EMD Should be Available to All 9-1-1 Callers Requiring Emergency Medical Assistance

The committee recommends EMD be available to all 9-1-1 callers requiring medical assistance, through 9-1-1 communication centers or other dispatch centers having the appropriate qualifications. A four-year phase-in of this requirement is recommended, along with state support of funding for specialized dispatcher training.

Increasingly, public safety telecommunications involves more than simply answering the telephone, getting an address, and dispatching a vehicle. This area of telecommunications has evolved into a distinct professional field requiring specialized training and the application of specific knowledge and skills. The practice of emergency medical dispatch -- that is the management of requests for emergency medical assistance -- is considered a specialty of public safety telecommunications and requires an advanced level of training. The goal of EMD has been simply stated as giving the caller, “the right help, in the right way, at the right time.”

Basic components. Two basic concepts form the basis of EMD; tiered or priority response and pre-arrival instructions. Tiered response (or priority dispatching) involves gathering information to classify a problem and activating the appropriate response, while pre-arrival instructions involve giving first-aid instructions via the telephone.

Priority response. The primary objective of priority dispatching is to send the most appropriate resources to a call. Proper caller interrogation will allow the dispatcher to differentiate between minor and severe situations. According to the National Highway Traffic Safety Administration, as the field of EMS developed it became evident the dispatcher typically had no uniform or consistent method of caller interrogation or response decision making. The result, asserts NHTSA, was the over-utilization of advanced life support (ALS), under-utilization of basic life support (BLS), and inappropriate use of first responders.

An essential element of EMD, then, is the matching of the appropriate vehicle configuration as well as the appropriate response mode with the level of assistance needed by the victim. The proper configuration refers to the type, capability, and number of response vehicles, while the mode refers to the appropriate driving technique (such as lights and sirens).

Pre-arrival instructions. The evolution of EMD recognizes the importance of communications personnel providing rapid access to EMS services. The dispatcher is responsible for making initial contact with the public and determining the appropriate response. They have sometimes been referred to as the “first, first responder.” Consequently, EMD can have a positive impact in many medical emergency situations. For example, according to the American Heart Association, cardiopulmonary resuscitation (CPR) should be started within four minutes of cardiac collapse, as the survival rate is four times greater than if the victim received CPR after that point. In the EMS literature eight minutes has been discussed as the ideal response time for a basic life support ambulance responding to a cardiac arrest. In addition, it takes time for an EMS crew to get to the patient, which some studies suggest is an average of 1½ minutes. So, even the best response times often exceed the physiological ideal to ensure patient survival. In many situations, then, an emergency medical dispatcher providing first aid instructions, including CPR, can fill the void.

Standard protocols. NHTSA has noted that historically EMS systems were lacking in appropriate interrogation methods and many communications centers giving medical advice operated with minimal or no medical oversight or direction. In response to this situation, EMD protocols were developed in the late 1970s and early 1980s to provide communications personnel with sound medical direction. There are several commercially available EMD programs, as well as locally developed programs, that provide planning, organizational assistance, training, and an Emergency Medical Dispatch Protocol Reference System (EMDPRS).

The reference systems (EMDPRS) are at the heart of EMD. They represent a standard set of questioning protocols (often referred to as “card sets”) that enable the dispatcher to properly and expeditiously interrogate the caller to identify:

situations that might require pre-arrival instructions such as cardiac arrest, choking, shock, profuse bleeding, respiratory problems, etc.; and

important information the responding crew may find helpful upon arrival and information regarding scene safety for the patient, bystanders, and responding personnel.

To be effective, the dispatchers ask questions and give instructions that are predetermined, delivered in a highly structured manner, and designed to be given over the phone to a third party. These medical protocols are dispatcher prompts that appear on flip cards or a computer and assist in providing pre-arrival instructions.

EMD protocols have developed in several different ways. Not all systems have been created with the involvement of medical oversight, contrary to recommendations in the EMD literature. EMD program status, according to NHTSA, ranges from in-house developed protocols, based upon locally identified needs, to professionally developed and marketed systems. The most notable commercial systems include: Medical Priority Consultants, Inc. (MPC); PowerPhone, Inc.; Association of Public–Safety Communications Officials, Inc. (APCO); and National Communications Institute (NCI). The State of Colorado currently maintains a reference system in the public domain and is available at low cost (or no cost), but has no litigation protection.

