CULTURAL SHIFT

by Josh McFadden

Since their creation 36 years ago, the Priority Dispatch System (PDS) protocols have revolutionized the way dispatchers do their jobs. With a standardized set of step-by-step instructions, dispatchers can effectively assess emergencies, guide callers through lifesaving techniques, and send the proper help to respond to dire situations.

From small beginnings, the protocols impact an enormous amount of people every day.

Available in 21 languages/dialects, the PDS has seen great success with its use spreading to 45 countries. With this growth, the International Academies of Emergency Dispatch (IAED) recognized the importance of keeping the protocols consistent, regardless of language. The Academy also realized, however, that facets of the protocols needed to be adjusted to match the culture of various countries, regions, and languages. In doing this, the Academy needed assurance that these cultural variations were absolutely accurate and necessary.

Thus, the IAED Cultural Committees were born.

How it all began

The genesis of the Cultural Committees can be traced to 1991 when Dr. Jeff Clawson enlisted the help of Registered Nurse Marie Leroux, of Montreal, Canada, to translate the protocols into French. Leroux was part of what would become the first Cultural Committee, a group that is composed of EMDs, doctors, paramedics, and EMTs.

Today, 12 Cultural Committees exist to address the need to take into account cultural differences between places across the world when updating medical, fire, or police protocols.

For example, did you know that Australia has more venomous snakes than any other continent on Earth—home to seven of the world’s 10 most dangerous snakes?1 Among these are the Eastern brown snake, the Western brown snake, the mainland tiger snake, and the inland taipan. You won’t find these fearsome reptiles anywhere else. 

Australians must also contend with other potentially dangerous animals such as jellyfish, stonefish, the highly venomous blue-ringed octopus, and a host of poisonous spiders.

Other issues are also considered when updating or creating protocols in additional languages and in other parts of the world. For example, on Medical Protocol 22: Inaccessible Incident/Other Entrapments (Non-Vehicle) in the North American English version, and in other language versions, Mudslide/Avalanche is a Determinant Descriptor. However, this is omitted in some language versions, such as the Malaysian Medical Protocol, because this country has no such threat.

On the European continent, it’s noteworthy to point out that due to the nature of its buildings, Germany has additional protocols on how to help people in structural fires get to safety. 

“Different instructions and codes are written to deal with the different problems on different continents,” said Irena Weight, Priority Dispatch Corp. (PDC) Director of Translations, Standards & Logic Design.

Weight said the committees play an integral role in the development and refining of the protocols. And the fact that the committees ensure the protocols are appropriate for the culture and the people who use and benefit from them, is greatly appreciated.

“Without the Cultural Committees, it would look like we were pushing an ‘American Thing’ on different cultures,” she said.

Weight further said that each cultural committee is created based on a need for protocol review to fit a specified geographical region and language/dialect. There is not a committee automatically created for every language/dialect in each discipline in which the protocols are translated, though this does happen in most cases. In some instances, a need for a committee arises after the translated protocol has been in use for many years.

Currently, Cultural Committees exist for the following regions/languages or dialects: 

•  Australia/New Zealand (English)

•  United Kingdom/Ireland (English)

•  Germany/Austria/Switzerland (German)

•  Italy/Switzerland (Italian)

•  Canada/Switzerland/France (French)

•  Spain/South and Central America/U.S. (Spanish)

•  Brazil/Portugal (Portuguese)

•  Netherlands/Belgium (Dutch)

•  China (Chinese)

•  Malaysia/Indonesia (Malay)

•  Middle East (Arabic)

•  Lithuania (Lithuanian)

Each committee is composed of experts in the field and culture they are representing. The Academy approves all Cultural Committee members.

“Committee members are recommended,” Weight said. “We find them as experts working in dispatch centers using our protocols. They do not serve for a term or any set amount of time. The number of committee members varies and can grow if needed.”

How it works

Adapting the protocols to specific cultures and countries begins with the core protocols—those written in North American English (NAE).

Anytime the Fire Priority Dispatch System (FPDS), the Medical Priority Dispatch System (MPDS), or the Police Priority Dispatch System (PPDS) is implemented into a new language or region, the Cultural Committee convenes to determine how the updates will affect that respective culture. Also, when the Academy releases a new NAE version, the Cultural Committees get together to confirm all changes and updates fit the language and culture. With the ultimate approval of the IAED Council of Standards, the Cultural Committees recommend culturally appropriate changes to their respective medical, fire, and police protocols. 

Depending on the nature, size, and scope of the updates, the Cultural Committee will either meet face to face, through Skype, or via email. No matter the form of communication, the Council of Standards is always involved. Ordinarily, it takes three to six months to release a language version after the Cultural Committee conducts its review.

“An expert from the Academy will go and lead the meeting,” Weight said. “Before the meeting, the changes get translated. Translators often attend the meetings as well.”

Culturally adapting the protocols, however, is not always a simple process.

Each Cultural Committee has a vested interest in ensuring the protocols coincide with an area’s customs, norms, and practices, as well as anything distinctive to the area’s physical environment. Naturally, the committee overseeing the protocols in Australia wants those protocols to include more detailed instructions about snake bite response and contact with jellyfish than would be included in the core North American English protocols where these animals are far less common, if not absent altogether. Other countries that use the IAED protocols don’t necessarily face the same challenges and therefore don’t need to address them in the protocols. 

At the same time, the Academy must maintain the integrity of the protocols and make sure each instruction is accurate. That is why final authorization rests with the Council of Standards.

“Sometimes other cultures won’t like the way something is written,” Weight said. “So the committee and the Academy have to discuss back and forth until they have the right information. The way something is written might not always sound elegant, but it’s written that way for a reason.”

