READY & ABLE
September 3, 2015
By Josh MadFadden & Audrey Fraizer
Not many professions have anything close to the challenge of the instant emotional refueling required in preparation for the next possibly major catastrophic event resulting in a call to 9-1-1. Seldom does anyone outside the profession come in direct or indirect contact with the types of incidents that are part of your daily routine.
Yet, these things happen all the time, and because of the professionalism you provide, callers receive the best prehospital care possible for an amazing variety of medical crises, as demonstrated in the following stories.
As a point of reference, the infographic found in this issue compares the odds of dying from various types of emergencies. Not every calltaker or dispatcher encounters every one of these types of calls, and some might go through an entire career without providing PAIs for more than a handful of these situations. However, as the National Safety Council (NSC) points out, the odds of dying from all possible causes are 1 in 1, so no one is immune from the odds-makers or, for you 9-1-1 dispatchers, the odds of answering a call involving at least one of these emergencies during your career.
And it’s no coincidence that the medical stories are featured in the same issue as the announced pre-release of Medical Priority Dispatch System (MPDS) Version 13.0. The odds of a protocol to fit your caller’s emergency are stacked high in your favor.
Medical emergencies are dependent on a lot of factors, but it’s often our fears that make the less frequent types of accidents much more frightening. For example, the risk of dying from a shark attack anywhere in the world in 2004 was 1 in 913,200,766. The risk of dying from scalding yourself with a hot water tap in the U.S. in 2004 was 1 in 9,773,050. Doing the math, that means the odds of dying from contact with a hot water tap are 93 times greater than those of dying in a shark attack.1
Chronic diseases cause increasing numbers of deaths worldwide.
Diabetes caused 1.5 million (2.7 percent) deaths in 2012, up from 1.0 million (2.0 percent) deaths in 2000. Lung cancers (along with trachea and bronchus cancers) went up to become the fifth leading cause of death in 2012, killing 1.1 million men and 0.5 million women in 2012. Injuries continue to kill 5 million people each year. Road traffic injuries claimed about 3,400 lives each day in 2012, about three-quarters of whom were men and boys.2
Dispatcher helps high school student save boyfriend’s life
In April, Katerin Torres commemorated one year as a dispatcher. During her time fielding 9-1-1 calls and following the Priority Dispatch System (PDS) protocols at Valley Emergency Communications Center (VECC), West Valley City, Utah, Torres has helped numerous callers with a variety of emergency issues. One call that she took this past February stands out.
And two high school seniors will be forever grateful she successfully handled a potentially deadly situation.
At the beginning of February, in the late hours of the day, Torres took a call from Hannah Perkins, an 18-year-old student at Riverton High School in Riverton, Utah. Perkins was with her boyfriend, fellow senior Caleb Barlow, on the front porch of his home when he “fell back” and made “weird gurgling, choking noises.” Barlow’s parents weren’t home, so Perkins got Barlow’s 12-year-old brother, Zach, to help her. Perkins called 9-1-1 and reported the emergency. She said Barlow would take a deep breath and then stop breathing for about 30 seconds before taking another one.
Then he wasn’t breathing at all.
“She (Perkins) called, and at first she wasn’t sure what was wrong,” Torres said. “Then I heard her say, ‘He’s not breathing.’ Before I knew it, I had her doing CPR.”
Fortunately, Perkins had learned how to perform CPR while taking a course with a church group. Still, the real-life situation made things tense.
“At first she was worried and unsure,” Torres said. “But she was more calm once I started asking the questions and once she started doing CPR. I was surprised how calm she was.”
Perkins was doing chest compressions by the time she heard the sirens and saw the flashing lights of the ambulance. Once help arrived, Barlow was breathing again. He was taken by ambulance to a nearby hospital and then flown by helicopter to another. Doctors expected him to make a full recovery.
Though dispatchers don’t always know the outcome of the calls they take, Torres was able to find out about Barlow’s successful revival.
“It makes me feel good to know that I helped someone,” she said. “We have all the right tools to help people survive. Knowing I get to help callers and give customer service is satisfying.”
Like any dispatcher, Torres has taken a multitude of calls where the caller is emotional and where the situation is a life-and-death matter. She’s able to manage the emergencies by staying calm and by reassuring and comforting the caller.
“The key is your level of calmness and showing that you want to help them,” she said. “If I can’t calm the caller down, I’m not satisfied. If I show my compassion and tell them help is on the way, they tend to calm down.”
