EXCELLENCE IS KEY - 10 | - The Journal of Emergency Dispatch
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INTERNATIONAL ACADEMIES OF EMERGENCY DISPATCH MAY | JUNE 2017 10 | FIRST ACE STILL GOING STRONG 32 | PROPER SUICIDE INTERVENTION 44 | SAVING A LIFE AFTER HOURS PAGE | 17 EXCELLENCE IS KEY iaedjournal.org
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••• COLUMNS MAY • JUNE 2017 | VOL. 21 NO. 3 4 | contributors 5 | the skinny 6 | dear reader 7 | from the emd side 8 | ask doc 9 | research ••• SECTIONS BEST PRACTICES 10 | ace achievers 13 | center piece 15 | faq ON TRACK 32 | police cde 36 | medical cde 40 | blast from the past YOUR SPACE 43 | dispatch in action ••• FEATURES CASE EXIT 17 | fast facts—NAVIGATOR 46 | after the accident 18 | NAVIGATOR 2017 Another amazing NAVIGATOR event inspired and educated. See what happened at this year’s conference in New Orleans. 26 | APPS FOR DISPATCH A handful of smartphone apps are now available to help comm. centers provide enhanced service to their callers. COVER PHOTO BY JOSHUA BRASTED Follow IAED on social media. The following U.S. patents may apply to portions of the MPDS or software depicted in this periodical: 5,857,966; 5,989,187; 6,004,266; 6,010,451; 6,053,864; 6,076,065; 6,078,894; 6,106,459; 6,607,481; 7,106,835; 7,428,301; 7,645,234. The PPDS is protected by U.S. patent 7,436,937. FPDS patents are pending. Other U.S. and foreign patents pending. Protocol-related terminology in this text is additionally copyrighted within each of the NAED’s discipline-specific protocols. Original MPDS, FPDS, and PPDS copyrights established in September 1979, August 2000, and August 2001, respectively. Subsequent editions and supporting material copyrighted as issued. Portions of this periodical come from material previously copyrighted beginning in 1979 through the present. may / june 2017 | THE JOURNAL 3
••• CONTRIBUTORS Art is a software instructor Sherri is the training and and IAED™-certified ED-Q™ operations manager for Waukesha instructor for Priority Dispatch County Communications, Corp.™ He has been a fire and Wisconsin, USA, a combined EMS dispatcher for 18 years and dispatch center in southeastern works at Union County Regional Wisconsin, just west of Milwaukee, Communications in Westfield, a land where the beer runs freely New Jersey, USA. Art has been and locals proudly stack cheese involved in 911 telecommunicator on just about everything and call training and medical quality it great. You can contact Sherri assurance since 1999. at 262-446-5085 or by email at sstigler@waukeshacounty.gov. ART BRAUNSCHWEIGER SHERRI STIGLER 7 | FROM THE EMD SIDE 20 | NAVIGATOR Bonnie has been a dispatcher Ryan is the Communications with Waukesha County Specialist for the 911 Wellness Communications, Waukesha, Foundation, a nonprofit working Wisconsin, USA, since 2010. to optimize the overall health She is an APCO-certified and well-being of emergency Communications Training dispatchers. Ryan is a former Officer, a member of the center’s Police Communications Operator quality assurance team, and and currently serves as an Adjunct an IAED™ ETC instructor. She Instructor at the Golden West enjoys working with and sharing College Criminal Justice Training her knowledge and expertise Center in Southern California. with people interested in the emergency services career. BONNIE DOUGLAS RYAN DEDMON 13 | CENTER PIECE 20 | NAVIGATOR WE WANT TO KNOW WHAT YOU THINK. Take our 5-minute Journal survey and be entered to win an Amazon gift card. VISIT SURVEYMONKEY.COM/R/R57ZZV2 TO TAKE OUR SHORT SURVEY. The survey closes on July 14. 4 THE JOURNAL | iaedjournal.org
THE SKINNY ••• INTERNATIONAL INTERNATIONAL OFFICES ACADEMIES OF AUSTRALASIAN OFFICE EMERGENCY DISPATCH 011-61-3-9806-1772 110 South Regent Street, 8th Floor CANADIAN OFFICE Salt Lake City, UT 84111 USA 1-514-910-1301 USA/Canada toll-free: 800-960-6236 Intl/Local: 801-359-6916 EUROPEAN OFFICE Fax: 801-359-0996 011-43-5337-66248 www.emergencydispatch.org ITALIAN OFFICE editor@emergencydispatch.org 011-39-011-1988-7151 MALAYSIAN OFFICE 011-603-2168-4798 U.K. OFFICE 011-44-0-117-934-9732 IAED JOURNAL STAFF THE WHOLE ENCHILADA CREATIVE DIRECTOR DIRECTOR OF ACADEMICS Lots of substance served up in this issue Kris Christensen Berg Isabel Gardett MANAGING EDITOR PRINT AND LICENSING ADMINISTRATOR Audrey Fraizer Jess Cook TECHNICAL EDITOR WEB DESIGNER Heather Darata Brett A. Patterson Dave Tyler I SENIOR EDITOR INTERNATIONAL TRANSLATORS Josh McFadden Hien Cam Giuditta Easthope t’s hard to believe it’s already summer. We have a lot in store COPY EDITOR Veronika Fagerer Heather Darata Abbas Hamed Lu Huan for you this time around. In addition to our NAVIGATOR ASSISTANT EDITORS Audrey Gonzalez Rebecca Tuft Michel Looyé Marco Mora coverage, we have a feature that touches on four specific Sara Scott SENIOR DESIGNER Serina Nielson Zhang Shengdong Carolyn Turcotte smartphone apps. Bystander CPR offers step-by-step CPR instructions and alerts users to the closest AED. GoodSAM alerts ACADEMY STAFF the closest volunteer responders registered with the app when PRESIDENT DIRECTOR OF INTERNATIONAL RELATIONS Jerry Overton Amelia Clawson there is a cardiac arrest. The volunteer responder accepting the ASSOCIATE DIRECTOR | U.K. ASSOCIATE DIRECTOR, MEMBER SERVICES Beverley Logan Arabella VanBeuge alert gets a map with the patient’s location and the location of ASSOCIATE DIRECTOR | AUSTRALASIA ASSOCIATE DIRECTOR, Peter Hamilton INSTRUCTOR SERVICES the closest AED and has access to the app’s tools, including a Bonni Stockman ACADEMICS & STANDARDS ASSOCIATE Brett A. Patterson ASSOCIATE DIRECTOR OF MEDICAL metronome and on-scene video streaming. Check out our feature CONTROL AND QUALITY PROCESSES ASSOCIATE DIRECTOR OF ACCREDITATION Kim Rigden Brian A. Dale to learn about the PulsePoint and FirstNet apps. People might think summer sunshine puts suicidal thoughts BOARDS & COUNCILS at bay, but it’s just not true. Suicide is the eighth-leading cause ACCREDITATION BOARD CHAIR COUNCIL OF STANDARDS CHAIRS Jerry Overton Brett A. Patterson (Medical/EMD) Gary Galasso (Fire/EFD) of death in the U.S., with 30,000 people dying each year. To ALLIANCE BOARD CHAIR Tamra Wiggins (Police/EPD) Keith Griffiths Michael Spath (ED-Q) Conrad Fivaz, MD (ECNS) learn about Crisis Intervention Training in addition to how the CERTIFICATION BOARD CHAIR Pamela Stewart CURRICULUM COUNCIL CHAIRS medical and police protocols are each used to handle suicide, read RESEARCH COUNCIL CHAIR Victoria Maguire (Medical/EMD Board) Marc Gay Mike Thompson (Fire/EFD Board) Jaci Fox (Police/EPD Board) the CDE articles in our OnTrack section and take the quizzes to Susi Marsan (ETC Board) Deanna Mateo-Mih (ED-Q Board) Gigi Marshall (ECNS Board) receive credit. If you’re in the mood for a cross-country trip, check COLLEGE OF FELLOWS out our Best Practices section to learn about Waukesha CHAIR UNITED STATES Marie Leroux Bill Auchterlonie (Kansas) Robert Bass, MD (Maryland) County Communications (WCC), Wisconsin, USA, and the AUSTRALASIA | SOUTH AMERICA Frank Archer, MD (Australia) Catherine L. Bishop (Michigan) Christopher W. Bradford (Florida) Albuquerque Fire Department (AFD) in New