Up on the dispatch desks, it’s the allocator’s job to decide which ambulance gets which call. This becomes partly tricky when we have more calls than ambulances, as is often the case. There are three main factors we use to decide:
The other day, we had one call and one ambulance nearby - simple! The call was a Doctor’s Urgent, which is a journey booked by a doctor which needs to be done fairly quickly (between one to three hours) but not with lights or sirens. These calls are supposed to be less serious than 999 calls, but of course with large numbers of people abusing the 999 system, it doesn’t work out that way. The Doctors’ Urgents are the people who really suffer from ambulance shortages, and they are usually old and frail people with things like pneumonia, mild strokes, broken hips etc. If it were up to me I’d give them top priority and let all the 999 callers wait! But it isn’t up to me, of course.
The diagnosis on this call was “89 year old male, end stage COPD, high potassium level”. COPD stands for Chronic Obstructive Pulmonary Disease and causes nasty breathing problems. A high potassium level means you are at substantially increased risk of a heart attack. In other words, this guy sounded quite sick to us, so we dispatched the ambulance immediately, even though it was our last one. (Sometimes if we have one ambulance and one not-very-serious call we wait for another ambulance to become available so we always have one spare for a serious call).
The ambulance was halfway to its call when another call came in - a Category A (Red) 999 call. “25 year old female, suffers from depression, on slimming tablets, palpitations, hyperventilating”. The ambulance was not far from this call, but we didn’t really want to take it off the Doctor’s Urgent, so I did what is known as a General Broadcast on the radio:
“This is a general broadcast all mobiles on Channel 18. We are currently holding a Category A call in Some Road, Somewhere, for a 25 year old female hyperventilating and having palpitations. Anyone able to deal with this call, please go Green Mobile and press your Priority Button. General Broadcast at 0909, Mike Mike, red base out”.
The crew on way to the Doctor’s Urgent pressed their priority button. “We’ll do that one, over!” (For some reason that I don’t get, crews don’t like doing Doctors’ Urgents).
The allocator thought it over for a few seconds. “The Cat A *could* be cardiac, what with the slimming pills, but it also sounds awfully like a panic attack. And there’s a response car on way, and that crew at the hospital nearby look like they’re about to become available. This crew are nearly at the Doctor’s Urgent, too. Tell them thank you, but please continue on the Doctor’s Urgent”.
A few minutes later, we got a call from the crew on their way to hospital.
“Just for your information, this old boy is fine, if a bit wheezy. I think you really should have taken us off this call for that category A.”
I cursed inwardly. “Thanks for letting us know. From the look of the diagnosis, we didn’t want him to wait, but I guess we were wrong.”
Then the FRU who had been sent to the Category A call rang up. Oh no, I thought, he’s going to say she’s suspended and we still haven’t got the ambulance there and now we’re going to have to explain why we kept that crew on that Doctor’s Urgent.
“Cancel the ambulance,” said the FRU. “She’s having a panic attack - I’m able to deal with it and she won’t need to go to hospital.”
Phew. Looks like we made the right decision after all.
October 14th, 2006 at 12:03 pm
I had panic attacks as a teenager. The first one was terrifying - after that then the worst part of having one in public was trying to do breathing techniques and to get control of it again while half a dozen passersby were trying to force me to lie down and offering to call ambulances, the conversation went “I don’t *gasp* need a *twitch* ambulance *wheeze*, I’ll be fine *gasp* in a few minutes *gasp* *twitch* honestly *gag* *choke* *wheeze*…”
But of course the other side of that is, would we prefer a society where passersby aren’t concerned when they see a person having what looks like some sort of fit, and won’t offer/summon necessary and possibly life-saving help?
http://batsgirl.blogspot.com/2006/08/helping-people.html
October 14th, 2006 at 12:45 pm
I agree totally with your post. As you say, there are many ways you can help someone other than dialling 999. In fact, some people dial 999 just so they won’t have to “do something” themselves, which is fairly pointless. You also make a good point in that the patient should have the last say in whether an ambulance is called — if they are refusing help, there’s not much point in calling because the ambulance crew can’t treat them without their consent.