Barlow is alive today due in large part to Torres’ efforts. But for her, it’s all part of her duties as a dispatcher—duties she’s thankful to have.
“I love my job,” she said. “I love what I do.”
From Boat Building to Lifesaving
EMD navigates to niche in long career
EMD Roxie Davis is a 9-1-1 customer service expert.
She doesn’t approach her job as a sales pitch, of course, but she’s firm about keeping the caller on the line, getting to the crisis at hand quickly, and convincing the caller that hers is the voice of reason.
“Roxie is very passionate about her work,” said Annette Ricks, Dispatch Supervisor, Chesapeake Police Department, Chesapeake, Va. “And it clearly shows in her patience and calming presence with each caller.”
When the caller is stumped and frustrated—as is often the case in an emergency—Davis takes the time to reassure the caller and understand exactly what is happening on the other end of the call. She is not known to lose her cool and basically becomes the rock for a caller trapped in a world fast falling apart.
While impossible to single out one call she’s taken over the 10 years working at the police department communication center, she is proud of the bystander CPR instructions she provided to an anxious and upset caller in September 2014.
“Her husband was in cardiac arrest,” Davis said. “She didn’t think she could do CPR right.”
Davis convinced her she could, and for the next seven minutes, even when the caller said she was too tired and far too emotional to continue, Davis stridently and reassuringly kept the caller in the compression mode until paramedics arrived to take over.
“Roxie maintained control, and the caller never quit,” said Ricks, who came to work at the center about the same time Davis did. “She stayed with the caller every step of the way with her calming voice, encouraging words, and assistance.”
That call and others like it, demonstrating Davis’ calming influence in the storm of crisis, were major factors meriting her selection for the Chesapeake Police Department’s 2014 Outstanding Teamwork and Exceptional Performance award.
Other considerations included initiative and performance.
Davis created a PowerPoint presentation on “Protocol Choices” that was used for an in-house training program to help co-workers better navigate ProQA and—in tandem—she arranged 63 EMD-related terms into a training crossword puzzle. Her EMD compliance always averages above the 95 percent required each month. She is one of two calltakers on the Dispatch Review Committee (DRC) and is also on the Certified Training Officer (CTO) committee.
Davis “loves” calltaking, but if it hadn’t been for a change in center policies in 2005, she might be back building boats or using her customer service skills to sell boating supplies.
“I was afraid I wasn’t going to make it because of the dispatch element,” she said. “I didn’t want to hold anyone up in an emergency and was ready to quit. If I could just handle the phone calls, I knew I’d be a very happy camper.”
A calltaker-only job description happened to be in the making, and Davis was the first to accept the newly designated position. Calltaking is where she plans to stay.
“I like being able to focus on what the caller is saying and watching the screen to make sure I’m following the steps,” she said. “I am helping the person the best I can.”
A job tying her to the same place all day answering calls and giving instructions is a far throw from Davis’ earlier careers. She went from 16 years in banking to boat building and spent over a year on an island in the Caribbean managing a prototype tri-hull charter boat she helped to build locally. The “Wild Thing,” as it was commercially known, turned into a speedboat tourist attraction, although the intention had been a military boat that could move more easily through choppy water because of the hull design. Next, she moved to inside sales at a wholesale boat parts distributor for a number of years, which is when she decided to make her final career move.
“I saw an ad and applied,” she said. “Calltaking is not a job for everyone, and you don’t know if it’s right for you until taking the first call. It’s something I can do and feel good about.”
Cool and Collected
Dispatcher credits 8-year-old’s calmness for helping save father
It’s not every day you hear about a 9-year-old heroically saving her father’s life. But that’s just what happened this past April in Friendswood, Texas, when Victoria Grabowski’s composure helped spare her father from bleeding to death.
And 9-1-1 dispatcher Stephanie Price was honored to play a role in Victoria’s bravery.
Price, a 29-year veteran as a dispatcher, took the call from Victoria after the girl’s father, Mark Grabowski, had severely cut his wrist on a broken glass while washing dishes. Grabowski was bleeding profusely. Later, it was disclosed that he severed six tendons, two nerves, and an artery.
And yet, Victoria remained cool under pressure, though, understandably, she was shaken by the ordeal.
