Dispatch Danger Zones

Heather Darata

Heather Darata

CDE Universal

*To take the corresponding CDE quiz, visit the College of Emergency Dispatch.*

Emergency Dispatchers play a crucial role in helping callers and patients get the right help at the right time in the right way. Agencies must set their Emergency Dispatchers up for success by implementing a proven system of protocols; providing professional training; having strong medical control; keeping proper records; providing proper supervision; encouraging team building; and having properly established risk management, quality assurance, and quality improvement programs in place. 

But even with most communication centers and Emergency Dispatchers striving to provide the best care possible, not all emergency calls have been handled the best way possible. Errors have been made. Lives have been lost. And we have learned from these unfortunate experiences. 

Because of the serious nature of dispatch errors and a desire to assist Emergency Dispatchers in providing the best care possible, the IAED™, through experience and case precedence, has identified specific areas of concern that, when understood with forethought, help us avoid adverse outcomes and govern the priority dispatch playing field.

Dispatch Danger Zones

In both Chapter 11 of the Principles of Emergency Dispatch textbook and Online Universal Telecommunication Essentials Course (OUTEC) curriculum, a set of Dispatch Danger Zones are presented—a list of recurrent errors, often common commissions  and omissions, that have emerged from legal action that has occurred or been threatened. Avoiding these is of utmost importance in successfully providing the best care possible and decreasing potential liability in the process.

