High up in the World Port Center Rotterdam – at Kop van Zuid – is a special contact center. Dozens of specialized dispatchers handle 112 calls from an area with a population of 1,3 million. These calls include small and large fires, animals in distress, serious injuries, and child resuscitation, but sometimes also radioactive rabbits. Ziptone visited the ambulance and fire dispatch centers of the Rotterdam-Rijnmond Safety Region. Part 25 in the series of unusual contact centers.

 

Robert Du Pree Du Pree has been head of the Fire Department control room for the Rotterdam-Rijnmond Safety Region, which also covers the South Holland South area, since 2023. Du Pree: "We handle 60 incidents daily. Our team consists of around 30 intake staff members who dispatch the fire department when necessary." The fire department control room handles 30.000 calls, two-thirds of which are incidents requiring emergency response. Du Pree has worked at the control room since 2005 and has operational experience with the fire department.

Thomas Van Autreve is head of the ambulance dispatch center for the Rotterdam-Rijnmond Safety Region. He leads a team of approximately 60 dispatchers with various specializations. Van Autreve previously worked as an ambulance nurse. "We direct the units and can call the trauma helicopters, also known as 'lifeliners.' By 2025, we will have processed over 185.000 reports for our own region."

Growing volume

That volume of reports brings us directly to daily practice. Van Autreve: “It's striking that our volume is increasing every year. More and more people are finding it difficult to organize their own care, the aging population is a factor, and we see that people are more likely to call 112 because other services are unavailable or closed at 17.00 p.m.—think of general practitioners and crisis services. Not every care request requires an ambulance, so in addition to acute care, we're also setting up a department that can provide non-acute care after triage. For the person reporting the situation, it's often very urgent anyway.”

Image: Rotterdam-Rijnmond Safety Region

The call flow of a 112 notification – Calls to 112 reach the 112 emergency dispatch center in Driebergen. A relatively small team of eight to ten employees is on hand there to answer all calls. The first request – police, fire department, or ambulance – is automatically played back, and the first part of the call is recorded so you can listen in on the call in the background. From Driebergen, the calls are forwarded to one of ten national emergency response centers, which handle the intake and dispatch. Previously, each of the 25 safety regions had its own emergency response center, but with the reduction in the number of police districts, the number of emergency response centers has also been reduced to ten. The average call duration in Driebergen is approximately 14 seconds. Calls received via the 112 app are also forwarded (digitally) from Driebergen.

Triage according to standards

When a medical report is received by the Rotterdam ambulance team via Driebergen, an employee starts triage according to a globally standardized and digital protocol, ProQA.

"After answering five to ten questions, ProQA generates a code indicating whether an ambulance is needed and, if so, with what priority," explains Van Autreve. "A0 means with the utmost urgency, such as for resuscitation. A1 means on-site within 15 minutes, also urgent. And A2 means non-urgent, but on-site within 30 minutes."

After the intake, the dispatch operator, supported by various algorithms, determines which ambulance is closest to the patient in terms of time and distance. The ambulance team that is deployed is briefed as it departs. "The intake operator often stays on the phone with the caller, for example, to provide instructions on how to stop a bleeding episode or to initiate resuscitation. In acute situations, the intake operator wraps up once the ambulance arrives. Until then, there is continuous communication between the intake and dispatch teams."

Image bubbles

Recently, the safety region has also been able to use picture bubblesWhen providing instructions, the intake operator can send a message to the caller's mobile device. The caller accepts the message, and the operator can then view the message remotely.

The emergency dispatch center can deploy different types of ambulances. "High-complexity" ambulances handle all A-level calls, while "Middle-complex" ambulances respond when medical professionals, such as a general practitioner, midwife, or district nurse, request an ambulance. These professionals have a direct line via a 088 number, and triage is also handled differently.

Practical experience with the fire brigade

The fire department's emergency dispatch center also employs intake dispatchers who take calls and ask questions. "A major difference is that we don't have a call-out protocol," says Du Pree. "Almost everyone who answers our calls has worked as a firefighter or still does, often with the volunteer fire department. This ensures they have a well-rounded background, and of course, they're trained to ask the right questions. We are, however, working towards implementing a call-out tool to support dispatchers in asking questions."

