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USA release new resuscitation guidelines

Both the European Resuscitation Council (ERC) and the American Heart Association (AHA) have this month released the 2015 International Resuscitation Guidelines. In December the Australian Resuscitation Council (ARC) will release theirs.

The Europeans and Americans have ensured that simplicity is the key issue, which is evident when one reads the AHA summary below.

It will be interesting to see if the ARC guidelines continue with its laboured and confusing ‘DRSABCD’ algorithm, instead of taking a fresh and simple approach to delivering basic CPR.

Here are some of the AHA recommendations:

Adult Basic Life Support and CPR Quality: Lay Rescuer CPR

Summary of Key Issues and Major Changes

Key issues and major changes in the 2015 Guidelines Update recommendations for adult CPR by lay rescuers include the following:

The crucial links in the out-of-hospital adult Chain of Survival are unchanged from 2010, with continued emphasis on the simplified universal Adult Basic Life Support (BLS) Algorithm.
The Adult BLS Algorithm has been modified to reflect the fact that rescuers can activate an emergency response (ie, through use of a mobile telephone) without leaving the victim’s side.
It is recommended that communities with people at risk for cardiac arrest implement PAD programs.
Recommendations have been strengthened to encourage immediate recognition of unresponsiveness, activation of the emergency response system, and initiation of CPR if the lay rescuer finds an unresponsive victim is not breathing or not breathing normally (eg, gasping).
Emphasis has been increased about the rapid identification of potential cardiac arrest by dispatchers, with immediate provision of CPR instructions to the caller (i.e., dispatch-guided CPR).
The recommended sequence for a single rescuer has been confirmed: the single rescuer is to initiate chest compressions before giving rescue breaths (C-A-B rather than A-B-C) to reduce delay to first compression. The single rescuer should begin CPR with 30 chest compressions followed by 2 breaths.
There is continued emphasis on the characteristics of high-quality CPR: compressing the chest at an adequate rate and depth, allowing complete chest recoil after each compression, minimizing interruptions in compressions, and avoiding excessive ventilation.
The recommended chest compression rate is 100 to 120/min (updated from at least 100/min).
The clarified recommendation for chest compression depth for adults is at least 2 inches (5 cm) but not greater than 2.4 inches (6 cm).
Bystander-administered naloxone may be considered for suspected life-threatening opioid-associated emergencies.

Dispatcher Identification of Agonal Gasps

Cardiac arrest victims sometimes present with seizure-like activity or agonal gasps that can confuse potential rescuers. Dispatchers should be specifically trained to identify these presentations of cardiac arrest to enable prompt recognition and immediate dispatcher-guided CPR. To help bystanders recognize cardiac arrest, dispatchers should inquire about a victim’s absence of responsiveness and quality of breathing (normal versus not normal). If the victim is unresponsive with absent or abnormal breathing, the rescuer and the dispatcher should assume that the victim is in cardiac arrest. Dispatchers should be educated to identify unresponsiveness with abnormal and agonal gasps across a range of clinical presentations and descriptions.

Emphasis on Chest Compressions*

Untrained lay rescuers should provide compression-only (Hands-Only) CPR, with or without dispatcher guidance, for adult victims of cardiac arrest. The rescuer should continue compression-only CPR until the arrival of an AED or rescuers with additional training. All lay rescuers should, at a minimum, provide chest compressions for victims of cardiac arrest. In addition, if the trained lay rescuer is able to perform rescue breaths, he or she should add rescue breaths in a ratio of 30 compressions to 2 breaths. The rescuer should continue CPR until an AED arrives and is ready for use, EMS providers take over care of the victim, or the victim starts to move.

Chest Compression Rate*

2015 (Updated): In adult victims of cardiac arrest, it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120/min. The number of chest compressions delivered per minute during CPR is an important determinant of return of spontaneous circulation (ROSC) and survival with good neurologic function. The actual number of chest compressions delivered per minute, is determined by the rate of chest compressions and the number and duration of interruptions in compressions (eg, to open the airway, deliver rescue breaths, allow AED analysis). In most studies, more compressions are associated with higher survival rates, and fewer compressions are associated with lower survival rates. Provision of adequate chest compressions requires an emphasis not only on an adequate compression rate but also on minimizing interruptions to this critical component of CPR. An inadequate compression rate or frequent interruptions (or both) will reduce the total number of compressions delivered per minute. New to the 2015 Guidelines Update are upper limits of recommended compression rate and compression depth, based on preliminary data suggesting that excessive compression rate and depth adversely affect outcomes. The addition of an upper limit of compression rate is based on 1 large registry study analysis associating extremely rapid compression rates (greater than 140/min) with inadequate compression depth. Box 1 uses the analogy of automobile travel to explain the effect of compression rate and interruptions on total number of compressions delivered during resuscitation.

