Peter Bradley, the chief of the ambulance service, says there is no such thing as an inappropriate 999 call — all our callers have rung us because they need help and have nowhere else to turn to. I’m afraid to say that after two and a half years of stubbed toes and runny noses, my attitude is a bit less sympathetic than his. Here are some statistics for you:
- 10% of Londoners would call 999 if suffering from flu symptoms. (Elsewhere in the country, the figure is 3%)
- 50% of Londoners would call 999 as a first course of action if a pregnant woman began to go into labour.
- 40% would call 999 if having difficulty getting through to their GP. 30% would call if they were told they could not get a doctor’s appointment for several days.
- Around 60% of 999 calls made in London have no medical need for an ambulance at all.
The ambulance service has tried campaigning to stop people calling 999 inappropriately, but campaigns such as “Only one of these is a taxi service…” weren’t terribly successful. Apparently they inspired even more people to call 999 with rubbish, their rationale being “well, if other people are doing it and getting away with it, why shouldn’t I?” Instead, they’ve tried a new tack. They will let the inappropriate callers continue to call, and tailored their services so the calls are no longer inappropriate.
The 60% who call, but don’t need an ambulance, is made up of various types of call: complete timewasters like the Toe Taxi man, people who need hospital but not an ambulance (eg. someone with a broken arm, women in normal labour), people who need medical treatment but not hospital (eg. someone with chronic backache), people who need non-medical help (police, social work, carer, alcoholics anonymous), etc, etc.
Instead of sending a bog standard ambulance to lower priority calls, they can be dealt with by one of the following. Most of these are sent out by the Urgent Operations Centre, a separate control room upstairs from ours:
- Introduction of “intermediate tier” vehicles, which have a grade 1 technician crew with basic training (not the same as the technicians on ‘normal’ ambulances, who have a wider range of skills and can give some drugs) . Their role is just to get people to hospital if they need to go, but not as a life threatening emergency.
- Emergency Care Practioners, a paramedic with extra training who arrives in a car and treats the patient at home without them needing to go to hospital. They are particularly useful for stitching and dressing wounds.
- Telephone Advice, who call back the lowest priority calls and either tell the patient how to deal with their situation themselves (either homecare advice or by contacting their GP/midwife/etc) or determine that they do need an ambulance, and if so, what kind of ambulance and how quickly.
- Sending a car to every call. This system has not been introduced yet, but my understanding of it is that they will get a responder on scene to all calls as quickly as possible, and that responder will evaluate what is needed next. An ambulance will still be dispatched at the same time if possible, so this will not cause delays, but it can be cancelled by the car responder, so time wasters will not get their free ride to hospital.
Things I’d like to see happen too:
- Fines for those who lie to get an ambulance, or call us out for something they know not to be a life threatening emergency.
- Small charges for all calls (perhaps refundable with a doctor’s signature?) to deter people using ambulances because they can’t afford a taxi.
- Help with transport costs to hospital in taxis for people on a low income.
- Better availability of emergency GP appointments and visits. My local surgery only offers emergency appointments if you ring up between 9 and 10am - not much use if you get ill at 1030am!
- More education for what you should and shouldn’t call an ambulance for, coupled with what you should do instead, and the consequences of calling an ambulance that you don’t need, both in terms of punishment and the other people who will be deprived by your actions.
- Ability for patients to request non-emergency ambulances for themselves in certain circumstances via a different phone number. At the moment this can only be done via a doctor or other healthcare professional
- Reforms to AMPDS for more accurate categorisation of calls
All the methods that I’ve mentioned here are in their early stages, and right now they’re very overstretched. There are not enough Intermediate Tier vehicles and people have a long wait for a call back from Telephone Advice (half an hour to an hour is usual). Any overspill goes back to Nee Naw Control and interferes with the emergency workload, causing delays reaching the most seriously ill patients. But the situation is getting better - even in the two and a half years I have worked in Control, I have noticed the difference. Let’s hope things continue to improve.
