No Place Like Home


Image courtesy Siegfried Weinert, MSc. and Susanne Ottendorfer, M.D

Audrey Fraizer

Hurricanes, earthquakes, wildfires, and spreading illness like the coronavirus pandemic mean different working arrangements depending on the profession. For emergency dispatchers, the unpredictability of what can happen next in populations and the environment puts the kibosh on working anyplace other than on-site.

But that’s not the case anymore.

Remote work for emergency dispatchers isn’t out of the question, considering web-based interfaces with CAD systems, along with mobile capabilities easing the transition and feasibility of calltaking and dispatching from center to home.

And two centers—144 Notruf Niederösterreich (Lower Austria) and the Department of Emergency & Customer Communication, Alexandria, Virginia (USA)—are proving just how well a home office works for calltaking personnel.

144 Notruf Niederösterreich (144 Notruf NÖ)

Christof Constantin Chwojka is a major proponent of working from home. In less time than it takes to find Austria on a world map, the managing director of Lower Austria’s 144 Notruf NÖ can list the advantages of a home office and wrap it all up in one succinct bit of reasoning.

“It’s a waste of time for the people driving in,” he said. “The systems they use are exactly the same. Calltakers sitting in the home office do exactly what they would do sitting in the communication center. There is no difference.”

144 Notruf NÖ is the only medical dispatch agency in Lower Austria, and as Chwojka explains, 144 Notruf NÖ is one center in four rooms or branches. The branches are connected in a central system and each is situated in one of Lower Austria’s four regions: one in St. Pölten, the state’s capital, one in Korneuburg, one in Mödling, and one in Zwettl.

The branches accommodate different kinds of calltakers. The calltakers and dispatchers have complementary functions.

Calltakers are specialized in handling emergency lines (144 for a medical emergency) and non-emergency lines to include the after-hours physician hotline (141), patient transport service numbers, and the telephone health advice service (1450). During the day shift, 24 calltakers and six Emergency Communication Nurses (ECNs) work at each of the four branches. Three calltakers and one ECN work the 12-hour night shift. The number of staff members depends on the call volume, which increases during the daytime.

Dispatchers coordinate resources and send response according to patient needs. The number and variety of resources they allocate staggers the abilities of all but the proficient multitasker: 221 ambulance stations, 889 EMS vehicles, 47 mountain rescue teams, 15 ski patrols, and 835 first responder teams. The list is not definitive. The number of dispatchers coordinating resources varies by shift. During the 12-hour day shift, 12 dispatchers are distributed among the four branches. At night, there is a minimum of three dispatchers. A supervisor is always on shift seven days a week.

From start to ongoing

Tragedy predicated the transition to home office, Chwojka said. Two calltakers killed in separate accidents while driving home after working 12-hour shifts was not only a loss on a personal level, but a wake-up call to charting a course in remote communications.

“I couldn’t let this happen again,” Chwojka said. “We had to change the culture from reporting to a comm. center to the ability of doing the same work from home.”

The pilot project (2017) allowed home offices for EMD-certified calltakers traveling long distances to work, quality assurance reviewers, and back office and IT staff. Numbers steadily increased and surged in response to the coronavirus pandemic. As of May 2020, 105 calltakers and ECNs out of a total of 160 calltakers and ECNs work from a home office. Dispatchers continue to work from the centers, although technology could eventually allow them the same option.

A home office saves the drive and, added to transportation safety, protects health and well-being, a point that Chwojka emphasized in relation to the coronavirus pandemic. Only the “absolutely necessary” staff members are present at the locations.  “In this way we can ensure that our people do not infect each other or take an illness home with them,” he said.

Rules of the home office

Siegfried Weinert is a support team member behind the curtain of the home office concept and implementation. He oversees workplace safety at 144 Notruf NÖ and is constantly keeping an eye out on the program’s development and the laws affecting the home office environment.

An overriding acknowledgement dictating the entire outcome relies on attitude. “There must be the acceptance that you are at work even though you are at home,” Weinert said.

For example, it is important to dress the part. While a 144 Notruf NÖ uniform is not required wear, studies show that people perform better when reporting to the home office in their work-style clothing. A structured schedule is inherent in emergency communication. There are no breaks to walk the dog or view a television show on shift. A dedicated workspace is 144 Notruf NÖ policy. Posting a “Do Not Disturb” sign cautions others in the household against interruptions during work hours.

Technical equipment

The technical equipment provided is the same for each calltaker—two monitors, mini PC, keyboard, mouse, USB headset, USB webcam, and pager. The calltaker agrees to several conditions involving the use of the equipment and internet connection. The office must be in the calltaker’s primary residence, and the office must be in a protected place. No setups are allowed in vacation homes, for example. No one except the calltaker can view the screen while calls are being taken. No one outside of operations is allowed within a specific perimeter of the computer and laptop during active shift work. Computers are equipped with cameras for video calls to facilitate periodic check-ins between the back office, shift supervisor, and calltaker.

