Public Safety Answering Points Research Articles

Continuity planning for public health crises: Designing workplace redundancies for organizational resilience.

Continuity planning prepares organizations to maintain essential functions despite disruptions to critical infrastructure that occur during crises. Continuity planning is especially important for Public-Safety Answering Points (PSAPs), which must prepare to answer 911 calls and dispatch first responders in all-hazard environments, including public health crises such as the COVID-19 pandemic. However, continuity planning typically focuses on disruptions to cyber-physical infrastructure rather than social infrastructure disruptions that occur when outbreaks of communicable disease limit the ability of essential personnel to perform an organization's essential functions. Reporting findings from interviews with US officials, this study examines how PSAPs decentralized essential personnel by designing redundant workplaces during the COVID-19 pandemic. Realizing existing continuity plans prepared PSAPs to relocate and recentralize essential personnel in a single, shared workplace, officials developed new plans to protect and decentralize telecommunicators across multiple, separate workplaces. To do so, PSAPs achieved passive, standby, and active workplace redundancies that recommend continuity planning objectives and requirements for organizations preparing for future public health crises.

Latent Occupational Burnout Profiles of Working Women.

According to scientific research, emergency call-takers and dispatchers (ECD) are particularly vulnerable to burnout syndrome. It can be observed that this occupation is predominantly performed by women. Moreover, the studies on occupational burnout indicate its different causes depending on employees’ gender. The aim of this research was to apply a Person-Oriented approach in order to examine the relationships between particular risk factors, the level of burnout, and its health consequences in a group of women. A cross-sectional survey study was conducted on 296 women (call-takers and dispatchers) from public-safety answering points in Poland. The Link Burnout Questionnaire and a sociodemographic questionnaire were used to gather information. The method of latent profile analysis (LPA) was employed in the study. The study revealed burnout patterns without full symptoms as well as four different burnout profiles. The findings partially confirmed initial assumptions about correlations between the length of service as ECD, marital status, motherhood, burnout symptoms, and body mass index (BMI). Sociodemographic variables differentiated the examined women in terms of their emotional exhaustion and BMI. Three groups of women at risk of burnout and overweight were identified: those with the shortest job experience, those with the longest job experience, and an intermediate group. In each of these groups, symptoms indicating a possible risk of burnout-related health issues could be observed. The application of a Person-Oriented approach allowed for assessing possible correlations between burnout risk factors, its symptoms, and health consequences.

5 Use of Emergency Medical Dispatch Protocols Improves Survival in Out-of-Hospital Cardiac Arrest

There are about 420, 000 emergency medical services (EMS)-assessed out-of-hospital cardiac arrests (OHCA) annually with a 10% survival rate. Public safety answering points (PSAP) are often the first point of contact and have an opportunity to guide callers in lay resuscitation techniques. Not all PSAPs use emergency medical dispatch (EMD) protocols in response to OHCA calls. Our study tests the hypothesis that return of spontaneous circulation (ROSC) is higher when EMD protocols are used for OCHA calls versus when no EMD protocols are used.

Burnout and Perceived Stress of Polish Emergency Call Takers and Dispatchers.

A scientific research has demonstrated that emergency call operators face unique risks to job stress and burnout. It was hypothesized that perceived stress (demonstrated as resourcefulness–helplessness dimension) may mediate relationships between work environments and burnout taking into account the buffering effect of self-efficacy. The participants of the study were 546 emergency dispatchers and call-takers from 14 Polish public-safety answering points. The Link Burnout Questionnaire, the Perceived Stress Scale and the Generalized Self-Efficacy Scale were employed. The method of path analysis was used and direct and indirect interactions between the variables were identified. Shorter work experience (fewer years on this specific job position) was associated with a higher level of burnout. The greater number of shifts per month was associated with a higher level of perceived stress (higher level of helplessness). Self-efficacy was combined with perceived stress by antagonistic relationships, but the assumed buffering effect on burnout was not confirmed. It was observed that engaging the resource of one’s own self-efficacy in professional work may lead to the loss of other personal resources, manifesting itself in the form of greater disappointment with the work performed.

