America’s First Responder Systems 911 and 988 Need Greater Investment and Focused Research

Just before 1:30 a.m., March 26, 2024, America experienced a historic transportation tragedy. The cargo ship Dali lost power, and brought down Baltimore’s Francis Scott Key Bridge.

First responders prevented an even deeper tragedy by closing the bridge moments before impact. 911 professionals expertly collaborated with police officers on-scene: imparting key details, supporting police in shutting down traffic over the bridge, and warning passersby. In fewer than 90 seconds, they effectively freed the bridge of all traffic, saving many lives.

911 professionals—including call takers and dispatchers—are the first first responders. They answer our calls when we need help, seeking to deploy the right response at the right time. Since July, 2022, 988 professionals have also joined our first response ecosystem.

Americans count on 911 and 988 systems for emergency help when we are victims of crimes, face medical emergencies, and, now, mental health crises. These systems are valuable national resources. Yet they face serious challenges that require greater and more systematic attention than policymakers and the public currently devote to them.

Consider one example. In reaction to public outcries regarding police violence, many jurisdictions have worked to improve public safety responses, including creating new and diversified responses to mental health emergency crisis calls, including support for 988 hotlines. Despite many innovations, the critical role of 911 and 988 professionals is largely ignored. 911 and 988 professionals are the gateway for accessing community-based mental health care for many people in crisis. Yet they do not receive the level of training, support, and resources that their role in emergency response and exposure to trauma warrant.

Another uncomfortable reality poses especially deep challenges: Millions of Americans have life experiences or tactile encounters with 911 and 988 systems that make them reluctant to draw upon these resources. In the case of 911, fears of police violence can make people reluctant to call, even in emergency situations. Consider the case of Frank Jude, a biracial man severely beaten by several white, off-duty Milwaukee police officers. Researchers later found that when community members became aware of this assault, they were 17% less likely to call 911. Such incidents, and their accompanying damage to trust in 911, is not unique to Milwaukee. Recent studies indicate that publicized incidents of police violence exemplified by the murder of George Floyd reduce 911 calls in the aftermath of gunshots and alarms.

Our expanding 988 system faces analogous issues of caller trust and confidence. While this system is young and evolving, one important study found that the majority of people surveyed who called 988 would not call again. As with 911, ambivalent potential-988 callers need to know that their calls will be answered by well-trained and supported professionals. 

Creating professional and effective 911 and 988 response systems requires sustained and effective attention to their development and practical operation. Policymakers, organizational leaders, and direct service professionals need reliable and transparent information regarding the volume of services and factors associated with effective responses. Although 911 has been in place for 56 years, the field lacks critical data infrastructure. So we do not know basic information about the system, such as the number of calls made and responses deployed by 911 each year.

Here our 911 system has much to learn from its young counterpart, 988. Upon the 988 system’s inception, the Substance Abuse and Mental Health Services Administration (SAMHSA) implemented key data infrastructure. These data indicate that 988 receives roughly as many calls each month as 911 receives daily. 911 and 988 receive massive call volumes, hindering efforts to answer crisis calls in accordance with professional call standards. High vacancy rates and retention challenges compound these challenges.

Some of the new 988 data underscore gaps in public and policymaker knowledge regarding 911. Most comprehensive 911 data are buried in PDFs and included with many other indicators in reports to Congress. These reports aren’t designed or made readily available for public use. Moreover, these data and the associated reports are not widely reported, only provided to Congress annually, and are produced via voluntary state self-reported data, which results in missing information, with limited quality assurance or data improvement processes.

In contrast, SAMHSA publishes and promotes monthly counts of how many people call and text 988 annually. Other data on 988 knowledge and usage are now regularly reported, including surveys on usage and results from 988-related public education campaigns. Analogous 911 data are still not systematically collected, even after five decades.

Policymakers, 911/988 leaders and front-line professionals face even larger information gaps regarding how to build and sustain an emergency response system. And much of what we do know provides cause for concern. Surveyed 911 professionals don’t feel well-positioned or trained to handle many types of calls, notably mental health calls. 911 and 988 professionals are in highly stressful positions that often require high-stakes, split-second decisions. Existing data suggest corresponding high rates of burnout and mental health challenges in this workforce that require proper training and workplace supports, and that require proper staffing to assure the Emergency Communications Centers (ECC)  workforce can handle the workload.

These gaps are particularly concerning for the burgeoning 988 workforce. Many 988 systems evolved from largely volunteer-driven personnel that lack many of the job supports required to create and retain a proficient workforce of seasoned professionals in this difficult work. ECC leaders and researchers report disturbing quality gaps between well-resourced organizations (e.g. county health departments) and smaller or less-integrated organizations operating within a fragmented patchwork of mental health and crisis-response services. Jurisdictions such as Tucson, Arizona have used wage increases and improved occupational supports to address high vacancy and sick-time rates. In contrast, reports from the field include anecdotes of 988 call professionals having to google local resources to assist callers seeking emergency aid.

These operational challenges also underscore the importance of an implementation science perspective in building and evaluating 911 and 988 systems, and in understanding what’s required to run these systems sustainably and well. Complementary service linkages, with best-practices for proper interfaces to other first response systems are essential, as is standardizing training in suicide safety planning and other key matters.

More fundamentally, these challenges highlight the need for uniform emergency crisis call-response and job quality standards, and the importance of providing predictable, and sustained resources to 911 and 988 call centers and their staff. Such resources are essential for these centers to reliably and proficiently execute their essential tasks.

Millions of Americans count on 911 and 988 when we call for assistance in the most challenging and traumatic moments of our lives. Our nation must rigorously deploy real resources with sustained attention to create an emergency response system that earns the trust we hope Americans can place in them.

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