When fire departments deploy, they look for the nearest fire truck. Du Pree: “Each type of incident requires a different approach. Teams can handle almost any equipment, but they must arrive at an incident with the right equipment, such as a diving truck or an aerial platform. When dispatching, we also consider factors like traffic congestion or open bridges using connected systems. And during dispatch, it's important to maintain a well-distributed capacity. An incident can also grow in size over time.”

Strategic resource allocation also applies to ambulances, says Van Autreve: "If you send an ambulance to a stroke and then a resuscitation event follows in the same neighborhood, the second ambulance will likely have to come from further away. That's one of the many considerations dispatchers have to make continuously for eight hours."

Control room operator training course

While fire department dispatchers often come from active duty, the largest group in the ambulance dispatch center consists of nurse dispatchers. There are also staff members who are not nursing-trained. Van Autreve: “Many dispatch dispatchers combine their work with a role as ambulance driver, so they bring knowledge of the street and vice versa, which is of course very valuable. It contributes to a great deal of understanding, both of the dispatch center processes and of what our colleagues encounter on the street. Drivers and paramedics are trained at the Ambulance Academy, and there's also a curriculum for 112 dispatchers.”

"The challenge is that emergency dispatchers only have verbal communication as a tool. They don't have blood pressure or oxygen saturation monitoring at their disposal," says Van Autreve. "Emotions are often high around the caller. It's a constant challenge for them to suppress their emotions and engage in conversation. That's what makes this role so challenging."

Emotions

Emotions are increasingly running out of control, not only on the street, but also on the leash, as colleagues Van Autreve and Du Pree experience.

Du Pree is adamant about this. “Sometimes it gets normalized: 'It's part of the job.' But it's not part of the job. I think aggressive callers are the least common at the fire department's control room; callers almost always receive help on-site or by phone. It's different with a splinter in your finger.”

Van Autreve confirms that people are calling 112 because they have a splinter in their finger. "There are also people who wait a very long time to call for help. But, as mentioned, the number of non-urgent requests is increasing rapidly. People sometimes have little patience when they're waiting at the emergency services or their GP. We, too, are struggling with the overloaded GP services. And sometimes it's difficult to tell them that an ambulance isn't coming. Last year, there were 57 reports of serious aggression during emergency calls, which I believe is a significant underestimate."

Blow off steam

Employees who encounter serious aggression on the phone can vent. Colleagues are attentive to each other's nonverbal reactions, says Van Autreve. "Sometimes a colleague next to them hears a deep sigh at the end of a report. Then you can talk to them right away. And there's a layered peer support system, including a 'Colleague Support Team' and a supervisor who can be contacted at any time. A company psychologist is also available."

Du Pree: "We don't look at discipline when it comes to collegial support in the emergency dispatch center. Everyone can tag along with someone else to let off some steam. We work well together in that regard."

"Serious injuries or child resuscitations always take their toll, especially when, for example, a caller isn't really cooperative while the dispatcher thinks, 'Just do what I'm asking,'" says Van Autreve. "We select employees who demonstrate mental resilience, and we focus heavily on mental toughness. When you handle hundreds of 112 calls a week, your workload is constantly building; it adds up."

Resilience and radioactive rabbits

This resilience is crucial, as emergency dispatch staff can easily hide within the call. Neither emergency dispatch center has systems in place to monitor every call in real time. As part of the quality cycle, reports processed in ProQA are reviewed monthly. This is done by the Emergency Dispatch Quality team and can lead to additional training or coaching.

Du Pree: "We once had a call from someone who said they saw radioactive rabbits jumping around in their room. How do you know those rabbits are radioactive? That kind of story makes everyone here laugh out loud. There should be some laughter here too."

Innovation

The ambulance dispatch team is eagerly exploring innovative solutions in areas like quality monitoring, but the IT environment still hinders their implementation. According to Du Pree, the fire department routinely considers the handling of telephone reports during major incidents. Automated transcription would be a significant help in this regard, but it too is difficult to manage. This is not only due to the technology, but also because there are many other stakeholders with different requirements. "IT is already under pressure," Du Pree says.

