Emergency call numbers The Czech experience 1996 – 2004 Ondrej Franek M.D. Prague EMS dispatch...

Emergency call numbers

The Czech experience

1996 – 2004Ondrej Franek M.D. Prague EMS dispatch medical director, Czech Republic

Emergency call numbers in CR(since 1970)

Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www.zzshmp.cz

150150155155

Phone and data links

158158

-Separate services

-Separate dispatches (with a few exceptions)

-Different numbers


EMS Dispatch City of Prague


Area of responsibility: - 525 sq. Km -1.4 mil. inhabitants- HEMS for Prague and Central Bohemia region (2.6 mil. Inhabitants)

Workload:Daily average 850 calls,250 emergencies / day

Avaliable resources:

8xRRU (M.D. staffed), 17 - 25 ALS ambulances (nurse staffed), 6-15 BLS ambulances (shared with non-acute medical transportation service)

Shift staffing:

Day shift: 3-4 C.T. + 1 DISP + 1 Supervizor + 1 M.D.

Night shift: 2-3 C.T. + 1 DISP + 1 Supervizor + M.D. on call


-Call prioritization under written gudelines, assigning one of 3 different crew types and one of 3 priorities to every open case

-Pre-arrival instructions including DLS are providing as a standard practise

CALL - TAKING

DISPATCHING

-Data transfer to personal pagers of all crew-members

-Advanced information technologies - geographical information system including GPS positioning of all ambulances in use, internal information system (intranet), open bed database (internet on-line database filled-in by hospital ICUs directly) etc.


112 in the Czech Republic

The History Milestones I.

1996

First GSM networks - the introducing of 112 (mobile phones only) with no publicity.

The lines were terminated on Regional Police Command and Control Rooms



The History Milestones II.

2000

Surprise No1

… as a result of FD Lobby…?

The Government Decision No. 391 was signed up: „The SEEL 112 will be inrtoduced on 2.1.2003 and

will be handled by Fire Rescue Service of CR“.



The History Milestones III.

2001

Surprise No2

„The 112 will be the only emergency line in CR since 2005, organized by Swedish model“ announced Fire

Chief, Colonel Stepan, the deputy of Minister of Interior and the member of the Czech Parliament, at

the parliament seminary on Crisis management



The History Milestones IV.

2001(August)

The first contact of FD officers with Regional and District EMS directors – Describing the FD ideas on 112. The EMS disagreement with the

design of the system was expressed.



The History Milestones V.

2002 (January)

The EMS reponse to FD activites: The Regional EMS directors meeting on 112 at

Prague. The highlights:

1) It is unaccepteble to receive medical emergency calls by non-medical staff

2) It is unaccepteble to separate responsibility for call-taking on one side and dispatching of resources on the

other oneDr. Ondřej Franěk, ZZS HMP – ÚSZS, www.zzshmp.cz


•We recognize the 112 as a supplementary emergency number, usefull when working beside the direct national emergency numbers

•We recognize the national direct emergency numbers as the main way how to call for help and it is unaccepteble to cancel them when the 112 will be introduced

•All emergency medical calls coming through 112 system should be switched to an appropriate medical dispatch center as qickly as possible

•It is unacceptable to present 112 as a competitive number to direct national emergency numbers. The public presentation of 112 is to be done under this manner


The folowing declaration was accepted by EMS directors and widely published:


The History Milestones VI.

2003

„Opening of new 112 system“ –with a small publicity. Because of a long term delay of the technology

finishing, the „new 112“ was opened at the „paper-and-pencil“ technology in existing FD control rooms.

112 is avaliable from both mobile and fixed lines since that date.

Under the pressure of time delays, technical, finacial and other problems FD officially accepted, that the

112 shuld be more a SWITCH, than a CALL-TAKING facility for medical calls.



The History Milestones VII.

2004(autumn)

The 112 computer system began to work on a basic, limited level. The advanced features (localization, data

transfers etc.) are still in a testing phase.

C.D.S.

Mobile networks Other private networks

Czech Telecom

-The OWNER of 112 technology is Czech Telecom

-The USER is Min. of Inf. - FD

C.D.S. Central Data Storage„The Mother“ – full

technology background„The Daughter“ – remote

workstation only

112 in the Czech Republic – how does it work?


The main technology features

- Caller localization when calling from the fixed line

-Approximative localization when calling from the mobile phone (localization of the phone in based on the determination of pre-defined areas of some 10 – 100 km2)

- Central recording of all calls

- Possibility of data transfers between CC112 and EMS dispatch and v.v.


Emergency Call Numbers in CR


155155 150150158158

112


Actual situation in handling of Emergency calls in CR

- FD, POLICE and EMS have their own dispatch facilities, providing both call-taking and controlling of resources

- CCs 112 works as a supplementary system, medical calls are switched to appropriate EMS dispatch

- Written agreements between FD and EMS are usual on regional level to specify exactly the limits and areas of responsibility for medical calls coming through 112 system



The procedure used in Prague112 op. asks for the nature of the incident and its localization. If the call is a medical call, he/she will handover the call to EMS dispatch immediatelly.