Chest Compression Depth*

During manual CPR, rescuers should perform chest compressions to a depth of at least 5cm for an average adult, while avoiding excessive chest compression depths (greater than 6 cm). Compressions create blood flow primarily by increasing intrathoracic pressure and directly compressing the heart, which in turn results in critical blood flow and oxygen delivery to the heart and brain. Rescuers often do not compress the chest deeply enough despite the recommendation to “push hard.” While a compression depth of at least 2 inches (5 cm) is recommended, the 2015 Guidelines Update incorporates new evidence about the potential for an upper threshold of compression depth (greater than 2.4 inches [6 cm]), beyond which complications may occur. Compression depth may be difficult to judge without use of feedback devices, and identification of upper limits of compression depth may be challenging. It is important for rescuers to know that the recommendation about the upper limit of compression depth is based on one very small study that reported an association between excessive compression depth and injuries that were not life threatening. Most monitoring via CPR feedback devices suggests that compressions are more often too shallow than they are too deep.

Bystander Naloxone in Opioid-Associated Life Threatening Emergencies*

For patients with known or suspected opioid addiction who are unresponsive with no normal breathing but a pulse, it is reasonable for appropriately trained lay rescuers and BLS providers, in addition to providing standard BLS care, to administer intramuscular (IM) or intranasal (IN) naloxone. Opioid overdose response education with or without naloxone distribution to persons at risk for opioid overdose in any setting may be considered. This topic is also addressed in the Special Circumstances of Resuscitation section. There is substantial epidemiologic data demonstrating the large burden of disease from lethal opioid overdoses, as well as some documented success in targeted national strategies for bystander-administered naloxone for people at risk. In 2014, the naloxone auto injector was approved by the US Food and Drug Administration for use by lay rescuers and HCPs. The resuscitation training network has requested information about the best way to incorporate such a device into the adult BLS guidelines and training. This recommendation incorporates the newly approved treatment.

Australia urged to take resuscitation seriously

Australia urged to take resuscitation seriously

This article was originally published on 22 January 2013. Please note that Professor Jacobs, mentioned in this article, passed away earlier this year.

Australian Doctor follows one emergency doctor's campaign to tackle the country's 'appalling' record on resuscitation.

It's been 23 years since Kerry Packer famously ‘returned from the dead'.

The six minutes he spent pulseless on a Sydney polo field in 1990, following a cardiac arrest, became a defining moment in the media mogul's life after paramedics resuscitated him using a defibrillator — a rarity in ambulances at the time.

Packer later told journalist Ray Martin he had seen the other side and there was "nothing" there — no heaven and no hell. The experience moved him to donate thousands of dollars to fit out every NSW ambulance with defibrillators, so other lives could be saved.

Eight years after his death in 2005, Packer's legacy lives on, with defibrillators still fondly known by many as ‘Packer-whackers'.

But it's become clear that his near-death experience represented the high point of Australia's interest in defibrillation and resuscitation. National dialogue has dwindled ever since, with precious little government funding or leadership.

One man who hopes to reverse that decline is Paul Middleton, an emergency physician at Sydney's Manly Hospital who chairs the NSW branch of the Australian Resuscitation Council.

"People need to push things for them to be on the radar. And cardiac arrest is something that gets lost, really," says Associate Professor Middleton.

"Notionally, people know it's something that can happen to almost anybody. They all watch ER and those programs about the RPA [Royal Prince Alfred Hospital] and The Alfred in Melbourne, and they think ‘It's never going to be me'. But the problem is it’s going to be you, or somebody like you, or somebody next to you.”

Black Hole

Roughly 30,000 Australians are thought to experience a cardiac arrest each year, 8% of whom survive.

About 30-35% of cardiac arrests are due to ventricular fibrillation, and therefore shockable when first encountered by medical staff. Survival rates are better in this group, at 20-25%, but still far short of what can be achieved when CPR and defibrillation are given rapidly.

Have a VF arrest in the Melbourne Cricket Ground, for example, and you have a 71% chance of surviving. Airports and casinos are also good places to arrest: Chicago O'Hare has reported 75% survival from VF arrests, and Las Vegas casinos 53%.

