Search Terms: Dispatch disasters, 911 dispatch systems, prearrival instructions, number of errors, Jeff Clawson, father of EMS dispatching, emergency medical dispatching, emotional content and cooperation score, personality traits, good dispatchers, field training, dispatch training, liability situations, trained public-safety telecommunicator, dispatch protocols, continuing medical education, continuing dispatch education, good customer service, basic telecommunicator training, concept of dispatch priorities, priority symptoms, training inadequacies, hazards of inadequate training, burnout, liability concerns, dispatch prioritization, incentives, closure stress, Ivette Correa, Parents Against Negligent Dispatch Agencies (PANDA), recognition, emergency medicine, 1995, 911 phone call

Emergency Medicine, August 1995
Marie Nordberg, Senior Editor

Dispatch Disasters

It's comforting for Americans to know that, no matter where they go within the United States, help is only a 911 phone call away-or is it?

Gary Ludwig, MS, EMT-P, communications chief and EMS program coordinator for the St. Louis Fire Department, recalls a disturbing incident that received widespread media attention.

" A woman called 911 on New Year's Day and told the dispatcher, "We had a party here last night and everybody is sick," Ludwig recalls from his days as deputy chief with St. Louis EMS. "The dispatcher took it for granted that everyone was drunk and hung over. The caller started describing flu-like symptoms of nausea and vomiting, and the dispatcher didn't listen when she said that two people were unconscious. It was an 8-minute conversation, where he argued with the lady about whether they needed an ambulance. Just to get her out of his hair, the dispatcher finally sent the ambulance, and it turned out there were 14 victims of carbon-monoxide poisoning from a block-up furnace. If we hadn't sent that ambulance, we probably would have had 14 dead people."

On March 1, 1990, Lauderdale Lakes, FL-resident Ivette Correa received a call at work from her 13-year-old daughter, Yvonne, telling her that 1-year-old Brooke had fallen into the family's pool.

"I just though there were people there to get her out," Correa says. "I told Yvonne I'd be home soon. I don't know what made me call back, but a policeman answered the phone and told me I'd better get home. I realized then that it was more serious."

As Correa soon discovered, Yvonne told the 911 dispatcher what had happened, asking repeatedly what she should do. When the dispatcher queried as to whether anyone in the house knew CPR, Yvonne replied no and asked again how she could help her baby sister, who was by then turning blue.

"All the dispatcher could do was tell her to stay on the line and help would arrive shortly," Correa says. "But he never instructed her how to do CPR, even though he obviously knew it was needed. I found out later that he wasn't allowed to give prearrival instructions." After 13 months in a coma, Brooke died at home.

On November 11, 1994, 16-year-old Edward Polec was beaten to death by five teenagers with baseball bats in the Philadelphia suburb of Fox Chase. Because dispatchers in the police communications center failed to recognize the situation's gravity, more than 20 calls to 911 were made and 45 minutes elapsed before police arrived at the scene. When EMS was finally notified of the correct address, an ambulance was dispatched immediately and Polec was transported to a hospital. But the damage was too severe to save his life, according to Edwin R. Baxter, acting battalion chief and communications officer for the Philadelphia Fire Department.

Current State of Affairs

The 911 dispatch system actually does more right than wrong, and the opening scenarios are atypical, says Rick Spurgeon, EMD instructor at APCO Institute, a training facility in South Daytona, FL.

"If we were to investigate the number of calls for service that come in across the county and the number of errors that actually occur, it's an extremely small percentage," he says. "Unfortunately, when the press gets hold of an error, they want to make it seem as though this is the norm, rather than the exception, and it's certainly not."

Generally, the public doesn't give much thought to 911's workings until the media catch the system making a mistake. To a great extent, dispatch is simply ignored by the public-and even by other branches of EMS-says Jeff Clawson, MD, owner of Medical Priority Consultants, Inc., in Salt Lake City, UT, dubbed the "father" of EMS dispatching for his pioneering work.

"Emergency medical dispatching isn't traditionally in the medical world," Clawson says. "Emergency physicians don't see it or interact with it, and it doesn't come to the hospital on the back of a fire engine. So, it exists in a public-safety netherworld that doesn't always see to it that dispatchers are adequately selected to do this sort of job, updated with continuing education or provided with appropriate tools to do the job."

