don’t know emergency-looking zwave buttons, but maybe you could combine generic emergency buttons with zwave relays?
It doesn’t matter if they look like “emergency” buttons. A simple “doorbell”-lookalike or key-chain would do.
As for combining generic buttons with z-wave relays … won’t the buttons mix with each other?
Can you show an example of a button and a z-wave relay that would work (assuming the price won’t skyrocket).
although I’m using wifi relays, the method is the same. I mounted these relays behind wallswitches (all replaced by momentary aka bell ones). switches are connected to smart relay inputs to drive them.
the point is to find small enough relays to fit them behind switches
Amazon/Aliexpress/Ebay link to these? 
which ones? I said I’m using wifi relays (Shelly to be exact). you have to find zwave based on your own
Just found another problem… Can multiple hubs be connected over LAN to a single HA instance ?
How about a D1 Mini ESP32 with the new Ethernet socket as a hub on each floor. You can expand the mumber of digital inputs from 16 to 128 as described here:
Assuming you have CAT5/6 runs back to your server location then everything would be hardwired which would improve reliability and eliminate the need to change batteries in the buttons. It may also be possible to use POE to eliminate the need for a local 5V power supply at each hub.
Quindor has done several videos on Youtube featuring these boards although his are aimed around driving LED’s.
Unfortunately running new cables is not an option, however, I think I’ve found a way to do what I need, thanks to @mitchell – Button button is there an RF button? - #4 by boxgrove
So → Sonoff hubs with custom firmware + good-looking RF buttons and HA on a RPI.
Here is what came to my mind.
At 50$ per button… price won’t even compare to a 5$ button
For commercial use they may last over 10 times as long though. 
Depending on where you are, a device listed for any kind of emergency use may be required to be a commercial listed and supervised emergency transponder or burglary system accessory. That means if the device has a low battery it must report a trouble signal, same if it is out of range or fails to report in on a regular basis. They may also be required to be water resistant so they will continue to function if the sprinkler system is dousing the room with water. And being listed means it is tested to certain requirements, such as being fully functional after a hard impact, or after the EMP caused by a lightning strike, etc.
There are only 2 wireless devices I know of that might meet those types of requirements, The Ademco 5802WXT, and I am not even sure that can be used in a commercial setting, and the 5869, which is a wireless version of the 270R wired holdup switch used by banks. The 5869 also has dual tamper switches, so you get a trouble alert if someone opens the battery cover or removes it from its mounting location. They are 345MHz devices, and they are expensive. You will also need at least 1 (up to 2 can be used) 5881ENHC wired transceivers which have a 60 metre indoor range, and a panel that supports them ( a Vista250 has enough zone support ), and the wiring, batteries, installation, etc. There are probably products by other companies like Tyco and DSC, but I am not familiar with them.
But…, think of how much a lawsuit could cost if you use something that is not listed for an emergency application, and someone tries to use it… and it doesn’t work? Independent of a lawsuit, what about the cost to your reputation? There are of course situations that could stop a 5869 from working, but they are far less likely than some off the shelf z-wave device, notwithstanding frequency range and interference.
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Coming from someone working in both the security and fire dep. fields I would not in a million years be responsible for such a set-up. I do not care the slightest what cost related reasons you might defend this with, it will come and bite you in the ass the day it fails. Go professional, go wired. Home automation is great fun, but you don’t go around playing games when peoples lives could depend on it.
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Considering the proposed system by some integrator looked 1/5th as decent as what I’m thinking of using…
They also used 433MHz buttons and hubs + a controller receiving the signals from all the hubs.
I don’t see why I can’t use the same but with HA receiving everything and doing the notification.
The buttons I’ve chosen are powered by a 12V battery so range should be good enough to be picked up by 2 or more hubs + are waterproof (the button location will be in the bathroom, in case of slip in the shower or something like that)
Are we sure these RF buttons will create unique codes?
I plan to contact the seller for that before purchasing…
Seller contacted, waiting for a reply.
Additionally - Is it possible for all buttons to write to the same “topic” - only the number of the room (that will be unique for each button), and have the subscriber (reader) get all the various room numbers (if more than 1 button was pressed) ?
I’m totally new to HA and MQTT, sorry if I ask somewhat stupid questions…
My plan is to use HA on a RPI and connect 8-digit 7-segment display directly to it, and have it “scroll” the pressed numbers for, say, 5-10 minutes before clearing them all.
If you’re willing to use Zigbee instead of Zwave, Ikea Tradfri shortcut buttons are cheap and customizable, I’ve never used one but Tradfri stuff has been reliable for me.
Is there any link or photo or make/model?
Purely out of curiosity.
If it’s 433 MHz then no.
The receiver can do it but not the actual button.
You can see what hub that sent the message, but not what button.
For HUB I plan to use a Sonoff one with tasmota firmware - get the RF signal from button → transfer via MQTT to HA.