law making it the nation's number to call in an emergency situation.  The term tactical dispatcher is even newer, but an increasing number of telecommunicators have moved to this type of specialized dispatch over the past decade, and the term continues to be defined each day.

Job Description
The primary duty of the tactical dispatcher is to protect responders in the field.  The size of the tactical dispatching team needed depends on the size of the department.  Too large of a specialized group and the need for each individual to call-out may be rare, while too small of a group could lead to burnout.  In the event a tactical incident occurs in your jurisdiction, whether it be a manmade disaster, terrorist event or natural disaster, you may want to consider a group large enough to handle that situation.  A contingency plan must be considered in the event members are unable to respond due to power outages or road closures.  A good rule of thumb is to have enough members on rotation at least once weekly for every four to six weeks.  Again, this is dependent upon the jurisdiction and how large of a community your agency services, as well as the number of average call-outs per month.  You want to ensure everyone is able to utilize their skills.

When considering the selection process you would like to institute for your agency, it is important to consider the attributes you would like your tactical dispatchers to encompass.  When we think of SWAT members, we think of them as an elite team.  The same goal should be set for tactical dispatchers, as they will be working with those elite members of the SWAT team.  The individuals chosen for this specialized duty must be a step above -- always taking advantage of available tools and resources, and always striving to learn more information.

Training & Preparation
The need for current and continued training is prevalent throughout the public safety communications field.  Telecommunicators at the level of tactical dispatcher have an even greater need for training to ensure they have the skills necessary to perform the functions required of the job.  The work of tactical dispatchers differs from standard telecommunicators location of dispatching, proximity to other first responders and, of course, the heightened tensions that often come with those scenarios.  Training must be completed with the responding units; when you are needed, you must be ready and prepared to get to work.  Each member of the responding unit will have their own jobs to do, there will not be anyone there to help you get your equipment set up or hold your hand.  As the team's tactical dispatcher, it is up to you to be prepared and ready to respond for any situation.

Each agency is different from the other, what works for one may not necessarily work for the next.  Several variables will play into the types of responses your agency's SWAT team and tactical dispatcher will respond to, however the training you receive and complete with them as their tactical dispatcher will help you understand how they respond to such incidents and anticipate their needs before the request is made.  It is not unlike other types of dispatching in which we get to know our officers and begin to collect or search for information prior to them asking for it.

There are several benefits to utilizing a tactical dispatcher rather than utilizing a dispatcher out of the communications unit.  When you have a team available, even if they rotate through on call-outs, there is a level of consistency and trust built, as well as a rapport between the team members.  In working as a team, one begins to anticipate what the other team members need and the process begins to run like a well-oiled machine.  During critical incidents this can become crucial, as each member will have their own jobs to accomplish, making it difficult to stop and assist or answer questions during a learning process.

Just as SWAT teams train together, tactical dispatchers should also train with the SWAT team.  This helps the dispatcher to better understand what is going on in the field while under safe training conditions, and it also allows the SWAT members to better understand the role of the tactical dispatcher and become familiar with them as well.  This process will assist in identifying any areas of weakness or issues with equipment, technology or other essential items, plus any needs that can be met prior to an actual incident occurring.

There will always be training challenges as well for most agencies.  This is especially true during economic downturns, when agencies may need to decrease overtime for budgetary reasons.  If an agency does not have the ability to adjust schedules for training purposes, an option may be to offer compensatory time instead to allow for training time.

What the Future Holds
The role of the dispatcher is ever-changing, and the future only holds more advancement and technological changes than ever before.  These changing times mean that public safety communications professionals also need to continuously move forward.  Just think, 15 years ago cellphones were fairly non-existent, CAD systems didn't give us the capabilities they do now and many still worked off pen and paper within their comm centers.  Now, households increasingly are getting rid of their landlines and using cell phones exclusively.  The more technology changes, the more our jobs change on a daily basis.

As each year passes, more situations will occur needing the specialized skills of SWAT teams and tactical dispatchers.  We are not the only ones who learn from previous incidents: the next individual wanting to do harm is also doing their homework, creating an essential need for those specialized teams.

The role and implementation of the tactical dispatcher is still relatively new to many agencies throughout the country and, as we all know, change does not come easy.  However, if you are interested in implementing a tactical dispatch program at your agency, there are numerous training manuals, books and online resources discussing this profession and specialized positions.  These are also beneficial if you are interested in stepping into one of these specialized positions to further your own career.

Training for Success: Tips for Onboarding New Telecommunicators

Taken from Public Safety Communications Magazine, January 2015
Written by Melissa Kumle-Hammes & Rachael Elvers; Melissa is a Public Policy and Administration PhD student.  She also works as a 9-1-1 dispatcher for the Joint Emergency Communications Center of Johnson County, Iowa, and serves on APCO's Editorial Advisory Committee.  Rachael is a 9-1-1 dispatcher and certified training officer for the Joint Emergency Communications Center of Johnson County, Iowa.  She is also a licensed paramedic.

After an exhaustive, extensive and likely expensive hiring process, the "right" candidate is selected to fulfill the duties of a dispatcher or telecommunicator in an emergency communications center.

So, now what?

