The universal 911 emergency telephone number, available in most locations, has greatly facilitated citizens' access to emergency medical care. In many systems, 911 answering centers have enhanced 911 (E-911) equipment that provides automatic number and location identification as well as additional information to assist the responding personnel. However, the advent of cellular telephones has complicated this process. In some urban areas, up to 25 percent of all 911 calls are made from cellular phones. Technology is being developed to address this issue.

The call to 911 is the essential front door of the EMS system. The EMS system must assure that those answering the calls have the knowledge and training to properly obtain initial medical information, dispatch appropriate personnel, and offer first aid information to the caller when appropriate. A variety of courses have been developed to train 911 dispatchers, those who answer calls and dispatch appropriate personnel and equipment. The 911 center must have adequate staff and equipment to ensure that calls are answered and responded to in a timely manner. The public should be encouraged to use the 911 number rather than call a hospital or physician when certain symptoms (e.g., acute chest pain, dyspnea, loss of consciousness, or focal weakness) occur.

Information can be collected and ambulances dispatched by the 911 center in many ways. The process known as priority dispatch utilizes structured information gathering by the 911 dispatcher, followed by direction concerning the most appropriate EMS response. Use of this procedure is on the rise. Many of the 911 dispatch protocols also contain first aid information that the dispatcher can give to the caller so that the caller can provide care until EMS arrives. Ambulance personnel must be able directly or indirectly to communicate with the hospital of destination. Most EMTs operate in the field under "off-line" medical control, according to standing orders and patient care protocols developed by physicians. However, there are times when EMS personnel may require "on-line" medical control, in which they talk directly with a physician for specific direction or orders. The communications system functions to provide public access, prompt dispatch of the appropriate vehicles and personnel, timely hospital notification, and on-line medical control.

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