You have to use Medical Guardian's subscription monitoring service. They will in turn call the people/entities (including 911) on your customized call list. But the initial call always goes to the call center. There are, however, systems available on Amazon that will send the notifications directly to you (or whoever you designate) and do not require a monthly subscription. When you search on Amazon, just look for medical alert systems that say something like "no monthly fees." Some will only contact one person or only 911; others will sequentially call several people. Because of unsatisfactory pre-purchase customer service from Medical Guardian (both here on Amazon and directly from the company), we're now looking into self-monitored systems ourselves. Those systems cost about the same as about 8 months of many subscription services with comparable features. So in addition to avoiding a call center, they might also save us some big bucks over time.