By and large, the current standard for medical-dispatch performance in North America is a medically approved protocol from with dispatchers make rapid over-the-telephone assessments of patients and determine which resources to send-'or not to send. "The problem," Clawson adds, "is that estimates show only 20% of U.S. and Canadian dispatch centers, at least on paper, have a system that approximates that practice standard. Even more scary is that only 5% of all centers are doing it correctly."

Does this mean the American public has been deceived by television shows like Rescue 911?

Not really, Clawson contends.

"At times, television really does us great service because it shows people the way dispatch ought to be and the way it's done in good places," he says. "Sometimes, they even show the public bad cases that appear good and, since the public isn't very discerning about whether they're seeing good, bad or indifferent medicine practiced, as long as they see the accouterments of someone trying to help by providing telephone instructions they put pressure on the dispatch centers to do it right. That also puts pressure on the EMS agencies, and some have complained about it.

"When I was medical director for Rescue 911," he continues, "one of the program directors told me that a lot of EMS providers were complaining that the show put too much pressure on them to perform well."

As an informed member of the public, Ivette Correa believes television leaves its audience with unrealistic expectations.

"Laypeople like me donāt know, until we have an emergency, that prearrival instructions aren't always provided over the phone," she says. "We teach our children that, when you have an emergency, thatās the number you call. It was very painful to find out that a system like 911 can fail you."

Behind the Scenes

Good dispatchers exist in a quality-assurance, management-defined atmosphere, says Clawson-not the black hole where dispatchers perform what he calls "Dodge City dispatching."

"Thatās where you do what you want to do, to whom you want to do it, whenever you want to do it to them, and thereās nobody to answer to," he explains. "That's the current state of affairs in many dispatch centers in this country."

Some dispatch centers are very responsive, run professionally, and have specific processes and procedures, Clawson says.

"Generally, the ones with that type of management technique have very few problems because they create a corporate culture that's similar to the way they manage," he notes. "But in some municipalities, we see a lack of reasonable management-the Īgood old boy' stuff-where dispatchers follow the notion that, unless they think the brass wants them to perform a particular way, they don'āt. I think thatās improving because the media are more attuned to the problems."

Still, under pressure, even well-trained dispatchers make mistakes. A highly publicized dispatch "disaster" occurred in Dallas in 1984, when a nurse screener for the Dallas Fire Department argued with a young man who was pleading for an ambulance for his dying mother. The nurse insisted on talking to the ill woman and said EMS didnāt respond to non-emergent calls. As soon as the son encountered the nurse's resistance, he uttered an expletive, and the nurse dispatcher began chastising him.

"We now tell dispatchers, "Don't kill the messenger," Clawson says. "Don't beat up the callers if they're upset, because their real message is ''please help us." When you can train dispatchers to look through the caller to the patient, so that they become patient-care advocates, you don't have these problems."

A common misconception: Callers are usually too upset to respond adequately, so dispatchers shouldn't ask questions; they should simply find out where the caller is and put the monkey on EMS responders' back.

"Published studies have indicated that probably less than 3% or 4% of callers could be even remotely deemed hysterical," Clawson says. "There's a widely used scoring system called the Emotional Content and Cooperation Score which is used to score callers upon entry into the EMS system. We found that, on a 1-to-5 scale-with 1 being normal conversational speech, like ordering a pizza, all the way to 5, which is totally wacko, screaming, waving the phone, and probably not even in oral connection with the dispatcher-the average caller ranges between 1.2 and 1.4. Even callers who were reporting what turned out to be cardiac arrest only averaged 2.1. So, most callers, are not hysterical.

In reality, Clawson asserts, callers seem to subjectively evaluate the dispatchers they've reached.

"A lot of people are innately distrustful," he says, " and if they've seen in the media that dispatchers have done terrible things, like refusing to send help or not answering the phone because they're asleep, there's a little suspicion that when their emergency occurs, things are going to go wrong. So, when they call in, they're anxious because they have an emergency, or at least a situation that's terribly disturbing, and they'll assess whether they've reached a helper or hinderer, a professional or an amateur, a leader or someone who's just as confused as they are. If they think they've reached any of the latter, you can imagine what happens to their emotional content: it starts to go up.

