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Everything you've wanted to know about the 911 system—and more!
If you need help right now
Mental health or substance crisis — call or text 988
Thinking about suicide, severe depression, panic attacks, or a substance crisis — yours or someone else's.
WEAVE — (916) 920-2952
Women Escaping A Violent Environment. Local Sacramento organization.
RAINN — 800-656-HOPE (4673)
Rape, Abuse & Incest National Network. National hotline.
How it Started
The reason it all began was because of a house fire in England. It was November 1935 and a dentist saw the house fire. Imagine a roomful of operators taking calls. They just took the calls in the order they came in. There were many calls that came through when dialing 0. They couldn't tell it was an emergency until they picked up. By the time the dentist got through, the fire brigade had actually already arrived from receiving a telegraph call from a milkman. England decided there must be a way to prioritize an emergency. So, they developed the 999 system which began in 1937. This led to a horn and a light sounding giving that call priority.
America was late
The United States came remarkably much later. The planning began in 1967 but the first call came in February 1968 from Haleyville, Alabama. And, if you think that was late, read on. Money, planning, hiring operators, establishing phone systems was very slow to roll out. And, by 1980, remarkably only 25% of the United States had the system. Which meant that 75% did not. You could drive one town over and have to dial directly to police or fire or whatever. Yes, I'm old. I very much remember next to our phone the sticky note with the numbers for Fire, Police, Ambulance, Poison Control. Even if you were a savant and memorized your local numbers, if you were visiting your friends in the next city, those numbers would have done you no good.
How many calls are we talking about?
Just how many emergencies are there? Well, access certainly accounts for the bulk of the change. And now, with so many cell phones, multiple calls will be received for the same emergency. But the statistics are roughly:
Year — 911 calls
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1980 — 50 million
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1990 — 130 million
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2000 — 220 million
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2010 — 235 million
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2020 — 240 million
And yes, in 2020 there were about 330 million people. And, considering that children and toddlers aren't calling. It almost seems that every person calls 911 once per year.
Are too many people calling 911?
Likely the answer to this depends upon your philosophy. What may seem trivial, like a dog barking incessantly, may actually be a dog alerting others that their owner fell down and needs help. Meaning, if your philosophy aligns more with, "if there is any chance this could be an emergency," then you wouldn't want to discourage phone calls.
The problem is this could create a system that gets so taxed that we are back to where we started from—being put on hold when there is a clear emergency. In this philosophy we would want more infomercials as to when should you call, when you shouldn't.
So, since I believe we could easily improve on a great system, I would suggest the following as my infomercial:
When to call, when not to call
When to call 911
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an immediate threat to life or safety
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serious trouble breathing, chest pain, stroke symptoms, unconsciousness, major bleeding, or severe injury
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a fire, significant smoke, or suspected gas leak
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a crime occurring now, violence, or an immediate threat
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a serious traffic collision or dangerous roadway hazard
When not to call 911
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crimes discovered well after they occurred, with no suspect present
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noise complaints
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minor property disputes
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routine medical questions
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prescription refills
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transportation to a scheduled appointment
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general information
Real calls
If you wanted a list of real calls, a student working with me now with an ambulance service remembers these recent ones:
— A man ran out of his medicine lasix and needed transport to the hospital to get some, no medical complaint. Before they actually arrived at the hospital, he noted he actually had three more pills remaining.
— A man called for back pain and said he needed to go to Kaiser south (from downtown) and when we were headed there he was texting his friend that he's going to go into the hospital and leave, so to have the weed ready to smoke when he gets there. As soon as they arrived, he started cussing people out and got kicked out of the waiting room—presumably to get the weed from his friend who was waiting outside.
— A man wanted to go to ucd because he's having auditory hallucinations, when asked when they started he said "i've always heard them since i was a kid." After he arrived, he felt the ER was too busy and so he just left.
— A woman who calls all the time, no complaints, just when she feels anxious. She was singing Hmong hymns and blessed the ambulance. She just opened the ambulance doors and walked in.
— A 60 year old female called 911 because her roommate was too loud. When firefighters arrived, the roommate was sleeping. She couldn't explain the emergency. She just kept saying, "this is an emergency." What should we tell the hospital? "Make up something."
I also learned something from my student. Legally, if the patient asks "do you feel I should go to the ER?" They can't answer this question. They are required to transport everybody.
Sadly, the list could go on and on.
What's the estimate for the amount of these frivolous type calls? They really don't keep statistics. But the rough estimate is about 20–30 percent.
Who keeps it running
How many 911 operators does it take to keep the system running 24/7 throughout the country? About 105,000. This is a huge work force of highly trained individuals. But, there's more. What about Mental Health? Substance abuse questions? What about victims of Rape?
