ROGERSVILLE — Questions surrounding the Emergency Medical Dispatching certifications of several Hawkins Co. Emergency Communications District dispatchers resulted this week in all staff having to be re-certified by an onsite instructor, and a full training audit of all staff members, because more than half were said to be non-compliant.
That training, and an on-site training records audit, will cost the county more than $8,000 and could have possible legal ramifications should questions arise about medical calls that were dispatched by a person who was non-certified at the time.
At an emergency meeting of the HCECD on Sunday afternoon, Nov. 17, 2019, Chairman Michael Herrell read aloud an email sent at 2:43 p.m., on Friday, Nov. 15, 2019, by Dorothy Cave, RPL, NREMT, the EMD Program Manager for the Daytona Beach, Florida-based APCO:
“As of Nov. 15, 2019, Hawkins Co. Emergency Communications District is not permitted to EMD (Emergency Medical Dispatch) calls due to agency/staff non-compliance. More than half of your staff’s EMD certification is expired. Currently, Hawkins Co. ECD is liable for any issues about EMD during the non-compliance timeframe.”
According to information obtained by the Review, an EMD program is administered under the direction of a medical director (medical doctor or physician’s assistant). Training can be done in-house, using certified curriculum, or may be contracted out to a private provider of such training.
When a person calls 911 with a medical complaint, the dispatcher goes to a complaint guide card and it directs the dispatcher to ask specific questions about that person’s complaint.
Depending on how the questions are answered results in how the dispatcher sends an ambulance — emergency or non-emergency.
The guide card also has specific pre-arrival instructions for the caller depending on the medical complaint. Pre-arrival instructions can be something as simple as “gather the patients medications”, or as important as pre-hospital CPR, talking someone through childbirth, or instructing a person that may be having a heart attack to take aspirin before the ambulance gets there.
Someone who is not EMD certified is basically a lay person advising an ambulance if they need to respond emergency or non-emergency to a medical complaint, the Review’s source said.
Without the EMD program, the dispatcher would not be able to determine what status to send an ambulance or give pre-hospital instructions. In other words, if a person called 911 for someone not breathing, then the dispatcher would not be permitted to talk the person through CPR until an ambulance arrived on-scene.
EMD only effects medically-related calls, with separate certifications required for law enforcement and fire dispatching.
Recertification for participating 911 dispatch center personnel is required, and all APCO Institute certified EMD Managers must provide proof every two years of 24 hours (12 hours per certification year) of Continuing Dispatch Education.
But, as stated in the emergency meeting on Sunday afternoon, questions have also arisen concerning the status of law enforcement and fire dispatch certifications, which has necessitated the need for a full “training audit” of personnel records by Cave on Monday and Tuesday of this week (Nov. 18-19), with EMD hybrid student classes taught to staff members on Wednesday and Thursday (Nov. 20-21). Then, on Friday, Cave said in the email, she will teach one person to serve as the APCO EMD Manager.
“Requirements for the APCO EMD program have always stated your agency will have either a certified in-house APCO EMD instructor or an APCO EMD Manager,” Cave said in the email.
Present for the Sunday afternoon meeting were Chairman Michael Herrell, E-911 Director Gay Murrell, and HCECD Board Members David Good, Fred Castle, Lynn Campbell, Mike Gillespie and Lawrence Wheeler.
“The other night when we had our meeting, some stuff came up about training, and there was stuff that we probably should have discussed but we weren’t aware of it until after the meeting,” Herrell said in opening the 2:30 p.m. meeting.
In that earlier meeting, which was reportedly held late last week, Herrell said it was discussed that the District has four dispatchers who are trained in ECD and six who aren’t.
Because of that, Herrell said, “they (APCO) have shut us down in part of how we dispatch”.
Director Murrell, however, challenged APCO’s assertion regarding six untrained dispatchers.
Six people in the office, including herself, are EMD certified, she said, but one employee, who was the training coordinator, quit on Friday “and walked out”, Murrell said, which leaves five with EMD certification and four who need need the training.
Getting dispatchers into the training classes is the training coordinator’s job, Murrell said.
“Now, we have to have an EMD Manager, which I was not aware of,” she said.
Several years ago, Murrell said, the local District did teach EMD “in house”.
A former employee, who was thought to be an EMT, was given the task of training dispatchers at that point, but that fell through when it was learned that that person did not have a current EMT license.
