CINCINNATI - To be a hairstylist in Ohio, you need a state license and at least 1,200 hours of training.
A massage therapist license requires 750 hours of instruction.
But the I-Team has obtained a scathing report from the federal government showing in Ohio, there are no minimum requirements or state certification required to answer life and death calls to 911.
"There are many citizens in our state that don't realize that their dispatchers are not medically trained," said Dr. Carol Cunningham, State Medical Director of the Ohio Department of Public Safety.
Dr. Cunningham was not surprised when the I-Team revealed first in May some Cincinnati dispatchers weren't trained to give medical advice over the phone, a report that prompted changes to the center's operations.
"If there's a child who is choking, and the dispatcher doesn't know how to instruct someone how to do the Heimlich maneuver, the brain tissue dies without oxygen within six minutes," Dr. Cunningham said.
When you dial 911, it isn't a phone line, it's a lifeline. If the dispatcher who answers isn't medically trained, they have no choice but to simply send an ambulance and cut the line. You're left holding the phone until help arrives.
But just across the river in West Virginia, everyone is fully trained to answer medical calls.
"You hate to have someone standing there for five or seven minutes until help gets there panicking 'what should I do?'" said Doug Moore, a certified Emergency Medical Dispatch Instructor in Wood County, W.Va.
The I-Team visited the Wood County 911 center, where dispatchers ask pertinent questions that get to the answers of how to help quickly.
"It's something that should be a national standard, or at least the states adopt their own," Moore said.
West Virginia is one of just 15 states that requires everyone who answers 911 calls to be certified as an Emergency Medical Dispatcher. The requirement came into effect on July 1 of this year.
"Going home at night, it definitely provides, 'I did my job, I followed what I was supposed to,'" Moore said. "…I may have saved a life."
West Virginia funds all of this at the state level with a $3 per month 911 surcharge on all cellphones.
How much is your life worth on a 911 call in Ohio? Just 25 cents; among the smallest 911 surcharge in the nation.
"There needs to be probably a state program and it certainly needs to be supported financially by the state," Dr. Cunningham said.
Dr. Cunningham told the I-Team that there is no organization that provides oversight for 911 training and standards in Ohio now.
The National Highway Traffic Safety Administration concluded in a critical assessment of Ohio's emergency medical services that "There appears to be no clear authority for emergency medical dispatch training or requirements."
The federal government also recommended that Ohio's EMS board "should seek authority to develop dispatch center and emergency medical dispatcher certification standards." Read the full NHTSA report below or at http://goo.gl/LVs8O.
"Seconds matter, they just matter," Dr. Cunningham said. "And the sooner that that person who calls in gets appropriate pre-arrival instructions, the better off the patient outcome will be."
Dr. Cunningham and the Ohio Board of EMS answered that government report with a 2015 strategic plan that calls for legislation to put the board in charge of 911 training and to require Emergency Medical Dispatch certification in Ohio.
Right now, the training is voluntary, and up to each 911 center.
Read the full 2015 strategic plan below or at http://goo.gl/MV2mp.
Next page: Progress in Cincinnati?
Following the I-Team's first investigation into Cincinnati's 911 operations, Hamilton County commissioners voted unanimously to take over the city's 911 operation, but the city has to agree, and even though City Council passed a similar resolution of that consolidation three years ago, the city manager says it's not going to happen, according to staff meeting notes obtained by the I-Team.
Dispatchers were told "No merger of ECC (Emergency Communications Center) with Hamilton County per City Manager."
In Hamilton County, all 911 dispatchers are medically trained. In Cincinnati, there are six permanent dispatchers and one temporary dispatcher who are not EMD trained, and in the notes the I-Team obtained, instructions are "These employees should not be scheduled to work the phones unless it is the last resort for phone coverage." The notes also mentioned that the next EMD training class would not be held until the last week in July.
"I don't know when I have to call 911, and I don't want my call disconnected, and I don't want my call answered by someone who can not help me," said councilman Wendell Young.
City Council called a special hearing with the ECC manager in May after our I-Team investigation revealed untrained dispatchers were disconnecting medical calls when they were unable to provide help.
In one particular case presented by the I-Team, the ECC manager, Joel Estes, said that the reason for no pre-arrival medical instructions was the result of the patient having a pacemaker.
Here is that call:
Caller: "My sister, she may be having a heart attack, (she has) a defibrillator."
911 Operator: "OK, ma'am?"
Caller: "A pacemaker and a defibrillator."
911 Operator: "Alright, we're going to go ahead and start EMS, OK?"
Caller: "Please hurry!"
911 Operator: "Ma'am, I'm not the one that's coming, EMS is coming, OK?"
911 Operator: "I'm going to go ahead and disconnect the call, they've been dispatched, OK?"
"In that particular case, that woman had a pacemaker, and when someone has a pacemaker, there are no pre-arrival instructions," Estes said in an interview with the I-Team.
That reasoning is wrong, according to Moore.
Moore, the EMD instructor, told the I-Team if a call similar to the one above came into the Wood County 911 Center, they would not have simply hung up.
"There are always pre-arrival instructions on a medical call. We would have stayed on the line until the paramedics arrived," Moore said.
Randy Lowe, 911 Director in Wood County, was shocked to learn that Hamilton County has fully trained dispatchers and Cincinnati does not.
"You're still a citizen of Hamilton County even though you're in the city limits of Cincinnati, but you're getting a different service," Lowe said.
Moore said that receiving pre-arrival instructions can "definitely" mean the difference between life and death.
"People do not become 911 dispatchers for the money," said Randy Lowe, 911 Director in Wood County. "They do it because, pardon the pun, it's a calling. And as long as you can support them and give them what they need, the respect that they deserve, then they're going to do a good job for your center, and obviously they're going to do a good job for your community."
While 10 new hires are trained to fill the 27 vacant dispatch operator positions in Cincinnati, one out of every five 911 callers on average hears a recording that plays when all operators are busy: "Please stay on the line. You have reached the Cincinnati 911 Center. Your call will be answered as soon as possible. If you hang up and call back, you will experience and even greater delay."
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38-time Emmy winner Brendan Keefe was named Best Reporter by the Ohio Associated Press in 2011, and Best Photographer in 2012 and 2013. He serves as Anchor and Chief Investigator for 9 On Your Side.
Jason Law joined 9 On Your Side in January 2013 as a investigative reporter with the I-Team.