Dispatch Protocol Systems, The Good the Bad and the Ugly.

9-1-1 Magazine January/February 2003
By Mike Scott

Dispatch centers around North America are increasingly using some form of protocol when handling public safety requests for service, but some wonder if that protocol has become too stringent.

Indeed as the number of calls continues to increase nationwide, the viability of dispatch protocols is in question. There may not be a more debated subject in the dispatch field because there are benefits and drawbacks to adhering to a strict protocol.

The pros of dispatch protocol include standardization, the ability to provide uniformed instructions and the ability to prioritize responses. A structured protocol can provide consistent answers to pre-determined questions that may improve the way dispatchers communicate with units in the field. Even more importantly, it has been shown to save lives.

Yet some industry experts prefer to rely on a dispatcher's experience when handling a situation. They feel that stringent use of protocols may lead dispatchers to becoming more of a robot— or at least feeling like fore of a robot— than a skilled professional. Increased scrutiny of a dispatcher’s performance can also lead to negative morale issues.

Allan Young, communications supervisor for the Hookset (NH) Police and Fire departments is in favor of utilizing dispatch protocols. He said the liability of public safety workers is reduced because situations are always handled in an identical way. If dispatchers are properly trained in using protocol cards and policies, there will automatically be documentation that can help an agency protect against a lawsuit.

"I support using protocols, because it becomes much harder to miss some key questions, like the who, what, where, when, and why," said Young.

The San Hose (CA) Fire Department has used Medical Dispatch Protocol System (MPDS) cardsets (the country's most prevalent EMD protocol system) since 1997 as part of its emergency medical dispatch protocol. The results have been extremely encouraging. Field units feel they are more prepared for what they will encounter as a scene and there have been a handful of documented saved lives because of the protocol, said senior Public Safety Dispatcher Doreen Hargrave.

"What we find important is to medically prioritize different calls for service," said Hargrave, whose department also considered card sets from APCO in the mid-1990s. "This is truly a structured set of questions that help determine medical priorities that in turn save lives."

MPDS also has allowed for flexibility and the customization of its card sets. Hargrave said the San Jose Fire Department has gradually affected changes in dispatch protocols, which gave been reflected in the standard card sets. One example is the inclusion of CPR sequences for adult and children in relation to tracheotomy situations. Those questions were recently implemented by MPDS.

"We have very few specific local protocols we use so the system we use works well for us," she added.

The use of a cardset based system (which now includes electronic card sets) works with the goal of uniform responses based on priority symptoms, said Margaret Hamrick, Communications Operations Manager for Tampa Fire Rescue in Florida. With these electronic or hard copy card-sets, the questions are also interchangeable no matter what the symptom may be.

Card-set protocols also give "customers" a better response to guiding them to help themselves. A good system will list questions that are relevant and pertinent, but also get to the root of the information needed to send a unit.

"The general public has been educated enough in that they expect quality instructions from a dispatcher," said Hamrick. "The level of response is determined by the questions asked and the answer received. Card sets help to maintain this consistency."

The closest thing to a governing body on dispatch protocol is the National Academies of Emergency Dispatch (NAED) located in Salt Lake City. Executive Director Robert Martin said the purpose of his organization is to develop an accredited protocol system and help emergency medical dispatchers (EMDs) around the country to become more skilled and educated in their roles.

Since the NAED was founded in 1988, it has developed 11 different accredited protocol releases, with a 12th release expected in the next couple of years. Public safety software vendors may choose whether or not to utilize the Academy's recommendations in their projects, but the NAED does release a list of their approved protocol options to any requesting public safety agency. Initially created out of the first medical dispatch system created by Dr. Jeff Clawson, then the medical director of the Salt Lake City (UT) Fire Department, the NAED has grown into an international standard setting organization for EMD. The Academy is now branching out into fire and law enforcement protocol systems.

"These days if you don’t use some type of protocol, you can be viewed as being negligent in your role," said Martin. "There is a uniformed acceptance that protocol is good. We consider that this is the first step in saving lives."

