A Qualitative Inquiry Into Their Work and Perceptions of New Technology

Abstract

Little is known about the work and experiences of rural 911 emergency dispatchers in the United States. In this pilot study, we seek to begin to understand the nature of their work, the challenges they face and acceptance of new technology. We interviewed seven dispatchers from three rural counties in Indiana and asked them to describe their daily work-related activities and difficulties. We also asked for their views on new technology and described a futuristic scene of delivering Narcan to overdose victims via drone to provide an example of technology to which they could react.

Dispatchers felt left out as first responders and struggle with difficult and traumatic calls. They had mixed feeling about the drones, but were generally accepting of new technology if provided with training, it does not add to their workload and it improves their ability to direct first responders. This study provides seeds for many additional studies related to EMS dispatchers.

Introduction

When an individual has a medical crisis in the U.S. and calls 911, they are activating an emergency medical service (EMS) response that begins with talking to a dispatcher. The dispatchers must act quickly to determine the location and what type of emergency services are required by the caller; then contact a variety of agencies to send police, fire rescue, and/or ambulances to the scene. Dispatchers stay on the phone with bystanders until help arrives to provide support and medical coaching, including telephone cardiopulmonary resuscitation (T-CPR), attempting to manage the situation with only their words.

To our knowledge, there have been no studies examining the experiences of EMS dispatchers in rural areas. Although outside the U.S. and in non-rural settings, qualitative studies^1,2 of EMS dispatchers are more likely to focus on processes, not individual experiences. In a large 2010 survey of emergency call centers examining the use of T-CPR across the U.S. (n=1924) only 5% (n=91) of the participants were front-line dispatchers with 86% (n=1658) of the surveys completed by management³, demonstrating the gap in knowledge about their work directly from dispatchers.

Related

As technological advances occur in emergency response new technology may be able to help dispatchers, but implementation and acceptability is unknown due to the lack of information about dispatchers. Existing research about technology utilization and acceptance in emergency response is more likely to be found in the context of emergency preparedness and disaster management, or with healthcare providers.

One study of emergency response systems did not include the role of the dispatcher and focused on responses to catastrophic disasters.⁴ In another study of technology acceptance, emergency operations centers refer to temporary control centers which are staffed by emergency managers specifically assigned to lead disaster operations.⁵ A literature review of emergency preparedness and response (EPR) in the context of rural responders focused on disaster management and did not include EMS dispatchers.⁶

Objectives

The objective of this pilot study is to describe the day to day work of EMS dispatchers in rural Indiana. In brief interviews with dispatchers, ranging from 7-24 minutes in length, the unique challenges dispatchers face at work and acceptance of futuristic technology into their work were discussed.

Methods

The study was approved by the Institutional Review Board. We began our participant recruitment through existing contacts at EMS agencies in three rural counties in Indiana: Montgomery, Jasper and Newton. One of our participants provided contact information for a dispatcher from rural White county who was also interviewed. Interviews were scheduled via email contact, and all participants received a study information form. Due to the pandemic, the interviews were conducted via Zoom and only audio was recorded by asking participants to turn off their cameras. No identifiable information about the dispatcher or the county was recorded. Interviews were transcribed using Temi.com and any information which could identify a person or location was removed.

A total of seven semi-structured interviews were conducted with the intent of beginning to understand the work of rural dispatchers and their perceptions of technology. We also presented a futuristic scenario describing dispatchers initiating the delivery of Narcan via drone ahead of the arrival of emergency personnel. The dispatchers were then asked to provide their initial thoughts and feelings about the scenario. Our final question allowed the dispatchers to voice any thoughts about their work that they felt were particularly important. We will discuss the themes that emerged about their work, use of technology, and the drone delivered Narcan scenario.

Due to the lack of prior studies on EMS dispatchers and technology acceptance, we used an inductive content analysis.⁷ The researchers read the transcripts independently coding the information for grouping into themes. The researchers then met and discussed their themes creating trustworthiness through consensus.⁸

Results

We separated our findings into three categories, work tasks, work challenges, and technology (Figure 1), which were then subdivided into themes. Each theme was representative of concepts found throughout the interviews.