Dispatch Danger Zones
1. Failure to verify basic information, such as the address: Failure to verify essential information can carry immediate and dangerous consequences. Your agency should have policies regarding the consistent verification of critical information. Always follow your agency’s policies. The Academy recommends that Emergency Dispatchers verify addresses and callback numbers by asking the caller to repeat the information when ANI/ALI information is not available or when it does not match the information provided by the caller. Repeating the information provided back to the caller, rather than asking the caller to repeat the information, has proven unreliable, as excited callers tend to agree reflexively and without prudent consideration. 
2. No-send policies in which a caller does not receive an EMS field response: Some agencies maintain “no-send” or “no-help” policies that require the Emergency Dispatcher to determine who gets help and who does not. These policies are inherently dangerous and expose agencies to serious risk. If your agency maintains this type of policy, rigorously follow established procedures to reduce your risk of personal liability.
3. Dispatch diagnosis: Problems stem from failure to properly follow a proven protocol system. The Emergency Dispatcher, especially if trained in another form of medicine, may tend to “diagnose” the patient’s issue and base decisions on that diagnosis rather than signs and symptoms derived from a standard interrogation driven by protocol. Historically, this leads to a failure to send help, or the right help, or to provide instructions that are inappropriate or even dangerous in the pre-arrival environment. These situations can be catastrophic because the consequences can be very serious or even fatal, shaking the public’s trust in the process.
4. Delayed response: A significantly delayed response creates a potential litigation risk if the patient/victim is adversely affected by the delay. The public expects a timely response to emergencies, especially if the incident involves severe injury, illness, danger, or damage. The Emergency Dispatcher must effectively gather the necessary information to classify the call correctly and assign it the proper priority. An improperly prioritized call can result in further damage, greater suffering,  or even lost lives.
5. Situations in which more than one call for help had to be made: More than one call for help can be a clear sign of trouble. Additional calls generally occur  because of a delayed or absent response. Multiple calls can create frustration; foster confusion; or create additional problems for first responders, callers, and  victims.
6. No protocols for the EMD to follow: Without protocols, Emergency Dispatchers must freelance questions and instructions. This practice causes variance in the  level of service provided to each caller. Using standardized protocols reduces this variance and ensures that each Emergency Dispatcher asks the appropriate questions and provides correct instructions. The IAED protocol never forgets—provided you follow it.
7. Failure to follow protocol: Failure to follow protocol can be as dangerous as not having a protocol at all. An Emergency Dispatcher who chooses to ignore  protocol, change protocol, or act outside the boundaries of the protocol loses the benefits it provides. Correctly using a protocol system helps ensure safety,  appropriate service, and the quick gathering of crucial information.
8. Requesting the caller’s permission before giving Pre-Arrival Instructions: Found on page 11.23 of the Principles of Emergency Dispatch, the official position of the IAED states: “Pre-Arrival Instructions are stop-gap emergency provisions that do not require informed consent of the provider (caller) and delaying or confusing telephone treatment by asking permission is considered contrary to the ethic of Emergency Medical Dispatch and may result in determined negligence or liability for the dispatcher and center advocating uninformed inaction.” A call to a public safety emergency line implies a call for help, which should, therefore, be  offered rather than prompted by inquiry.
9. Omission of Pre-Arrival or Post-Dispatch Instructions: Trained Emergency Dispatchers should give approved Dispatch Life Support Instructions whenever  possible and appropriate. These instructions can be the difference between a safe or unsafe scene, an efficient or inefficient emergency response, or an exacerbated illness or injury.
10. Asking to talk to the patient: Distrust is a dangerous attitude for an Emergency Dispatcher, and asking to talk to the patient or victim is often a clear sign of  doubt or mistrust. Emergency Dispatchers are obligated to be objective and accept the word of the caller as the truth.
11. Attitude problems: Negative emotions often precede dispatch error. When an Emergency Dispatcher expresses emotions like anger, frustration, or apathy, the result often has a snowball effect. As emotion escalates, judgment deteriorates, and the Emergency Dispatcher makes critical errors while neglecting the job at hand.
12. Preconceived notions and imposed, personal, negative impressions: Preconceived notions of any kind can impair judgment and lead to inappropriate decisions. Never allow caller integrity issues to influence your calltaking. 
13. Mistranslation or misinterpretation of the caller’s complaint: Because the correct classification of emergency calls is neither easy nor straightforward, the most  consistent and accurate method is to follow a protocol system. Protocols ensure that callers are understood and receive the assistance they need. Abandoning the protocol, or only using it partially, can lead to misinterpretation, and misinterpretation can lead to disaster. 
14. Problems at shift change: Shift changes, if not properly managed, can lead to serious communication problems, especially during prolonged incidents. Information can get lost in the added chaos of a shift change, over-response is common, and sometimes calls can even go unanswered or unattended to.
15. First-party gone-on-arrival situations (see Chapter 2 in Principles for a further review of this topic): An Emergency Dispatcher’s responsibility to first-party callers only ends when field personnel make personal contact. If it’s safe to do so, Emergency Dispatchers should stay on the line with any caller who is in obvious distress or whose condition may deteriorate. If this is not possible, it is the Emergency Dispatcher’s responsibility to inform the responding crew that the patient is alone to avoid potential abandonment.

Best practices of emergency dispatch
Now that we’ve covered the Dispatch Danger Zones, let’s look at important factors that can lead to success in the emergency dispatch environment. 

According to page 11.2 in the Principles of Emergency Dispatch, “A legally sound priority dispatch program means personnel are well-trained and use a medically approved and scientifically-based system that includes appropriate medical control and ongoing operational supervision in a total quality management environment.”

The IAED strongly encourages emergency dispatch agencies to follow the principles behind establishing a legally sound priority dispatch program. The benefits of  structured calltaking and protocol use include an established standard of service, prioritized responses, quality improvement procedures, certification and  accreditation, and reduced liability exposure.

Keep these things in mind for providing excellent patient care. For more information or a refresher, check out OUTEC.
1. Be mentally prepared for each call.
2. Accept all emergency calls.
3. Remain objective.
4. Answer calls promptly.
5. Assure callers they have reached the right place.
6. Use the caller’s name.
7. Provide alternatives.
8. Use appropriate vocal mechanics.
9. Use appropriate vocabulary.
10. Use simple, direct sentences.
11. Use active listening skills.
12. Elicit feedback.
13. Provide instructions—don’t ask for permission.

Remember, when things are going wrong, people turn to Emergency Dispatchers for help. You can get them the right help at the right time in the right way by avoiding Dispatch Danger Zones and putting best practices into play. You’ve got this.