The Kingston Central Ambulance Communication Centre (CACC) receives and responds to approximately 144,000 (2022) requests for ambulances every year, sending paramedics to medical emergencies in Kingston and the surrounding communities throughout Southeastern Ontario.
There are approximately 20,200 square kilometres in our jurisdiction with a population of approximately 523,787 citizens (Stats Can 2016). One of Canada’s most important and busy highways (Hwy 401) runs through the CACC jurisdiction. Our area is bordered on the south by Lake Ontario and the St. Lawrence Seaway.
What Happens When You Dial 911?
Jurisdictions in North America all manage an emergency call to 911 virtually the same way. The phone call sets off a chain of events that may pass through several different emergency call centers and several operators. Each link of the chain has a specific role.
In the city of Kingston when you dial 911, your call goes to the Public Safety Answering Point (PSAP) located at the Kingston Police 911 Communications Centre where it is received by a group of specially trained operators. Outside of the City of Kingston your call may go to one of three other PSAPs; the Ontario Provincial Police (North Bay OPP), Northern 911 or the Gananoque Police Service.
The operator who answers your call for help will say, “911 emergency, do you need Police, Fire, or Paramedics?” Depending on your answer to this question, the operator can forward your call to call takers at:
- Your local Police Service or the OPP
- Your local Fire Service
- Kingston Central Ambulance Communication Centre
After the call is answered at a PSAP it is relayed to the CACC where there are dedicated Ambulance Communication Officers (ACOs). At least two separate ACOs will manage each call that comes in from the PSAP operator; a call taker and a dispatcher, each with specific roles in managing the emergency.
The incoming call is received in a computerized phone system designed to manage multiple incoming emergency lines and record all information received by phone. The first ACO in the CACC to touch the call is the ‘call taker’.
- ACOs are trained for two roles in the CACC and rotate through the positions during a shift or as needed. The term ‘call taker’ is a reference to the first role in managing an incoming call. The second role an ACO fills is that of dispatcher. While acting as dispatcher the ACO is actively using radios, computerized mapping, phones and other tools to communicate with paramedics and direct ambulance movements.
The call taker will confirm the address where the paramedics are needed with a system called the Automatic Number Identifier / Automatic Location Identifier (ANI/ALI). The person calling is then asked important opening questions:
- “What is your emergency?”
- “Where do you need the ambulance?” (confirming civic address, city, is it an apartment, closest intersection and phone number)
- “Is the person awake?”
- “Is the person breathing normally?”
- “How old is the person?”
- “Tell me what happened”
If no potential life threatening conditions are apparent at this point, more specific questions will be asked. If the situation is life threatening, the call taker will provide emergency first aid instructions by phone.
Based on a caller’s answers, the call is then prioritized and sent through the Computer Aided Dispatch System (CAD) to a dispatcher who sends paramedics to the call with the initial information. From the time the call is first answered, it must be prioritized and sent to the dispatcher’s computer with initial information in less than 45 seconds, at the 90th percentile, for Code 4 (life threatening) calls.
While the paramedics are being sent, the call taker will continue to gather more information by following a computerized flow chart called the Dispatch Priority Card Index (DPCI). Depending on the nature of the emergency, the DPCI directs the call taker to ask precise questions that pertain to specific emergencies.The DPCI can also help the call taker provide clear and concise pre-arrival first aid instructions to the caller.
In the middle of all this, the call taker may also place the caller on hold to notify Police or Fire if they are needed. As you can see, this job requires someone who can stay calm under pressure.
The dispatcher gives paramedics information they need to help the patient including the location, any known hazards, the patient’s age and gender, type of medical emergency and what additional resources may be responding. They update the paramedics of any health and safety issues and any other pertinent patient information that may become available. They also liaise with police, fire and other agencies as required.
Dispatchers monitor paramedics from the time they are mobile to the location of the emergency until the time they leave the hospital and are available for another call. Often multiple dispatchers share the workload. Dispatchers may also separately manage different areas of the CACC jurisdiction or different Paramedic Services operating within the area.
Have you ever wondered what kind of technology is used from the time your call is placed until paramedics arrive and start treating life-threatening emergencies?
ACO Work Stations
The ACO work stations are ergonomically designed to support the ACO and all of the technological components to do their job effectively. Each station is equipped with a restricted radio system, backup radios, a secure phone system, a backup telephone, up to six computer monitors, 4 keyboards and 4 computer mice.
In the CACC Operations area (called “the floor”) these computers and other technological components run 24/7 and give ACOs the ability to monitor, manage and direct everything from one desk. This job requires an extraordinary ability to multitask, focus and stay calm under pressure.
The Priority System
When an emergency call comes into the CACC, the call taker prioritizes it based on the information they obtain. The priorities established by the call taker are also called “Codes”:
- CODE 1 – non life threatening or deferrable
- CODE 2 – scheduled transfer or appointment
- CODE 3 – emergent (may use lights or sirens)
- CODE 4 – life threatening (must use lights or sirens)
ACO work stations are typically equipped with six computer screens.
- SCREEN 1 – Administrative PC for accessing multiple resources such as policies & procedures and anything google
- SCREEN 2 – Used for radio system
- SCREENS 3, 4 & 5 – Computer Aided Dispatch with information about the status and availability of each ambulance, active calls and maps
- SCREEN 6 – Used for the telephone system
Secure Phone System
All conversations over the secure phone lines are recorded by a computer system and can be used to quickly review information or may even be used as evidence in court.
When CACC receives a call from a land line the call taker will see the caller’s address information pop-up on a screen called the Automatic Number Identifier / Automatic Location Identifier (ANI/ALI). The information is always confirmed to ensure that it is accurate. The paramedics are sent to the call once the location is confirmed.
ANI/ALI information is not received by CACC when callers use cell phones, however in most cases (i.e. smart phones) CACC does receive GPS coordinates of the general vicinity of where the cell phone is located. Cell phone callers are asked to be very specific about the location of the emergency when they call to ensure ambulances are sent to the correct address.
Voice Over Internet Protocol (VOIP) telephones are also commonly used now. VOIP phones do not transmit ANI/ALI information either, but most internet providers have ways for the VOIP user to register their phone location so that the location information can be passed to the CACC. It is important for VOIP users to keep this information up to date with their provider.
Restricted radios used by ACOs in the CACC are the primary tool used to communicate with paramedics.
When the paramedics are outside of their units, the transmissions are relayed from their portable radios to the repeater system in their emergency vehicle, to the communication towers which then relay the message to the CACC. The Kingston CACC operates using 10 towers located at various points across Southeastern Ontario.
All paramedic posts, hospital emergency departments and paramedic headquarters are equipped with a specific red phone that connects paramedics directly to the CACC and vice-a-versa.
If for any reason paramedic crews cannot be reached via radio, the red phone can be used for communicating.