The only number 112 works badly?

On the night of June 15, a fire broke out in an apartment on the first floor of a building in Messina, in Via dei Mille, a street full of shops in the city center. According to subsequent firefighter investigations, the fire was caused by the malfunction of an electrical outlet or a power strip. The apartment housed the Messina family, consisting of six people: two adults and their four children. The parents, owners of a street clothing store, managed to save themselves by walking on a ledge with two of their children, aged 8 and 6, and the other people who lived in the same building. The other two children, Francesco Filippo and Raniero, aged 13 and 10, died. According to the story of an uncle from Messina, one of the people who lived in the building, the older boy had returned home after going out to take his brother, stayed on the mezzanine in wood where they slept together. The building has two floors: the first and the second are burned.

A few days later, on June 20, there was a parliamentary question about this fire and the death of the Messina brothers. A deputy from Forza Italia, Antonino Germanà, asked if among the reasons why the children died there is no "lack of means and personnel" and if a "self-scale that probably does not fit to the type of intervention "was not used". The Minister of Relations with Parliament, Riccardo Fraccaro, responded by reporting the information of that night to the Ministry of the Interior.

At 4:13, a phone call arrived at the operations room of the Messina fire brigade, he was coming from the only central 112 of Catania. After a minute, from the central police station of Salandra Street, "the operational teams came out with adequate means"; after another seven minutes (exactly the time required, according to Google Maps, to get from the central to the Messina apartment address at 4 am) the fire department arrived at the location of the Fire, already advanced, where they were already police 4.09. Germanà has not added anything else on the issue of schedules, but it has been the subject of much discussion as a neighbor of Messina, Giuseppe Natoli, said his wife would call the rescue at 4.07 : for these six minutes between this call and the response of the fire department badumed responsibility for the one-stop shop of Catania 1.12

This is not the first time that the death of a person in a emergency situation is criticized 112.

Many do not know it but since 2010, in some parts of Italy, when we call it 118, 115, 113 or 112, do not respond health services, firefighters, police or carabineers. Instead of answering the operators of the unique emergency number 112. Who works there calls it "one-a-two" just to distinguish it from the "centododici" of the font: the number is the same , but the call in some parts of Italy does not speak anymore with the carabinieri. In the coming years, the single number for emergencies will be extended to the whole country: even by calling 118, 115 and 113, you will be automatically redirected to the 112 (with the apostrophe because is "one-a-two")

The introduction of the unique number is mandatory for the countries of the European Union, and Italy is pursuing it with delay: we are still in phase d & # 39; experimentation. Having said that the experiments are only to improve the system, we have tried to understand if the unique emergency number really works badly, as some of his critics have argued the following cases like those of the fire of Messina, talking to some people who are working there and trying to give the right weight to the tone used by some newspapers to report criticism.

Where does the 112 come from?
112 is the only emergency number of the European Union and many other countries in the world, including Azerbaijan, India and the United States. Iceland. Using the same number for all types of emergency situations in many different countries is one way of optimizing response management and even allowing those from a foreign country to report a situation. Emergency without difficulty. In Europe, the 112 was introduced at the regulatory level by the European Commission in 1991, the year after the first Italian tests with 118 – before it was necessary to call the individual hospitals – and before the extension of 118 throughout the country.

European countries adopted 112 at different times. Italy arrived late, so that in 2009, an infringement procedure was opened and closed in 2011 after the first introductions of the unique emergency number in our country. EU member countries have been free to choose how to introduce 112 and emergency services to link: in some countries it has become the only emergency number (although calls to old numbers are redirected), while in many others, it has been introduced in a parallel way, that is, as a number to call when you do not know which specific backup service to call. . Italy has chosen the first model, even though it has not yet introduced the system in all regions.