Martin said various Academy committees are charged with gathering information to be included in protocols, assessing that information, communicating with public safety organizations all over the country, and making a determination as to release changes, additions and deletions.

"We don't sell protocol products but we do determine the standards by which they should be judged," said Martin. "The more questions that are added to an electronic program or card set, the more exponentially the correct responses will grow. We are here to develop standards for those proper sequences."

Communications Supervisor Christina Russell of the Oakland County Sheriff's Department in suburban Detroit, MI acknowledges it can be difficult to juggle personal and work lives in a dispatch environment, but added that answering calls is the top priority. That is why protocol is critical. It allows a dispatcher to effectively handle calls in a consistent manner.

"Dispatchers must be able to control themselves and to multi-task," said Russell, who has worked in a dispatch environment for nearly 20 years. "We have to find a way to keep a call online and get as much information as we can. That is where protocol comes in."

"It makes it easier because there is a set process to follow and every call is treated in the same way," she added.

Developing a dispatch protocol can also relieve dispatcher stress. In such a fast-paced, high intensity job having a list of questions to ask can help keep a dispatcher calm, particularly those who are inexperienced or who handle a high volume of calls.

Meanwhile software vendors have improved their products as well. Medical Priorities' ProQA, for example, has developed a built-in logic system that gives the dispatcher answers to the predetermined questions electronically.

Pennington County 9-1-1 in Kansas uses a protocol system that was recommended by the NAED. Director Don Phillips said local medical personnel and hospital emergency departments are in full support of using a standard protocol.

One of the main reasons is that the protocol system has helped reduce the number of false calls and total runs, saving the county time and money while increasing reliability.

"It has reduced the number of "hot" or red lights and siren runs by our fire department and ambulance companies," said Phillips. "This in turn has reduced the number of accidents, which everyone wants."

The Aurora, CO Fire Department was on e of the first public safety agencies in the state to use layered responses in EMD, which is an effective method of ensuring a higher response probability, said dispatcher Kathy Cline of Golden.

"Aurora dispatchers can tell the units to respond routine or emergent (using lights and sirens or not)," said Cline.

But there are some drawbacks. Young said sticking to a protocol is difficult in a small agency where there may be one to three dispatchers working at one time, particularly during a time of high call volume. This could force dispatchers to forgo protocol in an effort to take every call.

Brent Finster, Telecommunications Manager for the Contra Costa County Fire Communications Center in California believes the MPDS protocol set for EMS is the best product of its kind available in the market today. However he has not yet seen a fire or law enforcement protocol product that he feels effectively meets the needs of the public.

One reason for this opinion is that EMS protocols must be approved by medical professionals, while law enforcement and fire protocols generally do not have guidelines that are as strict, according to Finster.

"We can't get to the point where we are just dispatching numbers," said Finster, who has worked in the dispatch field for 25 years. Fire and law enforcement dispatchers (in particular) need to ask questions immediately based on their experience and can't rely on the cookie cutter approach."

Contra Costa's Fire Communications Center takes calls for EMS and fire only, meaning that nearly 100 percent of all calls are classified as an emergency. Handling this many emergency calls a day requires a rapport with the callers that Finster believes simply cannot be communicated when protocols only are used.

"We need to train our (dispatchers) to answer the question using their training and skills," he said. "I just don't think that always flipping to a card-set is a good idea, particularly when you have someone who may be considering suicide on the other end of the line."

Young also feels the tone of the caller, which often can convey as much or more information as what they say, may not be detected by a dispatcher concentrating on the protocol. One of the roles of a good dispatcher, said Young, is to listen to the meaning behind what the caller is saying. Taking charge of a call and encouraging them to reveal even seemingly useless information can be the difference in saving a life.

In other words, use protocol as a tool, but don’t rely on it in all cases, said young.

"I think with protocol, it can take away from the natural flow of conversation and the dispatcher may not be able to bond with the caller," he said. "This can also limit the information that is gathered by the dispatcher. A person can get locked into using them and in the process forgets to think outside of the box."

