assignment receiving dispatchers

FDNY’s Computerized Triage Software

Dozens Rescued from Grounded NYC Ferry

Winter Storm Blankets East Coast

FDNY’s Computerized Triage Software in action.

The last time you received a software upgrade notification on your smartphone or computer, you probably paused and considered whether you wanted to undergo the hassle. Your phone would be shut down for a few minutes and when it restarted, applications would be different and you might find yourself fumbling, possibly taking longer to use the phone than before you ran the update. Now imagine that you’re adding software into the FDNY’s Emergency Medical Dispatch (EMD) system that handles about 1.4 million emergency calls annually. The lives and well-being of the New York City citizens depend on how that software upgrade goes, as well as how fast dispatch operators are able to learn the new system to make sure response time doesn’t increase.

Adding Computerized Triage Software (CTS) into Computer-Aided Dispatch (CAD) was a system upgrade the Department and its members did not take lightly. After years of research, procurement, testing and launching CTS in February 2017, the FDNY’s EMS response time and accuracy have improved. This revolutionary software incorporated into the FDNY’s emergency response will set the standard for the nation.

“Almost every time we looked at an EMS response, we said, we could improve triage even more,’” according to David Prezant, MD, Chief Medical Officer at the Office of Medical Affairs (OMA). “We pushed triage policy because it was critical and important.”

The old triage system was a priority call system established in the 1980s. Assignment Receiving Dispatchers (ARDs), who are trained EMTs, were instructed regarding how to ask questions and follow a paper-based system (called Cardex) to determine on a relative rate of severity how critical each medical call was in order to dispatch the correct ambulance. The FDNY realized improvements could be made with response time, data tracking and dispatch training, as well as accuracy of dispatching the correct resources for the call type.

“To get any big project moving forward…you need a group of people to figure out how to get through some of the hurdles. I think that computerized triage is certainly an example of that. Several years ago, we went through all of these paper algorithms to re-discover, re-vet, update them all to say, ‘All right, we’re going to spend all of this money computerizing triage, but let’s check that the algorithms are at least what we think they should be,’” explained Dr. Prezant. “So that was a huge project that took two years with OMA, EMS Operations and the Bureau of Communications collaborating. Members went through every question, every answer, every paper algorithm and they re-did them all. And then we looked for a computer software company that would be able to do this for us and link it as best as possible to the CAD system.”

The project received the support of Commissioner Daniel A. Nigro and the mayor’s office by late summer of 2015 before they vetted the software company. “That’s where Deputy Commissioner Edward Dolan was very helpful,” remembered Dr. Prezant. “He re-directed our efforts toward the software company [we went with] and that occurred within about a year,” Dr. Prezant continued. “We knew computerized triage would be beneficial eventually because we could analyze questions and accuracy and make changes based on what we learned. But we were concerned that…this actually might wind up taking more rather than less time,” Dr. Prezant said.

Luckily, the FDNY is careful, cautious and makes changes based on data and analysis, so it should be no surprise that CTS was a successful endeavor.

Finding the Best Vendor The world of EMS Dispatch isn’t very large. Commissioner Dolan and Dr. Prezant shopped around to find the software that would be the best fit for the FDNY system.

“When you look at the 911 system, it’s unique; nobody understands it like the FDNY understands it,” Commissioner Dolan commented. With his background managing call centers, he learned call-scripting software, which is essentially what you may have experienced when calling a bank or making a flight reservation. “Call centers are multimillion dollar global businesses. You don’t necessarily need to know EMS to know how to write call-scripting software,” remarked Commissioner Dolan. Realizing that this was the software EMD needed for computerized triage, he sought out those types of companies instead of ones with medical backgrounds. “We were the first and, to my knowledge, the only EMS system in the country that successfully bought a computerized triage software application from a company that doesn’t build their application just for 911 use,” he said. Commissioner Dolan knew it was important to make sure the company would be able to scale to the FDNY’s volume of 1.4 million EMS incidents per year. “While that seems like a lot of call transactions, call centers typically do in excess of millions of calls a year,” Commissioner Dolan continued.

The team decided on a U.K.-based company, Infinity CCS (Contact Centre Solutions), in April 2015, because it had a customer service model that better suited the Department’s needs for call type algorithms. Infinity began working with Commissioner Dolan and his team to configure their software for the Department’s needs. They finished in the fall of 2016 when the software was rolled out incrementally through testing phases at EMD from December through February 2017.

“When we were interviewing Infinity, we sent them some of our call types and the questions associated with them and they mocked up a call-scripting algorithm using our triage,” Commissioner Dolan explained. During Infinity’s presentation, they were able to show the team that they could change questions for a call type’s algorithms on the fly.

“The system is entirely configurable. It’s subject to whatever changes our physicians want, our dispatchers determine we need or external events determine. If we’re concerned about Ebola and wanted to throw in the question, ‘Have you traveled to West Africa in the past 21 days’?, we can do that now with administrative rights to the system,” Commissioner Dolan said.

Defining Segments and Call Types “Once EMD gets a call [passed over from the NYPD Police Communications Technicians], the ARD is responsible for triaging this in terms of both a segment and then a specific call type,” Dr. Prezant explained. “Segment defines the life-threatening nature of the issue–the lower the segment number, the more life-threatening. Segment 1 is a cardiac arrest or choking victim. Segments 2 and 3 also are life-threatening. Segments 4-8 are non-life-threatening medical emergencies. Within each segment, there are multiple call types. Each call type dictates A, what type of medical emergency it is, and B, whether it should get an ALS (Advanced Life Support) response or a BLS (Basic Life Support) response. Once the segment and call type are defined, then the ambulance is dispatched,” Dr. Prezant continued. Average response time of segments 1-3 in August 2017 was 6:26 minutes and 4-8 was 7:49 minutes.

How NYC’s 911 System Works NYPD Police Communications Technicians (PCTs) receive the initial 911 call in NYC. They then make the determination regarding what type of emergency is being reported and pass it along as appropriate. If it’s medical, they conference in an EMD ARD to triage the assignment. “Once an appropriate call type is identified using our Computerized Triage System, the assignment is sent to the appropriate borough Radio Dispatcher (RD) to find the closest ambulance,” explained Chief Napoli. “Our CAD system suggests the most appropriate unit response, but the RD must agree and release the assignment, then verbally announce it on the radio frequency to the responding units,” he said.

Why CTS Was Needed One of the many reasons that the FDNY wanted to move to computerized triage was due to the increase in volume over the years. “Currently, we are processing approximately 5,000 calls per day [during peak season] at the Emergency Medical Dispatch center,” Deputy Assistant Chief Anthony Napoli said.

There are 450 EMD personnel assigned to the Communications. On a daily tour basis, EMD operates with approximately 75 members, which includes the Training Staff, since we are constantly updating and training, explained Chief Napoli.

“A larger group of call-takers puts a heavy burden on the training and the protocol update for the expansion we’ve done over the years. Given that and the type of questions that need to be asked, it was getting progressively harder to drill everyone on every question or every possible scenario. It’s a logical progression to go to an electronic format where something can be changed or elements can be designed in a more efficient way,” he continued.

The goal of computerizing triage is to do a better job of typing patients on the phone so there will be improvements in accuracy and speed of the response.

