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LAFD launches overhaul of procedures for handling 911 calls

The Los Angeles Fire Department is launching a sweeping overhaul of cumbersome 911 call handling procedures that officials say contribute to delays in getting rescuers to victims in life-threatening medical emergencies.

By early next year, the agency expects its dispatchers to be using new, streamlined scripted questions that will help get LAFD ambulances en route seconds — even minutes — faster during cases of cardiac arrest and other time-critical emergencies.

The changes follow a barrage of criticism of the department's 911 response system, including what experts say are sometimes lengthy and confusing pre-written questions that panicked callers must answer before dispatchers can get help on the way.

"We have to focus on what really matters and get resources rolling with minimal delay," said Fire Department Medical Director Marc Eckstein, an emergency room physician who is overseeing the reform effort.

In 2012, a Times investigation found the LAFD call center fell far short of a national standard that rescue units be alerted within one minute on 90% of 911 calls. The analysis also found the average call processing time for medical emergencies, which account for the vast majority of responses, increased significantly between 2007 and 2012. Key findings of the analysis were later confirmed by city auditors and a Fire Department task force.

Eckstein said the current system has "gotten overly complex" and requires dispatchers to funnel medical emergencies into one of hundreds of different categories, including more than 30 different types of strokes.

Some dispatchers complain the scripted questions, instituted more than two decades ago after dispatchers mistakenly diagnosed a dying Chatsworth mother and refused to send help, are wasting precious time. But they say they are pressured to faithfully follow the computer-generated queries and document callers' answers.

"We ask a lot of questions that end up going nowhere, providing us with nothing and really upsetting people and delaying a response," said veteran LAFD dispatcher Robert Ashley.

The new program being created by department staff will have fewer questions and allow more flexibility to get rescue units moving as details are being gathered from 911 callers, Eckstein said.

Speeding up the dispatch of rescuers, he said, is at least as important to improving response times as hiring additional firefighters, a proposal now being discussed as part of city budget negotiations.

"If we're losing two or three minutes on the front end, we can throw 100 more ambulances out there, but you're not going to save what's lost," he said.

Eckstein said the cost of developing a new LAFD call evaluation program will be "minimal." Existing city employees can do the work, and about $400,000 has been set aside.

Other rescue agencies, including the Los Angeles County Fire Department, have designed their own dispatching software. Officials with those departments say such in-house programs allow changes to be made more quickly, compared with systems created by outside vendors, like the one used by LAFD.

"We needed flexibility and the ability to make change without going through a long, involved process," said Franklin Pratt, a physician and medical director for the county Fire Department.

The changes at LAFD are coming as the department struggles to upgrade aging technology and institute reforms prompted by years of inaccurate data provided to the public and City Council. Lawmakers say the data, showing rescuers responding to medical emergencies faster than they actually had, was relied upon to make ambulance and firefighter budget cuts that jeopardized public safety.

Mayor Eric Garcetti is searching for a new fire chief who can guide a series of expensive and complex technology upgrades aimed at improving the department's performance, including placing GPS devices on rescue vehicles and replacing an outdated, crash-prone computer system at the heart of the LAFD's dispatch center.

Fire officials also have promised to improve performance reports that will be publicly available by adding a new state-of-the-art analysis unit modeled on a much-praised program at the Los Angeles Police Department.

Fire Commissioner Andrew Glazier said that improving 911 call handling systems is a key part of meeting the myriad technological challenges confronting the LAFD. "We owe this city nothing less," he said.

The call screening system being disposed of is used by rescue agencies across the United States and in other countries, according to its developer, Jeff Clawson, a Utah physician and leading expert in the field.

Clawson did not respond to requests for comment, but he previously told The Times that LAFD's problems are caused by dispatchers failing to follow scripted questions — known as protocols — and not his program.

Clawson was hired by the LAFD in 1988 to improve the dispatching system after the death of 42-year-old Ziporah Lam in Chatsworth, an incident that made national headlines and sparked a series of reforms. Family members had to make three calls to department dispatchers, who dismissed complaints. Subsequent investigations concluded that dispatchers failed to ask proper questions.

Sidney Lam, who was at the hospital when his wife died in December 1987 after going into cardiac arrest, said he was glad to hear that the department was trying to fix how dispatchers deal with callers. "But I have to ask, 'Why did it take so long?'" he said. "And how much longer will it take to implement the new, more effective protocols?"

ben.welsh@latimes.com

robert.lopez@latimes.com

Copyright © 2014, Los Angeles Times
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