See also: The history of 999, the first telephone service exclusively dedicated to emergency situations

Where the 112 is active in Italy
Recently 112 has been talked about a lot because in many parts of Italy it went into operation in 2017, but the first adoptions of this number go back to 2010, when on an experimental basis it was introduced in the Varese provinces , Monza, Bergamo, Como and Lecco. Since 2015, the unique number has been active throughout Lombardy; from the same year there is also in Rome, where the introduction was planned because of the Jubilee. In 2017, it has been activated in Friuli Venezia Giulia, Trentino-Alto Adige, Liguria, Piedmont, Valle d'Aosta and in eastern Sicily. In some of these areas, the 112 can also be called with the help of a smartphone app, Where are they ?: Automatically transmits data on calls to the 112, including phone numbers from Other people entered through the same ER

Here is the map where you can use the official application of the unique emergency number 112
Click and download it: https: // t. co / LgAmegKX7e @AREULombardia @ 112_sos @ gmail.com 112_ITALIA @CriLiguria @CRISicilia @SicilaEmergenza @CRILazio @CNSASLazio @ SOSLambrate @CRIGrandate pic.twitter.com/CL0Apo3r9S [19659002] – SOS EMERGENCY (@sosemergenza) June 1, 2018

How does 112
In provinces where the unique number is active , 112 is the only number for emergencies that can call: who calls 118, 115 and 113, as well as 112 to think of hearing the carabinieri, is directed towards the center of the unique number. Even calls made to 911 by those who think it's the number for emergencies in Italy, influenced by American movies and TV series (they exist) or because they are strangers are redirected to 1.12

In the regions where 112 is In operation, there are several operational centers that receive calls from different provinces: Lombardy has three, Piedmont two (which also serves the Valle d'Or). Aosta) and Liguria. In technical jargon, the 1,112 control panels are also called "top-level PSAPs": the "second-level PSAPs" are rather the operational centers of the various emergency services. PSAP is an acronym that stands for "Public Safety Response Point". Although the protocol establishing the operation of the 1,112 power plants is carried out by the Ministry of the Interior, it is the regions that manage it: in certain regions, for example in Friuli Venezia Giulia, the task is Delegate to La Sicilia deals directly with the Regional Department of Health, while in Lombardy the Regional Agency for Emergency (AREU). The 1,112 power plants are described as "laypersons" because the workers who work there are not part of a state agency that offers emergency services and has not received training of 118 operators, but received special training.

What Happens After a Call to 112
For each call, 112 operators gather the first reported emergency information and insert it into an online form: a "Digital map". Then they transmit the card to the emergency rescue service – ambulances, firefighters, police or carabinieri – with the call itself. A big news of the 1,112, compared to the old emergency numbers, is that with the call operators receiving data to locate it, which arrive in about two seconds.

An example to understand what is happening in practice. If you call a person to report a car accident, the operator 1,112 notes the information on who is calling and asking where the incident should confirm the location he or she has received. After understanding the urgency, the operator 1112 sends the call to the health service, the fire brigade or the public security forces, as he was told. If there are injured, for example, health care is always called first. It then belongs to the first level second PSAP (in the case of the car accident with injured, health service), to call as soon as possible any other second level PSAP required (the carabinieri or the police, firefighters if there are inside a vehicle)

In cases where the caller does not speak Italian, the 112 operator activates, if necessary, a teleconference for translation with another operator; the connection with the interpreter continues even when the call is transferred to the second level PSAP

In all this, and it is a very important thing, the operators of the 1 112 also act as a filter, easing the work of the emergency services: blocking calls made by mistake, those who do not report real emergencies, information requests, jokes and unnecessary because they report facts already brought to the attention of d & # 39; ; others. Before all these calls directly reach the emergency services, now no. Between 2013 and 2014, the Lombard 112 reduced the number of calls received by the health care service by 16% compared to the average of the two previous years; In their first year of work, the Saluzzo and Grugliasco operations centers in Piedmont even filtered 45.9% of the calls received. This filtering work aims to avoid wasting time on health workers and other emergency services.

Another novelty introduced with the 112: every day everything concerning calls received by the centers of operations, since the time answer to the number of missed calls, is recorded with telephone conversations. The average data is sent to the Ministry of the Interior every morning. For this reason, daily operational center managers can check if there have been any particular delays in the responses and we can calculate annual averages on response times that could not be done. in the past.

112
Especially last year, the 112 received a lot of criticism from some unions of workers of the emergency services – those of the CONAPO firefighters, those of the SAP police , SIAP and SIULP and those of NURSIND nurses – as well as individual citizens. One of the criticisms that has been heard is Mario Balzanelli, director of the 118 of Taranto (where there is not 112) and president of the Italian company Sistemi 118 (SIS 118), an badociation representing managers and operators involved in health care services (some articles have defined it as a national director 'imprecise' 118 ').