Another factor for consideration was establishing greater uniformity among ARDs’ responses. “One desire was to enhance participation and ensure that we’re asking the same questions for every call regardless of who’s staffing the telephone that shift,” said Commissioner Dolan. The Department wanted uniformity among all ARD call-takers.

“We’ve always looked for a better way of doing triage and we knew that route was to go electronic. But the next problem we had to deal with was using a computer system that was so immense and heavily relied on,” said Chief Napoli. EMD didn’t have an option to go offline to update CAD with this CTS. Thousands of lives were at stake.

EMD Azure McPherson has been working in EMD for six years and said she likes the CTS system better than Cardex. “The CTS is easier than the Cardex because you had to turn away from the computer and flip through the Cardex to make sure you asked the right questions to get the call types. Now, with CTS, it’s like Cardex is built into it. You scroll down to what the [situation is] and from there, you question the caller. You don’t have to turn away from the screen,” EMD McPherson emphasized. There’s a drop-down menu in front of the call-taker and, based on what you select as an answer, the next question is prompted, explained EMD McPherson. “The computer makes the decision and it [forces you] to ask all of the questions. Whereas with the Cardex, you may have missed a question or two. With the new system, you can’t click ‘next’ until you ask the question, which is better for the callers and us. It just makes everything easier because you’re asking all of the correct questions to get the correct call type,” said EMD McPherson.

“Now that these algorithms and branch questionnaires are all computerized, it gives us the opportunity to say, ‘This is the way everyone is going to do it,’” said Dr. Prezant. “We’re monitoring it and if processing call types is taking longer than is necessary, we’re going to make changes. We’re able to monitor every aspect and, in fact, we learned something we never knew before–that every question adds seven seconds, on average, to the time interaction,” noted Dr. Prezant.

The Technology “Automation is the way to go in terms of improving the quality of service and to do more with existing resources,” said Chief Information Officer and Commissioner Benny Thottam. “There’s always an opportunity to automate new processes and the Fire Department took on the challenge and was successful. This has improved the response time already and I think it will improve the response time tremendously while assigning the best resources depending on the nature of the incident.”

The IT Department is responsible for enabling technology, continued Commissioner Thottam. That involves doing the pilot, working with the vendor to ensure service and the teams to provide guidance so that they can use the software, he said.

One advantage the FDNY had on this project is that the computer triage software had to interface with its CAD system. The Department’s CAD vendor, Northrop Grumman Corporation, was able to build upon its institutional knowledge and leverage its expertise to ensure success.

Translating Data Captured and Applying It The technology is critical to this triage project, but the FDNY also understood the role research and data analysis played in creating a successful computerized triage software operation. Assistant Commissioner Kat Thomson leads the Bureau of Management Analysis and Planning (MAP) and said their branch complements technology in areas where it’s appropriate. “We take data that are warehoused by the agency and collected through applications and then we use that data. We’re the end users of data that technology is responsible for procuring and protecting,” she explained.

MAP got involved in the triage project in October of 2016. “Once technology said, ‘We’re going to do a cutover,’ that meant we were going to adopt this technology. We want to know that this technology isn’t going to create any adverse effects. In the past, technology would have run automated reports, which could show hourly, daily and weekly response times for a particular borough,” Commissioner Thomson continued. “They’re good at packaging data and making sure the systems are protecting data, encrypting data; but they’re not analysts with data, not in the way that our shop is. Our MAP department grew and now we have much better ability to analyze data,” she noted.

The Department recently procured Tableau, a data visualization tool. “Tableau allows us to plug in to different application data sets. The [challenge] with computerized triage was that we’re rolling out this piece of technology that captures data, particularly how we’re typing calls,” Commissioner Thomson commented. “Dispatch is gathering that information. But other applications also are running simultaneously that capture their own data and they tell a story that is really important to this incorporation of computerized triage. Tableau gave us the ability to pull data from all the sources that we need. We never had that ability before,” she added.

CAD data now were pulled in by the MAP unit, combined with computerized triage data and eventually Electronic Patient Care Record (EPCR) data, continued Commissioner Thomson. “Now we could show data visualization in one comprehensive analysis. We could examine, ‘If we’re changing something over here, what’s the effect over there’? And we couldn’t do that before,” she said.

“To me, MAP was the best thing since sliced bread because I’m able to trove the efficiency of the ARDs’ dispatches based on the data that are being generated,” commented Chief Napoli. “[We were able to show] that some call type questions don’t work and we can save time by getting rid of a question since it only added to the response time. You want to do something that’s tried and true and analyzed and developed throughout this entire process.”

Using Data to Improve Call Response Times The questions and the speed and accuracy of the questions are a subject overseen by the Medical Director, so they had to meet clinical requirements, said Commissioner Dolan. “The software had to meet the technical network, firewall, security, speed and reliability requirements of our technology group and then it had to be able to be plugged into MAP,” he said.

“The goal of computerizing triage is to do a better job of typing patients on the phone so there will be improvements in accuracy and speed of the response,” explained Commissioner Thomson. With this new triage, the software is taking the answers to the questions call-takers ask and compiling the data. “That results in complex, multi-dimensional, structured data. While the ARD call-taker is asking questions about age and yes and no questions, the system is running and the data are captured. Then, that data are feeding into Tableau. Simultaneously, we’re moving ambulances with CAD and there are time stamps associated with moves,” she said.

“For example, we can see that we’re dispatching this ALS unit from this location at this time point and it creates a record in a different application. We take that data and marry it with the data from triage. Then MAP will sit down with Communications and OMA. Dr. Prezant can look at the data and tinker with the questions to determine the best order, while Chief Napoli and his EMD department make sure those questions don’t cause response times to increase. We take a look at all the data we’re acquiring, put it on one page and address it at a conference together, where we can zero in on all of the details during the rollover. We’re examining everything at the most granular level, which also is new for the agency and very important,” Commissioner Thomson added.

“Using the new computerized triage questioning data, we’re able to identify the most common pathways that people were taking to arrive at a certain [conclusion],” she continued. “We identified some questions that were creating inefficiencies. We were asking questions that…weren’t critical. Looking at the information, we were able to say, ‘Let’s ask a more important question first, so we can speed up our ability to triage, make a determination of the type of patient we have, so we can send the correct resources,” Commissioner Thomson explained. “I call it ‘trimming the fat.’ You’re cinching up all these little inefficiencies that are out there. It’s a huge, complex, organic problem you’re trying to solve,” she said.

“For all of our calls, processing time went down by 6.7 seconds after CTS was up and running,” said Commissioner Dolan. “We also found that processing times for our high priority calls–those that are potentially life-threatening–went down by 3.6 seconds,” he enthused.

Training on the Software “My dispatch team went through extensive training back and forth to make sure this was going to work,” said Chief Napoli. “I told the training classes that they were simply being guided by the analysis that we developed. I’m not turning them into robots, but they have to ask the prompted questions and use the drag and drop features to arrive at an appropriate call type. While asking more questions does give the dispatcher more knowledge about the situation, it doesn’t help with the response of the ambulance,” he explained.

“It was very important to have a test system in place, where we could test something without shutting down the 911 system,” said Dr. Prezant. “So the old version was still live, but the new version was in a test area and we would test that for a week or two and make sure that we hadn’t created any problems by accident. Then we would move it over to the live platform.”

