CAUTION AND PROTOCOL REQUIRED

By Audrey Fraizer

Sometimes, what a caller tells a dispatcher is not explicitly stated, as much as it is implied. Sometimes, it takes reading between the lines.

“As a dispatcher, you just don’t know what is going to happen, and it’s difficult at best, at times, to determine from what the caller tells us,” said Tracy Deitschman, EMD, EFD, during her NAVIGATOR 2015 presentation, “It’s the Law—Five Laws of Responders.” “Never get complacent, thinking, ‘This is just another routine call.’ Listen carefully because if you don’t, that’s when bad things do happen.”

While prevention is often 100 percent hindsight, dispatchers do have tools at their disposal to better protect responders and bystanders in real-time, including the International Academies of Emergency Dispatch (IAED) protocols, training, and now the five laws that encapsulate Pre- and Post-Arrival Instructions, as laid out by Deitschman, Record and Communication Manager, San Jose State University Police Department, and former San Jose Fire Department dispatcher (24 years). “I’m so glad we have the protocols; when I started, the one thing we could say was, ‘Help is on the way,’” she said.

Five Laws of Responders

Deitschman’s five laws correspond to the dispatcher’s role as the “first, first responder” and the ability to make the difference between life and death through the use of specialized skills and equipment to minimize risk. The laws can apply to EMDs, EPDs, and EFDs, although Deitschman’s presentation highlighted their application to the Fire Priority Dispatch System (FPDS ) and the EFD. Here are the five laws primarily based on laws found in the protocols:

1. Don’t take more victims to the scene.

2. Don’t get it on you or even touch it.

3. If there is more than one unconscious patient on-scene, there may be scene safety implications.

4. All electricity goes to the ground.

5. What you don’t know can kill you.

First Law:

Don’t take more victims to the scene.

Bystanders quick to react and responders lacking on-scene information can lead to a domino effect of catastrophe, turning a single incident into a mass casualty incident. This is a principle that applies to several emergencies scripted in the FPDS.

For example, a 16-year-old playing fetch with his dog along the coast of Northern California led to the death of three members of his family in November 2012. The dog was swept up by a wave; the teen jumped into the water to save the dog; the boy’s father went next to help his son; and the mother soon followed him. Only the dog survived.

While it’s easy to understand why the incident turned tragic, Protocol 72: Water Rescue/Sinking Vehicle/Vehicle in Floodwater could have possibly saved lives through PDI-b: “Listen carefully, this could be a very dangerous situation. Do not go in the water/mud or out onto the ice” if someone had called 911 and relayed instructions prior to the family’s fatal chain reaction. Protocol A-4: Water Rescue, Person in Water provides instructions to safeguard bystanders and the people in the water:

• Have someone constantly maintain direct sight of the person or the last spot s/he was seen.

Do not go in the water.

• If it’s safe to do so, throw a floatable object out to the person for her/him to hold on to.

In addition, a Determinant Code added to FPDS v6.0—72-D-8 Surf rescue—allows fire departments to assign a separate response and resource allocation for the rescue of people caught by incoming waves on a seashore or reef. Three new suffixes classify the number injured: M = Multiple-person rescue; X = Single injured person; Y = Multiple injured persons.

Second Law:

Don’t get it on you or even touch it.

Once again, the protocols come heavily into play, particularly in Protocol 61: HAZMAT. Protocol 61 includes two new Determinant Descriptors, corresponding Rules, and a new DLS Link that could help to avoid the following scenario from occurring in the aftermath of a chemical suicide, which in this case, happened in Lowell, Mass., in June 2015:

A man has died in a possible suicide involving a chemical gas, which injured seven responders trying to save the man, Lowell police said today in a statement. “Early indications are the death may be a suicide involving a male who has been the subject of domestic issues,” Lowell Police said. Captain Timothy Crowley, a spokesman for the department, said a state fire marshal and hazardous material personnel are at the scene on Rock Street and will soon determine what the gas was. “The smell was pretty strong,” Crowley said of the scene. “Officers were hit by it down the block.” Crowley was not at the scene and did not know what the gas smelled like. Four officers, a paramedic, and two EMTs were among 11 people hospitalized after the incident. Four of the building’s residents sent for evaluation are not initially believed to be injured.1

The new Determinant Codes 61-D-4 “UNCONTAINED chemical suicide” and 61-C-3 “CONTAINEDchemical suicide” address risks associated with hazardous chemicals and allocate the appropriate resources. Two Rules were also added to identify the Determinant Descriptor appropriate for the incident:

• Determinant Code 61-D-4 refers to “Chemical suicide situations in which the vehicle or room has been opened (no longer sealed).”

• Determinant Code 61-C-3 refers to “Chemical suicide situations in which the vehicle or room is still closed (sealed).”

The DLS Link, Chemical Suicide—D-1, directs the EFD to a new PAI Protocol D: Chemical Suicide. The PAI Protocol instructs the caller on what to do in the event of discovering a chemical suicide in a vehicle, building, or outside. The Protocol was added to FPDS v6.0 due to increased reports of chemical suicide and the urgency to protect the caller and bystanders from further exposure or contamination.

