It was a block of four day shifts this week, and I was allowed to allocate on every single one of them, so I’ve pretty much got it mastered now. I still have to ask my more experienced colleagues for advice from time to time, but usually it’s just for reassurance I’ve got it right. It helped no end that I’ve been with people who have taken the time out to help me even though they’ve got their own workload, so if you’ve been on the east sectors this week - thank you!
On my last post, a couple of you asked questions about how allocating works, so I’m going to give you a quick run down. Of course, I’m new to this and a more experienced allocator would probably be able to explain it better, but here goes!
There are three priorities of calls Red, Amber and Green (sometimes referred to as Cat A, Cat B and Cat C). Red are the most serious, followed by amber, followed by green. There are also subdivisions (red 1, red 2, red 3, amber 1, amber 2, green 1, green 2) but this is a minor detail really. When allocating, I sit and watch a screen, and when a call is received to my area (north-east London, which includes Waltham Forest, Edmonton, Tottenham, Stoke Newington, Enfield, Wood Green, Woodford Green, Dagenham, Romford, Hornchurch, Upminster, Ilford and probably some others I’ve left out) it pops up on the screen. At busy times the sector is split so there are two allocators, one taking the northern half of the section, the other the eastern half). As soon as there is a diagnosis and an address on the call, I decide what to do with it, even before it has been officially classified. I have to guess which category it is going to be - if I over-estimate, I can always cancel the ambulance, but if I’m not given enough information to know it is going to be a high priority call, then it will cause a delay. (This is why it is important for the caller to give the vital bits of information straight away and for the call taker to type it out as fast as they can - because otherwise, no ambulance. And no, “it’s very serious and you must get here quickly” isn’t good enough!) What happens next depends on the seriousness of the call:
Green Calls: These are ‘neither serious nor life threatening’. They include a lot of inappropriate calls and a lot of elderly people’s niggles. They also include ambulances which have been booked by a doctor, in which case the doctor will have indicated a timescale in which we should reach the patient - between 1-4 hours. If a call is classified as Green, it disappears from my screen and goes Upstairs to Urgent Care, who can then send a Patient Transport Ambulance or get Telephone Advice to call it back. If neither of these are appropriate or possible, I get the call back. I then send an ambulance on it, but only if one is free and nearby and I have other ambulances covering the area in case I get a more serious call. The ambulance will not use blue lights to this call. If I do not have an available ambulance, I will hold the call until I do. If I think a Green call is more serious and should have a higher category, I do have the option of sending on it straight away. I can ask the ambulance to use blue lights, or they can decide themselves to do so.
Amber Calls: These are ’serious but not immediately life threatening’ and include things like diabetic problems, fits, strokes, broken bones, back injuries, etc. If I have an available ambulance, I will send it straight away on blue lights. The FRU desk may also send an FRU (car) depending on the diagnosis. In general, I will not send a vehicle more than around 3.5 miles (as the crow flies) to a call because driving on blue lights is dangerous and a nearer vehicle often becomes available anyway. At busy times or if the call is in a rural area they may have to travel further. If I do not have an available ambulance, I will get the radio op to broadcast the call to see if any ambulances who are finishing paperwork or having an unofficial break offer up, and/or borrow an ambulance from another sector.
Red Calls: These are ‘immediately life threatening’ calls such as heart attacks, status epilepticus, serious head injuries and of course suspendeds. The practice is the same as for amber calls, except that an FRU is always sent if one is available, broadcasts are made more frequently and the nearest available vehicle up to about 7 miles away will be sent if no one else is available. Basically, one does not want a red call hanging around on one’s screen!
This is all quite simple when you have more ambulances than calls. Once you have more calls than ambulances (which is at least 50% of the time), decisions have to be made. These decisions are based on various factors:
- The priority of the call
- How long the call has been waiting
- How far the ambulances are from the calls
- Whether there are any other ambulances likely to become available soon
- Whether the call needs a paramedic or a tech crew
- Whether an FRU has already been sent
- Whether sending an ambulance to a particular area will unbalance the distribution of ambulances throughout London
- Whether sending an ambulance on a call will force them to keep working past the end of their shift
- Whether one thinks the call is a load of rubbish (Okay, not those last two. But sometimes it is tempting.)
