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Protocols and Policies: The Necessity of Dispatcher Discretion
Author: Barry Furey
Copyright: 9-1-1 Magazine, Feature Content
In early October, David Givot, a practicing attorney and former paramedic published an op-ed piece entitled “Humans vs. Toys: What Happened to Dispatch Discretion?” This was largely prompted by stories of prolonged dispatch times in Los Angeles that at least in some cases seemed tied to the use of Emergency Medical Dispatching (EMD) protocols. While the Los Angeles story continues, Mr. Givot’s missive probably stirred up more discussion than did the catalyst for the conversation. In his piece, he uses the illustration of one such call where the caller was told – and I am paraphrasing here – that medics wouldn’t be dispatched until “enough information was received.” His point here is that the caller already provided information that could indicate that the patient needed emergency medical care rather quickly. The article – and subsequent online conversations – can lead us down some interesting paths.
EMD has been around long enough now to have developed a track record, and I suspect that most people would consider that track record to be good. Interactive pre-arrival instructions provide solace to the victim and caller alike. And anything I’ve ever read suggests that the quicker you start CPR, the better. On the other hand, you’ll find some wags who will swear that the underlying reason for EMD in some cases is to manage EMS resources, so the more questions you ask the better chance you have at deciding whether a Basic Life Support (BLS) rig can be dispatched instead of the medics.
Whatever you choose to believe, there is rationality behind scripting at least some portions of public safety call taking in order to assure that basic information is gathered. Before we committed these scripts to flip cards and computer applications, we remembered them through catchy phrases. Anyone out there familiar with CYMBaL? You know: Color, Year, Make, Body and License when taking a vehicle description. Scripting also helps to attain uniformity. After all, if everyone in the center is using his or her own list of questions it’s a fair bet that incidents are going to be mis-categorized and critical information is going to be lost. Maybe the problem is not so much the scripting, but rather how that scripting is managed.
While there are many instances where dispatcher discretion is used on a daily basis, diverting from protocols may not be a common example. These are drilled into call taker’s heads like a deep well on the Texas plains. Do not pass go. Do not collect $200. Do not waver from the program. Unfortunately, this can lead to the phenomenon that I call “tunnel hearing,” wherein the PSAP employee ignores all data except the answer to his or her last question. That’s why exchanges like this happen:
Caller: My father thinks he may be having a heart attack. He has tightness in his chest and pain running down his arm.”
9-1-1:OK. I have some questions. Is he conscious?
Caller:No, he’s out like a light. But he’s talking up a storm. Ask away.
Well, OK, I made this up, but take a listen to your tapes sometimes. I’m willing to bet you’ll find some head scratchers. Maybe we spend too much time teaching people to ask questions and not enough time teaching them to listen.
But another insidious factor in this discussion is that telecommunicators hesitate to deviate from policy because they’re afraid to. Write-ups, days-off, and potential lawsuits can hang heavily over their heads. I’m not saying we shouldn’t expect adherence to rules and regulations, and that there shouldn’t be corrective action taken for people who routinely freelance. However, we do have a way of providing a path that allows our staff a means of quickly dealing with severe emergencies in the timeliest manner possible.
Whether you’re talking EMD or any other prepared protocol, someone is in charge of review. Often, all that is needed is the identification and approval of key words and phrases that can initiate immediate dispatch. Basic questions will still have to be asked, but the additional details can be obtained when the crews are en route. Will this result in added responses? Maybe. Will it cause the use of more lights and sirens? Yes; at least until data is received that will downgrade the call. But in the end, the patient wins. And we get to keep our toys. Sounds like the perfect solution to me.
Our PSAP Management columnist Barry Furey has been involved in public safety for more than 40 years, having managed 9-1-1 centers in four states. A life member of APCO International, he is the current director of the Raleigh-Wake County (NC) Emergency Communications Center. As an independent columnist for 9-1-1 magazine, Barry’s opinions are his own and do not necessarily reflect those of his public safety employer.