June 01--New data on how long it takes to answer emergency calls and dispatch responders is increasing pressure to reform the Dane County 911 Center's procedures.
On Friday, County Executive Joe Parisi called for a series of immediate steps, and the Dane County Public Safety Communications Center board has set a meeting for 1 p.m. Wednesday to consider them.
Parisi's request, based on data that show the center handled more calls more quickly with fewer staff in the mid-2000s than today, follows findings that the center is failing to meet national standards for answering the phone or sending help.
The data, including months of records requested by the State Journal, are also shedding light on exactly where time is being spent on handling calls and where efficiencies might be possible.
The director of the 911 Center, John Dejung, maintains the center is effectively handling the overwhelming majority of calls. But even before Parisi's urgent request Friday, the center, its board and committees have been exploring ways to streamline the process.
"We've got to make sure the public has confidence in the 911 system," said Maple Bluff Fire Chief Josh Ripp, the newly elected 911 Center board chairman.
The center, which gets more than 300,000 emergency calls annually, has been under fire since the rocky rollout of a new computer-aided dispatch (CAD) system in April 2013.
Recently, officials verified a complaint that it took 72 seconds just for someone to answer the phone on one emergency call.
Data show the center isn't meeting the national standard for picking up the phone within 10 seconds 90 percent of the time. And once a call is answered, the center is not coming close to the standard for dispatching fire emergencies within one minute -- or 90 seconds in medical emergencies where special instructions are needed -- 80 percent of the time.
Median times -- when half the responses are quicker and the other half slower -- which Dejung contends more fairly represent the typical response time, show the center coming closer to the 60-second and 90-second standard.
"The vast, vast majority of the time, we get it right," Dejung said. "Lives are saved. Property is protected. And we're working hard to do it better and better."
Where there have been problems, most can be traced to a number of changes that were made to the center "literally all at once," said Randy Pickering, president of the Dane County Fire Chief's Association, citing implementation of the new CAD system, radios and call-taking protocols for law enforcement. "You set up a no-win situation."
Debra Julian, who worked at the center for nearly 25 years before retiring in early April, said some changes have significantly added to the time it takes to answer and process calls, sometimes creating a loop in which staffers get tied up and unable to answer new calls.
"We're just getting too much information," she said.
In early May, at Parisi's prodding, the center board accelerated a pilot "pre-alerting" program for more serious emergencies that so far has cut roughly 30 to 60 seconds off dispatch times.
Now, the county executive wants to immediately suspend call-taking protocols for police calls pending a review of their effectiveness, redeploy resources for the peak summer season, develop strategies for call surges, hire part-time employees, review the process for handling hang-up calls, and maximize technology.
"There seem to be data-driven solutions here," Parisi chief of staff Josh Wescott said.
Cellphones, heavy use spur delays
Each emergency call can be broken into six pieces, and data are allowing new insight into where time is spent.
A call taker must answer the phone; get the caller's address, phone number, name and nature of the emergency; go through a series of scripted questions; alert a dispatcher; and, often, continue providing instructions before responders arrive at the scene. Meanwhile, a dispatcher must acknowledge the alert, ask a computer for a recommended response and send responders.
The most recent concern is the time it takes to answer the phone.
At any given time, five to eight call takers working 14 lines handle incoming calls, most of which are placed by cellphones. If a large number of calls come in, either because many people are reporting the same emergency or a lot is happening at once, calls are put into a queue and taken in the order received. Call takers have no way of knowing the nature of a call in the queue, meaning a call for a heart attack and a cat in a tree equally wait their turn.
In the first quarter of 2014, the center answered 82 percent of the 40,360 calls it received within 10 seconds, data show. But more than 1,000 calls took more than 30 seconds, and 578 of those took more than 40 seconds.
The long waits primarily occurred during times of heavy usage, Dejung said. "You want to build the freeway for rush hour," he said. "Nobody does. It's unaffordable."
Years ago, when all calls were made with land lines, the phone company could choke off multiple calls presumably reporting an event from a specific area, Dejung said. But with cellphones, it's a different story. The industry is now exploring if it can block calls that are coming from a certain distance of a cell tower, but "it's not ready for prime time yet," he said.
