Friday, January 8, 2010

"When it's not done right, people die and that's the bottom line."

Yesterday morning the Today Show touched on a subject that is near and dear to my heart during a segment called  "Today Investigates".  The report from NBC's Jeff Rosen dealt with the results of a three-month investigation into "a dangerous flaw in the the Nation's Emergency 911 System" and began with Rosen saying, "when you call 911, you assume the operator is well-trained and that they can actually get you the help you need but some safety officials now tell us that the system you trust - the system we all depend on - may let you down when you need it most."

If you don't have time to watch the whole video, the investigation seems to have stemmed in part from an incident that occurred in October of 2007 when a young boy in Texas lost his life.  Apparently what happened was that when his mother wasn't looking, the 21-month toddler went into his family's backyard, got his head tangled in their soccer net, and strangled himself.  Upon finding her son, who had turned blue, the mother called 911 and was - naturally - hysterical.  During the course of the 4-minute call the emergency dispatcher who took the call did not give the mother any medical advice and told her to calm down 11 times.  Three days after the incident, the boy died at the hospital and the family is now suing the City of Murphy, Texas citing "... [lack of] adequate hiring standards, training, [and] supervision ... of its 911 operators."

The City Manager of Murphy said that the dispatcher was doing the job that he was trained to do trying to calm the caller down while also dispatching the ambulance, the fire department, and the police officers.  When asked why the dispatcher was not trained in CPR, the City Manager stated that he was not required to be nor were any of the other 911 operators in Murphy, Texas.  The City denies any wrongdoing in the case and says that CPR would not have saved the child but they have since changed their policy and now train all of their 911 operators in CPR.

The results of the 3-month investigation found 911 operators in 18 states in the country are not required to be certified in CPR and receive no 911 training requirements at all.  Industry insiders said "...dispatchers dealing with life-threatening emergencies are treated like receptionists and often paid less" and without the training "what you get are major mistakes"  but "... until Congress beefs up training and especially funding nationwide then lives are at risk."

Those of us who are 911 operators and dispatchers (telecommunicators) here in the State of Connecticut undergo rather rigorous training in accordance with the Connecticut General Statutes and must maintain that certification once we achieve it.  In addition, the Connecticut State Legislature passed a law in 2005 which requires all medical calls coming into a Statewide PSAP (a Primary Safety Answering Point) or 911 Communications Center be handled under what's called an Emergency Medical Dispatch protocol.  Those of us who provide Emergency Medical Dispatch are required to achieve and maintain certification in the protocols along with our Telecommunicator Certification.

The EMD protocol involves a series of questions so that dispatchers can determine:
  • What the medical situation is
  • If intervention is needed immediately
  • What resources need to be dispatched (EMS, Fire, Police)
  • How those resources should respond (lights and sirens or with the flow of traffic)
  • And if pre-arrival instructions need to be given to the caller (CPR, bleeding control, child birth, etc)
As a certified EMD for over six years now, I know firsthand that people DO NOT like us asking a whole series of blankety-blank-blank questions and just want us to have the blankety-blank-blank ambulance materialize in front of their house with the single push of a button but - unfortunately - it just doesn't work that way.  There really is a method to our madness in asking all of those darnd questions and in the long run, those questions provide better care to our patients even if the caller thinks we are wasting time in sending them help.  Trust me, we aren't delaying help at all - generally the other dispatcher has started the ambulance out long before the operator on the phone gets anywhere near close to finishing up those blankety-blank-blank questions and providing instruction.  There is no delay involved whatsoever and I really wish that people could understand that.  However, I also know that time seems to go into slow motion for those who are anxiously awaiting help for a loved one and that what may in reality be just minutes, very well may feel like hours to the person on the other end of the phone.

Had the tragic situation spoken about in the video above occurred in Connecticut rather than Texas, a trained and certified 911 operator would have done his/her best to calm the boy's mother down and then given CPR instructions in order to attempt to resuscitate the child prior to the First Responders arrival on-scene.   Instructions are read from a specific script and not just rattled off the top of someone's head so you know that you are getting the proper help for whatever the situation may be.  Pre-arrival instructions don't always work - sometimes the patient is too far gone - but I know that at the very least the act of doing something is giving the caller(s) the assurance in knowing that they did everything they could to help the patient.