Calltaker competency

Calltakers are assigned to specific emergency and non-emergency lines according to skill level (such as EMD, ECN, or patient transport). Each calltaker is specially trained for the respective position. Call status is monitored (ready, talking, or not ready) and the data automatically collected indicates time spent on the call, calltaker routing (ECNS, EMD, or COVID-19 hotline), and disposition (medical doctor, ambulance, or COVID-19 test dispatch). Calltakers can transfer calls immediately to a more appropriate line if the line in which the caller connected to does not best serve the complaint.

Chwojka, an admitted fan of more than one emergency and non-emergency line, said the multiple numbers available at 144 Notruf NÖ ensure immediate access to the communication center. The responsibility of choosing the correct line, however, does not rest with the caller.

“People do not have to know who to call. “It’s the calltaker who has to know where to triage the call,” Chwojka said.

At-home efficiency

Rules governing the home office, however, have done nothing to diminish the initiative’s overriding commitment to the 1.8 million Austrian residents and the two million annual tourists.

As Weinert explained, the home office model is constructed to enhance operations.

Working from home gives the ability to cover call peaks, both in short-term events (such as a mass casualty incident) and in planning protracted events (such as the coronavirus pandemic). There is no rush into the center for an all-hands-on-deck alert. It takes two to three minutes to connect from home when an event demands added calltakers.

If any of the four centers are lost due to technical problems or evacuation, the “lost” region is immediately taken over by another dispatcher, designated by prior standard operating procedure.

“This is nothing unusual,” Weinert said. “We can and do switch regions because of special situations to focus dispatchers on the situation.”

Telephone health advice

The telephone health advice is critical, as documented in a proposal submitted for NAVIGATOR 2020 by Weinert, a volunteer with the Austrian Red Cross for over 30 years, and Susanne Ottendorfer, emergency physician and 144 Notruf NÖ Medical Director.

Calltakers assigned to 1450 (telephone health advice service line) adhere to criteria set by the Ministry of Health, and calls meeting the criteria are immediately transferred to the medical officer. Calltakers also use AMPDS™ Protocol 36: Pandemic/Epidemic/Outbreak (Surveillance or Triage), released in 2010 for managing EMD triage and locally limiting EMS responses in the event of an official pandemic flu outbreak, or for use as a flu surveillance tool to track flu symptoms without changing the EMS response. The Academy extensively revised the protocol to triage EMS response to COVID-19.

By using the line 1450 as a central point of contact for people with health issues regarding the pandemic, calls increased up to 25 times compared to the previous year (2019) to 3,335 calls on the busiest days. The resulting further health consultations also more than doubled.

Associated benefits

Many of the associated benefits of a home office are shared between the employee and company. The transition has proven economical (petrol (gasoline) costs are considerably less for the employee), ecologically beneficial (carbon footprint decreases), and risk reducing (travel, illness, etc.). Job satisfaction is two-way or three-way if you count patient satisfaction, although patients can’t always get what they want. They get what they need, Chwojka said, and options offered through the telephone health advice service line reduces the risks particularly to health-compromised patients receiving medical help without transport to a hospital.

Working at home is a good thing, Chwojka said.

“Our calltakers do a great job and enjoy the benefits that go along with it,” he said.

Do the homework

Weinert suggests looking at several factors when deciding to make the home office transition.

Performance

 Managers and supervisors need real-time insights into demand, workloads, and performance to ensure effective operation and detect emerging issues.

Operational effectiveness

Mobile apps and web-based interfaces must allow vital information to be easily accessed and shared in real time from any location, ensuring a seamless transition and smooth workflow.

Tools

The technical equipment described, combined with the ability to remotely access their CAD system via web or mobile app, allows dispatchers to work from anywhere. Cloud and web-based systems enable communication centers and home offices to quickly share CAD access with additional personnel if a scale-up is needed during an emergency.  

144 Notruf NÖ is a nonprofit limited liability company jointly owned by the Lower Austria government (66%) and rescue organizations. It serves a population of about 1.65 million people and registered 1.5 million calls in 2019 and up to 6,000 dispatches per day (13% time sensitive). 144 Notruf NÖ is a medical ACE and the first center in Europe to implement the Emergency Communication Nurse System (ECNS), for which it is also accredited.

Gaining ground

The coronavirus influenced emergency communications in the same way it has affected social and job interactions and that includes protecting workers through on-site precautions, setting up home offices, and placing pending projects on hold.

Charleston County Public Safety 911 Center Department (South Carolina, USA) began a project a year before COVID-19 to allow calltakers and dispatchers to work from home, according to center Director James Lake. Although the virus disrupted the process, a portion of the staff (administrative/support/QA/IT) was able to follow through with home office plans and—in that way—provide a beacon to establishing a viable path into the future.

Lake said the home office environment in emergency communications is feasible, considering today’s technology. “This won’t work for everyone,” he said, but it can be extremely beneficial in a childcare situation or other situations in which the individual can be more productive at a home office rather than reporting to the communication center.

DECC plan into action

Purchasing hardware compatible to remote work was all part of long-range plans to establish remote working locations at the Department of Emergency and Customer Communications (DECC), Alexandria, Virginia (USA). An upgraded phone system complemented the strategy. But it was not a priority, said DECC Deputy Director Doug Campbell. It was an eventuality.

