These bath salts pack Police Protocol changes Q not the ... · that’s not his decision to make. Once bitten, antivenom injec-to thousands of dollars, and that doesn’t take into

Bubbles Not Included These bath salts pack disastrous punchThe National Academies of Emergency Dispatch

Take The ChallengePolice Protocol changes response for the better

Left OutIn The ColdWill lack of funding freeze innovation?

Necessary & Nice?Q not the evil some make it out to be

Of EmErgENcy DispATch

TheJournal Journal July/August 2012

emergencydispatch.org

2 THE JOURNAL | emergencydispatch.org

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Ask the right questions. Get the right answers. Send the right information.

THE JOURNAL | July/August 2012 3

g columns4 | Contributors5 | Dear Reader6 | President’s Message7 | Ask Doc8 | Police Beat9 | Morale Booster42 | Retro Space

g industry insider10 | Latest news updates

g departmentsBestPractices

15 | FAQ When is it necessary to give control bleeding instructions? 16 | ACE SAMU-SP becomes the best in Latin America

OnTrack

28 | Medical CDE Weather too hot to handle sparks calls for help32 | Universal CDE Bath salts bring on unpredictable behavior

YourSpace

36 | Dispatch In Action38 | Dispatch Frontline39 | Off Hours

features20 | NextGen 9-1-1

Communications centers are working to figure out how to make the leap into the next frontier of 9-1-1.

25 | Queuing Up The QsQuality improvement can be tricky to handle well.

40 | Navigator RewindImproving morale in the comm. center requires making it a priority.

INSIDE theJournalJ U L y · A U g U S t 2 0 1 2 | v O L . 1 4 n O . 4

The following U.S. patents may apply to portions of the MPDS or software depicted in this periodical: 5,857,966; 5,989,187; 6,004,266; 6,010,451; 6,053,864; 6,076,065; 6,078,894; 6,106,459; 6,607,481; 7,106,835; 7,428,301; 7,645,234. The PPDS is protected by U.S. patent 7,436,937. FPDS patents are pending. Other U.S. and foreign patents pending. Protocol-related terminology in this text is additionally copyrighted within each of the NAED’s discipline-specific protocols. Original MPDS, FPDS, and PPDS copyrights established in September 1979, August 2000, and August 2001, respectively. Subsequent editions and supporting material copyrighted as issued. Portions of this periodical come from material previously copyrighted beginning in 1979 through the present.


CON

TRIBUTO

RS

Brett Patterson

Brett is Academics & Standards associate and Research Council chair for the IAED. His role involves training, curriculum, protocol standards, quality improvement, and research. He is a member of the NAED College of Fellows, Standards Council, and Rules Committee. Brett began a career in EMS communications in 1987. Prior to accepting a position with the IAED, he spent 10 years working in Pinellas County, Fla.

15 | FAQ

Kevin PagenKoP

Kevin provides both EMS and fire quality assurance and training for American Medical Response’s LIFECOM EMS & Fire Communications Center in Modesto, Calif. As a leading member of their QIU, he is tasked with curriculum development, quality management, and maintenance of their ACE.

9 | MorAle Booster

shawn Messinger

Shawn is a police consultant and Emergency Police Dispatch instructor for Priority Dispatch Corp. He is a former chief deputy for the Okanogan County Sheriff’s Office where he was the director of a combined 9-1-1 communications center. During this time he oversaw the deployment of a new CAD and countywide RMS system, a VoIP 911 phone system, and the deployments of ProQA in EMD and EPD. Shawn was also commander of a multi-jurisdictional SWAT team.

8 | Police BeAt


g dearreader

naeD Journal STaffCOMMUNiCATiONS | CrEATivE DirECTOrKris Christensen Berg

MANAgiNg EDiTOrAudrey Fraizer

TEChNiCAl EDiTOrBrett A. Patterson

SENiOr EDiTOrJames Thalman

ASSiSTANT EDiTOrSheather Darata Cynthia Murray

ArT DirECTOrlee Workman

SENiOr DESigNErChris Carr

grAPhiC DESigNErreeding roberts

PrODUCTiON MANAgErJess Cook

WEB | MUlTiMEDiA MANAgErErwin Bernales

WEB DESigNErJason Faga

acaDemy STaffPrESiDENTScott Freitag

ASSOCiATE DirECTOr | USACarlynn Page

ASSOCiATE DirECTOr | U.K.Beverley logan

ASSOCiATE DirECTOr | AUSTrAlASiAPeter hamilton

ACADEMiCS & STANDArDS ASSOCiATEBrett A. Patterson

ADMiNiSTrATOr OF iNSTrUCTOr SErviCESCindy grigg

COMMUNiCATiONS DirECTOrKris Christensen Berg

DirECTOr OF EUrOPEAN OPErATiONSTudy Benson

iNTErNATiONAl liAiSONAmelia Clawson

MEMBErShiP SErviCES MANAgErArabella vanBeuge

The National Journal of Emergency Dispatch is the official bimonthly publication of the National Academies of Emer-gency Dispatch (NAED), a non-profit, standard-setting organization promoting safe and effective emergency dispatch services worldwide. Comprised of three allied academies for medical, fire, and police dispatching, the NAED supports first-responder-related research, unified protocol application, legislation for emergency call-center regulation, and strengthen-ing the emergency dispatch community through education, certification, and accreditation.

general NAED membership, which includes a Journal subscription, is available for $19 annually, $35 for two years, or $49 for three years. Non-member subscriptions are available for $25 annually. By meeting certain requirements, certi-fied membership is provided for qualified individual applicants. Accredited Center of Excellence status is also available to dispatch agencies that comply with Academy standards. © 2012 NAED. All rights reserved.

TheJournalOf EmErgENcy DispATch

naTional acaDemieS of emergency DiSpaTch139 East South Temple, Suite 200 Salt lake City, UT 84111 USA USA/Canada toll-free (800) 960-6236 int’l/local: (801) 359-6916 Fax: (801) 359-0996 www.emergencydispatch.org [email protected]

inTernaTional acaDemieS of emergency DiSpaTchAUSTrAlASiAN OFFiCE011-61-3-9806-1772

CANADiAN OFFiCE1-514-910-1301

EUrOPEAN OFFiCE011-43-5337-66248

iTAliAN OFFiCE011-39-011-1988-7151

MAlAySiAN OFFiCE011-603-2168-4798

U.K. OFFiCE011-44-0-117-934-9732

BoarDS & councilSACCrEDiTATiON BOArD ChAirBrian Dale

AlliANCE BOArD ChAirKeith griffiths

CErTiFiCATiON BOArD ChAirPamela Stewart

CUrriCUlUM COUNCil ChAirSvictoria Maguire (Medical/EMD Board) Mike Thompson (Fire/EFD Board) Jaci Fox (Police/EPD Board) Susi Marsan (ETC)

rESEArCh COUNCil ChAirBrett A. Patterson

STANDArDS COUNCil ChAirSMarie leroux (Medical/EMD) gary galasso (Fire/EFD) Tamra Wiggins (Police/EPD)

college of fellowSChAirMarc gay (Emeritus)

AUSTrAlASiA | SOUTh AMEriCAFrank Archer, MD (Australia) Andrew K. Bacon, MD (Australia) Peter lockie (New Zealand) Peter Pilon (Australia)

CANADADrew Burgwin (Br. Columbia) Claude Desrosiers (Québec) Douglas Eyolfson, MD (Manitoba) Martin Friedberg, MD (Ontario) Marie leroux, rN (Québec) (Emeritus) Mark gay, (Québec) (Emeritus) Paul Morck (Alberta) Wayne Smith, MD (Québec)

EUrOPEAndre Baumann (germany) gianluca ghiselli, MD (italy) Jean-marc labourey, MD (France) Jan de Nooij, MD (Netherlands) gwyn Pritchard (Cyprus) (Emeritus) Bernhard Segall, MD (Austria) gernot vergeiner (Austria) Christine Wägli (Switzerland)

UNiTED KiNgDOM | irElANDTrevor Baldwin (England) Michael Delaney (ireland) Conrad Fivaz, MD (England) louise ganley (England) James gummett (England) Chris hartley-Sharpe (England) Andy heward (England) Stuart ide (England) Peter Keating (ireland) ray lunt (England) Andy Newton (England) (Emeritus) John D. Scott, MD (England) Janette K. Turner (England)

UNiTED STATESBill Auchterlonie (KS) robert Bass, MD (MD) Christopher W. Bradford (Fl)

Thera Bradshaw (CA) (Emeritus) geoff Cady (CA) Steven M. Carlo (Ny) Jeff Clawson, MD (UT) Phil Coco (CT) Brian Dale (UT) Chip Darius, MA (CT) Kate Dernocoeur (Mi) Norm Dinerman, MD (ME) Patricia J. Dukes, MiCT (hi) James v. Dunford, MD (CA) Marc Eckstein, MD (CA) John Flores (CA) Scott Freitag (UT) gary galasso (CA) Keith griffiths (CA) Jeffrey r. grunow, MSN (UT) Darren Judd (UT) Alexander Kuehl, MD, MPh (Ny) (Emeritus) James lake (SC) James lanier (Fl) Bill leonard (AZ) Stephen l’heureux (Nh) victoria A. Maguire (Mi) Sheila Malone (iN) Susi Marsan (gA) robert l. Martin (DC) Dave Massengale (CA) Jim Meeks, PA-C (UT) Shawna Mistretta (CO) gene Moffitt (UT) Jerry l. Overton (CA) Eric Parry, ENP (TX) rick W. Patrick (PA) Brett A. Patterson (Fl) Paul E. Pepe, MD, MPh (TX) ross rutschman (Or) (Emeritus) Joe ryan, MD (Nv) Doug Smith-lee (WA) Tom Somers (CA) Paul Stiegler, MD (Wi) Michael Thompson (SD) Carl C. van Cott (NC) Sheila Q. Wheeler, MSN (CA) Craig Whittington (NC) Arthur h. yancey, ii, MD, MPh (gA) Tina young (CO)

Snake, Rattle, And RunAudrey Fraizer, Managing Editor

Hikes along the foothills and broader ridges of the Wasatch Mountains are a

favorite spring opener for dogs and their two-legged buddies. Snow’s melted from the trails, making it easy to navigate under the welcoming sunshine. About the only negative is the greater likelihood of an encounter with a pair of unforgiving fangs.

the great Basin Rattlesnake is something to avoid around here, particularly in late May through June when they’re hungry, irri-table, and mating, according to Utah’s Reptile Rescue Service. Surprising them into action is never a good idea and I doubt snakes look at us as choice mat-ing material.

During the past 25 years, I’ve crossed paths with at least a couple dozen of these snakes. A few gave the warning rattle shake while others were content to con-tinue to slither across the path or remain coiled, head down in the shrubbery. One has yet to give chase and pass me. the largest great Basin Rattlesnake inter-rupting my hike was four feet long. I didn’t stop to measure, and the length is likely growing longer in time similar to a fish story, but even two to three feet provides an impressive lunge and strike force.

the snake’s reflexive spring to action follows a perceived threat; snakes lack ears but pick up on vibrations as a warning signal. the venom from the snake’s bite can immediately kill small creatures. Larger creatures take some time to die and rattlesnakes have killed five people in Utah during the past century. not a huge number but

enough to keep me on my toes.the same doesn’t hold true of

dogs. Some 150,000 dogs and cats are bitten by venomous snakes each year in north America. Many die.

Dogs are curious and impul-sive; when excited, they don’t look where they’re going or exercise cau-tion. My friend Ellen’s dog Albee is a prime example. the Borzoi/Border Collie mix is an energetic hiking companion with the Bor-der Collie’s intelligence dampened by the Borzoi’s influence (OK, out of fairness, there’s probably not a breed that can sense the danger).

Because of frequent encoun-ters between Albee and startled rattlers, Ellen leashes Albee when hiking on rocky trails and through mountain shrubbery. Albee dis-likes being leashed on a hike but that’s not his decision to make.

Once bitten, antivenom injec-tions for dogs can costs hundreds to thousands of dollars, and that doesn’t take into account expenses related to intravenous fluids, medicine, and surgery. the annual vaccine costs about $40, but it has received mixed reports.

If a rattlesnake does bite, Ellen has been advised to call 9-1-1 and deliver Albee to a veterinarian emergency clinic pronto.

I don’t know if the dispatcher would give the same Protocol 2 Pre-Arrival Instructions but I do doubt paramedics would be sent to retrieve the stricken dog from a mountain. Maybe 9-1-1 would contact the vet, which in that case would mean running like you’re a snake or, at least, running like one is after you for other than its passing interests. g


g President’sMessage

People approach me with all sorts of questions about emergency dispatch at the navigator conference. Most

of the questions I can answer, particularly when a question concerns protocol and the separate programs under the national/Inter-national Academies of Emergency Dispatch® (nAED™/IAED™). Questions beyond my expertise, I suggest asking someone at the Academy who should know. A few ques-tions remain in my memory to look up later so I can tuck my newfound knowledge into my navigator conference answer arsenal.

During the past conference, held in Bal-timore, Md., I set aside two general interest questions. Both involved numbers. the first—a question involving numbers of pub-lic safety answering points (PSAPs) in the United States—followed from my opening keynote. the second—a question involving the points required to become an Accred-ited Center of Excellence (ACE)—came shortly after nAED Accreditation Chair Brian Dale announced the addition of two tri-ACEs, making the total five.

the PSAP numbers question I could answer based on a Department of Justice Bureau report handed out during a Salt Lake City Fire Department communications brief-ing several years back (some numbers stick, but please don’t ask my anniversary date). At that time, the bureau released numbers from a national Emergency number Association (nEnA) report (2001) estimating 5,000 pri-mary PSAPs; the number gets a bit murky when figuring in the secondary PSAPs.

Since the figure was rather dated, the question stuck. I couldn’t let it go. I asked around and finally found the guy with an answer. greg Scott, who assists with research for the Academy, said a good source is the PSAP registry built on data collected by the Federal Communications Commission (FCC). My next step was the Internet.

According to the FCC Master PSAP Reg-istry, there are 7,666 primary PSAPs in the United States or, at least, that’s the running

total since December 2003 when the FCC started keeping numbers. During the past decade, some centers were orphaned (FCC term for a center no longer considered a pri-mary calltaking answering point) and oth-ers were added—they are new, consolidated (leaving the orphans behind), or, in a few instances, made it late to the list.

Recent additions include Dickenson County Communications Center in Clint-wood, va.; Lubbock Fire Department in Lubbock, texas; Marshall County EMS, Lew-

isburg, tenn.; City of Bethlehem Police Com-munication, Bethlehem, Pa.; City of thornton 911 Emergency Communications, thornton, Colo.; City of Aventura Police Department, Aventura, Fla.; and Lea County Communica-tions Authority, Hobbs, n.M.

As you might guess, the centers listed use the Fire, Police, and/or Medical Protocols, with the point being: the reputation of the nAED protocols is preceding the center. the protocols are part of the opening package and, in the United States, close to one-third of the primary PSAPs in the registry use at least one of the protocol systems.

Without getting too heavily into the history, the numbers are remarkable when considering the initial reluctance to adopt the Medical Protocol system outside of Utah when Dr. Clawson introduced the first cardset a little more than 30 years ago. now, there are 42 countries, including the United States, using protocol.

t h e tr i - A C E q u e s -tion can be subjective. the person asking—a dispatch center operations manager—wanted the “real” number of points required to achieve ACE. “there are 20,” I said. “they’re posted on the nAED website.” the man-ager laughed. “no, there isn’t,” she said. “not if you count between the lines.”

I understood what she was talking about. the Salt Lake City Fire Depart-ment has labored through the 20 Points twice and will go through once more to become a tri-ACE. From experience, I

know the work involved for each point at least doubles in terms of sub-points and

sub-sub-points. For answers, I turned to Don Aker, trainer supervisor for Prince george’s County Public Safety Communications Cen-ter in Maryland. Aker and coworker training Coordinator Angela vanDyke gave their esti-mates during the “getting Juiced for ACE” presentation at navigator.

Aker said the total is closer to 115, when dividing each point down to the sub-sub-sub-point level. “But don’t look at the num-bers,” he advised. “It’s a long-term investment achieved one point at a time. It takes a group to pick up all the parts.”

there’s no magic pill, according to van-Dyke. “It’s hard work.”

And once you’re there, no official in the world will want you to lose accreditation, Aker said. “It’s the right thing to do.”

