Training Program for Emergency Dispatchers Helps Make 911 a Lifeline : Response: Workers who are trained to give medical instructions are helping make the most of the crucial minutes between a call for help and its arrival.

Then there was the guy who swallowed a mouse. Alive. On a $20 bet. Only the mouse wasn’t giving up so easily.

“He called from a pay phone and said the mouse was running around in his stomach. I’m serious--he wondered when it was going to die,” said Rebecca Spradley of Hartson Medical Services, a 911 emergency medical dispatcher at the city of San Diego paramedic dispatch center.

Spradley checked her medical protocol cards--a system enabling dispatchers to give basic first-aid instructions over the phone while sending paramedics--but came up empty.

“There’s no card for swallowing a mouse,” Spradley said, chuckling. “The guy refused to be transported to the hospital. Eventually he hung up. . . . I don’t know what happened to him--or the mouse.”

Under its protocol-card and priority-response system, San Diego’s 911 medical dispatchers are trained to determine the seriousness of calls, send the appropriate level of aid and help panicked callers give medical assistance to the injured or ill before the ambulance arrives.

That training came into the spotlight last week when a 13-year-old girl was coached over the phone by a 911 dispatcher to give cardiopulmonary resuscitation to an unconscious elderly woman in Tierrasanta. The woman regained a pulse but later died.

Dispatchers’ instructions recently helped a man deliver his wife’s baby, which was in danger of strangling on its umbilical cord, before paramedics arrive. In another success story, an elderly woman followed a dispatcher’s instructions on performing the Heimlich maneuver on her husband, who was choking on a piece of food.

But San Diego is the relatively rare case of a city that trains its dispatchers to provide advice as well as send medical aid.

An estimated 75% of emergency dispatchers nationwide have no such formal training, nearly 20 years after the 911 emergency response system was developed in major U.S. cities and more than a decade after priority dispatching originated in Phoenix, Ariz.

In many cities, dispatchers take an address and hang up after sending paramedics.

“And the caller is left there unable to do anything in those critical few minutes,” said Scott Hauert, a spokesman for Medical Priority Consultants, one of the few agencies that trains dispatchers to give emergency medical assistance according to a specialized protocol. The company sponsored a dispatch seminar and conference in San Diego last week.

Common reasons why some communities shun the more specialized training that San Diego dispatchers get include liability concerns and the cost of starting a program and paying for continuing training to handle the rapidly rising number of 911 calls, authorities said.

“Often it’s resistance to change and just plain ignorance,” Hauert said. “They are fearful of the liability, but that’s a paradox” because doing nothing usually allows the injury or illness to worsen, Hauert said.

If dispatchers follow medical-card guidelines developed according to local and national standards, there is no liability risk, said Greg Scott, dispatch communications supervisor for Hartson at the city dispatch center, which started a formal protocol dispatching system in 1986. All of its medical emergency dispatchers are certified in cardiopulmonary resuscitation.

By contrast, Cincinnati, which has had 911 capabilities for several years, is one of dozens of major cities across the country with no formal emergency medical dispatching system.

Cincinnati decided to install Medical Priority Consultants’ program after residents there began questioning the city’s existing 911 system. Public scrutiny started last year when dispatchers in a nearby community gave instructions over the phone in the successful deliveries of several babies. Although the dispatchers were praised for their efforts, media coverage revealed that they had no formal training, which prompted public concern in Cincinnati that it should have a comprehensive program to handle medical emergencies.

“We’re working feverishly to get this training (by January),” said Margaret Ross, dispatch supervisor for the Cincinnati Fire Department. “We’ve given medical instructions before but never under a formal system. We realized we were late in doing it.”

Although medical priority dispatch systems are relatively new, authorities say statistics show that they decrease response times and often make a critical difference before paramedics or emergency medical technicians arrive.

Hauert said only one in 2,000 callers is unable to get help through his company’s system.

“Thousands of lives have been saved or the severity of a problem lessened,” he said. “And, in the 40 million cases we’ve been involved in, there’s no record of worsening an injury or illness.” San Diego authorities said local dispatchers provide callers with medical instructions several times a day, including a few cases each week in which a life is saved.

The Los Angeles City Fire Department, under criticism that its emergency medical dispatching system was inadequate, revamped the system in 1989 according to Medical Priority Consultants’ guidelines.

The Los Angeles County Fire Department, where civilians have replaced firefighters as dispatchers, uses a protocol card system but has decided to streamline its dispatching operations and adopt a more comprehensive dispatching program, said Capt. Eugene McCarthy.

Under protocol dispatching, a dispatcher gets the location, call-back phone number, the victim’s major complaint, age and whether he or she is conscious and breathing.

“What questions you ask is as important as what you don’t ask so as not to waste time,” Hauert said. “Time is critical here.”

The caller is told to take safety precautions--setting out flares, for example, in a roadside accident--and then begin administering the appropriate first aid, which is relayed according to concise questions and instructions on the protocol cards.

“We give instructions on every (medical-related) call, whether it’s minor or bad,” said Joe Patino, lead dispatcher for Hartson at the medical dispatch center. “There’s always something we can do for every situation.”

The whole time, the dispatcher is using practiced techniques to calm the caller, who often is hysterical, Patino said.

“It’s a highly emotional and intense crisis,” he added. “The dispatchers learn to control and calm these people” by repeating simple commands until the caller responds.

Hauert gave this example: “If a baby is not breathing, and the mother is hysterical, the dispatcher will say (repeatedly), ‘Calm down, ma’am, so you can help your baby. Listen carefully and do exactly what I say.’ (The dispatcher) will do this at most three times before--boom--it’s like a switch is turned on in the mother’s head and she realizes what she needs to do.”

San Diego’s 911 dispatchers receive scores of calls each day, about half of which are medical-related emergencies, dealing with everything from the aftereffects of rodent-swallowing to the more commonplace child births and blocked throats.

On Oct. 22, Spradley got a call from a 13-year-old girl who found an elderly woman unconscious in her Tierrasanta home.

The girl, Jessica Dale, had no medical training, but Spradley coached her to perform cardiopulmonary resuscitation before paramedics arrived. The woman regained a pulse en route to the hospital but later died.

Authorities nominated Jessica for a life-saving award for her heroic efforts, but for Spradley it was part of the job.

“Pre-arrival instructions are very easy if you listen,” she said. “Each call is routine, but it’s not just routine,” she said. “It’s a real challenge. It’s a good feeling, getting a person breathing again.” After four years as a 911 dispatcher, she said, “I haven’t gotten numb to it.”