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LYNN NEARY, HOST:

This is TALK OF THE NATION. I'm Lynn Neary, in Washington. Neal Conan is away. Last month, an elderly woman at a California retirement home died after a staffer refused to perform CPR. There's a lot we still don't know about what happened, but the incident made national headlines after the 911 call was released. And we'll hear some of that tape in just a moment.

Today, we're focusing on 911 dispatchers and their role in medical emergencies, and we want to hear from some dispatchers. What don't we know about your job? What's your most memorable medical call? Tell us your story. Our number is 800-989-8255. Our email address is talk@npr.org. And you can join the conversation at our website. Go to npr.org, and click on TALK OF THE NATION.

Later in the program, Julia Sweig joins us to remember Hugo Chavez, who died yesterday in Caracas. But first, 911 dispatchers. Joining us now is Brett Patterson. He worked as an EMS dispatcher for 10 years in Clearwater, Florida. He now trains medical dispatch protocol for the International Academies of Emergency Dispatch, and he joins us from member station WUSF in Tampa, Florida. Brett, welcome to the program.

BRETT PATTERSON: Thank you very much.

NEARY: Now, I'm going to play some of that 911 tape, 911 tape that I just mentioned. The dispatcher is asking the staff nurse to find someone to perform CPR. And as we said, details are still emerging in this case. There's a lot we don't know. But we want to focus here on the 911 dispatcher's response to the call. So let's take a listen.

(SOUNDBITE OF 911 CALL)

UNIDENTIFIED WOMAN #1: I understand if your facility is not willing to do that. Give the phone to that passer-by, that stranger that has that. I need - this woman's not breathing enough. She's going to die if we don't get this started. Do you understand?

UNIDENTIFIED WOMAN #2: I understand. I am a nurse. But I cannot have our other senior citizens who don't know CPR do this.

UNIDENTIFIED WOMAN #1: I will instruct them...

UNIDENTIFIED WOMAN #2: We're in a dining room.

UNIDENTIFIED WOMAN #1: I will instruct them. Is there anyone there who's willing...

UNIDENTIFIED WOMAN #2: I cannot do that.

UNIDENTIFIED WOMAN #1: OK, I don't understand why you're not willing to help this patient.

UNIDENTIFIED WOMAN #2: I am.

UNIDENTIFIED WOMAN #1: OK, great. Then I'll walk you through it all. EMS takes the liability for this, Colleen(ph). I'm happy to help you. OK, this is EMS protocol, OK.

UNIDENTIFIED WOMAN #2: (Unintelligible). I don't know where he is, but she's yelling at me and saying that we have to have one of our other residents perform CPR, and she'll instruct. And I'm not going to do that and make that call.

UNIDENTIFIED WOMAN #1: Colleen, is there anybody that works there that's willing to do it?

UNIDENTIFIED WOMAN #2: We can't do that. That's...

UNIDENTIFIED WOMAN #1: Are we just going to wait? We're going to let this lady die?

NEARY: All right, Brett, I just want to - I want to walk through that tape a little bit with you. First of all, how unusual is it for someone to refuse to do CPR like that?

PATTERSON: It's not terribly unusual. It's unusual for someone to refuse for bad reasons. There are lots of good reasons for not doing CPR, and that happens quite frequently. But in my experience, I think in my whole career, maybe once or twice, somebody didn't do CPR simply because they didn't want to do it.

NEARY: What are the reasons that people give for not wanting to do CPR? What are people's concerns?

PATTERSON: Well, the obvious one is when the patient is obviously dead, and there's no hope of resuscitation. Certainly that's a good reason. End-of-life issues are a very important reason - so if someone has expressed the desire not to be resuscitated through advanced age or a terminal illness or, you know, so forth. So they fear a worse outcome, essentially, if they try to be - if somebody tries to resuscitate them.

But for someone refusing simply because they don't want to, oftentimes people will initially refuse out of fear, and you can almost hear it in their voice. And it's quite easy, generally, to talk them into doing CPR.

NEARY: And is this what a 911 dispatcher is supposed to do, they're supposed to tell whoever's on the end of the line if they're in a situation like that to do CPR? Is that the protocol?

