Preparing for Pandemic Influenza:Recommendations for Protocol Development for 9-1-1 Personnel and Public Safety Answering Points (PSAPs)
Section 4:
Objective: During an influenza pandemic, EMS and public health resources will likely be
limited and normal services curtailed. In addition to identifying and assisting likely pandemic flu
patients, PSAPs will need to safely triage other non-influenza related requests for help,
appropriately matching need to resource, including alternative treatments, such as nurse assist
lines. Telecommunicators need to know what to tell callers if no response is available or will be
delayed. This should be part of the pre-pandemic planning effort. PSAPs need to have preestablished
links with other types of call centers (such as 2-1-1 or nurse assist lines) or
alternate care centers to ensure these resources can effectively be utilized in transferring or
referring callers. PSAPs should ensure that any such plans are in concert with the appropriate
medical and legal authority. An example of the types of call flow decisions to be made in a
period of pandemic influenza versus the norm is shown in Figure 1. Figure 2 shows an example
of a modified dispatch protocol based on the pandemic severity index. Figure 3 shows an
example of how triage, treatment, equipment, transportation and destination can vary depending
on the severity of the influenza pandemic. These figures, taken together, are meant to put the
planning process in perspective, and provide a possible template, to be modified to meet local
needs and to accommodate local resources.
4a. Tiered Responses/Altered Responses
Protocols will provide for tiered response of different EMS unit types. The protocol will include
a resource deployment table that lists the response for each severity level by EMS response
resources type, consistent with resource typing defined by the Department of Homeland Security
(DHS) for the National Incident Management System (NIMS), in FEMA document 508-3 (May
2005). This table will allow for changes and updates when responses are altered by local
authorities.
Local EMS authorities will determine when altered response is necessary and notify the PSAP.
Local EMS authorities will determine which specific call types will receive an altered response.
4b. Dispatch Protocol Modifications
In some instances, there may be no ambulances immediately available to be sent and the public
safety telecommunicator may be unable to pass the call on to another resource. As a part of their
planning, PSAPs need to address the need for dispatch protocols with their EMS medical director
when limited response, severely restricted response or no response occurs.
4c. Secondary Triage
Protocols will identify those 9-1-1 callers or patients appropriate for transfer to a secondary
triage specialist or alternate call center (e.g. nurse-advice center). Local EMS, emergency
management and operational authorities will determine when secondary triage should be
incorporated into PSAP processes. They will also determine when and how to notify the 9-1-1
center and the secondary call triage agencies (if those agencies are separate from EMS/medical
21
call-taking PSAP). Local EMS and EMD system physician medical director(s) will determine
which specific call types will be transferred to a secondary triage center (e.g. asymptomatic and
influenza-like symptoms with no abnormal breathing or other call types that are identified as
non-acute, such as a minor injury).. The PSAP will establish and maintain policies and
procedures for an effective transfer process to a secondary triage agency.
4d. Fatality Management and Effective Use of 9-1-1
PSAPs will likely get calls from family members about the deceased as well as for general
information. Plans should take this likelihood into account, with a coordinated effort with
alternate call centers and resources. The goal is to identify and divert these non-emergency calls
to a more appropriate alternate source.
4e. Managing the 9-1-1 Queue
During a pandemic outbreak, public safety telecommunicators with be faced with the significant
challenge of managing the incoming 9-1-1 call queue. They will need to quickly identify those
callers who are seeking help for the ill and injured from those who are simply calling for
information or non-emergency advice. In order to prevent 9-1-1 system overload, these ?worried
well? must be efficiently managed and directed to a non-emergency, non 9-1-1 call queue as
quickly as possible.
Public safety telecommunicators may need to enhance their standard call taking routine by
asking several clarifying questions when obtaining a complaint type or patient chief complaint.
As an example, a modified chief complaint query may include a question such as:
?Are you calling for ambulance, police, fire services, or non-emergency information??
OR, for EMS call centers (secondary PSAPs): ?Do you have a medical emergency or need urgent
medical care right now??
If the caller is able to clearly communicate that his or her needs are informational or nonemergency
only, the calltaker may transfer the caller to a non-emergency call queue, or when
available, an outside agency that can provide the proper help or advice.
Local governments should also consider 9-1-1 overcapacity mitigation strategies such as public
service announcements that provide information on accessing 3-1-1, 2-1-1, mental health
hotlines, animal control, and other 24-hour community service help lines. PSAPs may also want
to consider the use of automated answering systems, as an alternative of last resort to callers
unable to access 9-1-1 or getting busy signals because of call overload.
