Originally posted at the California Health Report.
By Padma Nagappan.
Baby Sebastian Caban’s parents were watching television in bed with him in suburban San Diego when his mother coughed, touching off a tragic series of events. The cough startled their dog, which then bit the child, only 3 days old, on the head. When the Cabans called 911 and were placed on hold, they rushed Sebastian to the hospital, where their newborn was pronounced dead.
The hold time and ensuing delay in treatment signaled a larger, statewide problem. California’s Office of Emergency Services (Cal OES) expects dispatch centers to answer 911 calls within 10 seconds at least 90 percent of the time, a standard suggested by the National Emergency Number Association. Yet news media reports show that callers in San Diego have waited for as long as 16 minutes this year.
This problem extends beyond San Diego. Dispatch centers attached to police, fire and sheriff’s departments across the state have had challenges answering emergency calls within the first few seconds.
The reasons for these delays vary, from inadequate staffing thanks to budget shortfalls, difficulty in recruiting and retaining qualified operators and challenges in pinpointing location accurately for cell phone calls.
Cell Phone Tangles
When 911 was designated the universal emergency services number in the 1960s by the FCC, there were only landlines and one telephone company. Since then, more telephone companies have entered the fray – and in the past 20 years the vast majority of calls are placed using cell phones.
Today, 70 percent of all 911 calls are made from cell phones, according to the Federal Communications Commission (FCC).
If apps like Foursquare can accurately detect your smartphone’s location, why can’t the 911 system do so? The answer is in part that cellular calls are routed through towers, which makes pinpointing location more difficult on mobile phones compared to calls from a geographically fixed landline phone.
“The 911 system is not built like a location services app,” says Jaime Young, president of the California chapter of National Emergency Number Association.
People have died while waiting for help because of the clash between an old system and newer technology, which leads to misrouting. If the 911 system doesn’t know where to route a wireless call, it automatically defaults to the CHP – the fate of about 40 percent of 911 calls placed from cell phone calls. The CHP triages the call, determines whether to reroute it, then transfers it if necessary, creating delays.
The FCC is pushing for a Next Generation 911 system that improves routing. The system will involve new software, hardware, data and practices to enable not just better location accuracy but also texts, images and video. But, it’s still in the conceptual stage, and the hurdles in developing and implementing the new standards, as well as the steep cost — estimated at $2.68 billion over 10 years — guarantee that it will take time to become reality.
Dispatch centers that have been able to meet the 10 second standard consistently are smaller and more rural.
“Small centers don’t get as many phone calls,” explains Dee Dee Teel, communications center support commander with the California Highway Patrol (CHP).
Dispatch centers in big cities handle very high call volumes, which means that more callers may experience delays while operators are on the phone with other calls.
Dispatch centers at police departments in small cities like Blythe in Riverside County, Hanford in the San Joaquin Valley, or up north in Yuba City have been able to answer 911 calls within 10 seconds 100 percent of the time over the past 18 months.
Yet the centers at the San Diego County Sheriff’s department and Bakersfield police department met the target only 70 percent of the time over the past 18 months, according to call answering data from Cal OES. Oakland’s fire department center met the target 83 percent of the time over the same period.
The CHP has 25 centers statewide that handle approximately 7 million emergency calls a year. Call data for 2015 shows that it answered calls within 10 seconds on an average of 90 percent of the time across all its centers. Operators spent an average of 71 seconds with each caller before transferring or disconnecting.
Call center performance is not just tied to its call volume, size and location – there’s also staffing, operator experience and operational efficiency – but size does make a big difference.
“In the rural areas, they don’t have a high [staff] turnover rate, so being more experienced, operators can process the calls quickly,” Teel said. “In our larger centers, we have more turnover and not as many experienced call takers, so it takes longer to process calls.”
High call volumes at urban centers and the high stakes nature of their jobs both take a toll on 911 operators. Staff turnover is frequent at busy centers.
Recruiting candidates is difficult, too. To qualify, operators have to pass extensive background checks and dispatch centers have a hard time finding people that meet hiring standards.
Since each call center can differ in call volume, distribution and pattern, Cal OES does not dictate what methods and systems should be in place to meet the 10 second target, explained Bill Anderson, acting assistant director of the Public Safety Communications Office at Cal OES.
“For some [dispatch centers] call volume can change hourly. An example is the active shooter incident in San Bernardino,” Anderson said. “An incident like that could generate hundreds of calls.”
Call surges about the same incident also create delays. When someone faints in a crowded restaurant, for instance, several people call for paramedics. This instinctive response ties up operators who could be attending other calls.
Young pointed out that people call 911 when they return from vacation and find their house was burgled, or if a storm led to downed trees blocking the road, or to report noise disturbance. A good number of 911 calls are non-emergency calls, but people continue to call because they don’t know better, or because they get tired of waiting for someone to pick up the non-emergency phone line.
“Call surge is a huge problem, but it’s a fine line we have to walk,” CHP’s Teel said. “We don’t want the public to assume someone else will report the hurt woman on the side of the road.”