Most communication centers have encountered frequent flyers; these are people who call 911 so many times—sometimes about trivial or odd matters—that emergency dispatchers know them by their first names.
These situations can be challenging for emergency dispatchers, but the real danger lies in not taking the frequent flyer’s calls seriously and downgrading—or worse, freelancing—a response that could endanger the caller. In particular, medical calls are where De Luca’s Law should reign supreme: EMDs will follow all protocols per se, avoiding freelance questioning or information unless it enhances, not replaces, the written protocol questions and scripts. (Figure #1)
While instances of freelancing medical calls are limited, they do happen and can prove deadly when the emergency dispatcher falls prey to what I call the Frequent Flyer Effect (FFE)—the point at which the frequency of calls/refusals for service associated with a person or event become so numerous that the emergency dispatcher allows them to negatively influence their behavior and by extension, the outcome of the incident.
The FFE turns a black-and-white situation (i.e., caller requests assistance and emergency dispatcher sends help) into a gray area (emergency dispatcher doubts the caller because he or she is a frequent flyer) by questioning the caller’s necessity for assistance, bypassing protocols, and creating a negative outcome. (Figure #2)
In January 2020, a 69-year-old man was having serious medical issues. He also had a history of refusing medical treatment. On Jan. 9, the first of five calls chronicling his troubles—including one from the patient himself—came into the 911 center. Two firefighters and a police officer responded, but he didn’t want to be transported.
The calls continued sporadically until Jan. 12 when a neighbor contacted 911 yet again and told an emergency dispatcher that the patient had had a stroke and provided the address. That should have been enough to process the call and dispatch help, but the emergency dispatcher balked at sending assistance immediately and engaged in a nearly eight-minute back-and-forth with the caller. Some of the exchange is shared below:
911 caller: “Ma’am, he’s had a stroke!”
Emergency dispatcher: “OK, sir, we can’t force ourselves on him. If he doesn’t want help, we can’t force ourselves on him.”
The caller becomes increasingly desperate.
911 caller: “Ma’am, he’s gonna die here.”
Emergency dispatcher: OK, so that’s why I’m saying you need to sit there and talk to him and explain to him why he needs help, but they won’t do it if he keeps saying no. He has to agree to have help.”
911 caller: “He won’t do that.”
Emergency dispatcher: “Well sir, then unfortunately there is nothing the fire department or police officers can do. They can’t force themselves on him. Does he have a doctor?”
The call ended shortly thereafter with no one dispatched to the patient’s residence. The following day the communication center received one more call regarding the patient from a neighbor who said, “You need to come up here and get this dead body.” The emergency dispatcher who handled the call was initially suspended; however, after an internal investigation she was subsequently terminated. A city official described the situation as “nothing short of a tragedy.” A tragedy that may have been avoided had the emergency dispatcher simply followed basic protocols.
The frustration that emergency dispatchers feel with frequent flyers is understandable, but that doesn’t mean protocols can be ignored in favor of expediency (or laziness) because of complaints coming from the same person or that person’s representatives. The simple rule that what comes into the dispatch center goes out of the dispatch center is a valid one. EMD Protocols keep emergency dispatchers on task to ensure that patients receive the correct level of help they need. De Luca’s Law keeps them honest.
