CINCINNATI - Dying for help, some of those in need of urgent medical care are left holding the phone because dispatchers say when you dial 911 in the city of Cincinnati, it's a game of roulette.
The startling fact that some 911 operators in Cincinnati have no or only partial medical training comes amid a city budget crunch that has left a hiring freeze on the Emergency Communications Center (ECC), which runs the city's 911 operations.
Rhonda Andrews was having a heart attack when her sister called 911 for help.
"I could have died that day," Andrews said. "My heart had stopped three times."
The 911 call for Andrews lasted barely more than a minute.
"No one gave us any instructions… they just hung up," Andrews said.
This was Andrews' 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?"
For seven minutes after the dispatcher hung up until help arrived, there was no one on the other end of the line to help Andrews as her defibrillator kept jolting her back to life.
"They're saying they're on their way, and hang up, and your life is in someone else's hands (who) doesn't know what to do," Andrews said.
Here's what a 911 call with a medically trained-dispatcher sounds like ( http://www.youtube.com/watch?v=I4hF9T_YmTA):
911 Operator: "Cincinnati 911.."
Caller: "He has no pulse, no breathing, no nothing."
911 Operator: "I'll walk you through CPR, are you ready."
911 Operator: "OK. We've got paramedics already responding, I want you to stay on the line, I want you to listen to me, you're going to help me out, OK? We're going to do what we can to try and save her."
911 Operator: "Alright, at this point I want you to pump the chest hard and fast at least twice per second, and at least two inches deep. Got it?"
911 Operator: "Can you feel her heart beating? OK, then stop.."
911 Operator: "..doing the compressions."
"I want to hear the person, a strong person, say 'take her, lay her down, do this, do that,'" Andrews said. "Instead I heard, 'OK, they're coming. Bye.'"
Two current Cincinnati dispatchers without the proper training whose identity the I-Team is keeping a secret said they are often assigned to answer 911 calls.
"I start the fire department and get off the phone to answer other emergencies," Dispatcher One said of how she responds to medical calls.
"It's sad and scary at the same time," Dispatcher Two said. "It's scary because you don't know what's going to happen to those people. And it's sad because you put yourself in their shoes and how would you feel if that was you?"
"It keeps me up at night because I've gotten calls that I could not handle with the training given to me," Dispatcher One said.
Below is an email sent from a Cincinnati dispatcher to their manager addressing their concern about their lack of complete training (email is in reverse order of sent date from top to bottom).
In Hamilton County's 911 center, it's a much different story: Everyone who answers 911 calls is a certified Emergency Medical Dispatcher.
Not only are they properly trained, but their response times are 400 percent better.
In Hamilton County, 19 times out of 20, a dispatcher will answer within 10 seconds. In Cincinnati, one in five calls takes 10 seconds or longer for a dispatcher to pick up.
To get to other waiting calls, dispatchers said they were told by their supervisors not to stay on the line if they are not trained to provide pre-arrival instructions.
During a budget hearing on April 29, Cincinnati City Council members grilled Cincinnati Emergency Communications Center Director Joel Estes, who told them the city's hiring freeze is the real problem.
"We currently have 17 vacant operator/dispatcher positions, and 10 vacant E911 positions," Estes told council of the ECC.
Those 27 unfilled positions at the newly civilianized ECC are why untrained people sometimes have to answer the phones.
"We're continuing to (train dispatchers on) either police or fire to get people on the floor as quickly and working as possible," Estes told council.
The I-Team tried to get answers about the situation with a request to speak with Estes, but were denied. Even as Estes left the council hearing, he wouldn't respond.
Next page: Estes explains
Estes confirmed to I-Team chief investigator Brendan Keefe that not everyone who answers 911 in Cincinnati is Emergency Medical Dispatch trained, meaning they aren't able to offer medical advice to a 911 caller over the phone, even if it means life-saving methods.
You can watch the full 45-minute interview with Estes at http://www.youtube.com/watch?v=CUvM940mO2c.
Three years ago it was a different story when the police and fire departments jointly ran the 911 and dispatch center. The city manager decided to consolidate the operation under civilian command. When police and firefighters jointly ran the dispatch center, 911 operators would transfer medical calls to paramedic-trained fire dispatchers sitting right next to them.