In the category of work tasks, we found themes of teamwork and variety. The dispatchers work as a team with other dispatchers on the same shift and also with the agencies they contact to respond to emergencies. The dispatchers feel like they are a part of the first responder workforce. There is a great deal of variety in the day-to-day work but also between agencies. In their daily tasks, rural dispatchers not only answer 911 calls, they also manage many administrative calls for the county government. The pace of their day also fluctuates and is inconsistent, including long periods without any calls followed by simultaneous emergency calls without predictability.

“A typical work day? I don’t know if you can even put typical in there. (laugh) Um, every day is different.” Between agencies, the staffing patterns vary as well as the assignment of duties. For example, in one agency a single dispatcher manages all aspects of a call while in another agency, one dispatchers talks to the caller and records the events, while another dispatches emergency response agencies.

The category of work challenges included themes related to difficult calls, mental health and missing information. Consistently, the most challenging calls were those involving children or where they were unable to determine the location of the caller. Several dispatchers mentioned that hearing traumatic events takes a toll on their mental well-being as does not knowing the outcome of the victims. Although they mention feeling like part of the first-response workforce, they also felt that not everyone views them as such in their agencies. This is seen when they are not included in the debriefings with firefighters, police and EMS crews who are exposed to a traumatic event.

“…Like when they do debriefing, it’s usually like the units and EMS, like, they don’t really think of dispatchers.” Even after a particularly traumatic call, they have to continue with their work and move on to the next caller. “You always have to be fine…there’s not a moment that it’s okay for you not to be okay.” This also coincided with a feeling of invisibility to both other agencies and the general public. “I don’t think that a lot of people realize that actually really goes on behind the scenes.” Several dispatchers mentioned that the newer Phase 2 cell phone location system alleviated the issues with locating people. However, it is often challenging to negotiate details of an incident from callers who are traumatized and panicked.

In our final category of technology, we identified generalized themes related to information and skills. We also specifically asked participants about a scenario involving drones as an example of emerging new technology and have a theme related to their views on the topic of incorporating drones into emergency responses. In the theme of information, the dispatchers reflected upon how video communication would impact their work. Some felt that video relays would provide them with important additional information.

“…If I had a way to, uh, communicate or see the caller better, that would obviously help, um, that would obviously help some certain situations.” While others thought that seeing an emergency scene would be traumatic. “I think that would be, that would be a lot for some people to see that, especially if they do end up dying, hearing it is different than seeing it.” They also voiced concerns about new technology that produces more information to attend to (e.g., video) as they are already managing information in multiple systems.

Regarding skills, two sub-themes emerged. The first was related to their own personal “tech savviness.” Most dispatchers felt that they were not particularly computer or tech-savvy, but very comfortable with the equipment they used at work due to their training. “I would say that I’m not super-computer savvy or have a lot of experience but the equipment that we use, we get a lot of training on.”

The second sub-theme was directly related to their training and skill in advising people in emergency situations. Several felt that improved training, possibly through simulation activities, would improve their abilities. “I think something that would be beneficial, especially for new people. Um, now that you say that is, somehow, if there they can make like a simulation, like then pick up the phone and somebody on the other end, in a frantic stage….” In our directed theme of drone technology, the responses were again mixed. Some of the dispatchers felt that the technology would be beneficial and that they would want to be a part of deploying and interacting with the drone.

“…If you’re having Narcan delivered to the patient that could immediately administer it by the caller, it would be even better. Yeah. That’s a great idea.” Others were more skeptical and worried about liability and endangering a caller through the interaction with the drone. “First? Wow. Um, I’m scared for liability on the dispatcher.” “Should they go out to get this drone and get hit by a car or whatever?”

Discussion

Our approach in this pilot study resulted in two distinct focuses: the current state and a future state. This paper is the first to describe the experiences of rural dispatchers and seek out challenges and barriers in their work. Our findings show that there are some experiences that are likely universal to all rural dispatchers and others that are unique to specific departments. While there is variability in the education provided, the systems used, and staffing patterns, there is consistency in the experiences of managing difficult calls, lack of follow up and personal mental health.