“When I listened to her voice, she sounded sad,” Price said. “But, she was calm and collected. The only time I could tell she was getting upset was when her father was not following instructions (he was about to faint) when she was attempting to get a towel wrapped around his wrist and have him hold the towel in place while she unlocked the door.”
Price walked Victoria through other instructions, and Victoria listened intently. Her attention to detail and instruction likely saved her father from dying of blood loss.
The fact that this strong-willed girl stayed so composed was a huge help, making Price’s job much easier.
“It helps so very much as a dispatcher (when the caller is calm),” Price said. “I understand, as I am sure countless others do, when your caller is calm during a crisis they can get so much more done. A trick that I use on hysterical callers is to tell them, ‘You can fall apart later, but right now, I need you to help me help you prior to the medics/fire/police arriving.’ The majority of the time this has worked and is a very valuable tool.”
Price didn’t have to do too much coaching with Victoria. She was able to give her address and location. She unlocked the door and immediately got the paramedics’ attention when they arrived, ushering them inside the home to where her father was.
Grabowski was rushed to the emergency room, where he was treated and then released. A few days later, he joined his daughter at the Friendswood City Hall as she received recognition for her bravery.
Price is thankful for the experience and that it ended happily.
“It’s wonderfully satisfying when you find out a call ends like this,” she said. “I was so happy to put faces with the names, especially Victoria. She and other kids that handle crisis with such grace are my heroes, along with the whole team of police, fire, EMS, and calltakers.”
Price has been a dispatcher for Friendswood Police for 20 years. She said she takes maybe one or two calls per month from children. Surprisingly, perhaps, she said child callers can often be easier to talk to than some adults.
“They sometimes don’t realize how bad things are or the situation,” she said. “The innocence of the child, in this respect, is such a blessing. Of course, it can—and usually does—break your heart when the situation is being described by this little voice.”
Victoria’s call is one of countless memorable and challenging calls Price has fielded in her dispatch career.
“There are calls that I will never forget, and there are calls I want to forget, but cannot,” Price said. “If you think you know it all or get cocky, chances are, you will be put in your place. There is always something new to learn—be it from someone that has been around for a long time or a new person that is looking at things with a fresh new perspective.”
Hard Candy Goes Down Wrong Pipe
Winnipeg to the rescue for choking 8-year-old
Grandparents Day celebrations turned out far from anticipated for Dave Desjarlais and his 8-year-old grandson Santana McFayden.
The Sunday afternoon that happened to land on the national day recognizing grandparents (Sept. 14) had started well enough. The two were at the football field, and while grandpa watched the game his older grandson was playing, Santana was playing his own spirited game of skipping up and down the lower bleachers.
While grandpa’s focus was tuned to the field, Santana’s attention was about jumping to the ground and, at the same time, absent-mindedly popping a piece of hard candy into his mouth. The two don’t go together.
“He swallowed the candy,” Desjarlais said.
Santana ran to his grandfather but fell down in a panic of choking from the candy lodged in his windpipe. Desjarlais got up from his seat, saw that Santana was struggling, and ran to his aid. A bystander, noticing the commotion, pulled out a cellphone and called 9-1-1. Winnipeg (Canada) Fire Paramedic Service (WFPS) EMD Cindy Semenchuk answered.
“The caller told me a young boy was choking,” Semenchuk said. “He was going unconscious.”
Semenchuk launched into the PAIs—following Case Entry—and the caller relayed to Desjarlais the instructions for the Heimlich maneuver.
Because Santana was lying down on the ground, Semenchuk had Desjarlais place his hands, one on top of the other, above his grandson’s belly button. Using his weight, Desjarlais pushed into the boy’s stomach.
“I did that for as long as I could,” Desjarlais said. “It may have been two minutes. I don’t know. It seemed like forever.”
Forever, that is, until Winnipeg Firefighter Chris Ducharme and Medical Supervisor Mario Ali arrived on scene within minutes of the call. Using a bag-valve mask, firefighters were able to get air into young Santana. Paramedics performed a laryngoscopy, which showed no visible blockage, and rolled Santana on his back.
“He was not breathing well and was almost unconscious,” Ali said. “I hit him real hard four times on the back. Out came the candy.”
Santana was talking by the time the ambulance reached the hospital, and upon his arrival, he was given an exam and reunited with his grandpa. Santana was kept overnight for observation. The next day, according to grandpa, he was ready for a return to the football field, but this time, without hard candy.