Quite often, the new employee fills out paperwork and then begins training with their assigned certified training officer (CTO).  Unfortunately, onboarding -- the process in which new employees acquire the necessary knowledge, skills and behaviors to become effective organizational members -- tends to be overlooked or skipped altogether.  Onboarding is a communications center's one and only chance to make a positive first impression on, and ultimately connect with, the new telecommunicator.  More specifically, successful onboarding will help a new calltaker or dispatcher to not only learn their job duties, but also understand the social, performance and training facets of their newly chosen communications career.

Why is onboarding important to your communications center?  Research indicates that onboarding creates happy and productive employees, and reduces the likelihood of turnover.  With an average cost of $18,388 per new hire, most communications centers cannot afford to lose trained dispatchers.  Yet, the nationwide turnover rate of emergency communications employees is nearly 20%, which means two out of every 10 telecommunicators exit the occupation each year.

Onboarding is a proven method to mitigate turnover is many industries, and it can be easily applied to any communications center.  Here are a few tips to create or improve the onboarding process for all new hires at your communications center.

Make the First Day Count
Use the employee's first day on the job as an opportunity to impress the new telecommunicator and reinforce their confidence that they made the right decision to accept the job.  While mundane human resources paperwork is a necessity, do not let it consume the entire day's activities.

Instead, construct comfortable situations to make staff introductions and then provide an opportunity for the new employee to be social with other staff members.  Create a "welcome kit" -- this can comprise items as simple as company pens or notepads -- designed to make the new telecommunicator feel like part of the team.  Make the first day as fun as possible.

The training process for a new telecommunicator can last upwards of a year depending upon the size of the communications center, and new employees may not count toward minimum staffing during that time.  But even if they don't count toward your minimum, they still matter and it's important for supervisors to demonstrate this.  Therefore, confidence reinforcement is extremely important during training to ensure the new employee knows they matter to the team.  In other words, create training tasks that help them feel like a contributing member whose efforts are valuable.

Introduce Stress & Teach Them How to Cope
Emergency calltakers and dispatchers are expected to possess significantly greater knowledge than ever before in order to provide quality and efficient life-saving services to their communities.  In fact, research indicates that telecommunicators experience comparable levels of stress to police officers on the street.

A relevant study details how 9-1-1 telecommunicators are subject to the symptoms of secondary traumatic stress and PTSD due to compassion fatigue.  Fundamentally, compassion fatigue is defined as being overwhelmed with compassion or concern for others.  For these reasons, a newly hired telecommunicator needs to be introduced to the stress of the job, but also given the tools to cope.

First, make certain the new hire is aware of any employee assistance program or mental health-related services offered by your agency.  Second, prepare them for the negative aspects of the job while still ensuring that their day is predominated by the positive and achievable aspects.  Third, teach the new telecommunicator how to separate their emotions from the necessary tasks of their job.  While empathy is important, calltakers and dispatchers need to maintain control of their emotions.  Finally, emphasize that every day will be filled with opportunities to help their community.  The new employee needs to feel proud that they will possess the skills to help people during what may be the worst event of their life.

Set Them Up to Succeed
The new telecommunicator may be the perfect person for your communications center, but they need to be treated, trained and valued properly from day one in order to succeed.  First, ensure your training program is up-to-date, adequate and measurable.  Second, create an organized orientation week to guarantee the new employee is immediately able to build relationships and feel comfortable at your center.  Third, provide the new employee with plenty of one-on-one time with their training officer (with and without the stress of the trainer counting toward minimum staffing).  Finally, vary the new telecommunicator's daily training tasks as much as possible.  Challenge them every day in new ways to keep them motivated and productive.

Do not waste the time, effort and money put into finding and training the "right" new telecommunicator by improperly introducing them to your communications center.  Take the time to prepare all new employees for their careers by incorporating a strategic and calculated onboarding process.  After all, research proves that proper new employee onboarding leads to higher job satisfaction, higher organizational commitment, higher performance levels, lower stress, and lower turnover.

Wednesday, February 25, 2015

Serving Callers in Need: Evaluating the Cost of a Smile in Emergency Communications

Taken from Public Safety Communications Magazine, January 2015
Written by Stephen Martini, emergency communications supervisor at Brentwood (Tenn)    9-1-1.  Before joining public safety, Martini was a newspaper journalist in North Carolina and Tennessee.  Contact him via email at martinis@brentwood-tn.org.

We are 9-1-1.

Telecommunicators proudly (and rightly) boast the fact they answer the call in the direst of circumstances.  We display mottos declaring we are there when seconds count and when lives are on the line; then we tell the police where to go.

But the reality in most centers is that 9-1-1 calls make up a fraction of our overall call load -- and many of those 9-1-1 calls are non-emergency in nature.  Having worked in two PSAPs in my career, I know firsthand that approximately 80% of calls placed into the PSAP are on non-emergency lines.

So why are we still using the urgent nature of our profession to excuse poor customer service?

In more than a decade in public safety communications, I have heard a variety of excuses for delivering poor customer service.  I have seen some telecommunicators curtly disconnect with a caller in the name of not tying up 9-1-1 lines, while others gave harsh, almost sarcastic, instructions to callers while advising their reported emergency was barely worth reporting at all.

In fact, one former co-worker once informed me they did not have to answer administrative calls at all, deeming it a self-declared perk of seniority.

Let's table the clear lack of supervision in the last example and focus on the core issue: customer service.  What does customer service look like in the comm center?  Where can we turn to learn more about such an important topic?  Where do we begin?  

