Administration and Leadership, Commentary, Communications & Dispatch, Exclusives

Advancing Public Safety with NG911, EMD Protocols and Increased Collaboration

Maria Jacques

Maria Jacques has spent her entire career working in public safety and for more than two decades, her focus has been in 911. Currently the director of the State of Maine Emergency Services Communication Bureau and president of the National Association of State 911 Administrators (NASNA), she is certified as an emergency number professional (ENP) and also serve as a vice president for the NG911 Institute.

In 1996, she was one of three individuals tasked with facilitating Maine’s statewide Enhanced 911 (E911) implementation and when appointed director in 2008, she began developing a plan for Next Generation 911 (NG911) implementation.

By July 2014, Maine implemented its statewide NG911 system, enabling its 911 call takers with geospatial routing and Internet Protocol (IP) delivery. Her team is responsible for all the geospatial provisioning, call taking equipment, training and monitoring, including emergency medical dispatch (EMD) and fire protocols.

In this interview, Jacques discusses the benefits of NG911 and EMD working together, the obstacles that public safety can overcome when these teams collaborate, and she shares some tips on how they can work together more effectively for safer and healthier communities.

JEMS: 911 centers have to collaborate closely with all public safety disciplines that they support. Why is it particularly important for emergency medical services (EMS) and 911 agencies to collaborate to provide EMD?

Jacques: In a rural state like Maine, there are many instances where there is a significant amount of time between when somebody calls 911 with a medical emergency and a responder gets to their location for help. Having an EMD protocol bridges the gap in that timeline to make sure the victim receives care immediately.

Otherwise, they can sometimes wait 10 minutes, 20 minutes and, in an extreme case in rural Maine, it could be up to 45 minutes. If you’re that caller with the heart attack victim, for instance, and you had to wait that long with no support, that’s a long time. Your spouse or your family member or your friend has to wait that long. Having a protocol in place supplies that lifeline. I know we’ve saved lives because of that bridge.

JEMS: How does your state office engage with EMS leaders at the state and local level? How has the continued collaboration helped 911 and your communities across the state?

Jacques: We partner with the Maine Department of Public Safety Emergency Medical Services for the EMD program. We provide the training for the protocols and they provide input from the medical director at the state level and with oversight of quality assurance, as well as EMD Dispatcher and EMD agency licensing. I think it’s a good partnership. It works well at the state level because we can share resources and learn from one another.

JEMS: If an EMS agency isn’t already working closely with their state and local 911 colleagues, how would you suggest they get started?

Jacques: Every successful dispatch center has regular meetings with their responders that they service. It’s in those meetings that the discussions can grow, and they can lead to the use of protocols and their acceptance of those processes.

They can provide feedback to the dispatch agency, and together can make refinements to make sure the protocol works most efficiently. If everyone is involved in the implementation process, and really throughout the life of your program, it will work that much better.

JEMS: What challenges might arise when trying to collaborate and how can those challenges be addressed?

Jacques: This collaboration works well with us, but if anyone is looking to implement this, and it is a change for them, there will more than likely be some adjustments. With any new change in procedure, change won’t be instantaneous.

Especially procedures that involve emergency response because they do things a certain way for a reason. They know what to expect and how things are going to go. There is an acclimation period and it takes a while, but as the responders work with the public safety answering points (PSAPs) and get used to their protocol, they get more comfortable with each other and see the value this brings.

PSAPs have a responsibility to provide outreach to responders to make sure they understand how the protocol works and what they should expect. I think the biggest fear for responders is they’re afraid they’re going to change or tell them the way to do things and that’s not really what a protocol is about. Getting over that hurdle takes time but once they do it works to the benefit of the 911 caller.

JEMS: Tell us about your state’s EMD protocols. Can you talk about how important you think those protocols are, especially for time sensitive emergencies like stroke and cardiac arrest?