“In the beginning we did testing, then when we were taking live calls, some [members] were kept in a different room, trying out the new system,” said EMD McPherson. “The people who were in charge of CTS were right there in the room to help us along if something wasn’t working the way we expected. We would tell them, ‘The system isn’t asking this or it should be asking that,’” EMD McPherson continued. The supervisors were there to provide extra help during that time CTS went live and was being tested by a small group of dispatch members.

With this unique software, EMD was able to analyze, “Which people are struggling with the new software”? or “What times of day are we the slowest”?, said Commissioner Thomson. “We also could answer the question, ‘How much training does each call-taker need before we can turn them loose on the new software’? The data showed that the first five times call-takers used computerized triage, they usually were very slow.” By approximately 50 calls, they were back to normal speed, answering the phone efficiently and [identifying the call type] at the same speed they did while using the Cardex system, remarked Commissioner Thomson.

“Previously, these data would have been a big question mark. We would have rolled this out and then we would have looked a month later at response times and realized, ‘Well, it looks like there’s a 30-second increase.’ Now, we can say, “No. For ARD A, in terminal B, at time C and it was call type E, you had a certain second increase.” We could get right to core of the problem every single time,” commented Commissioner Thomson.

“Overall, my experience with CTS has been very good. People tend to be against change,” said EMD McPherson. “When you’re used to doing things a certain way for a long time, it takes some getting used to in order to click one thing and then it jumps to the next screen. In the beginning, people were a bit frustrated, but now everyone went through it and everyone knows how to do his/her job.

“With CTS, you’re making sure you do everything correctly. In the beginning, we gave our feedback on certain first aid protocol and what certain call types should be. They made some fixes based on feedback we had. To me, CTS is faster,” EMD McPherson continued.

Changing Algorithms in Real Time “Right now, if there was [an outbreak] taking place in the City of New York where we had to ask specific questions related to the operation, we potentially can make that change on the fly and add another set of questions right into the algorithm,” Chief Napoli explained. “For example, if we had a smallpox virus outbreak in lower Manhattan, we could interject a question this afternoon that asks if the patient has been south of 23rd Street in Manhattan recently. And we can begin isolating specific questions to help determine if the patient may have smallpox,” he said. That flexibility and speed enhanced by this technology are useful for personnel at EMD, the EMS members responding to the call and the patients. “Ten years ago, if we had something like that taking place, I would have put up a big sign in the call receiving area–also called Assigned Seating Dispatching–that said the same thing about asking those questions of anyone who was south of 23rd Street in Manhattan in the past 24 hours,” Chief Napoli stated.

“The biggest part of this triage software is the fact that we have to be able to change the questioning to go with the ‘crisis du jour,’ if you look at it that way,” continued Chief Napoli. “Because there are things happening in this world that none of us would have dreamt about 10 years ago or even believed then, we have to be able to adapt and mold ourselves accordingly with what’s happening,” he said.

“The managerial analysis part of it was designed by us, it’s run by us and it’s molded by us,” Chief Napoli continued. “I’ve changed the reports numerous times with them because what was important to us last month is not necessarily important to us this month. If I need an analysis on something specific now, I know I can pick up the phone and within a day or two, our analysts can come back to me and give me that data.”

Improving Call Types and Segments “The main question we’re answering is, ‘What’s the impact of this new system overall on response times’? But then MAP breaks that down even further,” said Commissioner Thomson. “We examined, ‘What’s the impact of this cutover on our most critical call types’? because we care about those the most. We were able to isolate cardiac arrest calls, a difficulty breathing or other life-threatening call types that we don’t want to have an adverse impact on. And then, we looked at them using Tableau to find the outliers where calls were slowing down,” she added. “We could see where phone calls or triage outputs were making things slower by examining the time elements. And you can pull those out, quickly slice and dice, look at them, see what the problem is and publish it with them in a way that has never been possible before. So we would take on call type, response time issues and then we could diagnose and improve times,” she continued.

“These segments and call types are the most important items,” emphasized Dr. Prezant. “They’re in our power to change, we have that power to know through accurate analytic information what we need to do to improve our system. And the system needs to improve in a dynamic way. And if we achieve that—and we already have demonstrated that we are achieving that—then…the people benefit. We get there faster and we get there faster with the right resource,” stated Dr. Prezant.

The Hardware “This was a product that already was built and we installed it in our environment, so we didn’t need a lot of equipment and hardware,” said Commissioner Thottam. There was a one-time cost for initial setup, configuration and integration with the EMS CAD system. The main expense for the triage software was licensing. Additional equipment needed were Windows servers and some networking equipment, he noted.

The FDNY Always Has a Backup “We have backup systems so if something does happen to the [triage software] we’d go to a backup system so it’s redundant,” said Commissioner Thottam. “The EMS CAD system is configured in such a way that if CTS goes down, it won’t impact the CAD system and the ARDs would go back to the Cardex. We have redundancy in place for the computerized triage system, but no system is bulletproof.” “Even if for some reason technology goes down, our ARDs are still prepared to answer calls using simplistic questions on paper as a backup,” explained Chief Napoli. “I rely on the training for the ARDs to be able to efficiently know what to ask and what not to ask to make sure the call types are processed correctly [should the triage software go down].”

What Other Departments Should Consider Before Taking on this Endeavor

FDNY call-taker.

Make sure you receive good support from your vendor, recommended Commissioner Thottam. “We went with a vendor (solution) that could configure the tool the way we wanted. It’s critical to test and pilot before implementation because this is a critical operation. When algorithms are not perfected, it can have an adverse effect [on the patient].”

Other Departments should make sure that the tool they’re considering fits in their environment, continued Commissioner Thottam. “You don’t want to put new technology in an environment that doesn’t support it. Otherwise, it’ll be more expensive to maintain and support.”

For other call-takers who might take this system on, EMD McPherson suggested they be open to learning computerized triage. “Once they see how it works and how fast they can drop a call, I think they’ll like it. You don’t have to flip from the screen to the Cardex to see the call type and then look back at the screen. Everything is on the screen. Even during first aid, you’re able to click what you think it is and type in everything. I’ve done CPR over the phone since this launched and think CTS is easier for that. Once you click, you read everything for first aid and the call right there. You also can see how far away the unit is or if it pulled up yet. You’re not twisting and turning from the screen to look at the Cardex. The prompts are all in one place,” EMD McPherson summarized.

The FDNY’s EMD is One of a Kind “We have the only triage system in the country that the end user can configure at will,” noted Commissioner Dolan. “Because we have a full-time management analysis and planning team and we have invested in statistical software packages that can help us display data from across multiple data sources, in a very easy-to-see dashboard that you can put on your computer monitor or send around in real time, you can even make the information accessible to people and email it to them as a PDF.

“Computerized triage software is better for everyone on an operational basis because it gives us a higher reliability that we’ve captured the severity of the call accurately to the extent that this is possible since 1.4 million New Yorkers call us for help every year…and there’s a limit to how accurately we can get a call classified,” continued Commissioner Dolan. “We found with computerized triage that the percentage of calls that start off as a lower priority call and later get upgraded to a higher priority due to the patient’s deterioration went down by another percentage point. That’s one way of showing that we’re capturing calls more accurately and we’re better able to fine-tune what type of emergency we’re responding to, so it’s better for everyone, both in the dispatch center and the units responding to incidents,” he emphasized.