October 14th, 2006 at 2:59 pm
I’m still getting used to all this radio speak, sitting in the cab of a training truck the other day I heard my first ever blue call get put in, you could tell from the sound of the tech’s voice that she thought the guy didn’t have much of a chance. I would also like to aplogise about the coming week, all of the St Georges FdSc lot have obs in EOC untill Thursday, I think its two in the morning and two in the afternoon, so I therefore apoligise beforehand for the disruption. I’m in on Tuesday morning, I’m looking forward to going back. Wonder if they’ll let us bother you over on dispatch?
October 14th, 2006 at 5:57 pm
Speaking from the perspective of field personnel, I can tell you exactly why they hate Doctor’s Urgents (or in the US lingo a “transfer”).
It has everything to do with the nonsense they get from the doctor’s office or hospital staff.
I’ve been told some real gems such as “don’t treat the patient, just take them to the receiving hospital” (why did you call an ambulance then, just dump them in a cab)
or
“Oh, they really have nothing wrong.” (come to find out the patient had MRSA/VRE/CDIF and had open heart surgery 4 days ago)
or
“The patient speaks no english and is demented.” (As I’m moving the patient, they refuse transport in English and proceed to talk my ear off.. in English)
I could sit here and grouse all day, but the reality is, hospital based medical professionals tend to treat the prehospital professionals like crap, so they really hate dealing with Doctor’s offices and Hospital floors.
October 14th, 2006 at 8:01 pm
I agree with the last post - so often GPs are the worst abusers of the ambulance service. Often we are called to doctor’s urgents and find the only reason the ambulance has been sent is because the patient hasn’t got any transport, and it’s not that unusual to get to one and find the patient ready to walk into the back of the ambulance and the relatives ready to follow the ambulance in their car! Either certain GPs don’t get how scarce ambulances are, or they just don’t care.
Also we often get instructions coming through with the detail like ‘patient needs oxygen’. If the patient needs oxygen why hasn’t the doctor stayed on scene until the ambulance arrives and given them oxygen?! I’ve been to some really, really ill people who should have been a 999 call and end up in the resuscitation room, but the doctor has made it a 3 hour urgent. Occasionally by the time the crew gets there it has turned into a cardiac arrest.
I could go on, but I’m all worked up now and need to go and lie down in a darkened room…
October 14th, 2006 at 10:07 pm
I work in dispatch. Doctors Urgents drive me up the wall. Either they try to convince you to pick up a patient within 1 hour with a massive long latin diagnosis (which you later find out means something like “sore heel”) or they book a taxi….sorry….ambulance for a patient within an hour for a sore heel, and when you ask for more time to pick that patient up as it doesn’t appear to be a particularly life-threatening condition, they start having a go at you for trying to leave a patient with chest pain, difficulty breathing, and a reduced level of consciousness at home for any extra length of time. Even though you point out that they never mentioned any of those priority symptoms at the time of booking, and that would certainly get the patient picked up sooner. Ok, slight exaggeration, but only just.
Why can’t some doctors realise that we don’t often get a chance to let ambulance crews sit twiddling their thumbs while their patients wait for transport, that we are interested in the best care for patients, and that we just don’t have enough ambulances?! Oh, and that the doctor’s surgery closing in 20 minutes does not make Mr Smith in the waiting room’s sore knee a life-threatening emergency to be responded to with lights and sirens?
And don’t get me started on the emergency police calls for cut fingers………
Ok, rant over!
October 14th, 2006 at 11:13 pm
I think some of the Doctor’s Urgents that are pretty much taxi jobs may be because the family GP is more au fait with the financial situation and disposition of the patients.
For instance, the GP will know if a pensioner doesn’t have much cash and if they are the sort of person who is likely to consider the cost of a taxi to/from hospital too much of a chunk out of their weekly budget, and decide to “just go home instead and see if I feel better in a little while, no point making a fuss over nothing”.
October 15th, 2006 at 3:15 am
thats harsh, the hyperkalemic copd’er should be first priority, and have no idea why the ambulance crew would have thought they should have gone to a hypervent Pt instead, hate doing transfers, but sometimes get to see cooler shit than on a 26 alpha (or sick person, low priority call)
peace awt
paul
October 15th, 2006 at 11:33 am
This relates to something I find very hard to work out. I’m a power chair user - need both arms working to be able to get in and out of it, and steady legs.