Russell agrees. She said that while protocols definitely help determine the types of questions to ask, dispatchers need to learn how to get to the root of the call. Many times, the caller is in hysterics or has difficulty communicating the real issue. That’s when a dispatcher should divert from the standard protocol.

"Many times you really have to read between the lines as a dispatcher," said Russell. "In a domestic situation, we have to draw out what the problem is by asking questions but at the same time not putting words in their mouths."

Cline said another drawback is that the training and using of such a system is time-consuming, Stress can also be a factor.

Patty Maher is the EMD Program Manager for the Association of Public Safety Communications Officials (APCO). She said APCO suggests using a limited protocol format because it is impossible to create a card set that will adequately handle every type of call a public safety dispatcher will take.

"As far as we're concerned, we don't think there is a way that you can be sure every call should be treated with the same questions and dialogue," said Maher. "We like to let the experience of the dispatcher take over and we don't want to limit that in any way."

Maher said APCO has developed EMD Guide cards that are recommended for EMS agencies. The criteria in these guide cards are not based on a strict yes or no answer and the questions are listed so that dispatchers can easily guide a caller into follow-up questions.

There are no current APCO standards guiding the use of guide cards for fire and law enforcement agencies. Maher said APCO suggests that dispatchers be trained in call handling methods that are most appropriate for the local area in which that agency serves.

"We want to assist in developing and educating a dispatcher without having the privilege of taking the call in a certain direction away from that individual," said Maher.

One of the keys in developing a protocol is to use one that makes sense for a given department, depending on its location, number of field units, area topography and more. In this manner more public safety organizations are developing customized protocol options in-house.

Maher believes this is a good option because each department has different needs.

"The questions that work for one department may not for another," she said. "We believe (managers) need to look at what their own needs are, so it makes it tough for us to make recommendations."

Then there is the issue of measuring how well the protocol is being followed by dispatch personnel. Negative responses can lead to poor employee evaluations, thereby decreasing dispatcher morale and potentially increasing turnover.

Martin said agencies have a responsibility to not only measure the results of a protocol system but to find out if it is being used properly. He said when handled properly, constructive feedback will only improve an agency’s response capabilities and the level of education of its dispatchers.

"It's just like any management issue at any business in the country," he said. "If any quality improvement process is not managed properly it can lead to morale problems. It takes well-trained supervisors to understand how to communicate the effectively with dispatchers."

Martin said EMDs should be receiving at least an hour of on-the-job-training per month, whether this is through classroom education, attending seminars, or conferences, software training, etc.

Some dispatch training programs, either completed in person or guided by software programs, can lessen the importance of protocols. As a dispatch training software vendor, Advance Systems Technology (AST) in Lawton, Oklahoma, makes no recommendations to students on the subject of protocol.

AST Director of Accreditation and Business Development Evelyn Harmon said the training her company offers can teach the standards a dispatcher will need to learn their role. With the computer-based training that is provided by the software, an individual will already have achieved an advanced level of knowledge and skill that may not require the need for protocol.

"However, we always tell our students that they should refer back to their own agency's rules and regulations when using our training methods," said Harmon.

So what does the future hold for dispatch protocols? Martin contends that increased structure will continue to be the rule rather than the exception. This will lead to increased training of dispatchers, more certified vendors and employees —and less dispatcher turnover.

His theory is based on the idea that by further professionalizing the EMD, dispatching will be viewed more as a long-term career that requires highly skilled individuals —who would earn higher salaries.

"We need to redefine the definition of a first responder in this country," said Martin. "That designation should also be given to EMDs because the better care they give at the front end, the less (public safety agencies) will get sued and the more lives will be saved."

Martin said that higher level of efficiency will save departmental costs, thereby allowing the best EMDs to receive higher salaries.

"That only makes sense. An EMD is not just a secretary answering the phone. With a more structured system, and with higher salaries, an individual will have a greater desire to rise to a position that relies on a high level of performance."

Mike Scott writes for several national and regional publications. He previously worked in the public safety software industry. Mike lives in Waterford (MI).