A centralized system for providing dispatcher assisted CPR instructions to 9-1-1 callers at multiple municipal public safety answering points

BackgroundDispatcher CPR instruction increases the odds of survival. However, many communities do not provide this lifesaving intervention, often citing the barriers of limited personnel, funding, and liability. ObjectiveDescribe the implementation of a novel centralized dispatcher CPR instruction program that serves seven public safety answering points (PSAPs). MethodsSeven municipal PSAPs that did not previously provide dispatcher instructions implemented our program. Using a 30-min self-directed video, 84 PSAP dispatchers were trained to utilize a two-question protocol to identify and transfer suspected out-of-hospital cardiac arrest (OHCA) cases to a central communication center. At this central communication center, a trained communicator delivered CPR instructions to the caller. The 26 central communicators were trained with a 2-h in-person didactic session followed by a 2-h practice session. We collected and analyzed data from recordings of communicator-to-caller interactions. Results169 calls were transferred to the central communication center. Of those, 106 needed CPR instructions and 56 of those callers performed chest compressions (53%). The county-wide EMS documented bystander CPR rate was 20% the prior year. The 63 remaining transferred calls were non-OHCA calls. Of the calls where CPR was needed and performed, 11 victims survived to hospital discharge (20%); the countywide survival rate was 12%. ConclusionsUsing a central communication center for instructions allowed us to train and maintain a smaller group of communicators, leading to less cost and more experience for those communicators, while limiting the burden on PSAP dispatchers.

Data Management, Technology, and Public Policy: The Implementation of Next Generation 911 and Its Connection to Nationwide Public Safety Broadband Network at Public Safety Answering Points

Abstract Enhanced 911 call systems face the transition to Next Generation 911 (NG911) driven by the ubiquity of smart phones and other digital technologies. NG911 services include data management and databases to gather, process and store NG911 call and location data. Federal NG911 policies to implement and fund NG911 and consolidate PSAPs are insufficient to timely further NG911 services and fully integrate NG911 with the Nationwide Public Safety Broadband Network (NPSBN). Public Safety Answering Points (PSAPs) need NG911 emergency service IP networks (ESInets) to receive 911 emergency calls and NPSBN to deliver these calls and data to first responders.

Data Management, Technology, and Public Policy: The Implementation of Next Generation 911 and Its Connection to Nationwide Public Safety Broadband Network at Public Safety Answering Points

Abstract Enhanced 911 call systems face the transition to Next Generation 911 (NG911) driven by the ubiquity of smart phones and other digital technologies. NG911 services include data management and databases to gather, process and store NG911 call and location data. Federal NG911 policies to implement and fund NG911 and consolidate PSAPs are insufficient to timely further NG911 services and fully integrate NG911 with the Nationwide Public Safety Broadband Network (NPSBN). Public Safety Answering Points (PSAPs) need NG911 emergency service IP networks (ESInets) to receive 911 emergency calls and NPSBN to deliver these calls and data to first responders.

Telephone CPR Instructions in Emergency Dispatch Systems: Qualitative Survey of 911 Call Centers.

IntroductionOut-of-hospital cardiac arrest (OHCA) is a leading cause of death. The 2010 American Heart Association Emergency Cardiovascular Care (ECC) Guidelines recognize emergency dispatch as an integral component of emergency medical service response to OHCA and call for all dispatchers to be trained to provide telephone cardiopulmonary resuscitation (T-CPR) pre-arrival instructions. To begin to measure and improve this critical intervention, this study describes a nationwide survey of public safety answering points (PSAPs) focusing on the current practices and resources available to provide T-CPR to callers with the overall goal of improving survival from OHCA.MethodsWe conducted this survey in 2010, identifying 5,686 PSAPs; 3,555 had valid e-mail addresses and were contacted. Each received a preliminary e-mail announcing the survey, an e-mail with a link to the survey, and up to three follow-up e-mails for non-responders. The survey contained 23 primary questions with sub-questions depending on the response selected.ResultsOf the 5,686 identified PSAPs in the United States, 3,555 (63%) received the survey, with 1,924/3,555 (54%) responding. Nearly all were public agencies (n=1,888, 98%). Eight hundred seventy-eight (46%) responding agencies reported that they provide no instructions for medical emergencies, and 273 (14%) reported that they are unable to transfer callers to another facility to provide T-CPR. Of the 1,924 respondents, 975 (51%) reported that they provide pre-arrival instructions for OHCA: 67 (3%) provide compression-only CPR instructions, 699 (36%) reported traditional CPR instructions (chest compressions with rescue breathing), 166 (9%) reported some other instructions incorporating ventilations and compressions, and 92 (5%) did not specify the type of instructions provided. A validation follow up showed no substantial difference in the provision of instructions for OHCA by non-responders to the survey.ConclusionThis is the first large-scale, nationwide assessment of the practices of PSAPs in the United States regarding T-CPR for OHCA. These data showing that nearly half of the nation’s PSAPs do not provide T-CPR for OHCA, and very few PSAPs provide compression-only instructions, suggest that there is significant potential to improve the implementation of this critical link in the chain of survival for OHCA.

