A lot can happen in a minute and 43 seconds.
If your heart has stopped, you're halfway to brain damage.
If your house is on fire, the flames have nearly doubled in size.
But in Sarpy County, firefighters may just be learning that you need help.
That's because the county 911 center is taking longer than it should to dispatch calls.
National standards say that 90 percent of the time, 911 dispatchers should spend no more than a minute on the phone with a caller before the fire station is alerted to the emergency.
But in Sarpy County from 2008 to 2012, only one in five fire and medical calls was dispatched in a minute or less, according to a World-Herald analysis of 911 call data. The median dispatch time was 1 minute, 43 seconds.
That's far below the rate in Douglas County as well as the standards from the National Fire Prevention Association.
“Every minute means cells are dying, tissues are dying,” said Papillion Fire Chief Bill Bowes. “Every minute is very, very important.”
None of the fire chiefs or other top Sarpy County officials contacted for this article were even aware of the substandard pace of emergency dispatches until The World-Herald shared its analysis with them.
“It wasn't even on our radar,” Bowes said. “I wonder if it could have, should have been.”
Douglas County, which uses a different process for screening 911 calls, dispatches 97 percent of fire and medical calls in a minute or less.
Larry Lavelle, who oversees the Sarpy County 911 center, said he can't meet the guidelines without hiring more dispatchers. And he said a comparison with Douglas County is not appropriate because of the difference in workflow and call volume.
Every year since 2008, Lavelle has asked the County Board for an additional four dispatchers, noting that the call center has not added any dispatch positions since 1999. Sarpy is the fastest-growing county in the state, and fire and medical calls have increased 16 percent since 2008.
"The agencies that we serve have expressed concerns regarding the current staffing levels in the communications center,” Lavelle wrote in his 2011 budget request.
Lavelle asked for more dispatchers again this year. Last week, board members said they are now open to hiring more dispatchers, after they learned of the newspaper's analysis.
Of course, not all calls are time-sensitive. A broken ankle, for example, won't change much in 1 minute, 43 seconds. But for other calls, a few seconds can be crucial.
In two of the most serious fire calls this year — fires in Bellevue in February and March that killed three people — dispatchers spent about two minutes on the phone in each case before they dispatched firefighters.
That's not to say a faster dispatch time would have saved any lives. Saving seconds on the front end is just one aspect of reducing overall response times.
In both cases, the fires happened within a mile of a fire station and firefighters arrived about 4½ minutes after the call came in to dispatchers.
Overall, Sarpy County firefighters arrived at the scene of an emergency within 12 minutes after the call came in 90 percent of the time. The county's two departments made up of professional firefighters, as opposed to volunteers, usually took less time than that.
Still, a slow dispatch time “could mean the difference between losing the house and making a successful stop,” Bellevue Fire Chief Perry Guido said.
Generally, a fire in an enclosed space doubles every two minutes. Around seven to 10 minutes, the fire will “flash over” as the combustible gases in the room suddenly catch fire.
“No one survives the flashover,” Guido said.
At that point, the fire has usually moved to another room. And the bigger a fire gets, the more dangerous it is for firefighters. Eventually, if it's too big, they can't go into the house at all.
That's why fire departments pay attention to the National Fire Protection Association standards, which are calibrated so firefighters reach a burning building before flashover, said Ken Willette, manager of the association's public fire protection division.
In medical cases, brain damage sets in three to five minutes after a patient's heart stops beating, and the chance of surviving a cardiac arrest drops 7 percent to 10 percent for every minute the person is not receiving CPR.
“The reason we look at NFPA standards is that there are no 911 standards in the state of Nebraska,” said Mark Conrey, who heads the Douglas County 911 center. “There is nothing that requires 911 to perform at a certain level.”
Sarpy County Board Chairman Jim Warren, a volunteer firefighter in Gretna, knows from experience the importance of response times.
“The talk is always about the 'golden hour' — the first hour from the time of the incident. But if I just lost a minute on the response time before I'm even out the door, that's probably something we need to look at,” he said.
Douglas County minimizes the dispatch time with a two-step process: An operator screens calls and routes them to fire or police dispatchers. It's a streamlined system that larger 911 centers use to decrease call time.
In contrast, Sarpy County operators must answer calls as well as dispatch emergency crews. One dispatcher could be taking information from a caller about a car wreck in Bellevue while sending EMTs to a medical call in Papillion. That slows down the process, Lavelle said.
Lavelle cautioned against reading too much into these numbers, saying his department does well on other metrics, such as answering calls within 10 seconds more than 90 percent of the time, as recommended by the National Emergency Number Association.
And, he noted, the agencies he serves are changing as the county grows. Two of the five Sarpy County fire departments are now staffed with paid professionals, and a third is moving in that direction. It's more complicated to dispatch paid firefighters, he said, because the dispatcher has to figure out which truck and ambulance should go from which station. For volunteers, dispatchers simply page all the firefighters, and those available go to the station and choose the appropriate equipment.
Lavelle and the president of the dispatchers union say that's why they need more staff.
“The county continually believes that it is still the county of 20 years ago, with the law enforcement and fire issues that they had then. And it just isn't,” said Matt Barrall, president of the Sarpy County Fraternal Order of Police, which negotiates the dispatchers' contract.
Lavelle said he has 32 dispatchers, including six in training. Barrall said Lavelle's request for four new dispatchers isn't adequate; if Sarpy really wants to move to a two-step dispatching system, it needs eight additional dispatchers, he said.
"They're probably the most unappreciated group in law enforcement,” Barrall said of the dispatchers. “They work the hardest. They have the most stress.”
Lavelle has recently tweaked the center's quality assurance program to address concerns from local fire chiefs about how calls were being dispatched.
Two years ago, Bowes, the Papillion chief, and Guido in Bellevue asked the county to change how they're dispatched. For instance, they wanted dispatchers to specify which truck or ambulance the firefighters should take and to provide more information about the nature of the call — specifying “shortness of breath” or “chest pain” instead of just “medical call,” for instance.
“You tackle what you can tackle,” Lavelle said.
After dealing with some initial problems of dispatcher inaccuracy, the chiefs say they're starting to see improvements.
“What we saw is a change in the quality of the dispatch and fewer of those mistakes,” Guido said.
The Sarpy police union renegotiates the dispatcher contract next year. In the meantime, the County Board is open to hiring more dispatchers, provided Lavelle can convince them it would solve the problem, Warren said.
Board member Tom Richards of Bellevue said he would push for more dispatchers in the next fiscal year, which begins July 1.
“I think we need to take a hard look this year in the budget in getting more resources in the 911 dispatch center,” he said.
Complicating matters is an ongoing study to merge regional 911 operations. Representatives from three counties and six cities have been meeting to discuss sharing a call center and perhaps a unified dispatching center. Given this, Warren said, it might be premature to act.
“We're still waiting for the numbers to see,” Warren said. “Instead of him hiring four more people, would it be better for us to merge and let Douglas County do the call-taking?”
Now that they're aware of the dispatch times, board members are looking more closely at Lavelle's request for more dispatchers.
Warren said the slow times are clearly a problem.
“What I need right now is to know how to fix this, and what is the cost,” he said.
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