"Police use the term "complainant" to describe a caller, which is technically correct, but I think it's often interpreted as "complainer." So, in some ways, we've empowered dispatchers to resist people who they don't think have a true emergency, and its results in providing bad customer service."

The Folks Behind the Headsets

EMS dispatchers are a diverse group in terms of training, personality traits, and responsibility. Some have strictly basic EMD training, while others can stake a claim to years of experience as EMTs or paramedics.

"Dispatchers, in a way, are responsible for the overall flux of what's happening in the system," Clawson says. "They are in charge of every scene until someone else gets there. No one knows more about a call than the dispatcher because that's the only person who has talked to someone at the scene. Once EMS arrives, there's a new commander. Dispatchers have to be multitasking, fairly unflappable, and have to provide leadership and empathy to people who are in the midst of a crisis. On paper, their job is more complex than a field responder's-not more important or harder, but more complex. They change hats a lot in what they do."

The APCO Institute's Rick Spurgeon agrees that dispatching is a virtual juggling act.

"If the dispatcher has to focus on one item and complete it from start to finish before he goes on to something else, he probably won't be real successful in communications," he says. "If I had to pick one trait for a good dispatcher, it would be someone who can do several things at one time well."

Even though the dispatcher never interacts face to face with callers, a good personality is crucial, says Richard Schomp, EMT-P, a dispatcher with Sunstar Emergency Medical Services in Pinellas County, FL, who was named 1994 Dispatcher of the Year by the Florida state EMS office.

"A good dispatcher is someone with good interpersonal skills÷someone who is good with people and can calm them, reassure them, and instruct them in a proper manner on how to follow through with instructions if it's a lifesaving technique," Schomp says. "Iām a people person and enjoy interacting with them. I'm very sure of my skills, and I'm monotone-calm in a hairy situation." Schomp, who has worked in the EMS for 10 years, entered the dispatch realm to acquire a better understanding of the system.

"The more I know about the system I work in, the better employee I can be," he says. "I get bored easily and like to learn new things, and this was a challenge, so I went after it. I still work the streets every third day at the fire department and do quality assurance for our dispatchers to make sure they're doing their jobs right."

Do EMTs and paramedics typically make good dispatchers?

Clawson doesn't think so.

"Some people believe that being an EMT or paramedic is medical-like," so they should make good dispatchers," he says, "but in reality, they don't. If you look at EMT training, it's patient-advocate-based, and everybody is dying until proven otherwise, as it should be. Dispatchers are system advocates."

But Rick Spurgeon disagrees.

"EMTs and paramedics can make good dispatchers, just as police officers and fire fighters can be good dispatchers, and just as people off the street can become good EMTs and paramedics," he says. "I don't think a level of field training necessarily makes them good or bad dispatchers. Paramedic and EMT training is skills training, which is based on putting their hands on people and trying to assist in that manner. As EMDs, they have to know how to calm people down over the phone and how to elicit certain pieces of information from them, and they have to determine what's important and what's not quite as important."

"They also have to manipulate the resources to be sure the closest appropriate units are going to the most serious medical emergencies," he adds. "None of these issues are addressed in EMT or paramedic training programs. But I think the medical background information obtained provides a benefit for the EMS-trained dispatcher if it's focused properly. If the dispatcher deviates from his dispatch protocols on the basis of his field training, however, thatās a negative. Field training is not designed for dispatch, and dispatch training is not designed for field use."

Does field experience ever get in the way of following dispatch protocols?

"I believe it does, especially with a program like Dr. Clawson's, where it's very structured and you don't deviate from the [written protocols] cards," says Jack Tanski, a telecommunicator for the Colony Police Department in Latham, NY, and a former paramedic. "If you start to freelance, that's where you can get into some liability situations, and that's not good. Personally, with my field experience, I have to really concentrate on the cards rather than reading in anything extra."

"Being a paramedic is a bonus because we already know how to work from protocols in the field, so it's easy to adapt in the communications center," asserts Laurie Pettingill, utilization supervisor at Sunstar Emergency Medical Services. "And once we've asked all the questions on the cards, we can ask further questions until EMS arrives on the scene."

