Emergency Medical Dispatch Protocols are guidelines that a 9-1-1 dispatcher uses to evaluate the nature of emergency, resources to send and the nature of help provided to the 9-1-1 caller. The current Dispatch Protocols are based on voice only call. But the Next Generation 9-1-1 (NG9-1-1) architecture will allow multimedia emergency calls. In this thesis I analyze and model the Emergency Medical Dispatch Protocols for NG9-1-1 architecture. I have identified various technical aspects to improve the NG9-1-1 Dispatch Protocols. The devices (smartphone) at the caller end have advanced to a point where they can be used to send and receive video, pictures and text. There are sensors embedded in them that can be used for initial diagnosis of the injured person. There is a need to improve the human computer (smartphone) interface to take advantage of technology so that callers can easily make use of various features available to them. The dispatchers at the 9-1-1 call center can make use of these new protocols to improve the quality and the response time. They will have capability of multiple media streams to interact with the caller and the first responders.The specific contributions in this thesis include developing applications that use smartphone sensors. The CPR application uses the smartphone to help administer effective CPR even if the person is not trained. The application makes the CPR process closed loop, i.e., the person who administers the CPR as well as the 9-1-1 operator receive feedback and prompt from the application about the correctness of the CPR. The breathing application analyzes the quality of breathing of the affected person and automatically sends the information to the 9-1-1 operator. In order to improve the Human Computer Interface at the caller and the operator end, I have analyzed Fitts law and extended it so that it can be used to improve the instructions given to a caller. In emergency situations, the caller may be physically or cognitively impaired. This may happen either because the caller is the injured person, or because the caller is a close relative or friend of the injured person. Using EEG waves, I have analyzed and developed a mathematical model of a person's cognitive impairment. Finally, I have developed a mathematical model of the response time of a 9-1-1 call and analyzed the factors that can be improved to reduce the response time. In this regard, another application, I have developed, allows the 9-1-1 operator to remotely control the media features of a caller's smartphone. This is needed in case the caller is unable to operate the multimedia features of the smartphone. For example, the caller may not know how to zoom in the smartphone camera.All these building blocks come together in the development of an efficient NG9-1-1 Emergency Medical Dispatch protocols. I have provided a sample of these protocols, using the existing Emergency Dispatch Protocols used in the state of New Jersey. The new protocols will have fewer questions and more visual prompts to evaluate the nature of the emergency.

abstract: Extreme hot-weather events have become life-threatening natural phenomena in many cities around the world, and the health impacts of excessive heat are expected to increase with climate change (Huang et al. 2011; Knowlton et al. 2007; Meehl and Tebaldi 2004; Patz 2005). Heat waves will likely have the worst health impacts in urban areas, where large numbers of vulnerable people reside and where local-scale urban heat island effects (UHI) retard and reduce nighttime cooling. This dissertation presents three empirical case studies that were conducted to advance our understanding of human vulnerability to heat in coupled human-natural systems. Using vulnerability theory as a framework, I analyzed how various social and environmental components of a system interact to exacerbate or mitigate heat impacts on human health, with the goal of contributing to the conceptualization of human vulnerability to heat. The studies: 1) compared the relationship between temperature and health outcomes in Chicago and Phoenix; 2) compared a map derived from a theoretical generic index of vulnerability to heat with a map derived from actual heat-related hospitalizations in Phoenix; and 3) used geospatial information on health data at two areal units to identify the hot spots for two heat health outcomes in Phoenix. The results show a 10-degree Celsius difference in the threshold temperatures at which heat-stress calls in Phoenix and Chicago are likely to increase drastically, and that Chicago is likely to be more sensitive to climate change than Phoenix. I also found that heat-vulnerability indices are sensitive to scale, measurement, and context, and that cities will need to incorporate place-based factors to increase the usefulness of vulnerability indices and mapping to decision making. Finally, I found that identification of geographical hot-spot of heat-related illness depends on the type of data used, scale of measurement, and normalization procedures. I recommend using multiple datasets and different approaches to spatial analysis to overcome this limitation and help decision makers develop effective intervention strategies. / Dissertation/Thesis / Ph.D. Sustainability 2013

