Dispatch Drives the Business
Emergency medical dispatch is the lifeblood of Brewster Ambulance Service. Every call starts in the dispatch communications center and ends in the communications center. These are our customers. These are people in need in the communities we serve. Our neighbors. Our families. Our businesses and visitors.
The dispatch communications center comprises two primary elements: technology and people. The technology side includes computer-aided dispatch (CAD) consoles, Public Safety Answering Points (PSAP) to carry the calls, EMD (Emergency Medical Dispatch) Guidecards. The technology seamlessly integrates with other systems from our electronic Patient Care Reporting (ePCR) to billing, so each call is tracked throughout its lifespan.
The PSAP hardware is NextGen 9-1-1 compliant, which is an improved operational model over legacy analog, circuit-switched and point-to-point models based on IP transport, geographic information systems and modern network functional elements. This NextGen compliance allows cell phone callers' information to pass through right to dispatch centers once the carrier network infrastructure (new towers) are updated to support this type of data.
On the people side of the equation, our dispatch communications centers are staffed with trained call operators and Emergency Medical Dispatch-certified (EMD) dispatchers. When calls come into the comm center, the manner with which the dispatcher handles the call can make the difference between life and death.
Brewster Ambulance operates dispatch communications centers in Brockton, Boston and Fall River. Due to Fall River's low call volume, the comm center is staffed for 12 peak hours during the day. During non-peak hours, all calls are dispatched through the Boston comm center. There will also be a new state-of-the-art communications center going into operation at the new Brewster Ambulance headquarters in Weymouth.
9-1-1 Emergency Communities
The comm center handles a variety of calls ranging from prescheduled, non-emergent transports to 9-1-1 emergency response calls. Brewster Ambulance provides in-house 9-1-1 Emergency Medical Dispatch for these communities:
Brewster Ambulance also provides 9-1-1 Emergency Medical Services to the City of Brockton, however, the Brockton Fire Department operates their own dedicated dispatch center. Calls come in through Brockton's 9-1-1 call center and are then dispatched to first responders and to Brewster Ambulance.
Comm Center Operator Training
New dispatchers receive training and begin as call takers for approximately two weeks. They receive calls, gather the appropriate information and book non-emergent transports. These non-emergent transports are often prescheduled events such as transporting a patient to a doctor's appointment, dialysis treatment or other medical appointment. Because of age or failing health, their transport requires an ambulance and could also include special equipment such as oxygen, tracheostomy care or bariatric transportation.
The dispatcher has to have a high degree of patience and understand how to clearly communicate with the caller, as callers dramatically range in diversity and understanding of medical terminology and EMS transport procedures. For instance, most people don't know the difference between an ALS and BLS and chair car transport. Dispatchers have to gather as much specific information and ask the proper questions so the correct vehicle and equipment are assigned to the transport.
After a few months of this training and experience, Brewster Ambulance puts the new dispatchers through EMD training so they can literally save peoples' lives through the phone. The two state-recognized EMD training resources used by Brewster Ambulance include APCO International's EMD program and the International Academies of Medical Dispatch. Once the dispatcher has received their EMD certification from either of these programs, they are able to work 9-1-1 Emergency calls.
In addition to EMD training, it's important for dispatchers to have detailed area knowledge. Dispatchers also have to be able to multitask, prioritize and not cross vehicles. The best dispatchers are often those who have come off the road because they have area knowledge and in-the-field experience on-scene with patients and transports. Many dispatchers and comm center operators progress in their EMS career from being in the field as an EMT or paramedic to dispatch.
Performing under pressure
Although trained in-house and by these two premier EMD schools, dispatchers learn their discipline, patience and demeanor through experience. The skill set required to calmly communicate with a panicked caller who is in a critical situation is learned on the job. There is nothing like experiencing real-time events through the phone line when you have no ability to physically be there to help the caller.
Emergency Medical Dispatchers are trained to use EMD guidecards, which are pre-formatted scripts based on medical scenarios that provide pre-arrival care instructions for the patient. These guidecards take the pressure off of the dispatcher to "freelance" instructions and help maintain consistent directions for every call. Call takers and PSAP operators work eight- or ten-hour shifts.
In the dispatcher's in-house training, it is stressed that the dispatcher has the ability to save a life, that people can die on the other end of the phone call. Dispatchers are taught that the caller is at their most stressful, weakest moment during these calls. The dispatcher talks them through very scary situations, whether how to do CPR or provide other pre-arrival care to the person in need. This interaction is an intricate part of pre-hospital care.
Teamwork and Experience
Dispatchers are cultivated, not just trained. Brewster Ambulance's approach to training advocates experienced dispatchers and call operators to guide, support and share best practices with less experienced trainees. This required skill set revolves around how the dispatcher manages their tone and calmness with the caller. Modeling these behaviors is a key ingredient to a successful outcome for the patient as well as helping new dispatchers learn the ins and outs of call taking. Dispatchers support one another, have post-call discussions on what worked and what could be done better, and help one another to understand caller dynamics and best practices for handling stressful situations.
For more insight into what it's like to be a Brewster Ambulance dispatcher, read this team profile article.