Dispatcher Training

Standard Practice for Emergency Medical Dispatch, a recently released document from the American Society for Testing and Materials, defines the emergency medical dispatcher (EMD) as a trained public-safety telecommunicator with additional training and specific emergency medical knowledge essential for the efficient management of emergency medical communications. The ASTM further states that EMD programs require appropriate entry-level selection, orientation, quality assurance and quality improvement, case review, performance evaluation of dispatchers, continuing education, risk management, certification/recertification, reciprocal certification, program selection implementation and a physician medical director. These features have been implemented in the EMS field programs since 1975 and are just now being considered for EMD 20 years later, Clawson says.

"EMD is like the kid in the family who gets the hand-me-downs," he says. "EMS buys all the fire engines, helicopters and equipment, but balks at buying a protocol that may cost $300-about the same as a battery for a defibrillator and half as much as the chair a dispatcher traditionally sits in. It's gaining steam and things are getting better, but a lot still needs to be done."

Individual EMD systems have progressed on their own, and some have developed rigid personnel requirements. Sunstar, for example, mandates that all dispatchers-or "system status controllers," as they're called in Pinellas County, FL-must be practicing field paramedics with at least 2 years of experience. A portion of EMS providers' orientation is devoted to learning the basics of the dispatch center so they'll understand why and how things are done, ultimately leading to better communication between field providers and dispatchers. Every practicing paramedic must also acquire 3 hours of continuing medical education per month, says Chuck Kearns, Sunstar's government-affairs director.

"Our dispatchers go through a 4-week training class, after which they have continuing dispatch education," says Laurie Pettingill. "So, along with their state requirement for CE, they're required to have classroom hours to keep up their dispatch certification."

Dispatch classroom time is used to review employee weakness, point out their strengths and ensure that dispatchers are following protocols, which are based on Clawson's Medical Priority Dispatch System.

"Our latest CE class was on professionalism and telephone courtesy," Pettingill says. "These can be overlooked, and it's a very important part of our system to provide good customer service on the phone."

Although Philadelphia dispatchers are not required to be EMT-certified, the initial training period runs 4 weeks, followed by another 4 weeks of hands-on training in the dispatch center, says Robert J. McKeever, chief fire dispatcher for the Philadelphia Fire Department.

"It's about 8 weeks into the operation before we allow them to take a call," he explains. "That's based on the individual; some may take slightly longer. We evaluate them on a weekly basis, and when we feel they're ready, we permit them to go on their own."

Because there are no standard requirements across the country, length of training from state to state varies widely.

"We require 32 hours of EMD training," says APCO's Spurgeon. "But ASTM standards state that you have to have basic telecommunicator training prior to EMD, so we require anybody who takes our EMD program to document 40 hours of verifiable communications training. If they take one of our other training programs, we already know what they contain, but they can submit outside curriculum materials to us for approval so we can check to make sure they've had the required training."

"I don't know of any state that actually requires training for dispatchers to follow protocol," Clawson add. "If you look at rural America, you find the highway patrols, county sheriffs and small municipal police departments providing dispatch, and they don't want to incur the expense of EMD training. There's also some resistance because dispatchers are often looked upon as second-class citizens in the EMS world.

"Training for EMDs is very different from the training for EMTs and paramedics," he continues. "By and large, the early training programs were an extraction of emergency medicine at the emergency-physician level, because dispatchers think ALS. They evaluate patients and make triage decisions about who gets certain types of resources and how fast they get them. So, dispatchers make critical decisions based on an evaluation that we call the Īconcept of dispatch priorities, or priority symptoms. They think ALS, but they perform BLS functions because they're limited by being remote from the patient. A new program in North Carolina now licenses EMDs through the Board of Medical Examiners as ALS providers, which requires them to have medical control, adequate protocol, training and recertification."

Many of the 911 calls that "go bad" can probably be attributed to training inadequacies, says Jack Tanski.

"It might be a lack of control or your personal view of the incident you're handling," he speculates. "Sometimes, your own feelings interfere, and you get a little complacent and undersize the situation. Or, you overkill it and commit a lot more resources than you have to."

EMD training should probably be mandated from an agency standpoint, Spurgeon maintains.

"The agencies themselves should take the initiative to say, ĪWe have a certain responsibility to the citizens of our community, and that includes being sure our dispatchers are trained to an appropriate level," he says. "We do it with law enforcement officers, fire fighters and field EMS responders, but how about our dispatch personnel? Some agencies are doing a very good job of training, but others are not. EMD training is just that: training in emergency-medical-dispatch concepts, as well as training within the specific guidelines and protocols youāre going to use within your dispatch center."