This dissertation is a conversation analytic examination of recurrent practices of interaction in medicalemergency calls. The study expands the analytical focus in past research on emergency calls betweenemergency call operators and callers to pre-hospital emergency care interaction on the phone betweennurses, physicians and callers. The investigation is based on ethnographic fieldwork in a Swedish emergencycontrol centre. The data used for the study consists primarily of audio recordings of medical emergency calls.Fundamental procedures in medical emergency calls examined in the dissertation are: (1) questioning; (2)emotion management; (3) risk management and (4) instruction giving. Emergency call-takers ask questions toelicit descriptions by callers of what is happening and to manage symptoms of patients to help keep them safeuntil ambulance crews arrive. In the questioning practice about acutely ill or injured patients call-takers usemainly yes-no questions and clarify problems by questioning callers making a distinction between defined andundefined problems. The analysis reveals four core types of emotion management practices: (1) call-takerskeep themselves calm when managing callers’ social displays of emotions; (2) promising ambulanceassistance; (3) providing problem solving presentations including emergency response measures to concernsof callers, and (4) emphasising the positive to create hope for callers. Call-takers use seven key procedures tomanage risk in medical emergency calls: (1) risk listening through active listening after actual and possiblerisks; (2) risk questioning; (3) risk identification; (4) risk monitoring; (5) risk assessment; (6) making decisionsabout elicited risk and (7) risk reduction. Instruction giving using directives and recommendations isaccomplished by call-takers in four main ways: (1) acute flow maintaining instruction giving when callers areprocedurally out of line; (2) measure oriented instructions for patient care and emergency responsemanagement; (3) organisational response instructions and (4) summarising instruction giving. Callers routinelyacknowledge risk identifications and follow instructions delivered by call-takers to examine statuses and lifesigns of patients such as breathing, movement and pulse, and perform basic first aid and emergency responsemeasures.The findings generated from this study will be useful in emergency call-taker training in carrying out interactiveprocedures in medical emergency calls and add to the larger research programmes on on-telephoneinteraction between professionals and citizen callers. This is an essential book for pre-hospital emergency careproviders and institutional interaction researchers and students. / <p>At the Faculty of Social Sciences in the subject of Sociology</p>

Submitted by William Justo Figueiro (williamjf) on 2015-06-13T12:07:18Z No. of bitstreams: 1 9.pdf: 10943937 bytes, checksum: 80b5f4f166aef1f41cf8270b9c1def07 (MD5) / Made available in DSpace on 2015-06-13T12:07:18Z (GMT). No. of bitstreams: 1 9.pdf: 10943937 bytes, checksum: 80b5f4f166aef1f41cf8270b9c1def07 (MD5) Previous issue date: 2011-12-19 / UNISINOS - Universidade do Vale do Rio dos Sinos / Esse estudo, de cunho etnográfico (O’REILLY, 2009) e fundamentado pelo arcabouço teórico-metodológico da Análise da Conversa Etnometodológica (GARFINKEL, 1967; SACKS, 1992) e da Análise de Categorias de Pertença (SACKS, 1992; SCHEGLOFF, 1972; SELL; OSTERMANN, 2009)), analisa duzentas interações telefônicas entre comunicantes e atendentes do serviço de emergência “190” da Brigada Militar de Porto Alegre. Os resultados da pesquisa mostram que as interações apresentam uma macroorganização estruturada em cinco atividades chave (ZIMMERMAN, 1984; 1992), sequencialmente negociadas: 1) abertura/identificação/alinhamento; 2) solicitação; 3) sequência interrogativa; 4) resposta; e 5) fechamento, em que o grande par adjacente solicitação/resposta se constitui na sequência central do evento. Percebe-se, também, uma forte orientação dos comunicantes para a solicitação de uma viatura, e dos atendentes, para o envio de uma viatura como o produto final desse par adjacente central e da prestação de serviço dos atendimentos do 190. Quando a necessidade do envio de uma viatura é posta em dúvida, a rotina das práticas de atender é desestabilizada, e o mandato institucional desse serviço é questionado, gerando consequências interacionais para a conversa em andamento. A análise dos dados revela a orientação dos comunicantes para suas Categorias de Pertença (SACKS, 1992; SCHEGLOFF, 1972; SELL; OSTERMANN, 2009) na produção de accounts narrativos (DE FINA, 2009) que buscam convencer os atendentes da legitimidade de sua solicitação de ajuda. Orientados pelo conhecimento socialmente compartilhado do que se constituem