And that you can take from someone who knows. g

From Someone Who Knows numbers don’t always tell the whole storyScott Freitag, NAED President

ACE

To learn more about your state, find the fcc registry at http://transition.fcc.gov/pshs/services/911-services/enhanced911/psapregistry.html


g asKdOC

Dr. Clawson: A cardiologist sent me a letter in reference

to a patient having a Left ventricular Assist Device (LvAD), explaining that—in case of an emergency—chest compressions should not be done for this patient. Everything might be OK if a family member happens to call 9-1-1 and is aware of the patient’s condition and knows not to do chest compressions. But what if we are talking to someone unfamiliar with the patient’s condition. Do we need some form of questioning or a Pre-Question Qualifier in the Medical Priority Dispatch System™ Protocol (MPDS®) to help determine this condition and not proceed directly with chest compressions?

According to an article in JEMS magazine (Wayne A. Riddle, Rn, CFRn, PHRn, the High-tech Heart: LvAD emergencies in pre-transplant patients, July 26, 2008):

CPR & other treatment: Due to the loca-tion of the LvAD and its proximity to the heart, there may be risks associated with performing chest compressions. CPR may damage the LvAD itself or dislodge tubing, resulting in massive hemorrhage. the use of hand pumping in place of CPR is possible and may be indicated in some situations. Decisions on whether or not to use CPR should be left to medical control.

Jimmie turbevilleE911 technology SpecialistJohnston County, n.C., USA

Jimmie:I’ve asked Brett Patterson to help you

with the question.Dr. Clawson

Jimmie:In short, this issue has been addressed in

MPDS v.12.2 and will be released very soon. Here’s a synopsis:

the Academy has received several inqui-ries, and a Proposal for Change (PFC) or two, regarding actual calls involving LvAD patients. I researched the topic and brought the data to our MPDS v.12.2 Standards Council meeting.

these devices vary with regard to design, contraindications, back-up systems, etc., so attempting to “protocolize” the machines is problematic. For instance, while compres-sions are contraindicated with one model, due to the potential for tearing out catheters and causing hemorrhage, CPR is appropriate for others. Additionally, there is the question of machine failure versus patient failure, which is difficult for the EMD to evaluate and must be determined when considering a definitive course of action. Finally, the machines have different back-up systems, i.e., manual pumps, built-in versus external apparatus, etc.

With these factors in mind, the Standards Council decided to handle the issue by the Rule (What can I do?) and Axiom (What is it?).

Since ventilating a non-breathing patient is the only safe and universal instruction, the Rule allows for ventilating a patient with a circulatory support device when compres-sions may be contraindicated.

Protocol 9 RuleM-t-M Only instructions (e.g., C-13 and

C-14) may be provided for patients with InEFFECtIvE BREAtHIng when a healthcare provider insists that the patient has a pulse or if the patient has an implanted Left ventricular Assist Device (LvAD) or other circulatory support device.

the related Axiom provides the education:Protocol 9 AxiomLeft ventricular Assist Devices (LvADs)

are the most common type of several Circu-latory support devices designed to increase cardiac output in heart failure patients. Chest compressions are contraindicated with most but not all of these machines due to the risk of catheter displacement and subsequent hemor-rhage. Additionally, the device may be func-tioning without producing a pulse. Most of these devices have back-up systems that caregiv-ers have been trained to use if the device fails.

Additionally, Critical EMD Informa-tion has been added to Protocol 9 since these patients nearly always have support staff that must be notified and, at the same

time, able to provide additional assistance. It reads as follows:

“(Circulatory support device [LvAD]) Obtain phone number and contact any sup-port staff or facility assigned to the patient with a circulatory support device.”

Finally, consideration of external, wear-able defibrillators has been addressed by Axiom. From Protocol 9:

“Patients awaiting a more permanent therapy for certain cardiac arrhythmias may wear an external defibrillator fitted into a vest. this device produces a loud, audible warning prior to defibrillation. CPR is appro-priate when advised by the machine or when no warning is audible.”

EMDs should not stray from Protocol or be concerned about potential liability. the stan-dard of care is to provide CPR for unrespon-sive, ineffective breathing patients and the 9-1-1 call is an implied call for help. If the presence of the device is unknown, the patient should be treated as any other patient. If known, the Protocol provides an option to perform M-t-M only, which may be considered along with other treatments, including CPR.

Brett A. PattersonIAED™ Academics & Standards AssociateResearch Council Chair g

LVAD Status UnknownDoes that influence chest compressions for unresponsive, ineffective breathing patients? Brett A. Patterson


Making changes to training, technol-ogy, or policies and procedures in a communications center can be

some of the most challenging and rewarding processes a center director and staff can go through. As consultants, we are often asked about what to expect during the process of implementing police emergency dispatch protocol. While many of the issues may also relate to concurrent changes in the center, the following is a “heads-up” of what you might encounter with implementation of the Police Priority Dispatch System™ (PPDS®).

staff resistanceResistance to change is a normal

human reaction. People are geared to create order, and an accustomed level of routine is comforting. there is a feeling of control. throwing something new in the daily line-up can be upsetting. there is a feeling of imbalance. It’s an under-statement to say that telecommunicators can be resistant to change in their environ-ment. How many times have you watched a coworker’s frustration over something we might find barely a minor irritation? Maybe she doesn’t like the wall paint in the bath-room and views the location of the copy machine as inconvenient. Maybe he doesn’t like his keyboard or the arrangement of chairs in the breakroom. For some people, Protocol will be a source of major heartburn. the change is going to take encouragement, understanding, and framing the change into the larger picture of improved response.

Field unit pushbackgenerally speaking, police dislike change

as much as dispatchers, and they often have inherent trust issues since it’s often in an offi-cer’s best interest to hold tight to trust. they don’t hand it out easily. the lack of trust might even extend to the information a calltaker pro-vides from caller interrogation. After all, police are known for their territorial I’ll-do-it-my-way nature: “If I don’t ask it, they won’t get it.”

two campsWithout Protocol, comm. centers gener-

ally fall into either of two camps: asking a laundry list of questions prior to dispatching the call or conducting a limited interrogation and then dispatching quickly.

For those falling in the first category, explain the gap in their perception between old and new. In the days preceding MDts

and MDCs, responders had no idea about incoming calls until the dispatcher came over the radio and by that time, the calltaker had spent probably one to three minutes with the caller. Even with the advent of MDCs, telecommunicators would ask questions and take notes before initiating a CAD call and entering the information.

Police Protocol allows an earlier dispatch point, with many in less than one minute into the call. Consequently, officers can begin their response earlier in the call process sequence, and the information they receive, because of the Protocol’s design, will be more thorough. It’s a trust issue. Officers have to accept the fact that the calltaker and the PPDS will pro-vide the most up-to-date information while responders are en route to the call.

For those in the second category, explain that constant radio interruption slows down the call process and flow of informa-tion. Again, we’re talking about trust. Police have to trust that they will be updated as the information comes in.

Performance dipExpect temporary dips in performance.

the Protocol learning curve takes time and the process can be frustrating, especially for high performers. their days of glory are not over, but only back at the beginning. It’s also helpful to remind responders that their patience will be appreciated during a period of possible call processing delays, although they can expect vast improvements in the days soon to come.

Policy revisionsEach center has its way of handling cer-

tain tasks not directly covered by Protocol, and tweaks to policies and procedures prior to, and most importantly after, the go-live date should be expected. Instead of back step-ping to old comfort levels, focus on ideas for adjusting to new ways to accomplish goals.

saboteurs may surfaceIn my experience, most centers have at least

one person determined to subvert the system. the saboteur might try to use the structure or wording of Protocol against an outcome to force process failure. It might mean asking every single Description Essential element or taking data out of context to blame Protocol for longer call processing times. the members of what I call the Constant Complainers Club were not happy before Protocol; they won’t be happy with Protocol; and they won’t be happy when data proves them wrong.

My advice?Keep your chin up and reinforce the

benefit Protocol brings to your center, field response, and the public. Experience tells me it’s always darkest before know-how dawns. g

Post ImplementationIt’s always darkest before the know-how dawns Shawn Messinger

g POliCeBeat


Morale is often complained about in the same way a slow CAD applica-tion or a radio failure is viewed. they

are required components of a communications center but the problems are usually forwarded to someone else for resolution. While it is com-mon for employees to look to management to improve the morale of the center, it is just as common for management to look to their staff.

While not routinely a thought that is entertained, management personnel are also employees of the company or agency. there will always be a division between labor and management, us against them, but at the end of the day, everyone is stuck in a room full of CADs, tethered to a radio, breathing stale air, and trading the same colds and flus. Morale is universal and knows no bound-aries between title and rank. there are cer-tainly morale problems caused by poor management. Equally, there are morale prob-lems caused by toxic personalities or cliques within the workforce. Improving morale takes everyone’s participation.

Morale mattersMorale drives behavior. this, in turn,

affects the quality of work as well as self-satis-faction—which is a key component in the deci-sion employees make to remain at a job. So it is dually beneficial to value morale as it improves quality as well as employee retention. A core responsibility of all personnel should be cre-ating an atmosphere where everyone feels valued for their efforts, recognized for their accomplishments, and encouraged to con-tinue applying their efforts to improve the overall performance of the center.

Management should solicit input and suggestions from their staff members. By actively engaging key personnel, and valuing their efforts, they will be encouraged to work toward improving the atmosphere of the cen-ter. Providing recognition rewards positive behaviors and is the first step in changing the culture of a workforce and creating an environ-ment where personnel want to get involved.

Employees should take accountability for their own behaviors. Attitudes are conta-gious—both positive and negative. Listening to gossip or accepting hazing is just as dam-

aging to morale as actively participating in these toxic behaviors. “Leadership” and “Man-agement” are two different things. Anyone can lead by example and set the standard for an improved atmosphere and better morale.

employeestake accountability for your own morale.

there is nothing wrong with voicing com-plaints or venting frustration but when it is without respite—hour after hour, shift after shift—it can affect everyone in the room. Don’t wait around for someone else to improve your morale.

take advantage of solicitations and surveys by completing them. Provide honest feedback. volunteer for, or create, morale committees or employee action programs. Implement your own recognition programs or participate when management provides recognition.

Recognition works both ways. Everyone likes praise—even management personnel. When efforts are recognized, positive behav-iors are repeated. If management’s efforts to improve morale are recognized, even when they are small or infrequent, there is incen-tive for them to continue those efforts. this closes the circle between staff and manage-ment as both groups begin appreciating the efforts of one another.

ManagementEngage your staff and do so often. the

focus should be on quality interaction, not quantity interaction. Survey employees, ask-ing for their suggestions. value both their participation as well as their input—even if you don’t agree with their opinions.

Be a good listener. When an employee is angry, don’t take it personally. give that person a forum to vent. Better to blow off some steam behind closed doors than melt down in the middle of a call. Employees want to know that their needs and complaints are being heard.

Provide recognition. good leaders set clear guidelines—on both performance and behaviors—for their employees. When these standards are met, employees should be recog-nized. Reinforcing positive behavior provides an incentive to repeat or continue that behav-ior, so provide praise and recognition often.

Everyone should be held to the same standards. that includes management per-sonnel. gather input and participation from the bottom up but lead from the top down.

Regardless of title or responsibility, take the initiative to improve the morale of your center with the hope that one by one others will follow, because ultimately, we’re all responsible for improving morale. Like everything else, this takes practice, but a small step in the right direction is better than no movement at all. g

If It’s Broke, Fix It Like an old house, morale requires constant maintenance Kevin Pagenkop, ENP

g MOraleBOOster

Anyone can lead by example and set the standard for an improved atmosphere and better morale.


IndustryInsiderAlachua County PSAP partners with children’s advocacy group

the Alachua County (Fla.) Sheriff’s Office (ACSO) Combined Communications Cen-ter is now one of 63 centers in partnership with the national Center for Missing and Exploited Children (nCMEC) 9-1-1 Readi-ness Project. to qualify for the recognition, the 108 full- and part-time ACSO employees com-pleted a six-hour training course and—during the process—became the first agency to com-plete all partnership requirements through the new nCMEC online site.

ACSO technical Services Division Man-ager Linda Jones congratulated the staff for their “hard work and diligence” in reaching the goal while cautioning them that the cer-tificate they receive through the mail is not the means to the end.

“Be mindful this partnership is more than a piece of paper and a policy,” she said. “We need to be on our toes each time we receive

a call that may be a child in danger. Practice, review, and be ready. you are all the best.”

the 9-1-1 Readiness Project was created through collaboration with AMBER Alert; national Academies of Emergency Dispatch® (nAED™); national Emergency number

Association (nEnA); Association of Public-Safety Communications Officials (APCO); and nCMEC. Compliance (partnership) shows a 9-1-1 call center has incorporated the best practices in its policies and training and made a commitment to follow best practices.

there are 6,121 PSAPs in the U.S. handling an estimated 240 million 9-1-1 calls annually, which are answered by an estimated 195,791 public safety dispatchers. Of these numbers, 63 agencies have completed all the necessary steps to become a nCMEC 9-1-1 Call Center Partner. the state of tennessee has 10 part-nering centers followed by Utah and Florida with six agencies each.

Children inclined to fall down stairs

there’s a good chance that sometime in your career a child will fall down the stairs and the call will come to your queue.

A child younger than five years old was taken to an emergency department every six minutes for a stair-related injury in America from 1999 to the end of 2008, according to the Center for Injury Research and Policy. But it’s a number that’s on the decrease. the Research Institute at nationwide Children’s Hospital, Columbus, Ohio, reported that during that same period, the total yearly number of stair-related injuries for that age group dropped 11.6%. the research team gathered both sets of data from the national Electronic Injury Surveillance System of the U.S. Consumer Product Safety Commission and published their findings in The Journal of Pediatrics.

Most children who fall down the stairs do so without any object or activity related to the fall. those aged up to 12 months tend to have an injury related to a fall down the stairs while in their baby walker, in their stroller, or while somebody was carrying them. they were found to be three times more likely to be hospitalized than those injured on stairs due to other causes. the authors reported that: • 2.7% of children under five years old

brought to emergency departments for stair-related injuries were hospitalized

• 35% of injured children had soft tissue injuries—the most common type

• 26% had puncture wounds or lacerations • 76% had head or neck injuries—the most

common body regions to be affected • 11% had upper extremity injuries—the

second most common body region to be affected

911Lifeline keeps on growing

A free yahoo group started to fill the void left by the once popular but no longer operational 911Console e-mail site for dis-patch has grown into more than a forum for online discussion.

During the past six years since its incep-tion, Michael Wallach has turned 911Lifeline into a recognized industry resource offering a document library, RSS news feed, staffing analysis tools, and customized surveys.

“Mike has always been the visionary behind 911Lifeline, adding new features that caught the attention of others in the industry,” said 911Lifeline board member Jon goldman, Com-munications, Fire Alarm, and technology direc-tor for the Derry (n.H.) Fire Department. “We became a force to be reckoned with.”

Four years into the venture, Wallach’s dedication made 911Lifeline too elaborate for one person to manage alone. He incor-porated 911Lifeline in the state of Michigan

and obtained IRS 501 (c)(3) recognition as a non-profit organization. A board of directors was put in charge of the existing free yahoo group e-mail and features available through paid memberships.

the free e-mail group fosters unre-stricted discussion, although discussions must remain 9-1-1 related; business postings are prohibited although job openings are allowed. the e-mail discussion list is also used as a real-time resource; for instance, one agency posting a real-time question about an


the north West Ambulance Service (nWAS) nHS trust—Manchester area con-trol center is proud of its use of MPDS® and isn’t a bit apprehensive to show it. the cen-ter, which last year moved from a rundown facility built in the 1930s for a bus station, features script on walls listing every proto-col users’ favorite text: “What’s the address of your emergency,” “Stay on the line,” and “I’m organizing help for you now.” the desk pedestal design is specific to housing the Medical Priority Dispatch System™ (MPDS)

card index, and—the definitive measure of flattery—an embossed display on one of the walls resembles a strand of DnA, which intertwines with gIS mapping point and incident numbers.

the reason for the strand should be obvi-ous, at least for those familiar with the MPDS and the writings of Jeff Clawson, M.D., cre-ator of the protocol system.

DnA represents life, said nWAS Pro-gram Director Ray Lunt, who coordinated the move to the new facility.

“It’s what an ambulance service does,” he said. “We respond to geographically spread incidents that influence life outcomes.”

Ambulance call center staff in greater Manchester moved in April 2011 to a center they now share with nHS Manchester. the control center staff answers some 426,365 emergency 9-9-9 calls annually and arranges patient hospital transport.

nWAS isn’t alone in its protocol adoration.