Who Are Our Customers?
To start, we must determine who our customers are:

  • Responders in the field (fire, police, EMS, other dispatchable resources)
  • Residents and visitors who call for assistance (9-1-1 and non-emergency callers)
  • Our fellow first responders in the PSAP
How we interact with each of these customers will change based on the nature of their request.  For example, an officer screaming for back-up on the radio will receive an abrupt and targeted response from a focused telecommunicator keen to send the right help to the right place at the right time.  However, if that same officer called on the phone seeking a phone number to a business across town, our reaction would not be nearly as abrupt and targeted.  In fact, as we prioritize that request in light of other tasks we are completing at the time, we may ask the officer if we can call them back with that information--something you would never do if an officer called for help on the radio.

For this first article in a series on customer service, we focus on serving our callers.

A caller reporting a home invasion requires an exceptional level of care: a targeted response from a well-trained telecommunicator weaving strategically through relevant call guides and protocols to gather critical information to assist law enforcement and protect the caller prior to field responders arriving on the scene.  In this situation, it is important to focus the caller's answers to match your questions, and to keep the caller focused on providing relevant information for both their safety and that of the officers.

A seasoned telecommunicator may talk over the caller, cut them off or interrupt with a clear, authoritative tone to control the call.  All of these techniques are important when gathering critical information in a time-and safety-sensitive environment.

Can we apply the same call-handling techniques to the caller who starts his call saying "I know this isn't an emergency, but....?"  Those words are cringe-worthy.  Many telecommunicators shudder at what may follow some variation of this well-known phrase.

Or what about the citizen who calls to ask about trash collection, fireworks displays, noise ordinances,  or to report that their purse was stolen overnight from where they left it on the front seat of their unlocked vehicle?  Often, this is an area where our call-processing customer service falters.

Non-Emergency Calls Matter
When handling non-emergency or administrative phone calls, we should turn our attention to the wealth of training information available at corporate call centers that handle millions of incoming calls per year.  In those situations, we should borrow some pages from their personal selling playbook.

Personal selling is a promotional method in which one party uses skills and techniques for building personal relationships with another party, resulting in both parties obtaining value.

So what value do we give?  We offer confidence, competence and compassion for our callers in their time of need, regardless of the nature or priority of their emergency.  What do we obtain in return?  Happy callers tell their experience to their friends, neighbors, co-workers, family which work their way back to city or county administrators, commissioners, councilpersons and department heads through shared participation in civic organizations, church or other social events.  Happy residents are happy voters who are happy to fund municipal departments that add value to their lives.

Personal selling allows us to adapt to the situation, engage in a dialogue with the caller, so we can build relationships with the caller to ensure they receive the appropriate service and that their problem is resolved.

According to the 2012 Forrester's Customer Experience Index, 89% of customers are likely to buy from a competing company.  This may be why we offer poor customer service on administrative calls -- as government employees, we are the only option!  Who is our competition?  What other choice do our callers  have?  They're stuck, right?

But let's look at it from a different perspective: Customers who believe they are receiving poor service and believe they do not have options will be disgruntled and loud.  They may move away, negatively affecting our tax base, or they may stay and appeal to administrators and elected officials for reform.  Our customers deserve good service and they do have options when they feel they are being mistreated.

The same Forrester study reported that 69% of customers say they prefer live assistance over the phone because they feel their questions can be fully addressed, and 80% of companies want to use the customer service experience they offer as a way to differentiate themselves from their competition.  According to a 2013 study by LivePerson.com (a company that connects clients and companies online), 82% of people say getting their issue resolved quickly is the number one factor to a great customer experience.  According to an internal American Express customer survey conducted in 2012, 26% of consumers said they experienced being transferred from agent to agent without any resolution to their problem.  A 2011 article in Return on Behavior Magazine, 55% of customers would pay extra to guarantee better service.

Finally, according to customer service professional Ruby Newell-Legner, author of the book Understanding Customers, it takes 12 positive experiences to make up for one unresolved negative experience.

Personal selling is expensive and labor intensive, since guaranteeing a live person is on-hand to address and resolve your concern requires actual people rather than deploying an automated system (salaries, benefits and a comfortable work environment, are just a few of the associated expenses).  So the investment your agency makes in you is, in turn, an investment they hope you are making into your community.

Beyond Being 'Polite'
It is pretty easy to see the connection between providing high-quality customer care and receiving high-quality support from your community.

We must navigate call guides with measured ease, using the questions as a guide for fluid conversation rather than items to check off a list during a hostile interrogation.  With only one chance to make a great first impression upon which we can build rapport, callers must know we acknowledge and understand their concerns, not solely gather information so we can dispatch the "real help."  Often, that means listening to the caller long enough to determine their concerns so we can adequately determine how to deliver the right type of help -- whether that means dispatching responders or connecting the caller with an outside agency or civil legal service.

We have to fight the urge to blindly transfer a caller concerned about their faulty water heater, power outage or missed garbage collection date to an unstaffed voicemail without explanation because their call isn't an emergency.

Offering a higher level of care relies on a variety of outside factors: proper supervision, adequate staffing, proper training, access to relevant information, functioning technology to ensure proper receipt and transfer of calls, and adequate pay and benefits.  These aspects should be considered by all administrators who have a hand in providing high-quality, personal customer service.