NHTSA’s national curriculum. NHTSA recently joined with the American Society for Testing and Materials (ASTM) and the National Association of Emergency Medical Services Physicians (NAEMSP) to update its EMD national standard curriculum originally developed in the 1970s. Included in the NHTSA material are instructor and student guides as well as a manager’s guide. Some commercial systems are based on the NHTSA materials. These guides, however, do not include a specific set of protocols (or card sets) but focus instead on EMD training and system development.

Agencies may use NHTSA’s uniform standards to develop or select an emergency medical dispatch program. The 24-hour course is designed to prepare already qualified telecommunications personnel to perform EMD and can train them with any protocols whether locally or commercially developed. It does not require dispatchers to have any emergency care training or experience, except for having completed a course in CPR. NHTSA also provides guidance on the selection of EMD personnel, quality assurance measures, and public education critical to a successful EMD program.

Even though EMD is a relatively new profession, several well-recognized organizations have attempted to establish some common standards and define acceptable practices for the provision of EMD. Many associations have advocated emergency medical dispatching as an essential component of all dispatching centers.

EMD development and use has been endorsed by several professional organizations including: National Association of State EMS Directors, National Highway Traffic Safety Administration, American Heart Association, National Association of Emergency Medical Services Directors, and National Association of Emergency Services Physicians. In Connecticut, the state EMS Advisory Board, Enhanced 9-1-1 Commission, and EMS Medical Advisory Committee have recommended the use of EMD. In addition, at the September 9, 1999, program review committee public hearing regarding EMS services, several speakers representing commercial and non-profit ambulance agencies, as well as an organization representing dispatch centers in Connecticut, spoke in favor of EMD. No one spoke against it. The Department of Public Health endorsed the mandatory provision of EMD.

Provided below is an overview of the components and standards that address EMD system design advocated by these professional organizations. They include:

Highlighted below are some of the many benefits, cited in the EMD literature, which can result from a properly implemented EMD program.

Potential to save lives. As discussed above, even when emergency crews are able to meet what are considered optimal response times, they may exceed the physiological ideal to ensure patient survival. In Connecticut, many responses will exceed the ideal, because volunteers, who comprise most of the EMS services, often need to assemble a crew before responding and many towns encompass a relatively large geographical area. Emergency medical dispatch can, in many situations, reduce the time gap between the time a call is placed to the receipt of medical care.

Better resource allocation. Inevitably, EMS resources in any area are limited and finite. The issue of appropriate EMS resource allocation by dispatchers has been subject to considerable analysis. Several studies indicate emergency medical dispatchers, properly trained and utilizing a formal, medically controlled telephone triage system were able to properly direct the appropriate EMS resources to the emergency scene.

A principal benefit of prioritizing is the dispatcher can differentiate between a minor situation and a possibly severe one. This effectively preserves the paramedic resource for a call requiring that skill level. Moreover, this results in less wear and tear on equipment and personnel.

Pre-hospital provider information. An additional benefit of EMD is that it allows the dispatcher to relay more detailed information about the patient and the scene to the responding crew. The responders, then, can make better use of their time when they arrive on scene and also be better prepared for any hazards that may exist.

Reduction of collisions. Contrary to what may seem, upon first consideration, intuitive, not all calls for EMS require a lights-and-sirens, high-speed response (i.e., a “hot” response). As trained dispatchers are able to determine the level of severity of an emergency call, they are able to advise the field personnel how to respond. This reduces the number of lights-and-sirens responses and thereby increases the safety of the responding crew. In addition, it also diminishes the disruptions in the traffic flow and the potential for emergency-related accidents. This is called the “wake effect”, which refers to collisions resulting from the passage of the emergency vehicle but do not involve the emergency vehicle. It has been estimated the combined number of collisions involving EMS vehicles and the wake effect annually exceed 50,000 nationwide.

Sending a hot response for all calls is a fairly common practice among EMS services in Connecticut. This may subject the agencies to increased liability. A reliance on total light-and-sirens responses is likely misplaced. The EMS provider in Norwalk, for example, reported 55 percent of calls there do not require a lights and sirens response. Further, a program review examination of EMS responses in Hartford revealed only one-third of all EMS calls justified a hot response, based on a life-threatening, time-sensitive injury or complaint classification.

Increased dispatcher satisfaction. As the dispatcher’s role becomes more professionalized, a greater sense of ownership and satisfaction may accrue to the employee. Training in EMD gives the dispatcher an increased opportunity to make a difference and have a positive impact on an otherwise potentially tragic situation.

