Is Anyone Listening?

Is anyone listening? Lisa Heller, a brilliant young singer from Connecticut (USA), soulfully asks this question as she describes her own crisis for those who are, indeed, listening to the lyrics of one of her most popular songs. Most of us who have worked a while in the emergency dispatch profession can relate.

Of course, it is widely popular to see ourselves as “lifesavers”—the first, first responders who can revive patients in cardiac or respiratory arrest, save choking babies, successfully guide people trapped in sinking vehicles to escape, and seamlessly instruct callers to birth new lives over the phone by using our sophisticated training, fancy technology, and detailed, comprehensive protocols from the latest release of ProQA® software. And indeed, for many of you, this may be the most satisfying part of your job.

Consider, however, that the lifesaving component of being an Emergency Dispatcher is only a small fraction of what you do. The reality is that the vast majority of emergency calltaking for the seasoned Emergency Dispatcher—is relatively routine. Indeed, most of the emergency dispatch data tells us that less than 10% of all cases involve some sort of Pre-Arrival Instructions (PAIs)—those instructions reserved for lifesaving circumstances.

So, what is the best way to approach the other 90-plus percent of the calls we handle knowing that we can still communicate well and make a difference in those cases? After all, who hasn’t asked themselves after a long, exhausting shift: Why do we really bother giving those routine Post-Dispatch Instructions (PDIs) to so many callers when that stuff is not going to save a life and may not always get the attention of our callers, patients, or victims?

One answer to this question comes to us from recent literature written for the medical profession on a successful approach to patient care: the concept of “continuity of care.” This concept is important enough that we shouldn’t consider it only for medical cases in emergency services, but it can and should be extended to police and fire cases as well.

In health care, continuity of care can be defined both in terms of the patient’s experience (i.e., how well the patient feels they were treated) and in clinical quality—how well the sequence of patient services is delivered in the most effective, efficient way, according to clinical best practices, through “integration, coordination and the sharing of information between different providers.”¹

As patients’ health care needs are now rarely met by a single professional, multidimensional models of continuity have had to be developed to accommodate the possibility of achieving both ideals simultaneously. Continuity of care may, therefore, be viewed from the perspective of either patient or provider.²

In emergency dispatch, we should think about continuity of care in the same way. Caller/patient/victim experience must be considered, as well as the overall management of the case using public safety best practices, starting with the calltaker gathering information, continuing with caller instructions, then providing field responder assistance, and ultimately ending with case outcome or resolution.

By viewing public safety events as an unbroken, well-integrated operation, as opposed to a series of separate tasks performed by different people, the importance of even the most routine PDIs becomes apparent. PDIs serve to prepare the caller/patient/victim for the next steps, allowing for a more seamless delivery of the upcoming step in the service.

Take this simple PDI, provided for medical calls whenever safe and possible, “I’m sending the paramedics to help you now. Stay on the line and I’ll tell you exactly what to do next.” Not only does this statement prepare the caller for the next stage of the continuum of care (bystander care), but it transforms the caller from a passive reporter of information into an active participant in the case. It signals to the caller that not only is it OK for them to help, but it’s expected—the caller is now a helper and a patient advocate. Every statement you make from that moment on gives the caller the authority and permission to help. Studies done on helping behavior in an emergency demonstrate that knowledge, permission from an authority, and emotional arousal are all factors in the caller’s willingness to help.^3,4

The Emergency Dispatcher can impact every one of these factors by providing PDIs. And we never know when that help will be most needed. What we do know is that some routine cases can become more serious and more of a true emergency as time goes by, and it can happen in minutes or even seconds.

Also, we know that safety can be compromised by the caller’s own actions when they don’t have the knowledge that you have. For example, more than one law enforcement case has gone horribly wrong when callers were not given the following PDI: “Do not approach officers with any weapons in your hands, keep your hands visible at all times, and follow their commands.”⁵

As an Emergency Dispatcher, always think about the impact of your words. You are the first, first responder every time you answer the emergency line whether or not the case sounds routine, whether or not you provide lifesaving instructions, and whether or not those routine PDIs feel repetitive and rote. Either way, you are the voice of authority to all callers until trained field responders arrive.

As such, you have the unique ability to influence each case by enlisting the caller’s cooperation in the continuum of care at a key moment in the case—even when things may seem reasonably calm and under wraps. Just imagine how reassuring it can be to a pensive caller, anxiously awaiting the arrival of an ambulance to attend to their sick family member, to simply hear these words: “If she gets worse in any way, call us back immediately for further instructions.”

 By paying attention to providing seemingly simple statements in the PDIs, we can ensure that our callers, our public, and our communities get the best service we can offer. And we can be more secure in the knowledge that someone is always listening.

 

Sources

1. Gulliford M, Naithani S, Morgan M. “What is 'continuity of care'?” PubMed. Journal of Health Services Research & Policy. 2006; October. https://pubmed.ncbi.nlm.nih.gov/17018200/ (accessed May 19, 2023).

2. See note 1.

3. Jakubowski A, Kunins HV, Huxley-Reicher Z, Siegler A. “Knowledge of the 911 Good Samaritan Law and 911-calling behavior of overdose witnesses.” PubMed. Substance Abuse. 2018. https://pubmed.ncbi.nlm.nih.gov/28972445/ (accessed May 19, 2023).

4. Amato PR. “Emotional Arousal and Helping Behavior in a Real-Life Emergency.” Wiley Online Library. Journal of Applied Social Psychology. 1986; October. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1559-1816.1986.tb01164.x (accessed May 19, 2023).

5. Scott G, Warner D. “Case Report: Armed Caller Post-Dispatch Instructions.” Annals of Emergency Dispatch & Response. 2021; Volume 9 (Issue 3). Page 19.