Dispatches From the Future

One thing strikes you as you walk in the door at Lifecom, American Medical Response's new communication center in Northern California: The room is huge. Almost 6,000 square feet of space are loaded with computer stations arranged around a pair of glass-walled managers' offices in what was once a warehouse and compact disc factory.

     Those glass walls let Stanislaus County Communications Manager Jared Bagwell stay in visual contact with more than 40 full-time dispatchers and also let all the dispatchers see Bagwell.

     "I don't have any privacy in here," he says, waving his hand to indicate the personnel seated in front of multiple computer screens around his office. "It's like a fishbowl."

     Lifecom is a technological leap from the communication center it replaced. "All of the technology is new," says Bagwell. "All of the radios, all of the CAD, all of the phones are computer-based."

     Lifecom is a regional dispatch center and public service answering point (PSAP) for American Medical Response and seven smaller ambulance services spread over two counties with a combined population of nearly 1.2 million. The center will begin serving fire departments in San Joaquin County in August.

     In a center this large and busy, where the phone rings constantly, it's important to make sure the right people are available to take those calls. The origin of each call is determined by the phone line it comes in on, and it's routed by the Avala system computer to the appropriate person.

     "Before, the phones were just a regular phone system, trunks and non-trunks, and there was a separate program to record the phone and radio traffic," explains Bagwell. "This is all integrated. The phones are computer-controlled. You set a skill level for each person sitting there, and the phone distributes the call to the appropriate dispatcher or call-taker."

     Whether call-takers' phones ring is based on their training levels and how long they've been idle. The higher an individual's training level, the more lines they are able to answer. Nonemergency transport requests are routed to specific nonemergency call-takers, which helps keep workloads manageable and keeps dispatchers on the radio and off the phone.

     The only calls not routed to specific people are to 9-1-1. "9-1-1 calls ring on all positions and all positions can pick them up," says Bagwell, and that includes dispatchers. Other than 9-1-1 calls, dispatchers' phones do not ring unless the call is routed to an individual dispatcher by one of the call-takers.

     Lifecom is considered a secondary PSAP, meaning its 9-1-1 calls are routed via other communication centers. When the call is routed to a 9-1-1 line in Lifecom, basic ANI/ALI information is displayed on the phone's touch screen. Call-takers and dispatchers call this information "the splash."

     Currently, the transfer and the splash only happen after a call-taker in the primary PSAP answers the call and determines that an ambulance is needed. Soon, says Bagwell, the primary PSAP for San Joaquin County in Stockton will have a direct CAD-to-CAD interface. "The interface is designed so they get a 9-1-1 call and enter it for their fire agency, which immediately duplicates the call and sends it to our CAD," he says. "It eliminates the need for a phone call."

     Lifecom call-takers use Pro-QA from Priority Dispatch to determine the level of response for each call. Once received, calls are routed to the appropriate dispatcher. The center uses a modified Verdugo system to send ambulances out. A primary dispatcher assigns calls to the correct ambulances and sends the calls over the radio.

     As a call is dispatched, units are moved to a control channel, where another dispatcher tracks the call. This secondary dispatcher handles any incidental traffic for the ambulance, such as requests for additional resources.

     Once the center begins handling fire department traffic, says Bagwell, medical and rescue calls will be simulcast to the appropriate fire agencies and ambulances, so both will get the information at the same time. Each agency will have its own frequency and control dispatcher to track calls after initial dispatch. When units are finished with their assignments, they are posted to their next assigned area by the primary dispatcher.

     Lifecom is similar to REDCOM, a regional communication center in Sonoma County operated by American Medical Response. In fact, REDCOM and Lifecom have integrated systems that provide redundancy for each center. A switch in the REDCOM center reroutes all 9-1-1 calls from Lifecom to REDCOM's call-takers. All other lines are routed to other AMR communication centers around California.

     Answering the phones 140 miles away is different from trying to navigate ambulances through unfamiliar territory. Since REDCOM is so far away, Lifecom has several contingency plans for different scenarios. If there is a catastrophic event and it becomes necessary to route calls to REDCOM, Lifecom has outfitted a converted Type III ambulance as a communication van, where radio communications can continue with a dispatcher.

     Since the terrorist attacks of 2001 and Hurricanes Katrina and Rita of 2005, disaster response is a primary concern. Lifecom is designed to facilitate disasters of all types. A long conference table on the main dispatch floor is used for meetings of command personnel. One of the training rooms serves double duty as a classroom and situation room, where an entire wall is a dry-erase board, and two dispatch stations are capable of live dispatching.

     Bagwell is continuously busy addressing the glitches that come with new equipment, new employees and a whole new way of doing things. The cavernous dispatch floor has plenty of empty space ready for additional dispatch and call-taker stations. How big will it get? Bagwell doesn't know. "There have been some challenges," he admits. But even with glitches, he is obviously pleased with Lifecom and looks forward to expanding it.

Rod Brouhard is a paramedic for American Medical Response in Modesto, CA, and former director of the EMS program at Modesto Junior College.