Protocol 61: HAZMAT also contains an Additional Information section on chemical suicide that provides background on the dangers of exposure to hazardous chemical mixtures and common indicators that aid in recognizing the scene of a chemical suicide.

Third Law:

If there is more than one unconscious patient on scene, there may be scene safety implications.

Several FPDS Protocols indicate the potential of broader safety implications, including Protocol 52: Alarms, Protocol 55: Electrical Hazard, and Protocol 61. Alarms related to possible carbon monoxide (CO) poisoning are covered in Protocol 52, and the medical consequences should be handled using the Medical Priority Dispatch System (MPDS).

Carbon monoxide is an odorless, colorless gas produced when cars, small engines, stoves, furnaces, and other devices burn fossil fuel. CO poisoning can cause sudden illness and death, and, each year, CO poisoning kills an average of 430 people in the U.S.2

When responding to a CO alarm, the priority should be the safety of all individuals, including the would-be rescuers since, as Deitschman said, “Anyone trying to drag out people affected by CO poisoning might get asphyxiated in the process.”

The last sentence of PDI-d in Protocol 52 was revised in FPDS v6.0 to instruct the caller to “Leave the building/area immediately (and leave the door open)” to prevent further exposure and begin ventilation, if applicable. Two suffixes—X = CO/Industrial gas with single sick person and Y = CO/Industrial gas with multiple sick persons—were added to allow fire departments to differentiate their responses accordingly.

Fourth Law:

All electricity goes to the ground.

In the late evening of Aug. 22, 2013, two female good Samaritans coming from different directions jumped into water pooling curbside and into the road in an effort to save a driver who had crashed his car into a light pole and fire hydrant. The hydrant had burst, shooting water into the air, and unbeknown to the women, the gushing water pooled underneath the vehicle concealed the light pole’s exposed electrical wires, sending 7,000 volts pulsating through the water.

Five others, ranging in ages from 19 to 57, followed, and in their attempts to save the women were electrically shocked. The Good Samaritan rescuers died; the driver survived.

The women were electrocuted prior to the call connecting to 911. Fifty-five firefighters were dispatched to the scene, securing the area and treating victims.

“My heart aches for those two women,” Deitschman said. “Their doing the right thing resulted in tragedy. No one could see the vehicle was sitting on top of a light pole. This raises a question for dispatchers. If there is any question as to safety, is it wrong to provide PDIs for something you might suspect?”

The answer is found in Protocol 55, and, in this incident, it is dependent on information relayed or indicated by the caller (i.e., the downed light pole).

PDI-c in Protocol 55 raises awareness of the electrical risks and electrified water and PDI-d cautions: “Do not touch any unconscious people or anything touching the electrical hazard.”

According to Rule 4 in Protocol 55, and corresponding to Deitschman’s Fourth Law: “When an electrical wire is down but not ARCING, the wire as well as the ground are considered dangerousbecause wires can cause the ground to become charged.”

New to Protocol 55 is an “All dispatch codes” send point added after Key Question 3 (“Is waterinvolved with or near the hazard?”) with the “Send & return to questioning” symbol. Two suffixes—X = Single injured person and Y = Multiple injured persons—were added to give fire departments the ability to differentiate responses accordingly.

“It’s great we have the bystanders who want to help,” Deitschman said. “But we need the PDIs to keep them out of harm’s way.”

Fifth Law:

What you don’t know can kill you.

The fifth law can apply to “absolutely anything,” Deitschman said. “It could be walking into a meth lab, answering an alarm—anything.”

In the example Deitschman provided, the incident involved firefighters going to the scene of a house fire in upstate New York on Christmas Eve 2012. The man believed to have started the fire waited in sniper position, shooting four firefighters and killing two of them upon their arrival to extinguish the flames. One of the dead firefighters was also a 911 dispatcher.

While dispatch had no indication of the suspect in hiding—who later died from a self-inflicted gunshot wound—the information came in immediately after the first shots were fired. The wounded firefighter speaking over the scanner reported two possible DOAs, stopping firefighters from extinguishing the blaze until SWAT arrived and evacuated other people in the neighborhood.

The incident emphasizes the importance of timely updates in dispatch, Deitschman said.

“Protocol does help us provide responders with better updates, and if you feel something is not right, let them know,” Deitschman said. “It’s our job to deliver all the important information as quickly as we can.”

Sources: 

1 McMahon S. “Seven injured trying to save man from possible suicide by chemical gas.” Boston.com. 2015; June 15. http://www.boston.com/news/local/massachusetts/2015/06/11/chemical-gas-s…. html (accessed Nov. 6, 2015).

2 “QuickStats: Average Annual Number of Deaths and Death Rates from Unintentional Related Carbon Monoxide Poisoning.” Centers for Disease Control and Prevention. 2015; Jan. 24. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6303a6.htm (accessed Nov. 6, 2015).

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