FDNY processes 1.4 million calls every year.

“This software is efficient and fast and allows our efficiency and accuracy to go hand in hand,” said Chief Napoli. “I already have seen that this product is saving lives. I am working with the most highly trained professionals in the world in Emergency Medical Dispatch. This software has made it easier so that our ARDs don’t have to remember what the next step is, what they have to do and where they need to go,” he said.

“From a management perspective, I think one of the biggest reasons for the success of this project was that we involved all the different disciplines, both within the Fire Department and when we reached out to the private sector, we didn’t limit ourselves to just the available vendors who seemed to be the obvious choices,” said Commissioner Dolan. “We took a step back and evaluated what we really needed. To the extent that you can use existing software products in an innovative way, that sometimes might be better rather than trying to reinvent the wheel and buy something that’s just built for 911.”

“The major achievement in the 911 system this year has been the success of computerized triage,” noted Dr. Prezant. “We’ve implemented a whole new system that takes care of 1.4 million calls per year and we’ve implemented it without a hitch. We’re already seeing success. I think it’s a huge accomplishment. And it also builds confidence to tackle the next project. When you build an effective team and you have success, that builds confidence for the next project. And it just keeps feeding on itself. So people have to trust us, that if we have something new that we’re going to do, that we’re going to implement it with this measured, reasonable approach,” Dr. Prezant concluded.

About the Author

Edward M. Dolan is the Deputy Commissioner for Strategic Initiatives and Policy. He previously served at the FDNY as the Deputy Commissioner for Administration from 1994-1998, leading the development of CFR-D and the EMS merger, after working with the Department from 1987-1990 as a senior analyst in Mayor Koch’s office. He also has worked as a vice president at the Lockheed Martin Corporation and for the federal government, where he spent seven years with the U.S. Department of Homeland Security and nearly three years on the National Security Council staff at the White House. He holds a Master’s degree in Public Policy from the Kennedy School of Government at Harvard University.

Dr. David Prezant is the Chief Medical Officer for the FDNY, Office of Medical Affairs, and the Special Advisor to the Fire Commissioner for Health Policy. He is Co-Director of FDNY’s World Trade Center Medical Program. Dr. Prezant was in charge of coordinating FDNY’s overall preparedness and response to patients with potential Ebola Virus Disease.

Kat Thomson joined FDNY in 2015 as Assistant Commissioner, Management Analysis and Planning. Previously, she worked as an analytic consultant for various fire associations in the NY Metro area. She has 17 years of experience in wildland fire operations with nine as an air attack officer, specializing in fire aviation. Assistant Commissioner Thomson holds two Master’s degrees and a PhD from Columbia University.

Benny Thottam joined FDNY in 2015 and is responsible for overall management of the agency’s technology initiatives. He guides the Bureau of Technology Development & Systems as it pursues its mission to harness technology to improve service to customers. He evaluates and determines the agency’s long-term technology goals, policies and procedures and works to keep IT investments in sync with NYC’s technology strategy. He also oversees the development, design and implementation of new applications, as well as enhancements to existing ones. He came to FDNY after a 20-year career with the NY State Government, where he worked as the Chief Information Officer of the Education Department and the Labor Department.

Deputy Assistant Chief Anthony V. Napoli, Jr., has been a member of the New York City Fire Department since 1977. He is assigned to the Bureau of Communications, Emergency Medical Dispatch, as the Chief of EMS Communications. Chief Napoli has been a New York State-certified Emergency Medical Technician since 1976, when he began his career with his local community-based volunteer ambulance corps, of which he is still an active member for more than 40 years. He joined the ranks of the New York City Emergency Medical Service in 1988 and was assigned to the Bureau of Communications. He holds a Bachelor’s degree in Urban Studies.

Azure McPherson became a certified EMT in 2009 through training at the EMS Academy in Fort Totten. From there, she worked in Brooklyn at Station 32 and Station 35 before transferring to EMD in Brooklyn, where she is a certified EMD Assignment Receiving Dispatcher (ARD).

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Telecommunicators & Training

Public safety telecommunicators are often the first point of contact in an emergency. They begin the important work of obtaining essential information, remaining calm, calming others, and sending the appropriate responders to the right location. They may also provide instructions to the 911 caller, which in many cases is essential to stabilizing or saving a life.

Throughout the nation, 911 call centers or public safety answering points (PSAPs)—also called Emergency Communication Centers (ECCs)—are managed by a variety of local and state agencies . This varied governance produces a unique challenge for training telecommunicators, as each agency may have its own educational standards.

Some 911 professionals are certified as emergency medical dispatchers (EMDs), emergency fire dispatchers (EFDs) or emergency police dispatchers (EPDs). Managers and supervisors may also be certified as emergency number professionals (ENPs) or certified public-safety executives (CPEs).

The National 911 Program supports the work of the 911 community to provide training strategies for telecommunicators and has previously convened a working group of 911 associations to develop recommended minimum training guidelines for telecommunicators .

PSAPs continue to struggle with staffing and classification issues, and the Program supports efforts to improve recruiting and retention at 911 centers for the thousands of telecommunicators working to serve their communities across the U.S.

Telecommunicator Job Reclassification

As the duties of telecommunicators continue to evolve and expand, the National 911 Program works with the broader 911 community to reclassify the 911 Telecommunicator from “Office and Administrative Support” to a “Protective Service Occupation.” A four-part Public Safety Telecommunicator Reclassification toolkit helps PSAPs address the changes the Bureau of Labor Statistics needs to see to reclassify telecommunicators.

More Resources from the National 911 Program

Coronavirus/COVID-19 Resources

CPR LifeLinks: Dispatcher-Assisted Telephone CPR

NG911 for Telecommunicators

Telecommunicator Reclassification Toolkit: Establishing and Expanding a Public Safety Telecommunicator Training Program  

Resources for Telecommunicator Well-Being

Association of Public-Safety Communications Officials (APCO) Health & Wellness

National Emergency Number Association (NENA) Wellness Committee

NENA Wellness Continuum

911 Training Institute

Other Resources for Telecommunicator Training

APCO Public Safety Telecommunicator Certification

International Academies of Emergency Dispatch (IAED) Emergency Telecommunicator Certification

NENA Education & Training Program

NENA Telecommunicator Core Competencies Training

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Impact of Citywide Blackout on an Urban Emergency Medical Services System

2006, Prehospital and Disaster Medicine

Introduction:On 14 August 2003, New York City and a large portion of the northeastern United States experienced the largest blackout in the history of the country. An analysis of such a widespread disaster on emergency medical service (EMS) operations may assist in planning for and managing such disasters in the future.Methods:A retrospective review of all EMS activity within New York City's 9-1-1 emergency telephone system during the 29 hours during which all or parts of the city were without power (16:11 hours (h) on 14 August 2003 until 21:03 h on 15 August 2003) was performed. Control periods were established utilizing identical time periods during the five weeks preceding the blackout.Results:Significant increases were identified in the overall EMS demand (7,844 incidents vs. 3,860 incidents; p<0.001) as well as in 20 of the 62 calltypes of the system, including ca rd i ac arrests (119 vs.76, p= 0.043).Significant decreases were found only among calls related to psycholo...