PATTERSON: Well, I think it's important to note that it's our job to offer, as dispatchers. In other words, we don't ask: Do you want to do CPR? When you think about it, that's the patient's decision, who's unable to make that decision. So we take a call to 911 as an implied call for help. And if a patient's not conscious and not breathing and they meet certain criteria, we will certainly attempt to do CPR by offering instructions.

And it's a very passionate sort of job. So I certainly understand that in the young lady's voice. She's trying to get her job done.

NEARY: Yeah. And the other woman says I'm not going to take responsibility for this.

PATTERSON: Well, I'm unsure what she was referring to there, whether it was the CPR or doing something that wasn't appropriate at the time. It's - like you said, there's a lot that we don't know about that case. It's the first time I've actually heard it. But, you know, many things could be going on there.

NEARY: Yeah. One thing that comes out in that exchange between these two people is that the dispatcher says - I'm not remembering the exact words, but it was sort of that the - they will take responsibility, 911 will take responsibility, that the liability will be with the dispatcher or with the emergency service. Is that right?

PATTERSON: Well, I think what the dispatcher's trying to express there is to obliterate a fear that's relatively common that people have, that if they start CPR, if they try and help in some way, they're going to be responsible if the outcome is poor. And, in fact, that's not the case. And the dispatcher knows that. So in an effort to sort of convince the person that it's OK - if indeed that's the reason for withholding it, we certainly don't know that.

But that has been a common fear. People are concerned that if they start, they're going to somehow be held liable, when, in fact, if the person's in cardiac arrest, you don't get any deader than dead, as they say. So going in and trying to help is certainly the right thing to do. It's the moral thing to do, unless there are circumstances that would prohibit that.

NEARY: Now, is there a national protocol system for 911 dispatchers, for these emergency calls?

PATTERSON: Indeed, there's an international system for - you know, not everybody in the United States uses it, but a good deal of agencies do, and it's used 21 different languages and dialects all around the world by literally millions of dispatchers. And protocol is just very important, because it standardizes the way we treat people over the phone that we can't see.

NEARY: And so what happens? What is the protocol? You teach this, right?

PATTERSON: Yes, and I helped to develop and evolve the clinical standards of that protocol.

NEARY: So maybe, can you walk us through what is supposed to happen?

PATTERSON: Well, it's basically a structured interrogation where the wording of the interrogation is extremely important. As I mentioned, you can't see the patient. And you can't see your caller doing the things that you ask them to do. So you can't give that sort of visual feedback that you can in a classroom, which makes the wording of a protocol or the structure of a protocol so important.

And these things happen in the heat of the moment, with a lot of passion. So you can't expect people just to remember what to do in those situations. So we create a structured interrogation that's then followed by an assignment of a resource, what's the right resource for that given situation, and then structured instructions for, you know, anything from CPR or choking to just monitoring the patient, which we do an awful lot of in dispatch until the resource can get there.

NEARY: Yeah. So give us a sense of the kinds of calls that you might get from, you know, the - how do you sort of prioritize? And, I mean, I imagine sometimes you get prank calls and then, like, very intense emergencies?

PATTERSON: Well, prank calls, in my experience, are extremely rare. I would estimate - and I think most experts in our field would estimate - that only about 3 or 4 percent of our calls are what we would we call minute-critical, or pre-arrival emergencies. In other words, if we don't do something on the phone, the patient's going to deteriorate before the ambulance gets there.

Plenty of patients have problems that they certainly need to be seen at the hospital for or need evaluation for, but there's not a lot of calls where our clinical impact as a dispatcher makes, you know, an immediate difference. It's our job, really, to sort those out. And that's done very quickly in the protocol with a series of questions.

So we don't look for a diagnosis. We look for certain priority symptoms going on with a patient that can tell us that something is very wrong. The obvious is a patient not conscious and not breathing, which gives us an idea if the patient's in cardiac arrest. And then we have certain safety considerations, as well.

One of the most important questions we ask is: Tell me exactly what happened. So we can get a sense of what the safety issues are there and what, you know, what may be the root of the problem. And then the clinical interrogation goes from seeking out those very important priority symptoms sort of less and less, until we get an idea of what sort of resource that patient needs.