Jacques: With certain life-threatening protocols, there is an immediate dispatch followed up with additional questioning and instruction from the dispatcher per the protocol. The protocols are designed to send the appropriate resources for the situation and not a response to a situation with what is more than is needed.

It’s all about the continuum of care, from the time the call is made to the time they get help. That’s what the protocol is all about. The call taker really is the first responder in this respect.

And we try to celebrate the use of the protocols in different ways. For example, we have our stork awards for people that deliver babies, and we try to highlight “saves” at our Maine NENA conferences.

JEMS: Speaking of cardiac arrest, one of Maine’s EMS Office staff members served on the national committee to develop a training curriculum for CPR LifeLinks, which helps 911 and EMS to work together to tackle cardiac arrest through telecommunicator CPR and high-performance CPR. Why do you think telecommunicator CPR programs are important for local EMS agencies to encourage?

Jacques: I do think it’s a great resource for PSAPs that don’t have standardized emergency medical protocols in place. We have these protocols in place and have been doing it for so long that we assume everyone has them, but some agencies do not.

Our team member provided input to create a resource where any size agency can learn more and implement out-of-hospital cardiac arrest protocols. Agencies with a limited budget and resources who can’t invest in a full EMD program can really take advantage of the CPR LifeLinks resource. It’s a great program with the potential to save lives.

JEMS: After decades of planning for NG911, it’s becoming a reality in many locations across the nation. How will NG911 help EMS agencies in the future?

Jacques: There’s a lot of data that is available that we could be using and passing onto trauma centers so they’re ready for the people that are coming into the trauma centers, for example.

Today, we can verbally pass that information on to the ambulance, but it would be more efficient if we are able to pass that data on electronically and then onto the hospital where the ambulance might be driving. That’s just one example of how NG911 might benefit emergency medical response.

JEMS: How do you think that 911 will evolve over the next 10 years, and how might that impact EMS agencies?

Jacques: From early discussions I’ve had with agencies, what they’re really looking forward to is getting all different types of data directly. They are ready for us to pass on other sources of data so they can be better prepared for the emergency.

From telematics, from sensors, from whatever, data that could provide information to them about how many victims there are, and even what the extent of the injuries might be. Having the ability to pass relevant data all the way through to the responders, that’s the biggest gain that I could see coming out of NG911 implementation.

The current system relies mostly on someone communicating with a telecommunicator verbally. But if there’s a crash and nobody can speak, there may be one person or four people in the crash. Today we get only a limited amount of the information at best if the vehicle involved has telematics.

But with NG911, we might be able to receive more and know, for example, that two front airbags and two side airbags deployed in the car. That’s information that could be sent to the responders on site and to the hospital where the victims will be taken. I think that’s where NG911 will really go. We’re only in the infancy of coming to grasp what NG911 will be able to do for us.

They’re already talking about people wearing monitors to alert responders when someone has a heart attack. Those people will be able to get help by virtue of that sensor on them. There are all kinds of applications like that that will come along and will benefit emergency response.

JEMS: You’re currently VP for the NG911 Institute. What should people know about that organization?

Jacques: The NG911 Institute was founded in 2003 and we focus on educational efforts to try and bring congressional members up to speed on the benefits of NG911, why we need it and the barriers to get it implemented so we can keep improving 911. It’s governed by a 15-member board of directors made up of people from different backgrounds such as public safety, telecommunications and even the general public.

The NG911 Institute is important because there’s a lot of development and a lot of transition that needs to happen and there’s a lot of barriers to making that transition. We provide a forum to educate people who could be in decision making capacities that will help 911 and NG911 advance faster and further. In order to implement NG911, you have to move a significant amount of the population along.

The technology exists, but the funding, governance and policy is a challenge and has created a gap. The longer we wait to close that gap, the longer it will take to implement NG911, and the more it’s going to cost locally, at the state level and at the national level. If we can speed up the process, it will ultimately cost us less money. It is an evolutionary process and we’ve just taken the first baby step toward end state NG911.