One of the hazards of inadequate training is burnout, according to many experts.

"Anybody who had not been trained to an appropriate level is going to experience some helplessness," Spurgeon says, "and that helpless feeling does lead to burnout. Training helps counteract that, because if we're doing a good job and making a difference, and we're not making mistakes, we feel much better about ourselves and are less likely to burn out."

Much of the responsibility rests on management's shoulders, says Richard Schomp.

"If they're doing their job by rotating people, and making sure they get breaks and positive reinforcement, employees shouldn't get burned out," he contends. "It can happen in a high-volume system that is not staffed properly, which puts stress on the people who don't belong there."

In some agencies, management uses the communications center as a "dumping ground" for women who are on maternity leave, employees on light duty and those who have become discipline problems on the street, says Gary Ludwig.

The result?

A dispatch center staffed by employees with improper training and no desire to be there.

Liability Concerns

Following the death of her daughter, Ivette Correa began intensively researching the 911 system in her area and discovered that dispatchers are prohibited from giving prearrival instructions to callers.

"The main reason is liability," she says. "They don't want to be responsible for breaking a rib or doing the wrong thing. My feeling is, you can't hurt someone who is already dying: you can only help their condition."

A 1989 paper issued by the National Association of EMS Physicians states:

Prearrival instructions are a mandatory function of each EMD in a medical dispatch center. Dispatch prioritization is an essential element in any EMS system, for it establishes the appropriate level of care, including the urgency and type of response, i.e., lights and siren. Standard medically approved telephone instructions by trained EMDs are safe to give and, in many instances, are a moral necessity. Training as EMDs is required for all dispatchers functioning in medical dispatch agencies.

The paper has been ignored. Why? Fear of liability, according to Clawson.

"In my opinion, it's nothing by an excuse," he says, "with not a shred of evidence that it should be something of concern. People say, "There's liability if you do that. If you give telephone instructions, you could get sued. These same people say, "Doctors don't even give telephone advice." Well, doctors generally don't give telephone advice because people call to avoid having to come in to see them. In this case, it's only preemptive information-the do's and don'ts prior to arrival of the troops. It's not in lieu of treatment; it's just during that gap where we know we can't get response time to zero mechanically, but we can telephonically.

"The fact is, there has never been a lawsuit in this century, that we know of, against a dispatch center for providing EMD services," Clawson reports. "There was a big movement early in EMS, where people decided they had to pass Good Samaritan laws because "doctors, nurses and paramedics were getting sued when they were off duty, and stopped along the roadside to help." In fact, after all 50 states passed a Good Samaritan Act, someone looked at case law history, and there were not cases."

Incentives

Although the "bad" calls get the most press, there are many with satisfactory outcomes. Richard Schomp remembers the one that led to his Dispatcher of the Year nomination.

"A 43-year-old female began having chest pain at work and collapsed into cardiac arrest," he says. "None of her coworkers knew CPR, so I taught them over the phone, and they did CPR until EMS arrived. She did so well; she was not intubated and was up and talking an hour later. This was a mother of three children, who had had previous open-heart surgery. That's a call I remember because it just clicked right along."

Andy Millergren, EMT-P, another Sunstar employee, was Floridaās 1993 Dispatcher of the Year. He's been involved in EMS for 16 years, 6 of which have been spent in the communications center.

Because of his skill in relaying prearrival instructions, a little girl in Pinellas County just celebrated a fifth birthday that she probably would not have lived to see. That was a special call, he says, because he has a daughter the same age. Unfortunately, says Spurgeon, most dispatchers' good work is performed without fanfare.

"Some agencies do a very good job of rewarding their dispatch personnel," he says, "but they usually don't get noticed quite enough. In this profession of emergency-medical and public-safety dispatching, we're required to perform at 100% perfection and mistakes are not tolerated well, so 100% work becomes the status quo, and we only reward people for doing something extraordinary. A lot of agencies, then, don't identify everyday work as being extraordinary, because it's what is required on a daily basis."

In addition to seeing that employees are rewarded for stellar performance, it's important to inform them of difficult calls' outcomes, Spurgeon says.

