As in many other jurisdictions across the United States, the residents of Anne Arundel County, Maryland, who call 911 expect and usually receive prompt and efficient emergency services. In recent years, though, the dispatch procedures in many of the county’s 911 call centers have become increasingly cumbersome. New programs and processes were instituted toentify the specific type of medical problem(s) to ensure that 911 operators dispatch the appropriate equipment and personnel to the scene of an incident and provide lifesaving care as quickly as possible.
Unfortunately, achievement of that goal has led to a new type of problem for medical calls in the emergency services community. According to the 2002 Edition of NFPA 1221 (Standard for the Installation, Maintenance, and Use of Emergency Services Communications Systems), “Ninety-five percent of emergency dispatching shall be completed within 60 seconds.”
However, by the time the 2013 edition of NFPA 1221 was published, that standard had lengthened to 90 seconds for approximately 90 percent of incidents, and 120 seconds for 99 percent of incidents (in jurisdictions in which some type of emergency medical dispatch program is employed). Because time is always of the essence during almost any emergency, medical or otherwise, patients and other medical “customers” expect and require “due diligence” from the response process.
Finding a Cost-Effective Solution Anne Arundel County is a diverse community with a population of more than 522,000 people and encompasses a land area of not quite 420 square miles – most of it in the Baltimore/Washington corridor, and bordered on its eastern side by the Chesapeake Bay. The Anne Arundel County Fire Department (AAFD) is an all-hazards response agency that includes 31 fire stations, aided by four support facilities. The department carries out a broad range of missions including, but not limited to: emergency medical responses; fire suppression and technical rescue responses; fire inspections and investigations; and a broad range of other duties, including public education, special operations, emergency dispatch communications, training, and emergency management. The department also has a FY2014 operating budget of $109 million. Its staff – composed of more than approximately 770 career professionals, augmented by about 550 volunteers – responded last year to more than 77,000 calls for assistance.
Shortly after taking office, County Executive Laura Neuman, an entrepreneur and business leader in the information technology field, was briefed on the dispatch process and reemphasized her own personal and professional opinion that the department’s efforts should focus on the best possible services being delivered to county residents, in as timely a manner as possible. She also directed that the AAFD immediately improve its dispatch process, but in a cost-effective way.
To meet those objectives, the fire department’s senior officials established a new working group of professionals possessing varying degrees of experience in the Fire Department Communications Center. The primary goal of that working group was to find an innovative but, at the same time, fiscally prudent solution to solve many problems caused by the gradually increasing delays in dispatching emergency personnel.
Three Main Objectives, a Beta-Code Breakthrough & Stunning Success The first three objectives of the new AAFD working group were to:
- Develop strategies that would: (a) decrease call-processing times; (b) provide scripted 911 instructions that meet all national and state standards; (c) shorten the arrival time of medical providers; and (d) effectively manage departmental resources;
- Review all call-processing and response data to and from the department, as well as from other emergency response agencies around the region and across the nation; and
- Learn from and apply innovations from the call-processing workflows available from fire dispatch centers nationwide.
After meeting these first three objectives, the groupentified and developed a generic new “beta-code” process – i.e., a generic text code entered into the Computer Aided Dispatch System that provides a selected response based on the complaint received from a caller – that would work effectively and compatibly in conjunction with an established computer-aided dispatch system.
Building on the plans spelled out by the working group, a new group – composed primarily of operators in the Communications Center – began testing the beta-code process and achieved major successes. After programming and piloting the new “Rapid Dispatch Protocol” (RDP) for 30 days, a cross section of trained operators recorded some truly stunning results; analysis of the preliminary data suggested a major reduction in call-processing times, with some calls being dispatched in as little as 15 seconds. Precisely how the time saved translates into lives saved is impossible to quantify, but saving even one life justifies the efforts expended.
The New Rapid Dispatch Protocol Under the previous emergency medical dispatch system, before dispatching a responder unit, a call taker typically would ask a series of predetermined questions until he or she could decide what type and/or “quantity” of medical resources would be required. Under the new RDP system, which builds on the older system (but with a computer-code modification), call takers now: confirm the address, phone number, and nature of the call; then immediately dispatch the closest unit(s) available to respond.
Even as they notify the responder units, though, the dispatchers remain on the line with the caller to obtain additional information and immediately provide more precise pre-arrival instructions to the responder unit(s). If the information transmitted back and forth reveals that the incident requires additional resources and/or specialized equipment, the dispatcher can immediately order those resources to the scene as well. Most importantly, perhaps, is the fact that there is now no delay in dispatching emergency apparatuses while the call takers are obtaining additional information from callers.
This initiative has been a significant internal undertaking by the AAFD. More important, though, is that this solution has helped provide better services to citizens throughout the county; and it shows the commitment and ingenuity of the county’s fire department personnel. Faster call-processing times translate directly into the delivery of emergency care in a more effective and timely manner. From the perspective of the average county resident, perhaps the best aspect of the new protocol is that an acceptable solution to a literal life-or-death problem was developed and implemented at almost no additional cost to local taxpayers!
________________________ Michael E. Cox Jr. is a 25-year veteran of the Anne Arundel County Fire Department and currently serves as the chief of the Department. He holds an associate’s degree in EMS from Anne Arundel Community College, a bachelor’s degree in fire science from the University of Maryland, and a master’s degree in Executive Fire Service Leadership from Grand Canyon University. A nationally registered emergency medical technician paramedic, he is also a state-certified emergency services instructor and a graduate of the National Fire Academy’s Executive Fire Officer Program. The national Center for Public Safety Excellence also has designated him as a chief fire officer. Chief Cox can be reached at: firstname.lastname@example.org