EMS dispatcher work tasks are closely linked to other EMS colleagues and the overall first responder team. Although the theme of team is identified in discussions around EMS work, team is intricately integrated into all aspects of work, challenges, and technology categories explored in this study. For example, exclusion from the first responder team debriefs has been described to impact dispatcher mental health and job satisfaction. In addition, team will be a critical consideration with the introduction of technology. Specifically, dispatchers expressed varying levels of acceptance towards new technology.⁹

Most highlighted that lack of information is a key challenge to current work and expressed positive perceptions toward technology that tackle this challenge. However, perceived ease of use varied significantly among EMS dispatchers. Given the importance of the team in performing EMS work, significant variation among the team regarding technology acceptance must be accounted for in design and implementation.

Like other studies exploring new technology in the healthcare¹⁰, the dynamic and safety critical nature of the work present significant challenges for design and implementation. Clear needs are noted to improve their ability to help callers and responders, but addition of new tasks in their already high-workload jobs is unacceptable to most responders. However, techniques in usability for systematically understanding current workflow and potential changes in workflow by new technology (e.g., replacing/complementing less efficient tasks) may be able to address this barrier. In addition, many responders highlighted confidence and satisfaction in organizational supervision and training practices for new technology; these macroergonomic interactions can be another key component for ensuring safe and successful technology introduction.

Limitations of our study include the small sample and broad nature of the questions. The experiences we found were limited to a few counties in central Indiana and may not be generalizable.

Conclusion

The work experiences of dispatchers, specifically rural dispatchers, in the U.S. has not been widely studied. They are the crucial to the sequence of 911 emergency calls, yet are often excluded from discussions of first responders. This is found in both the research literature and in the experiences of rural dispatchers in their workplaces. Successful introduction of new technology for dispatchers will be most effectively accomplished by including them in the design and implementation process.

This pilot study provides insights into the experiences, challenges and opportunities for improvement that exist in the workplace for dispatchers. Future studies could be conducted focusing on a single theme or concept we discovered in our interviews. As EMS systems evolve and advance, incorporating technological advances into their day to day work, it is crucial to include not only the role, but the insight of dispatchers for seamless and successful implementation.

References

1. Adams K, Shakespeare-Finch J, Armstrong D. An Interpretative Phenomenological Analysis of Stress and Well-Being in Emergency Medical Dispatchers. J Loss Trauma. 2015;20(5):430–48.

2. Leonardsen AC, Ramsdal H, Olasveengen TM, Steen-Hansen JE, Westmark F, Hansen AE, et al. Exploring individual and work organizational peculiarities of working in emergency medical communication centers in Norway- a qualitative study. BMC Health Serv Res. 2019;19(1):1–10.

3. Sutter J, Panczyk M, Spaite DW, Ferrer JME, Roosa J, Dameff C, et al. Telephone CPR instructions in emergency dispatch systems: Qualitative survey of 911 call centers. West J Emerg Med. 2015;16(5):736–42.

4. Shen SY, Shaw MJ. Managing coordination in emergency response systems with information technologies. Proc Tenth Am Conf Inf Syst. 2004;(August):2110–20.

5. Prasanna R, Huggins TJ. Factors affecting the acceptance of information systems supporting emergency operations centres. Comput Human Behav [Internet]. 2016;57:168–81. Available from: http://dx.doi.org/10.1016/j.chb.2015.12.013

6. Gulatee Y, Yuan Q, Gasco-Hernandez M, Gil-Garcia JR, Sutherland-Mitzner M, Pardo TA. Technology adoption for emergency preparedness and response in rural areas: Identifying the main determinants. ACM Int Conf Proceeding Ser. 2020;469–76.

7. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107–15.

8. Foli KJ, Reddick B, Zhang L, Krcelich K. Nurses’ psychological trauma: “They leave me lying awake at night.” Arch Psychiatr Nurs [Internet]. 2020;34(3):86–95. Available from: https://doi.org/10.1016/j.apnu.2020.04.011

9. Lee Y, Kozar KA, Larsen KR. The technology acceptance model: Past, present, and future. Commun Assoc Inf Syst. 2003;12(1):50.

10. Cha JS, Monfared S, Stefanidis D, Nussbaum MA, Yu D. Supporting surgical teams: Identifying needs and barriers for exoskeleton implementation in the operating room. Hum Factors. 2020;62(3):377–90.

Rural EMS Dispatchers