Introduction

Utah Valley Dispatch Special Service District is located in Spanish Fork, Utah, and provides centralized dispatch services for police, fire, and Emergency Medical Service (EMS) agencies in Utah and Juab counties. All 45 dispatchers working in the center are certified in CPR, Emergency Fire Dispatch (EFD), and Emergency Medical Dispatch (EMD). These dispatchers are trained to give lifesaving instructions to callers during emergency medical situations.

At the time of the call, the EMD was on her fourth week of training and taking 911 emergencies as well as non-emergency calls on her own with little instruction. Her training included structured interrogation of callers to obtain critical information quickly, as well as EMD certification. This was her first CPR call.

The call began with the first MPDS protocol question: "911, what is the address of the emergency?"

"My boyfriend is not breathing," the caller replied. "He's cold and everything!"

The language used here—'not breathing' and 'cold'—poses challenges for EMDs because they are descriptors that could indicate an obvious death. In my experience reviewing medical calls, these obvious death descriptors complicate the critical decision of whether to provide CPR. Additionally, they can lead an EMD to engage in dispatcher diagnosis and discontinue providing CPR instructions. In this case, the EMD could have interpreted the two above descriptors as a clear sign of an obvious death, which would necessitate the selection of the Cardiac or Respiratory Arrest/Death protocol. However, the dispatcher, given her physical removal from the scene, could not know at that point that the patient was in fact deceased.