IMPLEMENTING A FIRE PRIORITY DISPATCH SYSTEM FOR THE LOS ANGELES FIRE DEPARTMENT EXECUTIVE DEVELOPMENT

Transcription

1 IMPLEMENTING A FIRE PRIORITY DISPATCH SYSTEM FOR THE LOS ANGELES FIRE DEPARTMENT EXECUTIVE DEVELOPMENT BY: David M. Yamahata Los Angeles Fire Department Los Angeles, California An applied research project to the National Fire Academy as part of the Executive Fire Officer Program June, 2003

2 2 ABSTRACT The problem was that the Los Angeles Fire Department (LAFD) dispatch center does not have a Fire Priority Dispatch System (FPDS), specifically with scripted standard pre-arrival instructions when processing 911 calls involving fire emergencies. The City of Los Angeles faces potential liability cases without providing the caller with standardized safety instructions. In this study, the purpose was to determine if the LAFD should implement a scripted FPDS when processing 911 calls involving fire emergencies. This was an evaluative research project. The research questions were: 1. What pre-arrival instructions does the LAFD currently use when processing fire emergency calls? 2. What dispatch legal cases has the LAFD or other Fire Departments encountered regarding pre-arrival instructions related to fire emergencies? 3. What scripted FPDS are available on the market for the LAFD to purchase? 4. What are the advantages/disadvantages to the LAFD of using a scripted FPDS when processing fire emergency calls? The procedures employed in this research project were: a review of the literature; personal interviews; telephonic interviews; searches of related areas via the Internet; an analysis of federal, state, and local laws, regulations, policies, and standards; and an analysis of the LAFD dispatch center. The findings of this research discovered two nationally and/or internationally recognized FPDS programs available that could be implemented by the LAFD. The result concluded the current LAFD pre-arrival instructions provided to 911 callers were inconsistent and there was a need to establish specific protocols for fire related emergencies.

3 3 Based on this research it is recommended that the LAFD implement specific pre-arrival protocols for dispatchers to provide for 911 fire related calls. In addition, the LAFD should establish a committee to research available FPDS programs to implement in the LAFD dispatch center or develop an internal FPDS program. Lastly, implement a Quality Assurance Program to evaluate dispatchers on fire related calls and seek political support and funding to implement a new FPDS program.

4 4 TABLE OF CONTENTS PAGE Abstract.. 2 Table of Contents... 4 Introduction 5 Background and Significance 6 Literature Review... 9 Procedures.. 27 Results 32 Discussion.. 40 Recommendations.. 43 References.. 44 Appendix A: Dispatcher (Call Taker) Experience. 47 Appendix B: Call Answering Statistics.. 48

5 5 INTRODUCTION When an emergency 911 call for help is answered in the communications center, it becomes the conduit between the caller and the resources dispatched to mitigate the emergency. The 911 service in the City of Los Angeles automatically provides the emergency dispatchers with the telephone number of the caller, the address, closest cross streets and map coordinates. Incoming calls are routed directly to a Public Safety Answering Point (PSAP). In the City of Los Angeles the PSAP is the Los Angeles Police Department s (LAPD) dispatch center. All calls related to fire and medical emergencies are immediately transferred to the Los Angeles Fire Department s (LAFD) dispatch center, which is located in a separate facility. When the LAFD dispatch center answers a 911 call, the following questions are asked to obtain critical information from the caller: Description of the emergency Location of the emergency including address, building or apartment number, cross streets Who needs help? : age and number of people Are they conscious and/or breathing? This information is critical in situations where a caller may hang up for any number of reasons but with answers from these questions, appropriate resources can be dispatched (LAFD, 2003). The problem is that the LAFD dispatch center does not have a FPDS, specifically with scripted standard pre-arrival instructions when processing 911 calls involving fire emergencies. Without standardized safety instructions to provide to the caller, the City of Los Angeles faces potential liability cases.

6 6 The purpose of this study is to determine if the LAFD should implement a scripted FPDS when processing 911 calls involving fire emergencies. This is an evaluative research project. The research questions are: 1. What pre-arrival instructions does the LAFD currently use when processing fire emergency calls? 2. What dispatch legal cases has the LAFD or other Fire Departments encountered regarding pre-arrival instructions related to fire emergencies? 3. What scripted FPDS are available on the market for the LAFD to purchase? 4. What are the advantages/disadvantages to the LAFD of using a scripted FPDS when processing fire emergency calls? Background and Significance The National Fire Protection Association (NFPA, 2001, 1221, ) states: 95 percent of alarms shall be answered within 15 seconds, and 99 percent of alarms shall be answered within 40 seconds. 95 percent of emergency dispatching shall be completed within 60 seconds. For law enforcement purposes, the authority having jurisdiction shall determine time frames for completion of dispatch. Where alarms are transferred from the PSAP, the transfer procedure shall not exceed 30 seconds for 95 percent of all alarms processed. The LAFD is an all-risk life/safety provider offering fire and emergency medical services including patient transport for a very diverse population of 3.7 million citizens encompassing a geographical area of 464 square miles (Wells, 2001). The City of Los Angeles itself is comprised of high-rise, commercial, residential, urban-wildland interface, Port of Los Angeles and Los Angeles International Airport. The LAFD operates 103 fire stations within this area

7 7 with a total of 3363 uniform personnel and 333 civilian staff (Wells, 2001). The LAFD responds to approximately 350,000 incidents on an annual basis. Of these incidents, approximately 81 percent are emergency medical related incidents the other 19 percent or approximately 66,000 incidents per year are fire related incident types. These incidents are classified as structure fires, reported smoke, automatic alarms, bells ringing, smoke detector, water flow, auto fires, and rubbish fires (Wells, 2001). In May 2000, members of the Dispatch Quality Improvement Unit (DQIU) conducted an internal study to evaluate the performance of the LAFD dispatch center. The study revealed a dispatch protocol system for Emergency Medical Service (EMS) incidents that had not been updated since Data collected indicated that dispatchers were not meeting the national standards and were dispatching inappropriately thereby increasing the risk of liability to the fire department and reducing the quality of patient care (L. Krokes, personal communication, January 17, 2003). In addition, on Tuesday, September 5, 2000, the front-page headline in the Los Angeles Times proclaimed Fire Department Dispatching in Dire Need of Revision. The story by Robert Lopez and Rich Connell cites an internal LAFD report that describes how breakdowns in the way the Los Angeles Fire Department dispatches emergency incidents have been tied to at least three recent cases in which patients died (p. A1). On January 18, 2001, the LAFD dispatch center implemented a new Medical Priority Dispatch System for call takers to follow when confronted with an emergency medical incident. This system is a protocol card set with specific scripted questions that must be read verbatim with a small margin of error. In addition, once resources have been dispatched to the emergency, there are specific scripted pre-arrival instructions that the call taker must provide to the caller to

