DISPATCH STAR POWER
August 9, 2013
By Audrey Fraizer
Dr. Henry Heimlich coached Rescue 911 Host William Shatner in the Heimlich maneuver at the first-ever EMD conference held in 1989 while the producer of the popular CBS show—Arnold Shapiro—looked on.
Dr. Heimlich, a featured speaker at the event, warned his audience to be prepared for rejection and ridicule when advancing on a new project. Criticism should be expected, he said, and sometimes it can even work out in the inventor’s favor. “Some useful criticism serves to identify flaws and contributes to eventual perfection of the idea,” he said. “If your peers initially understand and accept your idea, it’s not really very new or creative.”
Dr. Heimlich was preaching to the choir, a choir that has grown into the thousands since the conference 24 years ago. He was also preaching to relatively new although thoroughly convinced converts to the Medical Priority Dispatch System (MPDS): Shatner and Shapiro.
Rescue 911 was an early example of reality TV with its recordings of actual calls to 9-1-1 and interviews taken at the time the re-enactments were filmed in any of the pre-dominant locations in California, Idaho, and Utah. The show ran for seven years (April 18, 1989–August 27, 1996), outliving many similar programs because of its happy endings.
The following three stories featured are “success stories” incorporating the MPDS. In each of the episodes, the emergency medical dispatchers can be seen and heard using the protocol’s Pre-Arrival Instructions (PAIs).
Episode 215: Choking Granny; Jan. 16, 1990
A piece of a home baked roll fresh from the oven is lodged in 79-year-old Luella Patterson’s “windpipe” and the four- to six-minute window of survival is shutting to a close. A call to 9-1-1 from her frantic granddaughter, who finds Patterson leaning over the kitchen sink next to the chair where she had been sitting and eating the roll, is answered at Clark Regional Emergency Services Agency (CRESA, Vancouver, Wash.).
“Do something,” the caller pleads.
The dispatcher verifies location and assures the caller help is on the way. He hands responsibility to EMD Larry Cummings, quickly explaining to him that the victim is choking. A total obstruction of the upper airway is preventing her from talking and breathing. She is now unresponsive and swings in the arms of her grandson-in-law like a ragdoll when he catches her fall.
Cummings launches into PAIs, relying word-for-word on a printed cardset for the instructions he conveys to the caller who relays them to a third person in the room. The caller is, at times, hysterical and when she can no longer watch, leaves the room to summon help from a houseguest.
Patterson is fading. The Heimlich maneuver does not dislodge the bread, and after three attempts, Cummings tells the caller (now the houseguest) to position Patterson face up, straddle her hips with his legs, place his hands, one on top of the other above her belly button, and push. The granddaughter, hearing sirens, rushes to the front door. She waves arriving EMTs to the house, and less than a minute later, paramedics rush through the door carrying gear to pull the obstruction out from her throat. Patterson survives.
Episode 406: Toddler Glass Save; Oct. 18, 1991
Four-year-old Brittany Tanner is eating lunch, sitting in a booster seat propped on a chair at the dining table. Her younger sister is kitty-corner, looking in wonder as big sister swings her legs faster and faster to rock the grown-up chair back and forth between the table and the sliding glass doors behind her. Their mother, Susan, who is eight months pregnant, has just left the room to call her husband Stan at his office. She is well within listening distance of their two children.
Brittany keeps rocking, like a child on a swing set pumping her legs to go higher in the imagined dynamism to have her toes touch the sky. There is a crash. Susan looks. She screams. She hangs up the phone, but not before telling Stan that she must call 9-1-1.
Sensing an emergency, Stan takes off in the direction of their home in suburban Fresno, Calif. Susan is at Brittany’s side, begging for help from County of Fresno dispatcher Claudia Fernandez. Brittany is bleeding, hemorrhaging, and body parts are sticking out of her back. “A body part is sticking out of her back and I don’t know what it is,” Susan cries over the phone. “It looks like her liver. I don’t know.”
Fernandez reads the PAIs from the cardset at her CAD. She tells Susan to get a towel and to press the towel to Brittany’s back. Susan places the towel directly over the gaping wound and applies enough force to stop the bleeding. Brittany is pale, and Fernandez fears she is bleeding to death. “I didn’t think she could live through this,” Susan later said.
Paramedics arriving at the home immediately realize the life-threatening danger. They estimate two to three cups of blood are on the patio floor. She is intubated and rushed to the hospital, and Susan, upon their insistence, rides along in the ambulance in case she goes into labor. The younger sister stays with dad.
Two weeks later, Brittany is home from the hospital. She refuses to sit in the simulated rocking chair, and her parents have replaced every window in the house with safety glass. They celebrate Brittany’s survival at a picnic attended by doctors, paramedics, and the 9-1-1 dispatcher who provided the life-saving instructions.