Mexico, USA. Andrew K. Bacon, MD (Australia) (Emeritus) Geoff Cady (California) Peter Lockie (New Zealand) Peter Pilon (Australia) Steven M. Carlo (New York) Jeff Clawson, MD (Utah) WCC provides emergency communication services for 21 fire/ CANADA Drew Burgwin (Br. Columbia) Phil Coco (Connecticut) Chip Darius, MA (Connecticut) EMS agencies and 19 law enforcement agencies in the county. Kate Dernocoeur (Michigan) Claude Desrosiers (Québec) Douglas Eyolfson, MD (Manitoba) Norm Dinerman, MD (Maine) Patricia J. Dukes, MICT (Hawaii) AFD made history by becoming the first-ever IAED™ Accredited Martin Friedberg, MD (Ontario) Marc Gay (Québec) (Emeritus) Marie Leroux, RN (Québec) (Emeritus) James V. Dunford, MD (California) Conrad Fivaz, MD (Utah) Center of Excellence (ACE). Gary Galasso (Utah) Paul Morck (Alberta) Wayne Smith, MD (Québec) Keith Griffiths (California) Jeffrey R. Grunow, MSN (Utah) Your favorites are in here too—Ask Doc and FAQ. Darren Judd (Utah) EUROPE André Baumann (Germany) Alexander Kuehl, MD, MPH (New York) (Emeritus) Make sure you don’t miss out on an amazing survival story Jan de Nooij, MD (Netherlands) Gianluca Ghiselli, MD (Italy) Jean-marc Labourey, MD (France) James Lake (South Carolina) James Lanier (Florida) in our Your Space section. Miraculously, Jonathan Arteaga Stephen L’Heureux (New Hampshire) Harm van de Pas, MD (Netherlands) Bernhard Segall, MD (Austria) Victoria A. Maguire (Michigan) (Emeritus) Sheila Malone (Indiana) lived to tell the tale after a 37,000-pound mobile home fell Gernot Vergeiner (Austria) (Emeritus) Christine Wägli (Switzerland) Susi Marsan (Georgia) (Emeritus) Robert L. Martin (California) on him. Montgomery County Hospital District (Texas, USA) Dave Massengale (California) UNITED KINGDOM | IRELAND Trevor Baldwin (England) Jerry L. Overton (Utah) Eric Parry, ENP (Utah) communication center EMD Danielle Williams answered the Tracey Barron (England) Michael Delaney (Ireland) Louise Ganley (England) Rick W. Patrick (Pennsylvania) Brett A. Patterson (Florida) call. The two later had the chance to meet. Also inspiring is the Paul E. Pepe, MD, MPH (Texas) James Gummett (England) (Emeritus) Chris Hartley-Sharpe (England) Ross Rutschman (Oregon) (Emeritus) Joe Ryan, MD (Nevada) story of Anthony Bruno from Las Vegas Fire & Rescue, Nevada, Andy Heward (England) Stuart Ide (England) Peter Keating (Ireland) Doug Smith-Lee (Washington) Tom Somers (California) USA. On his way home after his shift had ended at 2 a.m., he Ray Lunt (England) Paul Stiegler, MD (Wisconsin) Andy Newton (England) (Emeritus) Michael Thompson (Utah) Carl C. Van Cott (North Carolina) came across an emergency scene. After stopping at the scene, he Janette K. Turner (England) Arthur H. Yancey, II, MD, MPH (Georgia) Tina Young (Colorado) heard a noise. His investigation led to a person in need of help, about 100 yards away from the initial accident. Bruno has been The Journal of Emergency Dispatch is the official bimonthly publication of the International Academies of Emergency Dispatch® (IAED™), a nonprofit, standard-setting organization promoting safe and effective emergency dispatch services worldwide. Comprised of three allied academies for medical, fire, and police dispatching, the IAED supports first-responder- related research, unified protocol application, legislation for emergency call-center regulation, and strengthening the emergency dispatch community through education, certification, and accreditation. recognized with several awards for his role in helping save the General IAED membership, which includes a Journal subscription, is available for $19 annually, $35 for two years, or $49 for three years. Non-member subscriptions are available for $25 annually. By meeting certain requirements, certified membership is provided for qualified individual applicants. Accredited Center of Excellence status is also available to man’s life. J dispatch agencies that comply with Academy standards. ©2017 IAED. All rights reserved. may / june 2017 | THE JOURNAL 5
••• dear reader DOUBLE THE FUN NAVIGATOR, NTW highlight eventful week Josh McFadden H ere at the Academy, we spend had provided during the week. It was emergency or to send a battalion emergency. months preparing to put on obvious that you take NTW seriously and That is a huge responsibility. Not everyone a memorable, educational, that you’re all part of a large group of like- can handle that responsibility. This is a enjoyable NAVIGATOR conference minded, hard-working professionals. special skill not everyone is built to do, but each year. We expend a great deal of My favorite part of promoting NTW if you are you must find it in yourself to time, energy, and resources to ensure it’s a on social media was when I posed this pick up the line and answer that call.” worthwhile week for you. open-ended question: “How do you — Patty Fernandez-Andres In years past, National Public Safety encourage someone to overcome the stress “Don't give up. The task of learning Telecommunicators Week (NTW) of the job and find success?” I asked our this job seems insurmountable, but it preceded NAVIGATOR. NTW gives followers to tell everyone what advice isn't. Take full advantage of the time you special acknowledgement and appreciation they would give a struggling dispatcher/ have with your trainer and learn as much to dispatchers and calltakers everywhere calltaker. The response was fantastic, and as you can from them; take the best of for their dedicated efforts as the first, first everyone who participated gave excellent each dispatcher you train with and put responders. It has been the perfect way to get advice. Here are some of the most those pieces together to be the best you ready for our annual conference. This year, insightful words of wisdom: can be. Most importantly, remember that however, NAVIGATOR we are all here for you!” was held a couple of weeks — Dawn Michele earlier than usual, placing “You will have good it at the same time as days and bad days—days NTW. This created some that you feel on top of the challenges on our end, as world because you know we tried to give appropriate you saved a life, and days recognition to each. It was when you just wish you also a unique experience to could go through the phone celebrate both important and do something to make a occasions simultaneously. difference. We all have the While a portion of days when the only thing our staff headed to New that helps is just being there, Orleans, Louisiana, USA, for and sometimes it is just to NAVIGATOR, April 12–14, listen and offer words of others remained behind to encouragement. But never take care of other duties. I had doubt for one second you the pleasure of promoting are not doing enough or you NTW on social media, and are not making a difference, it was enjoyable to see how because you are.” centers in the U.S. recognized This was one of the many thoughtful responses we got for our NTW Facebook campaign. — Lisa Howard the week. That was just a small Followers of our Facebook page sent “Each call that we take changes a life. sample of the wonderful responses us photos of themselves and their co- When a caller dials 911 it begins a chain of we received during NTW. It is a workers dressing up as superheroes or in events that in large part is controlled by pleasure to be involved in a small way crazy outfits. Others provided pictures you. That call creates a ripple effect. The in this profession and to hear so many of comm. center employees eating meals size of that effect is determined by you. inspiring stories and examples of together that local restaurants or stores You determine when to send a unit non- devotion and heroism. J 6 THE JOURNAL | iaedjournal.org
