Multidisciplinary Mystification

Becca Barrus

When I was hired by the International Academies of Emergency Dispatch® (IAED), I knew next to nothing about emergency dispatch, much less about the Priority Dispatch System(PDS). Although I was a writer, I wasn’t familiar with the protocols, so I decided that it was probably best to become acquainted with them the best way I knew how: running fictional scenarios through them.

I picked out key scenes from my favorite books, movies, and TV shows and tried to figure out which protocol would adequately deal with them. The Baudelaire mansion being burned down, thus beginning “A Series of Unfortunate Events”? Simple. Fire Priority Dispatch System(FPDS®) Protocol 69: Structure Fire. Cher Horowitz in “Clueless” getting mugged at gunpoint in a gas station parking lot on the way back from a party in Sun Valley? Like, duh. Police Priority Dispatch System (PPDS®) Protocol 126: Robbery/Carjacking. Ron Swanson in “Parks and Recreation” not being able to move because he threw out his back? Child’s play. Medical Priority Dispatch System (MPDS®) Protocol 5: Back Pain (Non-Traumatic or Non-Recent Trauma).

But when I got to Amy March falling through the ice of the skating pond in “Little Women,” I was stumped. There are a multitude of protocols that could be used: MPDS Protocol 14: Drowning/Near Drowning/Scuba Diving Accident; MPDS Protocol 20: Heat/Cold Exposure; and FPDS Protocol 72: Water Rescue/Sinking Vehicle/Vehicle in Floodwater. Would sending the fire department there provide adequate medical care? The water was, after all, freezing, so hypothermia is something to take into consideration. But if I only sent an ambulance, what if they couldn’t get her out of the water? If the nearest center only has either MPDS or FPDS, obviously you would use the one you have. But if you have both? Or all three?

That led me to spiral into a slew of logistical questions such as, “Are emergency dispatchers in those centers tied to one discipline or do they have flexibility?”

Welcome to the decidedly non-fictional world of multidisciplinary communication centers.

Decisions, decisions

Who decides which discipline should be used? Does the caller decide or is it up to the emergency dispatcher? Obviously, if the caller phones the non-emergency police or fire line, it will be handled by the respective disciplines, but what if it goes straight to the emergency line?

“We tried it both ways,” said Laurie Wilson-Bell, the Operations Manager of Salt Lake City 911 (Salt Lake City, Utah, USA). The center tried having emergency dispatchers answer the phone with “911, do you need police, fire, or medical?” but they got enough callers misdiagnosing their own problems (like asking for medical when really they needed police) that they knew they needed to do something else.

“Now we start with ‘Tell me exactly what happened,’” said Leslie Crockett, SLC 911’s Quality Assurance Supervisor. That allows the emergency dispatcher to get enough information on the incident to know precisely which discipline to use.

And if it’s a call that requires more than one discipline, like a lightning strike, an assault, a suspicious package, an explosion, a suicide attempt, or a traffic accident? Every one of these incidents could be handled by at least two disciplines, if not all three. At SLC 911, the emergency dispatcher who answers the call has the choice to stay with the call from start to finish and switch between disciplines or take care of one discipline and then send it to whoever is handling the other discipline.

A high traffic topic

Because traffic incidents are among the most common calls communication centers receive and because there is a protocol in each discipline that handles traffic incidents, the Academy conducted a study to find out which discipline communication centers use (or use first) and why. In the most recent issue of the “Annals of Emergency Dispatch & Response,” there’s an article by Chris Knight about just that.

Although the sample size was relatively small, the findings showed that “selections were almost exactly evenly split.” Neither police nor fire nor medical was significantly favored over its counterparts when it came to reporting traffic accidents. The article goes on to say that “a majority of emergency dispatchers use agency policies and/or interrogation at Case Entry to decide which protocol discipline to launch and use to process traffic accident calls.”1 In other words, it depends. Sometimes it’s the emergency dispatcher who decides which discipline to use, and sometimes the choice is directed by agency policy.

Heather Hedgcock, Quality Assurance Coordinator for Manatee County Emergency Communications Center (Bradenton, Florida, USA), said that in her center, they have a policy that helps determine which discipline to use based on information gathered before they start Case Entry.

