Doing It Right—From The Top

Question: What is the significance of some of the laws in the protocol, such as Bradshaw's Law and De Luca's Law? 

Dr. Clawson says: 

Both Laws have an interesting background that serve as a strong reminder that the protocol isn’t effective without leadership support, obvious commitment, and follow-through. 

In the early days of the protocol’s initial implementations, I met Thera Bradshaw (then at Clackamas County 911) and her compatriot Diane Brandt (then at Tualatin County 911) known as “sister” 911 communications leaders in Oregon (USA) for their close collaboration. 

At this time, the two had started a consulting company named B&B that dealt with police dispatching. In mid-1983, they heard me speak at an APCO International (Association of Public-Safety Communications Officials) convention in Salt Lake City, Utah (USA), and they were convinced they needed protocols and this training. We scheduled two certification courses in late 1983 and early 1984, which resulted in 110 new Emergency Medical Dispatchers—a great representation of the entire state! 

At that time, early implementors had no official process as the Academy was not yet formed. Once trained and “certified,” centers went live with the cardsets and largely governed themselves (with no required updates, recertification, or quality assurance).

When I attended an early NAEMSP conference in Portland nearly a decade later, I called Thera, and she gave me a tour of her agency (known as “Clark Regional Emergency Services Agency” or “CRESA” today) in Vancouver, Washington (USA). While observing their dispatch floor setup, I noticed the protocol cards were placed high above the console. When I asked her what they were doing up there, I was stunned at her reply: “That’s just where we keep them until we need them.” 

With an almost overwhelming effort to initially close my mouth, I asked about their protocol compliance levels. She asked me what I meant, which basically revealed the answer. With further prompting, she guessed they were performing at about a B+ or A- level. (Everyone, always, without formal QA functioning, gives themselves this exact level of “compliance.”) When I asked about providing Pre-Arrival Instructions, Thera stated they were providing them 100% of the time. Looking at their gleaming, pristine cardsets, I had a pretty good idea of how often they’d actually been used. 

Since I was scheduled to be in town the rest of the week, I decided to make a bet with Thera (and her two supervisors) that their compliance was not even 50%. The winner(s) would receive a dinner bought by the loser(s) at the best place in town. And after a QA-level review of 20 calls, that was the best dinner I never bought! 

Thera went on to become president of NENA (National Emergency Number Association) and was later named president of APCO International. Yet at that time she felt overwhelmed by the mountain before her to re-claim her center’s level of service and professionalism once built with protocol. 

I offered to help their center re-implement with the Academy’s standards, updated protocol cardsets, up-to-date training, and a new quality assurance program. 

On the morning of their re-opening (at the same place where I’d issued the compliance bet), I was present to hear her give a final pep talk: “Hey listen up, everybody. I know there’s some trepidation among you, but I just want to let you know that it’s time we start doing it right, not just fast.” 

I knew that quote would go down in the record book. It showed what you need for protocol to succeed is confidence from the top level down. Appearing as “Bradshaw’s Law” in the protocol today, it serves as a reminder of what I’ve learned the hard way: Striving to do it right is the goal. Bradshaw’s Law—included in the Additional Information section of the Medical Priority Dispatch System™ on Protocol 32—is intentionally “in sight” and “in mind” as a constant re-training point with a history to prove it. 

Similarly, De Luca’s Law has an origin from Los Angeles City (California, USA), where I asked Don Manning, the Fire Chief and Chief Engineer, to sign a memorandum to enforce better compliance to the Medical Protocol during their implementation. To my surprise, the chief said he wasn’t the face that would carry true power. He knew his place as “the downtown guy,” dealing with other details. He pointed to the Deputy Chief of Operations as the true “enforcer,” knowing if he signed it, people would know heads would roll. 

The wording of the November 1988 memorandum was powerful, but Deputy Chief Timothy R. De Luca had the reputation and trust to take the department from living off “outdated outlines” to providing documented compliance. 

With new commitment and confidence from a leader who prioritized protocol, the Emergency Medical Dispatchers treated the tool like a pre-flight checklist. When things went wrong, they pulled out the protocol and reviewed their own policies and procedures. Gone were the days of dusty cardsets. Eventually, within two years, they followed the protocol like lives depended on it, because they did. 

Today, De Luca’s Law states that “EMDs will follow all protocols per se, avoiding freelance questioning or information unless it enhances, not replaces, the written protocol questions and scripts.” 

This classic compliance statement is still the golden rule of protocol, leading with the wisdom to follow.