from the emd side ••• MEET BROCK One victim’s legacy to the Medical Protocol Art Braunschweiger T his column is dedicated to the that. I always give callers the instruction ProQA: one to access the Go To Specific young man in the photo. His name to get an AED if there’s one available.” PAIs button (“Target Tool”), one to is Brock Ruether. In May of 2012 Unfortunately, there usually isn’t; at highlight Protocol Z (AED Support), and he was a talented, athletic 16-year-old least, that’s what most of our callers a double-click on Panel Z4 – Place AED. living in Alberta, Canada, when he went say. Granted, not many people have And please, don’t just read this. Run a test to volleyball practice at his high school defibrillators in their homes. But think call and try it. one evening. During play, Brock collapsed about the places where from sudden cardiac arrest (SCA). CPR there are defibrillators. was started within a few minutes, but Large stores, office it didn’t save him. Sadly, the AED that complexes, movie could have saved his life was brought to theaters, and other high- his side and never used. occupancy buildings are Brock’s mom, Kim, now spends almost certain to have her time educating the public on SCA an AED mounted on the and the need for better AED access wall somewhere. Next and awareness in schools. (75 percent time you receive a call of SCA deaths in children occur on for a cardiac arrest from school grounds.) The statistics on SCA one of those places, and are sobering: nine out of 10 victims die, the caller says there’s including 7,000 to 10,000 children every no AED available, year in North America. Yet the chances remember Brock. Step of survival are nearly 100 percent if the out of the Protocol shock from an AED is administered for a moment and say within one minute of collapse. That “Sir, there should be a shock is arguably even more important defibrillator somewhere than CPR because SCA usually results in the building. Send from ventricular fibrillation, an erratic someone to go look for and ineffective beating of the heart that it.” That’s not freelancing; can only be corrected with an electrical it’s lifesaving. The shock from an AED—a defibrillator. caller may be in such Brock Ruether Brock’s death was the catalyst for tunnel vision because several changes in the Medical Priority of the patient’s collapse that they’re not Lastly, when you receive a call for Dispatch System™ Protocol. The AED thinking beyond the immediate area a patient in their early 20s or younger instructions have since been revised, and they’re calling from. Your prompt could who collapses with no outward cause, an AED dashboard has been added to literally mean the difference between a sudden cardiac arrest should be the first ProQA® medical. And in Version 13.0 positive outcome and a pronouncement thing you consider. Remember, too, that of the Protocol, to increase calltaker of death. breathing descriptions of “gasping,” “a little,” awareness of the vital need for the caller But what happens if you tell ProQA “barely,” and similar terms describe agonal to get and use an AED, Brock’s Law was there isn’t a defibrillator available, and respirations—not effective breathing. And added. It simply and directly states that as you’re doing compressions the caller remember Brock. Defibrillation is critical to “The presence of an AED does not ensure volunteers that someone showed up with survival. Get that AED to the patient’s side its use—the EMD does.” one? Would you know how to get to the and make sure it’s used without delay. J You might be thinking, “I know AED pathway? It only takes four clicks in may / june 2017 | THE JOURNAL 7
••• ask doc ‘CAN’T BREATHE’ OR ‘CAN’T BREATHE AT ALL’ Substance or Semantics? Dr. Jeff Clawson, Brett Patterson P erhaps the most influential agents Additionally, there is field data to suggest Likewise, a same or similar of change for the MPDS® are the that most of these patients are not as sick INEFFECTIVE BREATHING term may actual users. From Proposals for as the “Can’t breathe at all” group. In fact, be used when it is obvious the patient is Change (PFC) to rapid input regarding many of them are reported to be 1st party not in severe distress, most commonly the newest beta version, users provide the callers speaking in full sentences, while when 1st party callers are involved. This real-life feedback so necessary for quality stating, “I can’t breathe.” is most likely when the 1st party patient protocol evolution. In response to this excellent feedback, states “I can’t breathe” but is otherwise Case in point: MPDS v13.0 the Academy’s Rules Group, a working speaking in complete sentences without contained changes to the ECHO-related, sub-group of the Council of Standards, obvious distress. Again, the goal here is INEFFECTIVE BREATHING section of is in the process of addressing this issue appropriate triage in the best interest of Case Entry. These changes were inspired by removing the parentheses from this the patient, not simple word matching by by PFCs that detailed actual cases where phrase and addressing the issue here, the EMD. EMDs did not select an ECHO code in print. The Academy owes a great deal because the caller’s description did not The intent of the INEFFECTIVE of gratitude to the EMDs and their EXACTLY match the quoted phrases in BREATHING section, and its link to the agencies who take the time and effort to this section of the Protocol. In other words, ECHO code, is to capture the most acutely provide the feedback so important to the the patient was actually in dire straits but, ill patients that can benefit from the evolution of the MPDS. In this case, the because the description did not match the immediate response of the closest available feedback is being used to “fast-track” this Protocol phrase exactly, the EMD did not trained responder who, in many cases, is change into ProQA® and make it available code the call as ECHO. not part of the standard EMS response to users as soon as possible, perhaps In reality, these phrases were taken team (e.g., HAZMAT units, ladder trucks, even by the time of this printing. In the from actual calls, which is why they are police, etc.). Patients with INEFFECTIVE meantime, EMDs and ED-Qs should placed as quotations. However, they were BREATHING, as the term strongly consider the phrase “Can’t breathe” with never meant to be exact or absolutes. So, suggests, are not breathing adequately discretion when it is offered alone or after considering the related PFCs, the to sustain life. And it is expected that without further clarification, meaning Council of Standards voted to make a while emergency callers have predictable it is no