Public awareness of medical emergency telephone numbers: a scoping review

Article information

Clin Exp Emerg Med. 2025;.ceem.24.289

Publication date (electronic) : 2025 January 14

doi : https://doi.org/10.15441/ceem.24.289

Alexei A. Birkun, MD, DMedSc

Department of General Surgery, Anaesthesiology, Resuscitation and Emergency Medicine, Medical Institute named after S.I. Georgievsky of V.I. Vernadsky Crimean Federal University, Simferopol, Russia

Correspondence to: Alexei A. Birkun Department of General Surgery, Anaesthesiology, Resuscitation and Emergency Medicine, Medical Institute named after S.I. Georgievsky of V.I. Vernadsky Crimean Federal University, 5/7 Lenin Blvd, Simferopol 295051, Russia Email: birkunalexei@gmail.com

Received 2024 July 19; Revised 2024 October 30; Accepted 2024 December 12.

Abstract

INTRODUCTION

Activation of emergency medical services (EMS) by dialing the local emergency phone number immediately upon recognition of a problem constitutes an integral component of bystander response in a health crisis [1,2]. Trained dispatchers or telecommunicators may guide the lay rescuer to check the victim’s condition, promptly dispatch professional help, and, depending on the system’s organization, may also give instructions on how to provide help before the arrival of professionals at the scene. Rapid and direct calls to EMS are associated with shorter time to advanced medical interventions and improved outcomes in time-dependent medical events, including stroke, myocardial infarction, and cardiac arrest [3–5]. Conversely, when bystanders are unable to call EMS because they do not know what number to dial, it can have detrimental effects on the chain of survival.

A number of studies have examined public awareness of emergency phone numbers, demonstrating considerable variation in knowledge depending on geography and sociodemographic characteristics [6,7]. Such studies are important, as they uncover and measure the problem of community unpreparedness to respond to acute medical events and may guide interventions to enhance public awareness of how to rapidly activate emergency services.

However, it seems that no attempts have been made to date to summarize and systematically map related evidence on a global scale. This study aimed to provide a scoping review of original studies that reported public knowledge of emergency phone numbers and factors associated with this knowledge.

METHODS

RESULTS

Fig. 1 shows the flow diagram of the study selection process. The initial search in PubMed and Google Scholar returned 844 results. Of these, 54 records were considered potentially eligible. After removal of duplicates and the addition of 10 studies found through the hand search of reference lists and web search, 53 full-text articles were assessed for eligibility. Five papers were excluded as noneligible, and eventually, 48 articles were included in the final review [10–57].

Fig. 1.

Study search and selection flow diagram.

The selected articles were published between 2007 and 2024. Respective studies were carried out in 26 countries (12.7% of the 205 world’s sovereign states and 13.5% of the 193 member states of the United Nations) (Fig. 2), including 16 high-income countries (30 out of 48 studies, 62.5%) [10,14–21,26–30,32–37,39,40,43–45,47,48,52,56,57], 7 upper-middle-income countries (12 studies, 25.0%) [11–13,22–25,41,50,53–55], 2 lower-middle-income countries (2 studies, 4.2%) [31,38], and 1 low-income country (4 studies, 8.3%) [42,46,49,51], according to the World Bank’s classification [58]. The number of studies per country varied from one to five.

Fig. 2.

Distribution of the reviewed studies by global region and country.

The majority of publications (39 studies, 81.3%) presented the results of cross-sectional surveys [11–13,15,17–27,29–31,33,35,36,38–54,57], while five studies (10.4%) reported data from before-and-after studies [16,32,34,37,55], two (4.2%) from nonrandomized controlled studies, and two (4.2%) from randomized controlled studies [14,56]. In 46 studies (95.8%), the subjects’ knowledge of emergency numbers was assessed using self-administered questionnaires or interviews [10–13,15–28,30–57]; in one study (2.1%) the knowledge was evaluated in a simulation scenario of a health emergency [14], and in another (2.1%) both a questionnaire and a simulation scenario were used (the questionnaire survey results were preferred for the data synthesis of the current review) [29]. To assess knowledge of emergency numbers, 24 studies (50.0%) employed open-ended questions [12–14,17,20–24,28,33,34,37,39,43–46,48–50,53–55], 2 (4.2%) used multiple-choice questions [10,40], and 1 (2.1%) used closed-ended question [47], whereas 21 studies (43.8%) did not report the type of inquiry [11,15,16,18,19,25–27,29–32,35,36,38,41,42,51,52,56,57].

