Abstract

Introduction:

The International Academies of Emergency Dispatch® (IAED™) exists with a mission to advance and support emergency dispatch professionals and match callers in need of emergency, health, and social services safely, quickly, and effectively with the most appropriate response. Therefore, IAED sets the highest possible standards for emergency dispatching worldwide through conducting research, creating protocols, designing training, offering professional development opportunities and certification for emergency dispatchers, and publications on the trade and science of emergency dispatch. In a quality improvement effort, IAED has conducted ongoing reviews of 911 audio calls for over 40 years. This practice has revealed a is connect between the practice of emergency dispatch and the perceptions, beliefs, and expectations of the diverse communities it serves. IAED wanted to understand the nature of the disconnect and became interested in developing sustainable community-engaged emergency dispatch research and in establishing community outreach to connect the practice of emergency dispatch with the communities it serves.

Objectives:

Describe IAED's 12+ year process, results, and lessons learned for developing sustainable community-engaged emergency dispatch research and outreach.

Methods:

• Institutional knowledge through audio call case reviews by certified emergency dispatch quality improvement professionals (ED-Qs)
• Survey to measure public expectations of receiving telephone pre-arrival instructions from Emergency Medical Dispatchers (EMDs)
• Community Engagement Studio, a method originally developed at Vanderbilt University. It involves community members directly in studies that may impact them, where community members answer questions developed by the research team. The format is similar to a focus group but is conducted prior to a formal study, allowing community members input into the design and conduct of the study itself. Community members were recruited by IAED partners at the University of Utah Center for Clinical and Translational Science (CCTS).

Hypothesis Generation: Inquiry Processes and Results:

Institutional Knowledge (1979 – Present)

• Strong history of receiving feedback from Protocol users
• Ability to successfully conduct retrospective studies to evaluate protocol validation and effectiveness
• Decades of 911 audio call case review identified these issues:
  • Poor customer service
  • Barriers to calling and utilizing 911 (communication, language, mistrust, unawareness of the process, etc.)
  • Angry and frustrated callers

These issues could possibly be connected to callers' beliefs and expectations of how they would be treated, what would happen when they called 911, and these beliefs and expectations could be culturally determined.

Survey (2011) (emergencydispatch.org/articles/ScientificStudies/SS06_JournalMayJuneResearch.pdf)

• 207 members of the Salt Lake City, Utah community participated
• The majority of participants expected EMDs to provide lifesaving instructions

Community Engagement Studio (2017)

• 13 members of diverse communities in Salt Lake City, Utah participated—11 female and 2 male, aged 16-65, education levels from high school graduate to college graduate, mixed races and ethnicities
• 90-minute, facilitator-led discussion of four main questions. See the table below for the questions and a subset of the responses:7 out of 14 recruited participants completed the survey
• 1 respondent only supplied comments for each question. These comments were scored on the Likert scale as follows: "Yes," plus additional supportive comments = Strongly Agree, "Yes" or "True" = Agree, and in the case where a comment deviated from either of these options, researchers used best judgment to reflect intention.

Lessons Learned:

• In the early years, we didn't have much feedback about public expectations and were more focused on how well the Protocols worked.
• Without adequate community access, support, and collaboration it is particularly difficult to conduct prospective studies.
• Sustainable and easy access to an IRB for proposal submission and review was crucial. This ensured meeting best ethical standards of research.
• Creating a relationship with CCTS granted us an avenue for community buy-in, commitment, and engagement.
• The Community Engagement Studio helped us test whether our ideas were worth developing as a formal research study.
• May expect public acceptance of wider ranging and more comprehensive forms of telephone-directed patient evaluations, advice, and care.

Conclusion:

IAED, CCTS, and six diverse community partners created a Community Advisory Board (CAB) to design and conduct a community-engaged study. Incorporating the lessons learned from their combined years of conducting research and through open discussion, they generated a formal hypothesis and submitted an IRB proposal. The hypothesis was that identifying the attitudes, expectations, and barriers related to calling 911 improves the interactions between emergency dispatch calltakers and callers.