Hopefully someday the rest of the country will follow suit when it comes to how 911 calls are handled and people will no longer hear 911 horror stories like this but will instead hear stories of how people were able to save the lives of their loved ones following the instructions given to them by a well-trained 911 operator who was able to do more than repeatedly tell the caller to calm down.  Granted, calming down is half the battle with any emergency but a lot of times it's easier said than done.  Knowing that you've got a trained professional on the other side of that three-digit line has got to help calm a person down some - or at least that would be my hope!

At the end of the segment Matt Lauer made a very strong and valid point  ... "if any story should ever prompt people to go out and learn CPR, learn about poisoning prevention and things like that, it's this one - it really is."  He is absolutely right.  CPR and First Aid instruction is offered in so many places in so many communities that you really might be doing your family a disservice by not learning it yourself.  Though you might think you'll never need it, you just never really know and just like insurance, it's better to have it there than not.

As for those 911 operators out there who have not had to undergo training and certifications, I most certainly hope that changes soon as I have no doubt that they can feel pretty darned helpless when someone calls who really needs help and they haven't been trained on how to give it.  There is so much more to our jobs than answering the phone and asking "911, what's the address of your emergency?" and I, for one, wouldn't want to walk the tightrope of being a 911 dispatcher without having that safety net of training and certification under me.  I am sure that operator in Texas in the story above felt absolutely horrible but I also know that he couldn't give that poor mother what he didn't have - the knowledge and resources to provide possible life-saving instruction.

Perhaps this was a tragedy that those 18 states can learn from.  I sure hope so.


  1. I understand the feeling on both sides of this issue, the mother is at panic and the operator tried to calm her down and get proper medical personnel to help her to no avial. The problem is in todays world the 911 operator and city could be liable is the mother is instructed and makes a mistake. It is tough, i do not envy your job.

  2. Anonymous10:23 AM EST

    It's a sad outcome. You can get a lot of mileage from a basic Red Cross First Aid course.

    While seconds count in an emergency, in reality it takes minutes for help to arrive. WE ALL need to be prepared. Parents, aunts, uncles, neighbors, sisters and brothers...

    Each second counts...

  3. I'm not sure if emergency dispatchers here are required to be trained in CPR but recently my DIL's father had a massive heart attack and the dispatcher gave her mother instructions on how to carry out CPR until the paramedics arrived three minutes later. Unfortunately it didn't help he died but at least her mother felt as though she was doing something to help. :(

  4. Excellent post, Linda, and some very sound advice too on the part of Matt Lauer! How many of us have ever taken a first aid course -you know, just the basics? Probably not near enough. One of the classes I opted to take in college was in Emergency Care and upon passing it, not only did I get three college credits but I also received certification in first aid that was good through the Red Cross I think for a year or something like that. Fortunately -for me and for others too -I never had to use the CPR part of that training (Working on the dummy, Annie, I tended to forget every thing) but that summer while taking that class, I had almost every other subject we covered in class happen to either a customer or staff member at the place where I was employed then -yes, even a snake bite! Just the fact of learning to stay calmer and assess a situation a bit, as taught by these courses, is a good thing to know too!

  5. Charlie - You are absolutely right. One of the things they teach us is that it's better to not provide any instruction at all if you don't have the right instructions. You can't just "freelance" lifesaving instructions over the phone to someone - the liability is huge.

    Lois - Exactly! Seconds save lives and if you as the person there with the patient can provide some help before the professionals arrive then the patient has more of a chance of recovery and survival.

    Akelamalu - A lot of Dispatchers and 999 Operators in England are certified under the same program that I am through the National Academies of Emergency Dispatch which is a great organization! As a matter of fact, I jokingly ask my boss if I can attend the dispatch conferences in the UK every year but always seem to get turned down!

    Jeni - My point exactly! You never know when that training may come in handy and - even though it may sound like I'm just reciting the Boy Scout motto - BE PREPARED is something everyone should be. Especially parents these days as kids can get into things in the blink of an eye and that blink can change lives forever or even end them.

  6. Basic CPR is not a difficult course to pass. I took this course every two years until I was promoted to management. It's essential in relaying what needs to be done while waiting for paramedics to arrive. What a sad thing here.

    Thank you for being one of the folks that stand between life/death while waiting for help to arrive.

    Have a terrific day Linda. Big hug. :)

  7. i know. and until i saw that i had no idea florida dispatchers did not have to have the training. sad. very sad.

    great post.

    smiles, bee

  8. Like Sandee said, CPR is not a difficult course to pass. I haven't done it yearly but I had to do it a couple times in HS and there are instructions posted here at work that I've read a hundred times while waiting for my lunch to heat up.

