by Jim Marshall, M.A., President and Certified EMDR Therapist

Back in 1985 I visited my sister, Debbie, a 911 telecommunicator, at her workplace--the Waterford Police Station (MI). It was my first "sit-along" and I was fascinated.1 She explained her job as we began: "Our responsibility as dispatchers is to gather all the information from the caller, decide what help they need--fire, police, or medical, and safely send those first responders to the scene.."

In the first hour there were no "big" calls and I was starting to get a little bored. Just then a call came through from a lady who thought her husband was having a heart attack. I watched and listened carefully as Debbie whirred into gear: first she got the vital information: the woman's location, identity, and as she dispatched "first responders" to the scene, she pursued a more detailed description of the medical emergency.

Yet, she did much more than that: from the moment the call began she also practiced a careful tone, offered words of comfort and reassurance, and Debbie helped redirect the woman's energy and attention to assessing her husband's condition--she moved the woman from feeling helpless to becoming a first responder who could help increase her spouse's chance at survival. Then as they waited for the emergency medical team to arrive, Debbie guided the woman in gathering her husbands' medications, making plans to notify her children, and get support for their care in case she would not be returning home soon.

After witnessing this call, I took a deep breath, sat back and said: "Debbie< let me ask you something: since that woman called the station and you were the one who answered the call and helped her before anyone else could reach her, wouldn't that make you the first responder?" "Well, yeah..." Debbie explained, "... technically maybe but we're not called first responders--that's the professionals and paraprofessionals who arrive first on the scene--they're the first responders." Somehow it seemed she had learned to accept that she was not what she had in fact just proven herself to be. And this dismissal seriously undervalued her role in helping to save this man's life. But what's in a name anyway, right?  

Not long after that first visit to my sister's PSAP, Dr. Jeffrey Clawson (now widely regarded as the father of modern emergency medical dispatch) emphasized the crucial importance of recognizing the vital role that emergency telecommunicators play as the "first 'first responders'" to calls involving medical crises like the one I had witnessed. Representing the consensus position of the National Association of EMS Physicians, he wrote:

The Emergency Medical Dispatcher (EMD) is the principal link between the public in need of emergency medical assistance and the EMS system. As such, the EMD plays a key role in the ability of the EMS system to respond to a perceived medical emergency. Most often, all of the information obtained is through telephone communications with a caller who often is distressed and out of control. The EMD must have skills which allow him/her to match the personnel and equipment dispatched to the perceived emergency...

In essence, the EMD is the first "first-responder" and through immediate action effectively can eliminate the often deadly gaps which may occur between receipt of the call and the beginning of treatment which is delayed until after the arrival of the responding vehicles and personnel.2 

So, when in 2005, I began training 911 telecommunicators in personal management of traumatic and workplace stress, I was struck with concern in noticing that they and virtually all providers of 911 emergency response service still referred only to police, firefighters and EMS providers as First Responders--dispatchers were still categorically omitted from this designation. Today, after teaching over two thousand 911 dispatchers how to manage their traumatic stress on the job, I feel a sense of urgency to advance Dr. Clawson's position of respect for dispatchers as the First First Responders.
Historically, 911 telecommunicators were not seen as professionals by the rest of the law enforcement and emergency medical response team. They were considered to be performing a clerical duty--just answering the phone. And they were usually equipped accordingly--no mandatory training required locally or funded by the state, typically trained "on the job" and without the guidance of operating procedures and protocols to manage the most critical calls  (such as those involving suicide or domestic violence). With the help of NAED, NENA, APCO, and advocate-leaders from PSAPS around the country, many advances have been made. Yet, more must be done in respecting dispatchers as First Responders to callers, particularly those seeking help related to suicide, homicide, domestic violence and other mental health crises.
For decades police, fire fighters, and EMS have been formally trained in funded, carefully designed and regulated courses within academies leading to skill testing and proficiency examinations prerequisite for certification. These emergency responders operated according to established protocols and procedures. Leaders in the field, as well as legislators, policy makers, and training organizations have long recognized that the interventions performed by these on-the-scene responders are complex and the stakes too great to be left to chance. Clearly they had to be fully prepared to meet these challenges. So funding for training and program development, and policies guiding these professions, were all put in place.

In the last few years, the news media have highlighted errors made by 911 telecommunicators' resulting in deaths and increased tragedy. One very recent example is  the Readers Digest article "911 Nightmare". The lead-in to the story states: "wrong addresses, dismissive dispatchers, and crossed signals. Our police response system is in crisis, and the cost can be measured in lives."**  While this article rightly points to the need for standardized training as a key preventive measure, the media and the public are inclined to blame the individual dispatcher's who must then live with a sense of enormous failure. And the heroic, effective interventions performed by emergency telecommunicators every day in our nation go unnoticed.

But there is a serious problem that can't be explained away as due primary to bad employees. The root issue is systemic : it goes back to the underestimating of the pivotal role telecommunicators play in crisis intervention, and thus failing to establish them as professionals who deserve to be prepared and supported accordingly. It is time to acknowledge the obvious: 911 telecommunicators are the First Responders to citizens seeking emergency help. Their role requires uncommon personal strength, intelligence, skills, training, as well as equipping with standardized crisis call procedures and protocols. Across the nation our 911 centers strive to do their best in equipping their telecommunicators. But their success will depend on the investment of the entire emergency response community  respecting them as fellow professionals.

Even in 2010 we have yet to fully regard Dr. Clawson's early proclamation that the work performed by emergency telecommunicators is highly complex, high risk, and a vital part of the multidisciplinary emergency response on which the public relies in crisis. National, state, and local 911 leaders have worked diligently to launch directives to create Best Pracrtice standards related to professional competency, training, and the adoption of mandatory protocols. The creation of the Emergency Number Professional (ENP) credential is one such step in the right direction--it captures and designates the qualifications one should possess to be recognized as an expert and leader among 911 telecommunicators.

All these efforts are important elements of building and upholding a fully mature profession. But going forward together we--the various agencies that fund, staff, operate, and train our nation's 911 telecommunicators--must be guided by  the recognition that the names we give to things matters. If we call a problem small, we offer small solutions. If we perceive a worker's role within a system to be small, we give them small attention and resources to do their jobs. To be accurate, 911 emergency telecommunicators are First Responders. Their tasks are psychologically and intellectually demanding and just as  vital to the lives of the public in crisis as the On-scene Responders they support.

So, as stakeholders in the 911 community, when we need to ask the old question "what's in a name?" and offer up a better answer: "Everything!". By recognizing emergency telecommunicators as First Responders we are acknowledging our shared responsibility to provide them with the support they need to achieve best practice as professionals through better policy making, more access to quality training, and by equipping them to survive and thrive personally in the emotional terrain of the 911 center.