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Example SOPs: Dispatcher

We’ve made it easy for you to build your Dispatcher SOPs. Add the example SOPs to our SOPs template and then customise them to suit your specific systems & processes.

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Dispatcher SOPs

Dispatcher sop examples, dispatcher sop templates.

Creating Standard Operating Procedures for your Dispatcher work can be difficult and take time. That’s why we’ve created these example Dispatcher SOPs so you can jumpstart your SOP creation process. We want to help you set up your Transportation systems and processes by taking these sample SOPs and building out your own SOPs template library. By having all your Transportation procedures in one place, your team will have the information they need at all times. Let’s look at some Dispatcher SOP examples.

1. SOP: Dispatching Procedures Purpose: This SOP outlines the step-by-step process for dispatching drivers and vehicles to ensure efficient and timely transportation services. It includes receiving and processing customer requests, assigning appropriate drivers and vehicles, and communicating necessary information to all parties involved. The goal is to optimize resource allocation and meet customer demands. Scope: This SOP applies to all dispatchers within the transportation company. Person Responsible: Dispatch Manager References: This SOP references the SOP on Customer Request Processing and the SOP on Driver Assignment.

2. SOP: Customer Request Processing Purpose: This SOP details the procedures for receiving and processing customer transportation requests. It includes recording customer information, understanding their specific needs, and accurately entering the request into the dispatch system. The purpose is to ensure accurate and timely response to customer inquiries and requests. Scope: All dispatchers and customer service representatives involved in processing customer requests. Person Responsible: Customer Service Manager References: This SOP references the SOP on Dispatching Procedures and the SOP on Vehicle Availability.

3. SOP: Driver Assignment Purpose: This SOP outlines the process for assigning drivers to specific transportation requests. It includes considering driver availability, skills, and proximity to the pick-up location. The goal is to efficiently allocate drivers to maximize productivity and minimize response time. Scope: Dispatchers responsible for assigning drivers. Person Responsible: Dispatch Manager References: This SOP references the SOP on Dispatching Procedures and the SOP on Driver Availability.

4. SOP: Vehicle Availability Purpose: This SOP defines the procedures for managing and tracking the availability of vehicles within the transportation company. It includes recording vehicle maintenance schedules, tracking vehicle usage, and ensuring vehicles are in optimal condition for dispatch. The purpose is to maintain a fleet of reliable vehicles and minimize downtime. Scope: Dispatchers and fleet managers responsible for vehicle availability. Person Responsible: Fleet Manager References: This SOP references the SOP on Dispatching Procedures and the SOP on Vehicle Maintenance.

5. SOP: Communication Protocols Purpose: This SOP establishes the guidelines for effective communication between dispatchers, drivers, and other relevant parties. It includes protocols for radio communication, phone etiquette, and use of communication devices. The goal is to ensure clear and concise communication to facilitate smooth operations and enhance safety. Scope: All dispatchers and drivers within the transportation company. Person Responsible: Dispatch Manager References: This SOP references the SOP on Dispatching Procedures and the SOP on Emergency Response.

6. SOP: Emergency Response Purpose: This SOP outlines the procedures for handling emergency situations during transportation operations. It includes protocols for reporting accidents, breakdowns, or other emergencies, as well as coordinating with relevant authorities and providing necessary support. The purpose is to ensure the safety of drivers, passengers, and the public in emergency situations. Scope: All dispatchers and drivers within the transportation company. Person Responsible: Dispatch Manager References: This SOP references the SOP on Dispatching Procedures and the SOP on Communication Protocols

Looking for SOP templates for your Dispatcher work? We’ve got you covered. You can build out your company SOPs using the sample SOP information above (added to our template) or our team can put together a starter SOPs template based on your Dispatcher work. Get in touch if you’ve got questions about the quickest way to build out your Transportation SOPs library.

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College football players are caught up in human smuggling scheme: 5 things to know

For years, transnational criminal organizations have targeted American teens and young adults on social media and enticed them with the promise of fast and easy money to drive migrants in what’s essentially a black market rideshare service, completing a complex chain of human smuggling into the U.S.

But the issue is far larger and more pervasive than court records suggest.

An 18-month investigation by The Arizona Republic has exposed multiple instances of alleged human smuggling by former Arizona Christian University football players who were arrested by Border Patrol and released without criminal charges, revealed a current ACU player who allegedly distributed driving assignments to his teammates, and examined claims that a former ACU assistant and high school coach was involved in the scheme.

The investigation also found that far more people are arrested for human smuggling than are prosecuted by the U.S. Attorney’s Office for the District of Arizona.

The report details how illegal immigration is exploited by American citizens and directly endangers migrants, children and young adults in Arizona.

And as another fall sports season kicks off, it raises serious questions about the vetting and compensation of high school and small college coaches, considering their tremendous influence, and suggests parents and community leaders must warn teens against transporting migrants.

Here are five takeaways from the investigation:

1. Arizona Christian University football players have been arrested by U.S. Border Patrol for human smuggling and released without criminal charges

Late one night in January 2022, Arizona Christian University linebacker Malakai Samuelu and running back Junior Faualo were stopped by an Arizona state trooper in Bisbee, an old copper mining town near the U.S. border with Mexico, while transporting an injured migrant woman in a car they had borrowed from a teammate.

The officer radioed for U.S. Border Patrol and an ambulance, according to public records, and the players were arrested for human smuggling, a felony punishable by up to 10 years in prison per migrant or longer, in cases involving injury or death.

The woman was treated at a local hospital and deported, and the car was impounded.

But within hours, the ACU players were released without criminal charges.

“Due to the current COVID pandemic and lack of prior criminal history … prosecution was declined under Tucson Sector Guidelines,” reads a partially redacted Border Patrol investigation report obtained by The Arizona Republic through a Freedom of Information Act request.

Samuelu and Faualo, who are tied to the incident and identified in public records from the Arizona Department of Public Safety, were suspended from the ACU football team and chose to leave the school, an attorney for the university confirmed, calling the students’ detainment a “one-time incident.”

But the previous semester, during football season in Fall 2021, another ACU football player was arrested by Border Patrol in Sierra Vista, he told The Republic.

The former player detailed his experience — how he was recruited on Snapchat and paid $1,000 per head to drive migrants from border towns to metro Phoenix — on the condition his name did not appear in this story. He said he was caught on his fourth trip and acted alone, absolving his former teammates and coaches of any involvement.

Because his traffic stop and arrest solely involved Border Patrol, which redacts identities from the documents it releases, and he was not prosecuted, his name does not appear in public records.

Human smuggling and college football: A timeline of The Republic's reporting

2. Another ACU football player allegedly helped distribute human smuggling assignments to teammates and was suspended for spring practice

Arizona Christian wide receiver James “JJ” Mcelhenny, from Tolleson, helped distribute human smuggling assignments to his teammates, three classmates told The Republic.

Mcelhenny, then a reserve quarterback, was suspended from spring practice in connection with the arrests of Samuelu and Faualo but remained at ACU. He was reinstated to the team and continues to play for the Firestorm.

“Our goal, consistent with our Christian witness, is always to ‘restore and redeem,’” an attorney for ACU told The Republic.

Mcelhenny confirmed his suspension but declined to discuss his alleged involvement in distributing human smuggling assignments to his teammates.