longer a mandatory, ECHO-level couple of changes to clear things up. First, tendencies in their descriptions of these phrase in and of itself. the phase “… or reasonable equivalents …” patients, there is bound to be some Brett A. Patterson was added to the directive at the beginning variation. Therefore, EMDs should be Academics & Standards Associate of the section, and this has worked out encouraged to consider not only the Chair, Medical Council of Standards very well. Additionally, to more directly caller’s vernacular, but also the scenario International Academies of address one of the PFCs, the phrase “Can’t and any additional clues it may provide. Emergency Dispatch® breathe at all” was changed to read “Can’t Certainly, if the caller describes a patient Special thanks to the Central breathe (at all).” using one of the listed terms, and there Communications Center for Alberta Health But while the intent of the later are no obvious circumstances to the Services in Edmonton, Alberta, Canada; the change was actually to allow more contrary, INEFFECTIVE BREATHING Toronto Paramedic Services Communications discrepancy on the part of the EMD, it must be assumed and the appropriate in Canada; the Alameda County EMS has apparently opened the gates a little code assigned. But if the exact term or Authority in San Leandro, California, USA; too wide. Several high-volume agencies phrase is not used, and the EMD strongly the Oakland Fire Department in California, have reported spikes in the number of suspects INEFFECTIVE BREATHING, USA; and the various IAED™ National Q ECHO-level calls and have provided caution must always err in the patient’s clients who submitted their concerns and data that links the complaint of “Can’t favor; 1st party callers offer direct, audible supportive data to facilitate this important breathe” alone to the volume increase. assessment of their breathing status. change in the MPDS. J 8 THE JOURNAL | iaedjournal.org
research ••• CELEBRATION OF INNOVATION Conference explores advances in EMS and dispatch Christopher Olola, Ph.D. T he halls were lined with row The results support related (non- with NAEMSP allowing researchers after row of intriguing research IAED) studies: A metronome for five minutes to explain their research, summations presented on posters dispatchers to direct bystanders in leaving two minutes to field comments or and submitted from the finest researchers giving CPR is effective in helping questions from the people assembled at in prehospital care. This was a celebration bystanders achieve the correct your display. of innovation and genius in a health compression rate. As it turned out, our concerns went profession considered a significant link in The popular research poster exhibit unwarranted. Our research was well- the history of health care. serves several purposes, not the least of received, and we will carefully consider The event was part of the annual which is the venue to share innovation, the recommendations to improve National Association of EMS Physicians spark discussion, and encourage (metronome) protocol. We are confident (NAEMSP) conference, which was held networking among the many disciplines moving forward to the next step: writing in New Orleans, Louisiana, USA (Jan. under the EMS umbrella. The contest a paper for publication in a peer- 21–26). Educational sessions and research has also grown beyond posters highlighted response safety, expectation, resulting challenges unique to demographics in daily rounds to and geography, and contemporary assemble, view, and issues involving social media and take down posters in credentialing. There were several papers preparation for the on emergency dispatch. next scheduled group. The International Academies of Each day, conference Emergency Dispatch® (IAED™) research goers paraded along the team presented a summary explanation poster route, stopping signifying the first release of data from to hear a synopsis of the the Academy’s metronome study. A information organized metronome audio built into the Medical according to a standard Priority Dispatch System™ (MPDS®) research paper but ProQA® software signals the rescuer to do condensed to fit in a smaller space reviewed journal. We are also planning a chest compression at each click of the (a board). future research posters for conferences metered sound when providing CPR to a Standing in front of a research addressing public safety issues that victim of sudden cardiac arrest. poster to explain the research and benefit from the use of sound, time- The IAED research group conducted answer questions is little different tested, and internationally recognized the study in 2016 at four sites in Salt from standing in front of a classroom protocol systems. Lake City, Utah, USA, with each site audience, at least in terms of potential The research poster competition characterizing a different demographic unease. Both can be daunting. You complements the Academy’s goal to population (junior high, assisted living might ask yourself: Is data presented evaluate dispatch protocols through residential setting, community college, logically? What about visual appeal? an evidence-based process. It’s a stage and university). Participants were Did we catch spelling and grammatical allowing the Academy to showcase the randomly allocated to either of two errors and graphic blemishes? Did we importance of emergency dispatch to groups: standard instructions given by prepare an adequate summary? Will public safety and the power of protocol. EMDs over the phone (control group), our research generate discussion and We returned to our offices knowing and instructions complemented by questions? Will we leave our audience a our research lends to the vital link of the metronome audio over the phone take home message, perhaps stimulating understanding where we came from and (experimental group). further research? Time is a huge concern, where we go from here. J may / june 2017 | THE JOURNAL 9
••• BEST PRACTICES | ace achievers Albuquerque Fire Department RIGHT THING TO DO First ACE was accomplished for the people Audrey Fraizer T om Montoya helped write one and the ACE award in February 1993 like it firefighter,” said Chavez, now an for the Academy records nearly occurred in more recent times: Lt. Cosmes Academy Fire and Medical Protocol 24 years ago in his move from Madrid, supervisor; Lt. Randy Pennington, Instructor. “It was a place to mend before Denver, Colorado, USA, to Albuquerque, quality assurance; Capt. Jay Staeden, who going back in the field.” New Mexico, USA. was in charge of the Alarm Room; Assistant A growing recognition of what dispatch At the same time, he’s reluctant to Chief John Brown, who later became a fire actually does shifted perspectives, and by take any credit for the history-making chief in Texas; and Sharon Eberly, who the time Chavez was assigned to the Alarm first-ever Accredited Center of Excellence provided direct IT support and data analysis. Room years into the use of the Medical (ACE) achieved during his three-year “Those were the guys cementing the Priority Dispatch System™ (MPDS®), (1990–1993) tenure as chief of the changes in the Alarm Room,” Montoya said. dispatch was no longer second class. Albuquerque Fire Department (AFD). “This was all part of an EMS system change, “Dispatch was moving in a forward “I would like to take more credit,” said and there was a lot I needed to get done.” direction,” he said. “This was a promotion Montoya, who retired from firefighting in The Alarm Room, or communication and not a place for recovery.” 