September 10, 2012
By Audrey Fraizer
If a call came in from a 13-year-old girl calmly reporting a teenage boy trying to break into her house, how would you dispatch the incident?
A disturbance or nuisance call
A stalking or harassment call
Without more information, you might classify the call as either of the above and unwittingly jeopardize the safety of the caller by sending an ALPHA (whenever) or BRAVO (when available) response. Of course, in this era of emergency dispatch, the calltaker would ask several more appropriate questions. In the case of a suspected disturbance/nuisance classification (Police Protocol 113), a “yes” to Key Question 5 could make the difference between life and death in situations like these. It’s a question that could have saved the life of a 13-yearold girl police found dead 40 minutes after she made this very call.
The call had been classified as a “routine juvenile disturbance.” It was a simple human error made in the interest of appropriate resource allocation, in the judgment of James E. George, M.D., J.D., in a three-page article that comprised the major editorial content of a 1981 edition of the EMT Legal Bulletin.
Dr. George, senior editor for the Bulletin, did not lay sole fault on either the dispatcher or responding officers. In his opinion, the tragic outcome of the break-in was a consequence of an ineffective EMS triage process that, ultimately, left the door wide open for error, and the dispatcher potentially liable for negligence.
Errors may stem from several sources, Dr. George stated in the article: “The dispatchers may underestimate the urgency of a situation or err in gathering or recording essential information. Should harm result to a patient because of a dispatching error, the dispatcher as well as his employer may be held liable for negligence.”
Dr. George was a prolific writer on all things medico-legal. Although he had no direct training, education, or experience in the evolving science of emergency medical dispatching, he had a keen—almost prescient, predictive—idea of how to reduce a dispatcher’s risk of medical and legal liability. And it wasn’t a question of “if” but “when.”
According to Dr. George, “Where serious risks can be reasonably anticipated the law requires that precaution be taken.” His advice regarding the minimal safeguards to prevent or reduce error of the kind resulting in the death of the 13-year-old girl included:
• Confirmation of the caller’s address and phone number
• Tape-recording calls and responses to make sure that the information written down by the dispatcher is the information actually received
A third component missing from the list was perhaps the most important. While dispatchers often engaged in some form of evaluation of incoming calls, most centers practiced a sort of flying-by-the-seat-of-theirpants system to calltaking. Few had clearly articulated written policy in support of telephone screening of emergency calls, coupled with sound guidelines and protocols that, according to Dr. George, “would provide a ray of legal light in an otherwise murky area of heavy potential liability.”
At the same time, Dr. George stated, “Dispatchers had to avoid the appearance of responding to or categorizing emergency calls in a haphazard or arbitrary manner.” Dispatchers needed “reasonable guidelines” that would, among other goals, provide a structure to respond based on fact and not gut reaction. The ideal system would also discourage unnecessary calls and curb the abuse of the EMS system.
A unique example of such a system existed in Salt Lake City, according to Dr. George. The Salt Lake City Fire Department communications center was the first in the world to use the Priority Dispatch System™ for emergency triage and the Salt Lake City Council was a forerunner in controlling emergency triage by ordinance. Callers could be fined up to $299 or spend up to six months in jail for requesting emergency medical services when no real emergency existed. For example, the ordinance defined nonemergency situations to include alcohol intoxication, minor lacerations, hives without difficulty breathing, non life-threatening overdoses, and many other minor situations.
This ordinance was viewed as one way to solve the “uncomfortable dilemma” facing EMS—providing prompt and appropriate care in the face of rising costs and demands— and curtail abuse by callers demanding services for nonurgent situations.
“I applauded what Salt Lake was doing,” Dr. George said. “The city and Jeff’s protocol led to tremendous strides in EMS.”
Dr. George had been practicing emergency medicine for close to 12 years when he wrote the article. Thirty-two years later, he maintains his medical and legal licenses and serves as chairman of Emergency Medicine at Underwood Memorial Hospital in Woodbury, N.J., as well as president of Team Health East, also in Woodbury.
While he and Dr. Clawson haven’t crossed paths for years, he still remembers the intensity and enthusiasm Dr. Clawson brought to all matters relating to emergency medical dispatch.
“He introduced an interesting concept,” Dr. George said. “Many years back, we would run into each other at conferences and it was about the same time we started to hear good stories about the work he was doing. His system for emergency dispatching made perfect sense to me.”
The Salt Lake City ordinance has remained on the books and has since been revised:
11.04.130: EMERGENCY SERVICES; UNLAWFUL TO REQUEST SERVICE WHEN:
“Any person who shall request the city fire department emergency medical system to respond unnecessarily, falsely, capriciously or for nonemergency situations shall be guilty of a misdemeanor.
- For the purpose of this section, nonemergency situations shall be the following: alcohol intoxication, minor lacerations, minor contusions and sprains, minor illnesses, insect and animal bites not deemed emergencies, rashes, skin disorders, hives without dyspnea (difficulty of breathing), home delivery to avoid doctor and hospital services, venereal disease, patients seeking nonemergency transportation, forehead and scalp lacerations only, cold syndrome, sore throat, earache, hiccough, nervousness, anxiety, toothache, minor bruises, nonlife threatening overdoses, nonlife threatening self-inflicted injuries. (1987 Code: prior code § 14-2-8.1)”
A class C misdemeanor conviction can result in 90 days in jail and up to $1,500 in fines and surcharge.