April 13, 2017
Studies have shown that one in five vacationers suffers some sort of injury or mishap on a trip.1 As a dispatcher, taking calls from people who are away from home on vacation is not a rare occurrence, and they present unique challenges. These callers can be in unfamiliar areas and are sometimes far from help.
The following story tells the tale of the fictional Malchance family, which embarked across the United States on a long-planned, highly anticipated vacation. Let’s see what misfortunes befall the family and which Priority Dispatch® protocols emergency dispatchers would have used in response to the family’s calls for help.
Boat incident in San Diego
Kevin Malchance loaded his family of five into the minivan, leaving their Phoenix, Arizona, home for a monthlong voyage across the U.S. Kevin and his wife, Nancy, had selected 14 destinations, with the first in San Diego, California. They would then head north and then east to the opposite side of the U.S. before ending at the Grand Canyon, a few hours north of their home. Nancy wanted to fly from place to place due to her husband’s speeding habit and tendency to get into fender-benders, but Kevin convinced her that traveling by car would give the family a better experience.
The Malchances were novices when it came to boating, but once in San Diego, Kevin insisted on taking his wife and their three children out on the open water of the Pacific Ocean. Kevin found what looked like the perfect spot, rented a modest speedboat, and hit the choppy water.
But Kevin was worse at driving a boat than he was at driving a car, and after just 10 minutes on the sea, he lost control of the craft and rammed it into another speedboat. The driver of the other boat took off without a word, leaving the Malchances alone in the open water.
The impact sent little 5-year-old Bobby into the water (fortunately, he was wearing a life preserver, and he was pulled out). Susie, age 9, banged her head, and 15-year-old Steven had some cuts on his leg and lost his iPod to the ocean. The wreckage was severe, and their boat was inoperable. After checking on his family, Kevin called 911.
Upon taking the call and hearing Kevin’s story, the dispatcher correctly turned to the Fire Priority Dispatch System™ (FPDS®) Protocol 73: Watercraft in Distress/Collision. The dispatcher asked Key Questions, including, “What is the exact location of the boat? and “What type of body of water is this?” Kevin answered, and the dispatcher immediately considered Rule 1: Seemingly benign water emergencies may turn into immediate life threats due to changes in weather, tide, and location.
The dispatcher appropriately went through the rest of the questions and properly coded the call as 73-D-4Y. The dispatcher then went through the seven Post-Dispatch Instructions with this protocol, such as PDI-e: If it’s safe to do so, anchor your boat. Help arrived shortly thereafter.
Unhappiness in the Happiest Place on Earth
Undeterred by their oceanic wreck, the Malchances were treated for minor injuries, and the family was off the next day for Disneyland, in Anaheim, California. What could possibly happen there?
The family spent a delightful day in Disneyland and returned the following day for an encore. Things were going magically until a discourteous man and his young daughter cut in front of Nancy as she stood in a long line with Susie to get a picture taken with Queen Elsa from the movie “Frozen.” A verbal shouting match ensued, in which Kevin intervened, and the two men nearly exchanged punches.
Cooler heads seemed to prevail, and the rest of the day went as planned. However, as the family reached the parking garage on its way out of the park, the same hotheaded line-cutter darted out from a doorway, grabbed Kevin by the shirt collar, and shoved a gun into his chest!
Terrified but alert, Nancy screamed at Steven to run, and she grabbed her two younger children and sprinted to the safety of a stairwell and called 911. The responding dispatcher calmed the frantic wife and gathered the necessary information to move to Police Priority Dispatch System™ (PPDS®) Protocol 106: Assault/Sexual Assault. The dispatcher began with the critical first Key Question, “Were weapons involved or mentioned?” Nancy mentioned the gun, and this, along with her other descriptions of the incident, helped the dispatcher code the call as 106-D-4G: Gun.
One of the four Post-Dispatch Instructions told Nancy to “keep very quiet and stay out of sight.” She waited nervously for the police to arrive, not knowing what was happening with her husband. Sensing her anxiety the dispatcher provided help and comfort by offering Case Exit Instructions “An officer will be dispatched as soon as possible” and “I’ll stay on the line with you as long as I can.” Fortunately, the authorities arrived in time to apprehend the man and prevent Kevin from being seriously harmed.
Sin City situation
Shaken but determined, the Malchance family made the four-hour drive to Las Vegas, Nevada. Vegas isn’t exactly an ideal spot for children, but Kevin was intent on showing his family the glitz and glitter of the Las Vegas Strip.
Impressed with the dazzling buildings but hungry for something more than homemade sandwiches, the family visited the all-you-can-eat buffet at the Circus Circus casino. The family was soon calling 911 for the third time on the trip when a Swedish meatball became lodged in Bobby’s throat.
