The Norwegian Index for Medical Emergency is a solution developed by The Norwegian Medical Association and The Lærdal Foundation for Acute Medicine. Personnel working in emergency call centres uses this index to collect the appropriate information, define the degree of urgency for the particular emergency, and secure the appropriate help to the accident site. They should also give the right guidance for people who call in, based on international cardiopulmonary resuscitation (CPR). The purpose of the solution was to create an index personnell in emergency call centres could use and follow to ensure the quality and corecctness of help dispatched.
The solution is based on a "criteria-based dispatch" triage program developed in Seattle, USA. One of the prerequisites to developing such a solution in Norway was that it had to be free of cost and free for all to use in emergency call centres across the country. It is not mandatory to use this index in emergency call centres, but it has developed to become a norm, and most call centres use it. The index was on paper, but during the COVID-19 pandemic, the index was launched electronically.
The index was developed from a Law on The Health Service's Communication Preparedness of 1988. This was a technical reform that needed to be filled with medical content, and it was the Norwegian Medical Association that fulfilled this task, that also lead the process. Doctors from across the country contributed to developing this index, and it took several years before it was ready, but in 1994 the index was launched and some emergency call centres started to use it. The use of the solutions eventually grew across the country. The Lærdal Foundation for Acute Medicine took the responsibility of distributing and printing the index. In 2015 The Norwegain Health Directorate took over the responsibility of the index.
One important factor is that there needs to be internal backing within the organisation to implement such a solution. The use of the index and similar tools need to be internally anchored in the management of the emergency call centres.
The personnel in emergency call centres need to be educated in the health or medical field to be able to use the index in the proper and correct manner. The relevant education lays the foundation for the use of this index and ensure that the right help is sent to the education site.
The personnel using this index need a certain amount of training before using the index to be able to use it efficiently.
All personnel in emergency call centres has the possibility to give continuous feedback to editors on how the solutions work, their use of it and the medical content. Through this possibility, the personnel can correct mistakes, improve medical content and so on. Between the edited version of the index in 2015 and 2018, editors received around one thousand feedbacks from personnel using the index.
The index is also along with the feedback from personnel, also updated and improved based on new research and medical advances.
One challenge that occurred in the implementation and launch of the process of the solution was that the Norwegian Directorate of Health lacked support for the index. The Directorate avoided appointing the solution as a national and mandatory solution for all emergency call centres. This delayed the implementation process and made the process challenging. Because of this, developers were unsure if emergency call centres were to start using this index at all.
The lack of authorities' prioritisation affected the modernisation of the solution and made it difficult to develop an electronic version. For over 26 years, emergency personnel in call centres used an analogue, paper version of the index. Developers attempted to evolve an electronic version several times but failed. During the COVID-19 pandemic of 2020, an electronic version was finally launched. This issue was highly related to the lack of funding.
The lack of involvement from the Directorate for Health might be related to the specific organisation of the official healthcare services in Norway, which are run as individual enterprises covering large regions each. This means that each healthcare enterprise has a certain autonomy over each region they cover. This was challenging regarding the launch of the solution because the Directorate for Health does not have the power to make it mandatory in all Norwegian regions.
A challenge with maintaining the quality of the solution has been related to the nature of the job at emergency call centres. The work is psychologically demanding, and the person answering calls is responsible for sending out the right help to the accident and damage site, based on the use of the index. Personnel answering calls may misinterpret the information and send the wrong type of help or the wrong amount of first responders, which can have large impact on the results of the accident. This can of course be very demanding for the personnel working there, and one result is that people do not work in emergency call centres for a long amount of time. This affects the use and knowledge about the index, and the service emergency call centres can provide.