When the 9-1-1 call for actress Demi Moore was released a couple of weeks ago, it prompted a number of public sentiments – concern, ridicule, and jokes at her expense (not to mention calls to restrict the ability of the press to obtain 9-1-1 call recordings). One response that I didn’t expect, but probably should have, was criticism of the 9-1-1 operator and the process of asking so many questions of the caller. If we can get past the tabloid sensationalism of the incident, there are some great learnings about how emergency responders handle 9-1-1 calls (for other tips, you might also want to check out my last post on 9-1-1 facts citizens should know).
Let’s start with a few quick facts about Ms. Moore’s call that I will attempt to explain in this post:
- The 9-1-1 call lasted just over 10 minutes…how many seconds of the call did you hear? (I’d encourage you to listen to the full call on TMZ’s website)
- The 9-1-1 telecommunicator was forced to speak with three different people during the course of the call, two of whom were not terribly cooperative
- Demi Moore was reported by the caller to have “overdosed” and was “convulsing” and “semiconscious”
- The call taker was following an established emergency medical dispatch protocol
- The telecommunicator remained on the phone until paramedics arrived (~ 8 minutes from the point at which the location was established is a pretty decent response time)
Based on a 20-second sound byte of the Demi Moore call played on a local morning radio show, the hosts of the show immediately started criticizing the 9-1-1 operator (or call taker) for asking so many questions. “Just send help!” said one of the hosts. I finally took the time to listen to the call in its entirety. It actually illustrates several key issues everyone should understand about our emergency communication system and processes.
Routing of Wireless 9-1-1 Calls
This call was evidently placed from a wireless telephone. Wireless calls are routed to a specific 9-1-1 center based on the cell tower that the call is broadcasting from. In this case, the call was routed to the City of Los Angeles’ 9-1-1 center. Initially, there is some confusion as to whether the address is in L.A. proper or the City of Beverly Hills. Since the caller stated (incorrectly) that she was in Beverly Hills, the L.A. telecommunicator quickly transfers her to the Beverly Hills 9-1-1 center. Appropriately, the L.A. telecommunicator remains on the line. Once the Beverly Hills 9-1-1 call-taker realizes that the address is actually in L.A., she turns the call back over to the first call taker. All of that took 2 minutes and 6 seconds.
Structured Questioning & the Emergency Medical Dispatch Protocol
9-1-1 callers often get frustrated when answering questions because they don’t realize that responders, in this case at least Fire and EMS, are dispatched shortly after their address is verified. In the Demi Moore call, you can hear the call taker inform the caller very early on that paramedics have been dispatched. The systems in place in a 9-1-1 center allow for a call to be dispatched while the caller is still on the line and before all of the questions have been answered.
The vast majority of 9-1-1 centers use a highly-structured protocol, commonly known as emergency medical dispatch (EMD), for determining the nature of a medical emergency and identifying those patients with immediately life threatening conditions. There are several reasons for this. A protocol, not unlike one used for providing medical care or assembling a widget in a manufacturing plant, ensures consistent service provision across different shifts and individual employees. In this case, that is critical, since the answers to the questions dictate what emergency resources are dispatched to the scene, as well as prompting the 9-1-1 telecommunicator to provide specific instructions to the caller before responders even arrive (hence, why the L.A. 9-1-1 telecommunicator asks multiple times whether Demi Moore was still breathing normally – had the answer been “no” at any point, he would have provided CPR instructions to the caller).
Finally, while the telecommunicator didn’t necessarily have to remain on the line until the paramedics arrived, he opted to because he likely felt uneasy about either the patient’s condition or the callers’ reaction to the situation. There aren’t too many pre-arrival instructions to give to a caller in this situation other than to have someone meet paramedics at the door or driveway, not to restrain someone who is convulsing, not to put anything in their mouth, and to make sure that their airway remains open. You can hear the call taker repeat a couple of these instructions, which I suspect he did to keep the caller calm and to fill time.
Another incredibly important reason for asking structured and detailed questions is to establish the safety of a scene for responders, which is always priority number one. We can’t help anyone if we are injured or killed ourselves, and we’ve then also added to the total number of patients. Emergency incidents can be charged with emotion, can occur in unsafe areas, or be the result of a violent crime. They are also dynamic – a scene that starts off safe (or seemed to be safe at the time of the call) can rapidly devolve into a dangerous situation. Medical responders (Fire and EMS) do not have specialized training, powers of arrest, and weapons necessary for calming or controlling an unstable situation. Obviously, that’s left to law enforcement officers who generally don’t respond to medical calls unless needed.
The answers provided to certain questions contained within the EMD protocol, as well as other clues, allow the telecommunicator to establish whether a scene is safe for medical responders to enter or whether it is advisable for them to await the arrival of law enforcement. It’s a straightforward decision not to send EMS into a scene where someone has been shot until police can secure the scene. However, in more subtle cases such as overdoses, the decision becomes much less clear. This is why it is important to ask whether someone intentionally or accidentally overdosed, which the 9-1-1 call taker did during the Demi Moore call. Someone who has intentionally overdosed or attempted suicide will typically not be appreciative of attempts to save their life, which can result in an assault on EMS personnel.
Final Thoughts & Tips for Calling to 9-1-1
In short, while the Demi Moore call may have gotten off to a slightly shaky start because of the confusion over which city they were calling from, I believe the L.A. 9-1-1 telelcommunicator did a great job under some difficult circumstances. In any case, I hope that dissecting this incident a bit is useful to those who have never had call 9-1-1 or don’t fully understand how the system works.
Following these simple guidelines will help the 9-1-1 center send emergency assistance quickly:
- Call from a landline whenever possible
- Have an address or precise location to provide the telecommunicator
- Listen carefully to the telecommunicator’s questions and provide information as it is requested
- Attempt to speak as clearly and as calmly as possible
- Follow the instructions that the telecommunicator provides to you, unless you feel they will place you in danger
- If in doubt as to whether someone is in distress or something is suspicious, call 9-1-1
- Make sure your children know your home address and teach them how and when to use 9-1-1
- Create a safety profile in a system such as Smart911.com to provide relevant information about you and your family to emergency responders in the event you are unable to do so