    That said, since it is so easy to pass, I don't see why 911 operators wouldn't be required to learn that at the very least. Sad to know I'm in one of the states where it is not required.

    As I have never had to call 911 nor never known or been around anyone who needed CPR, I would want a professional that could help me. Even if I know it inside and out, and even if I read the instructions daily, it does not matter when it's your child and panic sets in.

    Thanks for sharing! I'm going to start making sure I learn it better and tell others out there to do the same.

  9. Sandee - You're welcome! Not sure how I got here but I guess it's where I'm supposed to be!

    Bee - I was VERY surprised to see Florida on that list - especially considering the National Conference for the group that certifies us is held in Orlando A LOT!

    Vivasuzi - I was kind of surprised to learn that so many states didn't require dispatchers to be trained in CPR either as I've always had to be certified - even when I was a police dispatcher and not an emergency medical dispatcher.

  10. First of all, I could never do your job. I would either be crying for the person on the other end, or I would hang up on any difficult person.

    While it is very handy and worth while to have all operators know CPR, I'm concerned that now it will suddenly become a position that people can be sued. These are people trying to help. They are not the EMTs nor the Dr's.

    How have we become a society that doesn't take responsibility for our own actions?

    I feel so terrible for that Mother; but why didn't she know CPR? I know she's in pain and suffering. She's probably going over in her head what could have been different. If she hadn't let the child out of her sight etc.

    And I feel this laying the blame on the operator is just some way to alleviate some of the blame from herself. (when it's really no one's fault) children wander away just as soon as your head is turned.

    While it would be helpful for these operators to be trained; I don't believe it should be made into a federal mandatory requirement. I believe it should be the organizing company's requirement. Not a state or federal requirement. It shouldn't turn into something that these operators will be held liable.

    PS: On another note, I gave you an award on my blog ;)

  11. My MIL worked as an EMD for a short time. She said it was the hardest job she'd ever had and she was most definitely NOT cut out for it. It takes a very important set of skills to be able to perform this job to it's potential! My hats go off to you and others who undergo all of the training that you do in order to perform this job to the highest ability!

    Unfortunately, tragedies will occur no matter what sort of training occurs. No one can bring that baby back...

  12. Manicurists and Yoga Instructors are required to be licensed but 911 operators aren't?! That's just insane. Something should be done...

  13. A very infomative post, Linda. Itb has facts I didn't know.

  14. Way to go Linda. As a staff nurse in a local hospital, I have seen the results of emergency care. The quicker it starts, the better, whether it is given by a "pro" or a family member. Great post,

  15. How very sad for that family, but then again, folks are expecting OTHERS to help and blaming THEM when the outcome is not a good one.

    Thanks for this great public service blog. Dick and I both have taken CPR classes. Everyone should know this technique.

    Big hugs, honey...keep up the good work.

  16. Your suggestion about people learning basic first aid and CPR is certainly valid.

    I wonder something else. Would intensive public service spots help also? Don't you think it's important not just to tell people they can dial 911 and get help, but to explain how that help works and the things a caller can do to assist the patient prior to the arrival of professional help?

    For example, you explain very well that there are two dispatchers where you work. And you explain that while one of you is asking all the questions, the other one has likely dispatched help. Maybe if a caller had seen public service announcements explaining all that, it might help ratchet down some of the tension and excitement during a call.

    Of course, there has to be budget for that. And I guess no matter what you do, there are always going to be those who become so overwhelmed and frightened by an emergency that they just can't keep themselves under control.

    Sorry to ramble. I really appreciate when you write about emergency response and the issues you face. It reminds me that there is a person on the other end of the 911 call who is doing his/her best to help.

  17. Anonymous2:03 AM EST

    I'm shocked and VERY disturbed that our 911 dispatchers here in TX are so poorly trained.

    Thanks for sharing this story, Linda.

  18. this is a powerful and informative post Linda

  19. you know about the call gone bad that I had with 911...prompting us to buy a gun.

    when Gator woke us at 5am not breathing well...the only question I was asked by the operator was "Are you a nurse?" "yes" "the ambulance is on it's way."

    I'm guessing most folk don't answer the "what is your emergency" with "I have a 4 year old child with difficulty breathing, substernal and clavicular retractions, and nasal flaring"

    can't imagine why not......


Thanks for visiting!