“I personally do not feel comfortable talking about the situation,” Mcelhenny said, “because it was taken care of, it is over and done with, it is now almost 2½ years in the past. Everyone has moved on.”

Mcelhenny also told The Republic that ACU, as part of its internal investigation, viewed security camera footage to debunk a claim that he and several teammates had visited a player’s room to threaten him to keep quiet about the scheme.

An attorney for ACU told The Republic that the school was previously unaware of the alleged confrontation and that no security camera footage was reviewed.

3. Border Patrol has arrested far more people for human smuggling than are prosecuted by the U.S. Attorney’s Office for the District of Arizona

The Republic found that far more people are arrested for human smuggling in Border Patrol’s Tucson Sector than are prosecuted by the U.S. Attorney’s Office for the District of Arizona.

The federal law enforcement agency regularly declines to prosecute 20% to 25% of suspects arrested for human smuggling due to agents failing to convey adequate probable cause for making a stop and the inability of migrants to serve as material witnesses, according to government officials.

And it has declined to prosecute countless others, including Samuelu and Faualo, citing the COVID-19 pandemic, their lack of criminal history and “Tucson Sector Guidelines,” according to public records.

The U.S. Attorney’s Office for the District of Arizona has reported between 188 and 335 prosecutions for human smuggling per quarter since the start of 2022, far more than at any point during the pandemic and among the most in the nation, according to the U.S. Sentencing Commission.

That's an average of two to four prosecutions per day.

Border Patrol does not release aggregate data about the U.S. citizens it arrests, but its agents reported 18 traffic stops resulting in 26 arrests for human smuggling in Tucson Sector from Jan. 24 to 25, 2022, including the incident with Samuelu and Faualo, according to redacted federal records obtained by The Republic.

That 48-hour window offers a small sample — but reveals an average of 13 arrests per day.

At least seven of the 26 suspects were released without criminal charges because of the pandemic and their lack of criminal history, in accordance with Tucson Sector Guidelines.

4. DPS initially denied public records existed and deleted body camera video of ACU football players transporting an injured woman, a migrant from Mexico

The Republic filed multiple federal and state public records requests for this investigation.

Border Patrol records were released with redacted names, but Samuelu and Faualo were identified in state police records obtained from the Arizona Department of Public Safety.

DPS initially claimed it had no documents related to this traffic stop and earlier this year closed a state public records request from The Republic. The request had included numerous accurate details about the incident, including the approximate time, date and location of the stop, the make, model and color of the impounded vehicle, which had a Washington state license plate, and identified Samuelu as the driver.

After an attorney representing The Republic threatened legal action, because Border Patrol records showed a state trooper initiated the stop, DPS released three written documents from the incident — a call-detail report, a contact data collection form and a copy of a repair order issued to Samuelu for a malfunctioning license plate light.

The agency also mistakenly provided a body camera video from an unrelated and benign traffic stop on Jan. 24, 2022, the day before Samuelu and Faualo were arrested by Border Patrol.

When informed of the error and pressed to release the correct bodycam video, an attorney for DPS told an attorney for The Republic that the video of the Arizona Christian University football players with an injured migrant woman on Jan. 25, 2022 — a video taken the day after the one mistakenly sent to The Republic — had been deleted more than a year earlier, “consistent with the State Library’s General Retention Schedules, and it cannot be recovered.”

5. ACU assistant coach fired shortly after arrests became head coach at River Valley High School, was demoted after one season and resurfaced at Saguaro, but ‘isn’t on staff’

ACU dismissed running backs coach Kevin Hall Jr., on Feb. 6, 2022, less than two weeks after Samuelu and Faualo were arrested, the university confirmed.

The school cited “completely unrelated” issues connected to his job performance.

But longtime head coach Jeff Bowen never addressed human smuggling with the team and only made passing mention of Hall’s departure, players told The Republic, leading to whispers of a connection and coverup on the tight-knit campus.

Less than two months later, in April 2022, Hall was named the head football coach at River Valley High School in Mohave Valley, in the northwest corner of the state.

The Dust Devils were soon cited for recruiting and heat-safety violations by the Arizona Interscholastic Association. Hall was demoted after one season and quit without saying a word, the school’s athletics director told The Republic.

Hall was recently on the sideline coaching running backs at Saguaro High School, a state powerhouse in Scottsdale, during the Sabercats’ season opener.

“From what I’ve been told, he decided to leave ACU. It was his decision,” Saguaro coach Darius Kelly told The Republic in late July, saying Hall “sat down probably four or five times and went through a tense interview process.”

The hire was awaiting clearance by human resources.

“He’s definitely a good man,” Kelly said. “He has good morals. … I really do trust him here going forward. No doubt about it.”

Last week, Kelly told The Republic that Hall “isn’t on staff” because the assistant coaching job conflicted with his work schedule and that Hall “does not work with Saguaro High School in any capacity.”

Hall did not respond to multiple requests for comment.

The Conversation That Can Change the Course of a Cardiac Arrest

Telephone CPR saved my father-in-law’s life. Why don’t all 911 services provide that?

T he call came in at 7:42:02 p.m. on March 21, 2019.

A man in his early 60s had just sat down to dinner with his daughter and her boyfriend at an otherwise empty North Brooklyn restaurant, when he suddenly slumped in his chair. The daughter shouted at a hostess to call 911. Within seconds—by precisely 7:42:16, according to my review of the incident—a New York City Fire Department emergency-response unit had acknowledged the assignment, and would arrive on the scene some two and a half minutes later. In the meantime, a dispatcher stayed on the line.

“Is this for you, or someone else?” the dispatcher asked the hostess.

“For someone else,” the hostess replied.

“Is the person breathing?” the dispatcher asked.

Confusion. Was the man having a seizure? Before long, it was established that he was not seizing and was unconscious. He had no discernible pulse. The dispatcher instructed the daughter and boyfriend, both in their 30s, to ease the man down to the hardwood floor, belly-up, and expose his chest.

The event was one of the more than 350,000 out-of-hospital cardiac arrests that occur annually in the United States. They are a leading cause of death , and only about one in 10 victims survives. Without early 911 access and cardiopulmonary resuscitation (CPR)—the first two links, followed by early defibrillation, in the out-of-hospital “chain of survival”—death is certain .

Over-the-phone CPR instruction by a dispatcher, also known as telephone CPR or T-CPR, can enable a caller to become a lay rescuer, and by doing so make the difference between life and death. Early CPR performed by a lay rescuer is associated with a roughly twofold increase in the chances of survival.

However, T-CPR is not as widespread as most 911 callers might expect. I would know. The boyfriend in this story? That’s me. The man was my girlfriend’s dad, Todd. For him to have a shot at survival, either my partner or I would need to intervene.

I was about to perform CPR on my future father-in-law.

M any dispatchers are trained to recognize signs of cardiac arrest from an oral description and then direct callers to begin CPR—even callers who might be in shock, as my partner and I were. But there is no universal requirement for dispatchers to do this. Few of the dispatch centers that have implemented T-CPR protocols deliver instructions consistently, and fewer still have strict quality-improvement measures in place. On the night of Todd’s cardiac arrest, I was fortunate that my hands were guided by the right dispatcher.