After being asked Medical Priority Dispatch System™ (MPDS®) Case Entry Question 3, “Okay, tell me exactly what happened,” Kevin fearfully relayed the emergency, including the fact that Bobby was unconscious. The dispatcher followed up with Case Entry Question 3c, “Is he breathing or coughing at all?” Kevin’s answer of “no” automatically signaled the dispatcher to code this call as 11-E-1. The dispatcher also instructed Kevin not to slap Bobby on the back.
Because consciousness and breathing questions were already answered, the dispatcher didn’t need to ask them in Key Questions of Protocol 11. The dispatcher went to Post-Dispatch Instructions and then to Pre-Arrival Instructions in Protocol B: Airway/Arrest/Choking (Unconscious) – Child 1–7 Yrs. The dispatcher instructed Kevin on steps 1 and 2. When Kevin reported that there was nothing in his son’s mouth, the dispatcher moved to steps 5 and 6 where chest compressions were explained. Kevin understood the instructions and then followed the directions for CPR plus Mouth-to-Mouth in steps 7 and 8. He continued the breaths and pumps until paramedics arrived. Bobby started breathing and regained consciousness shortly thereafter.
Lost in the desert
A relieved family had young Bobby back in his full capacity after the boy made a complete recovery from the terrifying event. Kevin thought the best way to put the near-tragedy behind them would be to enjoy a nice hike and fresh air at Arches National Park in the southeastern Utah desert.
The family found an off-the-beaten path trail but became lost when Kevin suggested leaving the marked trail and venturing over to some interesting rock formations. With no food and very little water, the family members began to suffer under the draining sun. Steven was in the worst shape. The exhausted teen’s skin was turning red and burning hot. He had no energy to do more than lie against a large rock that provided a tiny amount of shade.
With a rare stroke of luck, Kevin noticed he had cellphone coverage, so he called 911 once more.
The responding dispatcher determined through Case Entry to use Protocol 20: Heat/Cold Exposure. The dispatcher paid careful attention to Axiom 1, which states, “Because a patient has a problem in a hot or cold environment does not mean the problem was caused by the environment. Heat or cold extremes may trigger other medical problems.”
The dispatcher skipped Key Question 1, “Does he have chest pain or chest discomfort?” because Kevin reported the victim was under the age of 35. The dispatcher moved to Key Question 2, “Is he completely alert?” to which Kevin answered that Steven was not. Steven had never had a heart attack, so Kevin answered “no” to Key Question 3. However, the worried father did report that his son’s skin color had changed in response to the dispatcher asking Key Question 4. The gathered information told the dispatcher that this would be a DELTA-level response.
It took a few long, tense hours for help to find the Malchances. During the wait, the dispatcher instructed Kevin in PDI-b to “remove (Steven) from any sources of heat” and to “remove his outer clothing. Apply cool water to his entire skin surface while fanning him.” Search and rescue located the Malchances, and Steven spent the night in the hospital but was OK.
A word about remote rescue
Hearing from ill-prepared vacationers in remote areas is not uncommon. Frances Jimenez, 911 Programs Manager, El Paso County 911 District, El Paso, Texas, USA, for example, says the calls her agency receives from hikers and bikers in rural and remote areas can be challenging.
“Callers are almost always ill-prepared, with little water, no sunblock, and poorly charged cellphones,” she said. “Common calls we receive are due to heat-related illnesses, traumatic injuries, or simply people that get disoriented or lost.”
Jimenez added that environmental challenges, such as where our fictitious Malchance family got lost, make determining location and successfully reaching the victims difficult.
“The callers usually cannot tell us where they are, so it is up to the calltakers and dispatchers to find them based off of their CAD map and other landmarks,” Jimenez said. “Mountain Rescue and/or Special Angle Rescue teams are sometimes called out to assist if the caller is not accessible due to mountainous or dangerous terrain.”
A rash of disasters
The poor Malchance family: just when you thought their terrible fortunes would change for the better, their uncanny streak of 911 calls continued.
A trip to spectacular Yellowstone National Park in Wyoming resulted in a pair of 911 calls: a complaint of being burned by stepping in a hot pool (Protocol 7: Burns (Scalds)/Explosion (Blast), followed by a terrified call as the result of a grizzly bear attack on Nancy and Susie (Protocol 3: Animal Bites/Attacks).
Unwilling to let boiling-hot water and a 500-pound animal end their vacation, the Malchances soldiered on to Mt. Rushmore (South Dakota) and then to the Windy City (Chicago, Illinois). At Mt. Rushmore, during a thunderstorm, Kevin was standing near a lamppost when it was struck by lightning. Miraculously, the call to 911 only required a 15-C-1L Determinant Code from the responding dispatcher, as Kevin was alert and breathing normally after the strike.
