Although there is no basic standard or unified model for pre-hospital emergency care in China so far, provinces have taken a series of measures around "building a 15-minute emergency circle" to improve the efficiency and quality of pre-hospital emergency care. For example, electronic information systems have been introduced to fortify PMES efficiency; ambulance personnel is equipped with electronic mobile platforms for better communication (Ali, 2001; Hung et al. 2009; Tang et al. 2020; Yan et al. 2017). In addition, each province has set strict time limits for pre-hospital emergency response procedures; for example, a general hospital must dispatch an ambulance within three minutes after receiving an emergency order. And both ambulance personnel and dispatchers were required to record detailed data for each prehospital emergency separately (Zhan et al., 2020), and government departments monitored the response time for each emergency. (Huang et al., 2020). This may be the reason why there was no significant difference in PEMS efficiency between the two groups.
However, the difference in information accuracy between the two groups is notable. Dispatcher overload due to uneven allocation of PEMS resources was identified as one of the main factors contributing to inaccurate PEMS information transmitted through dispatchers. (Tang et al., 2020; Yan et al., 2017). Although both in the previous rounds of healthcare reform and the recently released Health China 2030 Plan, the Chinese government has been committed to providing the people with access to equitable, high-quality PEMS (Tan et al., 2017). But, there are still significant inequalities in PEMS between regions, cities, rural and urban areas. Studies indicate that PEMS resources are deeply affected by GDP growth and urbanization (Tan et al., 2017; Tang et al., 2020; Yan et al., 2017; Zhu et al., 2021). Historically, the western part of Sichuan Province has been at an economic disadvantage compared to the eastern part, especially in terms of road construction and population density. Most emergency facilities are concentrated in the eastern region, while the distribution of emergency resources in the western region is much less (Tang et al., 2020). Using the same PEMS model with different resources may worsen this situation. For example, Guangyuan City, which maintains a population of 2'667'000 in 16307.73 km2 (Tang et al., 2020), has only one emergency center and 10 dispatchers to handle all emergency calls. And these 10 dispatchers are divided into different shifts, with less than 5 actual dispatchers per shift. The dispatchers have to speed up the efficiency of collecting information and shorten the duration of calls, which results in insufficient time for them to verify the information and make appropriate judgments about the situation and give necessary and reasonable advice to the callers, which undoubtedly makes the information accuracy drops dramatically.
The Sichuan PEMS model is believed to be another cause of this result. In this model, the Emergency Medical Center owns no medical equipment or personnel. The Emergency Medical Center and its dispatcher are not directly involved in any PEMS, the dispatcher only needs to screen incoming calls, determine which are genuine alarms, and transfer the relevant information to the general hospital in a timely and accurate manner(Hung et al., 2009). Even if the information itself is not clear enough (e.g., vague addresses, third-party phone numbers) or even interferes with subsequent PEMS, it is neither the dispatcher's job nor does it create any recourse for them. In contrast, the medical staff will be directly involved in the PEMS, and unclear information can directly increase the workload of the medical staff and affect patient outcomes, and as the medical staff takes responsibility when inaccurate information delays the PEMS(Ning et al., 2021), giving the medical staff an incentive to clarify and confirm the information to ensure the efficiency of each PEMS.
Compared with medical staff, lack of relevant medical knowledge and clinical experience among dispatchers is another major contributing reason. A Chinese study pointed out that dispatchers generally come from nurses or doctors with clinical work experience, however, compared with active medical staff, dispatchers lack subsequent training in relevant dispatching skills and medical knowledge, and medical knowledge is not updated promptly (Gao., 2019). Worse still, in the wake of the above tragedy, media investigations found that as economic growth declined and local revenues decreased, emergency medical centers in many areas hired a large number of temporary workers to serve as assistant dispatchers, who did not meet the nationally mandated dispatcher admission standards and lacked relevant medical background (郑州120延误事件多人被处理: 调度员回拨11次电话, 不知报警, 2022). However, these people play the role of dispatchers directly in the workplace without proper supervision and guidance. In this context, dispatchers are unaware of the importance of information accuracy for subsequent PEMS and cannot summarize information to make accurate judgments.