However, we are ultimately responsible for ourselves.  We can control whether we smile while speaking with a caller (you do know callers can hear you smiling, right?) and whether we take the extra five seconds to explain a process or acknowledge a concern.

For more information on offering great customer service, read John Miller's book, QBQ! The Question Behind the Question, which focuses on what you can do to help others.  Another valuable resource is retired Phoenix Fire Chief Alan Brunacini's book, Essentials of Fire Department Customer Service, which explains the unique world of customer service in the realm of public safety.

Using the ERG: Emergency Response Guidebook Aids Telecommunicator Response

Taken from Public Safety Communications Magazine, January 2015
Written by David Donohue, MA, MEP, CEM, EMT-P, is the director of Franklin County (N.Y.) Department of Emergency Services.

Imagine it's a quiet Thursday afternoon at your PSAP, which serves a rural and suburban county of more than 200,000 people, providing emergency dispatch services to several small police departments and a combination of small, primarily volunteer, EMS and fire departments.  The PSAP receives a call from a local food processing company.  The caller, the plant manager, advises that a worker has driven a forklift into a cooling line, resulting in a leak of anhydrous ammonia.  The ammonia cloud is exiting the facility to the east, and is moving toward a nearby neighborhood and elementary school, located approximately a quarter-mile away.

You send emergency responders to the incident, and a nearby police officer is requesting information on how far out she should set up road blocks.  Shortly thereafter, the first responding engine advises that they are unable to find their Emergency Response Guidebook (ERG) and require assistance in researching initial actions and evacuation distances.

The Emergency Response Guidebook
The ERG, which is required to be on board every emergency vehicle, is a valuable tool for emergency personnel facing hazardous materials or weapons of mass destruction incidents.  The guidebook -- developed by the U.S. Department of Transportation (DOT), Transport Canada and the Secretariat of Transport and Communications of Mexico -- is designed to provide initial guidance for emergency personnel responding to a hazardous materials accident, as well as response to unknown substances or weapons of mass destruction.  PSAP personnel should be familiar with the ERG in order to better support field providers.

The ERG is broken down into five color-coded sections.  Each section provides information that leads to general guidelines for initial emergency response.  There are two sections of white-bordered pages.  The first white-bordered section runs from the front cover to page 19.  The response information begins on the inside cover by identifying where shipping papers for hazardous materials will be kept, based on the method of transportation.

Page 1 lists the three primary steps for using the ERG, and pages 2 and 3 provide general response procedures.  Pages 4 through 19 provide means of classifying hazardous materials by DOT class and division number, placards, United Nations (UN) Hazard Identification Number, container number and type, and pipeline.  In addition, the Table of Placards located on pages 6 and 7, and the container diagrams for both rail and road containers located on pages 8 and 9, provide initial direction on which emergency guide should be utilized based on the information available.  These guides are indicated by a circled 3-digit number located next to the diagram or placard.  This 3-digit guide can be found in the orange section, which is located in the middle of the guidebook.

The yellow-bordered pages, which run from page 20 through page 89, list chemicals by their 4-digit UN identification number.  Explosives, however, do not have a UN number and are listed first on page 21.  The UN number can be found on shipping papers, within placards and on the orange panel located on the outside of shipping containers such as rail cars and trucks.  In addition, some facility pre-incident documents and Local Emergency Planning Committee (LEPC) plans may list the UN number.  The column located next to the UN number provides a 3-digit number that corresponds to the emergency action guides located in the orange-bordered section.  The use of the letter P following the 3-digit guide number indicates that the material may be subject to polymerization.  In other words, the material may rapidly grow in size, resulting in a failure of the container to hold the material.

Blue-bordered pages are the third section of the ERG and are similar to the previous section.  The chemicals are listed in alphabetical order.  The emergency action guide is listed in the middle column and the UN identification number is located in the last column.  Some of the materials listed are highlighted in green.  This indicates that the materials are extremely toxic and require modified protective action distances.  If a material is highlighted in green and there is a leak or spill with no fire, then the initial isolation and evacuation distances listed in the green section should be used.

Beginning with Guide 111, located on page 160, the orange-bordered pages provide general direction to guide the emergency responders' actions through the first minutes of the hazardous materials emergency.  These two-page guides list the general hazard along the top border of the pages.  The left page has two sections.  The top section identifies the general fire or explosive hazards and health hazards.  Whichever hazard is listed first is the greatest hazard.  The second section identifies response actions including protective clothing and evacuation distances, which are intended to provide for the health and welfare of the community.  The right-hand page describes emergency response actions that may be taken, including methods of fire extinguishment, spill and leak control, and first aid measures.

The green-bordered pages are composed of three tables.  Chemicals listed in the green-bordered pages are either very toxic in low doses or produce toxic gases when exposed to water.  These materials require quick, positive action within the protective action zone to reduce the likelihood of death.  These actions may include shelter-in-place or evacuation.

The chemicals listed in table 1 of the green section, which are also highlighted in both the yellow and blue sections of the ERG, provide actions for both small and large spills, each of which begin with identifying a recommended initial isolation distance first.  This is the distance that should be evacuated in all directions.  This is followed by recommended protective action distances.