After the phone rings for about 20 seconds, the caller gets a recorded message or, if all 14 lines are in use at once, a busy signal. The challenge increases when a caller hangs up because call takers must attempt to contact the person, which only increases the workload.
Parisi asked for review of the abandoned call process, and Dejung said the center was already exploring ways to prioritize waiting calls, likely by having call takers ask a few quick questions, take some calls and put others on hold, and having more staff available for anticipated call surges.
Protocols: helpful, or hindrance?
Once a call is answered, data show that getting a caller's address, phone number, name and nature of emergency can take more time than any other part of a call.
For serious "Delta" level calls such as fires, it took up to 1 minute, 10 seconds in 80 percent of the calls just to learn that information, data from May 2013 through March 2014 show. Police calls took up to 1 minute, 53 seconds 80 percent of the time.
The delays are mainly due to cellphones. Many callers are under duress and, especially if in a car, often don't know exactly where they are, center operations manager Rick Lange said, adding, "Everything we do is preordained on location."
"Unfortunately, the call taker has to spend more time with them," Madison Fire Department Assistant Chief Lance Langer said.
Some time can be saved by initially focusing on the location and nature of the problem and not having to repeat information if it's clear the first time, Julian said.
The next step, asking a series of scripted questions, can take a lot of time and is a matter of intense debate. For a Delta-level fire call, the questions took up to 1 minute, 1 second 80 percent of the time.
The Dane County 911 Center was the first in the state to use computer-aided, scripted questions for medical, fire and police calls, vetted by and purchased from Priority Dispatch Corp. of Salt Lake City. Call takers ask a series of questions to get specific information to assure the right help is sent to the right place at the right time.
For the most serious, life-threatening emergencies, called "Echo" calls, which include a person on fire, trapped in a sinking vehicle, choking or not breathing; a vehicle in flood water or with the accelerator stuck and unable to stop; or an active assailant, the call taker essentially skips the protocol and sends basic information to the dispatcher while remaining on the phone with the caller to ask more questions.
The debate is about calls for other emergencies -- "Delta," "Charlie" and "Bravo" calls -- for events like a structure fire, domestic dispute, chest pain, retail theft or pregnancy complication.
The protocol ensures the right questions are asked and responders have a fuller picture of what going on at the scene. But it can be frustrating for callers and "takes four times as long," said Julian, who recommends getting rid of the rigid system.
Pre-alerting speeds process
The center board recently made changes, approving a pre-alerting program for more types of serious emergencies starting May 5, meaning responders are dispatched more quickly for certain types of fires and significant rescues.
Parisi, noting communicators are on the phone an average 25 seconds longer per call since Priority Dispatch for police began in 2010, has recommended immediate suspension of the program for police calls pending the center board's review.
The Madison Fire Department also would like to see pre-alerting for more types of potentially life-threatening or unknown situations. "The more calls that can be pre-alerted, the quicker we'll get closer to (national) standards," assistant Chief Laura Laurenzi said.
Dejung said such changes are "worth investigating" but cautioned that the center risks losing accreditation from the International Academies of Emergency Dispatch, which sets standards for Priority Dispatch, and opens the door to litigation from emergency victims.
After key information is gathered, call takers send a message to a dispatcher's screen. Data show dispatchers are spending time acknowledging the information, getting a recommendation from the computer about what to do next, and sending responders. For emergency fire calls, those phases took 58 seconds or less 80 percent of the time.
Dispatchers are typically multitasking and prioritizing, Dejung said. But the center is exploring the potential of automated pre-alerting.
The center also needs a new phone system and improved CAD technology, Julian said.
The center has 88 full-time staff, including 69 communicators cross-trained as call takers and dispatchers. Dejung said he'd like to implement various efforts to deal with call spurts before seeking more personnel.
But Dejung cautioned, "We want to be sure we don't overreact. We don't want to throw out protocol just for the sake of speed. In some cases, speed's not the most important thing -- accuracy is, for everybody's sake."
Copyright 2014 - The Wisconsin State Journal