A s e a s o n a l t r i b u t e t o protocol resolved the age-old question of what to give at Christmas for EMD Sue Filetti with Rochester Emer-gency Communications in new york. Filetti, who was relatively new to the posi-tion when the holidays rolled a r o u n d , p u l l e d R i c h a r d Rusho’s name for the annual

sort of Secret Santa drawing.Rusho, the center’s quality improvement

coordinator, might have anticipated the tried-and-true Christmas gift—like a Santa tie or a fruitcake—but instead was pleasantly sur-prised by a two-foot tall artificial tree bearing some very unique ornaments.

“She decorated the tree with lights and protocol,” he said. “She enjoyed the EMD class so much, she wanted to do something related.”

the tree spent the holidays on a filing cabinet in Rusho’s office and, once out from under the holidays, he put the tree in storage for next year’s celebration.

“She had a unique idea,” Rusho said. “It was a first and it will be back for seconds.”

Rochester Emergency Communications serves 84 public service agencies and last year the 192 employees handled more than 1.2 mil-lion calls for service. g

Decorations are in the eye of protocol users

out-of-state driver’s license had the answer posted by another agency within minutes.

the second resource, and parallel to the yahoo group, is a paid membership in 911Lifeline Inc. Active members pay $12 in annual dues, and associate members pay $50 in annual dues.

An active member must be employed by, or retired from, a vetted public safety related organization as a dispatcher, firefighter, man-ager, director, police officer, EMt, etc. Associate memberships include any commercial entity or vendor selling products and services to the 9-1-1 or public safety communities. Associate mem-berships are also open to other public safety organizations such as APCO or nEnA.

Paid membership provides access to all of the 911Lifeline resources. these include:

• Document library organized into 25 cat-egories such as SOPs, PowerPoint presen-tations, and training materials including 9-1-1 call recordings

• Customized staffing analysis that can be applied to a department’s specific call characteristics to produce a Staffing Analysis Report suggesting the optimum level of calltakers

• Compassionate assistance to agencies expe-riencing a Line of Duty Death (LODD)

• Mentor program pairing a new hire dispatcher or newly promoted Commu-nications training Officer (CtO) or supervisor with an experienced member of the same rank/grade

• Dedicated message boards designated by rank that give members access to a message board format within a nar-rowly-focused topic

Firefighter grants fund communication upgrades

800 MHz radio system upgrades aren’t the only perks when awarded Assistance to Fire-fighters grants (AFg) through the Federal Emergency Management Agency (FEMA).

It also brings peace of mind to resi-dents living within this corner of the tor-nado belt, according to Larry Steeby, a fire chief for one of 10 departments in Labette County (Kan.) sharing in the piece of the AFg pie.

ProtoCol triBute

Visit 911Lifeline at www. 911lifeline.org


“the biggest thing you always come up with in a disaster is communication issues,” Chief Steeby told local news station KOAM. “there are areas within the county that on cer-tain frequency ranges, we have poor coverage.”

the lion’s share of the county’s $1.1 million grant will be used to install an 800 MHz radio sys-tem on an existing tower to connect the county’s 10 fire departments. the funding will also

be applied to the purchase of 190 portable radios that comply with the new system and 61 in-vehicle radios. the county and participat-ing agencies will cover an estimated $200,000 over and above the FEMA grant without, at this time, increasing county taxes.

Upgrades should be completed and ready to go by early 2013.

Other fire departments and EMS agencies receiving grants include: • CCE Central Dispatch in northern Michi-

gan coordinated a $788,600 grant request that will enhance interoperable commu-nications between the 28 fire departments, dispatch, and other response agencies such as police and EMS within a tri-county area

• Dunklin County in Kennett, Mo., was approved for a $339,230 grant to update communication and paging equipment for all fire departments in the county and provide a backup radio at the coun-ty’s 9-1-1 centerSince 2001, the AFg program has pro-

vided one-year grants directly to fire depart-ments and nonaffiliated emergency medical services (EMS) organizations to purchase vehicles and response equipment such as personal protective equipment and spon-sor fire prevention activities. the grants require a percentage of matching funds based on population size in the jurisdic-

tion ser ved. the $404.2 million in grants awarded during the fiscal year 2011 included funding to fixed and mobile communica-tion hubs to coordinate field responses and provide agency interoperability.

the 2012 AFg program will provide an estimated $282 million in grants; applications were due July 2012.

SWAT callers could face prison time

A bill introduced in Michigan would make it a felony for anyone found guilty of placing a medical or other emergency report intended to fool emergency responders.

Penalties for those found guilty of plac-ing calls requiring response by Special Weap-ons and tactics (SWAt) teams depend on the response, with the death of an individual as a result of the response meriting up to 15 years in prison and fines between $5,000 and $10,000. the guilty party would also be responsible for paying the cost of response. Parents of a juvenile convicted of the crime could be ordered to pay restitution.

Swatters hack into video game consoles to send 9-1-1 messages using Internet connec-tions in hopes of eliciting a SWAt response. the hoax also highlights a security shortcom-ing with voice over Internet Protocol (voIP) phone services that let people mask their true location and the advent of Caller I.D. spoof-ing services offering to disguise callers’ ori-gins for a fee.

the Federal Bureau of Investigation (FBI) headed up the first federal swatting case in 2007 and since then has successfully pros-

ecuted several cases, including a group of swatters responsible for placing 300 calls in 17 states. three years ago, a legally blind Massa-chusetts phone hacker was sentenced to over 11 years in federal prison following his guilty plea for computer intrusion and witness intimidation charges. Among other charges, the then 19-year-old Matthew Weigman con-fessed to conspiring with other phone hack-ers to make hundreds of swatting calls.

Each swatting incident resulting in response costs taxpayers an average of $10,000.

Scams keep on coming

An identity theft con traveling the states has callers claiming homeowners owe extra money to receive 9-1-1 services. Although there are variations on the theme—such as fees

related to entering addresses in an emergency database—the callers request names and medi-cal information in order for the homeowners to “subscribe” and otherwise keep their 9-1-1 services viable. Scammers in Ionia County (Mich.) have even pitched a senior citizen special—a one-time only fee of $429.

Police are reminding residents that 9-1-1 services are funded through dedicated 9-1-1 excise taxes included on telephone bills and through other local government funds. the calls to collect fees are just a new twist on identity theft and a way to score free money.

A second scam for the record tries con-vincing grandparents to open their wallets for a “grandchild” unable to call because of injury or arrest. Police say the callers prey on emotions and are very effective in convinc-ing their prey to wire the cash requested.

Shakeouts quaking the country

A practice in protection that started in California four years ago is spreading to other states and regions similarly resting on rocks of unrest. Originally called the great Southern California Shakeout, the one-day earthquake preparedness event is now being held in nevada; Utah; Idaho; Oregon; guam; British Columbia, Canada; new Zealand; and tokyo, Japan. the Central United States Shakeout held on Feb. 7, 2012, included Missouri, Illinois, Indiana, Kentucky, tennessee, Alabama, Mis-sissippi, Arkansas, and Oklahoma.

According to the great Utah Shakeout website, the California Shakeout held in 2008 was based on a magnitude 7.8 earth-quake on the San Andreas fault in southern California and the destruction it would cause. nearly 5.5 million people spanning eight counties participated. two years later, the same event drew 7.9 million participants.

Shakeouts address earthquakes of 7.0 magnitude or greater and encourage com-munities to implement plans in case an earth-quake or other disaster occurs. At the exact time the earthquake is scheduled to occur,

information is available at www.fema.gov/firegrants


Intentional fires kill hundreds each year

During 2005–2009, an estimated 306,300 intentional fires were reported to U.S. fire departments each year, with associated annual losses of 440 civilian deaths, 1,360 civilian injuries, and $1.3 billion in direct property damage, according to a report by Ben Evarts available on the national Fire Protection Association (nFPA) website.

three-quarters (75%) of these fires occurred outside, 18% occurred in structures, and 8% occurred in vehicles. Despite being only 18% of all intentional fires, structure fires accounted for 88% of civilian deaths, 82% of civilian inju-ries, and 81% of direct property damage caused by intentional fires. Sixty percent of inten-tional structure fires occurred in residential properties, 6% occurred in storage facilities, 6% occurred in educational properties, and 4% occurred in mercantile or business properties.

A report nFPA recently released on the total cost of fire in the U.S. shows an estimated $331 billion, or 2.3% of U.S. gross domestic product, during 2009. Major fire causes include children playing with fire, elec-trical failures in home fires, home candle fires, home cooking fires, and home heating fires.

nFPA provides the low-down on just about every type of fire and the associated statis-tical report, with abstracts of the reports available to both nFPA members and non-members. Members have full access to the information.

Albany 9-1-1 might make pranksters think twice

Albany County 9-1-1 in new york might have a surefire route to making prank callers think twice before dialing: make the conse-quences known and enforce them. According to the “Facebook Story of the Day” presented by the local news station, the communica-tions center considers prank calls a serious matter that is pursued and prosecuted.

“We can trace these phone calls; we have had people that have made prank phone calls and we have traced them and certainly have proven that we have the capability to do that,” said Charlotte Floyd, Albany 9-1-1 communica-tions manager, in response to the daily question. Prank calls are considered class one misdemean-ors, punishable up to one year in jail and up to $2,500 in fines. g

the newest drug on the street is available over the Internet and, in some areas, over the counter in convenience stores, truck stops, head shops, and gas stations. While labeled as bath salts and branded with fanciful names like “Ivory Wave,” “White Dove,” and “Cloud 9,” the more appropriate branding would be more along the lines of a skull and crossbones.

these bath salts have nothing to do with bathing but are more of an imitation cocaine or LSD that when snorted, ingested, or smoked can result in euphoria and hal-lucinations. In extreme cases, the use of the

drug has led to self-mutilation, unprovoked attacks, and cardiac arrest.

the drug’s relatively recent street debut compounds problems for EMS. there are no hard and fast rules for response. Erratic behavior and insensible talking prevents dispatchers from gathering the appropriate information and ambulance drivers must make quick decisions about how to handle the drug’s abusers. Police are cautioned against restraining patients because of the risks associated with increased adrenaline release. the severity of the problem put bath salts response on the agenda for the Maine national Emergency number Association (nEnA) conference held in April.

Public access to the drug, however, may soon be designer drug history.

the U.S. Drug Enforcement Adminis-tration (DEA) used its emergency author-ity in October 2011 to ban chemicals used in the manufacture of the synthetic drug and at least 33 states have measures to con-trol the substance. In February, Sen. Charles Schumer (D-n.y.) proposed a national ban on the chemicals used in bath salts. the chemi-cals are already banned in the U.K., Canada, Australia, and Israel.

the DEA’s ban and state regulations make it illegal to possess or sell the drug’s key ingredients—mephedrone, methylene-dioxypyrovalerone (MDPv), and methy-lone—or any other products containing the chemicals. the ban is in effect for one year while the DEA works with the U.S. Depart-ment of Health and Human Services to fur-ther study control of the chemicals. g

Newest designer drug isn’t for sprinkling in bathtub as name implies*See CDE on page 32

Designer Drug Danger

participants—at home, at work, at school—are asked to “Drop, Cover, and Hold On” and maintain the position for at least 60 seconds. the three-step instruction has been shown to reduce injury and death during earthquakes and involves dropping down to your hands and knees before the earthquake knocks you down, holding your head and neck under a sturdy table or desk, and holding onto the shelter until the shaking stops.

the goal is to protect you from falling

and flying debris and other nonstructural hazards, and to increase your chance of ending up in a Survivable void Space if the building actually collapses.

It is the recommended three-step action to take in contrast to meth-ods like standing in a doorway, running outside, and the potentially life-threatening “triangle of life.”

more information can be found at www.shakeout.org

more information can be found at www.nfpa.org


While party caps and trumpeting party horns were absent from the celebration, ACE reaccreditation for the national Ambu-lance Service (nAS) north Leinster Area, Midlands Division caused quite a sensation without the added hoopla.

In addition to the staff gathering for the “thank-you day” party held at the north Leinster Area Ambulance Control Centre, the event brought in local media and Health Service Executive (HSE) managers from other sites around Ireland, according to Beverley Logan, International Academies of Emergency Dispatch® (IAED™) accreditation officer.

“those attending already confirmed that these are the footsteps they intend to fol-low,” Logan said.

this is the control center’s second round at accreditation, having first achieved its initial ACE in 2008. the center takes about 28,500 calls per year and covers a population of about 215,000.

the HSE was established in 2005 to man-age and deliver health and personal services in Ireland. three ambulance command and con-trol centers in nAS north Leinster coordinate pre-hospital emergency care services for 97 ambulance stations. north Leinster has a popu-lation of about 2.07 million and covers 16,031 square kilometers; 570 people staff the three centers and take up to 110,000 calls per year.

Conference signals things to come in Italy

A quality improvement brainstorming session among three regions in northwest

Italy using the Medical Priority Dispatch System™ (MPDS®) turned into a full-blown conference attracting representatives from operations centers around the country.

“Emergency medical services are close-knit in Italy,” said Amelia Clawson, director of International Relations for the Interna-tional Academies of Emergency Dispatch® (IAED™). “Word spread and the 30 attendees expected jumped to more than 200.”

the day-long event held May 3 at the San Martino University Hospital of genoa fea-tured opening remarks from each of the medi-cal directors from valle d’Aosta, Piemonte, and Liguria and three two-hour sessions cov-ering medical emergency 1-1-8 case reports, key components of the MPDS and ProQA®, and culminating with a session covering qual-ity improvement. Dr. Francesco Bermano, the medical director of genoa Central Opera-tions (C.O.) 118, and Andrea Furgani, M.D., managing director of genoa C.O. 118 quality improvement, organized the event.

the three regions—Liguria, valle d’Aosta, and Piemonte—initially planning an afternoon meeting to discuss quality improvement and a more unified emergency dispatch system across the regions are no strangers to the MPDS. northern Italy was the first to adopt uniform levels of emergency assistance nearly 20 years ago, prompting the entry of MPDS. Liguria, with five centers, including the one in genoa, went live with Medical ProQA between December 2010 and May 2011.

Clawson, project manager for the MPDS implementation, said Dr. Bermano, an advocate of pre-hospital care and 1-1-8 public education,

Ambulance service in Ireland celebrates reaccreditation

international news

is a standout in emergency medical services. “He doesn’t take anything at face value,”

said Clawson, who was invited to give a pre-sentation describing the MPDS in front of a panel of moderators. “But once he was con-vinced the process does work, he’s become a major advocate.”

PDC Consultant Ross Rutschman was among a group of moderators for the qual-ity improvement session.

Changing coursethe potential of the MPDS in Italy hasn’t

happened overnight. Clawson and others from the Academy have spent more than a dozen years in Italy and taken several trips specific to the three regions in the northwest. not only have they learned the culture but, also, became well acquainted with the coun-try’s evolving emergency healthcare system.

Legislation in 1992 called for the forma-tion of operations centers equipped with a short and universal telephone number (1-1-8) connected to one center. Initial service was limited to provinces in several north-ern regions (Friuli, veneto, trentino Alto Adige, Emilia Romagna, and Piemonte), although by 1995, 1-1-8 operations centers had extended to western (Liguria and Lom-bardy) and central regions (tuscany, Abru-zzo, and Lazio). Currently, all regions in Italy have at least one center per province.

the 1-1-8 medical centers are the connect-ing points of all healthcare emergencies, and all urgent medical and emergency telephone calls converge through the national emergency number system. the regional centers operate in close collaboration, although the 1992 directive allows each region to carry out autonomous implementation of local provisions, according to an article in the Journal of Preventive Medicine and Hygiene (2004; 45: 27-30).

Several factors delayed the country from taking full advantage of the MPDS, includ-ing those related to economics and the doc-tor exclusive emergency treatment.

“Dr. Bermano knew we were sincere about improving the 1-1-8 system,” Clawson said. “this wasn’t about pushing another American product and leaving the country once negotia-tions were completed. We are there to stay.”

the one-day conference held at the Uni-versity of genoa attracted interest from as far away as the Puglia Region at the south-ern heel of Italy, signaling the continuation of something good.

“Everyone was so positive, I’m sure it won’t be the last we hear,” Clawson said. g


g FaQ

Brett: We have two questions in reference to

control bleeding. 1. Does the bleeding have to be described as

serious bleeding for the need of control bleeding instructions?

2. If the patient is bleeding due to trauma, is it still appropriate to give the control bleeding instruction (for example, traffic accident with head injury)?Chancy Huntzingertraining/QA Coordinatornewton County Central Dispatchneosho, Mo., USA

Chancy:yes and yes.External bleeding should be uncon-

trolled (actively flowing or spurting) for the need to “control” bleeding. this is important as it only serves to distract the caller from observing potentially more serious issues when not needed.

