Author Rebecca Neusteter knows 911 is a number imprinted in the mind of every American. “It was probably the first phone number I ever really knew,” she said. It can be a line to life-saving services in an emergency, or to fatal consequences for someone in a mental health crisis. Both Neusteter, executive director of the Health Lab at the University of Chicago, and her loved ones have been helped and harmed through someone calling in.
But in an ongoing national reckoning over law enforcement, the system for dispatching police has largely escaped scrutiny. Neusteter’s new book, “911, What’s Your Emergency?,” is based on over a decade of research and reporting from inside 911 call centers. It looks at the history of the national emergency line and its role in our overreliance on armed police. The Q&A that follows has been edited for clarity and brevity.
Christie Thompson: I don’t think many people even think about 911’s origin; it’s such a given in our society. Is that part of why it hasn’t been more discussed in the broader police reform conversation?
Rebecca Neusteter: Absolutely. It’s ubiquitous, and more so than just about anything else. It's core civic infrastructure. I would argue it’s the most democratic tool we have available to us. You don’t have to be a citizen to call. You don’t have to be law-abiding to call. Also, 911 is literally the only number you can call when your phone is otherwise inoperable. So if I haven’t paid my cell phone bill, I can still call 911. And you see that in 911 centers quite often. I’ve heard mothers calling saying things like, I don’t have food to feed my kids, and I can’t call anyone else, and I can’t leave. And you see really remarkable things like 911 professionals pooling their own money and sending cops out to send the family groceries. I mean, it’s a remarkable solution for that problem, but it is not the right response [to poverty].
But 911 is also totally local. That means there’s very little consistency in how it operates and what you can expect. Even something as basic as administering CPR: In some 911 centers, 911 professionals area trained to help people on the scene administer CPR. In others, that was never part of the training. We think of it as this national system, but in reality it’s about 8,000 different centers operating under different standards, with different staffing levels and different technology. You and I could even be living in the same county and call 911 from opposite sides of the block, and we might have entirely different experiences.
You write about how we’ve come to equate calling 911 with calling the police. Why is that?
Since 911’s inception in 1968, and even before, we have always defaulted to the police for things that really have nothing to do with crime. You could look back at archival evidence from the 1800s when call boxes were first introduced. People were encouraged to use them for mental health crises, for abandoned children — for the same kinds of challenges that we are using 911 for today in ways that don’t work well. This isn’t a new problem, and it’s not an accident. So how do we enable 911 to be independent and equal to its co-branches of public safety and public health?
In most places, 911 functions as a directly subordinate division to law enforcement. I hadn’t really internalized what that means from a governance structure, that if the 911 center is subordinate to policing, then its standard operating procedures are driven by law enforcement. It starts to explain why these systems default so reflexively to law enforcement.
What is the biggest public misconception about this system?
I think that people assume that when you call 911, they know where you are. And in the vast majority of places, that’s not the case. 911 was developed on the infrastructure of landline phones, but less than 10% of 911 calls now come from landlines. There are solutions to allow geolocation data to be precise. But the vast majority of communities across the country haven't made the investment to make sure that happens.
Call after call that I listened to over the course of my career, somebody will call 911 and [the dispatcher will] say, “Where are you?” and they spend a minute trying to verify someone's location and [callers] get really frustrated. They’re like, “Don’t you know where I am?” It’s really a senseless tech hiccup that we could and should have solved a long time ago.
You detail in the book how 911 particularly doesn’t work in communities of color. Can you talk about this duality, where people experience an under-response to some emergencies, and an aggressive over-response to other calls?
There are a couple of studies that have found that the darker a person's skin, the less likely they are to receive a timely response, and the less likely they are to perceive that they will receive a timely response. Research in Chicago found that neighborhoods that have higher Black and other persons of color populations often receive slower responses.
Our research also draws on interviews that our partners at the Black Belt African American Genealogical Historical Society did a couple of years ago. They do oral history work all over the Black Belt in the South. 911 was founded in Alabama. So we partnered with them to understand people's perceptions about 911. We heard in these interviews people talking about trying to find a family member to take them to the hospital if they were having a medical emergency, because they couldn't count on 911 and an ambulance responding in a timely manner. At the same time, some folks would say, “I'm more likely to call 911 for a medical emergency than if someone I know is in a mental health crisis.” The fear is so real that a response by law enforcement with a gun has the potential to escalate.