“We ask if anyone needs an ambulance,” she said. “If the answer is yes, we use medical. “If the answer is no, we ask if there is a fire or a chemical hazard. If the answer is yes, we use fire. If the caller answers no to both questions, we use police and send highway patrol.”

Stirling Williams, Operations Manager for Boone County Joint Communications (Columbia, Missouri, USA), said that they primarily use police to handle traffic incidents.

Wilson-Bell and Crockett said that their center uses MPDS Protocol 29: Traffic/Transportation Incident for all calls reporting a traffic incident where someone is injured.

Jennifer Osborn, Quality Assurance and Compliance Specialist at Fayetteville Police Department (Fayetteville, North Carolina, USA), said that they also ask about injuries. If someone is injured, they proceed with MPDS Protocol 29. If the only damage incurred is property damage, the emergency dispatcher will proceed with PPDS 131: Traffic/Transportation Incident (Crash).

These responses square with what the study found: “Factors influencing the decision are the presence or absence of injuries, the need for special rescue operations or specialized response vehicles, and the presence of on-scene hazards or scene safety concerns.” Every multidisciplinary center tailors their own policy regarding response to traffic incidents according to the needs of the call.

Obviously, this doesn’t just apply to traffic incidents. Communication centers use that kind of filter for all calls that require more than one discipline. It’s all part of a multidisciplinary center’s daily balancing act.

Cross-training: It’s not just for the gym anymore

There is something to be said about the depth of knowledge and experience that emergency dispatchers at single-discipline centers have. It’s a given fact that the more you focus on and use a skill, the stronger it gets—protocol is no exception. However, the idiom, “jack of all trades, master of none” doesn’t quite fit for either centers or emergency dispatchers that handle multiple disciplines.

It varies from center to center, but generally emergency dispatchers in multidisciplinary centers are cross-trained. That is, they can sit down and field fire, medical, or police calls with relative comfort.

At Boone County, all of the emergency dispatchers are cross-trained, and everyone can do calltaker and dispatch functions. Manatee County is the same—all of their emergency dispatchers are cross-trained and certified in all three disciplines. For most calls, whoever answers the call will be the one to dispatch it. The city of Bradenton dispatches their own calls for police and fire, and if someone calling within the city limits gives Manatee County a call, the emergency dispatcher will transfer it to the city.

The emergency dispatchers at SLC 911 either rotate between fire and medical calls or mostly stick to police calls. Like Boone and Manatee, though, everyone is triple-certified and can step up to the plate should the emergency dispatchers in one discipline get overwhelmed.

Fayetteville Police Department divides their emergency dispatchers into two groups: Telecommunicator I and Telecommunicator II. Those with the Telecommunicator II designation are certified on both police and fire dispatch and rotate through the 3 police district channels and 2 fire service channels. Those in the Telecommunicator I group are new hires or those that choose to remain on fire dispatch. All of their telecommunicators rotate through calltaking and assist with calltaking when their dispatch channel is not busy.

One unique thing about Fayetteville’s 911 center is that they process calls for all three disciplines, but they only dispatch fire and police. They field medical calls and send them to the county agency to be dispatched to the medic units.

Loose lips sink PSAPs

As in other sectors of public service, confidentiality is an important issue for communication centers. Add in the fact that privacy standards vary from police to medical to fire records, and multidisciplinary centers may be staring down the barrel of a fully-fledged headache. No one wants their center to be in the news because one of their emergency dispatchers took a picture of their computer screen—which listed the client’s name, address, and details of the call—and shared it on social media, along with an unflattering quip about the caller. Neither do they want to be in hot water because one of their emergency dispatchers gave out an assault victim’s name to the press.

Most multidisciplinary centers have a confidentiality policy that covers the complexities of all three disciplines. A solid place to start is by treating every call with high confidentiality, both inside and outside of the center, and to ensure that any stories regarding calls fielded in the center are handled by the communication center manager or public information officer.

One of the things emergency dispatchers have to remember at the SLC 911 center is that it’s OK to say the name of a suspect over the police radio, but they cannot give the name of a patient over medical radio. Another thing they can’t give out over the phone is a license plate number.