Critics, who found space in newspapers after the death of some people, relate to various aspects of emergency management with 112. Sometimes the newspapers reported them with an alarming tone: after the fire of Messina and the criticism of the 12th, the station of Catania received calls in which someone gave the killers to the operators, he declared Post Nico Le Mura, head of the operational zone of the medical society d & # 39; Regional emergency urgency Sicilian 118 (SEUS 118)

For each criticism, we have therefore asked some people working in the organizations that occupy Lombardy, Piedmont, Lazio and Sicily to explain the mechanisms of the service and give its own version, to try to understand if the 112 works well or not. In short, everyone believes that no troubling situation has ever arisen since the adoption of the 112, even though they recognize that the system can be improved, as has already been done to several times at regional and national level

Overtime
One of the most criticized stories on the 12th is that of Gianfranco Ruggiu, a man residing in Albano Laziale, in the province of Rome , who died in the summer of 2017 after having an illness. His daughter Valentina, a journalist from Repubblica who has treated and criticized the city ever since, wrote a heartbreaking account of her waiting for help and numerous unanswered calls to ask for an ambulance: [19659040] "Stand by". More than two minutes have elapsed and that is the second call to 118. Attack and I try again to call: "Stand by." The third call I make from my mobile and starts at 3.19. In the meantime, my brother and his partner are coming. "Stand by". They lift him up, put him on the bed, and I see my father die. The call is still open, under the cries of my mother I hear the recorded voice: "Stand by". I do not know what to do, I just want an ambulance, someone to help us. (…)

Meanwhile, at 3:26 am another call to 118 begins on the phone of my brother's girlfriend. His wait is added to mine. (…)

Suddenly, the little voice of my smartphone stops, they answer me. I tell the operator where I live, I explain the huge noise that woke me up and how I found my dad. I tell him that he is still alive, but he is about to die. I saw him in the face. We need an emergency ambulance. He tells me "Ok, I'm transferring the call to the 118 unit closest to you". (…)

"Here," the voice continues from my neighbor's phone. My cell phone is silenced, I do not know if I hung up or they did it. I keep shouting and another man comes out. I also ask for help while at the next emergency number of health hangs up the phone. The wait is over, but in every sense: Dad is dead. At 3:34 and 3:36 he calls me a private number: "Madam, if she still wants me, I send her an ambulance".

An investigation for manslaughter against unknown persons was opened to the death of Ruggiu this type in Lazio), to understand if the response to phone calls from his family and neighbors was due to a malfunction of the 1212 in the transmission of the call or a problem of the health service.

The main criticism of Le 112, which Balzanelli dealt with in the first place, concerns precisely the issue of delays in cases like Ruggiu's, that is to say those of the red code, when the 39 Health worker intervention can save lives. Compared to the previous system, with 112 there are in fact two telephone exchanges, the central one in the 12th and the center in the second level PSAP; First, on the other hand, what is now the second level PSAP has been called directly. In an interview with the press agency La Presse Balzanelli explains: "Even 40 seconds gained allow you to increase the chances of hello by more than 5%. Forcing citizens to double in some cases may involve the risk of lengthening the overall time of the rescue response, which, depending on the case and severity, may have a cooperative or direct role in the conditioning of A disturbing result. "

The 40 seconds mentioned by Balzanelli are the maximum duration that, according to a corrective regulation from the Ministry of the Interior last January, should have the conversations between the caller numbers emergency and operators of 1,112 power plants.According to some critics, the fix is ​​not an appropriate solution, partly because it does not take into account that some phone calls, due to ambient noise problems , misunderstandings and excited tones last longer.

Cristina Corbetta, AREU Lombardy, the institution that handled the unique emergency number, said Post that 39 it is true that with the new system there is a lengthening of the times, but things are not so simple.

First of all, on average, from the moment when there is 1112 operator responds and the one where the call is pbaded to the second level P SAP, 50 seconds pbad. According to the Lombard experience, it is not these seconds that make the difference between life and death. In a single case, these extra seconds may have a weight, but since medical help takes an average of 11 to 12 minutes between the time of the call and the one when it is repaired (many factors come into play between one thing and another), 50 seconds are very little influential.