Table 2 in the green-bordered pages provide a listing of water-reactive chemicals that give off materials that are toxic by inhalation when they are wet.  If the materials become wet, then the action distances listed in the orange section should be followed.  For example, if a rail car containing potassium cyanide is involved in an incident, and the material becomes wet, whether by firefighting efforts or weather, hydrogen cyanide gas is produced.  If the incident occurs at night, then an initial isolation distance of 300 feet should be established and downwind protection actions should take place within 0.8 miles of the  incident.  However, if the same material is involved in an incident and is not exposed to water, then the initial isolation distance is reduced by 75% to 75 feet.  

Table 3 in the green-bordered section provides isolation and protective action distances for six common toxic inhalation hazards for incidents involving releases from various sizes of containers, and takes into account wind speed as well as time of day.

The final white-bordered section runs from page 356 through the back cover.  It begins with directions on how to use the ERG and describes potential actions that may be taken, including initial isolation, evacuation and fire control.  The section also briefly describes the types of protective clothing, their use and limitations.  Pages 365 and 367 provide information on Boiling Liquid Expanding Vapor Explosions (BLEVE) and page 367 has general information regarding liquefied tank fires, including critical time to failure, water needed and evacuation distances based on the size of the tank.  Pages 368 through 372 review the indicators of potential criminal or weapons of mass destruction involvement and page 372 provides safe stand-off distances for explosives and liquefied petroleum gas (LPG) tank explosions.

Finally, the ERG concludes with a glossary of terms, followed by contact information for emergency response, including poison control, Chemtrec, the Department of Defense and the National Response Center.

While all emergency responders, including emergency PSAP personnel, should be familiar with the ERG, the ability to use it in an emergency to provide critical information is limited by the user.  Regular review and practice provide telecommunicators the ability to assist field personnel with timely and accurate initial response, and ensure the safety and security of the community are maintained.  Understanding the use and limitations of the ERG will allow the PSAP to serve a a functional member of the response team during critical incidents, adding value to the role of the PSAP during emergency response.

The ERG is available for download at www.phmsa.dot.gov/hazmat/outreach-training/erg.

Kari's Law: MLTS E9-1-1 Awareness

Taken from Public Safety Communications Magazine, February 2015
Written by Mark J. Fletcher, Avaya's Chief Architect for Worldwide Public Safety Solutions.  He represents Avaya on the APCO Standards Development Committee and the NENA Institute Board, and also contributes technical guidance to various committees at the FCC.

On Dec. 1, 2013, in Marshall, Texas, Kari Hunt went to the Baymont Inn to meet her estranged husband with her children.  Little did she know, a single digit would stand between her and the emergency services she would so desperately need.  During the visitation, Hunt was brutally murdered in front of the children.  Her nine-year-old daughter attempted to call 9-1-1 on the motel room phone, but wasn't able to get through because she didn't know to dial 9 first.

At an early age, our parents, teachers, police and firefighters teach us that if you need help, you call 9-1-1.  Unfortunately, access to 9-1-1 from multi-line telephone systems (MLTS), also known as private branch exchanges (PBX) can be problematic.  Often, the caller is required to dial 9 and/or another numeral before placing any outside call, including emergency calls to 9-1-1.

In response, several major hotel chains have implemented policies requiring direct dialing to 9-1-1 as part of their brand standards.  Additionally, 18 states have legislation on the books regarding MLTS/PBX systems; two of those states have penalties for non-compliance.In January 2014, an updated MLTS/PBX plan was drafted and presented to FCC Commissioner Ajit Pai.  It focused on simple steps that could be put in place at little to no cost to enhance the public's access to 9-1-1.  These requirements are:

  1. Access to 9-1-1 with and without an access code: Telephones must have the ability to reach 9-1-1 by dialing only the digits 9-1-1.
  2. On-site notification of 9-1-1 calls: This is critical so staff can respond appropriately or direct emergency services upon arrival.
  3. Prohibiting the interception of 9-1-1 calls: Answering calls internally blocks the person who needs assistance from responders.
At the "9-1-1 Goes to Washington" event held in February 2014, Commissioner Pai reported on results of an inquiry to the top hotel operators.  The inquiry showed that less than half (44.5%) of corporate-owned properties allowed direct access to 9-1-1, and for franchised properties the compliance level was a mere 32%.  Commissioner Pai said these numbers are unacceptable.

"The data we've gathered suggests that the MLTS at tens of thousands of buildings across the U.S. may fail consumers during the most important moments of their lives," he said.  "As in Kari's case, systems at these properties will not perform one of the most important purposes of the nation's communications network -- connecting 9-1-1 callers to help."

Legislator Robert Trotta of Suffolk County, N.Y., was shocked to hear of the deficiency found in many MLTS properties.  Trotta brought Kari's Law to action in New York, where Suffolk County takes up about two-thirds of Long Island's 1,400 square miles and is a popular destination for many families.  Trotta was concerned not only for the lodging industry, but for businesses, which spurred his trip to Washington, D.C.  A test call to 9-1-1 he placed from his Suffolk County office failed to reach 9-1-1 services.  Why?  Because the cloud-based MLTS services in his office didn't allow direct 9-1-1 access.  Trotta's legislation was passed unanimously in just a matter of months, with current plans to bring the issue to Albany for action at the state level.