NEARY: Yeah, and are the callers - I mean, are the dispatchers, the people who are taking the call, are they medically trained? Are they medical professionals? Do you consider them medical professionals?

PATTERSON: Oh, I absolutely do. I think for many years, people did not. And a dispatcher was just someone who took an address, and then nothing happened until the ambulance got there. I think we can thank shows like "Emergency" and "Rescue 911" for some change in public perception. And I think if you were to ask the general populace today would they expect some sort of help before the ambulance gets there, that would be a very definitive yes, that public expectation has risen.

The wonderful thing about the job that we do is that because it's non-visual and because it's structured and because it's protocol-based, you can teach laypeople how to use a protocol in a relatively short period of time. It takes medical knowledge, but you don't need to be a diagnostician. You need to know what a seizure looks like and acts like and, you know, what - how patients describe chest pain and various things like that.

But the protocol, I mean, I've been doing this for a number of years, been a paramedic since 1980, and I wouldn't sit at a telephone without that structured interrogation. You know, I rely on that. So you can train somebody to use that protocol, and they can do a very good job. They need to be compliant with that protocol, and their agency needs to see to that, that they have good feedback - but with those tools, yeah.

NEARY: What about a case where someone's bleeding, for instance? We've been talking about somebody who's unconscious or maybe had a heart attack, but what about a situation - can you talk someone through that kind of an emergency, too?

PATTERSON: Oh, absolutely. There are priorities there. If someone's bleeding and not breathing, you'll be doing CPR, not bleeding control. But if someone is conscious and breathing, and they have an external bleed from somewhere, we use direct pressure to handle that and we have a definite script to do that, a place in the protocol, a link to go handle that.

NEARY: All right. Brett Patterson worked as an EMS dispatcher for 10 years in Clearwater, Florida. He now trains medical dispatch protocol for the International Academies of Emergency Dispatch. And Brett, you're going to stay with us as we take a short break here.

And if you're a 911 dispatcher, tell us: What don't we know about your job? Or if you'd like to share the story of a memorable medical emergency call that you fielded, we'd like to hear that, too. Give us a call at 800-989-8255. You can also reach us by email. That's at talk@npr.org. And we'll have more in a minute. I'm Lynn Neary, and this is TALK OF THE NATION, from NPR News.

(SOUNDBITE OF MUSIC)

NEARY: This is TALK OF THE NATION, from NPR News. I'm Lynn Neary, and today, we're talking about 911 dispatchers. Our guest Brett Patterson worked as an EMS dispatcher for 10 years, and now trains current dispatchers and others training to become dispatchers.

In a minute, we'll hear some tape of a call that he uses in his classes, but we also want to hear from you. If you've worked as a 911 dispatcher, what don't we know about your job? And is there a memorable emergency call that you'd like to share with us? Give us a call. Our number is 800-989-8255, the email address talk@npr.org. And you can also join the conversation at our website. Go to npr.org, and click on TALK OF THE NATION.

And Brett, I'm going to go to some tape now. First, a little background. This is a call that you received when you were working as a dispatcher in Pinellas County, Florida. A woman called in labor, and she was about to deliver twins at her parents' house. And a warning to our listeners: Some of you might find this clip a little difficult to listen to. It is very dramatic. Here it is.

(SOUNDBITE OF 911 CALL)

PATTERSON: Is there anybody there with you?

(Soundbite of screaming)

UNIDENTIFIED WOMAN: The baby just came out. Oh, my God. My baby just come out. It's screaming. What do I do?

PATTERSON: OK. Ma'am, ma'am, listen to me, OK? I want you to take anything you can and wipe the baby's face clean. Is that the baby crying?

UNIDENTIFIED WOMAN: I'm ready to deliver my second.

PATTERSON: All right. OK.

NEARY: Brett, that has to be one of your most memorable calls, I would think. I'm ready to deliver my second. What happened next?

PATTERSON: Well, fortunately, she didn't deliver the second, but her first baby stopped breathing, which was a bit unnerving. But these were very, very premature infants. They weighed less than two pounds apiece. And at that age, their lungs aren't developed, and it's common for them to stop breathing.

