Standard Practice for Emergency Medical Dispatch Management - Research Paper Example

Emergency Dispatchers & Civil Liability In the US today, 911 is undoubtedly the most commonly dialled number given that in many cases, it is the last and sometimes only line of defiance or protection in times of emergencies be they security or medical ones. The people responsible for operating the 911 lines are frequently referred to as 911 operators; however, this title is both misleading and largely demeans and trivializes the nature and scope of their professional role1 . Essentially, assuming a 911 dispatcher is just a phone operator is analogous to describing an emergency response worker or paramedic as an ambulance driver assuming that their job simply implies ferrying patients from point A to B, which is quite misleading. Similarly, the 911 dispatchers have to do more than just connect callers to different lines. 911 dispatchers are responsible for facilitating communication and gathering data concerning security and medical emergencies, they then forward the information to the operator of the agency concerned with the specific emergencies.2 They are also required to provide instructions on relevant security protocol based on the situation and in security related calls such as burglary assault they try to track the location of the incident so they can accurately direct the respondents. “For one to work as a dispatcher they must be certified through the Association of Public-Safety Communications Officials-International (APCO) and the National Academies of Emergency Dispatch”.3 As professionals, 911 dispatchers play a critical role in the wellbeing of society and how they react to a situation can be directly in indirectly determinant in life and death situations since they are the main conduit between those in distress and the agencies tasked with rendering assistance. For this reason, there exists protocol and procedures that have been instituted to guide them in accomplishing their respective duties and reduce the margin of error while proving the best possible service. Given that their job involves unpredictable scenarios or circumstances not covered by protocol or in which it can be difficult to adhere to them. This paper discusses how 911 dispatchers deal with situations concerning the procedures using real life examples of some of the civil and moral challenges that they face and the issues that arise when they follow or fail to protocol. Typically, the procedure when a 911 dispatch operator receives calls from someone in distress is; they introduce themselves and ask what the emergency is or if there is an emergency; this is done to determine if the caller can be put on hold as the operator responds to more urgent calls4 . The Dispatcher asks the caller what the problem is and they are expected to control the conservation is such way that they learn the nature of the emergency, the location and the time it took place or if it is currently in progress. If for instance it is a security or fire emergency they direct officers to the scene and if needful keep the caller on the line obtaining more data and rerouting it to responding parties so they are adequately prepared by the time they arrive. Should they determine that the call does not concern the police, medical or fire service, they are supposed to direct the caller to the relevant agency or provide them with the number to call. In their actions, the 911 dispatchers are expected to adhere to numerous rules that mediate their interaction with callers; they are required to be neutral and responsible in their response so that they do not aggravate callers. In addition, they should have efficient communication skills so they can get as much information as in the shortest time possible given that in emergencies even a few seconds can make a big difference.5 For one, they should have clear and audible articulation since otherwise, they would have to repeat the questions and this could result in wastage of precious time. In addition, they should be patient and tolerant and even though they are not expected to put up with profanities and abuse, they should deal with the callers professionally and never respond in kind. In addition, they should be as neutral as possible and avoid trying to be funny or using stereotypes, which may be misinterpreted by the caller. Dispatchers should treat all the callers with consideration and even chronic callers or prankster should never be dismissed by virtue of reputation since they may have important information. The rule of the thumb is that very caller should be given their due attention and every report investigated and this often requires diligence and professional discretion form the dispatchers. Owing the professional demands of the job, today 911 dispatchers are required to undergo rigorous training on a range of specific subjects and responsibilities applying to emergency telecommunication as opposed to simply general public safety.6 Prior to certification as a professional dispatcher applicants are required to complete weeks or months long training in several subject relating to the job.7 This way, they can acquire skills in areas such a working with computer aided dispatch systems radio functionality and particular terminologies used in fire, medical and security operations and psychological training on how to keep emotional or high strung caller calm and get them to respond to questions expediently.8 Probably more important than the other skills is that they are taught to remain calm and balanced in times of crisis since their support and cool is often instrumental in diffusing dangerous situations. This way they can effectively visualize a scene that is invisible to them and provide information and sometime advice catering for the callers as well as the responder’s safety. The training is formally structured in a comprehensive manner inclusive of intensive classroom simulations before they are “dispatched” to the processing of live calls .The scenarios to which they are exposed to in the training include; active shooters, mayday and mass casualties as well as other extreme situation that require quick thinking and decisive actions.9 Certified medical dispatchers are trained on delivering babies ad providing CPR, as well how to instruct people on how to do it through the phone line. Even after training, they are expected to take refresher classes to provide marinating and hone their skills especially those they have not had a chance to apply in the field. Some of the actions dispatcher are required to carry out in the course of their duties cause them to be exempted from some laws, however this still leaves them open to civil suits. For instance should a dispatcher learn that a caller in a medical emergency is HIV positive, there are two ways he can go