Professor Middleton says these successes could be replicated on a bigger scale, with the appropriate funding, implementation and leadership.

He describes Australia's survival rate as "appalling", particularly since more than half of cardiac arrests occur in front of other people. CPR is only attempted in one-third of cases.

NSW in particular has become a "black hole" for cardiac arrest, he says; there is no directory of automated external defibrillators, no statewide CPR training program and no centralised collection of data to inform practice.

The only proper estimate to date of Sydney's survival rates, published in 2006, found just 14% of patients survived a week after cardiac arrest and 11.5% survived a year. Professor Middleton is working on a new study that suggests overall survival has declined since then, although the reasons for this are unclear.

Having attended some 500 out-of-hospital cardiac arrests in his 20-year career, arriving "almost always too late", he believes a concerted, system-wide drive is needed to ensure effective CPR and defibrillation are given quicker in the community.

He estimates 90% of the arrests he has attended were fatal, with the window for intervention often missed as family members or bystanders watched on, helpless.

"We can improve all we want in hospitals, but we'll still have 10% survival and 90% death rates until we realise that it's not in my hands — it's in the hands of the bloke's wife standing next to him,” Professor Middleton says.

"I've been to endless scenes where there's so much that could have been done with minimal amounts of training. People often say they thought about doing CPR but didn't, because they thought they would be causing harm. Okay, occasionally you can break a rib, but isn't it better to have a broken rib and be alive than have an intact chest and be dead?"

CPR is now easier than ever to perform, he adds, with mouth-to-mouth no longer considered mandatory. Guidelines still recommend it where possible, but have acknowledged since 2010 that continuous, compression-only CPR is a viable alternative to traditional CPR. Indeed some studies have suggested it might even be superior.

Chain of survival

It's a different mood over in Victoria, which continues to lead the way for cardiac arrest care in Australia. Statewide, 30% of people survive to hospital discharge after an out-of-hospital ventricular tachycardia/ventricular fibrillation arrest and 11% after any cardiac arrest.

Associate Professor Tony Walker, a paramedic and Ambulance Victoria's general manager of regional services, says these outcomes are the best in the country and in the top 5% worldwide. This success reflects a concerted effort to shape the entire emergency response system around the "chain of survival", ensuring that every link is as fast and effective as possible, he says.

"The ambulance service across the country is fantastic but the difference is that we've really focused on cardiac arrest, and we do a lot of clinical research to inform improvement. We measure it, and we're all held accountable for those measures."

Community recognition of cardiac arrest has been raised in Victoria through the 4 Steps for Life program, which has taught about one million people to recognise cardiac arrest, call triple-0 and perform CPR. The program has just launched iPhone and iPad apps to guide bystanders through the process.

Ambulance Victoria has meanwhile reshuffled its dispatch systems to ensure suspected cardiac arrests are assigned the highest priority. It also harnesses other emergency services; in Melbourne, firefighters carry defibrillators and oxygen, are fully trained in CPR and can be dispatched to calls if they are closer than an ambulance. This program is being piloted across the state.

In rural areas, survival rates from VT/VF arrest have risen dramatically since 2008 when the Metropolitan Ambulance Service, Rural Ambulance Victoria and the Alexandra District Ambulance Service merged into a single provider, enabling them to harmonise their systems. Forty-two per cent of rural patients now survive to hospital and 17% to discharge, up from 23% and 7%, respectively, in 2007.

Crucially, Victoria is also home to Australia's largest cardiac arrest registry, which has now captured data on 60,000 cases, Professor Walker says.

Community pride

Internationally, Australia's survival rates from cardiac arrest are "middle of the road". "We're not lagging behind but we've got capacity to improve substantially," says Ian Jacobs, professor of resuscitation and pre-hospital care at the University of WA and chair of the national Australian Resuscitation Council.

The global benchmark is Seattle, with survival rates from VF cardiac arrest as high as 40%.

"They have a wide community education program, and there's a lot of pride in being the world's best place to have a cardiac arrest. They also have very sophisticated response systems ... and a very aggressive approach to resuscitation care."

The whole-of-community approach is also being ramped up in WA, where a St John Ambulance-led program has provided automated external defibrillators, community education and first aid courses to about 150 small towns across the state, says Professor Jacobs, who is also clinical services director at St John Ambulance, WA.

The program has also trained up about 300 ‘first responders' — designated members of the public who are dispatched to nearby cardiac arrests.

