Jeff Clawson, M.D.
Interesting question: Is it okay, when using the Police Priority Dispatch System™, to also include the “journalistic” method of questioning, i.e., who, what, when, where, why, and how in the furtherance of their mission?
Answer from Dave Warner: The “why” and “how,” at face value, are obviously freelance and investigatory. Investigatory questions that are not crafted to elicit a special piece of information that, depending on the answer, would or could change a response (based on the agency’s priority level-based response mode), offer little to no value outside of satisfying an emergency dispatcher’s on-the-fly curiosity. In addition, these questions have the potential to create the very kind of issues and challenges for which agencies have implemented structured calltaking processes to avoid in the first place. Variance in the same questions asked between one emergency dispatcher and another, increased call processing times, incorrect coding, and poor customer service, are open game for errors when freelancing is allowed. This is not to say that additional questions should never be asked when using the Police Protocol. Those asked that then elicit a more concise answer, from a given caller to a specific protocol question, can and should be considered by the EPD when using the PPDS®.
For instance, when asking a caller for a suspect’s location (“Where’s the suspect now?”), a follow-up question (“Is he inside or outside of the 7-Eleven?”) may be of high importance to responders, and is certainly considered a protocol enhancement. A common point, when freelance questioning arises in PPDS, is often during Case Exit, particularly when keeping callers on the line. Keeping a caller on the line until officers arrive is practiced in many centers, for a variety of events. This might include a crime in progress, a domestic violence situation, or when a disturbance is likely to turn physical. This leads to the question, how can emergency dispatchers engage a caller in further conversation if they’re not allowed to freelance? Where a primary purpose of keeping callers on the line is to provide updated information to responders, emergency dispatchers should focus on clarifying the very things they’ve already asked. In order to effectively update responding officers of changing events, efforts to determine what’s currently happening should be our primary focus. A suspect’s current location, what he or she is doing or saying now, whether more people are gathering, determining if a caller remains safe, or possibly adding additional, enhanced descriptions might certainly be appropriate. Regardless of this clarifying interrogation, good customer service and appropriate caller management should remain an overarching priority. Reassuring a caller that help is on the way, and avoiding questions that could push a caller into a state of greater emotion, should be avoided. Our focus should always be on the here and now.
I’ve passed this on to the Academy folks for their feedback. The last thing I want to do is give you bad information. Doc, what say you? …
Police Program Administrator, Priority Dispatch Corp.™
Doc’s answer: This argument sounds like, as Yogi Berra once said, “Déjà vu, all over again,” when you state that EPD calltakers should be allowed to freelance in the “furtherance of their mission.” This is the exact same argument we experienced in the 1980s regarding the Medical Protocol, when it was routinely heard that EMT- or Paramedic-trained EMDs felt they could add “something more” to the protocol process by asking “a few more questions” as they saw fit. To this, I have routinely asked, “Geez, you must have invented some new science? Have you been holding out on us? Tell me please, what those ‘questions’ are, as we would like to put them in the protocol soon.”
In reality, questions aren’t the issue—objectives are. Currently, and for the last 39 years, these objectives in either the police, fire, or medical protocols are basically the same (although their relative importance may vary somewhat per discipline):
1) Determine the proper response configuration
2) Determine the presence of conditions requiring Pre-Arrival Instructions
3) Help the responders address the call (provide all needed information)
4) Provide safety for all those at the scene (patients, callers, bystanders, responders)
A KQ is simply a vehicle to satisfying the specific objective of the things needed to be known at the emergency dispatcher’s point in time. And as questions, these are only a vehicle to fully satisfying an objective—and if the current protocol questions don’t do that—then the protocol needs to be modified, or new questions need to be scripted carefully and put in place, to accomplish these objectives.
A freelance question (like a blind squirrel) might find a neat thing (aka, nut)—once in a while. But if that nut is important, the protocol should then include a question that attempts to identify that nut every time. Freelance questioning has been shown to be detrimental to keeping one’s eye on the ball (the collective objectives) during the very time-limited environment in which our 911 emergency dispatchers are currently forced to live. And the prime directive here is then not accomplished by doing a bunch of extraneous things. It’s like the surgeon who is heard saying, “Hey, I think I’ll cut that thing, and see what happens.” Maybe it’s okay to experiment on you … but not on me!
Often freelance questioning is not vertical, but lateral—meaning that it is generated off of an “interest” in the answer to a question, but doesn’t satisfy the next or other listed objectives (covered in the KQ list) per se.