Summary of the Legal and Policy Landscape Surrounding Accessibility and 911

This white paper summarizes the current landscape of federal, state, and local regulations as they relate to provisioning 911 emergency service for deaf, hard of hearing, and speech disabled communities in Colorado. This document also looks ahead to those regulations that are currently under consideration at the federal, state, and local levels that may affect 911 accessibility.Our research was conducted at the request of the Colorado Public Utility Commission’s 911 Task Force. Next-generation 911 (NG911) applications such as text-to-911 (TT911), are especially important to people who are deaf, hard of hearing, and speech disabled, who may not be able to directly access emergency services through traditional means. In addition, NG911 access will benefit all members of a community by offering additional means of access during emergencies when calling may not be feasible or safe. Much of the focus of this paper reflects the current state of technology used, with TT911 at the forefront of NG911 technologies being implemented. It is important to note that TT911 and other NG911 applications currently being considered at the federal, state, and local levels may not directly serve the Deaf/Blind community or even all members of the deaf and hard of hearing communities. Further research is necessary to determine how TT911 may resolve the emergency access problems facing these communities, and how or whether other NG911 technologies such as video or multi-mode communications may better address the accessibility of emergency services.In Colorado, the decision to upgrade to NG911 rests largely with individual public-safety answering points (PSAPs). The Federal Communications Commission (FCC) has authority over wireless carriers, but almost none over PSAPs. The Department of Justice (DOJ) has issued PSAP requirements for ensuring 911 accessibility for all users, but has not taken action on that issue in more than four years. Several Colorado counties have implemented TT911 already, but many more have not due to budget or logistical reasons.The paper concludes by exploring several case studies of TT911 implementation in other states, including states with total TT911 across the state.

Emergency medical services public health implications and interim guidance for the Ebola virus in the United States.

The 25th known outbreak of the Ebola Virus Disease (EVD) is now a global public health emergency and the World Health Organization (WHO) has declared the epidemic to be a Public Health Emergency of International Concern (PHEIC). Since the first cases of the West African epidemic were reported in March 2014, there has been an increase in infection rates of over 13,000% over a 6-month period. The Ebola virus has now arrived in the United States and public health professionals, doctors, hospitals, Emergency Medial Services Administrators, Medical Directors, and policy makers have been working with haste to develop strategies to prevent the disease from reaching epidemic proportions. Prehospital care providers (emergency medical technicians and paramedics) and medical first responders (including but not limited to firefighters and law enforcement) are the healthcare systems front lines when it comes to first medical contact with patients outside of the hospital setting. Risk of contracting Ebola can be particularly high in this population of first responders if the appropriate precautions are not implemented. This article provides a brief clinical overview of the Ebola Virus Disease and provides a comprehensive summary of the Center for Disease Control and Prevention’s Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPS) for Management of Patients with Known of Suspected Ebola Virus Disease in the United States.

Trust in Public Safety Answering Points: A Swedish National Survey in the Late Modern Network Society

This study presents descriptive data from the 2009 Riks-SOM, a national Swedish public opinion survey (n=1501) on trust in the Swedish public safety answering point (PSAP), 112/SOS Alarm. Of special importance in the study is the trust in light of citizens' perception of mobile phones as a lifeline in everyday life. The main conclusion is that vulnerable groups like citizens with foreign citizenship, citizens in the largest towns of Sweden (Stockholm, Gothenburg and Malmo), the elderly and people in poorer health have relatively the lowest levels of trust in 112/SOS Alarm. Another conclusion is that a rather large number of individuals, who believe that a mobile phone increases the security in everyday life to a very high degree, also seem to have very high levels of trust in 112/SOS Alarm. The study appears to be the first main public opinion survey on the issue of trust in PSAP in correlation to the view of the mobile phone as a lifeline.