"The community is the ultimate coronary care unit. If you've got a trained community that can do CPR and shock, that's [as good as] a first responder program."

A new direction to take

Similar community-focused projects exist in other Australian states, to varying degrees, he adds.

As well as raising public awareness, Australia will need to address its lack of automated external defibrillator directories if it is to boost cardiac arrest survival.

The devices are thought to be commonplace, particularly in shopping centres and sports clubs, but they're as good as useless if they can't be found and used within minutes.

Ambulance Victoria runs a directory that allows triple-0 operators to tell callers if there is a defibrillator on site they can use. It has around 1000 defibrillators registered but even this is incomplete, since the system depends on owners to be proactive and log their defibrillators.

Outside Victoria, Professor Jacobs says he has "no clue whatsoever" how many devices are in Australia, or where to find them. He has, however, been freshly inspired by a recent ‘crowd sourcing' project in Philadelphia, which made a public competition out of finding and photographing automated external defibrillators.

"I don't see why we couldn't do that here," says Professor Jacobs. "It's an excellent way of getting the information."

Winning hearts and minds

Back in Sydney, Professor Middleton is gearing up for a publicity offensive to finally get resuscitation back on the agenda.

The Australian Resuscitation Council NSW, a voluntary, not-for-profit group that has traditionally focused on training health professionals, is now financially and structurally ready to step up its public profile and attempt to influence policy, he says.

Several organisations, including St John Ambulance and the Red Cross, run basic life support and CPR training courses, but what's truly needed is a statewide, government-sponsored program, Professor Middleton says.

He also wants serious financial commitment to public access defibrillation programs in regional towns and cities as well as Sydney. There has recently been some good news on this front, with the Red Cross launching a new national initiative called Project Defib, to subsidise defibrillators in sports clubs.

Nationally, there is also fresh optimism in the form of a recent $2.5 million, five-year NHMRC grant — the first serious injection of federal funds into out-of-hospital cardiac arrest research for years. The money has been used to establish Aus-ROC, the Australian Resuscitation Outcomes Consortium, which has brought together several experts to conduct multicentre clinical trials, examine existing systems and build capacity.

Aus-ROC also plans to join existing cardiac arrest registries in Victoria, SA and WA into one super-registry, which could turn Australia into a world leader for resuscitation research.

"It's getting some momentum. This is the first real effort to get out-of-hospital cardiac arrest onto the research agenda and to be able to inform policy and practice," says Professor Jacobs, an Aus-ROC chief investigator.

Professor Middleton says he is "under no illusions" that it will be quick or easy to get Australians fully engaged with resuscitation.

"All we've ever had is that single, high-profile event," he says of Packer's cardiac arrest. "But it needs to be a whole public health campaign. We've got 23 million people in Australia — a big chunk of them will die of a cardiac arrest, and at government level there's very little being done."

Continuous chest compressions as effective as standard CPR

Resuscitation Outcomes Consortium study of out-of-hospital cardiac arrest found little difference in neurologically intact survival

BIRMINGHAM, Ala. – Continuous chest compression, touted as the new way to perform cardiopulmonary resuscitation, was not an improvement over standard CPR, according to findings published in the New England Journal of Medicine Nov. 9.

Eight U.S. and Canadian universities were involved the Resuscitation Outcomes Consortium (ROC) study, which was the largest ever conducted on out-of-hospital cardiac arrest.

The study looked at more than 23,000 adults with out-of-hospital cardiac arrest, for whom EMS crews responded. Those patients were randomized in the eight participating communities to either standard CPR or continuous chest compression.

Standard CPR is 30 chest compressions with a pause for two ventilations, or breaths. Continuous chest compression (CCC) CPR is uninterrupted chest compressions with one ventilation every 10 compressions without pausing compressions while ventilating the patient.

"We did not see any significant difference in neurologically intact survival to hospital discharge between patients receiving standard 30:2 CPR compared to those receiving CCC," said Henry Wang, study co-author and professor in the University of Alabama at Birmingham (UAB) Department of Emergency Medicine. "The neurologically intact survival rate for patients receiving 30:2 CPR was 7.7 percent, against 7 percent for those receiving CCC."

The neurologically intact standard means that, upon discharge from the hospital, a patient has no significant cognitive deficit and can return to near-normal function.

