Emergency call numbers The Czech experience 1996

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

Emergency call numbers in CR (since 1970) -Separate services -Separate dispatches (with a few exceptions) -Different numbers 155 Phone and data links 150 158 Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

EMS Dispatch City of Prague Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

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: 8 x. RRU (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

EMS Dispatch City of Prague CALL - TAKING -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 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. Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

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

112 in the Czech Republic The History Milestones II. 2000 Surprise No 1 … 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“. Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

112 in the Czech Republic The History Milestones III. 2001 Surprise No 2 „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 Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

112 in the Czech Republic 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. Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

112 in the Czech Republic 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 one Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

112 in the Czech Republic The folowing declaration was accepted by EMS directors and widely published: • 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 Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

112 in the Czech Republic 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.

112 in the Czech Republic 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. Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

112 in the Czech Republic – how does it work? -The OWNER of 112 technology is Czech Telecom Mobile networks Other private networks -The USER is Min. of Inf. - FD Czech Telecom C. D. S. Central Data Storage „The Mother“ – full technology background „The Daughter“ – remote workstation only

112 in the Czech Republic 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 km 2) - Central recording of all calls - Possibility of data transfers between CC 112 and EMS dispatch and v. v. Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

Emergency Call Numbers in CR 112 155 158 150 Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

112 in the Czech Republic 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 Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

112 in the Czech Republic The procedure used in Prague 112 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 Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

112 in the Czech Republic Approx. Relative Call Volumes 155 - EMS 158 - POLICE 150 - FD 95% HOAX 4% POLICE 1% EMS 112 - CC HOAX calls Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

112 in the Czech Republic The Pathways of Emergency Medical Calls 155 112 System (99%) (1%) EMS Call-center and Dispatch Prague Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

112 in the Czech Republic 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 Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

112 in the Czech Republic 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. Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

112 in the Czech Republic 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. Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

112 in the Czech Republic 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…) Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

112 in the Czech Republic When the 112 is usefull? The service 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. ) Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

112 in the Czech Republic 112 as the only one emergency number? Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

What package would you prefere? RICE LENTILS BEANS Do you really want to carry 3 boxes? Or… Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

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

You can be happy… „Front“ user „End“ user … but what about your wife? ? ? Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

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

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

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

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

Of course, every problem has its solution… but… every solution has its cost… Maybe, isn´t it more clever not to make problems…? Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

112 in the Czech Republic 112 The BENEFIT: System (1%) EMS Call-center and Dispatch Prague The COST: more than 100. 000 CZK (>3. 000 EUR) / YEAR (simillar to the Prague EMS budget) Low workload, low responsibility, good money… Good job, isn´t it? (Especially for Czech Telecom…) Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

When having the only one number, the crucial question is: WHEN, WHERE and HOW to separate calls for different services? Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

The worst answer is TO SEPARATE CALL-TAKING and DISPATCHING = TO SEPARATE RESPONSIBILITY, … Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

…to separate the HEAD from the BODY… Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

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

The good solution? Maybe the system with direct numbers + 112 as a supplementary number combines advantages and eliminates disadvantages… 112 XXX ZZZ YYY Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

It´s clear, that the direct numbers are usefull… WHAT ABOUT THE SINGLE EUROPEAN DIRECT MEDICAL EMERGENCY NUMBER ? Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz

Thank you for your attention… Good luck! Dr. Ondřej Franěk, ZZS HMP – ÚSZS, www. zzshmp. cz