8 8 insure the maximum service to the public. The LAFD does not have a similar protocol card set system for fire related incidents (L. Krokes, personal communication, January 17, 2003). This study is important to the LAFD for two reasons. First, the LAFD has not and currently does not use scripted standard pre-arrival instructions when processing fire emergency calls. There are no established protocols for call takers to follow and any pre-arrival instructions provided to the caller are based on the experience level of each member. This places the LAFD vulnerable to liability cases if a complaint is filed against the department for inadequate prearrival information to a 911 caller. Second, 6 of the 57 uniformed firefighters assigned to the dispatch center are single function paramedics who are not certified firefighters. Each of these paramedics has no prior firefighting experience to draw from when providing pre-arrival instructions to a 911 fire related call (T. Somers, personal communication, January 10, 2003). This Applied Research Project (ARP) relates to Unit 11 legal issues model taught in the Executive Development Course. The legal issues model includes liability for both Personal and Agency/Jurisdiction (National Fire Academy [NFA], 2002, p. II-2). The project identifies the current LAFD dispatch center pre-arrival instructions, potential legal ramification of the LAFD s failure to use scripted standard pre-arrival instructions to 911 callers, and identifies scripted Fire Priority Dispatch Systems available on the market. The results will assist to determine if change is needed in the LAFD by identifying the advantages and disadvantages of using a scripted FPDS when processing fire emergency calls. This research project relates to the United States Fire Administration operational objective to promote within communities a comprehensive, multi-hazard risk-reduction plan led by the fire service organization. In order to provide the best service to the community and

9 9 reduce injuries or the loss of life, the LAFD must establish and provide consistent essential prearrival instructions to 911 callers related to fire emergencies. LITERATURE REVIEW The historical information regarding pre-arrival instructions in the LAFD dispatch center was derived from a review of unpublished internal documents and interviews. The literature reviewed for this research consisted of newspapers, fire and EMS journals, search of related areas via the Internet, along with standards, regulations, and policies published by federal, state, and local agencies. The purpose of this literature review is to investigate the current theories and practices involving scripted standard pre-arrival instructions for 911 callers. Four basic questions must be addressed. First, what pre-arrival instructions does the LAFD currently use when processing fire emergency calls? Second, what dispatch legal cases has the LAFD or other Fire Departments encountered regarding pre-arrival instructions related to fire emergencies? Third, what scripted FPDS are available on the market? Finally, what are the advantages and disadvantages to the LAFD in using a scripted FPDS when processing fire emergency calls? Furey (1985) cites the following example regarding communication: Smoke starts to seep out around the windows of an apartment building. A passerby spots the glow through the sooty glass and races to phone the fire department. After two short rings, the call is answered by a trained, professional communicator. Though the caller is excited and unsure of his exact location, he is calmed and reassured by the attitude of the call handler, who asks a series of carefully planned questions and dispatches the proper response. Units arrive on the scene within minutes of the initial discovery, and damage is held to a minimum without injury (p.155).

10 10 This scenario unfolds thousands of times a day across America and is illustrative of the norm, the call for help handled in an appropriate manner. It seems to be with increasing frequency, however, that the headlines and the evening news carry reports of incidents where help arrives too late or not at all. The failure to provide proper service can be attributed to many sources, including breakdowns in the dispatching process. When these breakdowns occur, lawsuits often follow (p.155). In relation to liability, Furey (1985) states: While the majority of emergency calls directed to any agency receive proper attention, there is always a chance that something may fall through the cracks. These errors may result from the failure of the dispatcher to follow established procedures or from faulty procedures themselves. As unthinkable as it may seem, departments or dispatching centers may not even have written operational procedures, instead using past practices and tradition as their guides. Though these might be appropriate in most cases, the lack of formalized procedure in such a sensitive environment will prove hard to defend in court. If not considered negligence, the nonexistence of established guidelines is at least the lack of common sense: it is difficult if not impossible to expect communicators to perform their functions properly when no definition of what is proper exists for the department (p. 155). What pre-arrival instructions does the LAFD currently use when processing fire emergency calls? The LAFD dispatch center is staffed by: 22 uniformed Firefighters, three Captains and one Battalion Chief on a 24-hour basis. There are three separate shifts that members work at the dispatch center, either on the A, B or C Platoon. Uniformed members assigned to fire

11 11 stations work the identical three-shift work schedule. Each Firefighter assigned to the dispatch center works in two capacities, either as a radio controller or call taker. As a radio controller, the member will dispatch resources out of fire stations or via the radio to resources in the field. The radio controller also maintains communication with field resources during emergency incidents. Due to the large geographical area of the City of Los Angeles and the number of emergency responses on a daily basis, there are three radio controllers on a 24-hour basis. The other members will occupy call taker positions answering 911 calls for help as well as assisting the public with other fire department related requests. To simplify designations, a radio controller or call taker will normally be referred to as a dispatcher (T. Somers, personal communication, January 10, 2003). At the present time, the LAFD dispatch center call takers do not use scripted standard pre-arrival instructions when processing 911 calls involving fire emergencies. LAFD uniformed firefighters have three classifications: firefighter certification, single function paramedic, dualfunction both firefighter and paramedic certification. Past practice has allowed each individual call taker the ability to provide pre-arrival instructions based on prior fire experience (T. Somers, personal communication, January 10, 2003). T. Somers, a supervisor at the dispatch center for over 10 years, states no formal training regarding pre-arrival instructions related to fire emergencies is provided as part of the training course for new 911 call takers. When a 911 call is answered at the dispatch center, the call taker verifies the address of the emergency, the telephone number the caller is calling from, and a description of the problem. In fire related incidents, once the call taker obtains sufficient information to determine the appropriate resources to dispatch, the call taker will notify the caller that help is on the way and then disconnects without providing further pre-arrival instructions. The call taker will only stay

12 12 on the line when the caller requests additional assistance related to the emergency. There is no current policy that requires the call taker to provide pre-arrival instructions to the caller (T. Somers, personal communication, January 10, 2003). T. Somers stated pre-arrival instructions or post-dispatch instructions vary from member to member and are normally ad-libbed. Information provided to the caller is based on the member s experience level, instruction passed on through tradition from senior members assigned to the dispatch center, and information obtained from the fire department library (personal communication, January 10, 2003). The job seniority and dispatcher seniority of members assigned to the dispatch center was obtained through the LAFD Member Information Tracking System (MITS). The data revealed 55 of the 57 dispatchers or 96 percent had over 10 years of job seniority. Of those 55 dispatchers, 30 members had over 20 years of job seniority. The data showed 28 of the 57 dispatchers or nearly 50 percent with over 10 years of seniority at the dispatch center. But the data also revealed 17 of the 57 dispatchers or 30 percent with less than five years of seniority as a dispatcher (Appendix A). T. Somers stated that although there is no formal training regarding pre-arrival instructions, each member receives training regarding the various types of dispatches to fire related incidents. Each member is trained on the type and number of resources dispatched to a specific incident which the call taker can pass on to the caller thus providing some reassurance to the caller. On many occasions the call taker has knowledge of the distance a resource is from the incident and will normally pass this information on to the caller, which also helps in reassuring the caller that help is minutes away (T. Somers, personal communication, January 10, 2003).