"There have been some smaller-scale studies that suggest CCC was as effective or perhaps more effective than 30:2; but until now, that had never been tested in a full-scale, randomized clinical trial," Wang said. "The current results indicate that 30:2 and CCC are equally effective. Further evaluation of the role of ventilation in CPR is warranted."

Wang says that, over the past 10 years, CCC has been suggested as an easier and safer way for an individual to perform CPR.

"In the absence of differences in patient outcomes between the two CPR strategies, the study’s conclusion is that EMS practitioners and their medical directors should decide on an individual basis if they will perform 30:2 or continuous chest compressions," said Shannon Stephens, an instructor in the UAB Department of Emergency Medicine and a study co-author.

The ROC CCC trial, which began in June 2011 and ran through May 2015, was carried out in Birmingham; British Columbia; Dallas; King County, Washington; Milwaukee; Ottawa, Ontario; Toronto and Pittsburgh.

Editor’s Note: First Response Australia (FRA) plans to launch a local community based program to encourage all citizens to understand the benefits of ‘Compression only CPR’. The program will be called ‘CPR tips without the lips’. FRA will be looking to local government and businesses to support the campaign to get the message out to the community. The campaign will include, distribution of posters and wallet cue cards along with public demonstration.

Unfortunately, since the arrival of ‘accredited ‘ training requirements, the standard of CPR training has declined dramatically and the message of simplicity regarding CPR has been lost.

Charles Makray

Medic saves shark attack victim with a boogie board string

Vacationing medic Marie Hildreth used a boogie board string as a tourniquet for the 12-year-old’s arm, and a string from a beach tent to stop the bleeding on her leg.

OAK ISLAND, N.C. — Vacationing Charlotte resident and paramedic Marie Hildreth was throwing a football with family members in the Oak Island surf Sunday when someone ran down the beach yelling to get out of the water because of a shark attack.

"At first I was like, 'Whatever, a shark attack here?' " Hildreth said. Even when a crowd gathered around the victim, Hildreth's first thought was that the attack could just be lacerations and cuts like the attack on a girl reported Thursday at Ocean Isle Beach.

MEDIC SAVE VICTIM WITH BOOGIE BOARD STRING

"But then when I got there and saw how severe the wounds were, muscle memory just kicked in and I went to work like I normally do," Hildreth said

Hildreth created makeshift tourniquets for 12-year-old shark attack victim Kiersten Yow of Archdale, who had part of her left arm bitten off and injuries to a leg.

After she identified herself as a paramedic, she said, she worked with the victim's parents and other law enforcement and fire officials who arrived. Hildreth grabbed a boogie board string and used it as a tourniquet for Yow's arm. Another bystander grabbed a string from a beach tent, which Hildreth used to stop the bleeding on the victim's leg.

In a news release, New Hanover Regional Medical Center said Kiersten lost her arm below the elbow after the shark attack and suffered tissue damage to her leg. She was transferred to another hospital Monday for treatment after surgery at NHRMC.

Hospital and town officials credited Hildreth and other first responders with helping to save the lives of Kiersten and Hunter Treschl, 16, of Colorado Springs, Colo., the victim of a second shark attack minutes later and 2 miles away. Hunter is in New Hanover Regional Medical Center after surgery to repair his amputated arm.

Hildreth can be seen in news photos helping after the first attack, with a boogie board just above Kiersten's head. Those photos, which have circulated across the world via The Associated Press, were taken by vacationer Steve Bouser, an editor at The Pilot newspaper in Southern Pines. According to the Shelby Star, Bouser and his wife described a normal beach scene that quickly turned into pandemonium.

Brenda Bouser told the Shelby Star the real heroes were those bystanders who took quick action.

"I'm not sure if it was her dad that brought her on the beach, but three young men and one woman swooped in and took over," Bouser said.

Then, describing Hildreth, Bouser said a woman who had a medical background was "barking orders for a makeshift tourniquet."

Steve Bouser began taking photos and documenting the quick action of the bystanders, the emergency responder's arrival and departure with Yow.

Hildreth, who has family on Oak Island and loves to visit, said the shark attacks will not keep her from coming back to Oak Island in the future.

“But I am just going to stay ankle-deep in the water this week," she said.

Source: McClatchy-Tribune News Service

Editor’s Note: Australia has recently seen and increase in shark attacks.

Unfortunately, in many instances, lay responders attempting the assist the victims are confronted with quite a complex situation that basic first aid training does not equip the rescue with the skills to deal with such events.

It’s time that the likes of lifesavers and other responders, who may often be the first responders in such situations are equipped with skills and knowledge that may save the victims of shark attack.

