CRR: Five Strategies for Responding Before the 911 Call Comes In

Fire and emergency services today do much more than fight fires. They have become all-hazards responders. The expanded scope of emergency response activities, if not the number of responses for any specific type of call, have kept responders busy and in some cases burdened agencies in ways they never imagined and remain unprepared to deal with. Some have been so busy, they have failed to ask whether all these calls are actually emergencies and few have asked whether they should respond at all.

Many if not most agencies find a significant proportion of all their calls come from just a few addresses in their jurisdictions. And a careful analysis of the urgency and importance of these calls, which is a measure of the opportunity to have a positive impact on outcomes, often reveals many could or should be handled differently. In other words, emergency services are delivering an awful lot of NON-emergency service. And they have yet to question whether this is reasonable and should continue.

In recent months, we have all witnessed a national and international conversation about the role of police in handling calls involving people in crisis alongside a much larger and more urgent conversation about systemic racism. Many elected officials and policy-makers have concluded police are ill-equipped to deal with mental health crises that do not involve a clear and direct threat of harm to others. Consequently, several cities have already changed response protocols to send firefighters or EMTs to these calls instead of police. But has anyone asked whether these responders have the needed skills to handle these calls?

Many fire and emergency services agencies have adopted response protocols that require firefighters or EMTs to either stage and await the arrival of police before entering volatile or dangerous situations that could involve weapons or threats of violence. Others require their responders to perform a threat assessment before engaging any scene and avoid engaging situations that could expose responders to a threat of violence.

The hesitancy to engage uncertain situations has created a Catch-22 and eroded public confidence in firefighters and EMTs once considered the public's most trusted professionals. In a few cases, it has resulted in lawsuits alleging the withholding of emergency medical service wrongfully contributed to a needless death.

This situation suggests our responses to the expanding role of fire and emergency services in meeting community needs must begin before the 911 call is placed. What does this mean and how does it influence how agencies understand and implement community risk reduction strategies? Here are five suggestions that may serve as starters for the conversations we need to have:

1. Redefine what constitutes an emergency: We were all trained that an emergency is always viewed from the perspective of those experiencing it. That's still true. But a citizen's emergency does not need to be an emergency for us. Fire and emergency services should see all of these situations as part of their routine. Response postures and protocols should be scaled to the urgency and impact responders can have. In the same way that each call requires a different kind of response capability, not all calls require a time-critical emergency response. Agencies might find scheduling "office hours" for walk-ins or home or business visits to deliver certain services meets many demands that otherwise result in 911 calls.
2. Clarify, reinforce, and stick to mission, vision, and purpose: No fire or emergency service organization can reasonably expect to handle every situation with equal skill much less achieve optimal outcomes while doing so. In fact, optimal outcomes are rarely even an option. The best outcomes usually went out the window before anyone decided to dial 911. As such, responders are always making the best of bad situations when they wait for 911 calls before they act. Reducing community risk requires a clear commitment to acting as soon as possible not just when absolutely necessary. If your agency is simply there as a last resort, then fine. Just say so and stick with that. But then don't complain when you're called upon to deliver services that neither require nor particularly benefit from your intervention. On the other hand, if your agency fancies itself aggressive and proactive, then you can't afford to spend all your time on preparedness and response. Prevention, mitigation, and recovery have to have more prominence in how you spend your time and resources.
3. Respond before the 911 call: One of anything is sheer chance. Two of something is coincidence. Three is a trend. Anyone who calls 911 more than three times in a 12-month period has something going on in their life that can be dealt with a better way than calling 911. Fire and emergency services have to take more responsibility for understanding the underlying issues affecting response patterns and work with citizens and other service providers to address underlying problems not just provide superficial solutions. Firefighters and EMTs have an enormous advantage over other medical and social service providers: They get to see people in their natural habitat -- their homes, the places where they are most comfortable. As such, they often have a unique perspective on the circumstances that sustain individuals' vulnerability. Responders can and should take more responsibility for managing the environment that sustains vulnerability rather than simply managing the impacts.
4. Make citizens the real first-responders: Calling firefighters, cops, and EMTs first-responders misstates their roles and responsibilities. Ideally, they should be the last line of defense not the first port-of-call. Reinforcing roles as first-responders enables moral hazard and fosters co-dependence. Much of what fire and emergency services do today was once handled by and within the community in other ways. In many cases, those responses were just as effective and almost always more efficient than what these agencies do today. Fire and emergency services can and should help the citizens build and maintain the community's capacity to handle certain situations entirely on their own. Much of the time spent training firefighters and EMTs to handle new demands would be far better spent training the people closer to where these events occur how to avoid, prevent, and manage them.
5. Seek-out opportunities for engagement: If you're worried about the uncertainty of volatile and dangerous encounters with citizens, that should signal a need to get out of the firehouse or station and meet people where they are. Forming proactive, constructive relationships with citizens and community groups is by far the best way to reduce response risks. And that means everyone without exception. In a previous position, I made no distinction between a neighborhood watch group and the local motorcycle "club." They both paid taxes that funded my salary. Both had tangible concerns about their community and how they were perceived by others. Anything I could do to serve as a bridge between them was a net positive for all involved. Making your service about "them" is ultimately the best protection for "you."

If community risk reduction is going to change the way fire and emergency services operate, it has to do so by re-prioritizing how they manage demands for our services. Genuine emergencies should still take first priority, but realistically these calls constitute only about 15-20 percent of 911 call demand. The rest represent opportunities for improvement and suggest the need for greater investment in alternate service delivery models.

If fire and emergency services can implement programs to mitigate the impacts of real emergencies and increase resilience, why can't they reduce or eliminate non-emergency service demands altogether? Agencies may have no choice whether to respond. But they can decide where, when, and how to respond. And doing so before the 911 call must become the norm.

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