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When Seconds Count: Being 9-1-1 Savvy
Draft version of the article printed in Hearing Loss, SHHH Journal July/Aug 2003
You can also view and print this article in Adobe Acrobat brochure form (PDF)

By Cheryl Davis

A key element in handling emergency situations is being prepared. Fire Marshals train us to plan an escape route for our families before a fire occurs. What you may not realize is that understanding how your 9-1-1 Call Center operates is an important component of preparedness! This becomes especially important for individuals with hearing loss, for whom telephone communication is difficult if not impossible.

"9-1-1. What is the address of your emergency?"

When the 9-1-1 Call Taker responds to a call, a carefully scripted protocol is set into motion. The first thing the call taker must do is verify the address of the emergency and the phone number there so that help can be sent. If you lose consciousness or are cut off before you are able to go into detail, the call taker is still able to dispatch help to the appropriate location.

Understand, even if your Call Center has Enhanced 9-1-1 features (e.g., ANI/ALI: Automatic Number Indicator/Automatic Location Indicator), the Call Taker will want to verify the address of the emergency. Some business phone systems (e.g., PBX) display a central office address rather than the location of the phone. For example, the City of Eugene has offices spread through several downtown buildings, but they are all connected to the same phone system. Thus the ANI/ALI information the Call Taker sees would be the City's central office address, rather than the building or office you are in. There are also issues of calls from cell phones, or calls made from someplace other than the location of the emergency.

"What is the problem? Tell me exactly what happened."

Once your location has been verified, the Call Taker will want to know the nature of the emergency; that is, is it a police, fire, or medical emergency? 9-1-1 Call Centers follow a carefully developed protocol from one of several agencies nationwide. If the caller says someone is not breathing, the Call Taker follows one set of questions; if the complaint is chest pain, different questions are asked. The questions are worded in a specific way and listed in a specific order so that they can elicit the exact information from you-no more and no less-so that the appropriate service can be dispatched in the timeliest manner possible.

Remember Joe Friday's famous quote ("Just the facts, ma'am, just the facts.")? You should let the Call Taker ask you questions, and answer the questions as they are asked. You may be tempted to tell the Call Taker that your husband is having chest pains, and it might be indigestion because of what he ate but it seems worse tonight. The Call Taker wants to know if he is conscious, turning blue, becoming clammy, or has pain running down his arm. Indeed, because the Call Taker must follow protocol, they are trained in persistent repetition; that is, they will repeat the question until you respond to it. This is a useful technique in emergency situations where people are panicking and not necessarily responding to questions or following a logical line of thinking.

Your responses are being logged into a computer system. The Call Taker will make the determination of which service (i.e., Police, Fire, or Medical) is needed and the level of urgency (e.g., emergency, non-emergency) based on your responses. Depending on whether you are in the city or county, the Call Taker will either dispatch that service or transfer your call to the appropriate service provider (e.g., Sheriff's Office), and relay a log of the information you provided. By law, they are allowed to transfer the call only once.

Some calls are silent; that is, when the 9-1-1 Call Taker answers the phone no one responds. These nonresponsive or "noncompliant" calls must be treated as an emergency. If the Call Center has the ANI/ALI Enhanced 9-1-1 features, a police car is sent to the address. The officer on the scene then dispatches other services (e.g., fire, medical) if they are needed.

What Does this Mean for Deaf and Hard of Hearing Callers?

As you well know, not being able to hear makes calling 9-1-1 extremely stressful. Deaf callers typically use TTYs (text telephones) to make phone calls. If the parties they are calling do not have TTYs, they may make the call using the nationwide Telecommunications Relay Service (TRS). The Deaf caller calls TRS and gives them the phone number of the person they want to call. The TRS Communication Assistant calls the number. The Deaf person types what he or she wants to say, the Communication Assistant (CA) reads it to the hearing party. The hearing person responds, and the CA types the response to the Deaf party. Because of limitations of the equipment, the parties involved must speak (type) one at a time. Also, no background sounds will be transmitted. Because typing and relaying of information is involved, the amount of time involved is much greater than for a spoken conversation between two people.

Because the individual who is hard of hearing often has clear or understandable speech, he or she may use a different TRS service called Voice Carry Over (VCO). With VCO, the hard-of-hearing caller speaks directly to the person he or she is calling. That person's responses are typed by the CA for the hard-of-hearing person to read.

The Americans with Disabilities Act of 1990 requires that telephone emergency services, including 9-1-1 services, provide direct access to individuals who use TTYs and computer modems. The Department of Justice mandated that all 9-1-1 Call Centers in the US be TTY-accessible by 1998. This means that the Call Centers must be prepared to take TTY calls direct from the caller, not with the assistance of TRS.