The coronavirus predicated social distancing at the center in Alexandria. Four shifts were broken into two shifts that reported to the primary emergency communication center and two shifts that were assigned to the backup center.

Numbers climbed. On March 26, the Alexandria Health Department confirmed six additional cases of COVID-19 in Alexandria, bringing the total to 20.1 Foremost concerns conflicted. How could they protect the health of calltakers and dispatchers and provide seamless, fully functioning operations to safeguard their fire, law enforcement, and police responders and, of course, the public depending on their non-emergency and emergency services?

They decided it was time to think outside the box.

Modeling the center

DECC management recruited volunteers and, in collaboration with IT and FirstNet, created a near replica of their PSAP communication positions at the individual homes. Each home center was set up with a laptop, headset and smartphone, FirstNet Wi-Fi hotspot, mobile router with CAD, and other hardware. A virtual private network (VPN) is used to secure connection to the FirstNet hotspot, hide the IP address, and make browsing private.

DECC implemented planning and testing in three phases. During the first month (March) the home center calltakers answered non-emergency calls only. An isolation dispatch team comprised of two fire dispatchers, two police dispatchers, and one telecommunicator was set up at a nearby hotel offering good phone reception (a high number of bars indicating signal strength). The at-home teams shifted to 911 calls once operations met the seamless functionality of the primary and backup center. They work regular 12-hour shifts.

Calltakers at the primary and backup ECC are socially distanced. Each center is vacant on separate days, one day each week, for a total cleaning and sanitization. Campbell and Director Renee Gordon go into the center for tasks they cannot complete in the home environment. They rotate between the two centers during the 24-hour vacancy periods. They do not go on the floor when a center is staffed and wear masks any time they step out of their offices.

No book of instructions

Describing the transition as a mad dash is an understatement. Project leads put in 18-hour days getting ready for the deployment and filling notepads with contingency plans to solve worst case scenarios and overcoming unexpected obstacles that could negatively impact emergency communications. They had no playbook to follow. While other centers were contemplating the transition, none had gone full bore. They are adapting as they go along.

“We learned to shift gears on the fly,” Campbell said. “We all shared the same concerns. We did lots of testing and discussing it among our people. We found it essential to establish a direct connect between the center and homes, as close to real time as possible.”

The experiment that went live on March 6 is thriving. Calltakers work their regular 12-hour shifts, and they can sign in instantly if necessary, to cover absences or, for example, mass casualty incidents. The list of volunteers is growing and, like training evacuations conducted every four months in the past, responders have not noticed changes in venue affecting their interactions. They are receiving the same stable connection and information regardless of location. The next big push is testing applications to allow radio dispatchers the same option.

Think outside the box

Progress, however, does not always follow a smooth path. There are setbacks and frustrations. For example, the hotel did not have the optimal phone reception anticipated. Radio dispatch stayed at the hotel but contacted a different internet provider. Since generators are not common backup equipment at homes, each setup now includes a mini generator (with 30- to 60-minute capacity) in case of power outages. Policies and standard operating procedures require constant review and revision. New ones are added.

While Campbell might have preferred a slower dash, he certainly likes the direction they’re going. He calls remote working a “new norm” that provides benefits they’re still discovering. There are cost savings in fuel and wear and tear on vehicles. No long commutes in snarled traffic or rerouted travel due to congestion. There is less overtime and sick leave.

Centers hearing of DECC’s program contact Campbell for more information. He tells them to expect “walking on pins and needles for the first few weeks.” Don’t get discouraged. Things happen. The transition takes a willingness to “think outside the box,” he said.

“If something doesn’t work, go down a different road,” he said. “Write down the next option and collaborate. You’re bound to learn something new every day.”

DECC is the PSAP for all emergency services within the city of Alexandria. 

The FirstNet network is a public private partnership between the First Responder Network Authority (FirstNet Authority, part of the US Department of Commerce) and AT&T. It provides a dedicated connection for public safety for everyday operations or emergency communications.

Sources

1 “Six New COVID-19 Cases in Alexandria, Bringing the Total to 20.” Alexandria Redevelopment and Housing Authority. 2020; March 27. https://www.arha.us/covid-updates-march (accessed July 9, 2020).

Note: Comments attributed to Christof Constantin Chwojka were taken from an EENA (European Emergency Number Association) webinar. Chwojka C. “Austrian Emergency Medical Calls During COVID-19.” European Emergency Number Association. 2020; May 4. https://eena.org/webinars/austrian-emergency-medical-calls-during-covid-19/ (accessed June 24, 2020).
A majority of the information about
144 Notruf NÖ is from the presentation “Working in a coal mine,” proposed for NAVIGATOR 2020, by Siegfried Weinert, MSc. and Susanne Ottendorfer, M.D. – Notruf Niederösterreich.

Audrey Fraizer is managing editor of the Journal of Emergency Dispatch. You can reach her at audrey@emergencydispatch.org

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