13 13 What dispatch legal cases has the LAFD or other Fire Departments faced regarding prearrival instructions related to fire emergencies? In an article from the Association of Public Safety Communications Officials (APCO) 911, Hagstrom (2001) reported, Dispatcher liability is a growing concern in any public safety agency. Although it often seems to be a management concern, the seemingly small actions or inactions of telecommunicators (call takers) can put everyone from themselves to the agency head in court. Most of them are avoidable (p.52). Taken from the Journal of Emergency Services (JEMS), Lazar (1989) describes: In dispatch, you rarely get a second chance to make a good impression. Dispatchers play an integral role in all emergency response systems. Whether dispatching police, fire or medical units, dispatchers represent the lifeline between those in need of emergency assistance and those providing such assistance. The law requires dispatchers to conform to certain generally accepted legal principles. Keep in mind, the law doesn t ask any more than you should be willing to give (p. 36). Lazar (1989) continues with the dispatch function, which can be divided into the following three distinct phases, all of which impose countless duties on dispatchers: The call-receiving phase The dispatch phase The post-dispatch (pre-arrival) phase During the call-receiving phase, the dispatcher must obtain the information necessary to process the call. Dispatchers must get sufficient and correct demographic information from the calling party to ensure that resources are sent to the correct location. The case

14 14 of DeLong v. Erie County, Mrs. DeLong dialed 911 stating she heard a burglar, the dispatcher recorded the incorrect address, failed to confirm the address and dispatched the police to the wrong location. Needless to say, the police arrived at the wrong location, found nothing, and left. Mrs. DeLong died from seven knife wounds inflicted by the burglar. The dispatcher was found negligent in failing to properly record the caller s address, failing to ask the name of the caller, failing to determine the exact location of the call, failing to repeat the address for verification and failing to follow up when no such address was reported (p. 36). The dispatch phase, after obtaining correct demographic information and classifying the incident correctly, the dispatcher will send the appropriate resources to handle the emergency. At the LAFD dispatch center, resources are automatically dispatched through a Computer Aided Dispatch (CAD) system once the appropriate incident type has been identified (T. Somers, personal communication, January 10, 2003). The period after dispatch but before the time of arrival is classified as the post-dispatch (pre-arrival) phase. Lazar (1989) states, Many things can happen once a unit is dispatched to the scene of an emergency. In EMS incidents, there are specific pre-arrival instructions that must be provided to the caller such as Cardio Pulmonary Resuscitation (CPR) instructions, which are vital to the welfare of the patient (p. 39). The LAFD dispatch center has written pre-arrival instructions for EMS incidents but not for fire related incidents (T. Somers, personal communication, January 10, 2003). This failure to provide common sense instructions to a caller in a fire scenario may be considered negligence by the dispatcher and result in liability against the fire department.

15 15 Taken from Dispatch Monthly (1997): The City of Los Angeles settled a lawsuit for $1.5 million, three years after a dispatcher failed to follow procedures, and fire units were dispatched in the opposite direction of a house fire that killed a mother and her three children. A caller first reported the fire at 2 a.m. in southwest Los Angeles. Instead of immediately transferring the caller to fire dispatchers, an unnamed police dispatcher took the information, hung up with the caller, and then contacted a fire dispatcher using a direct ring-down line (p.1). What s the name of the street? the fire dispatcher asked the police dispatcher, who answered, 9 th Avenue. The fire dispatcher apparently did not hear the street correctly and asked, Vine? The police dispatcher replied, Uh, huh. But in another exchange the fire dispatcher asked, OK, you said that was 3102 Vine? Finally, the police dispatcher repeats, No, nine as in the number nine (p. 1). The fire dispatchers received two additional telephone calls reporting the correct location of the fire before fire units were dispatched, but dispatchers apparently didn t notice the discrepancy in addresses. As a result, the fire dispatcher sent units to 9 th Street instead of 9 th Avenue, about four miles in the wrong direction. By the time the mistake was discovered and fire units were rerouted to the correct location, the mother and her three children were trapped by flames and died (p. 1). Four children survived the fire. But what if pre-arrival evacuation instructions were provided to the caller, would all members have survived? Taken from Dispatch Monthly (2001): Karla Gutierrez, 32, apparently drowned after her car left the highway and overturned in a 30-foot deep drainage canal in northwest Dade County, Florida. Police said she was

16 16 legally intoxicated and most likely fell asleep at the wheel. During the last minutes of her life, Ms. Gutierrez managed to dial 911 on her wireless phone and talked for some 3-1/2 minutes with dispatchers at the Miami-Dade County and Miami City communication centers. Gutierrez gave conflicting information about her location, and by the time rescue units located her car s skid marks on the grassy shoulder, her car had sunk to the bottom of the canal, and she had drowned (p.1). The article continues with Miami Assistant Fire Chief Joe Fernandez stating, The Miami City communication center call takers are not trained to talk people out of a submerged vehicle. The Miami fire dispatchers are trained to use the medical protocol card sets provided by the NAEMD. Officials confirmed that the medical protocols don t include pre-arrival instructions for sinking or submerged vehicle. (p. 4). The Miami City dispatcher was not held accountable for the death of Ms. Gutierrez. But the question arises, could she have been saved had there been a system of pre-arrival instructions available to provide to Ms. Gutierrez with a method of removing herself from the vehicle and swimming to safety? Hagstrom (2001) discusses several scenarios that resulted in public safety agencies defending themselves in court: Scenario one, in Shelbyville, North Carolina, a citizen reported a house fire. It was unclear if it was known if anyone was inside. The dispatcher delayed six minutes before dispatching. A woman and three children were inside the house. The mother and two kids got out. Law enforcement units, dispatched separately, arrived and heard the third child screaming, trapped by flames. They couldn t get in to rescue her (p. 53).

17 17 Although the fire station was 1.1 miles from the house, literally a minute away. The child burned to death before the fire department arrived. The North Carolina Supreme Court determined in this case the public-duty doctrine applied to the law enforcement officers but not to the telecommunicator, who could, therefore, be held liable (p. 54). If protocols were followed and pre-arrival instructions were provided, could the third child have been saved? It might also be assumed if established pre-arrival instructions were provided, then the telecommunicator would not be liable even if a death occurred. Scenario two relates the following: In Herndon, Florida, a citizen reported the neighbor s house was on fire. The call taker asked if anyone was inside and the caller said she thought there was. The agency policy said in cases of structure fire where someone is known or believed to be inside, EMS must be sent also. The telecommunicator waited until fire units got there to see if an ambulance was needed. In this case, the problem was compounded because the ambulance that eventually went wasn t the closest unit, nor was it an Advance Life Support (ALS) unit and therefore it was not oxygen-equipped. Because it broke down almost an hour later, the closest ALS unit eventually did finish transporting a burned 16- year old from the scene. The patient died of cardiac arrest (p. 61). In the Dispatch Monthly (1998): Two girls, ages eight and six, in Ft. Lauderdale, Florida died in the apartment on the northwest side of town when the fire broke out at about 7:20 a.m. Neighbors tried to rescue the two girls, left alone while their stepfather drove their mother to work in

18 18 Miami. The cause of the fire is under investigation. The dispatcher that answered the 911 call did not provide any life saving instructions to the caller (p. 1). Another incident from Dispatch Monthly (2001): Two toddlers died in a house fire in the tiny town of Homer, Louisiana, after a dispatcher misunderstood the address given by the caller and sent units to the wrong location. The Sunday morning fire claimed the lives of a 4 year-old and 5 year-old brother and sister. The children s parents were able to escape the blaze but couldn t re-enter the house because of the flames. In addition to sending units to the wrong location, no pre-arrival instructions were relayed to the caller (p. 1). What scripted FPDS are available on the market for the LAFD to purchase? During the research for dispatch protocol systems with structured questions and prearrival instructions, I discovered several products available on the market but most were only formatted for EMS incidents. My research resulted in two main sources of structured questions with pre-arrival instructions for public safety call takers: PowerPhone Incorporated and NAEMD. Both offering protocol card sets and training for dispatchers, PowerPhone s Desk Reference Manuals cover law enforcement, fire and EMS incidents, while NAEMD covers EMS and fire. National Academy of Emergency Medical Dispatch Taken from Dispatch Monthly, Allen (2000) states: NAEMD was formed in 1988 as a standards-setting organization for emergency medical dispatch (EMD). Until recently, the only EMD product they certified is one, originated by Dr. Jeff Clawson and now marketed by Priority Dispatch Corporation (PDC) as the Medical Priority Dispatch System (MPDS). NAEMD gives certified training in the