- How polite the caller was to the call taker
Here’s some examples based on real life situations over the last week:
1) I’m holding 2 calls - a Fitting (amber) and an Old Woman Fallen, On Floor, Leg Injury (green). K701 becomes available near Fitting. K702 becomes available near Old Woman. But K702 is a paramedic crew and K701 isn’t. Fitting might need a paramedic crew (the patient had actually stopped fitting at the time of the call, so they might not), Old Woman probably won’t. Do I: a) send both ambulances to the calls they are near and try to find a third crew with a paramedic for Fitting if needed b) send both crews to Fitting and wait for a third crew for Old Woman or c) send the paramedics to Fitting and techs to Old Woman, thus using one less ambulance but meaning both patients have to wait longer?
I started off doing a), then decided to do c), which didn’t please K701 at all, especially as they passed K702 on the dual carriageway, but I don’t think any solution is perfect…
2) I’m holding Asthma Attack in Edmonton (red) and Diabetic Hypo in nearby Enfield (amber). H701 becomes available at the hospital in Enfield - 3 miles from Asthma Attack and 1 mile from Diabetic. I decided to send H701 to Diabetic, because there are no other ambulances at Enfield Hospital but three busy ones at Edmonton Hospital. Sure enough, one of the crews in Edmonton responds to a second broadcast of Asthma Attack and both calls are covered. Had there been more ambulances at Enfield than Edmonton, I would have sent H701 to Asthma Attack.
The scariest thing about allocating is that you are responsible for any decisions that you make and, while there are guidelines and protocols for most things, they don’t cover every eventuality. And anyway, if a patient dies, it won’t be much consolation to their family if you stand up and say ‘but I was just following protocol’. The consequence of this is that I feel terribly anxious until I get every single call off my screen and I treat every call as if it were a national emergency, even if they are obviously a load of rubbish. I’m told this feeling passes after a while.
August 24th, 2007 at 6:04 pm
So you don’t send FRUs yourself, there’s a separate “FRU desk”?
August 24th, 2007 at 6:25 pm
Yep, the FRUs have a desk of their own. I could be assigned to the FRU desk as any of the normal roles, but at the moment I’m assigned to the north east.
August 24th, 2007 at 9:40 pm
[...] Zac Efron More Allocating » This Summary is from an article posted at Nee Naw - Blog of a Dispatcher in the London Ambulance Service’s Control Room on Friday, August 24, 2007 It was a block of four day shifts this week, and I was allowed to allocate on every single one of them, so I’ve pretty much got it mastered now. I still have to ask my more experienced colleagues for advice from time to time, but usually it’s just for reassurance I’ve got it right Summary Provided by Technorati.comView Original Article at Nee Naw - Blog of a Dispatcher in the London Ambulance Service’s Control Room » 10 Most Recent News Articles About Fergie [...]
August 24th, 2007 at 10:01 pm
Erm, so heart attacks are life threatening but strokes are not? If strokes are deemed as serious as broken limbs, no wonder Britain has the worst record for stroke deaths. http://www.timesonline.co.uk/tol/life_and_style/health/article2317318.ece
August 24th, 2007 at 10:51 pm
Some strokes are red calls (if the patient is having difficulty breathing or unconscious, for example, although often the more serious strokes are not identified as being strokes until later). Amber calls can be life threatening but not immediately life threatening - the timescale for stroke treatment is 3 hours, with heart attacks it is 1 hour and I guess the NHS’s definition of “immediate” falls somewhere between the two.
That said, I didn’t make up the call categories and I don’t entirely agree with them, and yes, if it was up to me I’d probably make it so ALL strokes were red calls. When you consider some of the nonsense that gets a red response, it’s absurd that the stroke patients are a lower priority.
August 25th, 2007 at 1:22 am
You forgot to mention that lots of “Red” calls are actually people with cut fingers, who are not “breathing normally” because they’re crying.
The vast majority of our calls seem to be in the 10 or 6 categories (breathing difficulties or chest pain) regardless of the actual problem…
August 25th, 2007 at 8:41 am
I have mentioned that on previous posts! It is a big problem that I hope gets fixed. Removing the “is s/he breathing normally?” question from several of the protocols would help enormously.
August 25th, 2007 at 9:08 am
I don’t think they’d be able to pay me enough for the stress of taking decisions like that. Then again, I guess if you’ve been dealing with 999 calls for long enough, it becomes less highly emotive and more like a logic-based computer game?
August 25th, 2007 at 9:27 pm
‘At busy times or if the call is in a rural area they may have to travel further’
Is that your rural or my rural?
Does how the calls are prioritised vary from trust to trust?