It was - it's an unusual case, because the woman was home alone. So there's nobody there to assist, and she has a two or three-year-old in the background crying, her first child. So it was challenging. And I mentioned protocols are scripted, but you can't script everything, and childbirth is a very patient-driven event. It's not a dispatcher-driven event. So I was fortunate to have my medical director walk in the communications center at the time and stand over my shoulder and listen to me.

NEARY: Now, why do you use that particular piece of tape in the training class? I mean, what are you - what can you teach your students by listening...

PATTERSON: Well, it doesn't - it's not so much in our everyday certification course, but we use it in conferences, in talking about patient-driven events. And it's just - in certain high-risk, low-frequency events that you don't deal with every day, it's very important that you go back and review protocol.

If you can remember with little babies, breathing and warm, if you can remember those two things and focus on them, you're going to do all right, hopefully, until the paramedics get there. But you don't do them every day, like a chest pain call. So it's not so fresh in your mind. And that's really the teaching point there.

NEARY: All right, let's take a call now. We're going to go to Jeffrey(ph), who is calling from Atlanta, Georgia. Hi, Jeffrey.

JEFFREY: Hi, how are you?

NEARY: I'm good, thanks.

JEFFREY: Thanks for taking my call. I have a couple of quick stories. In a hiking trail near where I used to live in Idaho, a couple of campers were coming down, or hikers, and one of them suffered what appeared to be a heart attack. It appeared later that it wasn't as serious. But his partner was quite concerned. And a first pair of hikers came by. They called 911 after having some trouble getting a signal, and the first pair of hikers came by, and they were absolutely at a loss what to do.

And fortunately, a second pair of hikers came by, and we were able to direct them. And the partner of the hiker who was suffering was able, with our help, to maintain some council and some calmness and listening skills and speaking skills to the victim, or the sufferer. And the second pair of hikers was able to keep things going through a combination of CPR - which wasn't completely necessary, as it turns out - but a good deal of calmness to listen for the ambulance, and that proved to be extremely reassuring and calmed everyone down.

But the perhaps more telling story is the service we provide, and that was regarding a car accident victim who got out of the car, having collided with a pole in a cloud of dust on a country road, a wilderness road. And they were walking around, and they called 911 themselves and said that they were doing fine, and they were walking around and so forth.

And I and a colleague immediately said to them: Don't walk around. You may feel fine, but you're - you've been in a serious accident. The airbags had deployed, and so forth. And we advised them to sit, and fortunately, some other folks came upon the scene and sat with them until the ambulance came.

But one of our counsels to them was stay calm, be still and don't assume you're well. You've called us. It's an emergency. We've sent all emergency and first responders on their way. But don't assume wellness. Think carefully about the fact that you've requested help. You think intuitively that you need help. And just be still, be patient and be a good patient and take care of yourself until folks whose expertise may be able to help you further.

NEARY: All right, Jeffrey. Thanks so much for calling.

JEFFREY: You're welcome.

NEARY: And I want to ask you about what Jeffrey just said, but before I do, I realize that I didn't make it clear: Were the babies that were delivered - that we heard one baby already had been delivered. But you said that they were very - they weighed very little. Did they survive? I mean, how were they?

PATTERSON: Yes, they did. The second was born en route to the hospital, or on immediate arrival. Fortunately, twins are generally born just a little bit apart. I don't know what it would have done with a second at the exact moment that the first one stopped breathing.

But, yes, I believe they were a little hydrocephalic. They had a little - which is normal, a little bit of fluid around the brain, where they put in a shunt. And they eventually outgrew that. But we didn't follow these children for a very long time, just knew that they had survived.

Of course, you're always interested, as the dispatcher, about your patient, if they survived or not. And generally, you can find that out.

NEARY: You know, something I wanted to follow up on with Jeffrey's call, and just something that's striking me in the tape that we're hearing, in the way Jeffrey was speaking, in the way you speak, there's an incredible calmness that you all seem to have when, frequently, the people who are calling you are as panicked as you can be about the situation that they're in. And I'm just wondering: Do you have to have a certain kind of personality, or can you be trained to be that way? Where does that calmness come from, and how important is that that the dispatcher maintain that calmness?

PATTERSON: Well, I think it's vital. I think if you were to ask me what the number one qualification of a dispatcher, or even a paramedic or anybody in the healthcare field that's actually dealing with directly with patients, it's got to be empathy. I mean, you just have to have that. And if you don't, you're just not going to be a very good caregiver.