Bleeding control can and should be accomplished without significant movement of the trauma patient; serious bleeding is a greater risk than the relatively minor risk of exacerbating a neck injury that likely does not even exist. Encouraging the patient not to move and asking the caller not to move the patient are sufficient.

Brett A. PattersonIAED™ Academics & Standards AssociateResearch Council Chair

Brett:I have listened to a few EMD calls in

which bleeding control instructions have

been necessary and, at the same time, caused a debate among our staff when we discuss the issue. I hope you can resolve the problem.

the first instruction on that panel is “Do not use a tourniquet.” there are neither parentheses around the instruction nor an associated PDI. Does that mean it’s not an optional instruction and one that must be read whenever bleeding control instructions are provided? When reading the instruction for a patient whose uncontrolled bleeding is somewhere on the head, however, it feels very awkward. During a recent phone call, the caller reacted in anger when hearing the instruction, saying something to the effect: “I told you his cut is on his eyebrow, I can’t use a tourniquet there!” When that happens, time is wasted calming down the caller and regaining control of the call.

the Q reviewing this call suggested starting the instruction with a situational or conditional statement, such as: “I know you said the cut is on his eyebrow, but if any other injuries are found, do not use a tourniquet.” Would it be more appropriate to skip the instruction or is the instruction required whenever bleeding control instruc-tions are accessed?

Heidi gillespieED-Q™ CoordinatorWeld County Regional CommunicationsCentergreeley, Colo., USA

heidi:you are correct in that the instruction

is mandatory, but PDIs are to be given when appropriate, possible, and necessary.

By Brett A. Patterson

Seeing RedHow much bleeding does it take before giving control instructions?

g FaQ g aCe

BestPractices


Was it inspiration, practicality, or compassion—or a combination of all three—that brought Accredited Center of Excellence (ACE) distinction to Ser-vice Mobile Emergency Care of São Paulo (SAMU-SP)?

If you ask Col. Luiz Carlos Wilke, he might say not one of the three elements trumps another. they all came into play and when they merged during the accredi-tation process is a moot point at best.

After all—and this is the practical angle speaking—Wilke, SAMU-SP director, is an ambitious person, determined to offer the best and to be known for offering the best first mobile service for emergency care in Latin America. SAMU-SP was the first center in Latin America to adopt

the Medical Priority Dispatch System™ (MPDS®), going live Feb. 24, 2011, and—only 10 months later—ready to submit an accreditation packet that would also make SAMU-SP the first in Latin America to become an ACE.

“the ACE title has special value for our SAMU,” he said. “It’s been our mis-sion to meet the requests classified as medical emergencies or urgencies in the shortest time possible.”

At the navigator conference held in Baltimore, Md., during the third week in April, Wilke spoke of the compassionate piece of the picture and the inspiration his caring has in turn provided to others.

In 2009, the SAMU went through a phase of restructuring that included the gradual hiring of people with disabilities. the service has a staff of 163 employ-ees (calltakers are known as assistants

By Audrey Fraizer

Latin American ExcellenceSAMU-SP ACE means special value for country

g aCeAs an EMD-Q®, I would be OK with either of the options you have described, prefer-ably the one with the situational comment. this is best because it shows concern for the caller/patient and ensures that the instruction was provided. Incidentally, I used to work as a phlebotomist in the hos-pital nursery and we routinely put a rub-ber band (tourniquet) around the infant’s scalp to draw blood from scalp veins. Call-ers do weird things, so it’s best to cover the bases. Again, I would not fault an EMD for not giving the instruction for a non-extremity wound.

Brett A. PattersonIAED Academics & Standards AssociateResearch Council Chair

Brett:Are complaints of “seeing things” or

“hallucinations,” considered decreased level of consciousness? If we use Protocol 25: Psychiatric/Abnormal Behavior/Sui-cide Attempt, it becomes an ALPHA-level response, which is nonemergent, according to our medical director. If we use Proto-col 26: Sick Person (Specific Diagnosis), it would be considered altered level of con-sciousness and becomes a CHARLIE-level response, which is an emergent response, according to our medical director. I want to make sure that my EMDs are handling these situations in the same way in order to pro-vide a consistent response to our patients.

Anthony L. Allen American Medical ResponseCommunications SupervisorIndependence, Mo., USA

anthony:Hallucinations are generally considered

a psychiatric complaint, but drugs or even illness may also cause them. It is impor-tant to listen carefully to the complaint and cover the safety and clinical (prior-ity symptom) basics. I would not fault an EMD for using either P25 or P26, but I would lean toward 25 just for patient mon-itoring purposes. I know it may not seem a great fit for a non-violent, non-suicidal patient, but that's the point—the Protocol rules these things out.

I completely agree with you, hallucina-tions are not what we consider a decreased level of consciousness, which, in our world, really means poor perfusion of the brain.

Brett A. PattersonIAED Academics & Standards AssociateResearch Council Chair g


of medical regulations or, in Portuguese, tecnicos Auxiliares de Regulacao Medica (tARMs)) of which 152 have emergency experience on a very personal level. the employees are divided into four shifts, send-ing emergency vehicles from their central location in the capitol city.

SAMU-SP draws its staff from a third-party agency representing applicants with various physical or sensory disabilities; the agency sends candidates to SAMU-SP based upon availability and openings. the major-ity of people with disabilities have not only worked in public service as either firefight-ers or police officers but they too sustained injuries requiring emergency response and ultimately the loss of jobs due to the sever-ity of the accidents.

now comes the part about inspiration.Wilke adamantly refuses and actually

becomes rather annoyed regarding any hint of “pity” in the hiring process. the option did not arise by chance or even a desire to fulfill the country’s Quota Law. the end to long stretches of unemploy-ment combined with a newfound pro-fession he believed would translate into dedicated employees, empathetic to a caller in crisis, were behind the decision.

“the focus is not inclusion,” Wilke said. “We are not a philanthropic agency. Our goal has always been to seek excellence in service. the people we have are indeed the best profes-sionals for the job with the skills required for anyone working in a place that has saving lives as a main goal.”

vinicius Oliveira is an exemplary fit. Seven years ago, Oliveira took three shots in one arm and two in the back while trying to break up a fight at a relative’s graduation ceremony. He left the party in an ambulance and spent months in rehab. With what has been called an impressive calm, today Oliveira responds to calls from people in similar situations.

“I’ve been in the role of the victim, now I can help others,” he said.

the supervisor of ambulance dispatch, thiago do Santos, was forced to leave his job after fracturing two vertebrae in a car acci-dent. He spent nine months in a hospital bed and has never regained full movement.

“SAMU emerged as the reason that I should not have died,” he said. “It is gratify-ing to see that I can make a difference in someone’s life.”

the tARMs also “clicked” with the struc-ture of call processing and dispatching response using the Medical ProQA® software. tARMs

were trained and certified within weeks prior to implementation using a Portuguese language version of ProQA. English-speaking EMD

instructors had the benefit of professional translators in a sound booth at the back of the classroom to provide real-time translation.

“The people we have are indeed the best professionals for the job with the skills required for anyone working in a place that has saving lives as a main goal.” – Col. Luiz Carlos Wilke


“the difference in language wasn’t a problem,” said Brett Patterson, International Academies of Emergency Dispatch® Academ-ics & Standards associate and Research Coun-cil chair. “I could look directly at the calls and what I said was heard immediately. they could ask questions and I could give answers without waiting for someone in front of the class translating each sentence.”

As in most implementations, the tough-est obstacle proved to be the medical staff assigned to patient triage. Under the former system, phone support transferred calls to a medical regulation team of physicians and assistants; they analyzed calls to decide patient need, dispatched the most appro-priate mobile care resource, and directed patients to alternative fixed resources or offered advice over the phone. Prior to MPDS, 15 medical doctors were routinely on duty for every shift.

Although the communications center was not the medical team’s preferred venue, desiring field response to phone response, relinquishing call analysis and dispatch was a tough sell. Once again, MPDS rose to the occasion. In just three months after going live, ambulances dispatched on ECHO- and DELtA-level calls were reaching destinations within 10 minutes compared to the former average of 35 minutes.

“the 15 doctors had to triage each call,” said IAED™ International Liaison Amelia Clawson, who directed the Academy side of the implementation. “that takes time.”

Medical staff turned the corner by listen-ing. they heard the questions asked of each caller and the instructions provided while

response was on its way. In one day alone, there were seven calls reporting cardiac arrests; three of the seven were revived using Pre-Arrival Instructions (PAIs) and were subsequently released from the hospital.

A call in the first few days of operations that required PAIs to successfully resuscitate a patient stands among the calls Walquíria Regia vilaça Mordjikian will long remember in helping to cement the transition.

“We monitored the call until the patient left the hospital,” said Mordjikian, executive coordinator of central operations for SAMU-192 do Município de São Paulo (SAMU 192). “We have similar cases every day, but this was the first using Pre-Arrival Instructions. MPDS has tremendous benefits for our people.”

Wilke said the doctors deemed the sys-tem safe. they are now back in the ambu-lances, where they want to be, rather than answering calls. the five supervising doctors routinely on the floor at the center are avail-able for medical decisions involving ALPHA, BRAvO, and CHARLIE calls and to give advice for calls coded as OMEgA.

With doctors, tARMs, and management on board, the ACE became an attainable goal. Adding fire to the fervor was the 91% compliance level reached within six months of operations and a positive public response. they were at accreditation levels by October 2011 and ready to submit their accreditation packet in January 2012. nearly 250 invited guests attended an ACE celebration party held on May 30 at SAMU-SP.

Wilke said ACE was a goal from the start.“It is with pride we say that the Service

Center SAMU de São Paulo is the largest and

most modern in Latin America,” he said. “But nothing is more important than our ability to save lives.”

about saMu-sPSAMU follows international standards of

emergency care and is regulated by national standards of the Ministry of Health and the Federal Council of Medicine (CFM). the organization of emergency care systems began with the gM/MS n. 2048 of nov. 5, 2002, which created the 1st technical Regu-lation State System of Urgent and Emer-gency Care that is currently in force.

the mobile service SAMU opened in a new center in October 2009 in Bom Retiro, the central region of São Paulo. this date was a historical milestone for SAMU because it was when they started to use Intergraph’s Incident Management solution, fully custom-ized by Sisgraph—the same Brazilian com-pany that one year later supported PDC™ and IAED on the MPDS implementation and the ACE achievement at SAMU. In addition, the three-year-old center is equipped with projec-tors and LCD televisions, providing the loca-tion of vehicles available for response.

São Paulo, with a population of about 10.5 million people, has the largest central pre-hospital care system in Latin America. Since 2004, the original fleet of 63 rescue vehicles has grown to 120 ambulances, a number expected to increase to 140 in 2012. the ser-vice also manages 55 technical reserve units to replace ambulances sidelined for repairs or in case of exceptionally high demand. Calltakers answer 8,000 calls daily, sending response to about 1,500 patients. g

What could be more important than protecting our children?

Announcing 9-1-1 CommuniCAtion Center Best PrACtiCes in CAses of missing ChildrenA missing child is a critically important and high

profile event that can rip the fabric of your agency

and community if not handled correctly. In terms

of urgency, use of resources and potential impact

on the community, a missing child requires a level

of readiness akin to a disaster. This joint initiative of

NAED, APCO, NENA, National AMBER Alert and the

National Center for Missing & Exploited Children

(NCMEC) was created to:

Promote awareness of the critical role of

the 9-1-1communication center in handling

missing and exploited children calls

Develop and endorse best practices

Develop tools for handling incidents of

missing and abducted children

Ceo overview Course9-1-1 Communication Center Managers and Directors are

invited to apply to attend the two-day oveview course

held at the National Headquarters of NCMEC in

Alexandria, VA. Courses are conducted approximately

every six weeks at no cost to participants.

for more information, visit www.missingkids.com/911 or email [email protected]

helping to ProteCt our Children is as easy as 1-2-3!

1. download NCMEC’s 9-1-1 Communication Center Best

Practices in Cases of Missing Children document from

www.missingkids.com/911

2. request a copy of the Public Safety Telecommunicator

Checklist for Missing Children.

3. Apply to attend NCMEC’s CEO Overview Course in

Alexandria, Virginia.

·

·

·



Nobody Doesn’t Like 9-1-1the free-for-all call, kind ofJames Thalman

Ask most Americans what numbers come to mind in case of an emergency and they’ll say 9-1-1. Ask most PSAP managers to say what numbers come to mind in case of an emergency

and they’ll string a long series of digits together, all starting with a dollar sign.

they will also be quick to note the significant costs of maintaining the other half of every 9-1-1--two-way radio communications. A 9-1-1 call engages dispatchers who then engage the police, fire, and medical responders over a radio system of relay towers that must work in all weathers at all times at all climes. Whether forest fires rage near the towers in lowland timber or winter encases them in sideways stalagmites of ice 2,000 feet above where trees don’t grow, towers must be up and humming 24/7/365.

Everything has to work, no matter what. Maintaining two-way communication can be tricky, even risky, as the cover photograph of the tower perched on Black Crook Peak near Salt Lake City shows in no uncertain terms. Winter storms regularly sculpt the sky-high tower into one bug-eyed alien monster of a maintenance trip.

And, no matter what time of year, landing a helicopter at 9,274 feet “is a little like balancing a glass of water on a pencil,” said Wade Matthews of tooele Emergency Management. “the tower has never failed, even though our folks have been certain it would a few times.”

It’s a combination of good luck, good work and money that keeps all the scenes behind the sceens of 9-1-1 going. the system is so good that it is taken for granted and the public it serves thinks it’s a free call. those who sit night and day at the consoles and those who mind that the radio

system so information is reliably transmitted to the field responders know the service isn’t free by a long shot.

In short, the 9-1-1 system might seem self-perpetuating after nearly 44 years, but it is constantly buffeted by some pretty stiff budgetary winds, yet keeps providing unparalled customer service. no brag, just fact.

While the marketplace will insist in a voice mail to customers how important their call is to a company, then advise them to “listen closely as our options have changed,” a real, live dispatcher answers the phone, usually on the first ring and sends help seconds into the call. If a comm. center uses the nAED™ protocols, the “customer” is provided guided help over the phone while emergency responders are on the way.

“yes, your call is very important to us, but we would never have to say that; callers know,” Danny gordon, an EMD with newton County Central Dispatch in neosho, Mo., told The Journal in April. “the call isn’t just important, it’s vital. It’s the catalyst to how the entire incident is handled. We not only have to provide the ultimate customer service, we’re providing the ultimate public service at the same time. We take it very seriously.”

Money is the main reason companies and telephone service providers have outsourced customer service to India or relegated calls to a menu repeated by a disembodied voice. there is no incoming revenue in staffing customer hotlines. there’s no money in staffing emergency call centers, either, but 9-1-1 still costs plenty. And with the advent of the digital age, providing the new and improved emergency data centers, which one day will save public safety resources flying out the door these days,

g Feature | nextgen9-1-1


requires hefty financial investments now. Fold in the migration to the fullest and

best use of IP broadband data sharing next generation 9-1-1 (ng 9-1-1) while at the same time having to maintain the current landline-based network, and the country’s public safety answering points (PSAPs) along with oversight committees in legislatures and in Congress are scrambling to figure out how to pay for both the legacy 9-1-1 system and ng9-1-1.

In short , if nothing is done about funding, financial support will undoubtedly b e s h o u l d e r e d b y f e w e r a n d f e w e r individuals right at the time the use of telecommunications continues to skyrocket but the cost per family for telecommunications is actually going down.

Free is expensivetwo people in line at a grocery store in

March who use prepaid cell phones said they don’t pay a penny for 9-1-1, and that’s how it should be. “the more people use a service, the cheaper it is to run. you say nearly every person knows the number and knows who to call in an emergency. that shouldn’t cost anything. no, I don’t feel bad that I’m not helping pay for it. I had a home phone for years, and I’ve shut that off. It’s somebody else’s turn.”

the traditional or “legacy” 9-1-1 system is underwritten by home phones wired into the network. A user fee or service provider kicked in a small monthly surcharge of around $4 or $5. the public’s notion that 9-1-1 always answers, therefore they’re financially fit, is convenient but flat; it’s simply not true.

“All things can’t grow wild and free, especially not a service that is available 24/7, 365 days a year, and has to be there no matter what and when things are at their worst, said Brian Dale, deputy chief with the Salt Lake City Fire Department and Accreditation Board chair for the national Academies of Emergency Dispatch® (nAED).

“the free-to-me attitude is understandable, but that causes direct harm to a PSAP somewhere,” Dale continued. “When people feel no need to help pay to keep the lights on and centers humming at every moment of every single day, someone else has to. It’s not like we have a choice to be open or not.”

