Core Components for Emergency Medical Dispatch Systems: An International Delphi Consensus Study

Through an international Delphi consensus study, this paper establishes a scalable roadmap of 227 core components across three maturity levels to guide the development and strengthening of Emergency Medical Dispatch Systems in diverse global resource settings.

The Gist

Imagine a global emergency room where the "phone" that connects a sick person to help is missing, broken, or just doesn't work well in many parts of the world. This paper is about building a universal instruction manual for that phone system, known as an Emergency Medical Dispatch System (EMDS).

The authors realized that while rich countries have sophisticated, high-tech systems to manage emergency calls, many poorer countries are trying to run these systems with outdated maps, paper notebooks, or by copying expensive models that don't fit their local reality. They asked: What is the absolute minimum we need to start? What do we need to get better? And what does a perfect system look like?

Here is the story of how they answered that question, using simple analogies.

The Problem: One Size Does Not Fit All

Think of emergency medical dispatch like a traffic control tower for ambulances. In a big, modern city (High-Income Countries), the tower has giant radar screens, automated computers, and direct video links to every car.

In a small, remote village (Low- or Middle-Income Countries), the "tower" might just be a guy with a walkie-talkie and a paper map. If you try to force the village to use the city's giant radar system immediately, it will fail because they don't have the electricity or the money. But if the city only used a walkie-talkie, they would be too slow.

The researchers wanted to create a "Lego Guide" for building these traffic towers. They didn't want just one set of instructions; they wanted three different sets:

1. Foundational: The basic bricks needed to build a small, working tower (for places with few resources).
2. Emerging: Adding more complex pieces as the tower grows (for places getting better).
3. Established: The full, high-tech skyscraper (for places with lots of resources).

The Method: The "Expert Tea Party" (Delphi Study)

To figure out exactly which "Lego bricks" belong in which set, the authors didn't just guess. They held a global expert tea party, but with a strict rulebook.

1. The Guest List: They invited 68 experts from all over the world—doctors, ambulance drivers, government officials, and researchers from both rich and poor countries.
2. The Game: They sent out a survey (Round 1) with a long list of 111 potential "rules" or "tools" (like "Do we need a computer?" "Do we need a paper map?").
3. The Voting: The experts voted on whether each item was essential. They used a simple rule: If 75% of the experts agreed it was necessary, it stayed. If 75% said it was useless, it was thrown out. If they were split, it went to the next round.
4. The Refinement: They did this three times. In between rounds, they showed the experts how everyone else voted, so people could change their minds if they saw the group leaning a certain way.
5. The Final Meeting: Finally, they brought 7 of the experts together online to sort out the tricky items where the rich-country experts and poor-country experts disagreed.

The Results: The Final "Instruction Manual"

After all the voting and debating, they ended up with a final list of 227 specific components (rules, tools, and jobs) divided into the three levels.

Here is what the "Lego Guide" looks like in practice:

• The "Foundational" Level (The Basics):

  • Analogy: This is like having a landline phone, a radio, and a paper notebook.
  • What they agreed on: You need a way to call for help (like a specific emergency number), a way to talk to ambulances (radio or phone), and a way to write down what happened on paper. You don't need fancy computers yet. You just need a way to know who is calling and where they are.
  • Key finding: Even in the most basic systems, you need a plan for who is in charge and how to train the people answering the phones.

• The "Emerging" Level (Getting Better):

  • Analogy: This is like upgrading to a smartphone and a GPS.
  • What they agreed on: Now you start using computers to track where ambulances are. You might use software to help decide which ambulance is closest. You start using electronic maps instead of paper ones.
  • Key finding: This is the "middle ground" where technology starts to help, but you still need to make sure the people know how to use it.

• The "Established" Level (The High-Tech Tower):

  • Analogy: This is the fully automated control center.
  • What they agreed on: Everything is digital. Computers automatically tell the ambulance where to go. The system knows exactly which hospital has a bed available. There are video links, AI tools, and real-time data analysis to make the system faster and safer.

The "Clash of Cultures"

One of the most interesting parts of the study was when the experts from rich countries and poor countries disagreed.

• The Rich Country View: They tended to say, "We don't need paper maps anymore; everything must be digital."
• The Poor Country View: They often said, "Actually, we need paper maps and digital tools because our internet might go down."

The researchers found that experts from poorer countries were actually more optimistic about using technology early on (like using mobile apps for location) because they saw it as a way to "leapfrog" old problems. However, the final group decided to be careful: Don't put high-tech tools in the "Basic" box if they require electricity or internet that might not exist.

The Bottom Line

This paper didn't invent a new ambulance or a new phone. Instead, it built a roadmap.

