In Case Of Emergency

Today in Tedium: Of all the things William Shatner has done in his career—captain of the starship USS Enterprise, veteran police officer, totally-game muse for Ben Folds, fairly good tweeter for being 86 years old—the one thing that's stuck with me the most is his years on Rescue 911, the early reality show that was America's Most Wanted (mostly) without the crime and Unsolved Mysteries with the solutions laid out clear as day. Part of this is my age—I grew up during a period when I would regularly see a show like this on CBS, and Star Trek meant Captain Jean-Luc Picard of the United Federation of Planets ('cause he won't speak English anyway). But the thing that was great about this show is that it seemed to celebrate heroism rather than focus on villains, a rarity for this era of reality television. Sometimes the stories are relatively minor emergencies; sometimes, they're a matter of life and death. But it wouldn't have existed had it not been for the hard work that went into the 911 system less than two decades before. Tonight's Tedium highlights the work that went into bringing the 911 system to life. — Ernie @ Tedium

Operator, can you help me place this call? (Dean Terry/Flickr)

The challenges of calling for emergency help before there was 911

The thing about the United States is that it's big, laid out confusingly, and full of municipalities big and small. And getting them all on the same page with something as simple as an emergency code is really friggin' hard.

But clearly there was some need for such a system, because people were calling random places to get emergency service. A 1921 article from Public Service magazine highlights the complexities of the situation, noting that New York City's Bellevue Hospital was fielding as many as 2,500 emergency calls per day.

And every city and municipality is different. A great way to think about this is with a modern-day example: The neighborhood-based online service EveryBlock is only in a few cities, while the much larger NextDoor is pretty much everywhere. The reason for this is a basic functional difference: Because EveryBlock relies on public data acquired from municipalities, it has to theoretically make deals with every single city in the country, which limits its scale.

Now just imagine the problems that patchwork of municipalities created in the days before 911. One example I spotted from a 1946 Washington Post article describing a woman whose apartment was on fire highlights the rigamarole of pre-911 emergency calls: " he tried vainly to reach an operator by dialing the emergency number '311.' In her excitement she forgot the fire control center's number, Union 1122."

In 1958, a New York City woman named Rosamund Reinhardt pointed out the severity of the problem when she attempted to call in a fire at a nearby apartment. But she dialed the easiest number she knew: 0, for operator.

That did not work very well; being someone who lives in the busiest city in the country, she was forced to compete with every other person dialing the operator at the time, meaning she kept getting dropped lines. In a New York Times letter to the editor, she noted that the awkwardness of the system had put her in danger.

"The reason it seemed so long to me was that I discovered the time I had wasted in telephoning was just enough to prevent my getting out of the apartment, as the hall was impassable due to smoke," she recalled.

Clearly, she survived. But the situation raised an incredibly obvious question for her: “Would it not be possible to cut out the operator stage by dialing directly some prearranged emergency number?”

So why was this not the case for the United States? Simply, the ball hadn't rolled quickly enough in that general direction.

The fire industry had long been debating the issues of how the telephone system would work during emergencies—in part because fire alarms relied on the system. A 1920 article in the Quarterly of the National Fire Protection Association, for example, highlighted a debate over whether to replace telegraph alarms with telephone alarms. And in the 1950s, some cities (notably Miami) had installed single-use physical telephones on city streets so that people could talk directly to the fire department if an emergency hit. (This setup, of course, led to lots of false alarms, along with a lot of controversy.)

But by the mid-1950s, officials from the International Association of Fire Chiefs (not the National Association of Fire Chiefs, as is sometimes cited, as that is not an organization) were starting to make the case for a single, national telephone number for the public to call in case of an emergency. It was the ball that rolled down the hill. Eventually.

Robert Wood Johnson II, the namesake of the Robert Wood Johnson Foundation. (Kilmer House)

The foundation that made the 911 system a reality nationwide knows all about bandages

To tell the story of the start of the 911 system—a phone call made by Alabama Senator Rankin Fite on February 16, 1968, made a little more than a month after AT&T officially designated the efficient-on-rotary-phones number—is to tell but half the story of the creation of the 911 system.

Because if a system for emergency treatment is to exist, it needs to work immediately. And in many parts of the country, it did not. To offer frame of reference you're familiar with: You know how the vehicle from Ghostbusters is a white hearse? That's because vintage ambulances were hearses. And in some rural towns, the hearses from the funeral homes pulled-double duty—and the funeral home employees didn't have much in the way of instruction beyond "drive fast." The EMT, as a concept, was still a few years off.

An ambulance hearse. (Greg Gjerdingen/Flickr)

That doesn't leave any room, of course, for much in the way of medical treatment before people got to the hospital—during a critical period. And of course, these rural areas were often not served by AT&T, so their local companies weren't in a position to switch over to 911—as it was not legally mandated by any single national law. (Even big cities, for reasons that can be best described as bureaucratic in nature, initially held their noses at the thought of 911.)

Fortunately, there was a new charitable foundation on the block that was in a position to help cover the gaps.

Robert Wood Johnson II, whose father had started Johnson & Johnson, had recently died at the time that the modern emergency apparatus was coming to life, and when the Robert Wood Johnson Foundation started in 1972, the medical world suddenly had a billion-dollar foundation ready to help—as the younger Johnson had turned the company into a corporate force (thanks in no small part to Band-Aids).

The foundation's earliest efforts, launched with a $15 million grant, focused on improving emergency services in poorly served rural areas. A side effect of the improvements was that these areas tended to pick up 911, or at the very least, a similarly centralized number. In a case study for Duke's Center for Strategic Philanthropy & Civil Society, author Scott Kohler noted that the the program's effects were most obvious thanks to the uptake of 911:

Progress in the emergency response capabilities of the forty-four grant recipients was considerable. One of the most visible developments associated with the program was the expansion of the 911 emergency system. In 1973, only 11 percent of people in the areas supported by the Johnson Foundation program had access to 911, or some equivalent emergency phone number. By the program's end, in 1977, 95 percent of them did. These outcomes were not mirrored in the nation as a whole. In 1979, only 25 percent of the U.S. population was covered by 911 or its like. Even today, the 911 system is available to only 85 percent of the population. But progress in the Foundation's forty-four grant areas did serve as a model of the emergency phone number's effectiveness. In this way, Foundation dollars were the spur that encouraged subsequent federal support.

The Johnson Foundation has remained a major advocate for 911's growth, and isn't afraid to speak about the results of the organization's early charitable work.

"Back in the early 1970s, when the Foundation was young, we realized that the nation’s emergency response system wasn’t much of a system at all," the foundation stated on its website. "Ambulance crews could not communicate with other ambulance crews. Nor could they share critical patient information with their destination hospitals. Only 12 paramedic crews existed in the entire country. Nothing like the 911 system existed at all."

Now, the 911 system very much exists—as does the proper infrastructure to back it. (Congress designated 911 the official emergency number in 1999, three years after Rescue 911's run had ended. Sorry, Shatner.)

The problem is that it has to keep pace with the way we use our phones.