Nov 19, 2008

 

Anatomy of a 9-1-1 Call
What Really Happens at the Other End of the Line
By Aaron Collins

Justin Montoya is heading straight for the gate his dad installed to keep him safely away from the family swimming pool. The gate—which is now unlatched—is intended as a barrier for active and curious two-year-olds like Justin. It is there to prevent harm should the freak moment arise when any child—Justin or maybe a wandering neighbor kid—is unattended.

Just moments before, Justin’s mom, Jennifer (fictional names are used in this article), by all accounts a great mom, was there alongside him, watching over him in their Tulare home. But when one of their smoke alarms went off—having been malfunctioning intermittently the last few days—she bolted into the house to quiet it, but also to make sure it wasn’t, in fact, going off for good reason.

Her split-second concern and distraction, then her absence gives Justin the very opportunity he craves to explore. But the “smoke alarm incident” will take an unfortunate turn, becoming the “pool incident.” By the time Jennifer returns from quieting the device intended to keep everyone safe from fire, Justin is unconscious, having sunk precious minutes ago to the bottom of the deep, frigid water.

Thus begins the examination of the anatomy of a 9-1-1 call, often from those desperate to save the lives of their loved ones, or themselves.

Each call routes differently, depending on whether they are placed from a landline or cellular phone, according to Anna Smith, who is director of communications for the Tulare County Consolidated Ambulance Dispatch (TCCAD). Add new voice-over-internet services, and 9-1-1 systems have their work cut out for them, doing their best to have information in-hand even before a caller can give it—if the stricken even know where they are when disaster strikes. Depending on the nature of the emergency, calls may go to police, fire, or ambulance.

Clearly, Justin needs an ambulance. Jennifer dives in and pulls her limp and pale son from the water. Hearing her frantic screams, her neighbor, Bill Hallman, is over the fence and into the Montoya yard. Luckily, the real estate agent never leaves his house without his cell phone in hand—even on a sunny Saturday morning when he likes to enjoy his coffee in the garden. Home sales have slowed to a crawl lately, so his phone is his lifeline. Now it is also Justin’s.

STEP 1: The Call
Bill dials 9-1-1 from his cell. That means his call reaches the California Highway Patrol, rather than the Tulare Police Department, as it would have done if he had run into the Montoya home and dialed from their landline.

STEP 2: The Answer
The call-taker clearly says, “9-1-1, state your emergency.” Fortunately when asked, Bill is clear-headed enough to give the Montoyas’s address and his cell phone number, rather than his own address and landline next door. Also beneficial, he is still audible to the call-taker at the CHP over the din of Jennifer’s hysterical screams. Bill says, “We have a kid here who fell in the pool and isn’t breathing.” The CHP call-taker instructs Bill to stay on the line while she transfers him to ambulance dispatch.

STEP 3: The Hand-Off
The CHP quickly conferences Bill’s call with TCCAD, a nonprofit set up in 1990 to coordinate the various ambulance agencies in the area in order to streamline services and shorten response times. The CHP call-taker also advises the Tulare Police Department to send a City Fire first responder. At this point, the CHP call-taker hangs up, and CHP is no longer in the loop. (However, if Bill were calling about a traffic accident on a freeway, state highway, or county road, CHP would remain in the loop as a responder.)

STEP 4: Dispatching the Ambulance
Using a computer-aided dispatching system, the call-taker at TCCAD immediately inputs the address and chief complaint given verbally by the CHP call-taker on Bill’s behalf while he waits on the line. “Non-breathing child” is the succinct way to state that Justin wandered into the pool and has lungs full of water, inching closer to death as the seconds tick away.

While the call-taker remains on the line, a second TCCAD dispatcher looks at a computerized map with illuminated locations showing the ambulance currently nearest the Montoya address, and contacts that ambulance agency, one of several ambulance companies in the county served by TCCAD including American Medical Response, American Ambulance, Exeter Ambulance, LifeStar, Dinuba Fire, and Imperial.

