How 911 dispatchers deescalate emergency calls

The first thing you learn is that a panicking caller is not being difficult. They are doing exactly what a human being does when something terrible is happening, and your job is to work with that rather than against it.

I took calls in Milwaukee County for six years. Here is what actually works, and none of it is complicated.

Lower your voice, do not raise it

When somebody is shouting, the instinct is to match them so you can be heard. It is the wrong instinct and it escalates.

You go the other way. Slower, lower, quieter. People unconsciously adjust toward the voice they are listening to, and within about fifteen seconds a screaming caller will usually come down toward you.

I was taught this in training, was sceptical, and watched it work several hundred times.

Use their name

Ask for it early and then use it. Repeatedly.

A name does something to a person in crisis that nothing else does. It cuts through, it establishes that there is a specific individual on the other end who is addressing them specifically, and it brings people back into the room.

If they will not give you a name, use anything. Ma'am, sir, whatever fits. The rhythm of being directly addressed is what matters.

Give one instruction at a time

A frightened person cannot hold a list. Their working memory has collapsed to almost nothing.

So you give one thing. Wait for it to be done. Then the next thing.

Not: go outside, unlock the front door, turn the porch light on and check his breathing. Just: is he breathing.

This is the mistake new dispatchers make most often, and every one of us made it.

Ask closed questions first

Open questions get you a story. You do not want a story yet.

Where are you. Is anyone hurt. Is the person breathing. Is the person awake.

Yes and no answers are things a person in crisis can produce. Narrative comes later, once the units are moving and you have time.

Tell them help is already coming

As early as you honestly can, and it is usually earlier than callers expect, because in most centres someone else is dispatching while you are still talking.

Callers think the ambulance leaves when you hang up. They do not know that units were assigned ninety seconds ago. Telling them removes an enormous amount of the pressure that is making them shout at you.

And it is true, which matters, because the one thing you cannot do is tell a caller something that turns out to be false.

Give them a job

This is the most useful thing on the list.

A person who is helpless is a person whose panic keeps rising. A person with a task is calmer, immediately, even if the task is small.

Go and unlock the front door. Put the dog in the bedroom. Turn on the porch light. Go out to the kerb and wave the ambulance down. Stay on the line and tell me if his breathing changes.

Half of those tasks genuinely help the responders. All of them help the caller, and the caller being functional is what gets the information you need.

Do not say calm down

It does not work and it never has.

What it communicates is that you think their reaction is the problem. Now they are frightened and defensive.

Acknowledge instead. I know this is frightening. I need you to stay with me. Then move straight to the next instruction, because dwelling on the emotion is not the job either.

The ones that stay with you

The hardest calls are not the loud ones. Loud is workable.

The hard ones are silence, or a whisper, or a child.

Silence usually means you have a line open and something has happened to the caller, and you keep talking anyway, because they may be able to hear you and because the recording matters.

I still think about specific calls, years later. Everyone in that job does. The people who tell you they do not are either lying or are about to leave.

What I would tell a caller

Stay on the line. Hanging up to call somebody else is the most common thing people do and it removes the only thread the system has to you.

Give the address first, before anything else, and give it twice. If nothing else gets through, that does.

And answer the questions even when they feel absurd and slow. They are not delaying anyone. The units are already moving while you are being asked.