By Kevin Pagenkop, ENP
I grew up playing with Legos: the small, plastic bricks and shapes that when interlocked and pieced together built anything from spaceships, to dinosaurs, to helicopters, to fire engines. This Danish innovation was one of the staples of my childhood toy chest.
Each gift-giving holiday I would eagerly await the familiar-sized box that contained a number of pieces proportional to the abilities of my age. The printed instructions provided a step-by-step, brick-by-brick outline of how to create the object or theme of that particular Lego product. Inevitably, I would either lose the instructions or drop one of the small pieces into the heavy shag carpet of my childhood living room, never to be seen again. Decades later, I’d like to think that whomever purchased that property and remodeled it to his or her own preferences found every lost Lego brick, Star Wars lightsaber, and missing wheel from my Matchbox cars (when they were still made out of metal and detailed in toxic lead paint).
What was great about Legos was that even without the instructions, you were usually able to complete the figure. Each piece had a specific function: a wheel, a wing, a windshield; and when a pattern or theme could be identified, each individual piece could be combined to complete the whole. The more you played with Legos, the more you learned about the specific form and function of each piece and the easier it was to “fill in the blanks” of the lost instructions and complete the item anyway. The same was true when one piece or several pieces were lost. There was no need to throw the toy away or give up trying to assemble it; there was always value in having the majority of the pieces. Provided the essential elements were still in the box, something could be built.
This is similar to emergency calltaking. As there are a variety of different types of calls, there is no template provided that can be applied and followed for every incident. Without an instruction manual to follow step-by-step, dispatchers must apply their experience to interpret the information provided by the caller and try to “fill in the blanks” to get the full picture. The more tenured dispatchers have more experience they’ve locked away in their toy chest to pull out and apply when processing a call. Provided they have the majority of the essential pieces, the incident can still be handled, help sent en route, and assistance provided.
MPDS Chief Complaint Protocol 32: Unknown Problem (Man Down) is often utilized in situations where the dispatcher believes he or she does not have all of the information required to select a Chief Complaint Protocol. Case Entry Rule 6 clearly outlines the conditions that must be present for Protocol 32 to be appropriate. Usage is based on a significant lack of essential information rather than just missing one small piece. When dispatchers don’t obtain as much information as they would have liked, it doesn’t mean that the call should be thrown away or that “Unknown Problem” should be chosen by default. Just like Legos, the dispatcher should be able to combine the individual pieces to complete the whole.
Guessing, relying on perceptions or biases, and/or questioning the integrity of the callers is not the same as drawing on past experience to make critical decisions with incomplete information. If a box of Legos contained two wheels instead of the expected four, a bicycle or motorcycle could be considered in place of a car; however, a spaceship or dinosaur would not be supported by the fact that wheels, in any quantity, were present. If a caller advised that someone was unconscious or altered, it would not be appropriate to only infer intoxication, nor would it be appropriate to simply select “Man Down.” Take all of the signs, symptoms, and information into consideration and begin piecing each block together within the context of the situation.
Experience cannot be taught or replicated; therefore, a priority should be on retaining employees so they can be developed into dispatchers who have processed enough calls and put together enough puzzles that they have the experience to select an appropriate Chief Complaint Protocol, and successfully provide assistance even when they don’t have all of the pieces.