Episode 502: Lightning Husband; Sept. 5, 1991
John and Lynn Endicott are getting ready for dinner on the first night they are home from a camping trip, a romantic getaway Lynn credits for saving their marriage. A storm is building outside their home on Sleepy Creek Road in Lakeland, Calif.; however, since the dogs are barking to go out, John figures he has the time for a short walk while Lynn makes dinner.
Thunder cracks, and the sound is so close, Lynn runs out the front door only to find her husband collapsed on the driveway. He does not respond to his wife’s pleas.
Heartland Communications Facility Dispatcher Scott Cullen answers her call to 9-1-1. It is his first call as a certified EMD, having finished the course the day before. He knows the problem is serious from the tone of Lynn’s voice and tells her to bring John close to the phone. Cell phones do not exist.
Lynn drags John to the landline next to the porch and proceeds to provide CPR following the PAIs Cullen reads from his cardset. Giving her the instructions, he said during a later Rescue 911 interview, was a moral imperative. “If I didn’t tell her what to do, he was going to die. No doubt about it.”
John does not respond. She continues giving mouth-to-mouth resuscitation.
“There was nothing there,” she later said. A Lakeland Fire Department truck arrives 12 minutes into the call and Scott Culkin, who is on his first call as a paramedic, quickly loads John into the ambulance and hooks him up to the machines. John was a flat line on the monitor. He was clinically dead. The base physician tells Culkin to administer sodium bicarbonate, a remedy for lightning strike victims he had only recently heard about. John’s pulse returns.
Despite a 1% chance of regaining any function, Lynn refuses to give him up. Two weeks into her daily visits to the hospital ICU, she recognizes a change in his condition when she leans down to kiss him. He kisses her back. Three weeks after that, John is released from the hospital and is able to return to his job following 20 months of intense speech, physical, and occupational therapy.
“My husband is alive because of a decision he [Cullen] made to give CPR,” said Lynn, during an interview as part of the Rescue 911 re-enactment. “I could never thank him enough.”
Cullen, a dispatcher for nine years, credits the ability to give the life-saving instructions. “The sad fact is that most fire departments don’t allow dispatchers to give instructions for CPR,” he said. “And nothing makes us feel so helpless as when someone calls up and they need help, and all you can do is sit there and say ‘I can’t tell you what to do because the agency is worried about being sued.’”
In July 2013, Cullen marked his 29th anniversary with the Heartland Communications Facility and, of course, he remembers Lynn’s call on that weekend in early September 1991.
He was in his ninth year of emergency dispatching, not counting the four years he handled fire dispatch part time while in the U.S. Air Force. Communication staff had just completed the EMD certification course but had been given instructions to hold off on using the protocol until that Monday.
The call came in Saturday evening, around dinnertime. The caller was obviously upset and described briefly what had just happened. More than anything, Cullen recalls Lynn’s determination to keep her husband John alive. John had been struck by lightning and was not responding to her verbal commands or nudging. She insisted Cullen do something.
“I needed to give her the CPR instructions,” Cullen said. “This lady was not going to be denied.”
The Rescue 911 re-enactment stays true to the incident, with a few minor exceptions.
Rain towers were brought to the Endicott home to create the rainstorm. The Endicott’s two dogs, however, would have nothing to do with getting wet when it wasn’t actually raining.
“They kept going to where it was dry just a few feet away,” Cullen said.
Stunt dogs from LA stood in.
Cullen had the opportunity to meet the Endicotts and has talked to them at various times over the years. Lynn manages a frame shop not far from the fire department, and John retired from the phone company, where he worked before and after the medical emergency.
“He has short-term memory loss, but last I heard he was doing very well,” Cullen said.
The call and Cullen’s PAIs for CPR represented a triple first for Heartland: the first time protocol was used in answering calls, the first CPR bystander PAIs provided from that center, and the first CPR save of a person struck by lightning.
Cullen downplays the star part. He did not meet Shatner. He said more important than star power are the changes that have taken place since 1984 when he started in emergency communications.
“I used to feel so helpless when I couldn’t tell people how to do CPR or give any other instructions,” he said. “I think of how many other lives may have been saved over the years if we had had the standards and practices we do now.”
Shortly after the incident, Cullen testified in favor of a dispatcher immunity bill (contingent upon following the protocols) before the California State Senate. In 1992, the state Senate passed a bill to allow 9-1-1 operators and other emergency dispatchers to give life-and-death medical advice over the telephone. Currently, limited liability protection is available to dispatchers under the state’s Health and Safety Code.
Cullen has never second-guessed his commitment to the profession.
“I wouldn’t want to do anything else,” he said. “I work at something I love that helps people. I don’t like being out there in the front, but I thought the story gave a good image of what dispatch does.”