Access to Emergency Number Services

Access to emergency services is mandated by Title II of the Americans with Disabilities Act (ADA). The Department of Justice oversees the accessibility of public safety answering points (PSAPs), popularly called 9-1-1 centers. The Federal Communications Commission (FCC) has at least two roles in emergency number access: (1) as regulator of the ADA's Title IV on telecommunications access, and (2) as regulator of communications companies with regard to support of and interconnection with PSAPs. The rules of both agencies contributed significantly to the improvement during the 1990s of access to 9-1-1 for people who are deaf, hard of hearing, or speech disabled. However, as new technologies for text wireless communications and relay services have moved quickly to Internet protocol (IP)-based technologies over the past 5–8 years, the use of traditional wireline telephones and text telephones among deaf, hard of hearing, and speech-disabled people has declined. PSAPs cannot be contacted via the newer forms of telecommunications, such as e-mail, instant messaging, and IP-based forms of relay services, including video relay services. The gap between the technology supported by policy and the technologies currently being used by deaf and hard of hearing people has become a serious problem that is difficult to solve because of the separate jurisdictions of the two agencies, the need for coordination within the FCC, technological challenges, and funding issues. In this article, the key policy and technology challenges will be analyzed and recommendations made for short-and long-term solutions to this dilemma.

Ambulance, fire, and police dispatch times compared with the atomic clock

Objectives. To quantify any differences between the times used by public safety answering points (PSAPs) in a multijurisdictional county compared with the atomic clock and to determine whether there was consistency in any time differences. Methods. All 25 ambulance, fire, and police PSAPs were contacted by telephone. The current time in hours, minutes, and seconds on the dispatch center's timepiece was -requested. The atomic clock time was simultaneously recorded. Time differences between the reported and atomic clock times were calculated and the absolute values were used to calculate the mean difference. The procedure was repeated one week later. Consistency in time deviation was evaluated by subtracting the time differences between weeks 1 and 2 for each center. Results. All 25 centers were contacted and three declined to participate. Time differences ranged from −551 to 117 seconds (mean difference: 61.2 ± 120.3) for week 1 and −103 to 79 seconds (mean difference: 36.9 ± 33.4) for week 2. Time deviations between weeks 1 and 2 were: 0 seconds for one center, 1 to 30 seconds for 12 centers, 31 to 60 seconds for four centers, and more than 60 seconds for five centers. Conclusions. The maximum time difference between dispatch center and atomic clock times was 551 seconds. This difference may be clinically significant for time-dependent research, quality improvement tasks, or medical legal reviews when multiple PSAPs are involved. Lack of consistency in time deviation over one week suggests systematic adjustment for these differences may not be possible. PREHOSPITAL EMERGENCY CARE 2000;4:28-30

T HE L AY P UBLIC ' S E XPECTATIONS OF P REARRIVAL I NSTRUCTIONS W HEN D IALING 9-1-1

Objective. To determine whether the lay public expects public safety answering points (PSAPs) to provide prearrival instructions. Methods. Two thousand telephone numbers were randomly generated from all listed residential numbers in a county containing urban, suburban, and rural communities served by 26 enhanced 9-1-1 PSAPs. Only a minority of the PSAPs provided prearrival instructions. Research assistants made two attempts to contact an individual at each telephone number. A survey was administered to any person who answered the telephone provided the person was at least 18 years of age and gave verbal consent. The respondents were asked their age, level of education, and gender. They were also asked what number they would call for first aid or an ambulance and whether they would expect telephone instructions from the dispatcher if a close relative was choking, not breathing, bleeding, or giving birth. Results. One thousand twenty-four individuals were successfully contacted; and 524 (51%) were at least 18 years of age and agreed to participate. The respondents' mean age was 50 (standard deviation 19 years). Sixty-five percent of the respondents were female; and 90% had at least a high school diploma. Only 37% had previously called 9-1-1 (nine-one-one) for an emergency. Ninety-seven percent said they would dial either 9-1-1 (85%) or 9–11 (nine-eleven) (12%) in an emergency. Seventy-six percent (95% CI: 73%–80%) expected prearrival instructions for all four medical conditions. Specifically, prearrival instructions were expected by: 88% for choking (95% CI: 85%–90%), 87% for not breathing (95% CI: 84%–90%), 89% for bleeding (95% CI: 86%–91%), and 88% for childbirth (95% CI: 86%–91%). Ninety-nine of 117 respondents (81%) served by a PSAP that did not provide prearrival instructions expected to receive phone instructions for all four emergencies. Logistic regression revealed that knowing to dial 9-1-1 or 9–11 in an emergency was the only significant predictor of prearrival instruction expectation [p < 0.03, odds ratio 3.4 (95% CI: 1.16–9.78)]. Age, gender, service by a PSAP providing prearrival instructions, and level of education were not predictive. Conclusion. The lay public expects prearrival instructions when calling 9-1-1, although they may not currently receive this service.