“People will call in to report that their vehicle has been stolen, but since we can’t verify that it’s them over the phone, we process the fact that it’s been stolen, but we don’t tell them the number if they can’t remember it. We then use their name to look up the license plate number and send it off to the police,” said Wilson-Bell. She explained that this policy exists as part of the effort to keep officers safe. “The officers need to know if they’re dealing with a stolen vehicle if they happen to pull the suspect over.”

The Fayetteville Police Department has also made some adjustments to their privacy policy. Osborn said that her agency and the police department have “decided that it is in the best interest of victims of criminal/sexual assaults to withhold their name from a call. For this reason, when our agency is processing these types of calls, we do not document this information.”

Walking the line between giving out pertinent information to those who need it to do their jobs and withholding it from people who don’t can be a tough act, especially in places where 911 calls are considered public records (like Florida). But it looks like multidisciplinary centers have it figured out.

Let’s talk about stress, baby

It goes without saying that stress is one of the constants in the life of an emergency dispatcher. But do Emergency Medical Dispatchers (EMDs) have higher levels of stress than Emergency Fire Dispatchers (EFDs) or Emergency Police Dispatchers (EPDs)? The Academy hasn’t conducted any studies on the subject (yet), but Hedgcock, Osborn, Wilson-Bell, and Crockett all had something to say on the matter.

“The kinds of stress are just different,” Hedgcock said. “Someone giving CPR instructions over the phone is a different kind of stress than someone taking a domestic disturbance call.” Overall, she said that medical calls are somewhat predictable, whereas violent situations involving police response are very unpredictable. Police calls are “a different monster completely.”

While Osborn hasn’t noticed different stress levels between the calltaking aspects of the disciplines in her own center, she has noticed that on the dispatch side, the EPDs are definitely more stressed than the EFDs. She also noted that the workload is different for each function that exists in the dispatch center, which naturally causes different kinds of stress.

Wilson-Bell and Crockett agreed that the stress levels between disciplines differ, although at their center, the more stressful calls tend to be Police and Fire.

“Fire stress goes more in waves,” Crockett said. When an incident requiring use of the Fire Protocol—such as a rollover—comes into SLC 911, it becomes a group effort. The EFDs who are handling the call are on the radio with the firefighters as the incident is going down, while the other emergency dispatchers in the center handle the influx of calls reporting the incident as well as those reporting unrelated incidents.

“Police stress is more constant,” said Wilson-Bell, who worked as a police dispatcher for 16 years. “The duties are handled from individual to individual instead of sharing the stress altogether.” In other words, the caller reports to the EPD, and then the EPD sends the information to the police officer, who takes care of it from there. The EPD isn’t necessarily along for the whole process, which generates a distinct kind of stress as opposed to the stress that is generated from beginning of the call from start to finish.

The ice of March

To end, let’s go back to the fictional scenario of little Amy March falling through the ice into a freezing pond and see how a multidisciplinary center would handle it.

Amy’s older sister Jo, calls the local communication center on the telephone (which won’t be invented for another 10 years) and tells the emergency dispatcher—let’s call her Mary—what happened.

Mary is currently taking medical calls, although she has access to the MPDS, FPDS, and PPDS (the oldest of which won’t be invented for another 110 years) and has to decide whether to use the MPDS or FPDS for this particular call. She decides that getting Amy out of the water is the first priority and dispatches the call to the fire department, since they have the equipment best suited to perform such a rescue. After the fire department has been dispatched, Mary also dispatches an ambulance to the scene to handle Amy’s inevitable symptoms of cold exposure when she is pulled out of the water.

Mary, the fictional emergency dispatcher, stays on the phone with Jo until the first responders arrive, then goes back to taking medical calls (mostly complaints involving typhoid and cholera).

After all, it’s all in a day’s work for an emergency dispatcher at a multidisciplinary center.

Becca’s writing background is primarily in creative writing, although she didn’t have a specific emphasis for her Bachelor’s Degree in English at Brigham Young University. She worked as a ghostwriter for two years where she wrote four novels and edited several more.

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