Dutch Center Sets Pace For Achieving ACE

From the 21^st floor of the World Port Center in the hub of Rotterdam City—about 80 km (50 miles) south of Amsterdam—Emergency Dispatchers enjoy a magnificent view of the historical Dutch city, the second largest city in the Netherlands.

Like many European cities, Rotterdam has a fascinating story. WWII bombings destroyed much of the original architecture, but Rotterdam was able to rebuild. Now it’s known for its modern architecture, rich maritime history, and vibrant culture comprised of about 180 nationalities.

In the integrated dispatch center, two ambulance services work together: the ambulance service of Zuid-Holland Zuid (ZHZ) and the ambulance service of Rotterdam-Rijnmond (RR). ZHZ employs 19 nurses, seven Emergency Dispatchers, two team managers, and a nurse specialist at the dispatch center.

Managing resources
The integrated dispatch center receives fire, police, and medical requests (though fire and police are dispatched separately), answering about 200,000 medical calls annually (87,307 emergency calls) from a population of 1,660,000 in their service area of 1580 square km (610 square miles). ZHZ has a service area of 743 square km (287 square miles), including the regions of Drechtsteden, Hoeksche Waard, and Alblasserwaard.

“In our dispatch center, it’s not one call, one go,” said ZHZ Team Manager Richtje Kant. “If we had that system, we would probably need 200 ambulances for every shift. We don’t have that, so not every caller gets an ambulance.”

Part of their success is prioritizing with protocol. ZHZ Team Manager Nicole Van Lersel has been a driving force for ProQA^®, establishing ED-Q teams for call review and working to implement the Emergency Communication Nurse System^™ (ECNS^™).

ECNS is a tool that can more accurately connect patients in non-urgent situations to another, more suitable healthcare provider and prevent overuse of ambulance services. “It's important for all residents that ambulances are available when every second counts,” said ZHZ Nurse Specialist Peter de Kruijter.¹

For medical requests, the center relies on triage from their staff of highly trained nurses who can listen to the caller’s description and make reasonable recommendations for treatment, such as transferring to a general practitioner or other healthcare professional or sending a low-, medium-, or high-care ambulance, if necessary. Nurses may also arrange a meeting point for patients or send a doctor to make a house call.

Like many centers, ZHZ personnel handle many falls, unconscious patients, and reports of chest pain. Uniquely, they handle higher-than-average reports of biking accidents as biking is a key form of transportation.

“When we started with the MPDS^®, we submitted a Proposal for Change (PFC) request to add ‘bike vs. bike’ to Protocol 29 [Traffic Collision/Transportation Incident],” Kant said. “It seems we have more bicyclists than pedestrians here in the Netherlands. Sometimes you’ll see a mother with three children on a bike system—going to school, going to work, going everywhere.”

In like fashion, during special events in nearby cities, the ZHZ ambulance bike team springs into action with a nurse and driver mounted upon a special bike, dispatched to quickly navigate through crowds.

With the exception of patient transportation, bike personnel render medical aid at events such as the Dordrecht Christmas Market (held in the historic city center), Dordt in Stoom (a parade of steam ships, steam trains, and old-timer busses), King's Day (a national holiday marking the birth of King Willem-Alexander), the Gorinchem Summer Festivals (a multi-day musical event), sporting events, and horse markets.²

Encouraging growth
Over the past few years, the role of emergency medical services has been growing in the Netherlands from primarily focusing on patient transportation to establishing a unique position within healthcare. The ZHZ ambulance team now aids with providing social services and care for the elderly, reporting domestic violence and abuse, and handling command and control for large-scale incidents.³

As ambulance services expand, the dispatch center adapts to take on greater versatility, though pride and meaning in their work has never been lacking—a theme that unites their team.

“Our center is able to keep our personnel,” Kant said. “We have some dispatchers and nurses who have been here for over 20 years—having earned the nickname of ‘center dinosaurs’—and they’re staying put. They are professional; they work as a team and learn from each other, finding meaning in what they do.”

Working toward ACE
ZHZ’s ACE journey was fueled by striving for better service and impact. Since the center’s MPDS implementation in 2012, their compliance levels had always been high, but they didn’t realize they could be recognized for what they were already close to achieving.

In 2017, the ZHZ staff set their eyes on accreditation. Relying on five motivated ED-Q staff who evaluated calls, provided feedback, and created personalized training, the team began to flourish in meeting and exceeding standards with even greater success.

“When our manager outlined what was expected of each of us, it really motivated everyone,” Kant said. “Our dispatchers and nurses caught the fire and weren’t afraid to ask for feedback and how they can do better next time.”

The ZHZ staff functioned as a self-steering team, relying on one another for a common goal. “I’m so proud of the way we’ve each contributed to accomplish this together,” Kant said. By December 2017, they had secured their first Medical ACE.

In addition to professional training and teamwork, time was a key ingredient for accreditation. “It takes time to get used to the protocols, time to inspire a team, and time to put in the effort,” she said. “Leading with positivity can help alleviate some of the pressure, especially for those who struggle with adapting to new procedures or standards.”

At times, it’s necessary to help each team member understand that the protocol really can be trusted. “There are ‘nice to know’ and ‘need to know’ details, and we must realize that finer points take more time to inquire about without affecting the response,” Kant said.

ZHZ encourages their well-trained and educated staff to utilize and build upon their own backgrounds and experiences. A few times each year, Emergency Dispatchers and nurses can request a day to shadow other professionals as an informal internship. They can ride along in an ambulance, visit a hospital emergency room, or watch deliveries with an OB-GYN to understand a broader perspective of their own roles in preparing the patient for treatment in these scenarios.

Celebrating success
ZHZ achieved medical re-accreditation in June 2022 (delayed due to COVID) and announced the official recognition of their third re-accreditation to their staff in June 2025. They celebrated with cake and team photos after the summer holiday season ended so everyone could attend. RR also recently earned re-accreditation for the second time, showing their elite collaboration.

While achieving and maintaining ACE status through several years has become easier, it doesn’t make it less special. At the heart of these teams’ success is their hope to help the public.

“None of us chose this profession by chance,” said Director Dr. Hans JM Janssen. “A passion for providing acute care runs in our blood.”⁴

Sources
1. "Ambulance dispatch will more precisely match patients with an appropriate healthcare provider.” Dordrecht Central. 2025; May 24. https://dordtcentraal.nl/actueel/ambulancemeldkamer-gaat-patienten-preciezer-koppelen-aan-een-passende-zorgverlener/ (accessed July 28, 2025).

2. “When Every Second Counts, You Make the Difference." Ambulancedienst Zuid-Holland Zuid. Ambulance Service South Holland South. https://ravzhz.nl/ (accessed July 28, 2025).

3. See note 2.

4. See note 2.