Handling emergency calls overload; the 112 Response Services during the COVID-19 pandemic in Liguria, Italy

The COVID-19 pandemic severely disrupted healthcare systems worldwide, generating widespread public concern. During the early stages, the European Emergency Number 112 – a standardized hotline providing access to emergency services across EU countries – faced an unprecedented surge of calls as citizens sought guidance. This study advances the hypothesis that emergency calls generate a form of collective intelligence, capturing real-time patterns in population behavior and healthcare system stress, thereby providing empirical evidence to inform policy and operational responses during public health crises. Focusing on the 112 Response Services in Liguria, Italy, during March 2020, the research investigates operational challenges and addresses four key questions: (1) How did the surge in calls affect operational efficiency? (2) How did rising COVID-19 cases and national containment measures influence call volumes? (3) Which factors primarily drove systemic overload in the emergency communication network? (4) Which strategies were implemented to mitigate challenges in emergency communication and response? Employing a mixed-methods approach, the study combines quantitative analysis of call volumes, call types, and COVID-19 data with qualitative analysis of government decrees and interviews with 112 regional managers. Findings indicate that, beyond managing medical emergencies, 112 Response Services played a pivotal role in addressing public uncertainty regarding governmental measures. A substantial portion of calls were non-urgent informational inquiries, contributing to system overload. In response, managers implemented adaptive strategies that effectively preserved service quality, offering valuable insights for managing future crises. These results underscore the critical role of citizen-reported data within healthcare systems. By delivering near real-time insights into public concerns, 112 Response Services support evidence-based decision-making, thereby guiding the development of more resilient crisis management strategies for future public health emergencies.