Illinois had MLTS legislation stemming back to the late 1990s in response to a tragic fire that took the life of a young businesswoman.  But, like many other states, there was no language on direct access, local notification or prohibiting companies to answer their own calls with untrained personnel.  After being inspired by the success in Suffolk County, Illinois Senator Jennifer Bertino-Tarrant took the lean and presented a similar bill to the full Illinois Senate floor, where unanimous and bi-partisan support was immediately received.  The bill was passed as an amendment to the existing bill, adding the three main components of Kari's Law as well as provisions for non-compliance penalties.

In Texas, the Commission on State Emergency Communications (CSEC) held a public hearing on the issue and decided to fast-track the legislative process by using language already written, as endorsed by the majority of agencies and interested parties in attendance.

The Colorado 9-1-1 Resource Center, a nonprofit organization providing support for Colorado 9-1-1 authorities and PSAPs, has also recommended that the Colorado Public Utilities Commission review their current legislation.

In response to the tragedy of Kari Hunt's murder, the emergency communications industry took action to correct the problem.  In the end, public education by MLTS manufacturers as well as the public safety community continues to raise awareness and ultimately saves lives.

Childbirth & the EMD: Instructions on Talking a Mother or Bystander Through Baby Delivery

Taken from Public Safety Communications Magazine, February 2015
Written by Stephen H. Reichman, Sr., involved in emergency communications since 1986.  He is currently superintendent of training at Bucks County Emergency Communications, located in the southeastern corner of Pennsylvania.  He has been an adjunct instructor for the APCO Institute for more than 11 years, is a contributing editor for the APCO CTO 4th and 5th edition curriculum and was in the first APCO EMD Instructor class in the early 1990s.

The birth of a child is a joyous event in the lives of new parents or parents of multiple children.  For the Emergency Medical Dispatcher (EMD), it can also be one of the most challenging, eventful and satisfying calls to handle.

After successfully verifying the location and dispatching responders, much of the call involves following the childbirth guidecards, as well as coaching the caller and those at the scene.  It is possible that the caller my be the mother who is about to give birth, or it could be a bystander(friend, family member, etc.) who will be responsible for following the telecommunicator's instructions.

Your agency has approved childbirth protocols to help you guide the caller through each step.  Adherence to the protocols will minimize confusion and create an environment where you can smoothly guide the process and maintain reasonable safety at the scene.  Understanding some background information about pregnancy and childbirth will enhance your ability to process this type of incident with proficiency.

Childbirth: A Momentous Event
Many people have faced an unexpected childbirth scenario, whether because the baby arrived prematurely or because the arrival was so sudden as to prevent the mother from safely being transported to a hospital.  The EMD is an integral part of this event to assist in the various aspects involved in emergency childbirth.

The reality in any childbirth event is that the mother does all of the hard work, but she needs the help of those around her for support and to help her work through one of the most difficult situations in her life.  The EMD and family member(s) or bystander(s) must work together to provide emotional support as well as basic first aid for the mother and baby.  The EMD's primary job is to get the whole team working together.

Verify the Location
One can never overstate the need for properly verifying the location of an emergency call, and this is the EMD's first order of business when responding to an emergency childbirth.  Obtaining the incident location is 95% of our job, and we have a stated need to get the right person, in the right type of response vehicle, in the right response mode, to the right place.  Any pre-arrival instructions (PAIs) we provide are just the icing on the cake.

If the telecommunicator fails to pay attention to location details, then help will be sent to the wrong location.  It is vital that we keep our guard up when verifying the location of the incident with the caller.  Always get verbal verification and make sure it matches up with your technology resources.  Identifying the location properly saves time and lives.  It is such a small step in the process, but it is the most important.

Additionally, the EMD needs to obtain the exact location of the mother and facilitate good scene management by getting the caller next to the mother in preparation for PAIs.  Doing this early on minimizes time delays caused by restaging the caller later, and puts the caller in a better position to visualize the situation for you.

Dispatch Criteria Determines Response Level
Remember that you need only one criterion to initiate a dispatch, but you will need to determine if the situation requires Advanced Life Support (ALS) or Basic Life Support (BLS).  Your local EMD/EMS protocols should be followed in each case.

As a simple guideline, verify the current status of:

  • ABC: If anything adversely affects the mother's Airway, Breathing and/or Circulation, dispatch ALS.
  • LOC: Any decreased, diminished or lowered Level of Consciousness indicates an underlying medical issue and requires the dispatch of ALS.
  • MOI: If there is significant Mechanism of Injury caused by some kind of trauma such as a motor vehicle accident, a fall, assault/violence, etc., dispatch ALS.
Pregnancy Trimesters
Pregnancy is a life condition, not an illness, and should be treated as such.  The medical events that occur during this  life event are what the EMD responds to and assists the mother with.  Pregnancy is a nine-month period divided into three, three-month phases referred to as trimesters.  Months 1-3 are the first trimester, months 4-6 are the second trimester and months 7-9 are the third trimester.  Our discussion revolves around the final stages of the third trimester.

As mother and baby advance through the trimesters, the severity of possible complications increases.  In addition, many factors come into play that can allow for early childbirth or imminent and precipitous childbirth situations, the two most common of which are miscarriage and premature birth.

Miscarriage is a spontaneous expulsion of the non-viable developing baby due to trauma or an unknown issue.  This can happen at any point in any of the three trimesters and has various levels of risk depending upon how far into the pregnancy the miscarriage occurs.

