A prehospital emergency medical dispatch system is activated when the general public calls into an emergency call center. Next, a rapid response and an effective command and control system is needed to activate the teams. During a pandemic, the risk posed to those working in the dispatch center could be critical and may disable the entire response. This is the reason that Magen David Adom (MDA) in Israel developed advanced technology that would allow the dispatchers activating the command and control center to work from home without being exposed to unnecessary and dangerous risk.
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Activating the emergency medical services in Israel is done by direct dial to MDA, the national EMS service, by calling 101. The average time it takes for the call to be answered by a paramedic or an EMT is approximately three seconds. The outbreak of the coronavirus pandemic led to many challenges in activating the dispatch center.In the first two months of the pandemic, the MDA dispatch system received approximately two million calls, and there were days when the number of calls were 15 times higher than average. The challenge was increased due to the need to divide the dispatchers into different shifts so the dispatch center could continue to operate if a dispatcher became ill. In order to accommodate the huge rise in demand and calls to the dispatch center, the organization made some vital changes to human resources, logistics and technology. One of the changes included the ability to activate a crew from the home of the dispatcher.
With first confirmed exposure in February, the organization set up a dedicated center for those affected by the coronavirus. The dispatch center received tens of thousands of calls every day advising callers which would need to go into quarantine, who would need a PCR check, who needed a coronavirus swab and who should be referred to their doctor. The dispatchers needed to deal with a great deal of anger, shock, fear and feelings of helplessness when those who called were informed that they had been exposed to the virus. Dispatchers allowed anyone who called to express what they were feeling, showing great care alongside determination ensuring that each caller undertook whatever actions were required for their medical condition. In this way, the organization ensured from the very first stage that all those who had been exposed, and could potentially be infected or infect others, would stay in quarantine. This bought precious time for the health system.
During this time, labs were created, and dedicated wards were set up in the hospitals. Ventilators were also purchased along with protective and other necessary equipment. Calls to the dispatch center were still made through the 101 number. When calling the dispatch center, the caller would select whether they needed the emergency dispatch center or the dedicated coronavirus center. If no choice was selected within five seconds, the call was transferred to an emergency dispatcher. The emergency dispatch center continued its activities as usual despite the fact that there was a large reduction in the number of calls received for routine emergencies, particularly trauma cases.
In order to cope with the huge rise in demand in the coronavirus dispatch center, 500 extra phone lines were set up alongside a dedicated call command system that was developed within a few days. The phones were set up at several locations: in MDA’s teaching rooms, tents, a school that had been closed down, the call center of a travel company whose activities had stopped, in the army’s command center, and in MDA stations across the country. All these centers enabled spacing in between each of the call takers, disinfection in between and during the shifts, permanent stations for the dispatchers on each shift and physical spacing between each set of 10 dispatchers. Precise lists of the dispatchers were kept on each stand, and food was given out in personal packaging. Each location had permanent dispatchers working permanent shifts, or capsules, and they were required to sign a health declaration and check their temperatures daily.
Within the first month however, a dispatcher was found to have been infected by someone in his family. The dispatchers working with him in his capsule were required to go into 14 days of quarantine. As the pandemic continued, several more dispatchers were found to be carriers and the number of dispatchers in quarantine increased. These events meant more dispatchers needed to be trained. Due to this fact the organization decided to change its approach. Instead of opening further dispatch centers or training additional dispatchers, it began to use the dispatchers who were in quarantine – but had no symptoms – from home. This allowed the dispatch center to continue to operate even when they capsule of dispatchers was in quarantine.
The dispatchers were excited at the opportunity. Instead of being out of work and feeling useless while their colleagues were at the center of the action, they became a significant part of the workforce, and even had conditions that were a source of jealousy. With no need for masks, no travel time, flexible work hours, and in particular a sense of being part of a national and organizational effort made this a successful and ambitious project.
Activation is done through a laptop that were given to the dispatchers that contained call-taking software along with an internet-based command and control system. This was all backed by the highest-level cyber-defense systems. A control system is in place that shows in real-time how many dispatchers are available for calls, the number of incoming calls, response times to each call and logs the hours worked by dispatchers. The system pushes the calls to the first available dispatcher and the response time of three seconds is maintained.
Managing call taking from home raises several challenges: cyber security, continuous technological and communication activity, and managing the remote and any available human resources at any given hour. The size of the challenge is also the size of the opportunity. The widespread availability will allow massive sustainability during faults within the fields of energy, internet providers and phone companies. When a call center is flooded by a massive influx of calls, it will be possible to add more and more dispatchers in real time to meet the demands of the public. Once the incident is over, it is easy reduce the numbers of dispatchers.