Studied populations included the general public (22 studies, 45.8%; mostly adult and usually without exclusion of people with a medical background) [11–13,15,17,20–22,26–28,31,35,38–40,43,45–47,49,52], patients, caregivers, and hospital visitors (10 studies, 20.8%) [16,18,23,24,29,33,41,42,44,54], kindergarten children and school students (9 studies, 18.8%) [10,14,19,30,34,37,50,55,56], and occasionally university students [25], medical students [45], female students of health science colleges [32], primary care physicians of community clinics [36], conscripts [48], marathon runners [53], persons holding a driving license [57], and women who gave birth within the previous 12 months at public health institutions [51] (1 study each, 2.1%). One study provided the percentage of subjects who knew emergency numbers separately for the general public and medical students [45], and hence the total number of data points reported below for the 48 reviewed studies is 49.

Sample size varied from 27 to 9,761 subjects (median, 468; interquartile range [IQR], 151.5–870.5), and the aggregate number of subjects across the reviewed studies was 40,151. The percentage of subjects who knew emergency phone numbers ranged from 0% to 97.8% with a median of 64.3% (IQR, 32.8%–80.0%). This value differed considerably between high-income countries (median, 69.6%; IQR, 54.1%–84.2%) and low- and middle-income countries (median, 34.6%; IQR, 19.4%–61.5%; P=0.003).

Twenty-two studies (45.8%) investigated the relation of various factors with the subjects’ knowledge of emergency phone numbers [11,13,15,19,20,24,27,28,30,34,35,38,39,41,43,44,46,49–53]. Table 1 provides a summary of factors found to be significantly associated or not associated with knowledge of emergency numbers [11,13,15,19,20,24,27,28,30,34,35,38,39,41,43,44,46,49–53].

Table 1.

Relationship of subject characteristics with knowledge of EMS phone numbers

Nine studies (18.8%), alongside reporting baseline knowledge of emergency numbers, examined the effects of different interventions aimed at improving participants’ knowledge and emergency response skills [10,14,16,28,32,34,37,55,56]. The proposed educational interventions, including instructor-led first aid and/or basic life support training for preschool and school children [14,34,37,56], implementation of general healthcare practice-improvement plans based on information services [16], a single physician’s advice for adults about correct emergency phone numbers [28], distribution of first aid awareness materials via email among students of health science colleges [32], and use of an educational mobile application for children [55], led to a significant increase in knowledge of EMS phone numbers. In the only interventional study that did not reveal a significant improvement in knowledge, the baseline (pre-intervention) percentage of subjects who knew the emergency number was as high as 97.8% [10].

The majority of articles (34 studies, 70.8%) contained authors’ recommendations regarding how to enhance people’s knowledge of emergency phone numbers [12,13,17,18,20–23,26–28,30,31,33–36,38,40–44,46–55,57]. These included the suggestion to implement targeted or community-wide educational interventions (in particular, mandatory training) and public awareness campaigns about how to access EMS, as well as to institute and promote a unified national or international emergency number.

DISCUSSION

To the best of the author’s knowledge, this review represents the first attempt to summarize and systematically map cumulative evidence from studies that examined public knowledge of emergency phone numbers and factors associated with this knowledge.

The percentage of people who knew emergency phone numbers varied significantly across the reviewed studies. In part, this can be explained by actual differences in public knowledge between different countries and regions, where high-income countries showed approximately two times greater community awareness of emergency numbers than countries with low or middle income. However, the reviewed research demonstrated substantial methodological heterogeneity. Different study designs, populations, sample sizes, geographic levels, and methods of data collection have undoubtedly affected the reported results. This suggests the need for developing uniform Utstein-style guidelines on the methodology of research and reporting of public awareness about how to respond to health emergencies in order to reduce possible bias associated with inconsistent research techniques and outcome measures.

