A Year of Hope With Protocol 41

According to the Centers for Disease Control (CDC) nearly half of the people who read this sentence have lost a family member or close friend to suicide,¹ facing the reality of an echoing absence. That’s why the International Academies of Emergency Dispatch^® (IAED^™) spent seven years developing a protocol for IAED trained Emergency Dispatchers to extend a lifeline to callers in crisis.

This pivotal investment in emergency responses for mental health crises is designed to address this widespread and growing problem. In 2023, U.S. 911 systems nationwide received an estimated 240 million calls, with roughly 24 million related to behavioral health.² Unfortunately, that same year, 49,000 U.S. citizens died by suicide³ (an average of one death every 11 minutes). 

At the heart of the development of Protocol 41: Caller in Crisis (1st Party Only) is an understanding of being human with the other human, a connection worth cultivating. 

Protocol 41 objectives and highlights
Working with a team of leading experts in mental health and Emergency Medical Dispatch (including Jim Marshall of 911 Institute⁴), the IAED developed Protocol 41 within the Medical Priority Dispatch System^™ (MPDS^®) to identify crisis calls, gather critical information, and send the right response or connect the caller through informed transfers to 988 (suicide hotline) or similar agencies. 

Beyond these objectives, the Emergency Dispatcher’s role is undeniably important in conversing with a caller in crisis. Currently 5,729 EMDs have completed the IAED’s four-hour Protocol 41 training provides specific calming and control techniques to actively listen, connect, and respond to a suicidal caller’s needs. With thoughtfully designed tools at their fingertips, Emergency Dispatchers can demonstrate care for the caller and de-escalate the crisis with greater confidence and resilience, aiming to secure the scene until help arrives. 

“Emergency Dispatchers can sometimes sound very clinical,” said John Lofgren, IAED Curriculum Council Chair–Emergency Police Dispatch (EPD) and Emergency Dispatch – Quality (ED-Q). “Maybe it’s a defense mechanism in the face of everyday emergencies, but first-party crisis calls need to feel different. It’s about showing a personal investment in the caller. You can sense a nurturing, compassionate tone.”

Often, Emergency Dispatchers have a natural abundance of concern for the voice on the line, but they fear responding appropriately to a fragile caller. By design, Protocol 41 arms them with research-guided prompts to unite the goal of preserving the caller’s safety while providing reassurance. For example, the Emergency Dispatcher may ask a caller on a ledge to “… please at least step back so we can sort this out and get you some real relief.”

Additionally, the Emotional Control Tool—displayed as a green target icon on the ProQA^® software toolbar—is an indispensable resource, providing the Emergency Dispatcher with 22 sets of scripted pathways for a myriad of crisis states to keep pace with the emotional needs of the caller. These include a caller demonstrating child-like behavior, mournfully grieving, showing panic, acting oppositional, or experiencing flashbacks. Ultimately, these words guide the Emergency Dispatcher on what to say while providing steady support. 

Analyzing Protocol 41 in the field
A year into its official launch (June 2024), the IAED is examining the use of Protocol 41, reviewing user feedback, listening to real calls, and analyzing the data to evaluate its use and future growth. Resulting statistics tell us more about how Emergency Dispatchers have been able to calmly, resourcefully, and confidently face each caller’s crisis with them.

At the time of publication, 97 U.S. agencies have adopted the use of Protocol 41. Of these centers, 27 have contributed 526 recorded cases to our IAED Data Center (established in 2012. Approximately half (50.6%) of all the Protocol 41 were coded as OMEGA-level calls. Specifically, about 15.4% of the Protocol 41 cases resulted in a 41-Ω-3 Determinant Code (NON-SUICIDAL, no injuries, responding normally). OMEGA-level calls typically indicate a transfer to a mental health hotline (such as 988) or other resource, reducing the need for police and medical resources and preventing potential confrontation with responders. 

IAED researchers not only gain insights into how the protocol is used but also identify trends in callers as well. Callers in crisis were typically alone (65%), 56% were male, and 94% were older than age 18 years. Nearly 29% of calls involved weapons, 26% met the local agency’s criteria for a CRISIS TEAM/ALTERNATE RESPONSE, 21% involved reported alcohol or drug use, and 15% of callers were violent in speech or behavior. 

When callers were asked if they were struggling mentally or emotionally, nearly 90% answered affirmatively, though only 50% had been seeing a mental health professional at the time of the call. Nearly 60% of Protocol 41 callers said they were thinking of killing themselves, and 50% said they had a plan to do so. However, only 7% said they were thinking about injuring someone else.

Emergency Dispatchers utilized the Emotional Control Tool about 37% of the time, selecting the “Separate from means” pathway in 18% of calls, “Depressed/sad” in 14% of calls, “Threatening to self-injure” in 10% of calls, “Disconnecting/quiet” in 7% of calls, and “Grieving” in 6% of calls.

