Neil Kirby

“Don’t forget the simple stuff,” said Neil Kirby, director of ambulance operations for Dubai Corporation for Ambulance Services, in one of several sessions at the APCO Global Congress on Wednesday, May 2, that addressed dispatch-specific issues. “Most people who die prehospitally do so because of one of four reasons,” he said: an injury that’s incompatible with life, a stopped heart, a blocked airway or an uncontrolled bleed. “The last three all have effective first aid treatments.”

“If a person is going to die before they arrive at hospital, they are most likely going to die before the ambulance arrives,” said Kirby.

In Dubai, all emergency calls are answered by a police calltaker. The call is transferred first to a police dispatcher, who initiates the emergency response and sends the closest appropriate ambulance in the case of medical emergencies. The call is then transferred to an ambulance dispatcher who stays on the line with the caller giving medical advice and pre-arrival instructions.

All ambulance dispatchers are trained medics and/or nurses and have served time on the ambulance before transferring to dispatch. The medical dispatchers are trained to give clear instructions. “Don’t ask,” said Kirby. “Tell.”

Pre-arrival instructions are critical, according to Kirby. “What we do changes the patient outcome,” he said. “It has to make a difference.”

How to make a difference in patient outcome following heart attack was the main thrust of the presentation on dispatcher-assisted CPR by Gary Thomas, assistant chief/9-1-1 coordinator, Allegheny County (Pennsylvania) Department of Emergency Services.

“Dispatch-assisted CPR provides citizens and bystander rescuers with crucial assistance in delivering and performing the key links in the Chain of Survival,” said Thomas. “Call receivers or dispatchers fulfill their role in the chain by promptly answering 9-1-1 [or 9-9-9] and dispatching EMS personnel, assisting callers in identifying cardiac arrest and initiating early CPR, providing premise information if AEDs [automatic external defibrillators] are nearby, and determining if ALS response is required.”

“Immediate bystander CPR plus defibrillation within three to five minutes of collapse has been repeatedly been shown to improve survival from sudden ventricular fibrillation (VF) cardiac arrest,” said Thomas. “Each minute delay represents a 10% drop in chances of survival. Getting bystanders started performing CPR prior to the arrival of the first responders is a key element in saving time.”

Providing CPR to a cardiac arrest patient can be challenging, said Thomas. A patient in cardiac arrest can be difficult to recognize. “Would-be rescuers can lack confidence because they are unsure the patient is in cardiac arrest, they may not clearly recall CPR training, they are concerned about injuring the patient or other reasons,” said Thomas.

Dispatcher-assisted CPR has been proved to effectively address these challenges by assisting callers in identifying cardiac arrest, encouraging callers and ensuring effective resuscitation is performed in a timely manner.

In Seattle-King County, Wash., between 1985 and 2007, the addition of dispatcher-assisted CPR increased the rate of CPR from approximately 30% to 50%. “In many communities, there is the potential to nearly double the rate of CPR provided to cardiac arrest patients if dispatcher-assisted CPR is available,” concluded Thomas.

Faysal Tay, PMP, ENP, director, RCC Consultants Inc., discussed the impact of Next Generation 9-1-1 (NG9-1-1) on dispatching, public safety answering points and emergency communications systems.

“In the beginning, there was Basic 9-1-1,” said Tay. “The telephone company end office is programmed to point all 9-1-1 calls to a single destination. … The original basic systems (some of which are still in operation) provided no identification of the caller.”

Then, in the United States, Enhanced 9-1-1 introduced automatic number identification (ANI) and automatic location information (ALI) data delivered with the emergency call. But only worked from landlines. Wireless phones didn’t have the same capability. Caller location information from wireless phones was the next challenge. It is being introduced in phases:

• Phase 0 = Call Delivery by Tower
• Phase 1 = Call Delivery with Tower ID
• Phase 2 = Call Delivery with Longitude/Latitude

But the technology that delivers emergency calls to the public safety answering point can’t yet handle text, pictures and video. “We can send these to each other, and we expect that we should be able to send it to 9-1-1 or 9-9-9,” said Tay, “but we can’t do that.” That’s where Next Generation 9-1-1 (NG9-1-1) comes in.

An Internet-protocol-standard based system, NG9-1-1 will allow for Geographic Information System-based routing control, location data transported with the call, non-traditional calls and messaging to 9-1-1, supplemental data, virtual PSAP capabilities and rules-based routing options.

“We are moving from an analog environment to an IP environment,” said Tay, “one which will require a new network. Think of NG9-1-1 as an application on the network. You need dedicated bandwidth, but not a dedicated infrastructure.”

With this system, incoming emergency “calls can be routed anywhere that can be reached via IP.” So if something interrupted 9-9-9 service in Dubai, a backup center in Abu Dhabi, for example, could seamlessly answer the calls and continue to dispatch resources located in Dubai to the emergency. Dispatchers could even conceivably work from home, which could ease response during quarantine situations, for example.

New skill sets will be required. New procedures and guidelines will need to be established.

“We want to standardize our response,” said Tay. “Work with your neighbors to develop [answering point to answering point] agreements.”

Keri Losavio, editor, Public Safety Communications

Gary Thomas

Faysal Tay