Then the TCCAD dispatcher (dispatchers and call-takers are cross-trained and can perform either role) confirms with Tulare PD that Tulare City Fire is on the way, just to ensure that a call hasn’t mistakenly been dropped. The call-taker at TCCAD stays on the line with Bill, asks for an update about Justin, and offers life-saving pre-arrival instructions—in this case, Cardio-Pulmonary Resuscitation (CPR) specific to a two-year-old.

Information about Justin’s condition is gathered by the call-taker then relayed to the responding ambulance company en route to the Montoya home, so they know what is happening with him as they quickly maneuver the streets of Tulare, aware of his condition as they arrive.

STEP 5: Arrival
As the ambulance and fire personnel arrive at the Montoya home, they begin the work of saving Justin’s life, and the call-taker’s work is complete. Thus ends one of many such calls received on a typical day.

Fortunately, 9-1-1 calls like this one are executed in only a fraction of the time it took you to read this article. Those steps are handled by highly-trained dispatchers in an instant. And many emergency callers are unaware just how much medical information dispatchers are called upon to give in a number of diverse emergencies.

But with so many variables, response times can mean circumstances even more dire than Justin Montoya’s, situations whose outcomes are dependent on such factors as the location of an emergency. Tulare County covers an area larger than the state of Connecticut. Fully half of the county consists of remote, steep places, and despite advances in modern communications, large portions of the mountainous and rural parts of the county have sketchy or nonexistent cellular reception.

Kings County is flatter and less populous, and its system varies from that in Tulare County, too (it has no separate fire dispatch like Tulare County does). But the heavily trafficked Interstate 5 cuts through Kings, connecting people in a hurry to get between Los Angeles to the Bay Area mean a host of dire straits particularly in foggy winter months, when auto and big rig pile-ups are not uncommon.

Where technology remains a limited solution, rigorous training is the best response. Dispatchers at TCCAD receive training in-house on local policies and geographical familiarization. Additionally, they attend a twenty-four hour course in Emergency Medical Dispatch where they receive EMD certification. This certification is given by the National Academies of Emergency Dispatch (NAED), which also offers certifications in fire and police dispatching.

These dispatch protocols were initially developed in 1976 and have been refined and revised as standards and technologies change. EMD has become the national as well as the international standard of care and practice for medical dispatching.

That is why—although call routes vary according to the emergency—the information sought does not: Dispatchers are all trained to elicit the same information. Emergency medical dispatch follows a very specific line of questioning used to determine the chief complaint, the appropriate response, and the appropriate pre-arrival or post dispatch instructions. Law enforcement and fire also follow the same standardized routes to gathering 9-1-1 call information from people in perilous situations, panicking, or worse.

Agencies and dispatchers who maintain certifications and appropriately follow the protocol are legally protected because they have followed the accepted standards of care and practice. (The NAED offers legal protection to those it certifies who properly use the protocols, but continued certification requires continuing education totaling twenty-four hours every two years.)

The best advice for emergency callers, according to Anna Smith:

• Remain calm so that you can be understood by the 9-1-1 operator.

• When you’re at home, use your home phone—cordless if possible so that you can be near the patient—so that your home address and phone number will be transmitted automatically (9-1-1 operators will still confirm your address and phone number).

• Know where you are and where the ambulance is needed. Provide helpful information if you are in a location that is difficult to find.

• Listen to the directions given to you by the 9-1-1 operator.

• Understand that when a call-taker remains on the phone asking questions, this does not delay the ambulance response. As soon as the call-taker knows the address and the problem, the police, fire crew, or ambulance is dispatched. Call-takers remain on the line to obtain additional information that could be helpful to the crew responding or to provide you with pre-arrival/post dispatch instructions.

For the Justin and Jennifer Montoyas of the San Joaquin Valley, that advice may be at a level of detail they never thought they would need. Don’t we all, at least on some level. Thankfully, some very dedicated people will be working behind the scenes to keep response times as short as possible, to keep technology up-to-date when someday, inevitably, we have to make a heroic call seeking help from some unsung, anonymous heroes. Be looking for angels not only with wings, but with headsets scanning a computer map with your name on it.

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