According to Robert Fazzino, a paramedic and the FDNY medical-affairs representative who procured our incident report, the hostess handed the cordless phone to my partner, Lex, who then handed it to me. Kneeling over Todd’s tensed body, I wedged the receiver between my right ear and shoulder. The dispatcher told me to interlock my hands—one atop the other, at the midpoint of the nipple line—and get ready to start pumping up and down, hard and fast.

The clock was ticking.

This wasn’t the first time I’d been involved in an emergency that required CPR. When I was a teenage pool lifeguard, a 74-year-old swimmer fell unconscious one summer afternoon. After I pulled her out of the water, five other guards and I performed CPR on her for several long minutes until paramedics arrived. She died days later.

Now here I was again, face-to-face with someone clinging to life—only this time, it was a loved one, and my training was rusty.

In my lifeguarding days, I was regularly drilled on the CPR procedures for infants, children, and adults. Was it 15 compressions to two breaths for an adult? Or 30 to two? I was blanking. “What are the ratios?” I blurted out.

The dispatcher, realizing I was at least somewhat CPR conversant, seized the moment. No breaths necessary, he said. “Just stay on my count.”

That’s exactly what I did, according to the call audio. I counted aloud with the dispatcher, using my upper-body weight to press down on Todd’s sternum, before releasing: down and release, down and release. One and two and three and four and five and six …

Time slowed. I closed my eyes. Don’t stop , I thought. After what felt like an eternity, I heard sirens approaching.

“The public assumes that if they call 911 and someone’s in cardiac arrest that they’re going to get [CPR] instructions,” says Michael Kurz, an emergency-medicine physician at the University of Alabama at Birmingham and the volunteer chair of the American Heart Association’s T-CPR Task Force. “That’s not the case. It is the minority of cardiac arrests that receive that instruction.”

If I’ve learned anything in the weeks and months I’ve spent reconstructing the events of that evening, and researching the availability of T-CPR nationwide, it’s that we were very, very lucky. Dial 911 to report a cardiac arrest, and depending on where you are—a big city, a rural town , or somewhere in between—you may be told to wait until help arrives, to stand idle as your loved one’s fate hangs in the balance. Why didn’t that happen to us?

O ne day in August 1974, a panicked mother called the fire department in Phoenix, Arizona. A dispatcher listened as the woman explained that she and her husband had just pulled their 2-year-old son from the family swimming pool, and that the toddler was turning purple. “He’s not breathing!” she shouted.

“I want you to stay on the line,” the dispatcher said, noting the caller’s address. “I have a medic that is going to give you some help while I send someone.” The phone was passed to a department paramedic, Bill Toon, who had just clocked in.

As Toon wrote in Principles of Emergency Medical Dispatch years later, the department’s single paramedic unit was far enough away that the odds of it arriving in time to help were slim. “The dispatchers had little or no training in this area at this point in time,” he added.

Toon took it upon himself to assist the family until the paramedic unit arrived.

“I began to give the caller a crash course in CPR because the only real chance the child had of surviving was with his family doing the saving,” Toon wrote. After about a minute of over-the-phone instructions, Toon heard the toddler start to cry—a relief, because if he could cry, he could breathe. “That was a pretty sweet sound for everyone involved,” Toon recalled.

The three-minute, eight-second call was a signal moment in the emerging field of pre-arrival instruction and T-CPR. Toon’s ad hoc actions were remarkable because T-CPR protocols did not yet exist, making the episode’s recording an instant historical artifact. As Audrey Fraizer wrote in The Journal of Emergency Dispatch in 2019, word of the event made the national rounds and, as she later told me, helped in the push to standardize care in emergency dispatching.

By the early 1980s, the emergency medical system in King County, Washington, had become the first to implement a T-CPR script for dispatchers fielding cardiac-arrest calls. In the time since, T-CPR’s spread has been significant, albeit somewhat haphazard. A 2015 evidence review conducted by the American Heart Association suggested that, despite “rapid and widespread adoption,” dispatcher CPR instruction “ does not lead to more successful resuscitations or improved survival .” But in Arizona, the birthplace of the practice, out-of-hospital cardiac-arrest victims who were provided with T-CPR were almost 65 percent more likely to survive than those who didn’t receive T-CPR, according to a February 2020 AHA T-CPR policy statement . Those who survived were also far less likely to have suffered brain damage.

Eight states—Indiana, Kentucky, Louisiana, Maryland, Tennessee, Virginia, West Virginia, and Wisconsin—currently require emergency dispatchers to provide T-CPR. But other states and jurisdictions—Arizona and New York among them—do not. The dispatchers in these states, says April Heinze of the National Emergency Number Association (NENA), a nonprofit that works to standardize 911 services, are going to send help, but until the ambulance arrives they may not be able to assist callers much.

To be sure, about one-third of the emergency dispatch centers in the U.S.—approximately 2,000—provide some sort of medical advice via telephone, helping bystanders assist someone who is choking, seizing, or even giving birth. Of those, “many do so without being required by law,” Heinze told me last spring. In her home state of Michigan, she added, more than 70 percent of dispatch centers provide these services, despite no mandate to do so. “Many others probably also do telephone CPR just because they know that’s the right thing to do,” Heinze, a former longtime 911 dispatcher, said.

Only recently has there been a proper drive, spearheaded largely by the AHA, to integrate T-CPR into the national 911 system, which itself dates back to only the late 1960s. “The push for telephone CPR just happened within the last year or two,” Heinze told me. “Legislation is very slow. It doesn’t happen overnight.” That at least eight states have T-CPR-specific legislation on the books, well, “I think that’s actually pretty good, to be honest with you.”

S till , nearly 50 years since Bill Toon’s impromptu T-CPR guidance, fewer than half of those who experience cardiac arrest outside of a hospital in America receive bystander CPR. Lay-rescuer rates are especially low in minority communities, due to both a lower overall availability of T-CPR and a widespread fear that involvement with a 911 call will lead to encounters with police or immigration authorities. The main obstacle to scaling up T-CPR, however, remains the patchwork nature of 911 itself. Though the national system is coordinated by the Federal Communications Commission, 32 states have adopted “ home rule ,” meaning that 911 and other services fall under local or regional control. As a result, implementing universal, consistent T-CPR programs is slowed by funding and staffing shortages and communication problems.

The AHA has argued that T-CPR is overwhelmingly cost-effective compared with other measures designed to reduce the time to first chest compression. Yet states and localities have limited budgets for new emergency-services initiatives. And 911 dispatchers, who are in short supply nationwide, were overburdened even before the start of the coronavirus pandemic. They are at the crux of a tightly choreographed feat of adrenaline, transportation, and communication; a high-stress job performed on marathon shifts, with varying degrees of training, and for low pay. Given the existing demands on dispatchers, who are disproportionately women, some are understandably wary of being held accountable for negative outcomes. “If anything goes wrong,” Heinze said, “the liability then falls more on the dispatcher than it does on the organization.”

Complicating matters is the fact that none of the nearly 6,000 emergency dispatch centers in the U.S. operates in exactly the same way. So when a 911 call from one area is routed to a dispatch center in the next town over—a not-uncommon occurrence—a caller may be transferred from a dispatcher trained in T-CPR to one who is not. And by the time responders arrive, it could be too late for someone like Todd in the throes of cardiac arrest.

Even when a bystander is lucky enough to connect with the right dispatcher, there are many points when things can go wrong. The reality is that not all bystanders can or will act.

