EMERGENCY RESPONSE SERVICES: Background and Motivation 2


While the scope and particular details of many systems vary, 911 systems operate according to the following standard procedure:

• 911 is dialed by an individual in an emergency

• Call is answered by a Public Service Answering Point (PSAP) operator

• A trained 911 call-taker evaluates the caller’s emergency and gathers necessary information (location, severity, etc…)

• Call-taker communicates with the appropriate emergency service agencies for dispatch to the emergency

While 911 calls can be routed to many different geographical locations, the adoption of 911 usually entails some increase in the centralization of call taking, to avoid duplication of fixed costs and adoption costs of the relevant telecommunications equipment. Even if centralization remains unchanged, 911 almost inevitably increases the degree of coordination between call centers.

From the perspective of the productivity analysis for cardiac patients, the most important benefit of 911 systems is to reduce response time. Our focus on cardiac care allows us to assess a particular medical condition for which outcomes have been closely linked (at least in the clinical emergency services literature) to the effectiveness of the emergency response system and ambulance technology. According to a variety of medical sources (see, for example, Cummins et al (1991), Bonnin, Pepe, and Clark (1993), and Tresch, Thakur, and Hoffman (1989)), several medical procedures can contribute to survival in the case of a cardiac incident, including CPR and defibrillation. In particular, the medical literature has tied patients’ survival probability to reductions in the time elapsed between initial collapse of a patient and the administration of CPR and defibrillation (Lewis et al, 1982; Larsen et al, 1993). While CPR can be in principle conducted by a non-professional bystander (perhaps with over-the-phone instructions from a trained call-taker), it is typically best performed by paramedics. Furthermore, defibrillation -electrical shock therapy to “reset” the electrical activity of the heart in the case of ventricular fibrillation (irregularity) – requires equipment which is transported in ambulances or available in hospitals. As a result, correct administration of CPR and/or defibrillation are dependent on the time it takes for an ambulance (equipped with a defibrillator) to arrive at the scene of an emergency. More info