"We don't do that anymore," Estes said. "Now the person who takes the call, in almost all cases, is EMD certified and they are able to provide those pre-arrival instructions for people."
Estes insisted 90 percent of his staff has been medically trained and EMD certified. But there are still calls like this:
911 Operator: "And you said your father's doing CPR?"
Caller: "Yes, yes. He's doing everything he knows how to do. We're not very great at it. He's older, I'm blind."
Caller: "My father is sick and he can't keep doing this. Please help us."
911 Operator: "All right, we're giving them all the information. They're on the way, OK?"
The father told the I-Team he was doing CPR on his wife based on what he had seen on television dramas. Fire department dispatch records show the woman was dead on arrival.
The I-Team obtained dozens of 911 medical calls and computer dispatch reports through a public records request for this report. In several calls, like Andrews' and the call above, the operators disconnect the call as soon as the ambulance is dispatched, without providing pre-arrival instructions or even simply staying on the line.
Estes said they just can't take someone off a phone or a police frequency at the moment to train them properly because of the volume of calls.
"The reality is we do the best we can, but operations always has to take precedence -- we have to have enough people on the floor to take the calls that come in," Estes said.
With 27 vacant positions, ECC managers are pulling police dispatchers and combining frequencies to staff the 911 lines. The only other option is mandatory overtime, taking 911 operators' shifts from an already exhausting 12 hours to a grueling 16 hours.
The dispatcher shuffling due to the empty positions comes while Estes received a raise...
... and went to council to push for job reclassification for his assistant managers - promotions that could come with raises of up to $10,000 in the future.
"When you call 911 it's more of a lottery, in my opinion," Dispatcher One told the I-Team. "Either you get someone (who is) trained to help you or you don't."
"I wouldn't call it a lottery when it's 90 percent certain that you're going to get an EMD-trained person," Estes said of the dispatcher's comments.
With those odds, of the 45,000 medical calls each year in Cincinnati, 4,500 are answered by operators who are not fully trained. Estes said those odds are skewed because nearly all people assigned to answer 911 calls full time are trained.
But he did admit the largest number of those still not trained is among his police dispatchers who are regularly assigned to answer 911 calls.
"There's usually between seven and nine of us on the phones at one time, and when dispatchers are on the phones, the chances of you getting (an untrained operator) are one in nine, two in nine sometimes," Dispatcher Two said.
Several states, like Connecticut (where director Estes came from), have laws requiring full emergency medical training before someone can even sit in the chair and answer a single 911 call.
"This is life and death," Dispatcher One said.
"The public's essentially in danger," Dispatcher One said. "If someone's choking, you could die within the three to five minutes it takes for the fire department to get there, and with layoffs on the table it's going to take longer than that. This is a serious problem."
"I lived through this," Andrews said. "I am a lucky person, I came home. (I've) seen my family again. The next person may not live."
Next page: Attrition and responsibility
"Reducing burn out is key because we lose an awful lot of people to burn out," Estes told city council in April.
Estes confirmed to the I-Team that the hiring freeze placed on the ECC prevents them from replacing operators that leave. He told council in April that the turnover rate was at 14.7 percent.
"Multiple people have resigned and taken lower-paying jobs just to get away," Dispatcher Two said.
"It is a cascading effect. And getting that turned around is what we're working on very hard right now," Estes said.
Dispatcher One said the untrained dispatchers want to help, but can't get the training to be certified.
"Since we separated from the police department, we have not received one 'in-service' and it is supposed to be yearly," Dispatcher One said.
"We have cut back on in-service training simply because of the fact that we don't have enough staff to replace the people when we pull them off the floor," Estes says of the situation.
As part of receiving EMD certification, the dispatchers are to be trained on one or both response systems: The MPDS card set and the ProQA software systems.
The MPDS cards are the most basic training to be certified, and allow you to sort through symptoms and determine how to respond with medical advice.
The ProQA software allows dispatchers to follow along in real-time as 911 callers describe what's wrong, and the program will take operators step-by-step with how to treat it while the ambulance travels to the scene.
