Don`t Get Lost in Translation: Best Practices for Communicating with 9-1-1

During my 30-year career, I was always perplexed when members of the general public would have outward disdain when questioned during the initial 9-1-1 call or after you arrived on scene. I realized this derived from a lack of public education on our part.

We have all heard people call 9-1-1 in frustration: “Why are you asking all these questions? SEND HELP!”

Even better is when we are actually on scene: “Why are you asking if he has had a heart attack before? Just take him to the hospital!”

I understand public perception that the questions are a waste of time. Confronting this on scene when you can hear the murmurs of the crowd can create those “heart in your throat” moments.

Imagine you are outside on a hot summer night with 100 people around and a member of the family standing very close to you questioning what we are doing and why. It’s never the smallest member of the family; it is the guy who looks like he is an ex-MMA champion. Did I mention he was getting really close to you?

A failure to communicate is not limited to the general public. Sometimes that failure occurs when emergency services providers attempt to access 9-1-1 for themselves.

My son is in the Boy Scouts, and they have a program called Scouting for Food. It is hectic trying to corral 30 young men-boys while trying to keep them focused. I am, like most people, over-worked, tired and my patience is thin. Trying to manage everything can be in a word exhausting.

I made a wrong turn leaving the food bank and I noticed a naked man walking out into traffic acting aggressively toward some of the cars. I was concerned, because there was tractor-trailer traffic that, in my past experience, can be exceptionally unforgiving with pedestrians. The challenge for me is, with my son and a couple of scouts in the car, I cannot get out and attempt to draw this person over to a point of safety. I figured it would be easy to call this into 9-1-1 and be on my way.

Depending on where you are in my state, if you call 9-1-1 on a cell phone you will either get the local police or the state police.

The unofficial transcript of my call:

State police: what is your emergency?

(Damn, I didn't want the state police. The local police would be more familiar with the area. I can't hang up or they’ll just call me back)

Me: Yes I’m on Army Street, there is a naked man out here acting aggressively. There is some tractor-trailer traffic out this way as well.

State police: A naked man. Is he doing anything?

Me: No. Well, he is walking around approaching people aggressively.

State police: Does he have any weapons?

Me: I don’t see anything, but he has a grey bag in his hand. I can’t tell what is inside it.

State police: What does he look like?

Me: Caucasian, 5 foot 10 inches, reddish brown hair, chubby, naked.

State police: Any scars or distinguishing marks?

Me: Excuse me?

State police: Any scars or distinguishing marks?

Me: Why do you need to know?

State police: So the officers can identify him.

Me: So a chubby naked white guy with reddish brown hair isn’t good enough? How many chubby naked white guys with reddish brown hair do you have walking around?

State police: Sir they need to be able to identify the person, can you answer the question?

Me: Hold on. Yes, it appears he has a tattoo below his waist. Wait, that’s NOT a tattoo. Never mind.

State police: Sir if there are no distinguishing marks just say no.

I answered the rest of the questions without difficulty, and in short order the police showed up. They handcuffed the gentleman and gently lowered him to the ground. They did a great job.

If this was the end of the story this would just be a funny story. We would have a laugh, and everyone would go on their way. If life was only that easy.

I related the story to my wife, who is a 9-1-1 dispatch/supervisor for the City of San Francisco. They handle all communications for police, fire and EMS. She holds multiple certifications and was an EMT for 20 years. She has received multiple awards for her work.

When I was done relating what happened, she said “Daniel…”

I knew immediately I was in trouble.

Perspective is a funny thing, she told me. If this request was being screened by an EMS dispatcher for a medical emergency, they would want to know the name, age, sex, location (floor/apt, street address), chief complaint, medical history among other things. Then they might provide some pre-arrival instructions before EMS arrived on scene.

When a fire department responds to a fire it is usually at a fixed location. They tend to correlate emergencies with an address. Mention a patient name and they probably will not remember the call. Mention an address and they’ll tell you how many times they responded there for the 5-year-old with asthma. If you were calling to report a fire, the dispatcher would want to know the street address, closest cross street, if the house was occupied among other things.

The police need different types of information to identify two groups: potential victims of a crime and the perpetrators of the crime. Their questions would be: was anyone hurt, where is the hurt person, what is their name, who is the assailant, what did he look like, what he was wearing, etc.

Sheepishly, I looked at my feet and said “I know. But he was naked. How many naked guys are there running around?”

She asked what was in his bag, and I responded that I didn’t know.

She said he could have had clothes in there, and when he heard the police siren he could get dressed and try to blend in with the crowd.

“What if he had a gun with his clothes and wanted to hurt someone? The cops are looking for a naked red-headed chubby guy. Here is someone who is dressed. If he had a scar or a tattoo now they would have something else to identify him by,” she said.

“But I waited until police got there,” I responded.

She said most people won’t wait.

I learned three important lessons that I might have easily overlooked if I didn’t have this experience.

First: The world we live in is bigger than ourselves. We are all interconnected in ways that we cannot appreciate. It was this interconnectivity that came into play when I tried to access the system. Only then did I understand the frustration and complexity other members of the public have experienced. Our actions affect people up and down stream from our point in time and space. At the end of the day it is never about us, it is all about a patient, a victim or the general public.

Second: Even though I work and live in EMS, I forgot the most basic of lessons. The wants and needs of EMS are different than those for police and fire. Information is power, and regardless of who is coming and what they are needed for, we require information to be effective for reasons that may not occur to us. Providing the information to them when they request it improves their effectiveness.

Words and phrases can complicate the transmission of information. They may have different meanings to different people, or they may need to conceptualize it in a way they understand. This all may be affected by culture or regional dialects.

I was born and raised in Newark, NJ, but I live in California now. I called in a mugging to the police in San Francisco. While I was talking to the dispatcher, she asked what the perpetrator was wearing. I gave a description, and I said he had on blue sneakers. She paused for several seconds and said “do you mean tennis shoes?”

That term never would have occurred to me, but if she didn’t provide me feedback, I had no idea if she knew of what I was trying to communicate to her.

Another issue with information exchange is translation. When I first became a paramedic, we responded to many Hispanic neighborhoods. They would state the location of the patient as the first floor, to me that meant street level but to my Hispanic friends that meant the first floor above the street. Street level in the Spanish culture was for stores and shops, first floor was always the first floor above the street or the livable space. Lesson learned.

Third: When I am tired and stressed, take a deep breath and hand the phone to my son.

References

Burba A, Chapleau W, et al. The Paramedic. Career Education, 2008 Jan.

Dan is the EMS Coordinator for the City of Oakland, the 33rd largest city in the U.S. He is a recognized expert in EMS System delivery and design, EMS/health-service integration and service delivery models for out of hospital care. Dan has worked with the Centers for Medicare and Medicaid Services on EMS and integration into accountable care organizations that resulted in EMS being included in the Innovations in Healthcare Grants awarded by Health and Human Services. Dan has completed a Fellowship at the Harvard University Kennedy School of Government for Local and State Leaders. He is also the Vice President of Local 21 of the International Federation of Technical and Professional Engineers and is a founding member of the International Association of EMS Chief’s. Dan is the author of numerous articles and book chapters, including topics on Human Resources for EMS management and ambulance operations. He was the lead consultant for the Ambulance Service Re-Design for Hong Kong Fire Services, Dan was recently invited back to work with AECOM on further system design and development for Hong Kong.