Notwithstanding the acknowledged methodological differences, the reviewed studies detected alarmingly low community knowledge of emergency phone numbers and imply that this problem has a global scale. Based on the aggregate published data, approximately 3 out of 10 people in high-income countries and 6 out of 10 people in the low- and middle-income countries would be unable to call EMS because they do not know what number to dial. Even though several studies showed a relatively high percentage of people who knew what number to call in an emergency (sometimes exceeding 95% [10,52]), the non-absolute community awareness of how to phone EMS indicates the high probability of loss of life because of the bystanders’ failure to activate an emergency response in time-dependent health crises. Furthermore, reporting the correct emergency phone number as part of a survey does not confirm the respondent’s ability to call EMS in a real-life emergency [21]. As demonstrated by Maes et al. [29], whereas 54.1% of study participants reported the correct emergency response number when completing a baseline questionnaire, only 28.2% dialed the correct number in a simulated scenario of sudden cardiac arrest.

Studies that attempted to examine factors associated with public awareness of emergency phone numbers have demonstrated contradictory results. For instance, although most research showed that subject age and gender are not associated with knowledge of EMS numbers, several studies observed an association with different age and gender attributes of the participants. This suggests that determinants of community awareness of emergency phone numbers may have country- and region-specific patterns. Hence, detailed investigation of multiple factors is advisable for future studies, as the results may guide the development of targeted interventions to improve community preparedness for emergency response [7].

Four studies assessed the association of knowledge of emergency numbers with previous first aid or cardiopulmonary resuscitation training, and a positive relationship was identified in all instances. This can partly explain the considerably lower awareness of emergency phone numbers among populations from low- and middle-income countries where the availability of community training on life-saving principles and techniques is much lower than in the developed world [59]. Other major contributors to low public knowledge of emergency phone numbers in developing countries could be poor availability of EMS (including lack of a country-wide organized EMS system, decentralized EMS, insufficient EMS resources, and fee-based EMS), lack of community awareness of the need and purpose for EMS, and cultural issues (e.g., people’s belief and use of traditional healing methods) [31,46,60,61]. It is worthy of note that studies that reported the lowest percentage of subjects who knew emergency numbers, namely 3.4% in Accra (Ghana) [31], 3.0% in Baghdad (Iraq) [22], and 0% in Libreville (Gabon) [23], were surveys conducted in capital cities of middle-income countries where organized EMS systems with universal emergency phone numbers were made available to the public before the studies’ commencement. This indicates the importance of accompanying the establishment and development of new EMS systems with large-scale information campaigns to enhance community awareness of the offered services, their benefits, and the optimal ways to access EMS.

Whereas international guidelines acknowledge the essential role of early activation of EMS as part of bystander response to life-threatening emergencies [1,2], the focus of the professional community on the problem of insufficient public awareness of emergency phone numbers is generally low. The current review found that for most countries of the world, there is a lack of information on the extent of public knowledge of emergency numbers. The absence of this information could be a major limitation to system-level optimization of prehospital management for time‐dependent medical events, as the integrity of the first (early access) link in the chain of survival is essential to the activation and viability of the whole sequence of care. High-quality national- and regional-level studies on the current topic seek to meet the needs of governments, public health, and EMS stakeholders. Beyond the paucity of research evaluating existing knowledge of emergency numbers and associated factors, few studies to date have explored the development and evaluation of methods to improve laypeople’s ability to access EMS. A call to action from authoritative international stakeholders is necessary, with a focus on recognizing and emphasizing the research gap, incorporating this issue into international research agendas, and potentiating research aimed at exploring the best practices, methods, and tools for enhancing public awareness of EMS access. Considering the profound vulnerability of populations in the developing world, optimal research, education and awareness strategies tailored to low-resource settings is a priority area, along with the establishment and improvement of publicly accessible organized EMS systems in low- and middle-income countries. To avoid unreasonable overutilization of EMS, education and awareness campaigns should also inform the community of how to identify a health problem as an emergency case and when it is appropriate to activate EMS.

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