As with any innovative approach, changes are often met with suspicion. The provision of EMD is no exception. There was, and still is in some quarters, skepticism over the principles of EMD.

Discussed above were some demonstrated benefits of EMD that attempted to address the basic issue of whether EMD works. What follows is a discussion of concerns that have been brought to the committee’s attention as barriers to EMD implementation.

Liability. One issue that prevents many communications centers from adopting EMD is the concern over legal liability. Program review found no lawsuits based on the use or nonuse of EMD in Connecticut, even though EMD has been used by some agencies in Connecticut for over a decade. Some believe the use of pre-arrival instructions is unacceptable because the potential for dispatcher error exposes agencies to possible lawsuits. By restricting dispatchers from performing tested and standardized life saving procedures, however, the effectiveness of the overall EMS system in performing life saving functions is reduced.

It is a basic legal maxim that any responsibility accepted by a public safety agency (or any other agency) comes with an obligation to do that job correctly. The EMD field has developed to the point where there are recognized standards against which a provider can be evaluated. The best recourse is in having a legally defendable system. Public safety personnel, acting in many capacities (police, fire, EMT, etc.), are frequent targets of various legal actions. It would be considered unacceptable not to provide police and fire services because someone may do something wrong.

The commercial providers of EMD systems point out there have not been any successful lawsuits against a properly implemented and managed system. The elements of a legally sound system have been defined and are identified above – properly trained personnel, medically approved reference system, medical control, and a quality assurance system.

Further, EMD advocates assert that, because many jurisdictions already provide pre-arrival instructions, the communications centers that do not provide this service are open to liability because of “dispatcher abandonment,” the failure to provide pre-arrival instructions when possible and appropriate. Their reasoning hinges on the belief that a “reasonable expectation” has been created in the public’s mind about the availability of pre-arrival instructions as a part of 9-1-1 services. It could be argued this expectation has evolved into a standard of care that is due. This expectation is compounded when some jurisdictions provide pre-arrival instructions, while others do not, especially in the same state.

Legal concerns also arise in situations where pre-arrival instructions are forbidden but some dispatchers attempt to give them in the absence of clear protocols, appropriate training, and oversight. From a legal perspective, this is probably the worst case scenario, but the impulse to provide help in a medical emergency is strong.

A recent case was documented in the New York Times where a dispatcher from Connecticut had talked a caller through a resuscitation and saved a child’s life. The dispatcher stated he would have done it, even if there were a policy against pre-arrival instructions, because the punishment received would have been worth saving a child’s life. However, no recognized authority recommends ad-libbed first aid instructions.

Staffing increases. Concerns are often raised about the strain on personnel resources EMD could present in many dispatch centers. It is often assumed EMD requires the dispatcher to spend more time with a caller and therefore, more staff will be needed. That assumption may not be correct in all instances. If a dispatch center is using a freestyle method of caller interrogation (i.e. non-scripted), time efficiencies can be realized with EMD. One study examined the call processing times in Los Angeles before and after the implementation of EMD and found the average time initially increased. But within a short period, the call processing times had returned to the historical average of 72 seconds even though staffing had not changed during the study period. In addition, call information was obtained in a more organized manner and was more useful. The need for time-intensive instructions, such as CPR, was fairly rare. Here in Connecticut, the city of Hartford has recently implemented an EMD program and no staffing changes have occurred.

It is asserted that EMD will be a particular strain on single-person dispatcher communications centers. Program review examined the call volume of all Connecticut Public Safety Answering Points (PSAPs) based on information provided by the Office of Statewide Emergency Telecommunications (OSET). Table IV-1 shows 9-1-1 call volume by range and reveals that 60 percent of all PSAPs received 10,000 or fewer calls of all types (police, fire, EMS) per year. Single dispatchers are most likely to staff centers with this volume. The average number of calls (police, fire, EMS) for a PSAP receiving 10,000 calls per year is just over one per hour.