“He loves football,” Desjarlais said.
Several months later, Semenchuk and the rest of the EMS crew involved in the incident met Santana and his grandfather at the Winnipeg Celebration of Life Awards Ceremony, where the boy’s love for football did not go unnoticed.
The annual awards ceremony is in conjunction with Winnipeg EMS Week to recognize both EMS achievements and bystander help during an emergency and as part of the 2015 event (on May 28), Santana was presented a signed jersey from the Canadian Football League and tickets to a Winnipeg Blue Bombers game.
Semenchuk was delighted to be part of the celebration.
“It’s so hard when you’re not there and don’t hear what happens,” she said. “So this was really nice to meet the people and know that you’ve been helpful.”
Semenchuk started with WFPS dispatch nine years ago at about the same time the communication center introduced the Medical Priority Dispatch System™ (MPDS®). The instructions, she said, were invaluable, and during the first quarter of 2015, she found them particularly helpful for not only helping Santana but, also, in delivering a baby.
“That happened very fast, but I made it through the instructions,” she said. “I heard the baby cry. I’m sure it went very smooth because of MPDS.”
WFPS is a secondary PSAP. Winnipeg Police Service triages all initial 9-1-1 calls and routes calls to WFPS for fire or EMS assistance in the city of Winnipeg.
Time is Precious
Quick-acting dispatcher and caller save life
Any dispatcher or calltaker will attest that when it comes to emergencies, every second counts. The difference between life and death can be a matter of moments. For one calltaker in Idaho, quick action potentially helped save the life of a 3-year-old boy.
On May 26, Canyon County Dispatch Center (Caldwell, Idaho) dispatcher Doug Ward took a call that he certainly won’t soon forget.
After giving Ward his location and phone number from which he was calling, the man on the other end of the line identified the nature of the emergency: “My son has drowned,” he said.
This wasn’t the first drowning or near-drowning call Ward had taken during his career—he said he takes four or five a year—but he was immediately surprised at how cool under pressure the father was.
“When people call, often the first thing you hear is screaming and shrills,” Ward said. “But he was very calm.”
The father’s calmness was key to the outcome, and his collected demeanor also allowed Ward to quickly determine the protocol to use and the action to take.
The father informed Ward that his son (whose name, at the family’s request, has not been released) was unconscious and not breathing. He was holding the boy in his arms, having pulled him out facedown from a pond. With this information, and armed with ProQA, Ward had the father on the ground giving his son CPR within 10 seconds of taking the call.
“I immediately clicked on the Drowning tab (in ProQA), and it triggered CPR,” Ward said.
Ward said he believed the father had never done CPR before, but still, he “didn’t miss a beat.”
Because the father and boy were in a rural area, it took emergency responders 20 minutes to get to the scene. Ward instructed the father to continue CPR while they desperately waited for crews to arrive. Due to these efforts, the boy had a faint pulse when paramedics reached him.
The young boy was rushed to the hospital where he was in critical condition. Shortly afterward, he was upgraded to serious condition, and as of June 16, he was in a medically-induced coma but improving daily. Doctors are hopeful but not confident he will come out of the coma and survive. Due to privacy laws, the hospital is not releasing much information about the boy.
Still, to guide the father in getting a pulse and keeping the boy alive this long are encouraging.
“It’s a good feeling to see the child live,” Ward said. “To save a life makes it all worth it.”
As of the middle of June, Ward hadn’t had a chance to meet the boy or his family. He hopes to have the chance, though for the time being the family wishes for privacy.
Ward said drowning and near-drowning incidents are not uncommon in Canyon County, where there are many lakes, rivers, ponds, and canals. Accidents are especially common in the summer when out-of-school children enjoy swimming.
Ward said it’s important to always know where you are and to be extra cautious when playing in or near the water. Not all calls to 9-1-1 end with a happy result.
“They don’t always turn out like this,” he said. “This was like that one good shot in golf that makes up for all the bad ones.”
Without the cooperation and incredible composure from the father, Ward doesn’t believe the child would have been alive when the paramedics arrived. There simply would not have been enough time. Level-headedness allowed Ward and the father to get to work quickly.
“If the father would have been panicking and screaming, and if I would have had to struggle and fight with him, the outcome would have been different,” Ward said. “The way in which a person responds totally makes or breaks the call. Someone who is calm makes it twice as easy for us.”
Ward also praises the ProQA software and the protocols for making his job so much easier.