about dealing with the information. He can advise the medial responders either so they can be extra careful to avoid possible infection or he can simply assume they will take care and keep it to himself. If he chooses to reveal the information, he would be technically not be in breach of federal medical privacy laws contained in the Health Insurance Portability and Accountability Act (HIPAA) of 1996, owing to his position as a dispatcher.10 However, state medical laws do not universally conform in this situation and although many states have exemptions for emergencies, it is not a guarantee of immunity.11 Consequently, an operator disclosing a specific individual’s HIV status on open radio may be viewed as an invasion of privacy and could be grounds for a civil lawsuit, furthermore the societal position on the broadcasting of such information may result to political or community objections for the dispatcher or agency involved. Although there exists a framework of procedures that dispatch workers are expected to apply, these are not always binding and sometimes the dispatchers to rely on their experience and discretion instead of strictly following the pre-set protocol. However, ideally a structured protocol is preferred since it provides constancy of information that is attributed to improvement in the communication between dispatchers and units in the field over time. However sometimes following protocol does not always provide the best results since some issue reported to 911 require the dispatchers to go think beyond these procedures to carry out their role of proving assistance effectively.12 In addition, even when the protocol is followed, in some scenarios the outcome can be negative. Allan Young, who has worked as communication supervisor is of the opinion that “… police and fire department units should apply specific procedures in handling calls.”13 This is motivated by the fact that in many cases, incident, incident reports and the response of the emergency service are often analysed after the event to determine who is to be held accountable if the outcome was negative especially if it could have been prevented. When Emergency dispatcher follow a pre-set procedure, they will have security from legal consequences should such an issue arise since there will be documentation to protect both the individual and agency. When procedure is not followed on the other hand, there are issues may arise if the effort of the emergency services do not bring the matter to a positive conclusion since it may be assumed they failed to carry out their duty effectively.14 However, it is worth noting that even when procedure is followed, in some cases, the situation can escalate and a person in distress may suffer as a result15 . 911 dispatchers who strictly stick to procedure have been faced with moral issues based on their inaction, which has resulted to the institution being challenged because the staffs are robotic with no human empathy putting the laws before human life. The Although EMS rules provide for immunity from prosecution for dispatchers in case the pre-arrival information they provide to callers turns results in aggravation of the situation or death, however, this does not cover uncertified dispatchers. As a result, in some cases dispatchers are forced to stand by as they wait for the ambulance to arrive and they cannot give any advice to the caller in case it results in legal ramifications.16 This is exemplified by a scenario which took place in 1991in Osceola county, Florida, whereby Evelyn Mellor was trying to revive her two year old who had fallen into a pond and nearly drowned and she called 911 for assistance. In this case, the dispatcher sent an ambulance at once, but when the mother asked for advice on how to resuscitate the child the dispatcher insisted they wait for the ambulance. According to the county laws, dispatcher are not allowed to give medical advice unless they have been specifically trained to do so,17 since the dispatcher did not say they were unaware of how to give first aid to the girl, but only that they were not allowed. This issue resulted in a great deal of criticism for the country government especially since the girl died before the ambulance could get to her. In such a scenario, the dispatcher may have known what was needed to save the life of the child but could give no advice until the medics came in fear that they may be sued since they have no medical training. This brings out the moral issue regarding the Good Samaritan laws, since the dispatcher was technically the only other person in the vicinity. Why would they not do what any other bystander would have been legally allowed and morally bound to do under similar circumstances? Evidently, inasmuch as following procedure serves to protect the dispatcher, in some cases, it can be argued that it defeats the very purpose for which they are employed. Nevertheless, had the dispatcher provided advice and the child had still died, they would be exposed to legal recourse if it was claimed that their wrongful advice resulted in the death. This is quite ironic given that in the situation, if the child was already not breathing and the mother could not help, it would have been nearly impossible for the medial unit to save the girls life. Given the pressure under which 911dispatcher operate, it is understandable that they may from time to time err and give wrongful information in addition they may occasionally “snap out of character” when dealing with irate callers. However, the basis of the training is that they should learn how to handle themselves and the clients irrespective of the pressure involved and thus, no matter how irate or abusive a caller is, they should remain calm since he/she may be calling about an emergency affecting someone else. In January 2014, there was a highly publicized and sensational case, in which a Las Vegas 911 fire department dispatcher was subject to public and media condemnations after she hang up on an irate caller. The man had come home after a 12-hour shift only to find his mother had collapsed and was not breathing; he called 911 and the police dispatcher connected him to the fire department dispatcher.18 The latter tried to communicate with the man and take down his contacts but the caller was very agitated and hysterical making it hard for him to focus on the questions. Things turned ugly when she told him to calm down and stop shouting at the operator since, she, “didn’t do it”, the man was enraged and let fly some obscenities at which the dispatcher said bye and hang up. Luckily, the police dispatcher was still online and he assisted the man although when the ambulance got to him it was too late for the woman.19 This example brings to the fore several questions about the proper procedure for dealing with such callers as