Computer Aided Call Handling: Improving Technology at the Front End of Dispatch Positioned at the front end of dispatch, CACH delivers protocols that are fully integrated to determine the appropriate responder skills required at the scene and their corresponding priorities. Over the past couple of decades, Computer-Aided Dispatch (CAD) has become a major force in the world of emergency communications. Evolving from the days when most calls originated from fixed landlines and were simply assigned a call sign, CAD has grown into a complex system that can be integrated with enhancements, such as mapping, records management and mobile data terminals. As a result, CAD is focused on the response to an incident rather than on the call information management and handling needed for the most efficient response. It s often said that location is everything in 911 call handling, but what happens when responders are dispatched without adequate information about the risks they may encounter? Or when a default response is authorized that doesn t relate to the actual priorities at the scene? Call handlers have historically had limited access to technology that centralizes critical lifesaving information and provides concise, structured questioning and objective recommendations. They lack a technology that does for their job what CAD does for the dispatch function. Why? Frequent replies to this question include: That s how we ve always done it. Our responders insist they go to every call, regardless of the circumstances. Asking too many questions will slow our dispatch times. If we don t offer advice to callers, we ll avoid liability risks. 1
In reality, CAD systems are too focused on incident response and structured questions, and CAD is invariably implemented after the incident has been categorized. By positioning CACH computer aided call handling, pronounced catch at the front of the dispatch process, call takers can make an effective dispatch determination, provide pre-arrival advice that improves performance standards, reduce liability exposure and enhance job satisfaction. Most important, CACH can provide communications centers with credible evidence that not every call warrants a blanket response. CACH addresses a significant gap in the 911 response, built on the premise that effective call handling is the foundation for an efficient dispatch response. Is CAD Designed for Call Handling? During CAD call entry, the telecommunicator answers the call and routinely determines an incident definition as the first stage in dispatching responders. In most cases, the incident definition will recommend a pre-determined dispatch of resources. Yet, after dispatch has been initiated, the telecommunicator may ask the caller more questions, possibly using a script that has appeared within a pop-up window. Although these structured protocols are intended to encourage consistency, measure performance standards and protect an agency from liability, telecommunicators do not always use them. There are inherent drawbacks to this approach: How can an incident be defined before a caller is questioned? How can one truly know what to dispatch without knowing what has happened and what the risks are? If a telecommunicator has the ability to bypass the use of protocols and consequently does not always use them, how can it be ensured that calls are being handled consistently? 2
Call demand has changed dramatically in recent years. Volumes have increased and wireless calls present their own unique problems. Yet many agencies do not consistently record duplicate calls as unique events in their CAD systems. As a result, they have no means to audit how every call received is handled. Logging each call may seem to be unnecessary, but the reality is every call has to be answered. In addition, until the call handler asks the caller some questions about the incident, the call must be assumed to be unique. Every call that is answered is a demand upon PSAP resources; failing to record these events limits insight into changing trends and restricts the planning of future management initiatives. Ideally, structured call handling is implemented at the time each call is answered. Unfortunately, this is not always the case, and the orientation of CAD toward resource management is the primary reason why protocol systems are generally implemented as pop-up features. Vendors are recognizing that the way protocol systems integrate within the dispatch process needs to change and despite what some may indicate, the technology to meet these challenges need not be financially prohibitive. ONE NUMBER ONE PROTOCOL 911 calls are frequently answered at PSAPs that have a responsibility to dispatch responders from several agencies. In PSAPs where this doesn t occur, calls are forwarded to secondary PSAPs. When calls are categorized by incident type fire, police or EMS and call handling protocols are used, the call is likely to have a focus that matches its classification. On the other hand, a call that requires more than one responder type is usually categorized according to the responder type of the agency handling the call. This often results in the caller being routed to another agency after initial questioning. From the caller s perspective, calls should be handled on the merits of the cause rather than the agency handling it. A multi-agency response is required in many emergency situations. Is routine call forwarding really the most efficient and effective service that can be offered? Evidence suggests the needs of a 911 caller would be better served if the original call handler were able to initiate an appropriate dispatch process without patching other agencies into the call or making additional calls to pass along information. Within public safety, the concept of one number, one protocol is often linked to an objective to develop protocols that can be used on a national scale. Yet this ambition, until now, has continued to be held within the boundaries of separate protocols for different services (police, fire and EMS). The result is potentially one number, three protocols. From the caller s perspective, one number, one protocol would connect them to a dispatcher who uses incident-related protocols to generate a recommendation for any appropriate responder skill regardless of whether or not the resources are dispatched from the physical location where the call is handled. 3