Second. The 50 seconds are not very influential, especially because, according to the AREU of Lombardy, the innovations introduced by the 1212 compensate them. The filtering of unnecessary calls saves time, the automatic location before 1112 did not exist, and with 112 all calls are answered; that closes before being answered is recalled. According to an internal investigation, it was verified that the 118 of Milan lost 17% of the calls, before there were 112: and we will never know how many came from people with a heart attack principle, pointed out Corbetta. In fact, before there was no way to recall those who could not speak with an operator, while with the 112 yes

Mario Balzanelli reiterated that the situations that are close to his heart are those of the red code. In these cases, it is very important that the telephone triage is the procedure with which the operators of the 118 give information and advice to those who are saving the person who needs the phone. ;ambulance. In this phase, the operator must understand the real seriousness of the situation and give instructions on what to do before the arrival of an ambulance: in some cases he explains how do a cardiac mbadage or a Heimlich maneuver, which you need to do some cases where a person suffocates.

Regarding red cases, according to Balzanelli, the time-saving forms allowed by the 112 are irrelevant, because the unsuitable calls to 118 are a minority (compared to other emergencies). The data for 2016 from AREU Lombardia confirm this: direct calls to 118 and filtered by the 1,112 power plants were only 26% in the Brescia power station and 23% in the Varese power station; in Milan, there was more, 46%, but this percentage is lower than that of other emergency services. In Catania, this is more or less the same: 28% of calls are filtered on the 118. As for the distribution of calls, those who call 118 really need 118, according to Lombard data: between 91 and 96% of the calls made to this number are then actually sent to health care.

According to data from the Ministry of the Interior, on average, the operational center of Brescia takes 2.7 seconds to answer calls, that of Varese 3.7, that of Milan 4.6. That of Saluzzo, in the province of Cuneo, which has been running for less time, lasts between 4.5 and 5 seconds. That of Catania, which is the best in Italy for timing, is only 2.6.

In Rome, where Ruggiu died, the average response times are higher: 9 to 15 16 seconds depending on the time of day and other circumstances. Corbetta, in his evaluations on the effectiveness of the 1,112, wanted to avoid making considerations on the 11th of Lazio. Livio De Angelis, regional director of public badistance and 11th Lazio for four months, said Post that average response times in Rome are similar to those of different numbers for emergencies before the adoption of 112, again in Rome.

"The funnel effect"
Another criticism of the 112 relates to the cases in which the "funnel effect" occurs, that is, to say there is a great urgency, like a big fire or a flood, and many people call at the same time to report the same problem. Since the 112 central receive calls to different emergency services, their number is greater than the number of calls arriving in the individual operations centers with the old system: this would create delays that would have could have been avoided before.

The problem of the funnel effect, however, said Corbetta, not only affects the power plants of 112: where the only number is not there, for example, occurs often at 115 when there are fires. That said, to try to solve the problem in Lombardy has been set up a special system: when they start to have so many calls to report the same serious problem, with the authorization of the second level PSAP involved are blocked all those who report the already known fact. Walter Occelli, head of the 1212 factory in Saluzzo, Cuneo province, declared Post that in case of need where the funnel effect occurs – and the average response time rises to about 17 seconds – the other Piedmontese plant, that of Grugliasco, in the province of Turin, collaborates with that of Saluzzo

The question of double answer
Another aspect of the 1112 system that was criticized is the fact that in cases where it is necessary the simultaneous intervention of two different emergency services, for example medical aid and firefighters, must be the first one who was alerted by the central 1212 to call the second: this should further slow down the response to the emergency situation.

However, it must be known that even earlier, when the 118 was called to a situation in which the intervention of other rescue forces was necessary, to prevent them. With 112 what happens in these cases, it is that the 1112 operator sends the digital card on the second call to the second level PSAP that could serve. An example: if a 112 operator receives a call that reports a car accident with injury in which someone is trapped in a car, immediately call 118 but at the same time sends the card that signals the car. incident also to firefighters, before Walter Occelli, the coordination between the different rescue services is better thanks to 1 112, because the transmission of the information sheet was not there before. Balzanelli rather thinks that contemporary responses can be managed more quickly by removing phase 1.12

Occelli also explained that it is difficult to further improve the mechanism of the dual response, given that people who call a rescue service can not He insisted that when a 112 operator sends the call to a specific emergency service, he does so by following a very strict regulation: this it is not the operator who makes the choice, but the rules on the basis of the information received by the caller, to indicate the emergency service to call.