As dispatch center supervisors across the country make their slow but sure and expensive way toward fully integrated IP broadband operations as part of the (ng9-1-1) overhaul, revenue from 9-1-1 fees and

surcharges from monthly home phone bills that kept dispatch centers up and running the past 44 years is dissipating.

Wireless service providers aren’t rushing to make up the difference, yet every single customer can still and probably always will be able to call 9-1-1.

A booming information technology market com bi ne d wi t h t h e pu bl i c ’ s

insatiable urge for the next latest, fastest hand-held device, means a shortfall in revenue is increasing every day. As the number of cell phone users and service providers who are paying a portion or nothing at all for 9-1-1 service increase, the fees collected from the use of a good, old landline home telephone, which have kept the 9-1-1 agencies afloat the past 44 years,


are going away faster than vHS tapes on the Internet.

the negative numbers are starting to add up, right at the time when additional funding is needed to make PSAPs truly 21st century communicators under ng9-1-1.

the state of vermont, which is a ng9-1-1 forerunner, is already projecting a $462,000 loss of revenue per year if prepaid cell phone

customers and providers in that state don’t start pitching into the 9-1-1 fund.

PSAPs around the country are reporting that nearly a fourth of wireless 9-1-1 calls, or 15% of all 9-1-1 calls, are made with a phone not billed in any way for the service.

Other industries have made changes converging new ways with old ways—land-wire telephone switching centers in this

case—but emergency communications must continue to be viable until the new ng9-1-1 is in place.

Although each industry has its path to its new hybridized version based on the digitizing world, the news media is a recent example of how print, broadcast, and broadband data have been blended into kind of a one-stop news shop, with digital data the main information conduit.

Financially, it’s beyond a Rubik’s Cube in getting the mix of funding styles to match up. As experts, researchers, veterans, and newbies alike say, when it comes to funding, distinguishing between which parts of the telecommunications costs are phone, video, and Internet are anyone’s guess at this point.

Service providers have competitive incentives to allocate costs away from p h o n e s e r v i c e s , w h i c h h a v e b e e n communications centers’ financial bread and butter. to this day, the old copper wire connections are underwriting a good portion of cell phone access.

And if that weren’t a nasty enough wrinkle, ng9-1-1 funding engineers have the daunting task of determining which portion of telecommunications costs amount to commerce that is therefore non-taxable state-by-state. they must also comb through the hair-like wires of regulations and which services are regulated locally, by the state, or by the federal government.

One dispatcher said from his point of view—from the console, not from the grand scheme of things—“What they’re up against is not unlike someone giving you a hatchet, telling you to go into the forest and to contact the outside world when you’ve figured out how to send an e-mail.”

Add the fact that there are more cell phones in America than there are Americans, and you’ve added an element of difficulty similar to the funding equation that could be described as something like trying to have a chat about polyhedral combinatorics at a Bunko party.

Funny as in weirdthe collection and distribution of 9-1-1

fees in the United States is funny, not as in “ha-ha” but as in weird, with practices as wide and varied as the landscape between the bright, blue shining seas. First of all, 9-1-1 calls are free but they’re not free by any means to respond to. that has been a kink in various parts of the system since Day 1.

t h e f i nanc i a l f i l i g re e of current operations is shown best in the past six

Photo illustration by 911 Dispatch Magazine. Source: U.S. Department of Transportation.


months by two reports, one on the federal level and one on the state level.

the first is a report to Congress from the Federal Communications Commission (FCC).

not only do states and agen-cies within states have their own unique ways of collect-ing fees, some—10 at least in 2010—used portions of the fees collected for purposes partial ly or completely unrelated to 9-1-1.

In 2009, 12 states were diverting funds for non-9-1-

1-related expenditures. While it’s good that the number of

states diverting 9-1-1 funds from their proper purpose has slightly decreased, FCC Chairman Julius genachowski said in a news release announcing the report, that the agency must be given the power to do more than detail funding practices and discrepancies among the various states.

“As we move toward a next-generation 9-1-1 system, the FCC is today seeking input on how to most effectively use 9-1-1 fees to enable the transition to sending text, video, and photos to 9-1-1. . the call to underwrite 9-1-1’s future was apparently heard in Congress: As part of the controversial payroll tax cut extension approved in February, Congress included $115 million in kick-start funding to state and local 9-1-1 authorities.

the funding may have come as a bit of a surprise to the public and to many emergency dispatch centers, but it shows that Congress can agree on something and that the call for a true, nationwide funding strategy is as integral a part of the move to Internet-based dispatching as a smartphone is to a teenager.

Steve Proctor, executive director of the Utah Communication Agency network (UCAn) and a former dispatcher who has been around the two-way radio side of emergency communications for as long as there has been 9-1-1, said succinctly: “[ng9-1-1] is a better mousetrap, but it’s being built for us, in a way. We have a vision of what the future is but we don’t have a plan to handle it or how to pay for it really.”

Just 10 years ago, most people didn’t have a cell phone and Facebook had barely reached the “gleam in the eye” stage for founder Mark Zuckerberg.

“now, not only does ever ybody go around ‘liking’ everybody on social networks, but we all have a phone in our pocket and the phone has a camera in it and video and

roaming access to the Web,” Proctor said. “the Baby Boomer/landline generation hasn’t even faded and the Internet generation is already taking over. they are just gobbling up technology, so we better too.”

As tricky as figuring out the funding schematics for ng9-1 -1, the savings from pooling calls and pooling resources through broadband is simple arithmetic. there’s plenty of evidence on the national Emergency number Association (nEnA) website and other state emergency services sites showing the financial benefit.

ng9-1-1 at this moment, however, is facing the daunting task of not only making sure that technology isn’t a barrier, Proctor said, but “whatever it is, it’s got to work. Whatever it takes right now, we have to streamline the politically and geographically peculiar funding approaches. Basically, those who use any technology to access 9-1-1 need to help pay for it. the overriding fact is that the broadband era in dispatching is a unified approach, and as we learned and preach as UCAn members, whatever we do is going to be cheaper doing it together.”

they’ve got our numberthe phrase “doing it together” scares a lot

of agencies that have become autonomous and have gotten used to charging fees for 9-1-1 to suit the political leanings and particular turf claims among police, fire, and medical emergency services agencies. Because the system is now evolving into that new mousetrap Proctor sees, the fact remains that

the guy hurt on the street or the family in their hour of need doesn’t care how the call comes in, only that help comes along, and fast.

According to the national Association of State nine-One-One Administrators (nASnA), the most common funding mechanism for 9-1-1 is a dedicated surcharge on retail telecommunication charges.

Fees are collected on wireless charges in most areas as well, often at the state level with a distribution mechanism used to funnel funds to local authorities.

In any case, it is next to impossible to know exactly how the collection and mechanisms are adapting because many prepaid plan cell phone users really are getting a free ride.

nASnA reports that the two fastest-growing forms of telecommunications—Internet and prepaid cell phones—pay little or nothing into 9-1-1 funds.

“that should be cause for concern for any agency and any state ,” James Lipinski, emergency services coordinator the the state of vermont, which is a forerunner in adapting emergency services communications to the digital age.

In broad terms, the national 9-1-1 upgrade has a lot of lines and multiple-choice blanks to be filled in by various state and local emergency communications centers. Overall spending on telecommunications is going up because consumers and businesses are purchasing more sophisticated services in greater amounts. However, voice telephone service, the costs that consumers actually pay, is going down. g

Photo illustration by 911 Dispatch Magazine. Source: U.S. Department of Transportation.

see the report at http://hraunfoss.fcc.gov/edocs_public/attachmatch/Doc-310873A1.doc


GREELEy, Colo.—Just before 5 p.m. on a warm day this past March, one of the nine veteran Weld County dispatchers attending Brian Dale’s Emergency Dispatch™ Quality Assur-

ance (ED-Q™) course pushed back from the table and asked no one in particular: “Who talked me into this?”

the group had just finished a somewhat spikey discussion about case review feedback and a short debate of what “obvious” really means. It capped an intense two days spent going deep into quality

improvement, discussing what ED-Q even means in the communica-tions center, how whatever that is is maintained, and who in the heck would want to take on asking the toughest questions inside a center: Why wasn’t this incident handled according to protocol?

Dale, who is the national Academies of Emergency Dispatch® (nAED™®) Accreditation Board chairman, let dispatcher Melody Pax-ton’s question hang as if it were to be the last official word of the class. He kept his right elbow on the lectern and his chin seated in the palm

Don’t Take It PersonallyQuality improvement is all in the deliveryJames Thalman

g Feature | Queuing up the Qs


of his hand. He raised his eyebrows, briefly surveyed the group, and then said: “there’s only one person who can answer that one, and it’s not me.”

Case reviewing is certainly not for every-body, Dale had said repeatedly during the previous two days. But having people who are willing to do it is a must, “and it must be done with fairness, attention, and near-infallibility if a center is to maintain the quality of calltaking and processing the public deserves.”

ED-Qs have to be über-dispatchers in a way. not only do they have to be an individual of exemplary interpersonal and organizational skills, but having traits listed in the Boys Scout’s Law—trustwor-thy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean, and reverent—doesn’t hurt.

In addition, ED-Qs, according to the ED-Q Course Manual, “. . .will need to be patient, tactful, empathetic, compassion-ate, and organized. you need to be able to express your thoughts and feelings in a way that shows your concern for the quality of care received by your agency’s customers, as well as your concern for the well-being and advancement of those tak-ing and processing the calls.”

It goes without saying that ED-Qs must know and show extensive working knowl-edge of the nAED protocols—the standard of care as well as the gold standard for pro-fessional emergency dispatchers. Minimum Q requirements vary slightly. EMD-Qs®, for example, must have Advanced Life Support level medical skills and knowledge. EFD-Qs™ and EPD-Qs™ must have corresponding levels of skill and knowledge in their disci-plines. A three-year commitment to be a Q is also expected.

Each center can take its own unique approach to quality assurance. the peer-to-peer review is how they do it in greeley. veteran dispatchers can take on ED-Q duty for three years or longer and rotate back to the console. Calltaking and processing can be done during the ED-Q commitment, but case review is the primary function. getting more Q in case review was the goal of dispatchers who attended Dale’s class.

Peer-to-peer is the healthiest approach, as long as case reviewers stay professional and don’t get personal, Dale said. A person sitting next to you one day and then in judgment the following day can create a “Who do you think you are?” attitude that must be openly addressed from the beginning, he said.

staying in the gamethe player-coach approach can be much

more effective in raising a call center’s qual-ity level and consistency because of the inherent all-for-one, one-for-all ethic, Dale said. It’s a matter of recognizing strengths as well as weaknesses, a big part of which is to be as detail-oriented in the praise as the evaluators tend to be in pointing out defi-cits, he advised.

“If the objectives are clearly stated and consistently and openly followed in improv-ing performance, the ‘Who do you think you are?’ aspect naturally fades away,” he said.

Just like a calltaker should be person-able but not personal, case evaluations should be the same way.

“Everyone worthy of the job should be open to improving their handling of every call,” Dale said. “good enough to get by is neither good enough nor getting by. If the standard is set, and everybody knows exactly what is expected, and that is maintained as a group, individuals can’t help but improve.”

“that, of course, is the ultimate exam-ple of ‘easier said than done,’” said Heidi gillespie, an ED-Q with the Weld County Law Enforcement Center, at the Q course. “When you take work as personally and as

seriously as dispatchers tend to take their profession, reviewing it becomes pretty personal, too. It’s pretty tricky.”

It doesn’t have to be if everyone knows and tries to show that case evaluations are about reviewing the incident, not about criticizing the individual, Dale emphasized at least a dozen times during the course. “People aren’t robots, and every incident has some obvious elements that are black and white and some are just a lot of gray. And sometimes what seems obvious to one might not be to another, and sometimes even obvi-ous isn’t obvious. But, again, case evaluation isn’t about you.”

those in attendance worked to under-stand the concept.

“But it is about you in a way,” Paxton, as well as others, said not trying to argue but to understand. “you’re looking for ways the dispatcher screwed up. At least that’s what a lot of people think; I know that’s how it feels to me sometimes, even though I try not to take anything personally.”

the subjective objectiveMaintaining quality in the communica-

tions center can be a combination of herd-ing cats and hypnotizing chickens—both


difficult tasks, yet easier than you think. Dale, deputy chief, Administrative Ser-

vices, with the Salt Lake City Fire Depart-ment, took ED-Q down to its essence by showing prompts for quality assurance and public safety every driver knows—speed limit signs.

Showing a slide of the ubiquitous black and white “55” sign, Dale said most driv-ers regard the limit as a “55-ish” suggestion, although they know a highway patrol offi-cer could technically pull them over and give them a ticket for driving 56 mph.

“Most officers won’t stop a driver for going 56; would they be more likely to stop them at 65? Probably, and drivers know it. there’s a tolerance built into the limit, every-body knows it, and traffic seems to keep going smoothly.”

Dale showed his next slide, a speed limit sign with the word “School” above “Speed Limit 20,” and then asked, “Does that mean 20-ish? Would a police officer be likely to notice a driver going 25 mph? Would he or she be ticketed? Probably, and both the driver and the officer would know it was deserved.

“Why?” Dale continued. “Because it’s a shared communal, cultural, and public safety

attitude that it is dangerous for kids to be in the close proximity of cars traveling faster than 20. Certain situations have looser condi-tions and tolerances; in others, the tolerances are very narrow and everybody knows it.”

times used to be such that the tolerance in dispatching was the expectation to say 10-4 at the appropriate time, Dale said. “then they started expecting dispatchers would get help to show up,” he said. “now they expect us—and they won’t tolerate less than—to tell people what to do until help shows up.”

that makes dispatching more difficult by a factor of 12, and the job of keeping the best possible performance and sticking to the protocols roughly twice that, Dale said.

Dale stressed that being a Q is not a matter of knowing the protocols inside and out, nor is it figuring out how to get the best review. “It makes quality an obvious and abiding goal of the PSAP and defining what quality is at the individual center, keeping track of it, and constantly trying to do better,” he said.

Check the local library, or, if your kind of quality includes instant access to infinite bits of information on a subject, google the word. It’s the most popular word in advertis-ing next to the slogan “new and improved.” the pursuit of quality has been both a great motivator for achievement and the dragon doggedly chased but never captured.

Dale believes quality is something to pursue, sought seriously but never quite achieved—not completely. the only defini-tion that works is what a center decides means quality for its region. It must be stated clearly, precisely, and often if people are really going to make any measureable dif-ference in their response time or whatever goal they choose.

It’s not like case review and improving the quality of call intake and processing is some kind of dispatching higher conscious-ness, but yet it kind of is, Dale said. “Just the effort of pursuing is a unifying act,” he said. “It’s what a center does when deciding to have trained and certified dispatchers and structured calltaking.”

Countering intuitionA customer is dependent on the dis-

patcher to provide the quickest help in the most appropriate way for his or her particu-lar set of circumstances. the person calling 9-1-1, unlike customers at a department store, for example, won’t know exactly what she wants, and will be less than able to obtain her own emergency services without a dis-

patcher’s help. there really is nowhere else to take her business.

the same goes for the Q, said Dale, who believes that “the dynamic of quality improve-ment is the singular important issue facing communications centers going forward.”

With that in mind, he offers a list—by no means complete—of guides for quality improvement within individual centers: • the emergency rule applies to the call-

taker as well as to the caller: A person in crisis is not held to the same standard as the person not in crisis.

• the calltaker has to do the call right the first time. Case reviewers do too. Qs should therefore mark their responses the first time through a call. they can lis-ten to the recording multiple times, but be honest enough in the review to note any mistakes the calltaker missed, the first time through the call. Remember, hindsight is 20-20.

• If you’re telling someone he or she did well on a call, don’t say “nice job.” Explain exactly what you liked. “Don’t put a smi-ley face on the report; what are we in kin-dergarten?” Dale asked. Don’t wait for a formal review if you hear about someone who did excellent work. Make a point of saying so immediately.

• the defining attitude is: People who understand the protocols will do their best to follow them; reinforce strengths.

• Avoid freelancing at all levels. If dis-patchers are allowed to do too many things differently because it “just felt like the right thing to do at the time,” a center can’t be sure it is upholding the standards and practices.

• Profanity is Plaintiff’s exhibit “A.” • you are reviewing human beings helping

other human beings in crisis. the situa-tion is fraught with slip-ups and errors. Correct them and commit together to doing better next time.

• Qs shouldn’t go around the call center trying to create “mini-me’s.”

• It’s not about you. It’s not about you. It’s not about you.

• take cases and the work seriously, but not yourself. Don’t create people who hate what they do.