19 19 MPDS, publishes training materials, and administers the process of updating and revising the EMD protocols (p. 1). The NAEMD completed a final version of the FPDS card set. The cards extend the academy s current medical card system to fire and rescue types of incidents. According to the academy, they provide, an intuitive, logic-driven flow with recognizable symbols to direct the call taker throughout the call process. The FPDS is very similar to the MPDS: it has case entry point, chief fire complaints (20 of them), key questions to ask the caller, response descriptors and codes (based on the caller s answers), post-dispatch and pre-arrival instructions, and critical fire information (p. 2). Features of the NAEMD Fire Priority Dispatch System from Priority Dispatch Corp. (PDC) 2002 are: Case Entry standardizes the beginning of each call while assisting the call taker in the identification of Chief Complaint type and life threats. When life threats are identified, it quickly and safely provides for early dispatch of resources. Chief Complaints provide defined, classifications for caller descriptions. These predetermined classifications enable specific, detailed interrogation and the provision of instructions tailored to the situation. Key Questions collect detailed information per Chief Complaint in a structured, prioritized format. This assures that all necessary questions are asked and the most important questions are asked first. Response Descriptors and Codes safely prioritize agency responses based upon information collected in Case Entry and Key Question interrogations. These set codes allow agencies to pre-assign apparatus based upon local policy and resources.

20 20 Post-Dispatch and Pre-Arrival Instructions improve quality of service by providing a Zero-Minute Response to callers. These instructions improve scene safety and response effectiveness. Critical EMD information prompts the Emergency Fire Dispatcher to perform critical actions specific to each Chief Complaint. This facilitates response efficiency by helping to ensure that appropriate dispatch actions happen when they should happen. Case Exit standardizes the process of all termination in a safe, reliable manner based upon information collected during the call process (p. 1-2). PDC (2002) The Emergency Fire Dispatcher (EFD) training course consists of three, 8-hour sessions. Upon successful completion of the training, including testing, individuals receive the EFD certification valid for two years (p. 1). PowerPhone Incorporated (2003) discloses the following information: Headquartered in Madison, Connecticut, PowerPhone is known as the international leader in effective emergency telecommunications training. As the first company to develop specific training programs on crisis (911) communications techniques for all public safety services (EMS, law enforcement, and fire), PowerPhone has been the leading force in shaping the way 911 emergency dispatchers answer phone calls from the citizens. Founded in 1984, PowerPhone has conducted over 3,000 crisis communications training programs for more than 100,000 public safety personnel. Dispatchers from all 50 states, Canada, Ireland, Puerto Rico, the Virgin Islands, Costa Rica, Italy, Germany, and Japan have been empowered by PowerPhone s philosophy that the emergency dispatcher is truly the first person on the scene of any crime, fire or medical emergency

21 21 and can have a tremendous impact on the positive outcome of a call with proper training (p. 1). Powerphone (2003) states: The Fire Service Dispatch training program consists of three 8-hour sessions. Upon successful completion of the training, including testing, members receive certification valid for two years. In addition to the Fire Service Dispatch training program, PowerPhone offers other courses to assist the 911 call taker, such as: Weapons of Mass Destruction, Domestic Violence Intervention, Suicide Intervention, Hazardous Materials Preparedness and Stress identification Management. All these courses are valuable to a call taker in providing the best service to the community (p. 1). Features of PowerPhone s Dispatcher s Guide to Fires/Incidents in Progress The following information was obtained directly from the PowerPhone Desk Reference Manual, Dispatcher s Guide to Fires/Incidents in Progress (2 nd ed.). The information is provided inside the manual and is recommended study for users of the manual. Using the manual, dispatchers should: 1. Ask the key questions 2. Dispatch the appropriate units 3. Give the listed pre-arrival instructions, as appropriate 4. Gather appropriate secondary and third level information from the caller(s) and relay to responders Key Questions This section is intended to capture the minimum information requested to begin the dispatch process by applying a Journalistic, Investigative Approach. The systematic

22 22 method of gathering information by asking where, what, when, who, why and how (plus weapons when applicable); also referred to as the 5W s + H + W. This determines the type of incident, the correct location, ensure the safety of the caller, and dispatch the appropriate response in the shortest possible time. Speed is important but must be balanced against safety priorities, accuracy, and completeness of information. Dispatch the assignment as soon as the location and nature have been determined, keeping the caller on the line, and updating responders as more information develops. Dispatch Priorities Throughout the manual, the Dispatch Priorities category contains the words as appropriate, as needed, or as necessary. Specific responses as to number and type of units should be based upon your department s policy; it is not the intent of this manual to void, invalidate or supersede any department rule, regulation or order. Different tabs contain instructions to dispatch various emergency services. Pre-Arrival Instructions This section contains specific instructions for callers, such as how to protect themselves, how to assist in certain situations, etc. Because situations change rapidly and dramatically, the dispatcher should refer back to this category as further information is gathered during each call. Inquire of Caller This category offers typical secondary and third level information gathering questions presented in their shortest possible form. For example, the STRUCTURE/APARTMENT FIRE tab includes the question Do any invalids/handicapped persons live there? and the AUTOMOBILE FIRE tab inquires,

23 23 If motor home, propane tanks on board? The importance of such information to effect successful rescue operations and/or ensure responder safety is obvious. Useful Information This category includes statements regarding updates, certain notifications, and background information for the dispatcher, etc. On all calls it is critical to relay and update the secondary and third level information gathered in the previous category. What are the advantages/disadvantages to the LAFD of using scripted FPDS when processing fire emergency calls? The most obvious advantage to the LAFD is by implementing a scripted FPDS the City of Los Angeles can avoid liability, which in turn will prevent litigation. From the National Journal of Emergency Dispatch, Patterson (2003) states: Liability is defined as legal responsibility. Its roots run as deep as the old adage an eye for an eye and a tooth for a tooth. Trial attorneys tell us that litigation, defined as a method of settling a dispute through a formal court action or lawsuit is necessary for two reasons when associated with liability. First, litigation provides a method for compensating victims of negligence. Second, liability litigation is necessary to deter further negligent behavior through punitive action. Liability relates to legal responsibility. Responsibility relates to duty which, in legal terms, is one of four essential elements needed to establish negligence. Duty is probably the most applicable term related to emergency communications liability and is one that should be understood by all communications personnel. Duty refers to your established responsibility (p. 4). In addition to protocols, policies, procedures, and consensus of public opinion, duty can also be established based on expert opinion and published, national or

24 24 international standards. Although not always written into law, expert opinion and published standards are often considered with regard to duty in negligence. To ignore evolving standards in favor of complacency, false pride, politics, etc., is to jeopardize the local standard of care and increase liability exposure (p. 6). Another important legal term applicable to the emergency communications environment, foreseeability. Foreseeability refers to reasonable predictability of associate risk. It is especially applicable to emergency communications because so much of what we do is essentially non-visual and requires us to rely on reasonable predictability to do our job. If a fire caller reports smoke coming from a structure, the fire protocol assumes that a structure fire is in progress and prompts the EFD to provide important safety information to the caller. Such protocol decisions are based on probability, which can be paraphrased as reasonable predictability. This fact is arguably the most valuable aspect of the priority dispatch protocols (p. 7). Through research, science, statistics, expert consensus, and experience, the protocols are preplanned. They enable call taking and emergency dispatch professionals to quickly make very important decisions without having to consider multiple probabilities during the very limited period of time afforded to process a call. As a legal concept, foreseeability often protects us. Because our protocols are planned in good faith based on accepted best practices, the actions they prompt help us fulfill our duties as emergency dispatchers. Foreseeability protects us when information provided by the caller is less than accurate, incomplete, or misleading. Although our decisions may not be appropriate for the actual situation in these cases, the law does not hold us liable for things we could not reasonably predict from wrong information (p. 8).

