112: the first therapeutic act in European emergency care
In the European Union, the emergency number 112 handles the majority of emergency calls and is recognised by almost all citizens.
112 as the primary clinical gateway to emergency care in Europe
According to the 2024 Report on the implementation of the EU emergency number 112, calls to 112 represent approximately 62% of all emergency calls across the European Union, confirming its role as the principal access point to emergency services. Public awareness has reached a mature level: around 94% of EU citizens report knowing that 112 can be used as a single emergency number throughout the Union, with consistently high recognition across Member States. From a clinical standpoint, these data suggest that the major challenges facing the system no longer concern visibility or accessibility, but rather performance, appropriateness, and integration within the emergency care continuum.
Once a call is placed, 112 activates a structured and time-critical sequence of events that precedes any direct medical contact. This phase determines not only response times but also downstream clinical pathways, including destination decisions and activation of specialised teams.
Early triage and dispatcher-mediated interventions in time-dependent emergencies
At the operational core of the 112 system are the Public Safety Answering Points (PSAPs), where calls are received, assessed and prioritised. The European Commission reports that a substantial proportion of calls are resolved at this level without being forwarded to emergency medical services. While this filtering process is sometimes perceived by clinicians and the public as an administrative obstacle, it functions as a form of population-level clinical governance. By identifying non-urgent situations early, PSAPs help preserve emergency medical capacity and reduce response-time variability for high-acuity cases. In this sense, early call handling contributes directly to appropriateness of care and system resilience.
The clinical relevance of this early phase is most evident in out-of-hospital cardiac arrest. Survival in this setting is critically dependent on the interval between collapse and initiation of cardiopulmonary resuscitation. Dispatcher-assisted CPR has emerged as a key evidence-based intervention within this window. In a scientific statement, Lerner et al. demonstrated that structured pre-arrival CPR instructions delivered by dispatchers increase the likelihood of bystander CPR and improve survival (Circulation, 2012). A subsequent systematic review by Eberhard et al. confirmed an association between dispatcher-assisted CPR and improved neurologically intact survival following out-of-hospital cardiac arrest (Resuscitation, 2021).
Other applications
Similar principles apply to other time-dependent emergencies. In acute stroke, early recognition during the emergency call influences prehospital prioritisation and access to reperfusion pathways. In major trauma, early identification of high-risk mechanisms and physiological compromise guides dispatch decisions and trauma team activation.
In trauma and critical care, increasing attention is being paid to the concept of the “Zero-Point Survey”, defined as the cognitive and logistical preparation that precedes direct patient contact. Within the European emergency system, the 112 call enables this process by providing structured, pre-arrival information from the PSAP to emergency medical teams. Accurate data on mechanism, physiological compromise, location and scene context allow clinicians to perform an implicit Zero-Point Survey before arrival, aligning mental readiness, resource allocation and clinical priorities even before the patient is physically assessed.
The European Resuscitation Council explicitly recognises dispatch centres and early call handling as integral components of “systems saving lives,” emphasising that outcomes are shaped by the entire emergency care chain rather than isolated clinical acts (ERC Guidelines, 2021). In this framework, the emergency call is not a neutral administrative step, but an early clinical intervention with measurable consequences.
Digital support and artificial intelligence: reinforcing early decision-making
The clinical impact of the 112 system is increasingly influenced by digital technologies designed to reduce uncertainty and delay during the earliest stages of emergency care. One of the most relevant examples is the widespread implementation of Advanced Mobile Location (AML), which enables automatic transmission of caller location data from smartphones to PSAPs. While AML does not change clinical priorities, it shortens the interval between call reception and dispatch, thereby facilitating earlier medical contact.
Recent discussions at European level, supported by the European Emergency Number Association, have highlighted the importance of extending high-precision caller location also to cross-border roaming calls. From a clinical perspective, this development reinforces continuity of care: a patient calling 112 abroad should enter the same emergency pathway as a local resident, allowing physicians in border regions to receive patients whose prehospital triage and localisation are clinically reliable, regardless of nationality or language.
The rising role of AI
Building on this digital infrastructure, artificial intelligence is emerging as a complementary tool in emergency call handling and dispatch. Current applications focus on decision support rather than automation, aiming to assist dispatchers in call classification, prioritisation and detection of life-threatening patterns under conditions of high cognitive load and time pressure. In prehospital emergency care, AI-based systems are being explored to improve consistency, reduce variability and support human decision-making at scale. Importantly, these tools are not intended to replace clinical judgement, but to reinforce it by providing structured support in an increasingly complex operational environment.
From a clinical perspective, the integration of digital tools and AI into the 112 system reflects a broader shift in emergency medicine towards system-based care. Outcomes in acute disease are determined not only by in-hospital expertise, but by the performance of the entire emergency pathway, starting with the first call. Understanding how early triage, dispatcher-mediated interventions and digital decision support interact is therefore essential for clinicians across specialties.
In this context, the emergency call to 112 should be regarded as the first therapeutic act in European emergency care, increasingly shaped by evidence-based protocols and intelligent systems, with effects that extend well beyond the moment the call is answered.
- European Commission. 2024 report on the implementation of the EU emergency number 112. Brussels: European Commission; 2024.
- Lerner EB, Rea TD, Bobrow BJ, Acker JE 3rd, Berg RA, Brooks SC, Cone DC, Gay M, Gent LM, Mears G, Nadkarni VM, O'Connor RE, Potts J, Sayre MR, Swor RA, Travers AH; American Heart Association Emergency Cardiovascular Care Committee; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Emergency medical service dispatch cardiopulmonary resuscitation prearrival instructions to improve survival from out-of-hospital cardiac arrest: a scientific statement from the American Heart Association. Circulation. 2012 Jan 31;125(4):648-55. doi: 10.1161/CIR.0b013e31823ee5fc. Epub 2012 Jan 9. PMID: 22230482.
- Eberhard KE, Linderoth G, Gregers MCT, Lippert F, Folke F. Impact of dispatcher-assisted cardiopulmonary resuscitation on neurologically intact survival in out-of-hospital cardiac arrest: a systematic review. Scand J Trauma Resusc Emerg Med. 2021 May 24;29(1):70. doi: 10.1186/s13049-021-00875-5. PMID: 34030706; PMCID: PMC8147398.
- Semeraro F, Greif R, Böttiger BW, Burkart R, Cimpoesu D, Georgiou M, Yeung J, Lippert F, S Lockey A, Olasveengen TM, Ristagno G, Schlieber J, Schnaubelt S, Scapigliati A, G Monsieurs K. European Resuscitation Council Guidelines 2021: Systems saving lives. Resuscitation. 2021 Apr;161:80-97. doi: 10.1016/j.resuscitation.2021.02.008. Epub 2021 Mar 24. PMID: 33773834.
- European Emergency Number Association (EENA). Advanced Mobile Location (AML): improving caller location accuracy for emergency communications. Brussels: EENA; updated 2024.