• Dispatchers are willing to have their job performance scrutinized constantly and at random. It’s not a thing to trifle with. g


g universal CDe g PoliCe | MeDiCal CDe

OnTrack

Put in terms of America’s favorite pas-time, summertime heat can be a 9-1-1 call-taker’s knuckleball.

When temperatures hover around three digits, dispatchers deal with children locked in hot cars, heat stroke victims at the local park, neighbors suddenly gone missing, and other summertime situations that make com-ing to the console feel a bit like stepping up to the plate with two strikes against you.

though overexposure to extreme tem-peratures doesn’t usually warrant a 9-1-1 call, the emergency lines still light up with beach bums with severe sunburns and dehydrated hikers who failed to consider nature’s indif-ference toward the lost and overheated.

Dispatchers should bear in mind, though, that high temperatures have a relentless, sap-ping quality that people in poor health or the enfeebled elderly literally can’t tolerate. According to the Centers for Disease Con-trol and Prevention (CDC) public health statistics, hot weather is much harder than cold weather for people with chronic health problems. though hypothermia victims are usually found outside in the winter, exposed to the elements, responders often find hyper-thermia and heat stroke victims within the shelter of their own homes.

Extreme heat indoors may result from a lack of air conditioning, fans, or other venti-lation due to expenses or rolling brownouts (caused by increased demand for electricity). Inhabitants of inner cities may also suffer from the heat by choosing not to open their win-dows for fear of becoming a victim of crime.

handling the heatRecognizing heat-related illness requires a

“good eye,” according to Richard Rusho, a Buf-

falo, new york, paramedic and faculty member with the national Academies of Emergency Dispatch® (nAED™). An overheated patient’s condition may be ambiguously described, he said, noting that heat stroke and its temporary side effects can all appear to occur at once.

However, the appearance of an over-

heated patient is not a reliable measure of severity. Heat exhaustion—a non-life-threatening problem with “flu-like” symp-toms including paleness, sweating, nausea, and vomiting—can seem far more severe to a caller than the potentially life-threat-ening condition of heat stroke with less obvious symptoms of red, dry skin and decreasing consciousness.

Fortunately dispatchers need not rely on appearance to identify the problem. Using the Medical Priority Dispatch Sys-tem™ (MPDS®), the calltaker uses the caller’s complaint description to choose the best Chief Complaint Protocol to care for the patient. Most heat stroke or heat exhaus-tion patients are handled on Protocol 20: Heat/Cold Exposure, but more specific complaints may be handled on Protocol 6: Breathing Problems, Protocol 7: Burns (Scalds)/Explosion (Blast), Protocol 18: Headache, or possibly Protocol 26: Sick Per-son (Specific Diagnosis).

Each protocol provides a specific interrogation to evaluate the patient’s symptoms while considering other possi-bilities. As stated on Protocol 20, Axiom 1, “Because a patient has a problem in a hot or cold environment does not mean the problem was caused by the environment.

Heat or cold extremes may trigger other medical problems.”

Built-in shunts act as a safety net to direct the calltaker to a different protocol if priority symptoms such as chest pain or loss of consciousness are discovered upon further interrogation.

take, for instance, 58-year-old long-haul trucker Jack Barney waiting for his paper-work and the abiding sticker shock that comes whenever he buys 100 or so gallons of diesel. He stands in the mid-August heat in the middle of the fuel-blotted tarmac of the truck stop—the one near the Will Rog-ers turnpike—waiting to get back to Okla-homa. Suddenly Barney feels weak in the knees and eventually passes out. A nearby trucker calls 9-1-1.

“they brought me around by getting me back inside and getting water in me,” Bar-ney said. “It was nothing serious, except the embarrassment of just keeling over doing a thing I do a thousand times a year.”

No Sweat Handling heat and hyperthermia

g universalCde

By James Thalman

Inhabitants of inner cities may also suffer from the heat by choosing not to open their windows for fear of becoming a victim of crime.


However “nothing serious” could have easily been a heart attack.

Priority symptoms, when presented in a patient exposed to extreme heat, may or may not be related to heat stroke or heat exhaustion.

A symptom of severe but dissipating nausea, as described by a patient or caller, could be caused by an amusement park ride, a severe lack of hydration, or the body’s cooling system trying to keep core temperatures under control; it might be a sign of a heart attack. A headache could be just a headache, or it could be the manifes-tation of a stroke.

“the dispatcher’s job, as always, is to find out definitively, then move on,” Rusho said. “these are calls when saying ‘Okay, tell me exactly what happened’ might have to be repeated a few times.”

heat and the back seatSummer also means that a surprising

number of children, most without any prior health trouble, will be seriously injured or even killed after being left in a parked vehi-cle in broad daylight. the CDC reports that between 1998 and 2011, at least 500 children in the United States died after being left inside cars, some of which got hot enough

to bake cookies in before their caregivers returned. Opening windows has almost no effect because much of the heat radiates off seats and dashboards.

Child vehicle deaths frequently occur on days with afternoon temperatures in the mid-70s. this may be because caregiv-ers falsely assume that the relatively mild temperatures are not a threat to the child if she or he is left for “just a few minutes.” However, the Police Priority Dispatch Sys-tem™ (PPDS®) classifies a child intentionally left in a vehicle without appropriate supervi-sion to be neglect, as defined on Protocol 102: Abuse/Abandonment/neglect.


though this classification may seem hard to a well-meaning parent trying to run a quick errand, this scenario can be deadly. A curious child may unintentionally shift the vehicle into gear, an unnoticed child may be abducted in a vehicle theft, or, most fre-quently, a child left inside a vehicle can suf-fer hyperthermia, even on mild days, as the glass-enclosed space amplifies the light and heat from the sun.

the hotter the temperature is outside, the faster the car’s interior temperature rises, which is even worse for a child whose body temperature rises three to five times faster than an adult due to smaller body size.

the Fire Priority Dispatch System™ (FPDS®) cites the following statistics on Pro-tocol 53: Citizen Assist/Service Call:

When the outside temperature is 83° F (28° C) and the car window is down 2 inches (5 cm), the temperature inside the car can exceed 109° F (43° C) in 15 minutes. When the outside temperature is 93° F (34° C) and the car window is down 1 1/2® inches (4 cm), the temperature inside the car can still reach 125° F (52° C) in just 20 minutes, and approximately 140° F (60° C) in 40 minutes.

the color of the car’s interior can also make a difference in interior temperature—darker colors (black, blue, green) absorb more heat than lighter colors (red, white).

According to forensics meteorologist and researcher Jan null of the golden gate Weather Services, who is arguably the most vigilant tracker of child deaths inside vehicles in the country, 33 children died from hyper-thermia in 2011. With warmer weather show-ing up ahead of schedule this spring, the annual tally is probably headed for a spike in 2012.

null said from 1998 to mid-2012, 529 chil-dren died from hyperthermia in parked cars; their ages ranged from 5 days old to 14 years old. Most of the deaths (253 or 52%) were the result of a caregiver forgetting the child was in the car (perhaps due to placement in the backseat), according to null’s latest report. there were 150 children (30%) who were playing in an unattended vehicle when they were overcome by heat, and 86 (17%) of the deaths occurred when an adult intentionally left a child in the car, most often to run an errand that took more time than she or he planned. Circumstances surrounding five of the deaths couldn’t be verified.

the dispatcher’s role may vary in han-dling these situations from reporting neglect from a passerby who notices an unsupervised child left in a vehicle (PPDS Protocol 102), to giving medical instructions to a distraught parent who finds his child has been playing inside a hot car and is now losing conscious-ness (MPDS Protocol 20).

A distracted caregiver may also find that she has unintentionally locked her keys in the car with her toddler inside. In this case,

a dispatcher may refer to FPDS Protocol 53: Citizen Assist/Service Call to send respond-ers (53-B-1) to quickly get inside the locked vehicle to prevent heat-related illness.

From the dispatching console, the rule of thumb when people call 9-1-1 because they’re too dry, too hot, too burned, or too pooped from the heat to know what to do is this: Sick-ness due to heat exposure is rarely life-threat-ening or even serious. A few, particularly heat stroke, can be deadly. the dictates of the proto-cols provide several correct, go-to options that permit the calltaker to be confident handling the gamut of presenting symptoms. It might take a little more attention to get to the trigger detail. Just get there, code it, and move on. g

Sources1 “Extreme Heat: A Prevention guide to Promote your

Personal Health and Safety.” Centers for Disease Control and Prevention. Emergency Preparedness and Response. http://www.bt.cdc.gov/disasters/extremeheat/heat_guide.asp (accessed June 11, 2012).

2 Sheppard K. “Climate Change Will More than triple Annual U.S. Heat Death toll.” Mother Jones. 2012; May 24. http://www.motherjones.com/blue-marble/2012/05/are-we-ready-killer-heat (accessed June 11, 2012).

3 See note 14 null, J, CCM. “Hyperthermia Deaths of Children in

vehicles.” Department of geosciences, San Francisco State University. 2012; May 29. http://ggweather.com/heat/ (accessed June 11, 2012).

5 See note 46 See note 47 See note 4

Minutes

Outside Temperature

10 20 30

80°

40 50 60

99° 109° 114° 118° 120° 123°


Answers to the CDE quiz are found in the article “No Sweat,” which starts on page 28. Take this quiz for 1.0 CDE unit.

1. Extreme heat indoors may result from:

a. a lack of air conditioning, fans, or other ventilation.b. expenses (of cooling/ventilation systems).c. rolling brownouts caused by increased demand for electricity.d. all of the above

2. heat stroke is a non-life-threatening problem with “flu-like” symptoms including paleness, sweating, nausea, and vomiting.

a. trueb. false

3. Most heat stroke or heat exhaustion patients are handled on:

a. Protocol 20: heat/Cold Exposure.b. Protocol 6: Breathing Problems.c. Protocol 7: Burns (Scalds)/Explosion (Blast).d. Protocol 18: headache.

4. Because a patient has a problem in a hot or cold environment does not mean the problem was caused by the environment.

a. trueb. false

5. The Centers for Disease Control and Prevention reports that between 1998 and 2011, at least ________ children in the United States died after being left inside cars.

a. 200b. 300c. 500d. 700

6. The Police Priority Dispatch System (PPDS) classifies a child intentionally left in a vehicle without appropriate supervision to be ____________, as defined on Protocol 102: Abuse/Abandonment/Neglect.

a. abuseb. abandonmentc. neglectd. at risk

7. A child’s body temperature rises two to three times faster than an adult due to smaller body size.

a. trueb. false

8. When the outside temperature is 93° F (34° C) and the car window is down 1½ inches (4 cm), the temperature inside the car can still reach ______________ in just 20 minutes, and approximately ______________ in 40 minutes.

a. 105° F (40° C); 120° F (49° C)b. 115° F (46° C); 130° F (54° C)c. 125° F (52° C); 140° F (60° C)d. 135° F (57° C); 150° F (65° C)

9. According to forensics meteorologist and researcher Jan Null of the golden gate Weather Services, how many children died from hyperthermia in 2011?

a. 28b. 33c. 38d. 42

10. Also according to Null’s latest report, most child hyperthermia deaths were the result of a caregiver forgetting the child was in the car.

a. trueb. false

$

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clip and mail your completed answer sheet along with the $5 non-reFUnDABle processing fee to:

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Rub-A-Dub-Dub these bath salts aren’t meant for the tub

“Ivory Wave,” “vanilla Sky,” and “Ocean Snow” may sound like the names for crystals sprinkled into your bath to create a calming and therapeutic effect.

But they’re everything but soothing.to avoid detection, the names, espous-

ing toiletries, are street slang for the so-called designer drug known as “bath salts.” Accord-ing to limited domestic and European law enforcement reports, bath salts are synthe-sized primarily in foreign countries—including China, India, and Pakistan—and labeled “not for human consumption” to evade U.S. Food and Drug Administration (FDA) scrutiny.

When bath salts were first introduced into the U.S., packets of 50 to 500 milligrams of the synthetic powder were sold in convenience stores, gas station mini-markets, smoke shops, tattoo parlors, and over the Internet. Prices for a tenth of a gram started at about $15, which made the drug a cheap—and, at the time, legal—alternative to the methamphetamine and cocaine drugs they mimic.

Considering the relatively recent arrival of bath salts to the U.S., little is known about their short- and long-term effects. Recounted stories of bath salt abuse, however, are less than comforting.

In March 2012, an Oneida County sher-iff arrested a suspect who was allegedly high on bath salts. the suspect was wearing only pajama bottoms, jumping in front of a pass-ing car, and fighting off deputies in his pur-suit. In April, Stroudsburg, Pa., police arrested a man who, while high on bath salts, forced his way into his neighbor’s home, barricaded himself in a playroom, and stabbed a samurai sword through a closet door.

According to Drug Recognition Expert thomas Reagan, of the Bangor (Maine) Police Department, these reactions are common to bath salt users who frequently attempt to flee from someone or something frightening and unknown, often while wearing little to no clothing. Dispatchers may identify potential use of bath salts from descriptions of “flight,” attempts to escape a non-existent threat, and lack of clothing (body temperature spikes).

“I ask dispatchers what they would think about a caller saying there is someone bang-ing on his roof at five in the morning,” said Reagan, who has given over 70 talks on bath salts during the past 14 months in both Maine and Canada. “It’s the paranoia bath salts can cause. In this case, the guy on the roof was trying to escape what he believed to be people in his yard that were after him. Of course, there was nobody in the yard.”

Doctors talk about ER patients on days-long hallucinogenic highs similar to the effects of LSD. Sometimes, people abusing bath salts become so violent, much like PCP users, that physical restraints are required. On Jan. 11, the Medical Examiner’s Office in Bangor reported the first confirmed case of death associated with bath salts. During January and February of 2012,

the Sullivan County (va.) Sheriff’s Depart-ment responded to 13 bath-salt-related cases and reported two deaths also attributed to the drug.

Chemical ingredientsAccording to the national Institute on

Drug Abuse (nIDA), the chemicals used in the manufacture of bath salts present a high risk for overdose, abuse, and addiction. While the exact composition differs among the vari-ous brands, bath salts often contain various hallucinogenic and amphetamine-like chemi-cals described below:1

• Methylenedioxypyrovalerone (MDPv) is a psychoactive drug with no record of FDA-approved medical use; its effects mimic cocaine and amphetamines

g POliCe|MediCalCde

By Audrey Fraizer


• Mephedrone presents a high risk for overdose according to reports from the United Kingdom

• Pyrovalerone is a psychoactive drug that causes changes to perception, mood, con-sciousness, cognition, and behavior, which also presents a high abuse and addiction liability

• Cathinone is chemically similar to amphetamines and induces the release of dopamine, which gives the user a euphoric feeling

• Flephedrone is a stimulant drug known to cause hyperthermia and convulsions in an overdose

Sometimes the key ingredients are cut (mixed) with an inactive powder such as bak-

ing soda, pancake batter, water softener, or baby laxatives. Because of their initially inex-pensive street price, the first available bath salts were less likely to be cut unless they were cut with a more potent drug such as lower quality cocaine; however, some decrease in availability (due to legal banning) has led drug dealers to add filler ingredients to decrease the quality while maintaining demand.

Beyond the lures of a cheap and still avail-able drug, bath salts offer further appeal in that routine drug tests do not detect the synthetic stimulants used in their production, which is a popular aspect among people required to undergo routine drug testing. However, labs are beginning to develop quantitative testing for bath salts’ key ingredients using blood, urine, and serum/plasma samples. In March, Randox

toxicology released two ELISA kits for the forensic detection of bath salts, and, late last year, forensic product companies began making portable bath salts drug test kits that police can use on patrol. the tests can detect mephedrone and MDPv in suspected bath salt samples.2

Medical effectsBath salts are linked to an alarming

increase in the number of ER visits across the country; however, the best approach to treatment remains uncertain because of the drug’s limited time on the market and the non standard mix of ingredients used in its production. From January to november 2011, the American Association of Poison Control Centers reported 5,853 calls related to bath salt exposure, a dramatic increase from 303 calls in 2010. Early bath salts users were reported to be an average age of 35 and most were admitted long-term addicts; recent statistics, however, indicate that the average user’s age is declining into the 20s, although the drug isn’t consid-ered a gateway drug to other addictive drugs.