2008 and now lives in Denver. “I kind of center, is an assignment. AFD operates stood aside and let staff do their work.” on a four-year rotation, promoting and Gaining momentum The AFD Alarm Room is a fire assigning firefighters to a multitude of In 1990, two dispatchers working and medical ACE. In February 2017, department roles. Dispatch wasn’t always out of a converted storage room handled the center received its sixth medical a coveted position, explained Patrick 28,000 calls, with each medical and fire re-accreditation and in 2015, it was re- Chavez, who retired in 2012, following a response meriting the full cavalry: rescue accredited in fire for the third time. 25-year career with AFD. vehicle and pumper truck rushing to the Montoya recalls the names of people “For a long time, dispatch was the scene, lights-and-siren blaring. The Alarm involved both in protocol implementation dumping ground for a sick or injured Room was the communication hub for 19 10 THE JOURNAL | iaedjournal.org
ace achievers fire stations employing 500 firefighters/ to get them going and accepted by the said. “We did the ACE for the people. EMTs. Three paramedics in one vehicle other dispatchers.” We kept on working at it, and like Dr. went on each medical call. Some members of the local firefighters’ Clawson would tell us, ‘It was the right Montoya assigned Brown to oversee union expressed doubt about protocol. thing to do.’ This was about saving lives. dispatch changes, and a three-month study The then-newly elected International Helping people.” subsequently conducted in 1991 showed Association President Capt. Eddie Madrid retired in 2004, after a 20-year an ALS response necessary in 35 percent Varela wanted the system changed. The career at the AFD. His many promotions of the calls; firefighters trained as EMTs determination of ALS or BLS response included AFD Division Commander could sufficiently handle the remaining should be up to the crew, not dispatch. in charge of communications and 65 percent. Staeden had an advantage. As former emergency operations. After retiring, At the same time, Montoya had others union president, he persuaded them to he volunteered with the Rio Rancho in his department scope out potential give MPDS a chance. After all, a change Fire Department. protocol systems. The existing calltaking some perceived as political should not Chavez said Madrid understood the and dispatching system was “ad hoc,” and get in the way of improved procedure, distinction, the hallmark of ACE. Montoya wanted a measureable method as potentially better patient outcomes, and “Cosmes knew the importance of part of a long-term goal to improve patient widely accepted standards. protocol,” Chavez said. “He knew the value outcomes and response times. He also had trusted advocates on of being an ACE. We had the backing of a Several systems were vetted with his side. complete system and Academy research to the MPDS coming out on top because “I liked what protocol could do,” said support what we did.” of scripting, structure, and a constantly Madrid, who stayed 12 years in the Alarm The ACE designation also sent a hands- evolving approach to complement Room following his promotion from the off message to media looking for a story EMS best practices and research. Codes field (firefighter/EMT-B). “It made sense. critical of emergency communication. established to dispatch appropriate response were a clincher. “A serious call and you could pop a dispatch right away,” Montoya said. “Less serious calls and the dispatcher could spend more time on the call without affecting patient outcomes.” The Emergency Medical Authority, which had EMS oversight in Albuquerque and the county, approved reducing staffing on the rescue unit from three firefighters to two firefighter paramedics, with backup by a pumper truck, and implementing the new MPDS. Montoya left AFD in November 1993 for the Castlewood Fire Protection AFD Alarm Room District (now South Metro Fire District) in Centennial, Colorado, less than a year The biggest part was giving instructions “The press came after our dispatch after AFD achieved the world’s first ACE. over the phone before response got there. center twice and didn’t find anything,” he Montoya recalls Academy President Jeff Bleeding. Choking. Heart attack. We had said. “ACE and protocols help. We’re not Clawson, M.D., and Academy Curriculum our part, and we could make a difference.” the type of center news salivates over.” Director Scott Hauert presenting the Protocol remained in force. award at a press conference at AFD Station The ACE, Madrid said, was a Out of storage 1, where the two newly certified EMDs statement of quality, not a contest to In 1996, the two EMDs left their were mastering the use of the MPDS see which center would be first to the storage room for the new AFD fire/ v10.1 cardset. finish line. Madrid knew other centers EMS and police consolidated public Staeden, Montoya said, deserves a lot of using protocol had tried, or were trying, safety communications facility and the credit. but that didn’t pressure the AFD Alarm administrative building. The Fire “He was the one to run with the Room into achieving accreditation. Academy on the first floor eventually protocol,” Montoya said. “He fought hard “It’s not about playing a game,” he moved to a dedicated building next door, may / june 2017 | THE JOURNAL 11
••• BEST PRACTICES | ace achievers freeing both floors for the separate police The intuition gained from relying on the importance of our work and the and fire/EMS communication centers. voice and background has also helped. protocol system.” Today, AFD is one of the few dispatch Marrufo won’t ever forget the call from Chavez gives credit to the support from centers in the country staffed by uniform a woman who reported her daughter Dr. Clawson and the team behind AFD firefighters. In 2016, the 26 certified EMDs drowned in the bathtub. The mother Alarm Room’s continued peak performance. and EFDs dispatched 105,000 calls requiring sounded almost relaxed, composed, even “Doc has always been supportive of medical or fire response, a number expected as he gave instructions to get the two- us,” Chavez said. “Reps like Tim Martin to grow at least 10 percent in 2017. Four year-old girl out of the bathtub for CPR. and Chris Murdock [PDC™ client service shift supervisors review 30 calls each “Something wasn’t right,” he said. “The representatives] have taken the relationship month, with any overflow channeled to QA girl survived, but there was something to a new level. They are considered friends Supervisor Alejandro Marrufo, firefighter, off about the situation, the way the and members of our fire department EMT-B, EMD, EFD, EMD-Q®, EFD-Q™. mother behaved.” brotherhood and sisterhood.” Marrufo asked for the