"In our training, we refer to the unknown element as Īclosure stress," he says. "Dispatchers are constantly initiating an action, but they never know the conclusions, and that does build up. Depending on the type of call and the situation surrounding it, the dispatcher is the initial contact point and becomes intimately involved with the caller until EMS gets there, so just letting it go unresolved can be a problem. Even if the outcomes aren't positive, just knowing whether the call did or didn't make a difference, or didn't matter one way or the other, draws a final aspect to the run."

Coming and Going

Despite the intensity of the job and its resulting stress, actual employee turnover is relatively low in most dispatch centers.

"Most of our comm-center employees are veteran paramedics who have been in EMS for anywhere from 7 to 15 years and want a change," Pettingill says. "They still want to do patient care, but they want an occasional change from the field."

When Jack Tanski began dispatching 13 years ago, there was a 60% turnover rate, but higher salaries, affordable training and an emphasis on dispatch as a career have turned the system around.

"Years ago, we had to take our own time and pay our own way for training," he says, "and most line communicators couldn't afford it. Our municipality now had a training budget, so we can take advantage of seminars and be reimbursed for them. That helps."

Spurgeon also sees dispatch becoming a long-term career.

"We have several people who have been in the communications field for 20-30 years," he says. "Up until a few years ago, EMS people were in dispatch for a short time and then back in the field, so there was a lot of transition. Now, we're seeing more civilian dispatch personnel coming into the field because that's what they want to do, and the better we can compensate them, the better off we'll be as far as longevity is concerned.

"Most of our turnover right now is due to stress and lack of training," he continues, "but, honestly, economics is a big factor, as well. Many people want to be dispatchers, but they can't make a livable wage doing it. I think the range for public-safety dispatchers now runs from $11,000-$50,000, so there's a vast disparity there. Itās unfortunate because they're all doing basically the same job."

Priority Dispatch

In many cities, 911 call volume has surpassed the number of available emergency vehicles, adding stress to already overloaded communications centers.

"A lot of places don't have appropriate policies and procedures, so dispatchers have to make split-second decisions," Spurgeon notes. "If a dispatcher makes a decision in the heat of a call, and if it happens to be an incorrect decision, he takes the brunt of it."

In fact, says Clawson, quality-assurance studies in a number of cities show that dispatchers who ad lib instructions leave out about 50% of the verification and treatment steps that would be found in equivalent protocol for that process.

As a result, many systems are turning to priority dispatch protocols, which help eliminate guesswork as dispatchers prioritize calls. Perhaps the most familiar and most frequently used protocol is the Medical Priority Dispatch System designed by Jeff Clawson in the 1970s. APCO Institute and other agencies have developed similar tools for individual dispatch centers.

"Our EMD program looks at the severity of the patient's condition, based on signs and symptoms, and classifies it within a certain category," says Spurgeon.

"If those signs and symptoms are considered non-life-threatening, it's classified as a low-priority run," he notes. "If it's not life-threatening, but I would like to get someone there relatively quickly to investigate, that's another classification, again based on signs and symptoms. Our program is designed to be customized by local medical control. Knowing what resources they have, and what kind of responses and calls they typically get within their community, they have the ability to modify the criteria and response levels to match their current protocols."

"If dispatchers follow what we believe is the correct methodology for providing dispatch-applied medicine, it becomes like a peripheral brain," adds Clawson. "It includes chief-complaint entry points in groups that provide a pathway to examine literally anything you can think of. Rather than ask dispatchers to reinvent the wheel every time the phone rings, based on their own anecdotal experience or EMT training, if they follow a formal, simply designed, well-thought-out, medically sound protocol, theyāll sound like rocket scientists."

A frequent excuse for refusing to use priority dispatch is that it will take more time, which means adding more employees.

"In fact, in evaluating systems where dispatch is reasonably staffed, we've never seen a dispatch center have to add people to do emergency medical dispatching," Clawson refutes. "In large centers where they've previously not been giving prearrival instructions, you'd think that adding them would add time incrementally to the overall processing, but it doesn't. One medical director suggested that what really occurs is that dispatchers are taking less time to interrogate because they're using programmed interrogation."

Educating the Public

Many dispatch experts believe a better-educated public would improve the 911 system overall, but Clawson doesn't subscribe to that philosophy. The 911 emergency number has been around long enough for most people to understand how it functions, he declares.