22
Section 4:
Objective: During an influenza pandemic, EMS and public health resources will likely be
limited and normal services curtailed. In addition to identifying and assisting likely pandemic flu
patients, PSAPs will need to safely triage other non-influenza related requests for help,
appropriately matching need to resource, including alternative treatments, such as nurse assist
lines. Telecommunicators need to know what to tell callers if no response is available or will be
delayed. This should be part of the pre-pandemic planning effort. PSAPs need to have preestablished
links with other types of call centers (such as 2-1-1 or nurse assist lines) or
alternate care centers to ensure these resources can effectively be utilized in transferring or
referring callers. PSAPs should ensure that any such plans are in concert with the appropriate
medical and legal authority. An example of the types of call flow decisions to be made in a
period of pandemic influenza versus the norm is shown in Figure 1. Figure 2 shows an example
of a modified dispatch protocol based on the pandemic severity index. Figure 3 shows an
example of how triage, treatment, equipment, transportation and destination can vary depending
on the severity of the influenza pandemic. These figures, taken together, are meant to put the
planning process in perspective, and provide a possible template, to be modified to meet local
needs and to accommodate local resources.
4a. Tiered Responses/Altered Responses
Protocols will provide for tiered response of different EMS unit types. The protocol will include
a resource deployment table that lists the response for each severity level by EMS response
resources type, consistent with resource typing defined by the Department of Homeland Security
(DHS) for the National Incident Management System (NIMS), in FEMA document 508-3 (May
2005). This table will allow for changes and updates when responses are altered by local
authorities.
Local EMS authorities will determine when altered response is necessary and notify the PSAP.
Local EMS authorities will determine which specific call types will receive an altered response.
4b. Dispatch Protocol Modifications
In some instances, there may be no ambulances immediately available to be sent and the public
safety telecommunicator may be unable to pass the call on to another resource. As a part of their
planning, PSAPs need to address the need for dispatch protocols with their EMS medical director
when limited response, severely restricted response or no response occurs.
4c. Secondary Triage
Protocols will identify those 9-1-1 callers or patients appropriate for transfer to a secondary
triage specialist or alternate call center (e.g. nurse-advice center). Local EMS, emergency
management and operational authorities will determine when secondary triage should be
incorporated into PSAP processes. They will also determine when and how to notify the 9-1-1
center and the secondary call triage agencies (if those agencies are separate from EMS/medical
21
call-taking PSAP). Local EMS and EMD system physician medical director(s) will determine
which specific call types will be transferred to a secondary triage center (e.g. asymptomatic and
influenza-like symptoms with no abnormal breathing or other call types that are identified as
non-acute, such as a minor injury).. The PSAP will establish and maintain policies and
procedures for an effective transfer process to a secondary triage agency.
4d. Fatality Management and Effective Use of 9-1-1
PSAPs will likely get calls from family members about the deceased as well as for general
information. Plans should take this likelihood into account, with a coordinated effort with
alternate call centers and resources. The goal is to identify and divert these non-emergency calls
to a more appropriate alternate source.
4e. Managing the 9-1-1 Queue
During a pandemic outbreak, public safety telecommunicators with be faced with the significant
challenge of managing the incoming 9-1-1 call queue. They will need to quickly identify those
callers who are seeking help for the ill and injured from those who are simply calling for
information or non-emergency advice. In order to prevent 9-1-1 system overload, these ?worried
well? must be efficiently managed and directed to a non-emergency, non 9-1-1 call queue as
quickly as possible.
Public safety telecommunicators may need to enhance their standard call taking routine by
asking several clarifying questions when obtaining a complaint type or patient chief complaint.
As an example, a modified chief complaint query may include a question such as:
?Are you calling for ambulance, police, fire services, or non-emergency information??
OR, for EMS call centers (secondary PSAPs): ?Do you have a medical emergency or need urgent
medical care right now??
If the caller is able to clearly communicate that his or her needs are informational or nonemergency
only, the calltaker may transfer the caller to a non-emergency call queue, or when
available, an outside agency that can provide the proper help or advice.
Local governments should also consider 9-1-1 overcapacity mitigation strategies such as public
service announcements that provide information on accessing 3-1-1, 2-1-1, mental health
hotlines, animal control, and other 24-hour community service help lines. PSAPs may also want
to consider the use of automated answering systems, as an alternative of last resort to callers
unable to access 9-1-1 or getting busy signals because of call overload.
22