This is an overly 'exaggerated' flowchart. Whilst there are many flaws with the 911 system, there are also several fallacies (though not universal):

STEP 2: <1% busy signal is a goal of and attained by a large number of PSAPs.

3: Many PSAPs have their dispatchers trained to the EMT level.

4 through 6 are happening concurrently, not as a single step flow.

6: Many PSAPs have a goal that the initial unit dispatch is within 60 seconds of call reception.

7: I've not seen a system yet that relies on ALS units punching an address manually into a TomTom. AVLS (automatic vehicle location system), and mobile data terminals pull the exact information that is entered into 911 (which whilst still prone to error, is an issue with Call9, too) and use GPS which is linked into maps + county GIS overlays.

8: Highly dependent on location. My county has an average 6min response time.

10: Most advanced procedures and medications are governed by offline medical control ("here's our protocol for using this drug / treatment. Indications, contraindications, dosing regime") - the goal is that the need to contact a physician is the exception, not the rule.

If the time taken for 'online medical control' is 14.9 minutes I'll be at the hospital already, because that's where definitive care happens. I, as a medic, am not going to wait on hold and have a leisurely chat with a physician for nearly quarter of an hour on scene. This is a gross distortion of reality. If I do need to call the ER doc, there will be one available, or the charge nurse will know that one needs to be found, now.

16a: at an SNF if we need access to medical records, we can get them. If a patient uses the same healthcare system, they're available at the hospital. Pretending like we're stabbing in the dark and shrugging our shoulders is devaluing the care that paramedics and EMTs do down to the 'ambulance driver' stereotype. Both are trained in patient assessment and history taking, even if not medically qualified to the same level as a physician. In 16b: In a non-critical situation AND there are insufficient resources, then triage is the most appropriate care situation. If you're non-emergent and there's capacity in the ED you're going to a bed.

17/18: As opposed to... what? Unless Call9 claims to be the sole definitive (and remote) care provided, there's going to be a transfer of knowledge.

Your example has it taking a quarter of an hour to get to the patient, an undefined amount of time treating, stabilizing and packaging the patient, supposedly before requiring an online sign-off and discussion with a physician lasting another quarter of an hour before finally loading the patient for another nearly quarter hour trip to the hospital, while some paramedic with no situational awareness gives a nurse a hand off to relay to the physician.

What really happens on scene in a cardiac arrest: BLS providers show up first, AED, CPR, bag patient, potentially with advanced airway, LMA, etc. ALS shows up, determines quickly whether to stabilize on scene or load-and-go, CPR still in progress. A call is made to the hospital, with no discussion with a physician, only the charge, giving pertinent information, and ETA.

"Code Blue, Ambulance, Bed A3, 4 minutes out."

RT, IV, pharmacy, imaging, are all ready. A team is ready to continue CPR. Physician is there. All staff with the exception of the physician move patient from gurney to bed, begin work, while physician gets information from ALS, and then begins directing the code.