Time is of the essence in cardiac and respiratory arrest. When your heart stops pumping blood, and when you cannot breathe effectively, you're a goner unless something intervenes to change things mighty quickly.
We often talk about the importance of having fire stations strategically located and the importance of rapid turnout times by firefighters and paramedics. You don't hear much, however, about the critical role of the first first responders: the dispatchers.
When someone calls 911, the response is not instantaneous. In all but the smallest 911 centers, the job of fielding the phone call is separated from the job of radio dispatching: the call taker gathers the information, then forwards it to a dispatch position when enough has been collected to know who needs to be sent, where, and with what level of response--basic life support, advanced life support, multiple units, lights and sirens or not, and so forth.
This all takes a little time. Callers don't always know their exact location, and cannot always communicate clearly right away. Even in the best circumstances, call takers must ask clarifying questions:
"Are you with the patient?"
"Is she breathing normally?"
"Is she clammy?"
"Did she take any drugs or medications in the past 12 hours?"
... and so forth. The basic details are often forwarded to the dispatcher as this questioning continues, but even then the dispatcher has to read the call information, decide what to do, find some clear air time on the radio, and actually say the words necessary to set the responders in motion. It takes longer than you might think. This interval of time, from the 911 ring to the dispatch of the responders, is known as call processing time.
Earlier this year, Lincoln's 911 Center implemented some changes to our protocol, under the supervision of our medical director, to try to shave a few seconds from the call processing time for the highest priority medical emergencies. Our medical director also did some great staff training to improve the ability of our dispatchers to recognize an ineffective respiration pattern known as agonal breathing.
The results of this enhanced training the protocol tweak have been impressive thus far. These changes were implemented on June 1st, and since that date we have dispatched 79 presumptive cardiac arrest events. The call processing time on these was 31 seconds faster than the 51 incidents dispatched during the same time period in 2015. The numbers are still rather small, but that is a huge improvement, and if it holds, represents an accomplishment that will contribute significantly to survivability.
My hat is off to our medical director, Dr. Kruger, and to the 911 Center staff. These early results are very encouraging, and I will keep tabs on the call processing time as we gather more experience.