How To Q A Caller In Crisis

Speaking with callers who are having a mental health crisis is hard. It’s hard for the caller, it’s hard for the Emergency Medical Dispatcher (EMD), and it’s hard for the EMD-Q. Although Protocol 41: Caller in Crisis (1st Party only) shares certain characteristics and the overall structure with the other Chief Complaints in the Medical Priority Dispatch System^™ (MPDS^®), it is different enough to give even the most seasoned EMDs (and EMD-Qs) pause.

Protocol 41: Caller in Crisis (1st Party only) was years in the making by psychologist Jim Marshall at the 911 Training Institute and other subject matter experts, experimenting with word choice and citing evidence-based research to put together a tool kit that gives the EMD a better chance of connecting with a caller in crisis—whether they’re actively suicidal or having suicidal ideation—and keeping them alive until reinforcements arrive. 

“For any call, Q makes an operational box you can do things inside of,” said Brian Dale, Senior Implementation Medical/Fire/ED-Q Protocol Expert with Priority Dispatch Corp^™ (PDC^™), in a session he presented on the topic at NAVIGATOR 2025 in Orlando (Florida, USA). “For this Protocol, we just made the box bigger. Clarifiers, conditional statements, Emotional Control Tool type stuff—the EMDs can use them any time as much as they want. That’s the size of the box you’re in. For suicide, we don’t tell the caller what to do. We encourage them to work with us to create a plan.”

Although this Chief Complaint is more flexible than others and the outcomes may vary vastly, there are still quantifiable ways to see how an EMD did in their attempt to connect with the caller, and there are ways to encourage them to do better should they take this type of call again. Here are some things you should take into account when reviewing calls where the EMD has utilized Protocol 41: Caller in Crisis (1st Party only).

Reasonableness: This has been a foundational principle for ED-Qs promoted by the International Academies of Emergency Dispatch^® (IAED^™) in recent years. It may seem like it goes without saying, but no matter how the call ends up, give your EMD the benefit of the doubt that they did the best they could with the tools they had at the time. It is critical that the EMD-Q be supportive and serve as a mentor and coach with these calls, embodying the principle of education over deviation. Putting yourself in the shoes of the EMD as the call progressed can help you understand why they made the choices they did, and if you need to, you can always follow up with them to earn a deeper insight and provide correction and clarification when needed.

The Universal Performance Standards state that the EMD-Q should mark statements contained in the Emotional Control Tool as “Used Correctly” as long as the EMD uses language that does not change the meaning or intent of the scripted text.

Time: While each center has different policies and restrictions that dictate the type of response that can be sent, in an ideal world the goal is to keep the caller on the phone for as long as possible. This will typically result in reviewing a call that could be three or four times longer than your standard EMD-Q fare. Based on the fact that these types of calls will only make up about 1–3 % of your annual call volume (maybe more or less depending on your local demographic), it’s a good idea to make sure that any time a call is triaged with Protocol 41: Caller in Crisis (1st Party only), an EMD-Q  prioritizes completing a focused review.

Debriefing: While some have the opinion that Q begins and ends with the case review, EMD-Qs should also be heavily involved in creating an atmosphere of support in the communication center. As with any other high-acuity, low-frequency event (such as an officer shooting or large residence structure fire), it’s a good idea to have a debriefing meeting or to separately check-in with the EMDs who handled these calls. Even if they say they don’t need it, having that framework of support built into your center’s culture is important. And even if your job as the EMD-Q is not to provide that support yourself, be sure to let the appropriate people know so the EMD won’t be left to cope alone. 

Training and practice: If the EMD is amenable and the call isn’t too traumatic, consider using the call’s audio as a training opportunity for your agency. Have your other EMDs talk about what they would’ve done in the same situation and point out the things that the original EMD did well. If you don’t already have ground rules for reviewing calls taken by your agency’s EMDs, it might be a good idea to lay some down. If the EMDs reviewing the call become overly critical of the EMD who originally handled the call, remind them that they have the luxury of hindsight and don’t have to make split-second decisions with limited information.

If that isn’t something your agency can do, you can make sure that your EMDs revisit the Protocol 41: Caller in Crisis (1st Party only) training on the College of Emergency Dispatch on an annual or semi-annual basis.  Make sure that the first time an EMD uses this Protocol/Chief Complaint isn’t when they are on the line with a caller who is actively in crisis! Being able to comfortably navigate the Emotional Control Tool and other connection prompts, as well as the response types your agency has available, is crucial in a time of heightened stress.

Cases with a caller in crisis are going to be very challenging, whether the caller has a plan to kill themselves or is experiencing ideation. The EMD must be flexible enough to jump to the Emotional Control Tool at any point in the call and bounce back and forth between that and the more typical Protocol questions. As an EMD-Q, you will need to have a lot of compassion for both the EMD and the caller during the interaction, and that compassion can be shown by using the experience to educate the EMD rather than penalize them for deviations.