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My dad has Great Call. When he presses the button, it alerts an operator who asks him who he’d like to be called, such as “would you like me to call your son?” It can be set to call in descending order the numbers you give them. The interaction with the operator is limited to making the call for you. I don’t know of a system without going through an operator
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Ditto what Daughterof1930 wrote:   the company that maintains and manages the system has to get the first call since it has the technology and support to receive the message.    Individuals don't have that option unless someone can create their own messaging services.

It's better that way as well; if you were the first responder, there would be no backup if you weren't available to take the call.   With a professional maintenance and response, there are typically 3 alternatives.   If one isn't available or doesn't respond, an alternate can be contacted.

And that's better protection for the individual wearing the alert system.
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Yes, there are Medical Alert Systems for Home Emergency using a landline or a cellular to call a "friends" list first (and only if you want to set it that way) and then call 911 if no one on the friends list answered. Most of these systems provide two way communication with the party called. Some of these systems also include fall detection these days. My SIL preferred a friends list be called first when she lost mobility following a stroke and got herself into "binds" more than true emergencies. The friends list called her husband first, then her closest neighbors, and then extended family. If no one answered (which never happened in her case), the system would call 911. She much preferred calling her husband who was working in the yard over 911 when she couldn't get her pants pulled back up or over balanced and couldn't back out of a kitchen cabinet she had leaned into. She had privacy in her home again with help just a button push away when she needed it.
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