“Like most designer drugs, they’re working their way down to younger users,” Reagan said.

the attraction to bath salts may be due to the desirable psychological effects users describe including increased energy and awareness and extreme euphoria. But the same mixture of ingredients can induce acute side effects such as agitation, anxiety, and delusions. Excessive cathinone usage, for example, can cause loss of appetite, anxiety, irritability, insomnia, hallucinations, and panic attacks. MDPv puts the user at risk for insomnia, nausea, increased body tem-perature, ringing ears, severe paranoia, breath-ing difficulties, and suicidal actions. Chronic abuse of bath salts can also result in personal-ity disorders and myocardial infarction.3

Physical signs that indicate a person may be using bath salts include: sweating, thirst, jerking body movements, grinding of teeth, and sudden violence with little or no warn-ing. Bath salts can cause severe agitation last-ing up to five days. the initial “high” often lasts for hours, but the resulting psychosis can last for hours to days or even longer. the faces of longtime bath salts users also appear drawn—hence the “Monkey dust” street name for the drug in the Bangor area.4


Chemical banCiting an “imminent threat to public

safety,” the U.S. Drug Enforcement Admin-istration (DEA) legally banned possession or sale of any product containing mephedrone, MDPv, and methylone. the ban, issued in October 2011, is effective for at least a year. During that time, the DEA will decide whether to issue a permanent ban.

the American Medical Association (AMA) supports national legislation to ban bath salts, and more than 35 states and the U.K. have implemented bans on the chemi-cals used to make the drug.

In February 2011, Arizona gov. Jan Brewer signed a bill that bans seven primary chemicals in bath salt drugs. In new Jersey, the manufacture, distribution, sale, or posses-sion of the banned chemicals is a third-degree offense; violators may be subject to a fine of up to $25,000 and imprisonment for a three- to five-year term. Maine recently passed its second law in April 2012, adding a ban of all cathinones to the state’s existing ban on the primary chemicals in bath salts.

Despite the bans, bath salts are hardly dif-ficult to find. Manufacturers simply tweak their formulas to modified versions of the old chemicals not specifically prohibited by law. Close to 50 analogs and derivatives can be formulated to produce bath salts. An Internet-based bath salt supplier offers a full refund for products that turn out to be “out-lawed in your area.” Overnight delivery can be arranged.

As with ecstasy and methamphetamine, bath salts are the next variety of street drugs whether snorted, smoked, or injected for achieving a cheap high.

“Bath salts are just the latest in the line of mind-altering crap we find on the streets,” Reagan said. “they’ll disappear and then a new drug will come along to take their place.”

Protocol and bath saltsBehavior stemming from the use of bath

salts is similar to the use of other illicit drugs or intoxication: unpredictable.

“these types of drugs put police officers in dangerous situations,” Reagan said. “Some users experiencing paranoia might want police protection from whatever they think is after them. Others might react violently to police. Response doesn’t always know.”

If an emergency situation appears to involve the use of bath salts, Reagan recom-mends sending both EMS and law enforce-ment to the scene. Depending on how impaired the person is, the officer will decide

whether EMS should take the patient to the hospital or if police will transport the indi-vidual to jail. In Maine, a zero-tolerance law results in jail time or a summons for any indi-vidual found to be using bath salts.

On the EMS side, Reagan recommends that dispatchers go by signs and symptoms rather than delay the response to determine the reason for the medical situation.

“If the individual is in a serious or threat-ening situation, it doesn’t matter what’s caus-ing the problem,” he said.

the most difficult situations involve callers who are unable to relay information because of a drug’s effects or who are unwill-ing to reveal details due to possible legal con-sequences. As stated in the Medical Priority Dispatch System™ (MPDS®), “Because overdose patients have a motive for their actions, they are frequently misleading about the time, amount, or type of drug taken.” the calltaker

may not find the patient or caller to be coop-erative when illegal drugs are involved.

A 9-1-1 medical call specific to bath salts poisoning or overdose falls under MPDS Pro-tocol 23: Overdose/Poisoning (Ingestion). While the ingestion of the drug could be clas-sified as either a poisoning (accidental intake of a potentially harmful substance) or an overdose (intentional intake of a potentially harmful substance), the dispatch response is based upon the patient’s condition.

Serious clinical consequences, such as drug-induced heart attacks and strokes, require ALS care. A DELtA-level code should be sent for a patient who is unconscious or who is changing colors of clinical significance (only ashen/gray, blue/cyanotic/purple, or mottled). A CHARLIE-level code should be sent for a patient who is not alert, breathing abnormally, or who has taken antidepressants (tricyclic), cocaine, methamphetamine (or derivatives, such as bath salts), narcotics (her-oin), or an acid or alkali (lye). A BRAvO-level code is sent for a patient who has overdosed but does not present priority symptoms.

After initiating dispatch, the EMD must provide Pre-Arrival Instructions (PAIs) to begin CPR for patients who are not alert and showing signs of ineffective breathing or who are unconscious.

In the situation of a violent patient, the EMD adds the suffix “v” to the Determi-nant Code for “violent or combative.” the “notify Police” symbol on Key Question 2, “Is s/he violent?” reinforces that law enforcement should also be notified and may be sent in conjunction with EMS as a safety measure when responding to vio-lent or combative patients. Since violence can escalate at any time, dispatchers should refer to applicable law enforcement proto-col, if available.

the Police Priority Dispatch System™ (PPDS®) handles drug situations on Protocol 116: Drugs; the questions on this protocol address weapons involvement (with vari-

ous suffixes to delineate the specific type of weapon), caller and bystander safety, location of the drugs, suspect description and loca-tion, and vehicle description (if applicable). Determinant Codes on this Chief Complaint Protocol address the use, possession, or sale of drugs, which merits a DELtA-level code while finding drugs or paraphernalia requires a BRAvO-level code. g

Sources1 nora D. volkow, M.D., Director, national Institute on Drug

Abuse. “‘Bath Salts’ – Emerging and Dangerous Products.” 2011; February. http://www.drugabuse.gov/about-nida/directors-page/messages-director/2011/02/bath-salts-emerg-ing-dangerous-products (accessed April 9, 2012).

2 nok-noi Ricker, Bangor police order test kits to identify bath salts, Bangor Daily News. 2011; 11 Dec. http://bangordaily-news.com/2011/12/09/news/police-beat/bangor-police-order-test-kits-to-identify-bath-salts/ (accessed April 11, 2012).

3 “getting the Facts about Bath Salts,” Penobscot valley Hospi-tal, Lincoln, Maine. http://www.pvhme.org/pvh.nsf/view/gettingtheFactsaboutBathSalts (accessed April 6, 2012).

4 “A year of bath salts in Maine; users getting younger,” Bangor Daily News. 2012; 11 April. http://bangordailynews.com/2012/01/02/news/bangor/a-year-of-bath-salts-in-maine-users-getting-younger/ (accessed April 11, 2012).

A 9-1-1 medical call specific to bath salts poisoning or overdose falls under MPDS Protocol 23: Overdose/Poisoning (Ingestion).


Answers to the CDE quiz are found in the article “rub-A-Dub-Dub,” which starts on page 32. Take this quiz for 1.0 CDE unit.

1. The designer drug known as bath salts are made from:

a. epsom salts.b. dried flowers and herbs.c. hallucinogenic and amphetamine-like chemicals.d. sea and table salts.

2. The effects of which of the following drugs mimic cocaine and amphetamines?

a. Methylenedioxypyrovalerone (MDPv)b. Mephedronec. Pyrovaleroned. Flephedrone

3. routine drug tests do not detect the synthetic stimulants used in the production of bath salts.

a. trueb. false

4. The American Association of Poison Control Centers reported a dramatic decrease in calls related to bath salt exposure in 2011 compared to 2010.

a. trueb. false

5. in October 2011, the U.S. Drug Enforcement Administration (DEA) legally banned possession or sale of any product containing:

a. epsom salts.b. baking soda.c. mephedrone, MDPv, and methylone.d. caffeine.

6. A 9-1-1 medical call specific to bath salts poisonings or overdoses falls under:

a. Protocol 2: Allergies (reactions)/Envenomations (Stings, Bites).b. Protocol 9: Cardiac or respiratory Arrest/Death.c. Protocol 23: Overdose/Poisoning (ingestion).d. Protocol 25: Psychiatric/Abnormal Behavior/Suicide Attempt.

7. A poisoning is defined as an accidental intake of a potentially harmful substance, and an overdose is defined as an intentional intake of a potentially harmful substance.

a. trueb. false

8. A DElTA-level code should be sent for a patient who is changing colors of clinical significance such as:

a. ashen/gray.b. pink.c. pale.d. red.

9. The EMD must add which of the following suffixes for a violent or combative patient?

a. Wb. ic. Ad. v

10. The PPDS Protocol specific to drugs is:

a. Protocol 107: Assist Other Agencies.b. Protocol 111: Damage/vandalism/Mischief.c. Protocol 113: Disturbance/Nuisance.d. Protocol 116: Drugs.

$

expires 08/30/13

To be considered for CDE credit, this answer sheet must be received no later than 08/30/13. A passing score is worth 1.0 CDE unit toward fulfillment of the Academy’s CDE requirements. Please mark your responses on the answer sheet located at right and mail it in with your processing fee to receive credit. Please retain your CDE letter for future reference.

CDE Quiz Mail-In Answer SheetAnswer the test questions on this form. (A photocopied answer sheet is acceptable, but your answers must be original.) We Will not Process AltereD sizes.

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g DisPatCh in aCtion g DisPatCh Frontline g oFF hours

YourSpaceDog Day Evening Protocol applies to more than just people

g disPatChinaCtiOn

light at the end of the tunnel A Springer spaniel named Joe rides to the surface of a 50-foot deep sinkhole attached to a har-ness worn by his rescuer Roger M. Clemmons, DVM.

A Springer spaniel named Joe was likely enjoying his early evening romp of amazing smells at Jonesville Park in gainesville, Fla., when quite by accident he triggered a response focusing on the flexibility of Fire Protocol.

“they [Joe and his owner] were out walk-ing and Joe disappeared down a hole,” said EMD Shanteria Whitehead, of the Alachua County (Fla.) Sheriff’s Department. “the owner was frantic.”

Whitehead, who had been at the job for about 15 months, coded the call as an ani-mal problem, although the call—the first of its kind made to the Alachua County Sher-

iff’s Department—was later upgraded to an entrapment, alerting the fire department that its assistance was needed. Joe had plunged 50 feet into darkness and there was no luring him out of the hole by waving teriyaki jerky to stimulate a four-paw power climb. Joe was up against a relatively smooth limestone wall.

“the fire department contacted the rescue team and one of its vets went down the hole for the rescue,” Whitehead said. “Joe was fine.”

this was no ordinary vet meeting in company with Alachua County firefighters. Roger M. Clemmons, DvM, is specifically trained to rescue and treat animals in situ-

ations gone awry. He was among the team coming to the aid of a trail horse named Mid-night bogged down in mud during a Decem-ber 2011 ride. He was also the vet lowered down a 35-foot sinkhole to rescue two cows and a 15-foot well to rescue a stranded calf.

“I said ‘Moo’ and the calf gave a ‘Moo’ back,” Clemmons said. “the calf actually did very well on its way out.”

While the calf needed light sedation to attach the harness and steady the roped ascent, the 60-pound Joe was good to go without the syringe.

Clemmons said Joe was “a nice dog,” and seemed to understand the submissive atti-tude necessary to get him out of the deep mess he had accidentally created. Joe was fitted into the harness and clipped into an “O” ring fixed on the harness Clemmons was wearing. Firefighters and the University of Florida Animal technical Rescue team, all trained in technical rescue, pulled Joe and Clemmons to the surface using a technical rope rescue system.

“Joe acted like he knew what he was doing,” Clemmons said. “that and having a great team around me made my job a lot easier.”

Joe came through with only a few tender spots resulting from the fall, a temporary loss of appetite—he snubbed the chicken nuggets Clemmons brought along for the ride—and with, perhaps, a better appreciation to watch the ground he’s sniffing. the park district filled the hole the same evening, which in a way is a credit to Joe’s roving instincts.

“It’s lucky Joe found the hole for us and not a child,” said Clemmons, a veterinarian for the veterinary Emergency treatment Service (vEtS), developed by the University of Flor-ida, College of veterinary Medicine (CvM).

Clemmons is an animal lover. He is an associate professor for the Department of Small Animal Clinical Sciences at the Uni-


One For All Dispatcher accepts award for heroes everywhere

versity of Florida, specializing in small animal neurosurgery, and would drop just about anything to aid an animal in crisis.

“I was home working on income taxes when I took the call about Joe,” he said. “We didn’t have much time since it was heading toward dark, but Joe was still moving.”

Clemmons’ first call for rescue occurred eight years earlier and from CvM Director of Medical/Health Administration John Haven, who was in charge of deploying a patient (animal) care team in response to Hurricane Charley.

“We set up a MASH-type hospital and volunteers treated animals people brought in from the storm,” Clemmons said.

After Charley, came Frances and then Jeanne. the results of their animal disaster response during that one hurricane season so impressed the Florida veterinary Medi-cal Association and the Florida Department of Agriculture and Consumer Services that Haven added a new calling to his card.

“We had done such a good job winging it, we were given the job,” said Haven, a CPA with a professional administrative background.

During the past eight years, vEtS has grown into one of the largest non-federal animal disaster response teams in the United States, providing self-contained vet-erinary care triage for predominantly small animals and advanced technical rescue for large animals. Funded through grants and donations, vEtS can deploy up to 17 people in response to local and national disasters and operates a fully-equipped mobile vet-erinarian’s office, three pick-up trucks, and two equipment trailers.

the team is a core component of the State Agricultural Response team and can be deployed to other states during a Fed-eral Declaration.

vEtS volunteers take technical courses geared for human rescue and adapt the strategies to animal rescue. they’ve trained members of similar organizations and Haven was recently appointed chair of a task group drafting an animal rescue standard for the national Fire Protection Association (nFPA).

“that’s what I get for going to the meet-ing,” Haven said. “Seriously, vEtS has been a lot of extra work, but tremendously reward-ing. It’s a good buzz handing back to owners an animal we’ve rescued.”

And don’t think that Joe’s rescue was the last thought EMD Whitehead’s given to dogs.

“I want a yorkshire terrier,” Whitehead said. “I’ve been looking at the newspaper ads because I really want a dog now.” g

When Karen Clark received the Res-cue Professional award from the Amer-ican Red Cross Santa Cruz County Chapter, she said she really did it for the profession.

the Santa Cruz (Calif.) Consolidated Communications Center dispatcher II doesn’t take credit for the good outcome on a call she handled on July 27, 2011, fall-ing back on her training and the actions of the caller on scene.

“I have to give so much credit to this citizen,” Clark said. “I think she deserves a lion’s share of the credit. She was every-thing you want in a caller. She was the hero in the situation.”

the caller was attending a conference in Mount Hermon when she passed a three-year-old girl who was unconscious and not breathing. Seeing the mother was too distraught to take action, the caller did.

“She said the girl had a marble stuck in her mouth and was turning blue,” Clark said. “She was very calm when she called and I didn’t realize that the child hadn’t been breathing for three minutes.”

After initiating dispatch during Case Entry, Clark continued to gather informa-tion from the caller and then instructed her on how to perform the head tilt and start mouth-to-mouth, according to CPR Pre-Arrival Instructions (PAIs). the situ-ation took a turn for the better partway

through the call—before they reached chest compression instructions.

“I guess the child must have swallowed the marble,” Clark said. “I was surprised when the woman told me the girl was breathing. I was very happy.”

A c o m p l e t e l y d i f f e r e n t s c e n e than described by the caller awaited response, which arrived eight minutes after initial dispatch.

“She said she’s fine,” Clark said. “She’s sitting up. She’s talking. It was just a won-derful miracle. It was a great feeling to know that the training I received worked. Often we don’t get the happy ending. It was a wonderful outcome.”

Administrative Supervisor Marsha MillerAyers nominated Clark for the award after finding out about the success-ful outcome.

“One of the fire captains called later and said the instructions we gave were perfect,” MillerAyers said. “We definitely saved her life. It was one of those high-priority, low-frequency events. the fact that we were successful with it, we were really pleased.”

Even when calls don’t turn out as well as this one did, Clark enjoys the job; it was a change she made 13 years ago after spending 21 years as a newspaper reporter.

“I like the fast-paced nature of it,” she said. “there’s something new every day. We do make a difference more often than we realize.” g

humble hero Dispatcher Karen Clark provided CPR instructions to a bystander calling for an unconscious and not breathing three-year-old girl. The girl survived and Clark gives a lion’s share of the credit to the caller.


In The Area Rushing into burning building wasn’t part of his new job description

Phone lines went berserk at newark (n.J.) Mayor Cory Booker’s office for days following his on-the-way-to-the-office res-cue of a 47-year-old woman trapped inside a burning building.

But like many elevated to hero status, the 42-year-old Booker downplayed the event and cordially thanked newfound admirers for offers ranging from an edible fruit basket arrangement to suggestions he campaign for new Jersey state governor.