dispatch Marrufo relayed his suspicions to The AFD Alarm Room answers all assignment three years ago. He wanted police. Further investigation revealed emergency and non-emergency medical to test a new environment, off field, and the near drowning resulted from the and fire-related requests for service found the change to his liking. mother’s attempt to punish the child by in Albuquerque, and they work in “I get to see the situation from the start,” forcing her into a bath of ice water. conjunction with the Bernalillo County he said. “I have the ability to calm the caller “Those kind of calls stick with you,” he Emergency Communications Center to and situation before response arrives.” said. “They are meaningful. They prove provide service outside of city limits. J Two weeks that will revive you... ...without the hospital bill. Register by July 10, 2017, and save $200 on the FALL Course! Online registration for the 2017 courses is now open. Presented by: Go to emergencydispatch.org/certccmcourse or call Sharon Conroy Fitch & Associates on behalf of IAED ™ at 816-431-2600 for more course curriculum and registration information. 12 THE JOURNAL | iaedjournal.org
center piece Waukesha County Communications MORE THAN ‘JUST’ CO-WORKERS Waukesha County Communications excels in building community Bonnie Douglas I n the world of dispatch centers, there assistant. The WCC team provides Bunch’ by any stretch of the imagination. is nothing that quite compares to a emergency communication services for There were hurdles for sure. We learned place that is truly a “home” to its staff. 19 law enforcement agencies and 21 fire/ that with open minds and appreciative A place where family comes first, and EMS agencies in Waukesha County. attitudes, obstacles and challenges can the health of the organization depends In 2016, we answered 346,000 calls for be overcome.” upon the good and purposeful work service. We continue to grow. Consolidation is a challenge under of the family members. A place where the best of circumstances. Technology, the mission, vision, and values are daily The beginning human resource management, and the fare … along with the state’s famous WCC was formed in 2004 with ability to serve the respective law, fire, and cheese. Such is the culture at one of the consolidation of the Waukesha EMS partners efficiently and effectively Wisconsin’s consolidated emergency County Sheriff Department dispatch does not happen overnight. New and dispatch centers, Waukesha County center, the Lake Area Communication unaccustomed processes require open Communications (WCC). Services dispatch center, the Brookfield and respectful communication to create Waukesha County, in southeastern Police Department, and the majority a center determined to provide the best Wisconsin, USA, consists of 576 square of municipal fire departments in service to agencies and the public. miles and, according to the 2014 census, Waukesha County. a population of 395,118. WCC engages “It wasn’t easy those first few Keeping connected 35 emergency telecommunicators, eight years,” said Sherri Stigler, Training and Organizing police and fire/EMS telecommunicators in training, seven Operations Manager. “I always tell people protocol groups went a long way in supervisors, training and operations that it was like blending three families unifying WCC, and they continue to do manager, director, communication center together, each with their own way of so. Monthly meetings of fire, police, and specialist, and emergency preparedness doing things. It certainly wasn’t the ‘Brady EMS field leaders and WCC staff provide may / june 2017 | THE JOURNAL 13
••• BEST PRACTICES | center piece the conduit to address issues, including EMDs, and EFDs, and are taught basic Staff has been working with Wisconsin personnel and equipment updates, skills in geography, CAD system/record state legislators to raise awareness for public feedback, and problematic calls. The management systems navigation, customer safety communication minimum standards center stays connected and hears what is service, phone system operations, and center of education and training as well as #iam911 working and what is not. specific call types. It’s the dispatch floor to reclassify dispatchers to the status of where probationary telecommunicators protected safety telecommunicators. Recruiting and selection begin calltaking training with a CTO Recruiting qualified individuals as and progress through their training on Celebrating success telecommunicators is a never-ending the Teletype, five police dispatch radio We celebrate what we do, especially calls task. To assist with that initiative, channels, and one fire dispatch channel. involving dispatch-assisted CPR “saves” and WCC appointed a committee of Based on prior experience and skillset, the births. Family, media, and staff are invited to telecommunicators, led by a supervisor, process takes six to nine months. these celebrations—when a dispatcher is able responsible for advertising job to cradle a newborn she helped to deliver or opportunities, recruiting, assembling hug a cardiac arrest survivor. resources used to help in making “The level of trust “It does not get any more real for selections, and participating during the dispatchers,” Stigler said. “These are the and cooperative panel interview. The WCC hiring team reinforcing moments that soundly deliver is always on the lookout for potential spirit we see among the ‘this is why we do what we do’ message.” recruits at community and four-year our agencies and the college job fairs. We are family Applicants must take a typing test center is a testament Each new hire receives a WCC and a telecommunicator exam, and those to the commitment of Challenge Coin and signs the “WCC passing both tests are scheduled for a two- Oath” describing our mission, vision, and hour “sit-in” with a telecommunicator everyone who works value statement with an emphasis on and a one-hour written questionnaire or partners at WCC. core values: Family, Integrity, Respect, covering introductory knowledge We can be very proud Responsibility, Service, and Trust. typical of a first interview. Candidates As a family, we throw parties or proceed to a panel interview, representing of that.” potlucks to celebrate major life events communication center staff, human such as milestone birthdays, pending resources, and fire and law enforcement births, and weddings. WCC Director departments. The final hurdle is a Community Gary Bell also gets into the act; he recently background investigation by the WCC is more than “just” an baked a cake in the center’s kitchen to Waukesha County Sheriff’s Department, emergency dispatch center. celebrate a probationary employee’s and conditional offers are provided During the December holiday season, 30th birthday. pending successful completion of hearing staff donates non-perishable goods, Through trial and error, WCC and drug screenings. personal hygiene items, and money to discovered that focusing on hiring local nonprofit organizations. This past people complementing existing staff and Training holiday, a group of telecommunicators principles, offering comprehensive training, The WCC Training