Setting

In Denmark a single emergency phone number (1-1-2) leads to a primary call center for emergency police, fire, or medical requests, manned by police or fire personnel. In case of a medical issue, the call is redirected to an EMDC in one of five regional EMS. The Capital Region of Denmark covers an area of 2,549 km² and has a population of 1.75 million inhabitants. At the EMDC medical dispatchers prioritize the call and provide pre-arrival instructions to the caller when appropriate. The medical dispatchers are either paramedics or registered nurses, trained to handle emergency calls and register relevant data (including dispatch codes) by use of peer training at the beginning of their employment. Dispatch processes are fully computerized with use of computer aided dispatch (Logis CAD, Logis Solutions A/S, Copenhagen, Denmark). A supportive criteria-based dispatch tool (Danish Index for Emergency Care) was implemented in Denmark in May 2011 [7] (https://www.regionh.dk/om-region-hovedstaden/Den-Praehospitale-Virksomhed/Akutberedskabets-organisation/112-AMK-Vagtcentralen/Documents/Dansk%20Indeks%20version%201.5%20-%20landsudgaven%20(enkeltsider).pdf). The system was developed in Seattle, Washington in 1990 [11] and further adapted into Scandinavian context [7, 12]. Overall the tool supports the process by translating the caller’s answers about symptoms and severity of conditions, into a recommendation for pre-hospital response and guidance. More specifically, emergency calls are categorized into 38 different main categories, including call_unclear. The categorization is the first entrance into the system and leads to specific questions that make the dispatcher able to stratify calls into five emergency priority levels (ranging from A-E). Level A describes life threatening or potential life threatening symptoms; B comprises urgent, but not life threatening symptoms; C is non-urgent conditions requiring an ambulance; D is non-urgent conditions requiring supine patient transport; and E includes conditions requiring medical advice only. Finally, the actual dispatched response is either red response (immediate response with lights and siren), orange response (immediate response without lights and siren, yellow response (non-urgent response with available appropriate resources), green response (non-urgent), and blue response (medical advice, referral to a general practitioner etc.).