I remember one woman saying that she had passed a young man of color on the street who was clearly having a crisis, and that she had a crisis herself of not knowing what to do. She wanted to call 911 to help him, but was scared that harm would come his way if she did. She doesn't know if 911 would help or harm someone. And unfortunately, that is the reality that I think so many people, and particularly families of color, are faced with.
Is that kind of delayed or absent response an issue with 911 and dispatch? Or is it the number of emergency responders?
In many cities where they just don't have enough 911 professionals answering the volume of calls, calls get missed or answered slowly. There are also technology glitches — New York City just experienced an outage of 10 hours or something where calls from certain areas of the Bronx weren’t coming in at all. So there are reasons why those delays start at 911.
I think it's also important to note that in rural areas, distance is a concern, but also oftentimes there are no full-time dedicated first response personnel. And if they exist, they tend to only be for law enforcement. So in many communities that only have volunteer fire departments or volunteer paramedics, how do you send the right response?
Two things we have done by default that are detrimental to the 911 system and to community members: The first is this default to law enforcement as a reflexive response. Part of that is because of the way the systems are structured and governed, and part of it is because there's a lack of the right responders to send at the right time. The other issue is that we have defaulted too much to sending an in-person response. Many times we could be handling things virtually through telemedicine or through what some of us are now referring to as rapid video response, or figuring out different ways to get people to the care that they need. Washington, D.C., did a really interesting demonstration project where they used Medicaid vouchers to pay for rideshare apps to take people to urgent care.
You begin the book by reminding us that George Floyd’s death began with a 911 call about a suspicion that he used a fake $20 bill to buy cigarettes. What role have 911 dispatchers played in some of these fatal police encounters?
One of the most tragic examples of this is [12-year-old] Tamir Rice. A passerby called 911 and said to a 911 call taker, “There's someone in the park. I think they're a kid and I think they're playing with a toy gun and I think it's probably fake.” And what was inputted into [computer-aided dispatch] and ultimately dispatched to the police was that there was a Black man in the park with a gun. For sure, the cops should have slowed things down — Rice was shot while the car was still moving. First responders need to take accountability and to do a better job of de-escalating. But it’s also incredibly problematic when key pieces of information, particularly if it pertains to somebody being skeptical about what they're seeing and that they're acknowledging their own blind spots, aren’t clearly communicated.
For a long time I have described this as the classic game of telephone. There are tragic consequences here, but you see the same idea play out, that somebody’s communicating one thing, and with each information transfer, other things get added or lost. In the Tamir Rice case, the caller’s saying, “I just want somebody to check this out. But I think this is a kid, and I think he's playing.” I can imagine how I would handle that myself, if somebody shared that information with me, versus how I would handle it if someone said, someone has a gun in the park.
What would a better emergency response system look like?
An ideal model would be asking, “What do you need to solve your problem? Is this a mental health emergency?” There are lots of times when people say [to police officers who show up], “We didn’t call for you; please don’t be here.” And it still doesn’t matter. There are countless cases where it’s like, I called for an ambulance. Why are you here and escalating my son’s mental health crisis? That is a real, real issue.
We need to get back to the place where 911 is a triage function, and where 911 professionals have the time to have fact-based conversations. They have the training to hold those conversations and to understand where the blind spots are, and where they have the resources available to deploy to different situations. That might mean sending the rideshare to pick you up and take you to urgent care. It might be transferring the call immediately to a mental health counselor that’s on site. It might be deploying the police, or a combination of these things. But we cannot assume there’s just one or three responses to everyone’s problems, when we have as many as 300 million calls to 911 every year.
We've also seen a lot of these alternative response models look at the narrow part of the triangle and think, What could we send a community response team to? And I'm arguing we flip it upside down and say, “What can't they go to? What [calls do] the police have to go to?” And start to think about the default in reverse.
My colleagues and I have developed a 911 Callers’ Bill of Rights. The idea is that we want people to be empowered with knowledge about what they can expect if they call 911. But also, what they can do to know how 911 works in their community and be in a position where they can knowledgeably ask for answers and potentially change their 911 centers locally. It takes people understanding how these systems work and having the opportunity to be active participants in decision-making. 911 can be a black box. They tend to be centers that are dark and dim and behind walls and in undisclosed locations. And when you can’t see behind the walls, you often don't see the best results. There needs to be a level of transparency to support the staff and the operations within these centers.