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9-1-1 Center Staffing & Standards: Stop Pointing Fingers and Give Us a Hand!
Author: Barry Furey
Copyright: 9-1-1 Magazine, Feature Content
It seems the older I get, the less it takes to stir the fires of righteous indignation. Although I’ve vowed not to become another grumpy old man, I’ll fess up to the fact that certain situations still get my goat. Rated high on this list are recommendations from so-called official sources on how dispatch times can be reduced.
Since I cut back on watching the television news, my personal irritants are now almost exclusively delivered by the Internet, which is frankly much more efficient because my surfing habits help to steer information of interest my way. Don’t believe in the power of cookies? Try searching for an item you’re interested in buying, and your screen and social media will be alive for days with ads from prospective vendors.
But this targeting can also be beneficial, as it brought me the kindling for this column, courtesy of the newly formed Global Resuscitation Alliance. What little I know about this group I also learned on the Internet, but they seem to have a noble intent: to reduce the number of cardiac fatalities by improving the delivery of resuscitation. Who wouldn’t go for that? Predictably, however, the first target for this improvement is 9-1-1. According to the website EMS1.com, this body’s first recommendation was to, “Dispatch first responders more rapidly.” This included the caveat that, “Process improvements may shave more than a minute in some emergency response dispatch centers.”
Now, I don’t know about you, but I am unaware of any dispatch centers that aren’t trying to get a call – especially a cardiac arrest – out the door as quickly as possible. If any facility has a disposable minute to lend during intake and alerting, then they certainly should give it up. And if someone wearing the telecommunicator hat isn’t focusing on expediting the response, then they need to change hats. But seriously, people. You really want to see a process improvement? Give us wireless technology that delivers exact dispatchable addresses, and give us enough trained people to keep up with the call volume and we’ll show you just that.
Back in 1970, when I became involved in public safety, the amount of information gathered by dispatch was minimal at best. The entire scope of most inbound calls consisted of, “Where are you, what’s the problem, who are you, and what’s your phone number.” On some occasions, even the last two items were omitted. In the decades that followed, scripted questions and pre-arrival instructions were developed that provided responders with a much clearer picture of what they were rolling into. Resources were dispatched on an incident appropriate basis, meaning that Advanced Life Support rigs, for example, could be reserved for the more serious calls.
With the rise in violence against uniformed personnel, I am all for asking every question needed to preserve their safety. But getting this data takes time. Things will never be as fast as they were when units sorted out what was happening upon arrival. Do you want a faster dispatch or a better dispatch? They are not necessarily the same.
The National Fire Protection Association's 1221: Standard for the Installation, Maintenance, and Use of Emergency Services Communications Systems, 2016 Edition, requires the answering of 95% of calls received on emergency lines within fifteen seconds, with 99% of such calls answered within forty. Dispensation is also provided for a variety of scenarios, including those involving Emergency Medical Dispatch, translation services, and other exceptions. These are granted extensions to ninety seconds for answering 95%, and one hundred and twenty seconds for 99% of these call types, collectively.
One of the “other exceptions” granted by the NFPA refers to situations where insufficient location information is provided. I suspect we can file most cell calls into this category. For starters, while lacking a conventional address, cell calls are also currently devoid of any elevation data, making the automatic pinpointing of incidents within multi-story structures impossible. In addition, the Federal Communications Commission’s wireless accuracy standards are pretty lenient, at best. A carrier can still be compliant if they are close, and they don’t even have to be close all of the time. As the old saying goes, close only counts in horseshoes. It shouldn’t cut it when we’re talking lives at stake.
Unfortunately, when centers are barely adequately staffed to meet the challenges of a slow day, it doesn’t take much to tip the delicate balance between promptness and delay.
Are the NFPA times reasonable? You tell me. Perhaps we need to ask for additional waivers, as do some performance-driven EMS agencies. I’ve seen more than one ambulance contract that included Mass Casualty Incident impact on resources and severe weather as being causes to stop the response time clock. Can we get similar consideration? Wouldn’t it be great to exclude our stats from that storm that set off every home alarm in town? You know, the same one where drivers who forgot how to drive in the rain were busy playing bumper cars? Although this sounds tempting, our focus instead should be on providing the best dispatch service possible in the shortest amount of time under all foreseeable conditions. Unfortunately, when centers are barely adequately staffed to meet the challenges of a slow day, it doesn’t take much to tip the delicate balance between promptness and delay. And while Next Generation 9-1-1 promises avenues by which to route spillover calls to other venues, it doesn’t make those facilities any less busy or any more staffed or any better prepared to immediately answer them than the first.
Which brings me to the second recommendation of the Global Resuscitation Alliance - the standardized provision of Cardio-Pulmonary Resuscitation instructions by telecommunicators. Now anyone who knows me understands that I have fought long and hard to have Emergency Medical Dispatching codified as a basic standard practice. Still, I have to ask myself if the best time to teach someone CPR is when they are looking down at a dying loved one? My instinct is that it is not. If the cardiac arrest survival rate can be improved through education, then why not provide CPR as part of our curriculum in middle and high schools, so that we grow into a generation of citizens who are adequately prepared? I can think of no other circumstance where we postpone lifesaving training until the instant the student is staring down death. While our intentions are noble, at what point do we place some burden for a positive outcome back on society and take it off 9-1-1?
A great many agencies have taken steps toward reducing the delta between the first ringing of the phone and the assignment of units to a call. Some who rely on scripted protocols often dispatch upon receipt of the chief complaint and an address, continuing questioning and offering updates en route. But at the same time we must also acknowledge that many first responders have been told to slow down in order to save lives. Some studies have shown little gain from the use of lights and sirens, and a great many departments now require units to stop – not just decelerate – while entering intersections. No matter where spent, seconds are seconds. Uncontrolled speed can also have deadly consequences inside the Public Safety Answering Point.
Until we recognize and address the limitations of technology and our chronic staffing insufficiencies we are ignoring the root causes of protracted processing times. Standards are meaningless to the caller whose only concern is that 9-1-1 is going unanswered. But standards are not the problem. Stop pointing fingers. Give us a hand.
With more than 45 years’ experience in public safety, including managing large consolidated dispatch centers in four states, Barry Furey now serves as a trainer and consultant for the 9-1-1 and public safety communications community. See www.barryfurey.com