25 25 Currently, call takers at the LAFD dispatch center use their experience obtained in the field as well as experience gained during their assignment at the dispatch center to provide prearrival instructions to 911 callers with fire related emergencies. This experience that has been compiled over years can be considered guidelines not protocols. Clawson (1994) states a guideline is defined as a statement or other indication of policy or procedure by which to determine a course of action. In contrast, a protocol is a precise and detailed plan for the study of a biomedical problem or for a regimen or therapy (p. 53). Clawson (1994) points out the National Association of EMS Physicians (NAEMSP) and the American Society for Testing and Materials (ATSM) have published documents that have significantly contributed to developing standards of care and practice for EMDs. Each of these documents takes the position that EMDs should utilize medically appropriate protocols in the decision-making process (p. 53). Clawson (1994) continues further by stating: Proponents of the guidelines approach believe dispatchers should basically listen rather then interrogate. The recently developed Criteria Based Dispatching Program (CBD) contains no structured questions that medical dispatchers are required to ask. Developers of the program state, Once you get a critical piece of information, no interrogation is required. Information is spontaneously given-no questions need to be asked. This approach to evaluating medical calls for assistance emphasizes primary reliance on the thinking, intelligent attributes of the CBD dispatcher that, according to the developer, protocol systems somehow fail to recognize. But the typical caller s perception of the medical dispatcher s needs is limited at best. In the vast majority of cases, the emergency caller is compelled by a Just send help! orientation. Advocates of the

26 26 guidelines approach say it treats the dispatcher as an intelligent human being who is capable of exercising good medical judgement. While this statement has undeniable merit, the argument built upon it neglects a vital fact: The practice of prehospital medicine is not guideline or judgement driven; it is protocol driven (p. 54). Another factor reinforced in following scripted pre-arrival protocols in terms of liability is the ability to implement quality assurance evaluations. In a guidelines oriented dispatch system, quality assurance of EMDs is impractical, if not objectively impossible. Simply stated, a protocol says, You shall, while a guideline says You may if you want. Given the fact that protocols require compliance to a predefined set of behaviors, it s possible to determine precisely, after the fact, the extent of compliance with these behaviors. On the other hand, a guideline does not require compliance and allows for or even sanctions deviation at the individual dispatcher s discretion (p. 55). The United States is currently experiencing lean economic times and the City of Los Angeles is no exception to budgetary difficulties. Governor Davis in an attempt to balance the state budget has reduced funding to cities throughout the state. In addition, the Mayor of Los Angeles is asking all departments to make cuts in their budget. Due to fiscal restraints facing the City of Los Angeles, money will become a limiting factor to implementing a new FPDS. To implement a FPDS protocol system will require funding for the materials, software and training, additional staff for Quality Assurance (QA)/Quality Improvement (QI), as well as funding to compensate dispatchers to attend the training. In a telephonic interview with Jon Gariepy, from NAEMD, he disclosed costs for materials, software and training to be approximately $139,000 (personal communication, May 12, 2003). On another telephonic interview with Kim Wardrop, from PowerPhone incorporated, she disclosed costs for materials

27 27 and training to be approximately $104,000, lower than NAEMD but stated that FPDS software is not available at this time (personal communication, May 11, 2003). Both amounts are for initial certification for two years thereafter additional funding must be earmarked to maintain certification for all members. Another factor to be considered is the time factor when answering and processing calls. The number of calls to the LAFD dispatch center continues to rise on an annual basis but no additional dispatchers have been added to augment the staffing (T. Somers, personal communication, January 10, 2003). A review of the call answering statistics since the implementation of the new MPDS reveals a decrease in the percentage of calls answered within 10 seconds. Statistical information obtained from Ms. Kathleen Evansen, Senior Systems Analyst, Management Information Systems, LAFD, demonstrates the percentage of calls answered within 10 seconds has dropped from 97.5 percent during to 95.8 percent during 2002-present (Appendix B). Procedures The research methodologies utilized for this Applied Research Project were historical and evaluative. The principle procedures employed in this research project were: a review of the literature; personal interviews; searches of related areas via the Internet; an analysis of federal, state, and local laws, regulations, policies, and standards; and an analysis of the current LAFD dispatch center protocols. All of the above items were reviewed and analyzed for their correlation to this Applied Research Project. Definition of Terms Battalion Chief Supervises Captains at the dispatch center.

28 28 Call Taker Any member working in a communication center that answers emergency telephone calls. Captain Supervises firefighters and reports to a Battalion Chief. Card Set A set of written protocols on flip cards organized with a specific format to follow when answering 911 calls. Certification A process whereby an individual is tested and evaluated in order to determine his or her mastery of a specific body of knowledge or some portions of a body of knowledge. Communicators An individual trained to communicate by electronic means with persons seeking emergency assistance and with agencies and individuals providing such assistance. Dispatcher Any member working in a communication center that dispatches resources to emergencies. A dispatcher can also answer emergency telephone calls. Dispatch Center Communications center receiving 911 telephone calls and dispatching resources to emergencies. DQIU Dispatch Quality Improvement Unit Emergency Fire Dispatching (EFD) Reception and management of requests for fire related response using approved standardized dispatch protocols or guidelines, and the provision of pre-arrival instructions to callers at the scene of a fire emergency before the arrival of the fire response personnel. Emergency Medical Dispatcher (EMD) Reception and management of requests for emergency medical response using approved standardized dispatch protocols or

29 29 guidelines, and the provision of pre-arrival instructions to callers at the scene of a medical emergency before the arrival of the medical response personnel. EMS Emergency Medical Services LAFD Los Angeles Fire Department LAPD Los Angeles Police Department MPDS Medical Priority Dispatch System, medically approved system used by a medical dispatch center to dispatch appropriate aid to medical emergencies, which include: 1) systematized caller interrogation; 2) systematized Pre-Arrival Instructions; and 3) protocols which match the dispatcher s evaluation of the injury or illness type and severity with vehicle response mode and configuration. NAED National/International Academies of Emergency Dispatch NAEMD National Academy of Emergency Medical Dispatch National Standard An established minimum level of performance implemented and validated by subject matter experts. NFPA National Fire Protection Association Pre-Arrival Instructions Telephone rendered written instructions given by trained communicators, which help provide aid to the victim and control of the situation prior to the arrival of emergency personnel. PSAP Public Service Answering Point Interviews A personal interview was conducted with Captain Tom Somers (personal communication, January 10, 2003) LAFD dispatch center supervisor, Los Angeles Fire Department, 200 North Main Street, Los Angeles, California. The purpose of this interview was

