Dear Andrea,

                         Unlike in the past, the  4 New Dispatch Medical Rescue Centers in Lombardy will have (for first level answer to an emergency call) Technician Operators only. This choice depended on the introduction of  a specific "Lombardy Dispatch Priority System", studied by operators' Coordinators of  Dispatch Centers. Nurses had to attend in a second level action (strict health management) or monitoring the operators work.

Kind personal regards,  GFV

I agree with Villa. It 'important to understand which system you want to adopt: a first level (run by technicians) to which you can access the second (run by nurses) if necessary, or one level run by nurses. In Lombardy until recently the majority of the dispatch centers was managed by nurses, while currently the focus was on two levels of response.

Best regards

GPC

In the Welsh Ambulance Services NHS Trust it is “operators” who are at the first point of contact. If however, when the call is categorised by the Advanced Medical Priority Dispatch System (AMPDS) as a low acuity call. It may be transferred to NHS Direct Wales, where Nurses will manage the call with the help of support software. There are however, plans to introduce clinicians i.e. registered paramedics into the Clinical Contact Centre (CCC) using the Manchester Triage system to support the operators.     

Thanks a lot for your answers.

Best regards

Dear Andrea, 

In Malaysia, all emergency call will go through the MERS (Malaysia Emergency Response System) 999 system which is service the the telephone company. At this point the call takers will decide whether the caller need Ambulance, Fire and Rescue or police service. If its for the ambulance, the call will be routed to the medical emergency call center. Here the call takers are the Assistant Medical Officer (AMO) or nurse but who has undergone training in call taking and priority dispatch. The AMO is either from a Diploma of Assistant Medical Officer program (3-years diploma programme) or BSc of Emergency Medicine programme (4-year degree programme). Once the call is receive and seive the message will be pass to the nearest ambulance service provider in the area for ambulance response.  

Dear Ismail

You used the Medical Priority Dispatch System? 

Best regards

Hi; here in Argentina it's different in each province,some has the 911 others the 107 wich is only for health emergencies.In Buenos Aires( capital)thecall to the 107 is received by first operators and there is always a MD acting as a regulator. we don't have nurses in our call center.

Dear Andrea,

Yes we use them. 

In Denmark a nationwide criteria-based emergency medical dispatch system has been changed in 2009-2010 from being staffed by police to being staffed by health care professionals. I have attached a follow-up study that describes how this was implemented.   

Hello, Andrea,

In Poland, there is an emergency telephone number 112. The operator is the first person to answer your alert. He (she) connects you to specialized services (ambulance, fire brigade, police), according to the emergency situation.

For the State dispatch of Vaud, Switzerland, paramedics and nurses take the calls for medical emergencies

Dear Andrea,

I'm researching emergency calls and dispatch protocols as a part of my doctoral thesis. It would be very interesting to read the full-text of your study, because this is the one issue which should considered on emergency dispatching.

In Finland we have six regional EMCCs. The same EMCC person works as well as call handler that dispatcher throughout the emergency call requiring urgent assistance, whether from police, fire and rescue service or medical care. EMCC personel have a formalized 18 month training, but are lacking the status of a health care professional.  In medical emergencies we use the national criteria based dispatch protocols, including four priority categories from A (highest priority) to D (lowest priority).

In my opinion, anyone who gets a proper education in call handling could evaluate the priority correctly by the protocols. However, at the low acuity calls, dispatchers without the status of health care professional (nurse, paramedic, doctor) leads to merely sending the ambulance and inappropriate use of ems resources. In my studies the ems non-transport rates in Finland were high (even 41% of the calls) and most of these calls were situations when any medical interventions weren't done.

Therefore I'm also keen to know more about the Welsh system, as Paul mentioned.

Kind regards

Marko

Hello Andrea,

Belgium uses the 112 emergency call center. Calls are taken by operators who will activate the response following protocols (ambulance and, if indicated, medical team).

We use MPDS/ProQA trained/certified calltakers for primary telephone triage, then lower acuity cases become a'hot transfer' to a secondary telephone triage centre.  The secondary triage is performed by nurses and paramedics using a McKesson/CECC product that has worked well for ten years. We understand that the CECC program is about to become orphaned in Australia for commercial reasons.

Hello again

There was an interesting paper published in the Emergency Medicine Journal (EMJ 2008) Gray and Walker (sorry I haven’t got the full reference) regarding the use of the Advanced Medical Priority Dispatch System (AMPDS) used in the Uk, when dispatching enhanced scope paramedics (these paramedics often have BSc(Hons) and MSc, allowing them greater autonomy in their clinical decision making, often treating patients at home and discharging them, or referring to points of care other than the ED. The findings of Gray and Walker (2008) suggest that this dispatch tool (AMPDS) was insensitive for dispatching this type of paramedic. Perhaps the paper is worth a read as it may point to a gap in the literature with regard to the appropriate “clinically focused” dispatch/tasking of such healthcare professionals. Just a thought??        

This paper? http://www.ncbi.nlm.nih.gov/pubmed/18723716

Hei Andrea

In France the first operator is a professional no MD but after the call is listen and finished by a medical doctor to decide what is the best response. This system is "expensive" in doctors but very efficient for some emergencies

http://academiccommons.columbia.edu/catalog/ac:159856  

Accuracy of a Priority Medical Dispatch System in Dispatching Cardiac Emergencies in a Suburban Community

Michael J. Reilly

In NYC in the 1970's shifted from police officers answering 911 calls to EMTs, with some use of nurses to try to "triage out" calls....but it never really cut the call volume because the system was too risk adverse....Now, I'm not sure if any of the nurses still exist- I don't think they do, although I don't know exactly when they were phased out.

https://www.dropbox.com/s/80xkwhnqhdhay3k/1971-Trial%20Run%20For%20Nurse%20Phone%20Triage%2C%20%22Demeaning%22%2C%20But%20Divert%2075%25%20of%20Questionable%20Calls.pdf?dl=0

https://www.dropbox.com/s/80xkwhnqhdhay3k/1971-Trial%20Run%20For%20Nurse%20Phone%20Triage%2C%20%22Demeaning%22%2C%20But%20Divert%2075%25%20of%20Questionable%20Calls.pdf?dl=0

https://www.dropbox.com/s/xhcte3dy9cuba8h/1973-Why%20Ambulances%20Are%20Coming%20Faster%20%28photos%29.pdf?dl=0

I'm working on a paper right now about making 911 a $1 toll call and another on $20 point-of-service co-payments to shift more of the burden from the system to the callers, who both hold more information about the emergency and now face no real barriers to calling for anything .  All of the data on emergency department co-payments has shown a decrease in low acuity patients without any significant impact on high acuity patient access.    

Scot 

In Malta (EU), 112 calls are filtered through an Emergency Call Center and calls requiring a medical response are forwarded to the ED Ambulance Control Room (which is within the ED). The ambulance control room is exclusively manned by ED nurses who take calls and triage them into three categories. The highest two categories (red & orange) are dispatched immediately with an ED nurse and 2 EARs (like ambulance technicians). The lower category (green) is dispatched as soon as possible (depending on the number of ambulances on calls and on stand-by) only with 2 EARs.

In Madrid province, there are two emergency numbers now: 112 and 061 (sanitary emergencies). Both calls are first answered by an operator, and like in France, if it is necessary, forwarded to a medical doctor who decides the best response.

Thank you Nicolas!

You're welcome!