Medical emergencies III: The European emergency phone number (112)

Thirty years after the first European directives that guided the EU Member States towards the adoption of a single telephone number for emergencies, the situation is still evolving, and uneven across countries.

An compact overview of the European emergency system

Thirty years after the first European directives that guided the EU Member States towards the adoption of a single telephone number for emergencies, the situation is still evolving, and uneven from coutry to country. This is part 3 of a short series on medical emergency systems. You can check our other articles here: 
Medical emergencies I: Italy and the 118 number
Medical emergencies II: France and Louis Serre, pioneer of the SAMU
Medical emergencies III: The European emergency phone number (112)

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Today we take it for granted that, in case of need, we can call a single emergency number. And also for granted is that, on the other side of the phone, there is someone capable of helping us, sending what is needed and coordinating operations. Today, we even have a single number that works throughout Europe, it is the 1-1-2 (one-one-two) number, easy to remember and to dial, and the basis of a rescue management system that knows and has all the resources available in a given geographical area. It does not matter whether you are in Rome, Berlin or Paris: in case of need, you can dial 1-1-2 and be certain that someone will be able to help you.

The case of Italy

In Italy, as we have already written about in the history of the national 118 number, the system for managing out-of-hospital health emergencies has been radically transformed in the last 30 years. Until the 1990s, anyone who needed an ambulance for an emergency had to know the number of the local Red Cross or some other ambulance service and rely on luck, since ambulance crews were not trained specifically and uniformly to treat the patient on the spot, there were no operational coordination centres, no integrated communication system had been created between ambulances, hospitals and other emergency services.

The creation of the 118 emergency service in 1992 revolutionised the system of medical assistance in Italy. In the meantime, the European Community directed all member states to adopt the Single European Number 1-1-2, for all emergencies, not just health emergencies (91/396/EEC: Council Decision of 29 July 1991 on the introduction of a single European emergency call number). This decision was reaffirmed by the European Parliament and Council about ten years later (Directive 2002/22/EC of the European Parliament and of the Council of 7 March 2002 on universal service and users' rights relating to electronic communications networks and services - Universal Service Directive).

In Italy, after a period of experimentation, the establishment throughout the national territory of the 112 number with operational centres to be set up on a regional basis was defined by the Delegated Law no. 124 of 7 August 2015 - Madia Law on the rationalisation of Public Administrations (Legge delega 7 agosto 2015 n. 124 - Legge Madia in materia di razionalizzazione delle Pubbliche Amministrazioni).

The model envisages the setting up of Single Response Centres (in Italian: Centrali Uniche di Risposta or CUR), where all emergency calls are collected and transferred to the body in charge of managing the specific emergency (State Police, Carabinieri, Fire Brigade, Health Emergency). It is therefore a two-tier organisation.  The first receives the emergency call and the second actually manages the emergency situation.

Today, six years after the Madia Law, the CURs are not yet active throughout Italy. They are operational in Friuli Venezia Giulia, Lazio, Liguria, Lombardy, Piedmont, eastern Sicily, Valle d'Aosta and the Autonomous Provinces of Trento and Bolzano. While waiting for CURs to be set up throughout the country, where they are not present, the 112 service is provided by the Carabinieri Operations Centres (in Italian: Centrali operative dell’Arma dei Carabinieri).

Therefore, despite the accumulated experience, both positive and negative, and despite the guidelines that aim decisively at uniformity in emergency management, we cannot fail to note that the emergency management system in Italy is still not homogeneous. Not only with regard to the organisation of the operational centres, but also with regard to the provision of means and equipment, the type and training of the personnel employed, and the organisation of the emergency departments.

112 in Europe

Who knows that 112 is the active emergency number throughout Europe? 52% of Austrians, 50% of Danes, 57% of Germans, 42% of Italians, 39% of French, 68% of Croatians, 49% of Portuguese, 30% of Spanish. We can therefore say that, on average, about half of European citizens do not know about the existence of 112.

According to the latest report on the effectiveness of the implementation of NUE 112 published last December1, the situation in Europe is also far from homogeneous. The report's data is based on responses from member states and two EEA countries, Iceland and Norway, to a specific questionnaire. In 2019, users in the European Union (EU) called the single European emergency number 112 almost 150 million times. 112 calls made up 56% of all emergency calls.

112 is the only emergency number in Denmark, Estonia, Finland, Malta, the Netherlands, Portugal, Romania and Sweden and, among EEA countries, in Iceland. However, only 20% of 112 calls in the EU are made in these countries: the vast majority originate in Member States where national numbers are still in use. In the latter, the use of the single European emergency number varies significantly, from 9% in France to 99% in Bulgaria.

The number of 112 calls depends on the degree of end-users' awareness of 112, but also on the co-existence of 'legacy' national numbers. In Member States where these numbers still exist, the use of 112 depends on the effectiveness of the organisation of their PSAP (Public Safety Answering Point) system. Twenty-one Member States, Iceland and Norway reported that the average response time needed to get in touch with the emergency services is less than 10 seconds.

In the EU, the implementation of caller locations derived from mobile devices (AML or Advanced Mobile Location) has continuously improved. By September 2020, 19 Member States, Iceland and Norway had AMLs enabled on their PSAP systems. It is estimated that over a projected period of 10 years, AML could potentially save more than 10,000 lives in the EU as a whole and in the meantime have a positive impact on a total of more than 100,000 lives in the EU.

Disabled end-users, in particular roaming end-users, do not benefit from fully equivalent means of access to emergency services. If they are unable to make a 112 call, they have to rely on fragmented solutions at national level, a situation which contrasts with the availability of the harmonised single European emergency number 112 for other end-users and which constitutes a significant gap in the accessibility of emergency services. Roaming end-users do not always have access to the emergency services guaranteed in the Member States visited and are not informed about the means of access available.

Further action is needed in the future for Member States to fully transpose the requirements on emergency communications and on the single European emergency number. The ultimate goal is that all end-users, including those with disabilities, should be able to call for, and receive help from emergency services effectively regardless of where they are in the EU. It is also necessary to promote the use of 112 with local campaigns in all Member States. Perhaps highly attractive events like Euro 2020, the European Football Championship, be good opportunities to promote this life-saving number?

1. European Commission. 2020 Report on the effectiveness of the implementation of the European emergency number '112'. 18th december 2020