But Tanski thinks there is still plenty of room for education.

"People call for an ambulance, and their attitude is, "Just get it here," he says. "They don't understand what valuable information we can gain or what intervention we can complete by asking questions. They think if they're being kept on the phone, it's delaying the response, and they have to know that someone else is already sending the ambulance."

Spurgeon agrees that educating the public on what 911 is(and is not")is extremely important.

"A lot of times, dispatchers end up getting overrun with situations that are nonemergency in nature," he says. "That doesn't mean it isn't an emergency to the person who's calling, but it's a nonemergency to the public-safety communications system. A lot of areas are doing a very good job of educating their own communities, especially school-age children. Trying to reeducate the adults is difficult, but when we can start with the children and teach them what to(and what not to)call 911 for, eventually we'll turn it around and have a better system."

Since losing her child, Ivette Correa has become an avid lobbyist for legislation that will require dispatch systems to provide prearrival instructions in life-threatening situations. She's presently working with Sen. Robert Wexler from Boca Raton, FL, to draft a law that sets specific standards and requirements, while protecting dispatch agencies from liability. She also started a group called Parents Against Negligent Dispatch (PANDA).

"The 911 system is like a security blanket for most people," she says. "They think if you have an emergency you just call 911 and everything will be perfect and it's not. In doing my research, I've learned that there's no standardization throughout the country, and I think that's the key issue here. Emergencies are all different, but the procedure for handling them has to be the same.

"It was very painful to find out that a system like 911 can fail, and to wonder if Brooke might be here right not if she'd been given CPR. Her medical bills were more than $1 million. Just think how much money could be saved by improving the system we have now. The thing that keeps me going is believing that laws will eventually be created that will save hundreds of lives."

Looking Ahead

It's apparent that U.S. dispatch systems have some problems, but that doesn't mean they can't be corrected.

Sweeping changes have been suggested for Philadelphia's police dispatch operation as a result of last November's incident, says Ed Baxter.

"A recent 31-page report to the mayor's office outlines several changes," he says. "Some have already been implemented, all with an eye toward alleviating the type of situation that led to the Eddie Polec case."

According to Joseph L. Ryan, MD, medical director for Sunstar EMS, fixing the system is primarily a public-policy issue.

"It costs money to have the kind of system we have, and it requires insight into how a system really works to provide quality care," he says. "When those two things are understood by policymakers and they can translate that expertise into something the public will understand, we'll see good systems evolving."

Ryan has high praise for the dispatchers in Sunstar's communications center.

"Everyone in the communications center is there because they're the best paramedics in our entire system, and they are highly motivated to be excellent in that role," he says. "They wouldn't have gotten there in the first place if they hadn't demonstrated over a long period of time that they're extraordinary people. Everyone has good and bad days, and things can always be improved. But it's often a problem with the process, not with the people."

Clawson believes difficulties occur when dispatchers are given insufficient time to do their jobs.

"We've created this system related to the "we save lives" philosophy-the hero thing-and it's really the opposite: Our No. 1 goal in EMS is not to save lives; it's to help people," he says. "Sometimes, tucking in the little old lady or soothing a child is just as important as the lifesaving stuff.

"Almost interwoven into this is the "seconds count" philosophy, which we hear all the time," he continues. "The problem is, in real medicine, seconds rarely count. But the minute the phone rings, it's like a ticking bomb and hurry, hurry! We're telling dispatchers, 'No, you need to find out what's the matter,' and there needs to be a reasonable amount of time to do that."

` Overall, says Spurgeon, most dispatchers are doing a good job, considering their circumstances.

"There's a lot of crossover these days within the dispatching, and more combined communications centers where they're doing police, fire and medical dispatching," he says. "These are extremely dedicated individuals, who wouldn't be there if they didn't like it. There will be occasional mistakes, and some of them will hit the news, but, the fact is, they aren't as widespread as what people would like to believe. We just don't hear about all the good calls."

For all of the dedicated, hard-working communication personnel, Andy Millergren offers this advice:

"Always remember that outside recognition is good, but recognition from within yourself-knowing you've done the best you can-is the best recognition you can get.

"You just have to pay attention to what you do, stay on top of things, read a lot, study a lot, follow up on your calls and try to improve just a little bit every day."