Public Health Should Be 'Pivotal' Part of Emergency Response

There have been seemingly endless discussions about various types of police reform since the murder of George Floyd sixteen months ago. But one essential element of police work—the 911 emergency call system—has flown under the radar. 

That may be changing now. 

On Sept. 17 and 18, two events will be held that launch a new 911 reform initiative created by the University of Chicago Health Lab called Transform911.

The lack of 911 reform efforts hasn’t meant they’re not needed. We know from our past research and reporting that 911 emergency call centers have long been plagued by a host of difficulties including low morale, high turnover, poor working conditions and low pay. Debilitating staff vacancies, a situation we wrote about in a Route Fifty column in November 2019, are a particularly troublesome challenge.

But as important as these issues may be, they don’t take a startling, and generally unrecognized, fact into account. Contrary to common belief, only about 25% of 911 calls involve crime. That simple piece of data raises a host of questions. 

Why, in fact, do people call 911? Are calls directed to the right responders? How does the functioning of 911 itself affect police activities and what impact does it have on criminal justice, incarceration and community trust?

While 911 calls are sometimes directed to fire departments or emergency medical workers, in most places, police response is the catchall default response category. That’s a mistake, says Rebecca Neusteter, Health Lab executive director, because it prioritizes enforcement over other kinds of care that 911 callers need.

To find out more about 911 and the potential for reform, we engaged Neusteter, in a wide-ranging interview that we have edited into the Q&A that follows. In addition to her current position, Neusteter also has a background in criminal justice and used to head the policing program at the Vera Institute of Justice.

Route Fifty: What spurred your interest in 911?

Rebecca Neusteter: I grew up in a strong, marginalized community where there was a lot of substance abuse, mental health issues and domestic violence, and 911 would frequently be called. The police would be deployed and oftentimes, it wouldn’t make the problem better.

Why is this reform initiative coming out of a health lab and not a criminal justice program?

Neusteter: Because public health should always have been a pivotal part of emergency response. If you look at the history of 911, we made a concerted decision to couple care with enforcement. That’s created a challenged system that’s severely aggravated already damaged police-community relations, particularly with communities of color, communities that are experiencing mental health crises, and those that are marginalized in other ways.

Even in nonmarginalized communities, most callers don’t want or need a police response. Research shows 75% of 911 calls don’t relate to a crime in progress. They’re about medical emergencies, noise complaints, overdoses, traffic violations, domestic disturbances—scenarios which may be better handled by nonpolice public health and safety professionals. 

We now need to disentangle those services and to make sure that people who need care can seek it without risking receiving enforcement instead.

What are the biggest challenges in reforming 911?

Neusteter: Similar to policing, 911 is incredibly localized. There are about 6,000 911 centers, formally referred to as Public Safety Answering Points or PSAPs, across the country. They’re all governed and managed totally differently. 

Most people have no idea when they pick up the phone and call 911 how that call is routed and who is answering it. Does it fit within their police department, a sheriff’s office, a nonprofit organization, a regional authority or a for-profit company?

Even if the general public is ignorant about 911 calls, there must be lots of information that experts have, right?

Neusteter: This is such an under-examined space. The information we have about 911 is not anywhere near where it needs to be. We need to know how many people are calling 911 every year; why they are calling 911; who shows up, and what happens when responders arrive. Are their underlying needs met? Are people who call satisfied with the response? Do call takers have the resources they need to identify the appropriate response, or the time and resources to determine fundamentally what people really need?

Are there performance measures in use that would help to answer any of those questions?

Neusteter: I would love to see customer service satisfaction ratings driving performance. Other countries incorporate satisfaction metrics, but I have not seen this used for 911 in the United States. 

The measures that have been prioritized and collected have adverse impacts. For example, the primary measure when we talk about 911 is response time – how long it took to answer the call and how long it took for the responder to arrive on the scene, 

What we know, however, is that often the quickest response isn't the best response. 

But we default to the police to solve those problems without ever properly identifying them because we are incentivizing speed. Answer the phone quickly. Get off the phone quickly. Send a police officer quickly. Move on to the next call quickly.

Your reform ideas put a lot of weight on the decisions made by call takers.

Neusteter: We need to invest in the call takers so that they can determine what the right response is at the right time. 

From an occupational perspective, it’s important to point out that the Bureau of Labor Statistics classifies public safety telecommunicators as administrative secretarial positions. We need to change the occupational title for public safety telecommunicators to properly define their role and attract people to the position who will be successful in it. We need to provide support to telecommunicators so they can successfully execute the critical gatekeeping role their jobs require.

On Sept. 17 and 18, the Health Lab is planning two events that will introduce the first part of your Transform911 initiative. Can you preview some of what you’ll be talking about?

Neusteter: We’re bringing people together to have a public conversation about how we transform 911 to develop a safe, supportive, community-driven emergency response system that is prepared to respond to a variety of scenarios in tailored ways and prioritizes health and safety. 

Transform911 is taking a comprehensive look at the 911 system, nationwide, gathering feedback from experts and community members, and reviewing research to develop evidence-based recommendations for state, local and federal policymakers to drive change.

On Sept. 17 we hope to bring people together to learn about 911 and to motivate people to join us in this work. Sept. 18 is a day of action in which we hope to start filling in some key information gaps. While there’s still much to be learned, there are some initiatives cropping up across the country which we’re cataloguing on the Transform911 website to make this information available publicly. We’ll be continually adding to this site and are encouraging people to share things we may have missed and make corrections or additions to the data we’re curating. 

Could you sum up your vision for the results you’d like to see?

Neusteter: I envision a future where we have a system that not only allows for but ensures that the right responder is dispatched at the right time with the right resources, both in the immediate term as well as in terms of follow-up care.

Practically, to achieve that, we need public safety telecommunicators to have the time and resources to properly identify needs and appropriate responses. This will require that we have a broader variety of resources that can be deployed and that call takers are afforded the time, training and supports to properly diagnose and triage the right response at the right time.