You have to be able to read a protocol, obviously, but you need to care about people. You can be taught techniques about how to calm somebody down, and you can follow those techniques and they generally work. But it's what they hear in your voice that provides them that reassurance that you're reasonably confident about what you're doing, but I think even more importantly, that you care about what's happening to them.

And when they sense that, they will typically calm down. If they can somehow relate your questioning - which is difficult for people. They just want an ambulance there. But if you can relate that questioning to helping the patient until the ambulance gets there, to care, people just innately respond to that.

NEARY: Do they ever get mad at you for asking these questions and just say, I don't have time to answer your questions? Or...

PATTERSON: Well, absolutely, they do. And the good dispatcher doesn't get angry back. I mean, it's sort of an impulse. Somebody yells at you, curses at you, calls you names, you know, you want to react with a defensive or even an offensive posture, which isn't the way to do that. They're not upset because they know you personally and they dislike you. They're upset about the situation, and there are certainly ways to handle that.

NEARY: All right. I want to bring another guest into this discussion. Doug Wolfberg is an attorney specializing in emergency medical services, and he also teaches at Widener University School of Law. And we should mention that Doug and Brett know each other, and that Doug has presented at conferences run by the International Academies of Emergency Dispatch. That's the organization that Brett works for. But he is not their legal counsel. And Doug joins me here in the studio. Welcome to the program.

DOUG WOLFBERG: Thank you. Good to be here.

NEARY: Let's talk about some of the liability issues, here. Are there laws in place to help protect people when they do help someone who's having a medical emergency? If they're in that situation and the dispatcher is trying - is asking them to take, you know, to give them CPR or something like that, are people protected?

WOLFBERG: By and large, yes. There's a patchwork of laws throughout the United States known colloquially a Good Samaritan laws. There's no federal or national standard for what those laws entail, but most states, if not all states, do have a version of a Good Samaritan law. Now, what protection those laws offer varies from state to state. But as a general rule, yes, those laws do protect, in most cases, bystanders who offer to help.

NEARY: I understand that they vary, but how do they protect a person? Can you give us some details?

WOLFBERG: Sure. What they do is they provide a qualified or limited form of immunity from liability in a civil case. So, for example, personal injury lawsuit or a tort case that a - an injured plaintiff or their family members might file would be filed as a civil case, and good Samaritan laws provide qualified or limited immunity to people who act voluntarily to help the person in need.

Where those laws are limited, in almost all cases, is they don't protect against acts of gross negligence. So some, you know, some conduct or omission that is so - such a deviation from normal standards of care, it wouldn't protect against liability for that.

And most of those laws also do not protect against intentional misconduct. So the Good Samaritan turns into a bad Samaritan and willfully does something wrong, then there would be no protection. But other than those exceptions, generally, those laws in - within most states would offer that kind of protection to those bystanders who act voluntarily.

NEARY: And what if somebody doesn't help?

WOLFBERG: Well, in most states, there's no affirmative duty to do that. And one state a lot of folks like to point to, the state of Vermont, has a $100 penalty provision on the books that they can actually enforce against a person who doesn't help in some circumstances. Other than that, the generally accepted legal rule is that there's no affirmative duty to help your fellow man if you're just a bystander.

Some people are paid to have a duty - EMTs, paramedics, dispatchers and others - so it's their job to act. But folks who are not being paid or engaged to do that typically do not have a legal duty. It really gets into the realm of ethics as opposed to legal duty.

NEARY: Yeah. What about the liability of the dispatcher? We heard earlier on the show at the beginning, in the case in California, we heard the dispatcher saying, don't worry. We'll be liable for this.

WOLFBERG: I was interested in that. I heard that clip a few times, and I hesitate to say that a dispatcher can transfer liability or absorb somebody's liability just by saying on the phone, we'll cover you. Go ahead. I mean, typically, it's not how it works. That representation by the dispatcher certainly would not be binding upon a judge or a court. Oh, OK, the dispatcher told you you're not liable, then case dismissed. You know, that would never happen.

NEARY: Yeah.

