We answer each and every 911 call that comes into the dispatch center at American Ambulance in a manner that is standard in 911 centers throughout the country. The most critical thing we thing need to know is where someone's emergency is because without that key piece of information we have no idea where to send the people who are going to provide help on the scene. Whether it be the police, a fire truck, or an ambulance crew they need to know where they're going first and foremost.
After years of experience, I have come to the conclusion that when that question is met with someone screaming on the other end of the phone line it's probably not going to be a good call, though some are much worse than others. Such was the case this morning when I answered what was probably my fourth or fifth 911 call of the day (some days it seems to ring constantly and other days not at all - today was constantly) and my question was answered with a screaming female caller. I was able to get the address and phone number from the NPD dispatcher and after trying to calm the caller down was finally able to determine what was wrong and with who.
In September of 2003 I became a nationally certified emergency medical dispatcher with training specifically designed for these types of calls. We operate under a protocol through the National Academies of Emergency Dispatch and have a computer-based system that guides us step-by-step through each call by giving us the correct questions to ask and then, based upon the answers we receive, we can give pre-arrival instructions as well as send the appropriate emergency medical response. It's a great system and is right more often than it's wrong. As the first first responders, it gives us the chance to have the caller render assistance to the patient that may make a difference in how the call turns out.
That said, not everything that we say on 911 is scripted through the protocol. We are trained in the use of postive reinforcement as well as repetitive persistence, which is the most effective method of reducing the caller's anxiety to below the hysteria threshold, but there is nothing scripted on the computer that tells you to say "you need to calm down so we can get ___ help", "if you want to help ____ you need to take a deep breath and calm down", etc., etc. Most times during a 911 call we don't need to calm down and reassure the caller but, when we do, it can be tricky to say the right thing to get the caller to a place where they can render aid to the patient before the "calvary" charges through the door.
The call that I took this morning took all of my training and then some as I tried to calm the caller down and walk her through the questions so she could help her loved one while the ambulance and fire department were enroute to the call. In cases like this, I stay on the phone with the caller until help gets there. Those minutes that it takes for help to actually arrive can seem like the longest in the world - not only to msyelf but to the person anxiously waiting for help to walk through the door on the other end. The most frequently asked question during this type of call is "when will someone get here?" and it never seems like soon enough - not to either of us. My caller would be calm one moment and then start to spiral towards hysteria again a moment later and it was my job to try to keep her as calm as possible.
All things considered, I thought today's call had gone well as the caller assured me several times that the patient was still breathing and she said she could feel a pulse. But as I gave her reassurance that she "was doing just fine" I said something that I normally never say to a caller which is that the patient would be okay. It probably doesn't seem like it would be a big thing to say that but when the crew finally got the patient down to the ambulance and began to transport, it was something that I wish I hadn't said as the patient had become what's known as a "working 100" or cardiac arrest. Though he had been breathing and had a pulse when the crew first got there he stopped doing both somewhere between the time he was loaded onto the stretcher and put into the back of the ambulance. When the EMT that was driving radioed in that they were transporting lights and sirens to the hospital with a working 100 my heart fell into my stomach as I knew exactly what that meant and it wasn't good.
I kept thinking of the poor girl who had called and how I had assured her that it was going to be okay and now there was a darned good chance that it wasn't going to be okay after all - that it was NOT going to be okay and never would be again. I felt like I had lied to her and betrayed her, that I had offered out false hope even though I had followed the protocol exactly except for that one small statement.
When the med-patch was given to Backus Hospital from the crew in the back of the ambulance, things sounded even more grim for the patient and my heart sank even lower with each passing moment. In my mind I kept hearing the caller lamenting that I had told her it was going to be okay, that I had lied to her, and I was just about ready to send myself home for the day to rethink my entire career choice.
God must have heard my silent prayers, though, as when they got to the hospital they were able to reestablish a pulse and the medic was credited with a "code save". Last I heard, the patient had been stabilized and put on a vent but was still alive in the Emergency Room. Only then was I finally able to heave a held-in sigh of relief. I'm sure he's not out of the woods yet but it sounds like he's got a fighting chance of survival.
Still, the whole thing shook me up a bit and will make me pay closer to attention to what I'm telling a screaming caller on the other end of the phone. It may even make me reevaluate my sanity in being in this career field but I doubt it will send me into Human Resources with my resignation in hand. Not yet anyway! But maybe I really DO need that thicker skin I've referred to before ...