A MBULANCE , F IRE, AND P OLICE D ISPATCH T IMES C OMPARED WITH THE A TOMIC C LOCK

Objectives. To quantify any differences between the times used by public safety answering points (PSAPs) in a multijurisdictional county compared with the atomic clock and to determine whether there was consistency in any time differences. Methods. All 25 ambulance, fire, and police PSAPs were contacted by telephone. The current time in hours, minutes, and seconds on the dispatch center's timepiece was -requested. The atomic clock time was simultaneously recorded. Time differences between the reported and atomic clock times were calculated and the absolute values were used to calculate the mean difference. The procedure was repeated one week later. Consistency in time deviation was evaluated by subtracting the time differences between weeks 1 and 2 for each center. Results. All 25 centers were contacted and three declined to participate. Time differences ranged from −551 to 117 seconds (mean difference: 61.2 ± 120.3) for week 1 and −103 to 79 seconds (mean difference: 36.9 ± 33.4) for week 2. Time deviations between weeks 1 and 2 were: 0 seconds for one center, 1 to 30 seconds for 12 centers, 31 to 60 seconds for four centers, and more than 60 seconds for five centers. Conclusions. The maximum time difference between dispatch center and atomic clock times was 551 seconds. This difference may be clinically significant for time-dependent research, quality improvement tasks, or medical legal reviews when multiple PSAPs are involved. Lack of consistency in time deviation over one week suggests systematic adjustment for these differences may not be possible.

Measuring Response Intervals in a System With a 911 Primary and an Emergency Medical Services Secondary Public Safety Answering Point

Study objective: Measurement of interval data is important in the accurate recording of events that occur in an emergency medical services system. Measurement of intervals should be a simple task. However, when two separate clocks are needed to record the beginning and end of an interval, accurate measurement may be difficult. We sought to accurately measure the 911 call receipt–to–vehicle departure and 911 call receipt–to–patient access intervals in a system with primary and secondary public safety answering points (PSAPs). Methods: We conducted a descriptive study between January 1 and July 31, 1993. All 911 calls beginning at the primary PSAP, transferred to the EMS secondary PSAP, and ending with patient access times were eligible. Clock-synchronization errors and unavailability of 911 time logs were the criteria for exclusion. We measured the 911 call receipt–to–vehicle departure interval by adding the primary-PSAP and the EMS secondary-PSAP call-processing intervals. The 911 call receipt–to–patient access interval was the absolute difference between the time when the 911 primary-PSAP phone rang and the time of patient access recorded by EMS personnel. Results: The data were best described with median and interquartile ranges (IQRs). We found 1,945 calls that met inclusion criteria. Of these, 270 were deleted because of clock errors and 616 for time log unavailability, yielding 1,059 calls for interval determinations. The median 911 call receipt–to–vehicle departure interval was 1.7 minutes (IQR, 1.2 to 2.2 minutes). The median 911 call receipt–to–patient access interval was 8.2 minutes (IQR, 6.4 to 10.5 minutes). Conclusion: The 911 call receipt–to–vehicle departure and 911 call receipt–to–patient access intervals can be accurately measured in a system with two separate PSAP computer-aided dispatch clocks. These intervals are variable and often lengthy. [Campbell JP, Gridley TS, Muelleman RL: Measuring response intervals in a system with a 911 primary and an emergency medical services secondary public safety answering point. Ann Emerg Med April 1997; 29:492-496.]