30 30 to gain background information concerning policies and procedures related to pre-arrival instructions, call load, staffing levels and associated dispatch problems. Captain Somers was asked specific questions about the above items and this information is included within the Background & Significance, Literature Review and Results of this Applied Research Project. A personal interview was conducted with Assistant Chief Lawrence J. Krokes (personal communication, January 17, 2003), Assistant Bureau Commander, Bureau of Support Services, Los Angeles Fire Department, 200 North Main Street, Los Angeles, California. The LAFD dispatch center is under the Bureau of Support Services and Assistant Chief Krokes was directly responsible for the implementation of the current MPDS protocols utilized by the dispatchers. The purpose of this interview was to gain background information concerning the contributing factors that led to the implementation of the new protocols. Chief Krokes was asked specific questions about the above items and this information is included within the Background & Significance portion of this Applied Research Project. A telephonic interview was conducted with Ms. Kim Wardrop (personal communication, March 11, 2003) Regional Account Manager, National Academies of Emergency Dispatch, 139 East South Temple, Salt Lake City, Utah. The purpose of this interview was to gain information regarding the FPDS product sold by their company. Ms. Wardrop was asked specific questions in reference to the cost related to materials and training in addition to information about the product itself. Ms. Wardop provided approximate figures based on her expertise and experience. There was additional information obtained from the Priority Dispatch Corp. website. Information is included in the Literature Review and Results of this Applied Research Project. A telephonic interview was conducted with Mr. Jon Gariepy (personal communication, March 12, 2003) Director of Sales, PowerPhone Incorporated, 1321 Boston Post Road, Madison,

31 31 Connecticut. The purpose of this interview was to gain information regarding the FPDS product sold by their company. Mr. Gariepy was asked specific questions in reference to cost related to the materials and training in addition to information about the product itself. Ms. Gariepy provided approximate figures based on his expertise and experience. Additional information was obtained from the Powerphone website. This information is included in the Literature Review and Results of this Applied Research Project. Assumptions and limitations The LAFD dispatch center implemented a new MPDS protocol for answering 911 calls for EMS incidents with scripted pre-arrival instructions. This transpired because of the poor performance of dispatchers in following previous procedures and failure to provide appropriate pre-arrival instructions to callers requesting medical intervention leading to liability cases for the City of Los Angeles. One assumption is that since there are no established procedures regarding pre-arrival instructions for fire related incidents it will only be a matter of time before the LAFD faces similar liability cases. A second assumption is that cases where there was a failure of duty in EMS incidents, specifically in failing to provide pre-arrival instructions can be directly correlated and utilized against the LAFD for a similar failure of duty to provide pre-arrival instructions for Fire related incidents. The research of products available on the market to purchase by the LAFD was limited to two: PowerPhone Incorporated and NAEMD. The research was limited to evaluating the LAFD dispatch center and did not include researching other fire department dispatch centers experiencing similar problems.

32 32 RESULTS Research Question 1: What pre-arrival instructions does the LAFD currently use when processing fire emergency calls? The results from the interview with Captain Somers indicated that there are no specific procedures, guidelines or protocols for dispatchers to follow regarding pre-arrival instructions for callers requesting assistance on fire related emergencies. Captain Somers indicated that dispatchers when prompted by the caller requesting additional information utilize their field and dispatch experience to answer the caller. Captain Somers stated this information might range from giving minimal information to providing the caller with specific directions on how to exit a building on fire. Overall there is a high level of field experience for most dispatchers to draw from. This experience is obtained over years of responding to multiple types of fire related emergency incidents. But, there are six dispatchers that are single function paramedics with no firefighting experience. These members can gain some knowledge regarding fire related incidents conversing with firefighters during their time in fire station assignments. The paramedics also gain insight regarding fire emergencies during their tenure at the dispatch center. Another factor regarding the experience level of the dispatchers is the length of time each member has worked at the dispatch center. A review of Appendix A shows almost half of the members currently working at the dispatch center have been assigned there for ten years or more. This indicates a high level of experience as a dispatcher but also indicates an out of touch perspective regarding new innovations from a field assignment perspective. Over the past ten years, there have been many changes to the equipment, apparatus and methods of operation in tactics and strategies of firefighting. There are numerous changes in residential and commercial

33 33 construction, in which for those members that have not been in a field assignment for an extensive length of time could have an adverse impact on their ability to provide the best service to the community. The results clearly indicate the LAFD dispatch center lacks consistency and conformity when providing pre-arrival instructions to callers for fire related emergencies. Farnsworth (2002) states: That without compliance to protocol, the actual purpose of having a protocol, namely that of providing consistent standardized service, is compromised. De Luca s Law provides the governing principle of protocol use by stating: Emergency Dispatchers will follow all protocols per se, avoiding freelance questioning or information unless it enhances, not replaces, the written protocols questions and scripts. The intent of De Luca s Law is to emphasize the necessity of compliance to the protocol (p. 1). Research Question 2: What dispatch legal cases has the LAFD or other Fire Departments encountered regarding pre-arrival instructions related to fire emergencies? The results epitomize the millions of dollars spent by the LAFD and other fire departments on legal cases related to the failure on the part of the dispatchers to follow protocols and provide pre-arrival instructions to a caller needing help. From the Journal of Emergency Care, Nordberg (1998) states: Although 911 has saved thousands of lives, dozens more have been lost as a result of errors made by poorly trained dispatchers who wrote down an incorrect address, dismissed the call as a non emergency, or simply refused to give pre-arrival instructions because they were afraid of losing their jobs if they did so and the call had a poor

34 34 outcome. Unfortunately, those are the calls that make newspaper headlines and undermine public confidence (p. 4). Its antiquated thinking when administrators say We re exposing ourselves to more liability when we give pre-arrival instructions, because it s not true, he says. When a 911 emergency call is handled incorrectly, there are at least two things that will almost certainly happen: Someone is going to get hurt; and someone is going to get sued as a result (p. 4). Taken from Medical Emergency Rescue and Global Information Network (MERGINET), Scott (2003) conveys: In following protocols during life-threatening cases, we should expect at least 95 percent compliance to the standard. In other words, not even slight errors can be allowed to creep in to the mission-critical process of following protocol when all the chips are on the table. Case in point, the 1986 space-shuttle Challenger disaster. That explosion was due to a failure of a single part (the O-ring) on a machine with thousands of working parts and systems. The Challenger crew was lost, in spite of the fact that percent of its parts and systems worked exactly as designed. Similarly, an EMD who fails to deliver totally accurate and complete instructions in a crisis moment risks disastrous results (p. 1). Providing pre-arrival instructions is a requirement for EMS incidents. Criteria cited against agencies in failing to follow protocols for EMS incidents will soon become a basis for litigation against agencies for fire related incidents. Garza (2001) cites one example: Gant vs City of Chicago, where a jury awarded $50 million to the family of a 19-year old man who died due to an asthma attack. In this case, the dispatcher failed to provide pre-arrival CPR instructions (p. 1).

35 35 Furey (1985) states, Without question, the best protection possible against liability is the dedicated telecommunicator who understands and follows established procedures on each and every call (p. 156). Research Question 3: What scripted FPDS is available on the market for the LAFD to purchase? The research found two reputable companies that have products available for purchase by the LAFD: NAEMD marketed by PDC and PowerPhone, Incorporated. The first company, PDC (2002) provides Public Safety Priority Dispatch Systems (PSPDS), products and related services. PDC s Fire Priority Dispatch System (FPDS) protocols, cards and software are central to such products and services. The FPDS have been derived from the MPDS by an expert group of professional firefighters and Fire Department executives and protocol and QA/QI experts (p. 2). PDC (2002) has: Implemented its PSPDS systems at thousands of Emergency Communications & Dispatch Centers. The protocols underlying these PSPDSs have been field proven over almost a quarter of a century to provide significant improvements in emergency dispatching and decision-making, and in providing appropriate telephone instructions to emergency callers (p. 2). Produced and distributed the Protocol in formats that Emergency Dispatchers may easily use for identifying appropriate dispatch determinant codes and response levels. Such formats include Priority Dispatch Cards, Software for Computer Aided Dispatching, and Software for QA/QI management of Priority Dispatch operations. PDC provides licenses to users who evaluate and select such systems as appropriate to their use (p. 3).

