When Seconds Don’t Count
October 12, 2018
This morning on the way to work an impatient driver passed me, only to end up just two cars ahead of me a mile or two farther on. I’m used to that. Where I live—in New Jersey (USA)—we have some of the most aggressive drivers in the country. (In my travels, nearly a lifetime of driving here has stood me in good stead on the German Autobahn and the Italian Autostrada despite their own formidable reputations.)
Impatience can get us into trouble. On the road it can get us a ticket or get us killed. In 911 it can cause us to miss key information. Here is my perspective on when and why it might be beneficial to curb that impatience and listen for a few extra moments.
“Okay, tell me exactly what happened.” This is arguably the most important question we ask in our interrogation of emergency callers. But do you ever find yourself interrupting your caller as soon as he or she gives you the Chief Complaint? For many of us, the following is all too typical after asking the above question:
Emergency Dispatcher: “My husband started feeling nauseous and dizzy this morning—”
Emergency Dispatcher (interrupts): “Okay, ma’am, we’re sending an ambulance to help you. Are you with him now?”
If the caller wasn’t interrupted, she might have added “ —after he was running the generator in the garage for a while.” Clearly that additional information would change the protocol choice from Protocol 26: Sick Person (Specific Diagnosis) to Protocol 8: Carbon Monoxide/Inhalation/HAZMAT/CBRN, and almost certainly require a fire department response in addition to EMS.
As new Q’s are taught, 95 percent of calls are not seconds-critical. Taking 45 seconds versus 83 seconds to dispatch a chest pain call is not likely to make a difference in patient outcome. Many times callers volunteer key information immediately after our opening statement before they give the address. We train new emergency dispatchers that the address and callback is paramount and to obtain it before all else, and the rationale behind that is obvious. But is it really necessary to interrupt callers every time they’re giving us good, solid information? If you answer with “911, what’s the address of the emergency?” and the caller starts to tell you exactly what happened, why not just listen for another few seconds (providing the caller isn’t rambling on) and then ask for the address? Technically that might delay your call entry, but you might well make that time up a few questions later when you come to the “What Happened?” question in Case Entry since the answer might be obvious by that point. Interrupting isn’t always necessary and can actually add time if the caller has to repeat part of what he said.
Don’t be too quick to cut your caller off before he or she has finished answering a Key Question, either. Often what comes at the end of an answer changes what was said at the beginning.
Let’s remember, too, that finding out what happened is vital. “I’m having some kind of problem with my heart” doesn’t tell you, and we don’t clarify statements like that as often as we should. “What exactly is bothering you?” or “What kind of problem are you having?” are perfectly appropriate clarifiers. In some cases it might even be necessary to ask “What is she doing right now?” or “What was he doing just before this happened?” to determine the correct protocol to use. Neither are freelance questions. They shouldn’t be asked automatically, but on some calls they’re vital so we aren’t handicapped by not having the full picture.