Team consists and supervisors baked and distributed providing community involvement of 12 communication training officers thousands of cookies to law enforcement opportunities, and establishing core values (CTOs), three training supervisors, departments and fire departments in provide the foundation for best serving and the training and operations Waukesha County. the public and the fire and police agencies manager. Each training team member The WCC leadership team created depending on what we do. is APCO CTO certified and, as part a Community Education Team (CET) “We are in such a better place now of the job, updates training materials that promotes positive community that we are established,” said Stigler, and takes adult learning training relations between dispatch and the who was hired in 2004 for a supervisory courses when not actively training a public and provides education about position. “The level of trust and probationary telecommunicator. the 911 system and emergency dispatch. cooperative spirit we see among our Training begins with six weeks in a The CET participates in several events agencies and the center is a testament to classroom. Probationary telecommunicators to forge better relationships with the the commitment of everyone who works certify as International Academies of community and law enforcement and or partners at WCC. We can be very Emergency Dispatch® (IAED™) ETCs, fire agencies. proud of that.” J 14 THE JOURNAL | iaedjournal.org
faq FALL OR PUSH? Protocol 30 handles both Brett Patterson Brett: traffic than for individual patient injuries. Hello Brett, We have had several recent cases where Specifically, ejection mechanism is related Please help us solve a long-standing people were thrown from a moving car. to the force of going through a windshield, issue within our call center. Is a parachutist They were not in an accident or anything— and auto versus pedestrian is related to the injury a traumatic injury or a fall? The just people thrown out of the car! My discrepancy in mass of one versus the other. jumper jumps out of the aircraft, doesn’t calltakers didn’t know how to properly Therefore, Protocol 30: Traumatic fall out, has a fully inflated parachute, code these incidents. All of the calltakers Injuries (Specific) is most appropriate for lands on ground but breaks an ankle, leg, used different protocols and Determinant a person falling or being pushed out of a etc. What is it? I say it’s a traumatic injury; Codes, such as Protocol 30: Traumatic vehicle, provided there are no significant my co-workers say it’s an EXTREME Injuries, or various codes on Protocol 29, i.e., traffic accident concerns, and the person fall, but like I said, he comes down at the Pedestrian struck or MVA with Ejection. wasn’t subsequently run over. Notably, regular rate of descent as other jumpers Could you provide me with clarification as there is a new Determinant Descriptor in but just doesn’t land right. to how we should properly code this? MPDS® v13.0 that addresses cases such as Thanks, Regards, this when the patient does not appear to be Juan Rodriguez Nicholas J Camisa MICP, NREMTP critically injured but the EMD is concerned Communications Officer EMS Supervisor, University Hospital- about the mechanism of injury: 30-D-5 Joint Communications Unit REMCS, Newark, New Jersey, USA “HIGH VELOCITY impact/MASS injury.” Fort Bragg, North Carolina, USA Thanks, Hi Nicholas: Brett A. Patterson Hi Juan: Protocol 29: Traffic/Transportation Academics & Standards Associate I love long-standing disputes! You are Incidents was designed more for Chair, Medical Council of Standards correct. This mechanism simply doesn’t mechanism of injury and scene safety issues International Academies of Emergency equate to the same forces involved with associated with motor vehicle crashes and Dispatch® an EXTREME fall, and the specific may / june 2017 | THE JOURNAL 15
••• BEST PRACTICES | faq injury is the reason for the call. I’ve attached an article from Dr. Clawson that addresses issues such as this. I would also point out that Protocol 30, v13.0, has a new Determinant Descriptor (HIGH VELOCITY Impact/MASS Injury) for cases when the EMD is concerned about a high mechanism, but the body area injured doesn’t code high enough to satisfy the EMD. A similar code is also available on Protocol 29. Hope that helps to settle the debate! Brett Juan: Protocol 30 would be the appropriate choice. There are a zillion things that cause injuries to people (all you need to do is think of an amusement park and the potential of accidents there). We don’t have a special protocol pathway for accidents involving falls from bicycles. The same goes for skiers. The spectrum of “Tour de France riders” through “kids on tricycles” cannot be jammed simply into a mechanism of injury format. Regarding velocity, we don’t assess on Protocol 30 how fast the boom on the forklift was going when it hit the worker in the back or the speed the skier was going in a downhill race, either. The Protocol does, however, provide information about the severity of the injury in terms of the body area symptoms. Some use MPDS Protocol may present in different ways, and affected in much more detail compared 25: Psychiatric/Abnormal Behavior/ the EMD needs to know “… exactly to Protocol 29. Suicide Attempt, while others use MPDS what happened” in order to select an As you’ve probably determined, even Protocol 26: Sick Person. appropriate protocol. if you go to Protocol 29, you basically end Which would be most appropriate? So, the answer to your question is up in the same Determinant Level based Thank you, to find out not what the caller thinks on what is known and what is not known Michelle Rossi is the underlying problem but rather about the patient’s priority symptoms CMED Telecommunicator, North what sign/symptoms/actions are and injuries. Central Connecticut EMS Council prompting the call. By far the best Hope that helps. Hartford, Connecticut, USA way to do this is to repeat Case Entry Onward through the “what-if” fog ... Question 3. Common to the anxiety Doc Hi Michelle: attack diagnosis are symptoms such When you think about it, a as rapid breathing (Protocol 6), racing Brett: complaint of “anxiety attack” is heart or palpitations (Protocol 19), chest My co-workers and I were having a actually a caller diagnosis rather than pain (Protocol 10), or simple anxiety/ discussion about which protocol to use a description of what has happened. nervousness (Protocol 26). for an anxiety attack. I wonder if you can It’s like saying the patient is drunk I hope this response helps to answer provide some clarification. or is having a heart attack. All of your question. It’s for a patient with no priority these conditions or caller diagnoses Brett J 16 THE JOURNAL | iaedjournal.org
113 1,320 sessions attendees 1,056 candy bars 12 handed out research posters 15 countries represented 42 exhibitors 16 169 tracks speakers
excellence | NAVIGATOR 2017