August 26th, 2007 at 9:35 am
Probably not very rural compared to your rural, but we do cover some places that I consider to be out in the countryside. Biggin Hill for example, is about five miles from the nearest ambulance station.
The call priorities are set by the Department of Health, so I *think* every ambulance service in the UK has to use the same ones.They do change from time to time, though, and I’m not sure if it is the DOH or the LAS changing them. Does anyone else know?
August 26th, 2007 at 6:39 pm
Is the ‘FRU Desk’ a seperate desk that allocates FRU responses across all of London with a seperate team of people? Or do you have an FRU Despatcher for each sector, working with you?
With regard to Stroke’s being CAT B… I did hear last year, that they were meant to be changing it so that all strokes were graded as CAT A. Cannot remember the time scale that was banded about for this happening though?
August 26th, 2007 at 11:22 pm
snip-I consider to be out in the countryside. Biggin Hill for example, is about five miles from the nearest ambulance station.-snip
Oh, I wish!
Our local ambulance station was closed recently. I think it is 8 miles to nearest one, then 16 miles to the nearest hospital.
If you really want rural, try mid Wales or Scotland!
August 27th, 2007 at 11:58 am
[...] Mark Myers at Nee Naw gives us an induction course in the fraught art of allocating ambulances: “The scariest thing about allocating is that you are responsible for any decisions that you make and, while there are guidelines and protocols for most things, they don’t cover every eventuality. And anyway, if a patient dies, it won’t be much consolation to their family if you stand up and say ‘but I was just following protocol’. The consequence of this is that I feel terribly anxious until I get every single call off my screen and I treat every call as if it were a national emergency, even if they are obviously a load of rubbish. I’m told this feeling passes after a while”. [...]
August 27th, 2007 at 12:29 pm
Womble; At risk of wandering off post, you have hit on an interesting point,all the recent discussion surrounding the removal of A+E and maternity from District hospitals seems to assume that all A+E dept’s are two miles down the road, not around here there not! (more like 10-15m) If they move them to nearest specialist centres that are then 25-30m away, its going to be a rough ride for rural patients and that’s just from the ‘clinical’ perspective rather than the ’social’ (i.e not considering what it would be like for the elderly trying to visit their husbands/wives with scant public transport.)
Serves us right I suppose for living in the country.
opps sorry, gone off on a rant again!
August 27th, 2007 at 1:56 pm
I’m quite surprised to learn that diabetic problems are classed as amber as both hypo and hyper glycamia ultimately if left untreated will result in death??
August 27th, 2007 at 2:14 pm
A lot of amber calls are things that will result in death if untreated. A red call, theoretically*, is something that will result in death if not treated IMMEDIATELY.
An unconscious diabetic would get a cat A, of course, because they’ve already reached the stage where the problem has become immediately life threatening. Fortunately, someone usually realises the need for an ambulance before that stage.
* I am well aware that, due to Caller Exaggeration and AMPDS Uselessness a lot of red calls aren’t actually immediately life threatening but this is something I have talked about at length on other posts and therefore don’t want to go into it too much here!
August 27th, 2007 at 5:57 pm
[...] Mark Myers at Nee Naw gives us an induction course in the fraught art of allocating ambulances: “The scariest thing about allocating is that you are responsible for any decisions that you make and, while there are guidelines and protocols for most things, they don’t cover every eventuality. And anyway, if a patient dies, it won’t be much consolation to their family if you stand up and say ‘but I was just following protocol’. The consequence of this is that I feel terribly anxious until I get every single call off my screen and I treat every call as if it were a national emergency, even if they are obviously a load of rubbish. I’m told this feeling passes after a while”. [...]
August 28th, 2007 at 7:39 pm
I have been reading these blogs for a while and appreciate the way that ambulances get sent to us. However, I do worry that one day I’ll get an operator who takes ‘is she breathing normally’ to mean ‘it’s not urgent’. Most of what I call 999 for doesn’t really fit the script for AMPDS- I know, because all the questions are irrelevant when they ask me them! I’ve called ambulances for fetal bradycardia (now when mum is completely 100% fit and well adn the ‘patient’ is not even born yet, that’s interesting). The last two ‘not in labour/needing urgent obstetric treatment’ calls I made, the operator asked me if the woman was in labour or if I could see any part fo the baby about six times. Now 1) I am a midwife and 2) I’d TOLD them that! I think midwifery is one area that is outside normal eventualities. But also it would be great if telephone operators were in some way able to do a proper phone assessment for people in labour- so they could prioritise maternataxis as green calls, where a woman is in early labour and would be asked to make her own way anyway. If we can’t stop people calling 999 at least stop those calls getting in the way of more urgent calls.