well as the penalties for such dispatchers should they be found to have behaved in a manner contrary to the exactions of their profession. The public was not just appalled by the dispatcher’s actions but also the fact that the dispatcher was still employed by the fire department despite the fact that the chief of the Las Vegas fire and rescue department said action had been taken without specifying which.20 While it is understandable that the public would clamour for her immediate dismissal one must consider whether her actions warrant it given that she had after all being provoked and had a right to be angry although she clearly overreacted. Assuming the police dispatcher had not been available, the man would have been left without assistance even after he had dialled 911 and this could have exposed the operator to more serious consequences from a legal perspective since she may have been held liable. In a similar case in 2008, Sharon Nichol a Detroit 911 dispatcher was probably the first dispatcher to be convicted for negligence after she ignored a call form a boy whose mother was dying dismissing it for a prank. Unfortunately, the boy’s mother died, as Sharon was consequently fired from her 911 job, and she was sentenced to two years of community service and $ 450 fine.21 In some situations, a dispatcher may fail to follow procedure owing to unavoidable circumstances, however the bottom line remains that their inaction whatever the reason can directly or indirectly result in the death of someone at the end of the line. Case to point; in most of Americas’ government run dispatch agencies, there are perennial issues of understaffing and as a result, the few employees are often overworked and forced to take on difficult and perhaps impossible shifts.22 As previously stated, the conditions under which dispatchers work are complicated and unpredictable and thus it is impossible to make allowances for every possible scenario. Consider a real life scenario in which a Maryland medical service dispatcher in Montgomery County, call falls asleep in the middle of an emergency and even starts snoring! The caller was a woman whose husband had collapsed and she needed an ambulance routed as well as instructions on how to assist him before it arrived.23 Fortunately, the police dispatcher who routed the call took over and assisted and the man went on to receive medical assistance and make a full recovery. However if he had not, there is a good change that the dispatcher may have been put to task or even held responsible for being lax in his duties. This is more than just disregard of procedure, in fact, many people condemned the agent and recommended that they be fired until the real story emerged and their angst was redirected to his employer. The agent it turned out had been in his 17th hour of a 24-hour shift given that after 12 hours without sleep it has been scientifically verified that the body begins to shut itself down, the man can hardly be blamed for falling asleep on the job.24 This brings out the issue of why the service would institute such draconian policies for its employees then expect them to perform in line with strict protocol and procedures that require maximum alertness.25 The emerging issue here is therefore on the extent to which dispatcher can be held responsible for such incidents when they are working abnormal shifts in which they cannot reasonably be expected to be the last line of defence in case of life and death situations.26 The agent in this case was placed on paid administrative leave but the scenario still warrants investigation into the conditions under which 911 operators work especially in the wake of revelation that 16 hour and 24-hour shifts are quite common.27 Nevertheless, should anyone wish to bring legal action against a dispatcher in similar circumstances they would be within their rights to do so and the fact that they were working long shifts would not guarantee their exoneration from responsibility for wrong doing. In the context of some States like Alaska’s law on the matter of professional responsibility in service provision, the dispatcher could have been liable under the 09.65.070 rule. The rule states that, “… based upon the exercise or performance or the failure to exercise or perform a discretionary function or duty by a municipality or its agents, officers, or employees, whether or not the discretion involved is abused”. 28 This is a reflection of most of the state laws; however, it is likely that any legal action under such extreme circumstances would have been directed towards the agency rather than the dispatcher. Dispatchers and the agencies for which they work are often taken to task whenever their actions or lack of whereof results in injury or death. This can be exemplified in a case in Socorro New Mexico, (2012) where the family of a Mary Theresa Saiz who was trapped in the trunk of her car sued the dispatcher who they claimed kept the girl on the line although she said her phone was dying.29 As a result, when the police tried to trace her they could not track her cell signal and she eventually died in the trunk of the car before she could be found. In normal circumstances, emergency response procedure require that the dispatcher take down all the information they can from the caller by asking them the questions which would help them trace their location.30 Therefore, the dispatcher, inasmuch as she was accused of causing the wrongful death of the young woman was technically following procedure , however as it has been demonstrated severally in this paper, this does not guarantee immunity owing to unpredictable circumstances . It is also worth noting that agencies that use dispatcher’s services are required to hire and retain legal representatives for them so that in cases when they may not have immunity, they will at least have counsel. In conclusion, it is evident from the above discussion as well as the described case studies that the job of the 911 dispatcher is as complicated as it is demanding since their actions to save life can result in civil suits irrespective of whether they were following procedure or not. Nonetheless, they have to be constantly on guard to ensure they follow procedure although sometimes following it will inevitably result in either negative implication either legal or moral. Given the life and death decisions they often have to make in split seconds, they sometimes are forced to make tough calls that may overreach their mandate when they feel they are obligated to do for the sake of the welfare of the distressed party. Ironically, it is plain that despite the invaluable role they play, as they are in most cases forced to work under impossible conditions and this is one of the main causes of infectiveness and poor attitude among many dispatchers. End Notes Read More