Despite the technological challenges and wish lists, every control room can see in real time what is offered in Driebergen and what the line occupancy is in each of the ten control rooms.

Du Pree: “If the lines to Apeldoorn are full, we shouldn't be surprised if the next call is ours.”

Good cooperation

When answering calls transferred by 112, there's a maximum wait time of 90 seconds; after that, Driebergen can retrieve the caller and route them to another emergency dispatch center. Furthermore, professionals from the police, fire department, and ambulance service can view the shared emergency dispatch system in real time, where all dispatchers, including the units on their way, record incidents. "Compared to other countries, we collaborate very well in the Netherlands," says Du Pree, not without pride.

But there are also challenges. Van Autreve gives an example: "The ambulance dispatch center has a module for route planning, intended for arranging 'ordered transport' between hospitals, for example. But that system isn't integrated with GMS, the solution that supports dispatchers with a real-time overview of the dispatch center's activities." The national search for a new solution with easy integration has already been put on hold several times.

Peaks in supply

Aside from New Year's Eve, which accounts for ten percent of the year's call volume, the fire department's workload is fairly evenly distributed. The situation is different for ambulance services. There, factors such as the weather and large-scale events like the Rotterdam Marathon and the Summer Carnival must be taken into account. Traditionally, Friday and Saturday are closed hours, according to Van Autreve. Schedules are always scheduled with limited overcapacity, so that in the event of an unexpected peak, an additional dispatcher is available to quickly handle the situation. If necessary, staff postpone their breaks. "With three intake dispatchers permanently on duty, we can handle almost anything."

Complexity

The main challenge for both sides is the increasing complexity. In the fire service, the number of incidents remains stable, but buildings, chemicals, and people's behavior are changing. The number of specialists within the fire service is increasing, partly "because we want to do our work better and better," explains Du Pree. "All these specialties converge here in the emergency dispatch center. It's good that all these specialists are here, but how does the dispatcher get them in the right place? We need to think and act less and less like the Rotterdam emergency dispatch center and more and more like the Netherlands emergency dispatch center. We need to harmonize more. My on-call role is called TOA, tactical officer emergency dispatch center. In The Hague, it's called HON, and in South Holland South, they call it OBAC." These roles all fall under the same collective labor agreement, Du Pree confirms.

Smartwatch as a new contact channel

Van Autreve sees challenges in the 'channel switch'. “The way to contact 112 is changing. The classic way was by telephone. Of course, we have e call "We've introduced a system where the car automatically contacts us. But there's also been an increase in the number of notifications via smartwatches that detect a fall or report missing pulse. These notifications don't lead to a call, but they do reach us, including their location. Then we go to the patient." These notifications are remarkably reliable, thanks in part to the smartwatch wearer's ability to cancel the notification within seconds. Van Autreve wonders where this will go in the future.

Functional residence time

Another challenge is the gradually decreasing time spent on a job. "As an organization, we'll have to develop a certain degree of flexibility and do more with strategic staff planning, including job differentiation. Three years ago, we intervened because we couldn't find enough nurses. To be able to scale down calls, we now have a doctor in the emergency room during certain time slots." This doctor can manage the increasing non-emergency care needs – which often means telling someone they can see their GP the next day. "Because adding 20 ambulance units every year is obviously not sustainable."

However, the increasing demand means that first the ambulance dispatch center, and then the rest, will have to look for a larger location. Van Autreve: "What do we need in 2030 to handle the intended volume of calls? Not every call will result in an ambulance being dispatched, but we do have to handle them all. And will all calls still be answered by people, or will we have AI to assist us? The number of people determines the square footage."

Rotterdam-Rijnmond Safety Region (VRR) is a government organization that carries out tasks on behalf of 13 municipalities in the areas of disaster management, crisis management, risk management, fire services, ambulance services, and medical assistance. The 13 mayors from the region together form the general board. It is chaired by Rotterdam Mayor Carola Schouten.

(Ziptone/Erik Bouwer)

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