Table 9.

Examples of lessons learned and recommendations for technical issues and interoperability (based on encountered challenges before and during the first three COVID-19 waves).

Area	Lessons learnt	Recommendations	Participants (ID)
Technical issues/Interoperability	Lesson learnt	Dispatch center Heinsberg: Major cross-border incidences are presented on a large information screen but the information is not directly connected to the dispatch system and can only be entered manually into the German dispatch system	7
	Recommendation	Dispatch systems in the EMR should be connected to improve visibility and communication (incl. resource locations and status, automatic translator)	7
	Lesson learnt	Radio and telephone compatibility is crucial but currently largely lacking [incl. (cellphone) service problems in border regions] (between foreign EMS and dispatch centers)	3, 6, 7, 14
	Lesson learnt	Radio communication between NL and the German helicopter remains difficult; A Dutch radio is currently built into the helicopter to solve communication issues	3, 8