Some simply aren’t physically capable of doing so. CPR requires two hands and has been compared to shoveling snow or walking through sand; one must push down 2.5 inches on the victim’s chest 100 to 120 times a minute in order to generate enough cardiac output. “It’s very tiring,” Fazzino, the FDNY liaison, explained.

Others might be concerned about infection risk, a worry inflamed by the coronavirus pandemic. Still others might be hesitant to perform CPR for fear of inadvertently causing physical harm, or of interfering with what they believe fate has decided for the victim.

To avoid these pitfalls in the course of T-CPR, dispatchers such as Adolfo Bonafoux don’t ask many questions once they’ve established that someone is calling on behalf of a person who is not breathing. “I will tell you what to do,” says Bonafoux, who fields emergency medical calls at the heavily fortified, Bronx-based PSAC II, one of New York City’s two public-safety answering centers.

By not asking questions or for a caller’s permission, “it takes the option away from you,” Bonafoux explained to me. “You’re more willing to act and follow my direction. Because if I give you the choice, you’re gonna stop and think. You’re gonna start to weigh all the variables. And that time is very valuable.”

Bonafoux is a former U.S. Army medic with 20 years of emergency-medical-service experience. He joined the FDNY in 2007, first as a paramedic and then, after being injured in the field, as a dispatcher. (He has formal training in, among other things, T-CPR protocols, a requirement instituted by the department’s medical directors.) Technically, he’s what’s known as an ARD, or assignment-receiving dispatcher. He isn’t the first person a caller talks to—that would be a police dispatcher, who discerns whether the caller needs to speak with the police, the fire department, or emergency medical services, and notes the caller’s location. Bonafoux receives the medical calls transferred from that police dispatcher, and handles the pre-arrival medical portion of the relay.

“My philosophy is if you’re not willing to do it, you’re going to stop me,” Bonafoux said. “Obviously I can’t force anybody over the phone to do anything. So I take an aggressive stance. A lot of times, people in a pressure situation, they’ll just do. They won’t hesitate, they won’t think about it, they’ll just do.”

Following Todd’s accident, I suspected that simply asking “What are the ratios?” had indicated to our dispatcher that I was familiar with CPR. And because of that baseline, it didn’t take much to get me to go .

Bonafoux later confirmed that hunch. He was the voice on the other end of the line, who walked us out of the depths of what Lex and I have taken to calling the Bad Night. “Muscle memory,” he said. “Once you have done it before, you remember it. Your brain starts remembering it. Your body remembers how to do it. That all contributed to the success of your father-in-law.”

T he first responders , a paramedic team, arrived on the scene at 7:44:55 p.m., followed by the engine company, an FDNY lieutenant, and basic and advanced life-support units.

“From the time that the call comes in to the time that somebody is actually standing there, a professional provider, is [about] four minutes,” Fazzino told me over the phone, as he paged through our case file. The “real magic,” he said, is in that response time.

I remember a paramedic from the first unit crouching beside me, slinging a life-support bag off her shoulder and asking how long I’d been going at it, before relieving me. “Would you have guessed that was, you know, two and a half minutes of CPR you did?” Fazzino asked. “You get that serious fight-or-flight adrenaline rush. Your sense is enhanced. It becomes very surreal.” What felt like an eternity was really 150 seconds.

By 8 p.m., Todd had been shocked seven times with a portable defibrillator—typical, Fazzino said, for ventricular fibrillation, the kind of electrical disturbance of the heart that Todd experienced. Responders, now numbering at least a half-dozen, ran Todd’s electrocardiogram . That included the multiple defibrillation attempts, medications administered, and intubation.

Start to finish, the event clocked in at about 35 minutes, on par for this type of resuscitative effort in the field. Total call duration, including the T-CPR? Six minutes.

By 8:20 p.m., Todd was loaded into an ambulance. Lex and I got into a second ambulance, which followed closely as our caravan sped toward NYU Langone, the nearest hospital, about 10 minutes away. Port Authority officials temporarily halted Queens-Midtown tunnel traffic to allow us to slip through. I remember the lights streaking past our windows.

Todd was shocked an eighth time after being reeled into the emergency room. A long night was still ahead of us. But he now had a pulse—a testament to the help we’d gotten in those crucial first moments.

Without T-CPR, “God forbid, what could have happened to your father-in-law?” asked Democratic Representative Norma Torres of California. “You wouldn’t have had somebody talking you through that.”

Torres, a former 911 operator in Los Angeles, is the lead sponsor of the 911 SAVES Act , a bipartisan bill that aims to reclassify 911 operators and other public-safety telecommunicators as “protective service occupations” under the Office of Management and Budget’s Standard Occupational Classification System . As it stands, dispatchers like Bonafoux are classified more as office secretaries. Torres wants to change that federal labor designation—with no disrespect to secretarial workers, she said—to encourage states to recognize dispatchers as crucial workers, recognition that in some states could exempt them from government furlough. Without dispatchers, Torres said, “we can’t get the help that we need.”

A recently formed NENA-AHA working group, meanwhile, is focused on further standardizing T-CPR. (The AHA, for its part, has also launched Don’t Die of Doubt , a campaign to address the “ alarming drop ” since the start of the pandemic in 911 calls and ER visits by people needing urgent medical care after a stroke or heart attack.) But it would seem that scaling up T-CPR is as much about recognizing and supporting dispatchers as it is training lay people in CPR, something Lex and I have undertaken in the aftermath of our experience.

Here’s what I do know: The FDNY location from which the responding units were dispatched is mere blocks from the restaurant. NYU Langone happens to be one of the country’s top cardiac-care hospitals, too. Not only did I have the advantages of previous CPR training and Bonafoux’s experienced help, but we were in the right place at the right moment. Both luck and privilege—our well-appointed location, my previous training—were on my family’s side.

But the further I dig into the night of March 21, 2019, the clearer it becomes that I won’t ever be able to fully account for what transpired. I’d been on the fence about joining Lex and Todd for dinner, but made the last-minute decision to go. What if I hadn’t? It’s also entirely possible that, had Lex not immediately cried out for someone to call 911, kick-starting the “chain of survival,” this story would have a much different finale.

I asked Fazzino how many out-of-hospital cardiac arrests were reported in New York City in 2019, and of those patients, how many survived until either emergency services arrived or they reached a hospital. He couldn’t say for sure, but noted that the “vast majority” of patients behind such emergency requests that come into the city’s two call centers ultimately do not make it.

Of the minority of people who do survive, how many of them get to go home? That number, Fazzino said, is even smaller. Todd did what many people have not, “which is to cross the line and then come back to tell the story about it.”

The first night at the hospital, Todd was put into therapeutic hypothermia—“on ice,” the doctors called it—in an attempt to redirect blood from the rest of his body to his brain. We were told he would stay in this medically induced coma for up to 72 hours. The next morning, less than 18 hours after his heart gave out, he woke up on his own. I can still see the look of surprise and excitement on the attending nurse’s face. “Who did the bystander CPR?” one of his doctors asked. Lex pointed at me. “Well done.”

The following evening, in a quiet moment in a hospital lounge, Lex and I decided to get married. Todd was able to come to the wedding, three months later.

“By the way,” he said, shortly before being discharged. “Thanks.”

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