36 36 PDC (2002) states: Because neither an instructor nor a training program, curriculum, or materials can guarantee a trainee s learning outcome, PDC S responsibility is to assure that its duly certified, authorized, and contracted Instructors do what is reasonably possible to help trainees succeed in learning from such Training Programs and Materials. If they are successful, such trainees become NAED-Certified. Public Safety Communications & Dispatch Centers, in meeting their responsibility to select an emergency dispatch protocol system and training program, may choose to develop their own, or they may choose to acquire the right to use proprietary protocols and training programs from others. In either case, such centers are responsible for the evaluation, selection, operation, and use of protocol systems and training programs as they alone determine to be appropriate to their particular needs (p. 4). While no preventive measure can preclude someone from filing legal complaints of dispatch negligence against a provider agency, proper implementation of the appropriate Protocol system (including Academy-Certification training of Emergency Dispatchers in its proper use, and QA/QI Management Systems to assure a high level of compliance to the Protocol, and to the agency s policies and procedures for its use) has proven over time to be an effective protection against such complaints (p. 4). As indicated above, the Protocol and its related Systems, Training Program and Materials have a long and well-established history of significantly improving the costeffective and appropriate dispatching of emergency services to callers for police, fire and medical help, as well as of reducing to zero, legal claims of dispatch negligence (p. 4).

37 37 The second company identified, PowerPhone (2003) has: Consulted with and conducted training for both public and private sector organizations around the world. Clients include virtually every local and state law enforcement agency in the United States, federal law enforcement bureaus (including the Department of Justice, the FBI, and the Secret Service), plus leading companies such as Ford Motor Company and John Deere (p. 1). Served as an expert witness in cases involving communications liability and has been a crisis communications consultant to ABC News and Good Morning America. PowerPhone employs a training corps of over 30 crisis communications experts who bring the latest techniques and tactics to students around the world. The company s staff represents hundreds of years of combined communications and field experience, and they are continually sought for expert commentary on the latest issues in public safety (p. 1). Aimed to provide both public and private organizations with the tools and techniques they need to communicate properly in a crisis. All PowerPhone training employs unique Journalistic Investigative Approach to call taking, which ensures that accurate information is gathered, properly assessed and acted on by the telecommunicator during a crisis. PowerPhone stands behind its graduates 100%. All students are tested on their knowledge upon the completion of training. If a PowerPhone graduate s actions should ever come into question or be the subject of a legal action, PowerPhone will testify on behalf of the student and the agency regarding their endeavor to train in light of a recognized need (p. 2).

38 38 In the Dispatch Monthly (2001) the following was published: Both the NAEMD and PowerPhone Inc. market protocol card sets that provide dispatchers with a structured list of questions to ask callers, and pre-arrival instructions to give. For example, in Florida, where a female drowned in her car that had fallen into water: NAEMD had pre-arrival instructions to provide and have since revised their instructions after the incident; PowerPhone s card set did not previously include any prearrival instructions for handling a submerged or sinking vehicle. However, after the incident the company consulted with several public safety, diving and rescue experts to create a lengthy training article on handling these incidents. In addition, written questions and instructions have been developed by a PowerPhone trainer (p. 1). Research Question 4: What are the advantages/disadvantages to the LAFD of using scripted FPDS when processing fire emergency calls? The research indicated a number of advantages and disadvantages to the LAFD in using scripted FPDS when processing fire emergency calls. Advantages Captain Somers expressed that there are no specific guidelines, protocols or procedures for dispatchers to follow when providing pre-arrival instructions for fire related incidents. After obtaining sufficient information to process the call, the call taker has the option to give further information or disconnect the call by simply stating Help is on the way. On most occasions the deciding factor is how busy the communications center is at the time of the call (personal communications, January 10, 2003). Providing specific protocols to follow will ensure consistency and accuracy among all dispatchers. Regardless if the dispatcher is newly assigned or a tenured employee, the

39 39 information provided to a 911 caller will be uniform. Implementing scripted pre-arrival instructions will also reduce and possibly prevent liability. Requiring dispatchers to follow scripted protocols will allow the LAFD dispatch center the ability to implement a Quality Assurance program to evaluate the performance of each dispatcher relative to fire related calls. The LAFD dispatch center currently has a program in place to evaluate its dispatchers when answering 911 EMS related emergencies. PDC (2002) states: While no preventive measure can preclude someone from filing legal complaints of dispatch negligence against a provider agency, proper implementation of the appropriate Protocol system has proven over time to be an effective protection against such complaints. Neither PDC, nor to its knowledge, any such properly licensed Training and QA/QI Management systems has ever been charged in a dispatch negligence lawsuit over use of the system, or has been challenged in any way regarding its related training and materials (p. 4). The research project has also identified two established companies that currently market a FPDS program with scripted pre-arrival instructions for fire related incidents. The two companies are Powerphone, Incorporated and NAEMD marketed by PDC. Both products are utilized by agencies throughout the United States and Internationally. Disadvantages After the implementation of the new MPDS in conjunction with an annual increase in 911 calls, there has been a decrease by dispatchers to answer calls within the ten-second threshold. This is substantiated in Appendix B where the call answering statistics indicate a drop from 97.5 percent in 2001/2002 to 95.8 percent in 2002/2003. This can be attributed to scripted protocols

40 40 that call takers must read verbatim for every EMS call thus keeping the call taker on the line longer and delaying answering the next 911 call (T. Somers, personal communication, January 10, 2003). Implementing a new FPDS with scripted protocols that must be read verbatim will increase the call processing time and further reduce the ability of the LAFD dispatch center to answer calls in a timely manner. Although the LAFD dispatch center currently meets NFPA 1221 standards, implementation of a scripted FPDS program may cause the dispatch center to fall below standards without additional staffing for the dispatch center. One of the most restricting factors in implementing a new program is funding. Although implementation of a FPDS program will most likely reduce liability, current budgetary restraints may prevent this program from becoming a reality. In addition to cost for the FPDS, there is also an additional cost to staff and implement a Quality Assurance program. Elected officials may decide to roll the dice and take a chance, hoping to avoid dispatcher lawsuits rather than implement a program at the cost of placing the City of Los Angeles in a budgetary deficit. DISCUSSION The results of this study clearly demonstrated the need for the LAFD dispatch center to implement a FPDS program with scripted pre-arrival instructions. The importance of accurate and consistent protocols for the LAFD will certainly reduce liability cases. Two call takers may answer identical calls but the likelihood of both calls being handled alike is very remote without established protocols. Allen (1998) states, Most important, agencies have many options of their own to reduce their chances of being the subject of a lawsuit. Modern, clearly written protocols and procedures, and properly trained dispatchers are always a deterrent to negligence lawsuits (p. 1). Holt (1993) reported:

41 41 Why should you worry about liability if you limit your dispatchers simply to obtaining the address, phone number, and nature of the problem? If they don t go any further than that and they get that right, there s no problem, right? Wrong? Standards of care for dispatchers have been steadily evolving for years. What others do, whether you like it or not, has a big influence on what you are expected to do. If your department does not do it for example, give pre-arrival instructions to callers seeking medical assistance, you are asking for litigation. Why? Because everybody knows that some departments give such instructions. How does everybody know this? Because they watch television (p. 64). If millions of people watch any one of a number of network and syndicated real life emergency shows each week and they see dispatchers giving instructions to folks calling in with choking babies, drowning victims, and lots of other familiar sounding incidents, then it s reasonable to assume that some citizens in your jurisdiction are operating under the assumption that they can expect the same level of service when they call your department (p. 64). At this time the LAFD dispatch center has an ineffective procedure for providing prearrival instructions to 911 callers with fire related emergencies. Allowing dispatchers to provide information based on field and dispatcher experience establishes little guidelines and no protocols. Although there are a number of dispatchers with years of fire experience to draw from, there remains a lack of continuity from one dispatcher to the next. A new dispatcher taking their first 911 call has only a few seconds to make a decision and can become quickly flustered without specific instructions to provide to the caller. A seasoned dispatcher may be at a disadvantage in having been assigned to the dispatch center for an extensive time period, because he may be out of touch with current firefighting tactics and strategies. Changes in technology,