Then in Chicago, the family was carjacked at knifepoint and thrown out onto the street, losing their car and money in the process. By providing accurate Description Essentials to the dispatcher using PPDS Protocol 126: Robbery/Carjacking, police were able to locate the thieves and return the Malchances’ car and other belongings.
It didn’t get much better at Niagara Falls or in New York City. Susie slipped and fell 8 feet from a rock and landed on her back. As Protocol 17: Falls tells the dispatcher, the back is a POSSIBLY DANGEROUS Body Area, and given this, combined with the fact Susie wasn’t bleeding and was completely alert, the Malchances’ 911 call was coded 17-B-1G: On the ground or floor.
Susie was OK, but things got scary for the family two days later in a New York City subway train when electrical issues started a fire. Several trapped passengers called 911, and the FPDS was used to code the call as a 75-D-3S. Help soon arrived, and no major injuries resulted.
Breathing problems and a body
How much abuse could one family take? Nancy and her three beleaguered children begged to go straight home, but Kevin moved the family onward, reasoning that they might as well finish the trip after everything that had happened.
In the nation’s capital of Washington, D.C., Kevin’s asthma flared up while walking from site to site. It was so bad that Nancy called 911, the number the family had grown so accustomed to dialing.
Kevin was alert but was having a hard time speaking between breaths. His color wasn’t changing, but he didn’t have an inhaler with him. The experienced dispatcher taking the call knew that the statement in Rule 2 of Protocol 6: Breathing Problems, “Breathing problems are potentially life-threatening until proven otherwise,” meant this call could go in any direction.
The call was accordingly coded as 6-D-2A, based on the information given in Key Questions. Paramedics arrived and gave Kevin an inhaler just as he was running out of breath.
The family avoided injury or accident at the next stop at Great Smoky Mountain National Park in Tennessee. However, the five weary travelers did stumble upon a dead body on a hiking trail. There appeared to be a gunshot wound to the chest. Using Protocol 112: Deceased Person, a dispatcher got police to the scene.
A brief discussion on phones and PAIs
The Malchances were able to get out of the Smoky Mountains without any trouble, but had they been stranded much like they had been at Arches National Park, the situation would have been more dire.
Cellphone coverage in mountain areas is erratic at best, making communication difficult for both the caller and the dispatcher. John Hinkle, Supervisor/Trainer with Gallatin County (Montana) 911, said dispatchers need to be careful about how long they’re on the phone with callers in remote locations, as callers’ cellphone battery power can diminish quickly. Instead, his agency will periodically call back the callers while they’re waiting for EMS. He also said Pre-Arrival Instructions can be helpful in providing comfort when rescue is far off.
“Making sure we provide DLS Instructions helps the injured and also reassures them and gives them the sense they are being helped,” Hinkle said. “It eases their concerns or fear. Our search and rescue folks do a lot of follow-up with them mostly by text message because it saves on battery life and because of cellphone reception it might be the only way to effectively communicate with them.”
Let it end!
Enough was enough for the Malchance family. Seeing a dead body in the woods was the last straw in a remarkably long line of horrible experiences on this ill-fated vacation. A unanimous vote confirmed that it was time to cut this nightmare short and return home. After all, the five family members were visibly traumatized and physically battered by what they had encountered.
Aside from getting a flat tire and hitting a deer, there were no further incidents on the way home. The Malchances at last pulled up to their home; it seemed like an eternity since they had been there. Kevin’s heart sank, however, when he noticed the door had been kicked in and a basement window was broken.
“Tell me this didn’t happen,” Kevin said as he sank into the seat of the car in complete exasperation.
If your center serves an area popular for tourist activity, you’re likely to receive calls from panicked vacationers. Because these callers are not in their usual element and may be in areas difficult for emergency responders to reach, there may be a heightened sense of urgency. Consider these points:
- PDIs and PAIs are critical in calming and reassuring callers.
- Be aware that vacationing callers will often be unfamiliar with their surroundings and may have difficulty identifying their location.
- Be familiar with Rules and Axioms.
- Be careful how long you stay on the line with callers who may be calling from rural or wilderness areas. It could be hours after dispatching crews before their arrival on scene, so you don’t want to risk draining a caller’s cellphone battery.
- Vacationers may be calling from difficult-to-reach areas where special rescue teams may need to provide assistance.
- Don’t take a vacation with the Malchance family.
1 “One in Five People Suffer Some Kind of Injury on Vacation … Here are the Most Common Ones.” Mix 106.5. CBS Local Media. 2012; June 4. http://mix1065fm.cbslocal.com/2012/06/04/one-in-five-people-suffer-some-kind-of-injury-on-vacation-here-are-the-most-common-ones/ (accessed Dec. 2, 2016).