The handover procedure

Step 1: 112 op. will pass the number of the caller and all other usefull informations, if are avaliable, to EMS op.

Step 2: EMS op. confirms receiving the number of the caller.

Till this moment, the responsibility of the call-handling had FD. Since this moment the responsibility of call-handling has the EMS.

Step 3: 112 op. physically switches the call to EMS dispatcher



Approx. Relative Call Volumes


155 - EMS

158 - POLICE

155 - EMS

112 - CC

HOAX calls

95% HOAX 4% POLICE 1% EMS

150 - FD


The Pathways of Emergency Medical Calls


EMS

Call-center and Dispatch Prague

155

System

(99%)

112

System

(1%)


Problems and errors


Evaluation errors

In general, the calls are switched to and evaluated by EMS dispatcher. But some times, the call is evaluated by 112 dispatcher for some reason…

-„Dead body“ – CPR after arrival to the scene

-„Drunk man“, „Diabetic coma“ – cardiac arrest


Problems and errors


Errors in localization

The system switches incoming calls to another 112 control room when all operators in Prague are busy.

The operators from distant centres does not know the Prague local and unofficial names, the differentiation between similar street names can be a problem, here is

no database of such objects as petrol stations, bus stops, supermarkets etc.


Problems and errors


Time loss

Because of an excessive number of HOAX calls all calls are primarilly answered by an automatic machine with

announcemet in 3 languages. After this announcement the call is switched to the 112 operator.

It took at least 40 seconds till summer 2004, and some 10 seconds now.

The basic evaluation, handoff procedure and switching to EMS takes at least next 60 seconds.


When the 112 is usefull?


Translation service

The 112 provides the translation service in case when a forigner calls 155 and there is no operator speaking

appropriate language.

(The most often the callers are clients of Italian teleoperator WIND, whose hotline has number 155…)



The service for forigners who does not know the national direct numbers.

The service for people who cannot dial direct national numbers (for example owners of pre-paid cards with

no credit etc.)

When the 112 is usefull?


112

as the only one emergency number?



RICE LENTILS BEANS

What package would you prefere?

Do you really want to carry 3 boxes? Or…


…will you choose ALL-IN-ONE pack???

Maybe YES… It is simple to buy - do not care the difference between beans, rice and lens – it is cheaper – the only one box is used - some

times, you need all the items together…


… but what about your wife???

„End“ user

You can be happy…

„Front“ user


But… What about the result….?

you was so happy…

…but you WILL NOT HAVE THE LUNCH

(or – maybe – will have it tomorrow…)

Dr. Ondřej Franěk, ZZS HMP – ÚSZS

www.zzshmp.cz


Isn´t it a little bit simillar situation

to the idea of the only one emergency number ?

IT IS SIMLPLE for the front-user…

OK… but how does it work inside???


In every system, there are three basic types of emergency calls and three types of resources...

Isn´t it consistent to have three different emergency lines?


If there is the only one emergency number, we have to solve the problem…

…WHEN, WERE and HOW to seperate the calls of different types?


Of course, every problem has its solution… but…every solution has its cost…

Maybe, isn´t it more clever not to make problems…?



EMS

Call-center and Dispatch Prague

112

System

(1%)

The BENEFIT:

The COST: more than 100.000.000 CZK (>3.000.000 EUR) / YEAR (simillar to the Prague EMS budget)

Low workload, low responsibility, good money…Good job, isn´t it? (Especially for Czech Telecom…)


When having the only one number, the crucial question is:

WHEN, WHERE and HOWto separate calls for different

services?


The worst answer is

TO SEPARATECALL-TAKING and

DISPATCHING=

TO SEPARATERESPONSIBILITY,…


…to separate the HEAD from the BODY…


And… keep in mind some more RISKs

of the only one emergency number

•The reliability and vulverability of the single system

When evaluating the calls:

•The MEDICAL evaluation by NON-MEDICS

•The RESPONSIBILITY for accurate prioritisation, because the system of such type have a strong

tendency to OVERTRIAGE

The good solution? Maybe the system with direct numbers + 112 as a supplementary number combines advantages and eliminates

disadvantages…

XXX


YYYZZZ

112

It´s clear, that the direct numbers are usefull…

WHAT ABOUT THE

SINGLE EUROPEAN DIRECT MEDICAL EMERGENCY

NUMBER ?



Thank you for your attention…

Good luck!

Emergency call numbers The Czech experience 1996 – 2004 Ondrej Franek M.D. Prague EMS dispatch...

Documents

Transcript of Emergency call numbers The Czech experience 1996 – 2004 Ondrej Franek M.D. Prague EMS dispatch...