Table IV-1. 9-1-1 Calls to Connecticut PSAPs, 1998

Number of 911 Calls

Number of PSAPs

Cumulative %

Est. Calls /Hour

5,000

37%

0.57

10,000

59%

1.14

15,000

67%

1.71

20,000

73%

2.28

25,000

78%

2.85

30,000

82%

3.42

35,000

85%

4.00

40,000

92%

4.57

45,000

93%

5.14

50,000 & over

100%

Source: OSET and LPRIC calculations

The number of 9-1-1 calls that are EMS related are not collected by OSET. Through a survey of Connecticut’s PSAPs (Appendix C), program review obtained the number of EMS calls received monthly from 80 PSAPs and the results are depicted in Figure IV-1. It was determined that:

There is recognition within EMD systems that multiple calls will occur at the same time. The potential for dispatch overload always exists, with or without EMD. Dispatch training assists in teaching techniques on how to handle such incidents. For example, if a caller needs to be instructed in CPR, it is not necessary that the dispatcher stay on the line the whole time. The dispatcher may provide the instructions to get the bystander started, put the caller on hold to answer other calls, and check back when the other calls have been answered. It is also important to note that a full interrogation is not necessary before sending assistance

Costs. Each of the elements of a proper and legally sound EMD program has a cost. These elements include: initial training; recertification; protocol reference system; paying substitutes while others train; implementation of a quality assurance program; and the assistance of a medical director. Costs are discussed at length below.

While the state encourages the use of EMD, it is not mandated. Consequently, not all 9-1-1 callers have access to EMD. However, because no state agency maintains information on the number of PSAPs that provide EMD, it is difficult to identify those that offer the service, or its comprehensiveness.

Connecticut’s emergency telecommunications system is regulated by the state but operated on a local and regional level. The state has provided a number of direct and indirect incentives to provide EMD. For example:

The state has paid for, upgraded, and maintains a highly reliable “enhanced” 9-1-1 statewide system, that currently provides for automatic number identification and automatic location identification for non-wireless users. The state has recognized the benefits of a telecommunications system that provides critical information in order to facilitate a quick and appropriate response in an emergency. The next logical step is to minimize the time between the call receipt and the delivery of appropriate medical services – a principal benefit of EMD.

All telecommunications personnel hired after January 1, 1990, are required to complete a public safety telecommunications course and be certified (and re-certified) by OSET. The state-sponsored and funded training program includes an EMD component. However, the local PSAP is responsible for developing and implementing the other components of EMD.

The state provides transition grants to municipalities for the planning and establishment of new regional dispatch centers, and ongoing subsidies for telecommunications centers that decide to consolidate and include at least three towns. Aside from cost savings, regionalization allows additional opportunities for increasing the professionalization of dispatchers, including training in EMD.

The provision of EMD is not prohibited by statute or regulation. Any municipality, PSAP, or ambulance company can choose to implement EMD on its own.

Several barriers to EMD implementation have been identified above. These include concerns over liability, staffing, and costs. Another element that cannot be overlooked is the sheer number of PSAPs in Connecticut and the difficulty that presents in implementing a new expanded program. There are 108 public safety answering points, located throughout the state, including eight regional PSAPs. As the General Assembly’s 1996 9-1-1 Task Force concluded, “…Connecticut with more public safety answering points per capita than virtually any other state in the nation would be equally or better served by far fewer dispatch centers.” At this point, however, the state policy has been to offer financial planning and operating subsidies rather than to mandate consolidation.

The Legislative Program Review and Investigations Committee recommends all Public Safety Answering Points (PSAPs) be required to provide emergency medical dispatch (EMD) or arrange for EMD services to be provided to all callers requiring emergency medical services. Each PSAP or other entity performing EMD functions shall maintain an EMD program. The Office of Statewide Emergency Telecommunications shall provide oversight of EMD implementation.

Each EMD program shall have, at a minimum, the following characteristics: 1) use only trained EMDs to provide medical interrogation, prioritization, and pre-arrival instructions; 2) use a medically approved emergency medical dispatch priority reference system; 3) provide a continuing medical dispatch education program; 4) implement a quality assurance program that, at a minimum, includes the monitoring of EMD time intervals, utilization of EMD program components, and appropriateness of EMD instructions and EMD dispatch protocols; 5) employ a mechanism to detect and correct discrepancies between established protocols and actual EMD practice; and 6) provide for EMS physician medical direction.

In recognition of the initial start-up costs in providing EMD, the committee recommends OSET reimburse PSAPs for the costs related to the initial training of dispatchers and for purchasing an emergency medical dispatch priority reference system. Funding shall be allocated from the surcharge on phone lines that support the 9-1-1 system. Regional communication centers (i.e., Consolidated Medical Emergency Dispatch (CMEDs)) shall also be reimbursed for the initial training and card sets for EMD if they are providing this service for a PSAP. OSET shall approve for use in Connecticut any national or locally developed EMD course that meets the requirements of NHTSA National Standard EMD Curriculum.