WOLFBERG: But the sentiment underlying what the dispatcher said, as Brett said earlier, to try to encourage the person to act was fundamentally right. The cases of liability against bystanders and people like that are the exception. In most cases, those folks are not found to be liable, though, of course, there are cases that hold that they were.

NEARY: Yeah. So, as a lawyer, do you have any advice for future good Samaritans who, you know, might be there in an emergency medical situation?

WOLFBERG: Yes. I tend - I think a lot of folks who opine on this subject tend to get a little tangled in the patchwork of laws. I'd say be a human being first, and the law side of it, the liability side of it, will take care of itself. You know, again, this is as much of an ethical question as it is a legal question. And at the end of the day, juries are going to want to do the right thing for people who do the right thing.

And I think if we get so entangled in fear of what our company policy is and what our legal liability might be, we sort of lose sight of that. And I think if somebody acts as a good person first, generally the pieces of the puzzle will fall into place for them under the law.

NEARY: Doug Wolfberg is an attorney specializing in emergency medical services. He also teaches at Widener University of Law. He joined us here in the studio. Doug, thanks so much.

WOLFBERG: Thank you.

NEARY: And you are listening to TALK OF THE NATION from NPR News. We're going to take a call now from Tony(ph) in San Antonio, Texas. Tony?

TONY: Hi. Thanks for taking my call. I just wanted to comment. I was a 911 dispatcher for about seven years in Alabama, and I think one of the most important things that a 911 dispatcher can portray or get people to do when they call in, is just to remain calm and know that help is on the way.

I had a particular instance where I had a gentleman who was a patient, who was in cardiac arrest. His wife called in, and she just completely panicked. She thought because I was going through a script and asking her questions that we also didn't have paramedics on the way to her. So she kept hanging up and hanging up, and calling back and calling back, thinking that was going to get her help faster instead of going through the script.

And her husband, unfortunately, ended up passing away before paramedics could get there. And so I think it's really important for 911 dispatchers and anybody that calls 911 just to remain calm and listen to the dispatcher and know that these are professionals who deal with this a lot, pretty much every day, and that they know what they're doing, and just because they're asking you questions, that help is on the way and just to follow their instructions.

NEARY: All right. Tony, thank you so much for your call. Is that good advice, would you say, Brett?

PATTERSON: Oh, absolutely it is. I think it's completely natural for people to, in a situation like that, to just think that you as a dispatcher on the other end of the phone have an idea of what's going on or perhaps even that you don't need to, that you just need to send somebody.

In our non-visual world, however, we have to ask certain questions in order to gain some appreciation for what's happening at the scene, and those questions are extremely limited. They all have very specific objectives which are not always known by the caller, and that can be a little frustrating. But as your caller said there, you can do a lot just by reassuring and letting them know that somebody is on the way.

I found the most helpful way to calm somebody down in a situation like that when their concern is questioning, is to relate the questioning to helping the patient. If you just simply say, if you can answer a couple of questions, we might be able to help until the ambulance gets there, you know, that makes perfect sense. Why did they call?

NEARY: And, I guess, you have to keep reassuring them the ambulance is on the way to - or else there'll be panic. And I want...

PATTERSON: Yes, absolutely.

NEARY: And I want to read an email that came in, because we're running to the end of the program. But this is from J. Cameron Derks(ph), and he says: I'm a paramedic on duty right now. I often see the effects of pre-arrival instructions by call-takers and dispatchers. When I arrive at the scene of emergencies, the information they collect shows up on my screen and provides really useful clues to what my partner and I are going into. Thank you dispatchers and call-takers. So there's a real example of what you guys do right, I guess, right?

PATTERSON: Well, that's a fantastic accolades from a paramedic. I mean, we work very closely with these folks out in the field. And it's been a long time coming to see the emergency dispatcher as part of that team and that's finally happening, and I think that's just wonderful, but they're a very important of that patient-care chain.

NEARY: All right. Well, thanks so much for joining us, Brett.

PATTERSON: Thank you.

NEARY: Brett Patterson works medical dispatch protocol for the International Academies of Emergency Dispatch. He worked as an EMS dispatcher for 10 years in Clearwater, Florida. And you're listening to TALK OF THE NATION from NPR News.

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