42 42 equipment, apparatus, LAFD fire code, and construction standards can put a seasoned dispatcher behind the eight ball when relating experiences and information to a 911 caller. In reference to standards, Hunjadi (2002) states: If your organization does not have standards, protocols, guidelines, bylaws, policies, or procedures, call them what you wish, it is imperative to begin to develop them. Once you have standards in place, be sure everyone has a copy and understands what is expected of them. Services that previously did not have written standards may be amazed at how greatly their problems are reduced. Employees who previously were thought to be doing whatever they wanted may happily follow a new set of standards (p. 2). The millions of dollars agencies spend on litigation cannot be overemphasized as to why the LAFD should implement a FPDS program with scripted pre-arrival instructions. More important is the responsibility of all dispatchers to provide the best service to the community and possibly save the life of a 911 caller. Two FPDS products currently on the market are available for purchase by the LAFD: PowerPhone Incorporated and NAEMD. A study must be performed to determine the practicability of implementing one of the two products identified in this research project. If neither products are applicable to implement at the LAFD dispatch center then at the least, one or both of the products can be utilized as a template to develop an internal FPDS. Another significant deficiency in the current LAFD dispatch center is the lack of a Quality Assurance Program to evaluate the performance of dispatchers answering 911 calls related to fire emergencies. From the Emergency Medical Dispatch Course Manual, (1996, p. 2.6) the rule states it is estimated that for every one complaint received, there are 40

43 43 more that go unreported, and 90 people who hear about the problem (this is an established rule used in the quality improvement process). RECOMMENDATION Based on this study, it is recommended that the LAFD dispatch center implement specific pre-arrival protocols for dispatchers to provide to 911 fire related calls. The LAFD can purchase or develop its own FPDS, with scripted pre-arrival instructions. As a leading metropolitan fire agency, the LAFD must follow other fire agencies in utilizing protocols for fire related incidents. Established protocols, procedures and policies have been an issue in the fire service for years and must be embraced by the LAFD. The importance of having established protocols for dispatchers to follow will prevent future litigation. In addition, the LAFD should establish a committee to research and further evaluate FPDS programs available on the market to purchase or to develop an internal FPDS program itself. It is important that personnel from the dispatch center, field assignments and administrative staff be assigned to this committee to provide an in-depth departmental evaluation. With the potential for litigation, it would benefit the LAFD to implement temporary protocols, policies and procedures immediately on an interim basis until established protocols can be finalized. A Quality Assurance program with appropriate staffing must also be created to evaluate dispatchers and their effectiveness in answering fire related 911 calls to prevent future litigation. Most importantly, the LAFD should seek the political support and funding needed to pursue and implement a new FPDS program.

44 44 REFERENCES Allen, G. (1998, May). 911 Liability: There is no easy answer for centers. Dispatch Monthly, 1. Retrieved on March 11, 2003, from Allen, G. (2000, September). NAEMD pushes forward with new training. Dispatch Monthly, 1-6. Retrieved on March 11, 2003, from Magazine, 23. Allen, G. (2001, February). Woman s Desperate 911 call for help raises questions of training. Dispatch Monthly, 1-6. Retrieved on March 11, 2003, from Clawson, J.J. (1994, October). Protocols vs. guidelines choosing a medical dispatch program. Emergency Medical Services, Dispatcher s guide to fire/incidents in progress. (2 nd ed.). (1996). Madison, CT: Powerphone Inc. Farnsworth, B. (2002, Spring). Liability: What every emergency dispatcher should know. The National Journal of Emergency Dispatch, 1, 4-8, 24. Furey, B. (1985, September). Call mishandling & dispatcher liability. Firehouse, Garza, M.A. (2001, January). Verdicts spotlight dispatch problems. EMS Insider, 1. Hagstrom, J. (2001, December). Don t sue me How lawsuits happen to dispatchers. Association of Public Safety Communications Officials 911, Holt, F.X. (1993, January). Standards of care for dispatchers. Fire Engineering, 2-6.

45 45 Hunjadi, D. (2002, November). Setting the standard. Medical Emergency Rescue and Global Information Network, 1-3. Retrieved on March 26, 2003, from LA settles for $1.5 million in 1995 dispatch error. (1997, May). Dispatch Monthly, Retrieved on March 11, 2003, from Lazar, R.A. (1989, February). Dispatch and the law. Journal of Emergency Services, Lopez, R. and Connell, R. (2000, September 5). Fire department dispatching in dire need of revision. Los Angeles Times, pp. A1, A15 Los Angeles Fire Department. (2001). Where we were, where we are, where we are going. Los Angeles, CA: Wells, William. Los Angeles Fire Department. (2003). The 911 System in Los Angeles [Data file]. Available from the Los Angeles Fire Department Web site. National Fire Academy. (2002, June). Executive fire officer program operational policies and procedures applied research guidelines. Emmitsburg, MD: author. National Fire Protection Association. (2001). Fire Protection Handbook (2001 ed.). Quincy, MA. Nordberg, M. (1998). Emergency medical dispatch: A changing profession. EMS The Journal of Emergency Care, Rescue & Transportation, Patterson, B.A. (2003, Spring). Liability: What every emergency dispatcher should know. The National Journal of Emergency Dispatch, 1,4-8,24.

46 46 Powerphone. (2003). About Powerphone. Retrieved on January 21, 2003, from Powerphone. (2003). Fire Service Dispatch. Retrieved on January 21, 2003, from Priority Dispatch Corp. (2002). Fire protocol. Retrieved on January 16, 2003, from Priority Dispatch Corp. (2002). Legal. Retrieved on January 16, 2003, from Scott, G. (2003, January). When 90 percent compliance isn t good enough. Medical Emergency Rescue and Global Information Network, 1-3. Retrieved on March 26, 2003, from Similar street name pointed fire units in wrong location. (2001). Dispatch Monthly, Retrieved on March 24, 2003, from The rule. (1996). Emergency Medical Dispatch Course Manual, (19 th ed.). p 2.6. Salt Lake City, UT: National Academy of Emergency Medical Dispatch Two girls die, confidence in dispatch is shaken. (1998, February). Dispatch Monthly, Retrieved on May 24, 2003, from Two Protocols for handling submerged vehicles. (2001, February). Dispatch Monthly, Retrieved on March 11, 2003, from

47 47 APPENDIX A DISPATCHER (CALL TAKER) EXPERIENCE 0-5 >5-10 >10-15 >15-20 >20-25 >25 YEARS YEARS YEARS YEARS YEARS YEARS JOB SENIORITY DISPATCH SENIORITY

48 48 APPENDIX B Call Answering Statistics Percent of Calls Answered MONTH within 10 Seconds July 97 August 98 September 98 October 98 November 98 December 98 January 97 February 97 March 97 April 97 May 97 June 98 Average 97.5

49 Call Answering Statistics Percent of Calls Answered MONTH within 10 Seconds July 97 August 97 September 96 October 96 November 95 December 96 January 95 February 95 March 95 April 96 May - June - Average 95.8