Protocol 41: Caller In Crisis (1st Party)

Author’s Note: Much like needed, albeit unasked for, advice, not every answer in Ask Doc can wait for a specific question. Please forgive this minor breach of journalistic etiquette. 

As of today, 447 agencies have initiated the process of training all their staff (9,459 EMDs) to utilize the new, critically important, and much-requested Protocol 41: Caller in Crisis (1st Party). And for what it’s worth at this early date, P-41 is effective and without any reported problems—psychologically, medically, or legally—during use. This different and clinically focused “help” protocol is quite unlike any other in the Medical Priority Dispatch System^™ (MPDS^®). 

Given its unique structure and focus, P-41 requires all Emergency Dispatchers to complete a specialized (four-hour) training course before use, as well as requiring medical director approval. While this has been generally forthcoming, there has been an occasional holdout, which has caused significant delay in providing Emergency Dispatchers with the tools they need to bridge the gap for troubled callers in a state of crisis, who—because of long-ingrained public safety initiatives—continue to call 911 instead of 988. All of us need to be formally and confidently there for these callers each and every time they call us at the figurative, and frequently literal, end of their rope. 

Advertising special numbers to call on a national basis takes not years but decades, and likely generations, to become embedded in the psyche of the targeted, needful population group—as the history of 911 penetration in the United States has shown. Despite the substantial push around 988, national awareness is nowhere close to that of 911: A NAMI/Ipsos poll conducted just this summer found that while 74% of Americans have heard of 988, only 29% understand what it is and what it does. The unfortunate truth is that 988 may never be assimilated by the American population to 911’s extent, which itself was a multi-faceted effort beginning with the indoctrination early in life of eager, learning children. 

P-41 is a special, if not directly medical, attempt at addressing a widely recognized problem: a caller-in-crisis’ suicidal (direct or inferred) outcome placed squarely in the lap of a non-psychologically trained Emergency Dispatcher—maybe just in their first week or month at the console. With the advent of novel specialty training and very specific, but less-scripted protocols to have available, Emergency Dispatchers now have the tools that were specially crafted to handle just these sorts of emotional encounters. 

P-41 has undergone years of formative development, with its core idea provided by the current world expert in 911 psychological intervention, James Marshall, M.A., and based upon the LifeBridges Program that he created. Along with his special input and experience, the International Academies of Emergency Dispatch^® Standards’ “engine” developed a mostly scripted protocol directly advising first-party callers to separate themselves from “the means” to do personal harm and help them get to a better place in their currently overwhelming mental chaos. Along these same lines, the Emotional Control Tool—a first-of-its-kind Pre-Arrival Instruction—gives Emergency Dispatchers mental state-specific techniques to de-escalate situations where callers who are in personal crisis are overwhelmed by emotional or psychological distress. 

As a new protocol, questions are understandable and improvements and refinements are certain to come, consistent with our internal mantra to continuously ensure that the Unified Protocol System “is perfect once again.” But this is no time to let the ethereal perfect be the enemy of the current—and very tangible—good. Time will tell if this protocol has a significant effect on these special callers, and time is something, right when calling, they often feel they have very little left of.