A four-year phase-in for this requirement is recommended. This will allow OSET at least one year to select appropriate training providers and establish an administrative mechanism to oversee the training. PSAPs would also decide whether to provide EMD themselves or establish a system where callers could be transferred to an EMD provider. In addition, the committee recommends all PSAP dispatchers performing EMD be trained over a three-year period. PSAPs must provide an affirmative statement to OSET that they either have in place all the elements of an EMD program identified above or transfer to a provider who does within that four-year time frame. This affirmation must be received before any reimbursement from OSET takes place.

The program review committee believes it is important that a state requirement to provide EMD be coupled with a state financial commitment. Outlined below are some of the anticipated costs in implementing this proposal. As identified earlier, the cost items include: initial training; recertification; protocol reference system; paying substitutes while others train; implementation of a quality assurance program; and the assistance of a medical director.

The primary costs to the state would be for initial training of EMD dispatchers and for reference card sets. The estimated total three-year cost to the state would be about $200,000. Staff has identified two non-General Fund sources of financing that could be used to pay for the state’s share.

The impact of this requirement on PSAPs is much more difficult to determine. Costs to municipalities will differ greatly depending on the individual situation of each PSAP. Several PSAPs already provide all or some elements of an EMD program, so their costs would be much less. Other PSAPs already transfer calls or could arrange to transfer calls to an ambulance service or other facility that provides EMD and may not represent any increase in costs. According to the program review survey of PSAPs, the total cost of EMD implementation for PSAPs currently doing EMD ranged from $0 - $50,000. Five PSAPs indicated they were able to implement EMD within existing resources; most PSAPs indicated an amount under $8,000. Most of the costs identified were for training.

Training and EMD reference cards. Table IV-2 highlights some of the costs involved in adopting a commercial EMD program. The two vendors selected for illustration purposes represent the largest EMD providers in the market. The costs for the initial 24-hour training course ranges from $175 to $249 per student. The cost of a protocol reference card set for one vendor is included in the price of training and the other charges $395 per card set. Both vendors indicated this rate does not include any price reduction based on volume of business.

Table IV-2. Comparison of Costs Between Two National Vendors

Training

Card Set

Recertification

Vendor 1

$175-$250

$395

$45

Vendor 2

$249

Included in training cost

$129

Costs are approximate. Both vendors noted the price could decrease depending on volume.

Source: Vendor pricing materials

Recertification. Standards issued by ASTM indicate that recertification should occur every two to four years. Recertification costs charged by commercial providers are also indicated on the chart. Vendor 1 requires recertification every two years and charges $45. Vendor 2 requires recertification every three years and charges up to $129 (undiscounted) for the required training. Some ongoing training may be required depending on which program is selected.

Paying substitutes. Paying for a substitute dispatcher may be necessary in some PSAPs to complete the initial training course. The Capitol Region Council of Governments recently completed a study on the impact of consolidating PSAPs in the greater-Hartford region. The study indicates the annual salary for dispatchers in 13 towns ranges from $27,516 to $41,340. Using those numbers as an approximate representation, the cost to pay a substitute to fill in for the person training would range from $106 to $160 per day based on straight pay, or $159 to $240 per day based on overtime pay. Program review could not determine how many PSAPs will need to hire substitute dispatchers or what the overall costs might be.

Quality assurance program. Quality assurance efforts are aimed at: ensuring that all employees know and comply with polices and protocols; promoting safe, effective, and efficient practices; and correcting any problems. Broadly speaking, quality assurance refers to: prospective processes, such as training and hiring practices; concurrent processes, such as continuing education; and retrospective processes, such as case review. Costs associated with some of the prospective and concurrent processes have been discussed. A key element of the retrospective processes – case review – is considered below.

Commercial EMD providers suggest different levels of effort for retrospective call evaluations. The exact cost of this could not be calculated. Prudent business practices would appear to dictate that PSAPs, even without EMD, should already be reviewing some portion of all calls to ensure acceptable dispatcher performance. That number should depend on what the PSAP manager believes provides an adequate representation to evaluate a dispatcher’s performance. It is also assumed a salaried management employee, not requiring additional overtime pay, would conduct the review.