“I rely on it so much every day,” he said. “It gives me confidence to do my job. When you use it every day, it’s simple to use; it walks you through every scenario. With ProQA, we have all the tools we need. In any given situation, I feel confident I can help the caller.”
Fast CPR critical to saving arborist
In an area where boating and swimming accidents are more the norm for 9-1-1, the call Scott Cronkhite answered at the Okaloosa County Emergency Communication Center, on Jan. 28, 2015, was every bit as unexpected as a fatal shark attack in the Choctawhatchee Bay waters bordering the northwestern Florida community.
“Those happen in Pensacola,” said Cronkhite, who joined the department in August 2002 following his retirement from the military. “Not so much here.”
At first, Cronkhite couldn’t make out exactly what the caller was saying. The background was noisy; the scene was obviously chaotic.
“I thought he said someone’s been shot,” he said. “No. I was able to calm down the caller to understand what he was saying. Someone had been shocked.”
Cronkhite immediately went into CPR instructions for the bystander aiding arborist Levi Buttrill, who, by later accounts, had accidentally made contact with a live line at his shoulder or hand while up the tree in a bucket trimming branches to clear distribution lines. Buttrill went down.
The reaction on ground was immediate.
Co-worker Joshua O’Malley lowered the bucket and lifted Buttrill out. At the start of the call to 9-1-1, he told Cronkhite the victim wasn’t breathing.
“He’d been electrocuted, and that doesn’t often turn out well,” Cronkhite said.
Within moments, Ocean City-Wright Fire Control District Deputy Chief Scott Funchess arrived on scene, followed by Ocean City-Wright firefighters Brian Thomas, Blake Good, and Mike Taylor. Firefighters applied an AED to shock Buttrill back to life, while Okaloosa County Paramedic Tom Pocta and EMT Mason Salsgiver got the ambulance ready for his transportation to the hospital. They secured his airway and off they sped, lights-and-siren.
Okaloosa County Public Safety Communication Center Chief Daniel Dunlap was down the hall that morning when he received a call alerting him of the situation.
“The call was from the patient’s sister,” Dunlap said. “She’s a paramedic for the county and didn’t know what happened except that something had happened to her brother.”
Dunlap listened to the audio and was immediately impressed by Cronkhite’s composure and skill in calming the caller and providing Pre-Arrival Instructions, including cautionary advice to avoid taking more victims to the scene.
“I felt such a sense of pride for what Scott did,” Dunlap said. “You hear a lot of bad outcomes from high voltage, and this turned out to be a great outcome.”
Communications Division QA/Training Officer Linda Sapp, EMD-Q, said everything about the call was perfect.
“He did an excellent job, and his call got a high compliance,” she said.
Buttrill survived and walked out of the hospital 10 days later.
Buttrill’s sister Kayla DuBois said her brother is back to work, fully recovered with only the scars from skin grafts to repair burns to hands, elbows, and shoulder.
“He’s doing great,” she said.
The communication center received the highest honor through an email Dunlap received from DuBois on the day her brother left the hospital. An excerpt from the email reads:
I have a new meaning to come to work and a new meaning to do what I do. I hope each of you know how important your job is, and that you are appreciated. It is easy for us to get complacent in our jobs, but lives really do rely on you and your training. I am thankful for Scottie’s training and calling for this career. Without him, my family would have a giant hole in our hearts. Thank you to each and every dispatcher in this county. You are appreciated.
Cronkhite said it’s not the type of call he’d like to repeat.
“Something like that happens and the blood pressure goes up really quickly,” he said.
Electrocution due to electrical voltage is an obvious and not all uncommon hazard for arborists. The Tree Care Industry Association (TCIA) reviewed 158 occupational tree care accidents reported by the media in 2013. Of these accidents, 79 were fatal, and 12 of the fatalities were due to electrocution.1
1“Risk of death from shark attack.” Bandolier. http://www.medicine.ox.ac.uk/bandolier/booth/risk/shark.html (accessed July 21, 2015).
2Mortality and global health statistics.” World Health Organization. 2013. http://www.who.int/gho/mortality_burden_disease/en/ (accessed July 22, 2015).
1"TCIA Reports 2013 Tree Care Accidents." American Arborist Supplies Blog. 2014; March 6. http://blog.arborist.com/tcia-reports-2013-tree-care-accidents (accessed July 21, 2015).