Premature births are births that occur before the baby's body is fully developed for birth at the normal time.  Doctors determine viability for premature births as those that have reached at least 24 weeks of gestation.  Premature birth requires intensified care to assist the baby in reaching physical maturity outside of the womb.  Specialized neonatal (newborn) care is vital for the baby's survival.

Active Labor & Transition
When a mother's body is readying for the delivery of the baby, the uterine muscles contract and relax at intervals that will cycle at quicker rates as labor progresses.  Increasingly intense pain accompanies the contractions.  The muscle contractions will periodically cease, which gives the mother time to regroup her strength for the next set of contractions.

Timing between the contractions helps to identify if the birth is imminent of not.  The active contractions phase is called "active labor."  When the mother's body has adjusted the baby into position for delivery, the muscles will contract at a heightened level with intense pain so as to encourage the mother to push and complete the delivery of the baby.  During this time, mothers are often close to the edge of their willingness to participate in the process and need to be encouraged and coached through this phase, which is called "transition" (i.e., the transition from labor to delivery).  During transition, positive reinforcement; calm, clear, respectful and sometimes firm tone of voice; and repetitive persistence will be the strategies of choice.

Complications by Trimester
In addition to active labor and delivery, telecommunicators should be prepared for a number of complications that can occur unexpectedly throughout pregnancy.  First and second trimester complications include:
  • Miscarriage: bleeding and other complications may indicate miscarriage and may not present as something related to the pregnancy.  If there appears to be no relationship between the bleeding and pregnancy, or the caller's chief complaint differs from pregnancy, use the appropriate guidecard.  The EMD determines severity, dispatches the appropriate response and provides PAIs accordingly.
  • Vaginal bleeding and other gynecological complaints should be handled by using the appropriate guidecard.  Again, determine severity and dispatch the appropriate response vehicle providing any necessary PAIs.
Third Trimester complications may include:
  • Imminent or precipitous birth: Imminent birth involves labor pains less than two minutes apart.  Precipitous birth means that the birth comes extremely fast; that is common for women who have had multiple children.
  • Arms, hands or feet presentations (breech): In this situation, the EMD should instruct the mother (or have a family member or bystander instruct the mother) to get into a position on her hands and knees to use gravity to maintain the baby's current position and remove some of the pressure off of the mother's lower back.  On her knees, the mother can also place her arms and head down on a pillow with her hips upright.  Instruct the mother to take slow, deep breaths to help her remain calm.  Instruct her not to push.
  • Umbilical cord presentation: If the baby's head or neck gets tangled in the umbilical cord during delivery, the EMD should instruct the caller to carefully remove the cord from around the baby's neck.  If the cord presents before the baby, instructions will be similar to those given in a breech situation.
  • Placenta previa: This is a condition in which the placenta has grown over the opening of the uterus.  When dilation occurs, it causes broken blood vessels and bleeding.  This is a true medical emergency and treatment for shock is paramount.  EMDs should instruct the caller to have the mother lay on her left side with her legs and feet elevated if possible.
The Roles of Those Involved in Emergency Childbirth
The mother and baby are the focal point of this event.  Together as a team they are working to bring new life into the world.  Whatever we do will be based upon what is best for 1)the mother, and 2) the baby.  Once delivery is complete, the EMD has two patients who will need to be cared for.  Never forget that the mother is doing all the hard work, we are just assisting.

If the caller is a bystander (not the mother herself), that person is your on-scene source of information and should be called upon to perform the actions necessary to assist and care for the mother and baby.  This caller must also work to ready the scene for the arrival of emergency responders.

It is not unheard of for a young child to call 9-1-1 for his or her mother while she is in labor.  Always be prepared for any type of caller.  Your ability to coach them through with encouragement will make the difference.  Make sure to clearly articulate your questions and your instructions and, if necessary, ask them if they are OK with the instructions to verify understanding.  Repeat a question or instruction to ensure you get things right.

The EMD is the primary response person -- the first person from emergency services to have contact with the scene.  Their primary responsibility is to ensure that EMS is dispatched to the correct location and provide updates on the incident.  Remote scene management is also a large part of the responsibility, ensuring the caller is with the patient and that emergency services can access the patient.  In addition, the EMD is the primary coach for the caller (family, friends or bystanders), providing vital PAIs to assist in caring for the mother and baby.

As well as helping the mother and baby, another skill that comes in to play is high-performance coaching.  The EMD assists the caller with emotional support through the use of effective verbal techniques, proper use of the guidecard and verbal encouragement while they are performing the basic skills to help the mother during the birth.  The EMD understands various caller emotional phases and overcomes them with the proper techniques.

The EMS responder and emergency room personnel round out this extraordinary team of people who will ensure the mother and baby are taken care of after the 9-1-1 call is complete.

Pre-Arrival Instructions for Childbirth
Your agency has developed PAIs and protocols that best work for your region and comply with the basic PAI standard.  The EMD should always stick to the guidecard and provide the information located there as necessary.  Appropriate voice tone and clarity of wording is important to properly deliver the instructions.  Some wording on APCO's childbirth guidecard is in bold typeface, which means this word should be emphasized and articulated clearly to the caller.