Touch wood, I’ve not had any reason to go to A&E so far…but as all the wheelchair accessible taxis around here insist on 48 hours notice, I’d be in trouble if I did need to go to A&E…but equally I wouldn’t want to call an ambulance out because of that (I’d feel guilty if e.g. I’d caught my arm somewhere, couldn’t move it, funny lump on my arm and just wanted to get it checked out, as most other people would be able to get a taxi).
What do you do in that situation? (blatantly not a 999 call, and non-transport ambulances don’t take wheelchairs, so in that case I’d have to be found a bed too…or lie on the floor).
October 15th, 2006 at 11:44 am
Thanks to everyone for your enlightening comments about Why We Hate Doctors’ Urgents!
Hannah, if you were in that situation you might well end up being a Doctor’s Urgent. If you need a non-emergency ambulance, give your GP a ring and ask him/her to arrange you one. 48 hours for a wheelchair accessible taxi sounds ridiculous - it’s not just trips to A+E that come out the blue so it must be a real pain for you to get anywhere. Hope the situation improves soon!
October 15th, 2006 at 2:57 pm
Yes, getting anywhere in general is a pain - I ended up having to wait 48 hours to sort out bank issues for the same reason - unfortunately that’s life for now unless you live somewhere like London (public transport doesn’t have to be accessible until 2020 at the moment).
October 15th, 2006 at 3:00 pm
We have this problem where I work- as a midwife doing home assessment in labour (to stop people coming in too early) we are often with a client who needs to be in hospital but has no personal transport… so we get them to call a cab… and you try getting a cab at 11pm on a weekend in South London.
Last time I was with someone like this we literally had to call 999 as there was no other way of getting to hospital- after all you can’t prebook a taxi for when you go into labour! The crew were lovely about it and didn’t mind at all.
Conversely, a while ago we did a job with a woman who needed an urgent transfer to her booking hospital (not the nearest one to her house but she couldn’t go there as she wasn’t booked there and had previous bad experience there leading to PTSD) and she really needed a fast transfer- previous caesarean section, in fast labour. So we called ambulance- called again half an hour later to be told the crew that had been on its way to us had been diverted elsewhere. We waited an hour for an ambulance in a potentially risky situation, with a very distressed woman, and when the crew turned up they argued about the destination hospital and were rude to me and my colleague and to the woman and her partner. In this case we couldn’t call a taxi (she wouldn’t have tolerated the journey) and I know LAS don’t like maternataxis but sometimes they are necessary- I don’t call 999 lightly.
October 15th, 2006 at 9:00 pm
…”try getting a taxi at 11pm on a weekend in south london”….
Try this number……999.
..”after all you cant prebook a taxi for when you go into labour!”….
No, but you can alert any family or friends that drive months in advance as to when the happy day is! Then get one of them to drive you there, how radical!
These would be the same F&F that would happily ‘follow the ambo in the car’.
Makes my teeth itch.
October 16th, 2006 at 10:53 am
SWbod, you may be thinking of a different social section… in my current home town I know exactly TWO people who can drive *and* have a car. One recently broke his wrist and was told not to drive. The other will give me a lift anywhere I need to go as long as it’s not while he’s at work, and not on the evenings where his partner is at work and he has to stay in the house because his child is asleep… so that’s not much of a window.
I agree about the stupidity of people who cheerfully decide to follow the ambulance in the car though.
October 16th, 2006 at 11:10 am
Re. the maternataxi debate - I think the trouble is that we get so many unnecessary maternity calls that we tend to assume all of them are unnecessary. We can’t tell if someone genuinely has no way of getting to the hospital, or if they have no way of getting there because they haven’t bothered trying to find a way because they think we’ll give them a free lift. We can’t tell if someone is about to deliver because nearly all of them say their contractions are two minutes apart, and most don’t have a single contraction in the ambulance on the way to hospital. We had to stop making “imminent delivery” a cat A emergency for this reason.
Those who abuse the system don’t realise the problems they cause for those who genuinely need us.
October 16th, 2006 at 4:28 pm
I’ve often had cases where the PT, not knowing the best course of action, has phoned for advice from their nearest and trusted sorce of medical advice. Usually a family GP or the local MIU. The amount of people we get who call 999 for something minor because they were told “well, get an ambulance to hospital” Even some of the medical profession think we’re just taxis.