Many years ago, a troubling process of unstructured interrogation was identified in which dispatchers applied their own questioning randomly until a “positive” answer was obtained. Upon making a “hit” (as these “positive” answers were first called 10 years ago) the emergency dispatcher, sensing they were “on the trail,” asked a series of related questions as one such case from a very calm young caller demonstrates (demographic questioning not relevant to understanding this call has been bypassed):
Caller #1: Um, hello, can I have you come over to my house?
Dispatch: What’s the problem?
Caller #1: She started throwing up in the night and then everybody tried to wake her up and she wouldn’t. She just kept snoring and just kept lying there and wouldn’t wake up.
Dispatch: Okay, who is this? Is this your sister or something?
Caller #1: No, it’s my mom.
Dispatch: It’s your mom? How old is your mother?
Caller #1: Um, she’s 48
Dispatch: And how old are you?
Caller #1: I’m 10.
Dispatch: Okay, do you know, she wasn’t throwing up blood was she?
Caller #1: I don’t know, let me see. Dad, was she throwing up blood?
Caller#1: No, just throw-up.
Dispatch: Okay, and you can’t, you can’t wake her up now, right?
Caller #1: Uh uh (no).
Dispatch: Has she been drinking tonight, do you know?
Caller #1: Yeah.
Dispatch: She has?
Caller #1: Uh huh (yes).
Dispatch: Does she get sick when she drinks very much?
Caller #1: Yeah.
Dispatch: Okay, we’ll have them right there, alright?
Caller #1: Okay.
(First call was terminated at this point. Sick Person ALPHA call assigned. BLS ambulance sent COLD.)
This case represents a consistently observed, risky pattern in unstructured interrogation (the “guidelines” approach). One added but irrelevant question (“Has she been drinking?”) leads to a process known, in medical dispatch terminology, as “side-cycling.” The emergency dispatcher here got off the main track, and, in this case, allowed a bias to creep into ultimate decision-making. In a “protocol” system, emergency dispatchers are prompted—in a verifiable, repeatable manner—to ask for information that they need to know, not what would merely be interesting to know. Such a system protects the emergency dispatcher from being swayed by personal bias, prejudice, and intolerance—as well as by anecdotal experiences and just plain curiosity.
Biases can, as the above case shows, cause a dispatcher practicing without a set structure, to “lead” a caller along inappropriate information-gathering pathways.
For the same reason lawyers are overruled when “leading” a witness, emergency dispatchers should not be allowed to introduce significant personal bias by concocting questions “as-they-go” (i.e., there must be a “reason” why the emergency dispatcher asked them). It has become apparent that such processes defeat the very basic philosophy of introducing consistency, quality assurance, and non-arbitrary appropriateness at dispatch.
Just letting our emergency dispatchers “ask away” isn’t the way to solve each call’s needs or to evolve a protocol forward. If asking something “else” is that important, simply identify the dispatch objective that the current protocol is missing—including when and why—and submit a formal Proposal for Change to the Academy. Once it, and its supporting rationale, passes the required muster by IAED™ experts that are doing this every day (the Police, Fire, and Medical Councils of Standards), it will then be formally added to the protocol—guaranteed. Remember the old saying that “a correct protocol never has a bad hair day” or, more specifically, the protocol never forgets to determine the required information needed to satisfy each of the required objectives—on every call … but only if that protocol process is actually used and used correctly.
My “question” back then is, do you understand this whole thing a bit better now? Since you are an Academy Instructor, I sincerely hope that you have learned something more about the core philosophy of structured calltaking and the Emergency Priority Dispatch System.
When submitting a PFC, please always do the following:
1) Base it on actual use of the current protocol—not what you surmise it will, or won’t, do.
2) Include the objective (modified or new) needed to be satisfied for your proposed change.
3) Add any real case reports, audios, data, studies, or real examples demonstrating what is missing, or needs fixing, as explained above.
As we say, there are a million ways to practice structured calltaking, and more specifically the various disciplines of priority dispatching—and this is but one of them. But it is the only one that is built, and evolves, on a scientific method of input, data, rationale, studies, and experience from all users—the world’s biggest protocol “user group.” That’s why Unified Protocols, very similar to the AHA’s CPR, BLS, and ACLS protocols, are so clearly maintained this way and move forward on evaluated input, real examples, and studied, if not published, data.
Jeff Clawson, M.D.
Division of Research, Standards, and Academics