how would you get this to work on a old 200 digital that doesn't have the speed dial option in form 19. Normally I change the tennant on the Ext and program that tennant to go to a speed dial that rings 911 but that isn't a option in this old digital.

Maybe get a programmable jack.?

You could try to forward a phantom extension to a system speed dial that calls 911 and use it in form 19

Program it to ring on an extension, then CFA the extension to 911.

This will not give you notification at the console, however.