It tells a country: "If you are just starting, do these 63 things first. Once you have those working well, move on to these 84 things. Once you have mastered those, you can aim for these 80 advanced things."

The goal is to stop countries from trying to build a skyscraper on a swamp. Instead, they can build a sturdy hut, then a house, and eventually a tower, ensuring that no matter where you are in the world, when you call for help, someone knows exactly what to do.

Technical Summary

Technical Summary: Core Components for Emergency Medical Dispatch Systems

Problem Statement
Emergency Medical Dispatch Systems (EMDS) are critical for reducing delays in accessing emergency care, a factor estimated to prevent approximately 40% of emergency deaths. While EMDS in high-income countries (HICs) often operate within mature frameworks utilizing standardized protocols, electronic decision support, and quality assurance, these systems are frequently absent or underdeveloped in low- and middle-income countries (LMICs). Existing challenges include the lack of context-appropriate guidance, the failure of imported HIC models to adapt to local resource constraints (workforce, infrastructure, epidemiology), and the isolation of bespoke LMIC systems which limits knowledge sharing. There is a critical gap in globally supported, scalable guidance for establishing EMDS across diverse resource settings, necessitating a framework that aligns with local realities rather than imposing uniform, resource-intensive models.

Methodology
The study employed a modified Delphi methodology to achieve international consensus on essential EMDS components. The process involved three distinct phases:

1. Initial Framework Development: A multidisciplinary core team convened in March 2025 to conceptualize three EMDS maturity levels based on resource availability: Foundational (basic functioning), Emerging (integration of newer technologies/standards), and Established (advanced technologies/protocols). They generated an initial list of 111 potential essential components across 11 operational domains.
2. Three-Round Delphi Survey: Between June and August 2025, 68 international experts (including clinicians, dispatchers, policymakers, and academics from HICs and LMICs) participated in an iterative survey. Participants rated components on a 5-point Likert scale. Consensus thresholds were set at ≥75% agreement for inclusion or ≥75% disagreement for exclusion. Components not reaching consensus by Round 3 were removed. Subgroup analyses were conducted based on respondents' primary country income status (LMIC vs. HIC).
3. Consensus Meeting: An online meeting with seven selected experts from Round 3 resolved inconsistencies, particularly where components were deemed technologically advanced for "Foundational" systems or where there were conflicting views between income groups. This step finalized the component list and ensured practical feasibility.

Key Contributions and Results
The study generated a comprehensive, tiered framework of essential EMDS components, resulting in a final list of 227 components distributed across the three maturity levels:

• Foundational Level: 63 components
• Emerging Level: 84 components
• Established Level: 80 components

These components span 11 operational domains: Essential products/technologies, Call taking, Emergency prioritization (triage), Advice giving, Resource dispatch, Resource location tracking, Patient data capture/destination triage, Ad hoc communication, Information & research, Human resources & training, and Governance & leadership.

Key Findings:

• Consensus Patterns: Strong agreement was reached on core domains including communication infrastructure, structured call-taking, intervention coaching, resource tracking, and data management.
• Income Stratification: LMIC respondents tended to endorse more components, particularly at the Foundational level, often favoring technology-enabled solutions (e.g., real-time electronic data capture, mobile apps) that HIC respondents viewed as less feasible for early-stage systems. Conversely, HIC respondents were more likely to exclude certain technology-dependent items from Foundational levels.
• Refinement: The consensus meeting was crucial in re-evaluating components that were initially endorsed for Foundational systems but were deemed too infrastructure-dependent (e.g., advanced GPS, automated digital interfaces). These were re-assigned to Emerging or Established levels to ensure the Foundational tier represented a minimal, feasible set of core functions.
• Final List: The final framework emphasizes that while technology is a driver of efficiency, the bedrock of EMDS remains reliable communication, structured processes, and operational clarity. The framework allows for a staged approach where systems begin with core governance and communication functions, layering in complex protocols and technologies as capacity grows.

Significance
This study provides the first global consensus on essential components for Prehospital Emergency Medical Dispatch Systems. Its primary significance lies in offering a scalable roadmap for countries or regions at different stages of EMDS development. By distinguishing between Foundational, Emerging, and Established levels, the framework supports policy and planning that is context-appropriate, avoiding the pitfalls of imposing high-resource models on low-resource settings. The authors assert that this guidance aligns with global policy mandates, specifically the World Health Assembly resolution 76.2, and serves as a basis for developing practical tools (e.g., call-taking scripts, data templates) and performance indicators. The study concludes that future efforts should focus on operationalizing this framework through pilot studies to validate feasibility and refine the placement of components across the maturity levels.