em eventos moralmente sancionáveis, ao mesmo tempo em que vitimizam o comunicante, os accounts narrativos produzidos pelos comunicantes constroem uma relação de antagonismo entre ele e o seu agressor, o qual é responsabilizado pelos fatos reportados. A orientação dos participantes para determinadas Categorias de Pertença também é revelada na formulação do local para onde a viatura deve ser enviada. O engessamento provocado pelas limitações do formulário eletrônico de solicitação de serviço é materializado, por exemplo, na necessidade de informação do nome de um logradouro e de um numeral previamente cadastrados no software utilizado. Esse tipo de restrição impõe limitações quanto à inserção de outros formatos de endereço – vigentes na organização social atual, principalmente das camadas sociais menos favorecidas – e que divergem do formato padrão, dificultando, assim, o acesso dessas pessoas à segurança pública. Verificou-se também que, para a manutenção da intersubjetividade no atendimento telefônico do 190, tanto o atendente, quanto o comunicante, precisam estar orientados para o atendimento das demandas impostas pelo software operacional, o que tornou possível compreender que a investigação da intersubjetividade nos novos contextos tecnologizados demanda que o pesquisador alargue os campos semióticos (C.GOODWIN, 2000) investigados. Da mesma forma, os recursos linguístico-interacionais mobilizados pelos comunicantes, ao formularem o local para onde a viatura deve ser enviada, demonstra a sua falta de letramento quanto às práticas sociais em questão. Esse estudo resultou em um curso de capacitação de 50 horas/aula para a qualificação dos atendimentos telefônicos desse serviço de emergência e na implementação de um processo seletivo interno para o ingresso na função de atendente, que também são discutidos no texto. / This study analyzes two hundred telephone emergency calls between callers and call takers at Brigada Militar (190), in Porto Alegre, from an ethnographic (O’REILLY, 2009) perspective and based on Ethnomethodological Conversation Analysis (GARFINKEL, 1967; SACKS, 1992) and Membership Categorization Analysis principles (SACKS, 1992; SCHEGLOFF, 1972; SELL; OSTERMANN, 2009). The results of this research study show that the interactions present a macrostructure organized into five key activities that are sequentially negotiated (ZIMMERMAN, 1984; 1992): 1) opening/identification/alignment; 2) request; 3) interrogative sequence; 4) response; and 5) closing, in which the adjacency pair request/response consists of the main sequence of the event. Callers’ strong orientation to the request for a police car and call takers’ orientation to the dispatch of a police car are also identified as the final product of this adjacency pair and of the provision of the service. When the need for the dispatch of a police car is questioned by a caller, the routine of the practices involved in the processing of the call is destabilized and the institutional mandate of 190 is questioned, and this fact brings in interactional consequences to the flow of the interactions. The analysis of the data reveals callers’ orientation to certain Membership Categories (SACKS, 1992; SCHEGLOFF, 1972; SELL; OSTERMANN, 2009) in the production of narrative accounts (DE FINA, 2009), which aim at convincing call takers of the legitimacy of their requests. Based on the socially shared knowledge of morally loaded events, at the same time that these narrative accounts victimize the caller, they also build an antagonistic relationship between caller and aggressor – with the latter being allegedly responsible for the facts being reported. Participants’ orientations to certain Membership Categories can also be seen in their formulation of the place to where the police car must be dispatched. The limitations imposed by the electronic form is materialized, for instance, in the need to insert the name of a street and a number, which can be retrieved from the database, in the address slot. This restriction limits the insertion of other formats of address – which can be found in the current social organization (especially in the less privileged social classes) – and which restricts the access of those people to public safety. It was also possible to notice that, the maintenance of intersubjectivity in emergency calls depends on callers’ and call takers’ orientation to meet the demands of the software, and this fact shows that the study of intersubjectity in new, technologized contexts demands that the researcher considers other semiotic fields (C.GOODWIN, 2000) in the investigation. At the same time, the linguistic resources mobilized by the callers when formulating the place where the police car must be sent to displays their illiteracy concerning the social practices of the modern world. This research resulted in a fifty-hour training program to qualify the call-taking services and in the implementation of an internal recruitment process for the position of call taker, which are also discussed in this work.