“At that time, I was told by APCO, and that was my fault that I did not get it in writing, that we did not have to have an EMD Manager,” Murrell said. “From that point forward we have always trained for EMD online.”
Murrell said that she, herself, was re-certified last year. Two other dispatchers were re-certified this year.
“I would have thought that APCO knew we didn’t have an EMD Manager, but they have told me they don’t keep up with that,” she said. “They keep up with our certifications, why would they not keep up with whether we had an EMD Manager? But I can’t get an answer. I have asked in emails over the weekend. We didn’t have one (EMD Manager) so that makes us out of compliance. I understand that we are out of compliance. What I don’t understand is this, we have these people that are certified, we have paid to have these people certified, and have their certificates in hand, and they want these people to go back through this certification and pay to train these people again, and I don’t think that’s right, I don’t think that’s right at all. If they want to come and do a (training) audit, that’s fine, I don’t have a problem with that. I don’t know what they’re going to audit.”
Murrell said she did not think the audit would include law enforcement and fire dispatch training.
Campbell, however, said that he and Herrell were told that the audit would include all training records for the past two years.
Murrell said that with the resignation of the certified trainer on Friday, and the lack of an EMD Manager, decisions will have to be made as to who is appointed to fulfill those requirements.
“The question I’m asking is, why weren’t you on top of it?” board member David Good asked.
“I should have been, but I thought she (the employee who quit on Friday) was doing a good job because every time I asked where we were on our training she said we were good on our training,” Murrell said.
One employee, Murrell said, told her that he went to that former training coordinator several times asking about training.
“So that is my fault,” she said.
Good asked why Murrell thinks the District has more employees whose training is up-to-date than what APCO has stated.
“Because I pulled the records myself Friday morning,” she said.
“Is there a reason why their numbers are different from yours?” Good asked.
“The way APCO works, I can’t get into their system,” she said. Even though she identified herself as the E-911 Director, APCO reportedly told her that it will only release those records to the District’s certified trainer.
Reading from another followup email from Cave, Herrell continued:
“Your agency will not be refunded any money from certification or recertification. All staff will complete the EMD course being taught next week.”
Murrell added that the District is not required to have EMD certification.
“We do query the caller about questions that we know to ask,” she said.
“But we’re doing it illegally,” Good responded.
“We’re not doing it illegally, the agency is out of compliance,” she said. “Let’s not use the word ‘illegally’.”
“But it makes us liable if someone comes back on us,” he said.
With EMD, there is no specific decision-making, Campbell said.
“You ask specific questions and ever how they answer, that’s how you send the ambulance,” he said.
The District does have a Medical Director.
Murrell said that she met with Hawkins Co. EMS officials on Friday as soon as she spoke with APCO.
Because the ambulance service also apparently has to verify or confirm the status of dispatchers’ EMD certifications, that will probably also affect reports required of that agency as well, she said.
Herrell, quoting from the APCO email, said it would cost the board a maximum of $10,265 for the training and audit, but that subtracting the cost of training the former employee who quit on Friday, and other possibly non-essential portions of the training, the actual cost could be closer to $8,361.
“I’m asking that we go ahead and approve the full amount to be paid from savings account, and if we don’t use it we can put it back,” Herrell said.
A motion to that effect was made by Campbell, seconded by Wheeler, and approved unanimously.
One board member said that a spreadsheet, or some form of tracking mechanism, needs to be put in place to keep up with the training needs and achievements of all employees and when each is due for recertification.
“Is there any more training they are not certified in that we don’t know about?” Herrell wanted to know.
“Everything I saw Friday is good, but until I can get into those (APCO) files, I don’t know,” Murrell said. “This has never been a board ‘push’. You never said that we want all staff trained.”
Campbell said that he felt the cost of the audit and training is worth it to “make sure everyone is on the same page”.
Whomever is appointed as EMD Manager and Quality Assurance Officer needs to have the power to issue disciplinary actions, or to pass that decision up to the Coordinator, Campbell said.
On a motion by Good and Campbell, the board voted to approve assigning the Training Coordinator duties to Murrell, and the EMD Manager/QA duties to Caitlin Smith.
The board also agreed to call a special meeting of the Personnel Committee for Wednesday, Nov. 20, at 4:30 p.m., at the ECD base at 2291 E. Main St., in Rogersville, to discuss the situation.