But, to join in the urgent bashin…
Doctors seem to think that when there are no available vehicles and they’ve had to wait over an hour to get their sore heel patient into hospital, threatening to phone 999 is supposed to scare us into being quicker? They use it like an ultimatum because they’re late for golf (a cliche, I know). I must admit to a smug pleasure in explainng that dialling 999 won’t magic up a vehicle if there aren’t any available, and the patient would be prioritised on a medical basis, which would most likely be a Cat C and give us another hour to move them anyway!
October 18th, 2006 at 8:21 pm
i take it your service doesnt have any of that marvellous InstoAMB powder then?
simply put, what you do is get some add water and hey presto, 1 ambulance plus crew, but just remember only lasts one job then poof back to station for a mealbreak or to wshops to be lost in the ether.
but i do AGREE, THE URGENTS ARE CRAZY, IT JUST DOESNT ALLOW US ALOT OF COVER, AND WHEN YOU SAY WE ARE ON EMERGENCIES THE USUAL RESPONSE IS WELL WHEN WILL IT GET HERe to which the response it, well we are an emergency service.
BWTS aren’t we all
October 19th, 2006 at 12:43 pm
I keep biting my tongue to stop me making comments about people who call ambulances for a panic attack, because I have to remember that it may be their first one and not know what the hell is happening to them. I, on the other hand, should have a phd in panic by now…
October 19th, 2006 at 6:19 pm
SWBod,
The clients in question do not have any family in the area, or possibly in the country. None of their friends drive. The social area where I work means that not only do some people not have a car themselves, they have no friends with a car, and they may in some circumstances have no friends at all… which is why they end up having to bring their 2 year old with them, because there is nobody to care for the child.
But no, it annoys me when people ‘follow the ambulance’; the only time I’ll do it is if we need an ambo transfer but I don’t need to stay with the client, in which case I’ll drive behind because if anything happens they will pull over and it’s better for me to have my car with me, as it saves the Trust a cab fare back to my car once it’s all over.
October 19th, 2006 at 7:12 pm
Sometimes, though, you do have to follow the ambulance. Sometimes it isn’t possible to find someone to look after children at 3 in the morning, and the ambulance won’t fit an EMT/paramedic, 3 children and an extra adult in the back!! Or, you can go in the ambulance but then there is no way to get back home afterwards short of spending £60 - £80 on a taxi (not joking - I did it once 7 years ago from the Scottish Borders to Edinburgh - went in the ambulance with my daughter, then had to catch a taxi back the next morning to collect her overnight back, clean clothes for myself and re-organise child care for my eldest daughter, and the taxi was £65!! It will have gone up now, I expect). So, in a city situation or where there are excellent public transport networks, following the ambulance sucks - but sometimes, just sometimes, there are good reasons why we do it
October 20th, 2006 at 11:24 am
It’s not about sometimes following an ambulance when there is a sick person inside, that’s perfectly understandable. It’s more about following the ambulance in the car that was perfectly capable of taking the person to hospital in the first place. Thats was annoys crews.
October 23rd, 2006 at 10:46 am
All I have to decide is if the person at the bus stop but without hand out would like me to stop; and if I don’t and they did want the bus so what, there will be an other bus in 8 mins.And even that level of decision strsses me out at times.
November 16th, 2006 at 8:36 pm
All I ask is that the lovely ambo people don;t take it out on the surgery staff when they do GP Urgents.
I work at a city centre GP Surgery with 16000 patients. We inevitaby have times when the drs require an urgent (non-blue light) ambulance, and, low and behold, it’s the admin staff that are given the instructions as with all their training the drs cannot use a telephone to dial out! We aren’t medically trained and therefore can’t make a decision on whether it’s neccessary. Fair enough we are the first people you deal with on the phone/in person when you come to collect the patient, but please please please don’t take it out on us! I’ve had my fair share of verbal dressing-downs from ambo crews on arrival - but please remember that us low-life reception staff get sworn at by the patients and docotrs already….we’re only doing our job!
Other than that though - you guys & gals rock - keep up the good work with what little the NHS gives you! :0)