Using Protocols or Guidelines The terms protocols and guidelines are frequently used to describe call handling scripts, with an inference that protocols are more effective and guidelines are less structured. According to independent research, the reality is that both methods are effective. Continuing dispatcher education and ongoing monitoring of the call handling process ultimately ensure the effectiveness of a PSAP s performance. Structured call handling is about more than dispatch priorities and prearrival advice. Responders should, whenever possible, be provided with all the information that could prove valuable before they arrive on the scene. Since maintaining high-quality standards is a key objective of protocol implementation, agencies should look closely at how protocols or guidelines are implemented, making certain that every call is subjected to a structured approach. This includes duplicate calls where a dispatch recommendation doesn t need to be determined, but the recording of secondary information or the ability to offer pre-arrival instructions is important. Whether an agency uses protocols or guidelines, it is essential that dispatchers view the scripts as beneficial to their task, not an imposed mandatory requirement. CACH: The Next Logical Step in 911 Automation While CAD concentrates on incident management and allocating resources at the scene, CACH addresses a significant gap in the 911 response, built on the premise that effective call handling is the foundation for an efficient dispatch response. CACH systems are designed to ensure that structured call handling is applied, with varying degrees, to every call based on the circumstances. If each call is handled consistently, then each one can be subjected to a retrospective audit that verifies performance standards. Positioned at the front end of the dispatch process, CACH delivers protocols that are not structured around police, fire or medical designations. Instead, CACH protocols are fully integrated to determine the appropriate responder skills required at the scene and their corresponding priorities. 4
Through a series of risk calculations, CACH systems can make an objective dispatch recommendation based on information provided by the caller. This is the missing link in today s 911. The information gathered can be electronically communicated to one or more CAD systems for resource allocation, making the ideal of one number one protocol a reality. Because the nature of the emergency might require responder skills not provided by the agency handling the call, dispatch recommendations can be transmitted to multiple CAD systems without additional agencies intervening on the call. This not only reduces the time and cost of engaging several call handlers on the same call, but is also less confusing to the caller. Considering the process most agencies currently employ, CACH does not add an extra step to the process or increase dispatch times. Using CACH, initial calls to an incident are triaged and prioritized to determine what responder skills are needed at the scene. Duplicate calls are processed to ensure that any secondary information is passed (via CAD) to responders en route. Responders from other agencies can be mobilized without call transfers or unnecessary delays. CACH promotes the ideal that whenever a citizen uses 911, the situation will be handled consistently regardless of which agency actually takes the call. Flexibility for Local Conditions While the protocol s content should conform to accepted standards, the details should be relevant to the community in which it s used. Protocol content is not always best served when it is completely defined by a third-party organization. An effective call handling tool must allow the user to implement local requirements. Customization is essential to ensure that call handlers can reference relevant SOPs or other requirements sanctioned by medical direction or regulatory bodies. There are two current examples of the need for local customization. Recently, medical directors in some U.S. cities made the decision to implement chest compression-only CPR in cases where lay rescuers are present. Not all agencies will need to make such a change. A system that allows for protocol customization can facilitate these changes when an agency is ready to adopt them based on their medical director s decision. The second example involves the war on terrorism, which has placed public safety agencies in the spotlight. During the anthrax scares of 2001, agencies had to quickly reassess their procedures to meet caller demand. Using CACH, an agency can create localized protocols to ensure the gathering and relaying of information is audited and the standard of care is consistently met. 5
A New Way to Look at Quality Assurance Continuous assessment ensures protocols and procedures are focused on supporting current demand. This should apply to every call, even those that do not merit a dispatch recommendation. If the audited-call scope is limited, how can a communications center manager be sure that protocols are being used correctly? Systems that only assess calls based upon protocol use leave a significant gap in understanding the everyday demands of a communications center. If quality assessments are intended to reduce liability risk, the quality assurance process must extend beyond this limited scope. CACH creates a complete audit trail of every call, from the time it is answered through closure, allowing the call handling process to be assessed regardless of protocol use. This ensures that even a decision not to use a protocol can be verified. The output can be used not only to assess dispatcher performance, but also to analyze protocol effectiveness and highlight trends in call center operations. The use of data generated from CACH need not be solely applied to the use of call handling scripts. Because a broader range of the communication center s activity is recorded, the scope of using management information will also increase with minimal need for analytical resource. Issues surrounding resource planning with predictive assessment of future demand also can be supported by data captured during normal call handling activities. The output can be used not only to assess dispatcher performance, but also to analyze protocol effectiveness and highlight trends in call center operations. Consolidation of small communications centers is a topic that is gaining attention. The biggest hurdles to overcome are often local politics and human resource implications. With the capability to electronically communicate dispatch recommendations to multiple CAD systems, CACH can enable virtual consolidation, while more difficult aspects can be resolved through evolutionary change. 6
Moving Call Handling Forward Technology solutions should be designed as tools to help the user achieve definable objectives that are relevant to the needs for which they were created and to provide flexibility to empower the user. Public safety dispatch is a complex process originating with a call for help from someone who is not interested in the mechanics of the process, but most likely has high expectations about the service he or she will receive. Success stories that get media attention only heighten this expectation. The public already questions incidents where callers are transferred between different dispatchers, or where a dispatcher is reluctant to provide pre-arrival instructions. Until now, public safety call handling tools have been molded around CAD, which is much more focused on managing events after a call has been taken. Agencies that do not record duplicate calls or that implement call handling protocols that may be bypassed by their dispatchers, may have significant gaps in their quality systems. A lack of quality monitoring increases an agency s exposure to liability risk. It s time to take a fresh look at 911 call handling. CACH positions PSAPs to meet these challenges with increasing professionalism by filling the technological void that currently exists at the front end of the dispatch process. 7