The hope is to make an emergency system better. One of the thoughts is to separate different type of emergencies to get the right personnel to arrive. A rape victim intuitively may not want two large male police officers coming to her door. The problem is that many don't know about these specific services and call 911 anyway.
Crisis lines
I only recently heard that there is a separate number for those with severe mental health concerns such as
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thinking about suicide
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severe depression
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panic attacks
OR substance abuse issues — having a substance abuse crisis themselves or questions about someone else.
The thought was that many of those suffering from these issues find the police knocking on the door traumatizing. So, not only does it burden the police force, it makes the person suffering feel even more scared; it escalates the situation rather than defusing it.
WEAVE—Women Escaping a Violent Environment (916) 920-2952. They are an excellent local organization.
RAINN—Rape Abuse and Incest National Network 800-656-HOPE (4673) is the national network.
Ambulances and EMTs
I think anyone who watches medical shows like ER or The Pitt would agree that those who work on ambulances are highly trained and trusted to save our lives. And yet…. they are grossly underpaid.
In Sacramento, a starting salary for an EMT ranges from $17 to $20 an hour! Note: the starting wage for someone working at McDonald's is, by law, no less than $20 an hour.
The primary reasons for this are two-fold. Unlike fire and police, EMS is not consistently designated as an essential service across the United States. Second, ambulances only get paid when they transport a patient. They often don't get paid a dime if the patient stays at home. Imagine an ambulance coming to your house because you are unconscious. They drive lights and sirens to your house. They do an EKG, start an IV, give you oxygen, give you Narcan. And then, when they check your sugar it's 36. They realize you just need glucose. After half an hour you are sitting at your table eating a sandwich and waving them goodbye. You aren't charged a dime and they can't get any money from your insurance company.
And yet, the following true story came out of a piece I saw on YouTube from John Oliver on EMS services. A couple drove to Roseville hospital because her water broke. They stopped just a few hundred yards away because she pushed and out came the baby. The ambulance arrived and drove them to the hospital. The two-minute ride cost them $3,400 ($1,700 each for mom and baby)
One more random thing is that Medicare and Medicaid set very low rates. Which forces ambulance companies to overcharge other insurances such as Aetna or Blue Cross. By law, ambulances must accept the fees given by Medicare and Medicaid. But their rates are very low. Yes, they can accept and bill other insurance, but they often do something completely different. They won't accept ANY other insurance and just bill you cash.
To summarize, it's something of a free-for-all. EMS is regulated and funded through a complicated patchwork of federal, state and local rules, with enormous differences from one community to another. Rather than acting like insurance where everyone pays perhaps $10 per month. If you ever need their service, they soak you for a few thousand.
(Note: This can become a very bad problem. If word gets out it might cost an arm and a leg, to go by ambulance, then people will just use Uber instead. Which sounds like a good idea unless you actually need your Uber driver to perform CPR).
The power of the media
I continue to believe that the media can help. I feel that with more education, people will utilize services that are better for them personally and save money for the community. They can learn which things actually are an emergency worthy of calling 911—and what aren't. My hope is that, in a small way, I have helped educate those who come to my site. But there is so much more that can be done.
An example is 988, the three digit number we are supposed to dial for mental health and substance abuse emergencies. This replaced what was known as "The suicide hotline" which was 1-800-273-8255. Yes, 988 is much easier, but still…who knows about it? And, honestly, only with researching this piece did I learn of RAINN, the Rape Abuse and Incest National Network. These are fantastic services that are being underutilized.
What can the media do? Well, I heard of something truly amazing. In 1988, the phrase "don't drink and drive" was always being used. It didn't really make a difference. Then, a Harvard public health researcher, Jay Winsten, decided to try another approach. Don't tell someone what NOT to do, tell them what they SHOULD do. He convinced the main networks of the time, and many movies in Hollywood to just put in the phrase, "I'll be the designated driver." After just four seasons, there was a dramatic drop. He helped make the idea of having one person not drink acceptable.
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Alcohol related traffic fatalities dropped from 24,000 to 18,000
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Those driving with any measurable alcohol dropped from 26 to 17%
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Those reporting to be a designated driver went from 5% to 25%
And finally, the government really must make EMS or Emergency Medical Services "essential." Without this designation, EMS receives far less federal support than one would expect for such an essential service. States and municipalities can have wildly different systems. Rural communities suffer the most with little choice. And, frankly, most of these highly skilled workers are underpaid.
If you need help right now
Mental health or substance crisis — call or text 988
Thinking about suicide, severe depression, panic attacks, or a substance crisis — yours or someone else's.
WEAVE — (916) 920-2952
Women Escaping A Violent Environment. Local Sacramento organization.
RAINN — 800-656-HOPE (4673)
Rape, Abuse & Incest National Network. National hotline.