This is a boon for TTY users; but VCO and other Relay Service customers will still have difficulty for several reasons. The Relay Service is national, not local. When you call 7-1-1 (the nationwide TRS number), the CA answering is probably in another state. When you ask the CA to call 9-1-1, he or she will have to ask you where you live and look up the 10-digit emergency services number for your area (they can't just call 9-1-1, because a local Call Center would respond). Also, your ANI/ALI information will not be transmitted to the Call Center through TRS because you have not dialed them directly (although the TRS may be equipped to forward this information). Finally, while it is difficult to interrupt someone in direct communication on a TTY, it is impossible through the Relay Service. The equipment used in relay calls generally allows the CA communication in one direction. If you launch into irrelevant medical history, you will not be interrupted with a request for your address (the CA may not even be able to hear the 9-1-1 Call Taker trying to interrupt), and life saving assistance may be delayed.


1. If you have a TTY, use it to call 9-1-1 direct. Because of the ADA, non-responsive or silent calls should automatically be switched to TTY mode after the question ("9-1-1. What is the address of your emergency?") has been asked twice. With some systems, if you hit your space bar 4 times within 4 seconds, it will automatically switch the Call Taker's system to TTY mode.

2. If you don't understand the question, say so! The Call Taker's assumption is that you understand English but that you are stressed out. If you don't respond to the question (or make a response that doesn't answer the question), they will keep repeating it until you do!

3. Find out now if Enhanced 9-1-1 service is provided in your home and office environments. Call the 9-1-1 non-emergency number in your phonebook to obtain this information. This will help you in decision making about how to obtain emergency help when you do need it.

4. The equipment found in Call Centers will vary. Some will be have TTYs and some will have a computer system that can be toggled between voice and TTY mode. Either way, ask if the Call Takers have been trained in VCO. If they understand the concept of using GA and different ways the caller might be making the call (e.g., via a special phone with a screen, or using a phone in tandem with a TTY), VCO users won't need to go through TRS in an emergency.

5. Find out from your relay service provider how they handle 9-1-1 calls in general, and if they are able to forward your ANI/ALI information to the appropriate Call Center.

6. If you cannot hear on the phone but can speak, dial 9-1-1, state that you are deaf, your location, if you need fire, medical, or police assistance, and what the emergency is. (e.g., "I am deaf and I cannot hear you respond. My name is Mary Jones and I'm at 345 ABC Street off of Main St. I need an ambulance. My son fell out of a tree and is unconscious. I'll keep repeating this because I cannot hear you. My name…")

7. Don't hang up! Recognize that the line may ring many times on your end of the phone before the call taker ever hears the first ring. This is because the 9-1-1 call is first directed to the national 9-1-1 Call Center, then directed to the center with the ANI/ALI information, then directed to the local 9-1-1 Call Center. Our local Call Center has reported that callers may hear as many as 9 rings before the call reaches their center.

8. If you can hear enough to use an amplified phone, make the effort to find a cordless phone that works for you. People who are going to have a medical emergency in your home rarely do so next to your TTY or amplified corded phone. This can reduce a great deal of stress if you are in a situation where you need to follow instructions from the Call Taker.

9. Take a CPR class…better yet, get your SHHH group (or any other organization you belong to for that matter) to sponsor a CPR class. If you feel nervous about it, remember: You don't have to do CPR very well to still be able to save a life! Besides CPR, these classes include basic medical information like how to stop bleeding.

10. Post information like this to your SHHH website, and have your local 9-1-1 Call Center do the same.

11. If you do use the relay service, ask the Call Taker to repeat your address back to you after he or she has gotten the main information from you. There have been instances where information was read incorrectly to the Call Taker resulting in a delayed response time.


There are several resources available for working with 9-1-1 Call Centers. For example, Washington State has a 911/TTY Education Program. For more information go to www.cscdhh.org/911_tty.htm . They have developed a training video, student guide, and teacher guide. In addition, TDI Publications has developed a training guide. It is called Emergency Access Self Evaluation and can be found at www.tdi-online.org/publications.htm .

Other organizations are also involved in keeping 9-1-1 Call Centers accessible as technology changes. For example, the Alliance for Telecommunications Industry Solutions issued this press release regarding the use of cell phones and enhanced 9-1-1 www.atis.org/atis/PRESS/pressreleases2002/111902.htm in response to the FCCs request for comments (see for example http://hraunfoss.fcc.gov/edocs_public/attachmatch/DOC-229405A1.doc ). (The FCC oversees the Telecommunications Relay Service. For more information, see www.fcc.gov/cgb/dro/trs.html ) The Department of Justice oversees the regulation of the ADA. They have published their guidelines for access for 9-1-1 and telephone emergency services at www.usdoj.gov/crt/ada/911ta.htm .

Volunteer to work with your local Call Center to make sure that both the primary and secondary call centers (e.g., sheriff's offices) are able to effectively handle TTY/VCO calls so that when seconds count, you can call 9-1-1 direct with confidence! The business of Call Centers is fascinating. You'll learn a lot as well as provide a valuable service to your community!


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