August 29th, 2007 at 2:30 pm
Claire: any call from a midwife where there is a problem with the baby or the mother is automatically triaged as a Cat A/Red. But we still have to ask all of the questions including “can you see any part of the baby?” and “is she having contractions”. One of the questions is “are there any high risk complications” and we might not need to ask that one, because you gave the information at the beginning of the call, but that’s the one that triggers the ‘Red response.
It’s just a little bit of annoying red tape to get over with, but doesn’t delay getting help. Maternataxis should usually come out as green as a result of the same questions.
Good news, anyway, the protocols have recently changed so healthcare professionals (midwives, doctors, dentists, nurses) only get asked two questions: “What’s wrong?” and “How quickly do you need us?” Which I think makes a lot more sense!
And PLEASE don’t call us operators - we like it as much as paramedics and EMTs like being called Ambulance Drivers!
August 29th, 2007 at 7:00 pm
Hi Mark,
Haven’t seen anyone including yourself mention the recent ITV1 series “London Ambulance”. I thought that the format is a bit weak and possibly a bit pointless in the grand scheme of things - especially with so many similar programs that litter the digital world of these days - not to mention the superior quality of your blog. BUT… we did catch a glimpse of your control room a 2-3 weeks ago - couldn’t quite pick you out from the crowd though
Keep up the good work.
August 30th, 2007 at 4:06 pm
Actually, I was in the control room the day it was filmed… but somehow the camera pans always cut off just before they reach me…
September 5th, 2007 at 8:19 am
Thanks for a very educational post, keep up the good work, I must say I don’t envy your responsibilities.
The driving instructor
September 7th, 2007 at 12:27 am
“Womble; At risk of wandering off post, you have hit on an interesting point,all the recent discussion surrounding the removal of A+E and maternity from District hospitals seems to assume that all A+E dept’s are two miles down the road, not around here there not! (more like 10-15m) If they move them to nearest specialist centres that are then 25-30m away, its going to be a rough ride for rural patients and that’s just from the ‘clinical’ perspective rather than the ’social’ (i.e not considering what it would be like for the elderly trying to visit their husbands/wives with scant public transport.)
Serves us right I suppose for living in the country”
Good comment - around here (Bognor Regis) we’re currently 7 miles from our local maternity unit/24hr A&E - this has, debatably I suppose, already cost us, personally, a miscarried child…without wanting to knock the hard-pressed ambulance service, since the call centres were centralised, in the event of emergency it’s safest to find a neighbour with a car…recent experience based on two neighbours we’ve helped suggest an ambulance at night can easily take between 45 minutes and an hour to even find us…
Theyre now debating closing down the facilities at St Richards Chichester and possibly Worthing too, leaving us with a choice of Portsmouth (20+ miles off in the next county) or Brighton (some 30+ miles off)…people are going to die…more babies will die…and yet the parasitic blood-leaching local health authority guru (another rich *** with private health insurance) says this will be an improvement…who does he think he’s kidding?
The saddest thing is, as hard-pressed taxpayers and council-tax payers WE are employing these pricks…they are now undergoing a round of public meetings “to discuss options”and can’t even be arsed to organise enough room for the people who turn up (”we’re optimising the debate” they said last time there wasn’t enough room)…I think I’d like to optimise their funeral plans…
September 12th, 2007 at 11:25 pm
I would love to be able to allocate in London for a while, if your “rural” is 5 miles from the nearest Amb station!!
Our rural is 45mins on blue lights to the nearest amb station!
September 12th, 2007 at 11:35 pm
Crikey! What would you do as a call taker if you got a suspended in a location like that? Would you still get the relatives to do CPR for all that time? Do people still expect you to turn up straight away even if they live in the middle of nowhere?
September 13th, 2007 at 12:04 am
Yes the calltakers stay on the line all that time and give CPR instructions, and yes the public expect the Ambulance to be around the corner!
September 18th, 2007 at 5:52 pm
I am stressed just thinking about doing this!
November 4th, 2007 at 11:33 am
We’re 30 miles from the nearest A&E, about half of that on winding rural roads and single carriageway A-road before hitting the dual carriageway.
Not all of us expect the ambulance to be just around the corner. The city blow-ins do, but the rest of us are pragmatic and/or resigned to reality. We know the emergency services do their best and what more can we ask for?