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.

The Kingston Central Ambulance Communication Centre (CACC) receives and responds to approximately 144,000 (2022) requests for ambulances every year, sending paramedics from Lennox and Addington Paramedic Services, Leeds Grenville Paramedic Service, Lanark County Paramedic Service, Hastings-Quinte Paramedic Services, and Frontenac Paramedics  to medical emergencies in Kingston across Southeastern Ontario.

What Happens When You Dial 911?

Jurisdictions across North America all manage an emergency call to 911 in a similar way.  The phone call sets off a chain of events that may pass through several different emergency call centres and several operators.  Each link of the chain has a specific role.

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 will forward your call to call takers at:

• Your local Police Service or the OPP
• Your local Fire Service
• Kingston Central Ambulance Communication Centre (KCACC)

After the call is answered at a PSAP, it is relayed to the KCACC where there are dedicated Ambulance Communication Officers (ACOs), who have been certified as Emergency Medical Dispatchers (EMDs).  

Depending on the context, the titles of Ambulance Communication Officer (ACO) and Emergency Medical Dispatcher (EMD) may be used interchangeably; but both titles refer to the same staff at KCACC. Ambulance Communication Officer is the official position of an Emergency Medical Dispatcher who is employed at a Ministry of Health designated Ambulance Communication Service or Central Ambulance Communication Centre, while the certification as an Emergency Medical Dispatcher is an internationally recognized accreditation that indicates the standard of education that the ACO has achieved. At KCACC, all ACOs are fully qualified and accredited EMDS. 

At least two separate EMDs 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 EMD in the CACC to touch the call is the ‘call taker’. 

• EMDs are trained for two roles in the CACC  and rotate through the positions during a shift or as needed.  The term ‘call taker’ refers to the first role in managing an incoming call. The second role an EMD fills is that of dispatcher.  While acting as dispatcher the EMD actively uses radios, computerized mapping, phones and other tools to communicate with paramedics and direct ambulance movements.

Call Taker

The call taker confirms 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 the caller’s answers, the call is then prioritized via the Medical Priority Dispatch System (MPDS) and delivered to the dispatcher who sends paramedics to the call with the initial information.

Paramedics will respond to urgent and life-threatening cases as quickly as possible but those who call 9-1-1 for less-urgent, non-life-threatening matters should expect longer wait times. Callers for less-urgent cases will be supported through regular contact with ambulance communications officers who will monitor the patient’s condition.

While paramedics are en route, the call taker continues to gather more information. Depending on the nature of the emergency, the MPDS directs the call taker to ask precise questions that pertain to specific emergencies. MPDS also helps the call taker provide clear and concise pre-arrival first aid instructions to the caller.

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.

Dispatcher

The dispatcher gives paramedics the information they need to help the patient including the  location, any known hazards, the patient’s age, and gender, type of medical emergency and whether other emergency system partners may respond as well. They update paramedics on 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 begin moving toward the location of the emergency they are available for another call. Multiple dispatchers may be involved.  Dispatchers may also separately support different areas of the KCACC jurisdiction or different paramedic services operating within the area.

911 Technology

KCACC ACOs use several technologies and tools for each call.

ACO Work Stations

The ACO work stations are ergonomically designed to support the ACO and the technological components required 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, four keyboards, and four computer mice.

In the KCACC Operations area (called “the floor”), these computers and other technological components run 24/7. They equip ACOs to monitor, manage, and direct everything from one desk. This job requires an extraordinary ability to multitask, focus and stay calm under pressure.

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 to serve as a record of events as they unfold.

When KCACC receives a call from a land line, the call taker sees 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. Paramedics are dispatched as soon as the location is confirmed.

ANI/ALI information is not received by KCACC when callers use cell phones, KCACC does receive general GPS coordinates from calls originating from smartphones. Cell phone callers are asked to describe the location of the emergency very specifically when they call to ensure paramedic arrive as quickly as possible. 

Voice Over Internet Protocol (VOIP) phones do not transmit ANI/ALI information either but most internet providers allow the VOIP user to register their phone’s location so location information can be easily passed to KCACC.

Restricted Radios

Restricted radios used by ACOs in the KCACC is the primary tool for communicating with paramedics.

Red Phones

Each paramedic base, hospital emergency department, and paramedic headquarters is equipped with a red phone that is used as a back-up connection between paramedics and the KCACC.