Responders need to be equipped with commercial tourniquets, specialised haemostatic clotting agents to immediately control severe external haemorrhage , along with ‘Impedance Threshold Devices’ to help maintain blood pressure, which dramatically drops when such amounts of blood is lost.

These skills and use of specialised equipped are easily taught to lay rescuers, but because they are not mainstream subjects taught in First Aid, they are either not even considered for these circumstances, or sadly they are not even known about.

Charles Makray

Are there alternatives to Emergency Triple Zero (000)?

Australia’s primary emergency call service number is Triple Zero (000), which can be dialled from any fixed or mobile phone, pay phones and certain Voice over Internet Protocol (VoIP) services.

There are also two secondary emergency call service numbers - 112 and 106.

112 is available from all GSM or GSM derived mobile phones. 106 connects to the text-based relay service for people who have a hearing or speech impairment. All calls to the emergency numbers, whether from fixed, mobile, pay phones or VoIP services are free-of-charge.

The Australian Communications and Media Authority (ACMA) has produced a webpage of frequently asked questions on the Emergency Call Service.

For more information on the 106 Text Emergency Relay Service, Triple Zero (000) by internet relay and Triple Zero (000) by Speak and Listen, go to the National Relay Service website.

106 - Text Emergency Relay Service

If you have a hearing or speech impairment and your life or property is in danger, you can contact police, fire or ambulance on 106 directly through a TTY (also known as a teletypewriter or text phone). It is not possible to contact emergency services using the Short Message Service (SMS) on your mobile telephone.

The Australian 106 Text Emergency Relay Service is provided as part of the National Relay Service (NRS). The service is available 24 hours a day, 365 days a year and calls made using the 106 service are given priority over other NRS calls.

Using the 106 Text Emergency Relay Service

Dial 106, which is a toll-free number you will be asked if you want police (type PPP), fire (FFF) or ambulance (type AAA). Note Speak and Listen (or voice carry over) users just need to say 'police', 'fire' or 'ambulance' to the relay officer.

The relay officer will dial the correct service and stay on the line to relay your conversation.

As a TTY is connected to a fixed line, the emergency service can locate where you are calling from - You will be asked to confirm your address.

The 106 service can only be dialled from a TTY, it cannot be used by:

- An ordinary phone
- text message (SMS) on a mobile phone, or internet relay.

If you have further questions you can contact the National Relay Service Help Desk (Monday to Friday 9am to 5pm AEST)

When calling from a mobile telephone

Triple Zero (000) is Australia's primary telephone number to call for assistance in life threatening or time critical emergency situations.

To find out more about calling Triple Zero (000) from a mobile telephone, visit the Australian Communications and Media Authority website.

112 - International standard emergency number

Triple Zero (000) is Australia's primary telephone number to call for assistance in life threatening or time critical emergency situations. Dialling 112 directs you to the same Triple Zero (000) call service and does not give your call priority over Triple Zero (000).

112 is an international standard emergency number which can only be dialled on a digital mobile phone. It is accepted as a secondary international emergency number in some parts of the world, including Australia, and can be dialled in areas of GSM network coverage with the call automatically translated to that country’s emergency number. It does not require a simcard or pin number to make the call, however phone coverage must be available (any carrier) for the call to proceed.

There is no advantage to dialling 112 over Triple Zero (000). Calls to 112 do not go to the head of the queue for emergency services, and it is not true that it is the only number that will work on a mobile phone.

Dialling 112 from a fixed line telephone in Australia (including payphones) will not connect you to the emergency call service as it is only available from digital mobile phones.

Voice over Internet Protocol

Voice over Internet Protocol (VoIP) is a technology that allows telephone calls to be made over broadband Internet connections. Some VoIP providers may not provide access to emergency calls, so check with your VoIP provider if you require the emergency call service.

For information about using Voice over Internet Protocol (VoIP) visit the Communications Alliance website.

For more information on the key issues to consider before changing to VoIP is available on the Australian Communications and Media Authority website.

State and territory emergency service organisations

Within Australia, the protection of life and property is the responsibility of state and territory governments. A number of Emergency Services Organisations (ESO) provide their own information on what to do in an emergency.

For more information, visit the state and territory emergency services organisations page.

911

911 is the emergency telephone number used in other countries such as the United States and Canada. This number should not be used in an emergency in Australia. If dialled within Australia, this number will not re-route emergency calls to Triple Zero (000).

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