Overall, Caller in Crisis (1st-Party Only) calls account for longer than average call prioritization times (134 seconds), mostly due to the high percentage of OMEGA level cases. A great benefit to these low-acuity calls is that they can be managed without a police or EMS response if alternative mental health resources are available, such as a mental health crisis team or a suicide hotline that can direct the patient to mental health facilities available in the local community.

More specifically, OMEGA-level calls, which accounted for about half of all P41 cases,  yielded an average prioritization time of 150 seconds, while DETLA-level calls took the shortest time (84 seconds). Indeed, de-escalation, by avoiding a police or EMS response whenever possible, and utilizing behavioral health community resources is one of the main goals of Protocol 41.

Beyond the data, the true marker of Protocol 41’s success is best heard on the line. “As we listen to Protocol 41 calls and look for insights, the quality of connection with the caller can’t always be quantified with data,” Lofgren said. Neither does it measure the impact of a life saved. 

Training with confidence
Eager to arm their Emergency Dispatchers with more resources, the Illinois Valley Regional Dispatch (IVRD) center in Peru, Illinois (USA), was an early adopter of Protocol 41, citing trust in protocols as an essential part of their culture. Over the last year, IVRD has built their confidence with training, implementing, and utilizing the new Caller in Crisis Protocol to address those clinging to their words.

According to Brandon Miller, Executive Director, their center was right on the cutting edge with getting their 17 Emergency Dispatchers trained in a timely manner. 

“It was rigorous training,” he said. “I have been using the IAED Protocols for 28 years now, so the functionality felt familiar, but I was most impressed with the in-depth mental health calls involved, the way certain terms were defined, and how the protocol could be personalized to the needs of each unique caller.” 

Prior to Protocol 41, it’s understandable how some Emergency Dispatchers could feel unprepared to handle callers in crisis with life hanging in the balance.

“Imagine being an Emergency Dispatcher, not knowing what to say to someone who says they want to kill themselves,” Miller said. “There were common myths about things you should or shouldn’t say. But now Protocol 41 and the training behind it has helped us understand our role, and knowing the data and statistics behind the protocol helps us feel more confident in what we’re saying to the caller and why.”

Implementation in action
Ironically, Miller was the first to take a caller in crisis call while helping out with some call overflow shortly after IVRD had implemented Protocol 41. 

“We don’t get a lot of calls like this,” Miller said. “I found the new Protocol to be extremely helpful. It’s different when you are talking to a first-party caller, but I felt comfortable.” 

Of course, Emergency Dispatchers are typically trained to be efficient in sending help, but handling a caller in crisis is more about connection: asking, listening, and digesting. “Initially, the adjustment was a little clunky; Protocol 41 is a lot more organic and fluid,” Miller said. “But with time and practice, our Emergency Dispatchers are becoming more natural at balancing professionalism and compassion effectively.” 

As communication centers become more comfortable with connecting with suicide lines and mental health crisis teams, Miller said they’ve started envisioning the pillars of 911 (medical, fire, and police) to include the added pillar of mobile crisis.

“Even though we aren’t sending fire, police, or ambulances, we are still sending these callers in crisis to someone who is professionally trained to help them,” he said. “Explained in that way, it makes a lot of sense to the people in the dispatch chair.” 

IVRD also has regular meetings to build the relationship between mental health providers and the 911 team, gaining respect and appreciation for how they can work together to meet callers’ needs.

Conclusion
Ultimately, Protocol 41 is about providing Emergency Dispatchers with tools, guidance, and the confidence the caller can lean upon in a time of crisis.

“Even outside of the capability to connect or transfer to other resources, there’s extreme value for Emergency Dispatchers to have Protocol 41 so they can really speak to people facing a major crisis in their lives,” Miller said.

As more centers adopt Protocol 41, Emergency Dispatchers will be able to better serve first-party callers struggling with mental health crisis. “The Emotional Control Tool is one of the biggest advances in the course of the Protocol in my time using it,” Miller said. “I think you’re going to see lifesaving impact with a dispatcher and a caller uniting in a good outcome using this Protocol.”

Sources

1.    Singichetti B, Wang J, Lee R, Ballesteros MF, Mack KA. “Notes from the Field: Suicidal Thoughts and Knowing Someone Who Died by Suicide Among Adults — United States, 2023.” Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep 2025; April 10. https://www.cdc.gov/mmwr/volumes/74/wr/mm7412a4.htm (accessed Sept. 13, 2025).
2.    Drysdale, S. “States still wrestling with crisis call response solutions.” WWLP.com. Nextstar Media Group, Inc. 2025; Aug. 7. https://www.wwlp.com/news/massachusetts/states-still-wrestling-with-crisis-call-response-solutions/ (accessed Sept. 16, 2025).
3.    “Suicide Data and Statistics.” U.S. Centers for Disease Control and Prevention. 2025; March 26. https://cdc.gov/suicide/facts/data.html (accessed Sept. 16, 2025).
4.    “Administration, Jim Marshall, Co-Founder, Instructor, and Consultant.” 911 Institute. 2021. https://www.911training.net/jim-marshall (accessed Sept. 24, 2025).