Childbirth PAIs are divided into three main sections: Labor; Imminent or Active Delivery; Complications; and Labor:Non-Imminent Delivery

Labor: Imminent or Active Delivery -- follow these instructions when contractions are less than two minutes apart, the mother has a strong desire to push, the caller reports crowning of the baby's head, etc.  Throughout the call, periodically encourage the caller or mother that help has been dispatched and that you will stay on the line.

If the mother is in the bathroom, encourage her to stay off the toilet.  Instruct the mother to lay flat on her back on a bed or the floor and to try to relax by taking slow, deep breaths through her mouth.  Instruct the mother to remove her clothing below the waist and to bend her knees. (Keep in mind the environment the mother is in and try to ensure some amount of privacy is provided.)

Continue by having the caller or a bystander place a clean towel under her buttocks and have additional towels ready, if available.  Prepare the caller or birth assistant by letting them know what is going to happen:
  • The baby's head will deliver first, usually.  Careful support of the head is required as he or she is delivered.  Never pull on the baby, only support it.
  • If leg, arm, buttocks or umbilical cord is presented first, you will need to refer to the complications section of the guidecard.
  • If the umbilical cord is around the baby's neck, instruct the caller to carefully and gently slip the cord over the baby's head with their fingers.
  • Let them know there may be some water and blood with the delivery and that this is normal.  Excessive bleeding should be reported back to you.
  • The rest of the baby's body should deliver with the next few contractions.  Make them aware this could happen quickly and be ready to continue to support the baby.
Once the baby is delivered, instruct the caller to clean out the baby's mouth and nose with a clean, dry cloth to ensure a clear airway.  Then have them wrap the baby in a warm, dry blanket or towel.  Instruct them not to pull on or cut the umbilical cord.  If the baby is not breathing or crying on its own, they should rub its back or gently slap the bottoms of the baby's feet to stimulate a response such as breathing and crying.  If there is no response then you will need to go to the infant CPR guidecard for the appropriate PAIs.

If all is well, tell the caller to keep the baby warm and place the baby between the mother's legs.  This is lower than the placenta and mother's heart and will protect the baby's blood flow (the baby continues to receive blood flow from the mother when still connected to the placenta).  The mother may want to lie on her left side and have the baby lay next to her.  This is fine and helps to keep the baby below the mother's heart level and at or below the level of the placenta for proper blood flow.  Contractions may again start up when the placenta is delivered.  Again, this is normal and will also involve water and blood.  Always keep the baby at the same level as the placenta.

The EMD now has two patients, monitoring both for normal breathing is important.  If there is any excessive bleeding by the mother, have her lie on her left side and elevate her legs and feet slightly.

Complications -- as previously discussed, the instructions for complications are simply to encourage the mother to get up on all fours (hands and knees) and have her try to relax by taking slow, deep breaths.  Be sure to instruct her not to push.  Let the caller know that help is on the way and you are staying on the line.

Non-Imminent Delivery -- refer to this section of the guidecard if the caller does not indicate imminent birth (no crowning, contractions greater than five minutes apart, no urge to push, etc.).  Instruct the caller to have the mother lie in a comfortable position of her left side.  According to the online parenting resource KidsHealth, lying on one side eases stress on the mother's heart because it keeps the baby's weight from applying pressure to the large vein -- the inferior vena cava -- that carries blood back to the heart from the feet and legs.

Some doctors specifically recommend that pregnant women sleep on their left side throughout pregnancy.  Because the liver is on the right side of the abdomen, lying on your left side helps keep the uterus off that large organ.  Sleeping on the left side also improves circulation to the heart and allows for the best blood flow to the fetus, uterus and kidneys.

Tips for Caller & Patient Care
Verbally indicating respect and exhibiting a calm, competent voice tone and demeanor is important on every 9-1-1 call, especially during a childbirth event.  Always remember to treat the caller and mother the same way you would like to be treated if you were in similar circumstances.  This seems to be universally understood, but you as the EMD need to actively make it happen.

For the mother, this whole experience revolves around her.  Create an environment that exhibits calm, action and confidence by encouraging the caller to communicate what is going on each step of the way.  Always emphasize that your instructions are "to help the mother with the delivery," "to do this for the mother" and that you are there in support and will stay on the line until medical responders take over.

The caller will need you to be patient and respectful, so speak articulately and clearly.  The caller's emotions could be just about anywhere on the emotional spectrum, so be ready to adjust to their emotional presentation.  You may need to be firm yet respectful, or you may just need to be direct by reading the PAIs directly from the card.  You may need to use calming techniques (i.e., have them pause and take a deep breath or two to reboot), including using repetitive persistence to provide instructions.

Once the baby is born, work with the caller to help you monitor both the mother and the baby, periodically checking to make sure they are breathing normally, etc.  Be a positive coach and tell them often they are doing a great job.  Have the caller also tell the mother she is doing a great job.  Keep the team energized with positive words and positive voice characteristics, and provide reassurance that help is on the way.

Childbirth events can be some of the most challenging yet satisfying calls the EMD may handle.  Understanding the basic information on pregnancy and childbirth will help prepare the EMD to handle the call with confidence.  The EMD role is central to a smooth handling of the 9-1-1 caller and managing the scene for the mother's and newborn's comfort and safety.  Adherence to the childbirth guidecard protocols in combination with positive and professional caller interaction will help to bring the event to a proper conclusion and a new life into the world.