Medical direction. The medical aspects of the EMD program should be overseen by a physician trained in emergency medicine. This may or may not represent additional costs. Program review found medical oversight at one PSAP in Southeastern Connecticut, for example, was furnished by a doctor from a local hospital at no cost. The physician meets with members of the center and an oversight committee about three times per year. This type of medical relationship may be able to be replicated throughout the state.

Medical direction of paramedics is required by law and is already provided by local hospitals. Most pre-hospital providers have a relationship with a sponsor hospital where a medical director provides both on-line and off-line medical direction and authorizes certain types of care for patients whom he or she has not seen. Reviews are also conducted by the hospital to ensure conformance with patient care protocols. Ideally, having the same physicians provide input on EMD in their area would complete their oversight of the EMS loop from dispatch to scene care to transport.

Alternatives for municipalities. Currently, a number of PSAPs in Connecticut transfer callers to EMS agencies that provide EMD and others may wish to utilize this option. The advantage of this approach is that it allows the PSAP to increase the level of service to residents without incurring the expenses of training staff and maintaining an EMD program. One method allows the PSAP telecommunicator to receive all incoming 9-1-1 calls, determine the nature of the call, and transfer those medical calls requiring pre-arrival instructions. Three-way conferencing allows the dispatcher to stay on the line with the caller as well as the ambulance service.

Currently, some towns transfer EMS calls to commercial ambulance providers or to regional communication centers called CMEDs. There are 13 CMEDs in Connecticut that provide a communication interface between service providers in the field and emergency room physicians to facilitate direct, on-line medical direction. CMEDs are largely supported by municipal governments and may represent a cost-effective way for small towns to provide EMD.

The primary costs to the state for this mandate would be to fund the additional training of dispatchers and cost for card sets. Discussed below are the estimated costs and assumptions associated with those estimates.

The committee identified two sources of funding that could assist in paying for the state’s portion of this program and reduce or eliminate any reliance on the General Fund. They are the Enhanced 9-1-1 fund and the Federal State and Community Highway Safety Grant Program (“Section 402 funds”).

Enhanced 9-1-1 fund. Public Act 96-150 created the Enhanced 9-1-1 Telecommunications Fund to finance the enhanced 9-1-1 telecommunications system and is under the control of the Commissioner of Public Safety. The funding scheme was part of a major overhaul as proposed by an E9-1-1 task force created in 1995. The task force found the existing 9-1-1 equipment was obsolete and recommended: replacing the equipment; expanding OSET; and changing the method of funding for the 9-1-1 system.

Fund revenue is generated from a monthly fee assessed against each telephone subscriber. The monthly fee amount is determined by the Department of Public Utility Control each June, based on information received from the Commissioner of Public Safety. The current per-line assessment ranges from 31 cents for one line to 6 cents per line for 100 or more lines. Fund money is authorized to be used to: (1) replace existing 9-1-1 terminal equipment for PSAPs; (2) subsidize regional public safety telecommunication centers, with enhanced subsidization for municipalities in excess of 70,000 population; (3) establish a transition grant program to encourage regionalization of public safety telecommunications centers; (4) establish a regional emergency telecommunications service credit to support regional dispatch centers (CMED); (5) train personnel; (6) pay recurring and capital costs of the telecommunications network; and (7) support OSET.

Per-line assessment. The current assessment for the 9-1-1 fund for a single line is 31 cents and is legally allowed to rise to 50 cents. After the current network upgrade is completed, the assessment may be reduced by as much as 12 cents. It is estimated by OSET that each cent assessed against the fund raises about $300,000. Thus, using the committee cost estimates of about $200,000, the impact on the assessment would translate to less than a penny for the entire three-year period.

Federal highway safety funds. Section 402 funds are administered by NHTSA and the Federal Highway Administration. The purpose of the fund is to assist states in developing and implementing non-construction highway safety programs designed to reduce fatalities, injuries, and property damage caused by motor vehicle crashes. The main intent is to provide “seed” money for new programs. The maximum amount of time a program can be funded is six years and an increasing percentage of state or local money is required in the last three years. The state Department of Transportation administers the fund in Connecticut. As of December 1998, the federal funds obligated to Connecticut were $1.7 million.

Various EMS training and related expenses have been funded in the past through this grant program and emergency medical dispatch training is an eligible expense. Due to program restrictions, the money is available only for the start-up of a program, but this should be sufficient time to train the bulk of Connecticut’s dispatchers.