The question of the double answer was at the center of the most recent criticism of the 112 because of the fire in Messina, for which an investigation by the prosecutor. On the case there is some confusion because the information provided by Minister Fraccaro, on the basis of data from the Ministry of the Interior, was added by those of the Ministry of Health of Sicily, who stated that the first call at 1.12 has arrived at 4.05. The newspapers said that this information contradicts those of Fraccaro, but this is not the case: that the call would start at 4.07 is information that newspapers have obtained from Messina's neighbor Giuseppe Natoli.

Nico Le Mura gave Post a little more information: to him it turns out that the response of the first call to 1,212 came after 1.2 seconds and that it was not possible to find the answer. after only 33 seconds the 1212 operator had located the place of & # 39; fire, made the necessary issues to the person who had called (a woman) and transferred the call to 115. The walls also specified that priority was given to 115 and not to 118 because the l 39; Operator from 1112 had asked the woman that he had called out they were injured and that he had told her that there was only one fire. The Walls also clarified another information given by the Sicilian Councilor, that after that the conversation between the woman who had called to prevent from the fire and the "hanging of the emergency situation" lasted one minute and 58 seconds: not that is the time elapsed between the response of the 1112 operator and that of 115, but the sum of the 33 seconds of the first and the moment of the conversation between the woman and the policeman 115. For the reconstruction of the facts to be complete, it will be necessary to wait for case studies

An alternative to the 12th such as it is now
Criticisms of the system 1112 also have proposals alternatives. According to the unions of the emergency services workers, it would be necessary to set up "inter-forces forces", in which the telephone operators of the different emergency services would work together, in the same room, and could coordinate more directly the work of lay operators. ". Mirko Marin explained to Post that this is what is happening in 911 US power plants and that this would be the best way to prevent emergency services being informed of non-urgent situations: for example those of people closed out of the house who would only need a locksmith. Cases like this do not happen often, says Marin, but captain, according to CONAPO, because the operators of the 1,112 central are not emergency services professionals.

The solution proposed by Mario Balzanelli, which opposes the idea of ​​the central interforce, is another. For him, we should move to the model adopted by other European countries, including France: keep the 112 as a parallel emergency number, to be managed by the carabineros, for people who do not know who to go to. turn, and in the meantime make it accessible to direct the 118 and other numbers for emergencies. To implement this project, Balzanelli explained to Republic it would be necessary to provide more human resources to the carabinieri, reopen the 118 provincial power stations that were closed and increase the number of existing ones.

are national data?
At the present time, there is no national data to directly compare the performance of System 112 with that of the previous system, but according to some critics of 112, the differences are already visible. Marco Piergallini, un responsable des pompiers de Rome et syndicaliste de la CONAPO, a déclaré à Repubblica qu'en huit mois à Rome il y a eu huit morts d'incendies dans des appartements: «Figure que nous n'avons pas jamais atteint quand nous avons géré les appels, pas même dans 10 ans. "

Pour contextualiser ce fait, nous devons dire qu'en Lombardie, la région dans laquelle le 112 existe depuis longtemps, il n'y a pas eu de problèmes similaires. Cela a été confirmé à Post Mirko Marin, vice-secrétaire du syndicat CONAPO pour le commandement des pompiers de Milan, qui est cependant très critique de la 1.112. Toujours pour compléter le contexte: le centre de Rome, contrairement à ceux de Lombardie, mais aussi celui de Catane et du Piémont, compte actuellement le nombre d'employés nécessaire pour que le 112 fonctionne bien. Un concours a été organisé pour recruter 115 nouveaux opérateurs pour l'usine de Rome et les prochains pour le Lazio; entre-temps, en tant que solution de pont, d'autres personnes travaillant déjà pour la région ont été formées pour le travail des opérateurs.

Afin de comparer le système de celui avec le précédent, l'entreprise italienne Sistemi 118 travaillera s ur une étude montre les moyennes du temps écoulé entre l'appel et l'intervention avant et après l'introduction du numéro d'urgence unique: de cette manière, vous pouvez vraiment évaluer si le 112 a rendu le système de secours plus efficace.