The Hold Button

Brett Patterson

Brett Patterson

Best Practices

Brett Patterson


I am a new EMD, and I have a question about a hypothetical situation and am looking for guidance if it should ever occur.

Let’s say you are in the dispatch center by yourself, and you are on a 911 call giving dispatch lifesaving instructions (e.g., CPR, compressions, or choking). Your other 911 line rings. Is it acceptable to put your current patient on hold or temporarily stop giving instructions to answer your other 911 call? Or, is it our duty as an EMD to stay with the patient and continue with instructions and have the other 911 line continue to ring and potentially not get answered due to giving lifesaving instructions to the first patient? Our agency has no policy on this, and I am looking for advice from other EMDs on what they would do if faced with this situation or if there is a protocol for this.

Thank you so much for taking the time to read my question. I look forward to hearing from you. I hope you have a great day.

Jennifer Boedicker

Richfield Police Department

Richfield, Minnesota, USA


You have a challenging question!

Fortunately, being faced with such decisions in an emergent environment has for many years been considered by our courts, and there are provisions for essentially “doing the best one can given the circumstances.” In short, the standard of care is “adjusted” based on the unpredictable challenges we face. This principle in law is called the Emergency Doctrine, and it is based on the “reasonable man” concept. I have attached an article I wrote for 911 Magazine that explains this in more detail. (See the accompanying column)

To answer your question specifically is difficult because every situation is different. If, for instance, you were providing CPR instructions when a slew of calls hit your center, your decision to put a caller on hold may be based on where you were in the instruction process, i.e., you decided to stay on the phone until compressions were started, or you decided to put the caller on hold while they were getting the patient to the floor. Both of these decisions could easily be justified using the “reasonable man” concept.

And while agency policy may be helpful in these situations, you can see how it would be difficult to create a policy that covers every possible situation. More often, policies are created to change response plans or suspend PDIs/PAIs during unpredicted, high call volumes. In addition to the consideration of policy, however, you may be comforted to know that doing the best you can, given your training and experience, is always considered in a court of law. And important to the agency's administration, predictable spikes in call volumes are generally not considered under the Emergency Doctrine because they are foreseeable. In other words, an agency is obligated to prepare for what is predictable.

Feel free to contact me directly with any additional questions or comments.

Brett Patterson

Academics & Standards Associate

Chair, Medical Council of Standards

International Academies of Emergency Dispatch®

Editor’s Note: The following article was published in the January/February 2006 issue of 911 Magazine.

Head: Dispatch Overload

Subhead: Applying principles of law to disaster management

Brett Patterson

The record hurricane season of 2005 and the subsequent criticism of how the disasters were handled by emergency agencies and their leaders have many of us in emergency communications considering ways to be better prepared for times of crisis. However, preparing for call volumes that can implode any reasonable staffing and equipment preparations is no easy task. It seems that no matter how well we prepare before a storm, our resources are taxed beyond their limits leaving line personnel, supervisors, managers, and administrators to make uncomfortable triage decisions, often in the heat of battle without a moment’s notice.

Fortunately, our system of justice provides some consideration for such times, within reason, of course. Our system of justice, and that of most western civilizations, is generally based on something called the reasonable person concept. In civil law, this concept uses a hypothetical person to set a standard of care based on what actions may be considered reasonable in a given situation. Furthermore, this concept is considered in the definition of negligence where the actions of the defendant are compared to the hypothetical or testimonial actions of a reasonably prudent person given the same, or similar, circumstances.

There is another principle in law that has more specific regard to the practice of public safety where explosive call volumes and desperate situations are more common than are universally expected elsewhere. The emergency doctrine considers times of crisis separately from normal, expected situations. In other words, our law allows for instinctive reactions, even if those reactions do not meet an ordinary standard of care, when they are the result of a sudden, unexpected need.

On the surface, these concepts appear to protect emergency professionals from civil liability during times of crises. If only these principles are considered it seems that, for instance, the emergency dispatcher need only perform reasonably well during normal times and rely on instinct when disaster strikes. In reality, these concepts in law are considered in conjunction with perhaps the most important legal principle pertaining to public safety: foreseeability.