To see an example of what the ProQA software can do, go to http://www.prioritydispatch.net/sites/default/files/flash/medical/proqamedical.html.
Even the dispatchers that have received some training still need that yearly in-service as a refresher.
"We have a stack of (MPDS cards) that we can use, but we had only three days of training on it and that was two years ago," Dispatcher Two said.
If the dispatchers have some knowledge of life-saving procedures, they are told they legally can't help without that proper, certified training.
"Even though I know how to do the Heimlich maneuver, I'm not medically trained to tell them how to do it over the telephone," Dispatcher Two said.
Dispatcher One says they know more about avoiding a lawsuit than keeping someone alive as a result of the lack of efficient training.
"We've been told what not to say, rather than what to say," Dispatcher One said. "Medically trained call takers have received recognition for delivering babies over the phone and things like that. A non-medical call taker would say, 'don't push! They're on the way.'"
Estes says it takes nine months to fully complete all the medical training when a new operator is onboarded, which includes learning the response systems, 80 hours of classroom training, 360 hours of police dispatch training, 240 hours of call-taking training, and 320 hours of fire dispatch training. Estes notes they are trying to get that training down to six months.
The dispatchers said their training schedule has been accelerated since the I-Team started asking questions in April.
Cincinnati City Council member Charlie Winburn accepted a sneak peek viewing of this report, and even before it was published had sworn to immediately draft a motion to fully staff the 911 center that he said would be put in front of city council as soon as possible. Read the motion at http://goo.gl/KJpZF.
"When you call and you have a medical emergency, I should be able to tell you exactly what steps you need to take while you're waiting for the fire department to arrive on scene." Dispatcher Two said.
You can hear the full comments of the dispatchers that spoke to the I-Team below or at http://www.youtube.com/watch?v=-CEgPenYkhg.
Next page: The city responds
The city of Cincinnati used Twitter to react to an I-Team investigation revealing not all 911 operators are medically trained.
" ALL our full-time 911 call-takers & fire dispatchers (plus all but 6 police dispatchers) can give medical direction over the phone," the city tweeted Wednesday.
The tweet contradicted the results of an I-Team investigation showing some people who answer 911 calls in the city's Emergency Communication Center disconnected emergency calls because the operators and dispatchers were not trained to give medical advice.
In an email dated May 9, responding to the I-Team's request for more information, the city's director of emergency communications, Joel Estes, insisted, "all of our E911 Call-Takers are EMD certified."
Three current police dispatchers told the I-Team at the time that the full-time operator who answered Rhonda Andrews' heart attack call, and several other "dispatch and disconnect" medical calls the I-Team reviewed, was not Emergency Medical Dispatch (EMD) certified.
When confronted with this information in a reply email from the I-Team, Estes confirmed that the operator was not medically trained, but did not include her in the original statement indicating, "all of our E911 Call-Takers are EMD certified."
Estes said she didn't count because she, "returned as a temporary employee." He added, "because we weren't sure if she was going to stay, we didn't schedule her for EMD training when we had full-time employees who needed it."
Because of the hiring freeze, the operator in question can't be fully reinstated, but the dispatchers told the I-Team she is working full-time as an operator without the medical training. Estes responded, "nevertheless she is now scheduled for EMD training next month."
Also contradicting the city's tweet, Estes admitted in an email to the I-Team that Cincinnati's Emergency Communications Center can not currently qualify for accreditation from the National Academies of Emergency Dispatch.
"We are not NAED accredited because we have not yet been able to get everyone EMD certified," Estes wrote.
You can read Estes' emails below or at http://goo.gl/2SmeX.
One of the dispatchers the I-Team talked to confirmed Wednesday that Andrews was indeed trained last week
Those sources also told the I-Team that their managers changed the rules allowing EMD certified dispatchers to give medical advice even if their certification was obtained years ago, or if they had not completed the previously-mandatory shadowing with a fully-trained operator.
Requirements for 911 operators by law:
Full 50 states list: http://psc.apcointl.org/2010/09/01/state-training-certification-survey/
National Academy of Emergency Dispatch:
Inside the Emergency Communications Center