“I didn’t feel bravery—I felt terror,” said

Booker, whose suit coat was burnt by the flames. “I didn’t feel too heroic. . .It happened very quickly.”

A similar story in Colorado garnered far less press, but the hero of our story—like the mayor—can still credit himself a fire rescue absent protective turnout gear, a helmet, or a self-contained breathing apparatus.

“that’s what crossed my mind after I was outside the building,” said yon nunez, assis-tant fire marshal for West Metro Fire Rescue in Lakewood, Colo. “I lacked gear.”

granted, nunez’s 20 active years in fire-fighting gave him the edge compared to a mayor with an equivalent number of years of political experience. But the risks were no less life threatening. A year earlier, nunez had transferred to the Life Safety/Fire Pre-vention Bureau. He now wears a duty uni-form and drives a car to inspect fire alarms.

“not everyone is a lights-and-siren guy,” he said.

On April 21, 2011, nunez was driving to an inspection when a call came in over his portable service radio. there was a structure fire with potential parties trapped close to his route. nunez drove to the scene, parked his car against the opposite curb, and ran into the house after radioing West Metro Fire communications of his plans to help a woman standing in a smoke-filled hallway.

“He told us he was going in, and that was his choice,” said Megan Reyes, who was the supervisor on duty that morning. “We sent fire and medical units.”

nunez did a grab and go, cradling the startled woman like a bride across the thresh-old. He took her down the porch stairs, car-ried her to the car, and grabbed an oxygen tank from an engine that had just pulled up. An ambulance transported the 85-year-old woman to the hospital.

“She had just been in the hospital for pneumonia,” nunez said. “She would have never made it down the stairs alone.”

the incident might have gone unno-ticed if a former field paramedic student of nunez’s hadn’t caught wind of the res-cue. now a West Metro lieutenant, he and another lieutenant nominated nunez for Colorado’s Red Cross Professional Rescuer Award, which nunez received at the 2012 Breakfast of Champions and Award Cer-emony held on March 15, 2012, in Denver.

nunez said this rescue was more poi-gnant than others from his firefighting days. But that doesn’t mean he’s feeling any more heroic.

“that’s our job,” he said. “We risk a lot to save a lot. I did nothing different than anyone else in the department would have done.” g

g disPatChFrOntline

going in Yon Nunez didn’t wait for fire rescue gear before rushing into a burning building to save an 85-year-old woman trapped inside.


Christian Millette really thought he could dance. Apparently the 29-year-old ballroom dancer and dispatcher for groupe Alerte Santé in Longueuil, Quebec, Canada, wasn’t the only one.

When Season 4 of So You Think You Can Dance Canada (SYTYCDC) aired its finale in September 2011, Millette finished strong in fourth place beating out 18 other dancers also chosen for the show after auditioning.

“It was really, really fun,” Millette said. “We were like one big family. I was not expecting to be in the finals. I was compet-ing against 19- and 20-year-olds. It helped me with my confidence.”

t h e c o m p e t i t i o n w a s 7 5 d a y s i n toronto, Canada, spent at a grueling pace—near the end of the show Millette said they spent 16 hours a day in training from trying on costumes, traveling to practice, going to the gym, checking out music, and dancing for up to eight hours with styles ranging from ballroom, to hip hop, to Bol-lywood, to Latin, to jazz.

“I had a lot of time to concentrate on my dancing,” Millette said. “the last week I was sleeping only three to four hours a night. I didn’t have time to sleep. It was a really good experience to see what your body can handle.”

Ballroom dancing is in his blood and his positive attitude and focus on dancing have taken him far—not only on the show but since Millette started competing at a young age. growing up, dancing was as natural as walking with Millette learning moves at two years old.

“My parents are ballroom dancers as well,” he said. “I did my first ballroom competition at four years old.”

For years, Millette was coached by his dad (Alain Millette, president of the Canadian Dance & Dance Sport Council). Placing third in the under 12 category at Millette’s first competition cemented his love of dancing.

Since then his long list of accomplish-ments include placing sixth at the World 10 Dance Championship 2011, having a walk

on part in Shall We Dance, being a dancer at Epcot at Walt Disney World in Orlando, Fla., and dancing for Bulgaria (birthplace of his current dance partner Denitsa Ikonomova—she finished in the top 8 on SYTYCDC) beginning in 2009.

Despite the demanding pace of travel and competition, Millette teaches dance; he enjoys dispatching for groupe Alerte Santé, a job he fell into 10 years ago while working on a project for a computer sci-ence class he was taking. the center was

hiring and Millette applied. “(the job) is always different,” he said.

“I like helping people through their bad moments. I like the people I work with.”

Millette said connecting with people is common in dance performance, although no words are necessary.

“It’s all about the movement and the music and how you can express yourself,” he said. “I used to be really shy and quiet. you’re putting something else on the floor to show what you can do.” g

Dance Off Dispatcher’s talent and passion score him fourth-place finish in tv show competition

g OFFhOurs

he’s got the Moves Dispatcher Christian Millette has come a long way since his first ballroom dance competition at age four. He and his dance partner Denitsa Ikonomova have a long list of accomplishments including dancing for Bulgaria.


Peak Behavior timely tips can push morale over the topAudrey Fraizer

g navigatOrrewind

A dispatch center is a conglomeration of strong personalities, all under stress at least part of the shift, and

expected to work together harmoniously and take turns baking brownies for everyone on staff, including management.

no one is crabby, preoccupied because of personal issues, or disgruntled because the working conditions are ideal and the pay and benefits are tops. Members of ad hoc commit-tees are always representative of everyone’s concerns and no rules are made without full and total agreement.

If you nodded “yes” to all of the claims in the previous paragraph, your manager is standing behind you while you’re read-ing The Journal. While most centers might

include an objective to create and maintain an “employee friendly” atmosphere, the odds are seldom in their favor.

“We want our dispatchers to have a good day, but that doesn’t always happen,” said Leslie Whitham, instructor, Public Safety training Consultants (PStC). “We get a little cynical and a little distracted. there comes a time for all of us when we need to refocus on what it is we’re supposed to be doing every time we come into work.”

Whitham was among several speakers at navigator 2012, held during the third week of April in Baltimore, Md., to explore the cus-tomer service side of emergency dispatch and dismiss notions of “if it’s broke, you can’t fix it.” the pre-conference workshop—the Spirit

to Serve—drew nearly a dozen dispatchers, supervisors, and training specialists interested in resolving negativity in the workplace.

Attitude has a snowball effect, Whitham said.For example, a dispatcher complaining

about the lack of attention management gives to national Public Safety telecommu-nicators Week (ntW)—and rightly so—is picked up by another dispatcher and in less time than it takes to put up a banner, the entire shift is playing the blame game, point-ing fingers and assigning fault.

negative comments about what manage-ment might believe to be insignificant (or too expensive to recognize) can grow expo-nentially and before you know it, the job is bad; the management is worse; nobody cares

and it shows An employee who likes her job does wonders for customer service.


enough to listen; and the “don’t expect me to do more than anyone else around here” atti-tude takes over. Morale sinks. tempers flair.

PStC Instructional Coordinator Kevin Willett said part of the problem lies in the lack of communication (rather ironic consid-ering the job requirements, he noted) and the lack of morale boosters due to demanding schedules, limited “face” time, and budgets on quick weight loss plans.

“Morale isn’t a priority for many of us,” Willett said during the Balancing your time Between “taming the Shrew” and “thank-ing those Who Do” workshop. “We’re all over spending for n e w t e c h n o l o g y and ignore fixing what’s right in front of us. Our employ-ees are the priority and to make a dif-ference, we have to go out of our way to thank them.”

Students in both workshops offered suggestions they’ve tried for combat-ting dipping morale and declining funds. For starters, never dismiss the week set aside each year to honor dispatch-ers and don’t ignore any opportunity in general to show appreciation.

tony Wilkens and Karyn Kretzel, of West Metro Fire Rescue in Lakewood, Colo., gave a propane-powered barbecue grill to their dispatchers, and not just for firing up on the occasional holiday or birthdays.

“In Colorado we barbecue year-round and a grill was something asked for in the past,” Kretzel said. “We revisited and bought one before anyone had to ask again.”

Other centers send their dispatchers to the navigator conference, either on a rotat-ing basis or as an incentive for exemplary per-formance. Food is always a welcomed guest, whether it’s a chili potluck brought in or a bacon and egg breakfast cooked on the prem-ises. Jerry Stallings, of Queen Anne’s County communications center in Centerville, Md., said people still talk about the thanksgiving meal they served a few years back to locals in public service scheduled to work the holiday.

“It made us feel good to do that,” he said.St. Charles 911 Communications District

in Hahnville, La., gutted its existing center, turning it into a place not as happy as home, but close enough. Ergonomic furniture, self-controlled hot/cold ventilation systems, and new carpeting and paint more than made up for the inconvenience of cramped quarters during reconstruction.

“We broke morale and then built it,” said Cary Armand, St. Charles 911 Communica-tions District. “they were so ready to come back from temporary space.”

Appreciation, however, doesn’t have to come with a huge price tag or expand into new digs. Less expensive signs that you care

include the insulated lunch bags and coffee mugs Sussex County (georgetown, Del.) Emergency Operations Center Manager Debbie Jones gave to her dispatchers to fos-ter ntW celebrations.

no fat funding makes dress-down days, an extra 30 minutes added to a meal break, and thank-you notes affordable options. the “atta boy/atta girl” bulletin board at West Metro Fire Rescue provides the space for 32 cards giving positive notice for anything from a bystander CPR rescue call to extend-ing a welcome to a new employee.

Letting employees know you care can even be as simple as keeping frustra-tion levels at bay. If the overhead light-ing blinks and sputters, have the system checked before being asked again and again and again. Offer remedial training with tools that the struggling dispatcher can put into practice.

Zerelda nelson, Hillsborough County (tampa, Fla.) Sheriff’s Department commu-

nications center, said gratitude can begin at the team level and stay there.

“We do things to build morale within our teams without going overboard,” she said. “Every little bit helps and sometimes it’s tak-ing the time to understand what’s affecting the individual.”

If it all works out as hoped for, the pay-off of good morale inside can translate into employees willing to go the extra distance for better customer service, said PStC Instruc-tor traci Deitschman, who co-presented the Spirit to Serve workshop. In other words, a supervisor or manager showing concern

and respect for the team might rub off through a dispatcher who works to ensure every 9-1-1 caller he or she talks to has the best experience pos-sible during a crisis.

“ We h a v e t h e ability to change someone’s experience in the way we act toward that person,” Deitschman said. “We have to react from their perspec-tive, not our own.”

Improving morale can also mean going outside center walls to introduce the voices behind emer-

gency communications. Karima Dash, Augusta (ga.) 9-1-1 Emergency Services, partnered with the Red Cross for clothing and coat drives. For the past four years, center calltakers have trained volunteers answering the hotline at the Safe Home Domestic violence Center.

“going out in the community lets the public see that this is someone they know and someone they can feel comfortable talking to in case of an emergency,” Dash said. “the reaction has been very positive on both sides.”

no matter what you try, there’s always going to be the bad apple or the “problem child” taking the bulk of corrective atten-tion; a day to sack the uniform in place of a pair of comfortable blue jeans isn’t neces-sarily going to turn a negative ned into the positive advocate you can bet the farm on.

“Wishing for change is not the answer,” Willett said. “But as managers we have to stand up for our people. Don’t miss an oppor-tunity to create positive relations.” g

Crowd Pleaser Discussions of ways to build morale draws large audiences.


ProgressionSalt Lake City made leap to computerized dispatchAudrey Fraizer

g retrOsPaCe

A mistake made during an emergency phone call isn’t the only reason dis-patchers might get sent to the office.

A Salt Lake City Fire Department dispatcher was suspended for three days in June 1975 for refusing to cut his hair. the 32-year-old Frank Conte argued that rules applying to firefighters should not be enforced across the board, particu-larly in his case since hair length did not interfere with his ability to answer emergency calls.

the senior dispatcher obviously won his fight. A newspaper article published 10 years later highlighted Conte in a story about hun-dreds of additional calls in a lightning storm that plunged “most of Utah into darkness” early on a Sunday morning, according to a story in the July 8, 1985, issue of the Deseret News.

“the computer was down and so every-thing had to be done off the top of our heads,” Conte said. “We had to keep track of equipment, locations, crews, as well as relief crews. We had to send crews from one place to another and remember where we had them.” Conte was fairly new at the controls when Salt Lake City finally decided to follow the nation’s swelling tide of a standardized 9-1-1 emergency number and computerized dispatch for its police and fire departments.

the concepts weren’t an easy sell. Salt Lake City Fire Department Chief

Leon R. DeKorver had consistently argued against the transition, insisting that dialing three digits would be less efficient than dialing either “0” for the operator or the department’s seven-digit number, which had four lines con-nected directly to the alarm office. Computer-ized dispatch was out of the question.

“If a call came into the alarm office on the proposed 9-1-1, it would take a genius to determine the exact location of the fire,” the chief told a reporter in an article published in early 1976. “Some calls made to 9-1-1 merely go into a tape recorder if another call is in progress, and a tape recorder isn’t able to ask questions.” A system incapable of helping the public, he said, wasn’t worth the estimated $800,000 investment.


Chief DeKorver’s resistance lost favor.the career firefighter left the post on July 1,

1976, after nearly 34 years of rising through the department’s ranks. His successor, Chief Evan Baker, a former assistant chief and with the depart-ment for 29 years, had a vision for a technologi-cally and pre-hospital care savvy future. Within two months of his August hire date, Chief Baker unveiled the department’s ultra modern $45,000 computerized dispatching system.

“It’s only part of the total fire alert system,” he told reporters for the Salt Lake Tribune news-paper. “the cathode ray tube computerized pro-gram backs up our regular dispatching network. the old system was very old and obsolete.”

Using the new system, Conte could listen to the phone call for help and type the address of the fire or other emergency. the address typed in the computer would pull up additional cat-alogued data gathered by fire inspectors, and the data would appear on the television-like screen of a cathode ray tube. the same data was printed on teletype-like units in all 14 fire stations and in the battalion chief’s office.

From the computer printout at the dis-patch center, Conte could pull up data to advise firefighters about additional hazards such as flammable liquids, the nearest fire hydrants, and water mains.

“In the past we had to rely mainly on oral communication,” Chief Baker said. “Engines were dispatched with loudspeaker instructions and sirens. Printed information is particularly important for the battalion chief driving across town. He doesn’t have time to stop and take down the information. this way he has the information by the time he arrives on scene.”

Chief Baker said the computerized system wouldn’t bring firefighters to the scene any faster—they already responded in about two minutes—but it would provide the informa-tion necessary to put out the fire more quickly.

Computerized dispatch and the city’s transition to a 9-1-1 call system were only the beginning. Chief Baker was an early pro-ponent of pre-hospital care. He introduced the public to bystander CPR and brought

the first paramedic program to the Salt Lake City Fire Department, believing it would add greater stature to the job of firefighting. Once trained through a five-month classroom and in-service paramedic training course offered through Weber State College (now Weber State University) located 40 miles north, Chief Evans tapped into a progressive emer-gency medical doctor working at the local St. Mark’s Hospital.

Jeff Clawson, M.D., was already devising his medical dispatch program when Chief Baker approached the Salt Lake City fire sur-geon to become the medical advisor for the newly-formed Paramedic Advisory Council. the council’s role in coordinating paramedic services north and south of Salt Lake County proved contentious. Pre-hospital care pro-vided by anyone other than a board certified physician was a relatively new concept.

Chief Baker and Dr. Clawson prevailed.the chief and his wife Marjorie trained

as EMts and responded to emergencies in vehicles dedicated to medical response. they stabilized the patients, leaving transport to gold Cross Ambulance. Marjorie was consid-ered the go-to person at South High School, where she worked as an administrative assis-tant. First and foremost, however, has been her unwavering support of firefighting and emergency medical care.

“I was the fire chief’s wife who helped on calls,” said Marjorie, during a recent phone interview from their home near Salt Lake City. “Evan worked very hard to get it going in the city and I loved working alongside him with the paramedics.”

Baker retired 25 years ago, after 25 years with the fire department. He stepped down as fire chief in 1982 and for several years served as an assistant chief. now 86 years old, he lives in West Jordan, Utah. Firefight-ing and emergency rescue has been his life.

“Evan left the fire department in very good condition,” Marjorie said. “We have a lot to look back on. Firefighting and the depart-ment, that meant everything to him. g


THE PREMIER EDUCATIONAL CONFERENCE FOR POLICE, FIRE, AND MEDICAL DISPATCH

NAVIGATOR SALT LAKE CITY

13 888.725.5853 | April 1

7-19, 2013www.emergencydispatch.org

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