In tort law, foreseeability is considered an essential element of proximate cause. In other words, causation, or the direct relationship between one’s actions and the damages associated with a negligence claim, is somewhat dependent on the ability of the defendant to foresee the problem. This directly relates to emergency operations because many of the crisis situations we face are indeed foreseeable; in fact, they are predictable.

Modern weather forecasting technology makes the tracking and landfall predictions of a hurricane more accurate than ever. The emergency command centers associated with Hurricane Katrina were able to anticipate disaster days before the storm made landfall. Additionally, past hurricanes and scientific predictions provided accurate assessments of what may happen if a hurricane of such magnitude were to strike the Gulf Coast of the United States in the vicinity of New Orleans, Louisiana. With such information available, can it be said that public safety officials were reasonably able to foresee the need for public aid, and the demand that would be placed on their operations, in the event of such a storm?

Given the reasonable person concepts that protect emergency workers in times of crises, and considering the principle of foreseeability that protects the public, how can we better prepare for disastrous situations? While it may not be reasonable to provide enough resources to manage a disaster as we would during normal operations, public expectation demands that we do everything in our power to prepare, using all available means of prediction. In addition to staffing to full capacity, this means pre-planning and training that outlines specific methods of triage for times when resources are depleted and some calls must, necessarily, go without a traditional response. In the communication center, a pecking order of duties must be established ahead of time so that personnel act consistently, as compared with each other, with regard to answering calls, providing interrogation and instruction, assigning resources, and coordinating field activity. Personnel should be adequately trained and practiced to manage times of severe overload in order to make the best possible use of limited resources. Such practices should be written into protocol, where possible, and summarized in guidelines when exact specificity is not possible.

Most of us can find it in our hearts to excuse an action with an untoward outcome when such an action is performed under duress and made with the best of intentions. However, as situations become more predictable, the handling of those situations becomes more manageable, and the level of expectation naturally rises. From the predictable rise in call volume on a full moon or celebration night, to the anticipation of a record hurricane season,

we share a responsibility to prepare our services to a level that meets reasonable expectations.

While no man can be expected to perform at his best doing something he has not had the opportunity to learn, every man should learn from the lessons of history and prepare for the expected.

Reasonable Person: A hypothetical person used as a legal standard, especially to determine whether someone acted with negligence; the reasonable person acts sensibly, does things without serious delay, and takes proper but not excessive precautions.

Emergency Doctrine: A legal principle exempting a person from the ordinary standard of reasonable care if that person acted instinctively to meet a sudden and urgent need for aid.

Foreseeability: The capacity to be reasonably anticipated; foreseeability, along with actual causation, is an element of proximate cause in tort law.

Source: Black’s Law Dictionary, 1996


My co-workers and I were having a discussion about which protocol to use for an anxiety attack. I’m wondering if you can provide some clarification.

It’s for a patient with no priority symptoms. Some use MPDS® Protocol 25: Psychiatric/Abnormal Behavior/Suicide Attempt, while others use MPDS Protocol 26: Sick Person.

Which would be most appropriate?

Thank you,

Michelle Rossi

CMED Telecommunicator

North Central Connecticut EMS Council

Hartford, Connecticut, USA

Hi Michelle:

When you think about it, a complaint of “anxiety attack” is actually a caller diagnosis rather than a description of what has happened. It’s like saying the patient is drunk or is having a heart attack. All of these conditions or caller diagnoses may present in different ways, and the EMD needs to know “… exactly what happened” in order to select an appropriate protocol.

So, the answer to your question is to find out not what the caller thinks is the underlying problem, but rather what sign/symptoms/actions are prompting the call. By far the best way to do this is to repeat Case Entry Question 3. Common to the anxiety attack diagnosis are symptoms such as rapid breathing (Protocol 6), racing heart or palpitations (Protocol 19), chest pain (Protocol 10), or simple anxiety/nervousness (Protocol 26).

I hope this response helps to answer your question.