excellence EXCELLENCE You’ll find it at NAVIGATOR Audrey Fraizer E xcellence has a way of moving you to the next step Awards and beyond. NAVIGATOR attracts the dedicated—emergency Excellence has a way of opening your eyes, letting you dispatchers, supervisors and center directors, and public safety see the best path to follow. experts—to a single source that celebrates the profession. The Excellence builds a foundation that benefits you and awards start on opening day and continue through the Closing everyone connecting to your world. Luncheon two days later. When each recipient accepts an And excellence was the theme this year at NAVIGATOR, award, it’s also a sure bet that the person will acknowledge held April 12–14, in the Big Easy. co-workers. “It’s what you do that makes the difference,” said Academy “I couldn’t have done it without my partners,” said President Jerry Overton during his Opening Session remarks Dispatcher of the Year Erin Berry, EMD, Loveland Police building up to this year’s Dispatcher of the Year Award. emergency communications, Loveland, Colorado, USA. Contrary to the nickname bequeathed upon New Orleans, Berry was honored for professional excellence exemplified Louisiana, USA, in the 1970s, however, excellence in emergency by her lifesaving efforts during a call that led to the revival of a communications is neither a slow nor easygoing way of life. Loveland High School student (read the DOY story on pg. 24 to “What you’re doing is everything but that,” Overton learn more). said. “You are committed 24/7 to making a difference. Your And NAVIGATOR awards were just getting started. excellence makes a difference in each and every call.” Jeff Cicillian, former Lake County Sheriff’s Department The distinction of being “extremely good” doesn’t work police officer and 911 center manager, Lake County, Illinois, independent of objectives. It also depends on where you choose USA, received the Instructor of the Year Award. Cicillian to concentrate professional efforts, and, as Overton pointed out, specializes in Emergency Police Dispatch and the Active at NAVIGATOR opportunity abounds, with choices packed Assailant Protocol. into every hour and bordered by some of the best networking in Sherri Stigler, Training and Operations Manager, Waukesha the industry. County Communications, Waukesha, Wisconsin, USA, won “NAVIGATOR is an eye-opener,” said Richard Lindfors, first place in the Research Poster Contest. Quality Improvement Manager, Richmond Ambulance Janice Warshauer, RN, Northwell Health Center for Authority, Richmond, Virginia, USA. “I get to see what other Emergency Medical Services, Syosset, New York, USA, received agencies from the rest of the world are doing. At the end of the the Bill Boehly Award for Clinical Support Desk (CSD) Clinician. day, we’re in the same business, with the same issues, and we’re Charles R. Goodwin, Lead Dispatcher, Natick Police here able to discuss them in a focused, nonworking atmosphere.” Department’s Public Safety Communications Center, Natick, may / june 2017 | THE JOURNAL 19
excellence | NAVIGATOR 2017 LET THE GOOD TIMES ROLL This is my fourth NAVIGATOR, and it’s always so awesome, especially the First-time USA NAVIGATOR attendee Stephanie Dandonneau, people you get to meet. You realize Operations Chief, Groupe Alerte Santé Inc., Québec, Canada, said you’re not alone. NAVIGATOR is a she was impressed with all of the sessions she attended, and great time to focus on the issues and was especially interested in Kim Rigden’s stress management share ideas. presentation. Dandonneau said their personnel take turns attending Cindy Sparrow, 911 Communications, Red Deer Emergency Services, Alberta, conferences, and NAVIGATOR in New Orleans, Louisiana, USA, was Canada especially exciting for her. “This place is just beautiful,” she said. “I am meeting lots of people I was impressed with the ETC and learning, too.” Instructor manual someone from a Mindy Thomas, Manager, Queensland Ambulance Service, neighboring 911 jurisdiction showed Rockhampton, Australia, traveled all the way from the Land Down me, so I signed up for the instructor Under in order to breathe in the sights and sounds of NAVIGATOR, course at NAVIGATOR. We have a her first American conference. She said networking was a highlight, lot of new hires and want to give particularly when it came to discovering the universality of emergency them an overview of the profession dispatch issues, such as investing so much in training only to see the beyond policies and procedures. new person leave within a few years. The ETC course will provide a “We all have a difference in structure, yes, but I am finding out that great foundation. the challenges are the same,” she said. Laurel Strandberg, Lakewood Police The exquisiteness and excitement of New Orleans cuisine was fully Department, Lakewood, Colorado, USA enjoyed. Though some of us (myself included) did not venture past the safety of our accustomed palates, others were quite adventurous It’s amazing to be in a room with so as they feasted upon the likes of charbroiled oysters, spicy jambalaya, many agencies and open your mind and even alligator wings. I think it was just as much fun to watch their to what the rest of the emergency reactions during those first few bites! communications world is doing. Sherri Stigler, Training and Operations Manager Richard Lindfors, Richmond Ambulance Waukesha County Communications, Waukesha, Wisconsin, USA Authority, Richmond, Virginia, USA I was pleased to see several breakout sessions that focused Dispatch is my career. I started on stress management, health, and wellness. Christine Bannister, as a volunteer firefighter, got into Supervisor, Waukesha County Communications, Wisconsin, USA, gave a dispatch, and have watched it evolve comprehensive overview of stress and healthy ways to manage it in her for the past 19 years. I liked the presentation, “Wellness For the First, First Responder.” Tami Wiggins, protocol from the start. It gives you Training and QA Manager, Harford County Department of Emergency something great to go by. Services, Maryland, USA, and Madeline Marks, Clinical Psychology Shawn Trainor, Montgomery County Hospital District, Houston, Texas, USA Program, University of Central Florida, USA, partnered for the session, “When Trauma Hits the Dispatch Center.” New sessions included a how-to in creating a 911 public education This is my second NAVIGATOR, and program, presented by Ben Bills, PIO, El Paso-Teller County 9-1-1 I definitely come for the training. I Authority, Colorado, USA, and Sasha Vargas-Fimiani, Public Educator, started out wanting to be a police Charleston County Consolidated 9-1-1 Center, South Carolina, USA. officer, changed into dispatch, and Both are pioneers in the industry using creative ways to engage their loved it. There’s so much about it that communities in the 911 system. I enjoy: the adrenaline rush, helping Ricardo Martinez, Founder, “Within the Trenches Podcast,” and people, and never having the same Creator of #IAM911, recorded several new episodes with guests for day twice. his podcast, recorded live from the Exhibit Hall. I had the honor of Angela Barnes, Dispatch OIC recording Episode #141. Gulfport Police, Gulfport, Mississippi, USA Ryan Dedmon, Founder, Operation 10-8 Anaheim, California, USA 20 THE JOURNAL | iaedjournal.org
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