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The 118 out of hospital (OOH) emergency service guarantees assistance on the whole National Italian land by providing adequate interventions in every health emergency event, either to single people or in the setting of multiple emergencies.  This assistance is ensured24 hr/day throughout the year.  The most adequate equipes and rescue means are provided on the spot.  

Since 2011 the Lombardy OOH EMS has gone through several changes especially when the Regional government deliberated the Council Resolution n. 1964 (6th July 2011) with the goal of improving the rescue activity via an entire re-organization of the whole Emergency Regional Service. 

The main steps of this renewal consist of:

  • A new design of the technological infrastructure to provide an improved technology to support data transmission in real time by favoring at the same time communications among all Dispatch Centers distributed on the Regional Land.
  • Re-organization of the 12 Operative Dispatch Centers.
  • An increased number of the rescue vehicles together with a more effective location of these means on the territory.
  • An enhancement of the relationships with agencies, volunteer associations, Social cooperatives to re-define the training programs. 

AREU has fully accepted the Regional proposals by creating those changes in the EMS which in the updated version will consist in:

  • A flexible and dynamic CEO staff.
  • 12 Joint Territorial Systems (JTS) distributed on the regional territory covering approximately the provincial area of competence.  These JTS have the role of coordinating all emergency vehicles operating on their land, the crews and locations of the rescue vehicles.
  • 4 Regional Emergency Service Operative Centers  covering larger than provincial-based territories.  These are linked together by two large centralized servers, one of these acting as a backup in case of crash or system failure
  • 4 “functional” units called Macro Areas identified with the territory where the main Dispatch Centers and the corresponding JTS are located.

The peculiarity of AREU’s EMS is the capability to involve every rescue Agency, Association and Social Cooperative that make available personnel, rescue means and equipment in order to provide the Basic Rescue Service. 

Under the practical point of view, the rescue activity is performed by:

  • Physician, nurses and technicians provided by the local Hospital Companies of the Health Regional Service as defined by specific agreements between AREU, Hospital Companies, Scientific Institutions, and Local Health Services.

  • Volunteers and employees belonging to rescue Agencies, Associations and Social Cooperatives who provide their aid as either rescue volunteers or drivers.


 Land and Rescue means

The Head Office analyzes the whole activity of the OOH EMS (amount of interventions, quality of the services provided, reasons of EMS requests such as medical interventions, road accidents, violence, etc).  Severity codes are also taken into account as well as the hospital destinations where the patients are transported.  By these analyses it is thus possible to monitor the whole activity and to improve the service with the most appropriate changes of the organization (like for instance location and/or number of the rescue vehicles).

The estimated goal is a growing flexibility of the land vehicles which are thus moved by the Operative Centers in a dynamic way such as to provide more rapid and homogeneous interventions on the territory.

Personnel and organization

AREU pays attention to:

  • The training development of the path for rescue team
  • To standardize all kind of behaviors under the organization and of the management point of view. 

Great attentions is paid to training and scientific upgrade which are of paramount importance to the development and growth of the personnel working within the system.  This increases the performances and the personnel motivation.  To this purpose the training covers a strategic part of the organization for which important financial resources are dedicated.   



AREU technological infrastructure is designed taking into account the specific peculiarities of the activity.  It guarantees the changes necessary to the process modernization and allows the necessary flexibility when continuous changes are ongoing.

  • The technological features of the infrastructure are:
  • Availability of all communication on the regional land;
  • Easy and quick accessibility to the technology for every operator;
  • Homogeneity of the available technological instruments to guarantee the best interventions
  • Technology reliability and adequate resilience for a proper "business continuity";
  • Continuous innovation such as to be rapidly updated when innovation are upcoming.