**9. The key pieces to effective emergency service provision**

To implement the proposed solution the following needed:

A.Ambulance service and call center: The key factor in this system is the presence of a good ambulance service with an optimal distribution of its resources at standby locations situated around the state or country (**Figure 6**) and skilled staff, coordinated by EMDs responding to the emergency calls gathering information form patients, providing them with advice, and dispatching ambulance crews as required (**Figure 7**) [14, 37]. Whether it is through a emergency or medical advice phone number, healthcare call center staff can play a key role in addressing a large number of simple medical cases by providing telephone advice and consultations [17, 38]. When an ambulance is dispatched, upon reaching the patient(s), paramedics can assess their health condition using a validated triage system, and

#### **Figure 6.**

*Standalone ambulance standby locations geographically distributed based on call volumes in urban and rural areas to reach patients rapidly.*

**Figure 7.** *Emergency medical dispatcher in the Ambulance Service control room.*

initiate treatment before deciding of the most appropriate patient disposition (**Figure 3**). We recommend the use of the emergency severity score (ESI) because it is easy, fast, and requires little training on the part of the clinicians [28, 32].


#### **Figure 8.**

*Emergency room in primary healthcare center. It is near an entrance for easy dropping and transfer of patient by ambulance.*

#### **Figure 9.**

*Emergency department available 24/7 with the capacity to receive patients coming by ambulance or by their own means of transportation.*

also by their own means of transportation (**Figure 9**). At the point of entry it is now common good practice to have a triage area for walk-in patients. The lowest acuity patients should be advised to visit their local PHC urgent care clinic (**Figure 5**). This will keep space and resources available for the patients with more severe conditions and need to be managed in the ED.

D.Support: The successful implementation of such initiativerequires the support from higher authorities that can promote the collaboration between the various institutions involved. There is also a need for public education to explain how emergency services provided by the various institutions should be used effectively.