After the committee members feel comfortable that the core protocol changes fit their country or area, and after the Council of Standards approves the changes, the protocols are published and made available to dispatchers.

All international dispatchers use ProQ, so after the changes are approved and made, dispatchers have the updated software at their disposal. But Weight said making country-specific adaptations to the software is not always cut and dried. Sometimes what looks good in the cardsets doesn’t flow logically in the software, so further tweaks are made.

“The protocol software can do logic rules, so sometimes what might seem like a good idea doesn’t fit in ProQA logic,” she said.

The protocols must not only be worded correctly for the dispatcher from a cultural standpoint, but the language must address the needs of the callers.

Leroux said the committees basically have a twofold mission.

“We give verification that the translation will be functional,” she said. “First, we make sure the protocols address the user—the EMD—and second, that they address the general public—everything that will be done with the caller. Both must be covered. We provide the highest quality of interaction with instructions and Key Questions. We make sure we address the caller and that everything will be clear.”

Leroux, who received an Emeritus Award for lifetime service to the Academy, began her career working on a health information telephone line. Today, she and about 10 other members work diligently on the French Cultural Committee to guarantee the protocols provide dispatchers, and by extension the public, with the information they need to respond effectively to emergencies.

“It’s very hard work, very challenging, and fun,” Leroux said. “When you go so much in-depth with a tool that is a standard, you become part of it. You cannot leave it; it cannot leave you.”

To begin with, Leroux said her Cultural Committee is focused on seeing whether the wording after translation is correct.

“The members of the Cultural Committee must understand their duty,” she said. “Initially, we’ll see if the language is proper. We find a balance of good language and syntax with purpose.”

One of the committee’s chief focuses is verifying that protocols are localized and include the proper language that is unique to the area. She said the French-speaking people of Quebec, Canada, use various expressions that differ even from the French that is spoken in France. Dispatchers must be aware of these locally used sayings and how to respond to them in their conversations with callers.

The French Cultural Committee carefully observes that the protocol translations use these expressions properly. Often, the North American English core version cannot be translated word for word because the expressions simply won’t make sense in other locations.

Leroux said the French-speaking protocols must also include commonly used and understood expressions by the public that might not necessarily be found in the core North American English protocols. For example, in MPDS Protocol 9: Cardiac or Respiratory Arrest/Death, there are instructions to the dispatcher on how to code certain volunteered statements from the caller regarding ineffective breathing. One such statement French-language dispatchers should look for is “Court après son souffle,” which directly translated into English means “Running after my breath.” Such an expression is nonsensical to English speakers, but it makes perfect sense to a French Canadian. The English equivalent in the protocol is “Barely breathing,” which, directly translated, would be “Respirant à peine,” but the French protocol uses the expression familiar to the local population.

There are even differences in language between the North American English, UK English, and Australia/New Zealand English protocols. For example, the Australian Cultural Committee members helped change the UK English that was in the Australian protocols to include words and phrases that were more common among Australians. These included changing Alert, Seizures, Lorry, and Articulated Lorry to the more Australian standard Completely Awake, Convulsions/Convulsing, Truck, and Semitrailer. Also, patients in the U.K. say they are “feeling poorly,” while in Australia, they say “feeling crook.” These changes are all reflected in the protocols.

Some protocol variances come because of differences to manmade structures. A prime example is in Germany, where an additional fire protocol has been created to address the uniqueness of the country’s buildings.

Many houses and buildings in Germany have wooden staircases, creating a significant concern that fires could spread even more rapidly. Additionally, a large percentage of the homes and buildings have wooden doors that usually prevent smoke and fire from getting inside the home. With these factors in mind, the German Fire Protocol has Protocol E, whereas the NAE counterpart does not. Protocol E directs dispatchers to keep callers inside the building when a fire is outside.

“We don’t want people going out of their apartment before they are sure the stairway is free of smoke and heat,” said Andre Baumann, Deputy Chief at Berlin Fire Department. “Therefore, people better stay where they are until we get them out. If the fire is in their apartment, we of course want them to leave and close the door behind them to make sure the fire can’t spread.”

Both Germany and neighboring Austria have substantially different equipment to fight fires with and thus employ different tactics to battle them. Recognizing this, the Cultural Committee has made the necessary adjustments to the German Fire Protocol by creating additional suffixes to address the source of the fire, not only the building.

“In the German and Austrian fire departments, there are no trucks like in the U.S.,” Baumann said. “The truck really is a turntable ladder, and that’s it. Firefighting and ventilation are done by the engine companies. So, some fire departments decide to skip the ladder for small buildings or add ladders for roof fires.”

In some cases, the Cultural Committees need to take into account differences in the actual dispatch centers. A prime example is in Italy, where most centers have the presence of a doctor to assist dispatchers and callers. After the EMD handles the call and sends the resources, the doctor will contact the caller if necessary to collect more information. The doctor may even conduct a conference call with poison control if the situation requires.

As the Priority Dispatch System protocols continue to be translated into more languages and are adopted in different countries, Cultural Committees will be formed to address the needs of the local population. Working in tandem with the Academy, the Cultural Committees are devoted to providing the tools dispatch centers need to most effectively communicate with callers and help resolve their life-threatening situations.

“The Cultural Committees are good groups of people,” Leroux said. “They’re very good at looking to see if they’ve covered every aspect of an issue.”

ABOUT THE AUTHOR :
Josh McFadden has more than 12 years’ experience in journalism and marketing writing. During his career, he has written about topics ranging from sports to biochemistry and just about everything in between.

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