It’s become a bit of a running joke that whenever I work on a particular desk on the other side of the room (usually when I am in on overtime), everything kicks off and there is calamity and disaster. Well, the other week, I worked on that particular desk as an allocator, and it was the day from hell. There were three open leg fractures, an old lady crushed by a milk float, a stabbing, a bottling, a fight between forty people and an extremely suspicious death… but one call overshadowed the rest.

The Desk of Disaster, unlike my usual home, the North East, contains large patches of countryside, the no man’s land between London’s suburbs and the territory of the neighbouring ambulance service. Even on blue lights, running from the nearest ambulance station, it takes at least fifteen minutes to reach these areas. (Okay, I am anticipating a derisive snort for those of you who work for Scottish Highlands Ambulance Service and the like, but for us, that’s a long way. Most Londoners live within five minutes of an ambulance station. It’s rare for me to run one more than three miles on the North East). Of course, not a lot tends to happen in these areas, so they don’t generally cause much concern, and now we have every crew’s favourite Active Area Cover (explanation from Tom Reynolds) we have an ambulance hovering around the one village in this area anyway. Which meant when had a call to an 80 year old man who had fallen and banged his head, we were on scene within 5 minutes. Super!

Unfortunately, fifteen minutes later, another call came in Ruralsville, and now the nearest available ambulance was 8 miles away. It was at one of those big posh country houses up a track, miles from the main road. Response time hell. I gritted my teeth and silently prayed it was going to be something trivial, because we had nothing for it.

“TODDLER FELL IN SWIMMING POOL” typed the call taker. “NOT BREATHING.”

Now, I don’t panic. This job requires one to have a clear head and unflappable nature at all times. But if I was going to panic, that would have been a good moment for it. You may just have seen a bead of sweat on my forehead if you looked closely. There I was, doing a job two grades above what I am paid to do, on an unfamiliar desk, working with people I’d never worked with before, and I had a suspended toddler in Outer Mongolia that I couldn’t cover! This was not good.

The first thing I did was to dispatch that ambulance 8 miles away in suburbia. I can imagine their faces as they saw the address and diagnosis, but they didn’t question it and started running on the call straight away. The second thing was to stop the radio op, who was in the middle of dealing with something else, in her tracks and demand that she broadcast the call straight away. (First rule of dispatch manners: don’t interrupt the radio op, it is v rude and irritating. Second rule of dispatch manners: when you have a suspended child, drop everything, including manners). A crew at the nearest hospital heard the broadcast and offered up straight away. They were still five miles away, but a three mile improvement. I sent them and cancelled the first crew. We were getting there. Checking the log, I saw an FRU had been dispatched from 3 miles away and HEMS had also been sent (these are handled separately by other desks in the same room).

Then, our prayers were answered. The crew who’d been on Active Area Cover in Ruralsville, and were just leaving for hospital with the elderly gentleman on board, called up to tell us they would attend the call to render aid to the child until the others arrived. (They later explained that they’d had a third person, a student paramedic, on board, who sat with the elderly man whilst they dealt with the child). They were less than two miles away.

Meanwhile, whilst my colleagues on the Disaster Desk and I performed the less urgent tasks like notifying the police, the DSO (ambulance crews’ manager) and our managers, two call takers were on the phone to people at the scene. Both these call takers did fantastically and afterwards the crews rang up to ask us to pass on their thanks. One call taker was speaking to an adult male at the scene and got us the full address and directions very quickly. The other was speaking to the biggest hero of the story – a teenage girl who was at the poolside. It was this girl who’d spotted the toddler in the pool and dived in to drag her out, and now, with the call taker’s instructions, she was performing perfect CPR, which she continued right up until the moment the first professionals arrived.

It’s a bit strange in the control room when you get a complicated call like this, because there is so much to do until the crew arrives on scene, but once they get there, it all goes quiet and there’s nothing you can do but wait. Oh yes, and deal with the constant stream of heart attacks, road traffic accidents and teenagers with flu that have come in in the meantime.

About an hour or two later, we had a call from the DSO, who let us know the latest. It was very tentative good news – the toddler had been taken to the Royal London by HEMS and was alive, but in a very serious condition. All the crews involved were going off the road for a stiff cup of tea (except the crew with the old man on board, who had to stop off at the hospital to drop him off!) HEMS told us that the toddler was on a ventilator and was undergoing tests on her brain. They’d let me know the outcome next time I was in.

I thought this was a pretty good example of teamwork and how well people can pull together when we’ve a genuine emergency on our hands. If one piece of the jigsaw – the professionalism of the call takers, the quick thinking of the crew with the old man on board, the prompt action of the crew at the hospital, the heroism of the teenage girl on the scene, the way we on the Disaster Desk pulled together – had been missing, the child would have been dead before anyone arrived on scene. It just goes to show that whilst we might all bicker about each other (lazy crews that spend too long at hospital, unsympathetic control staff who bully crews who have done nothing wrong, call takers who can’t spell, unhelpful members of the public, etc…) when it really counts, none of that matters.

I’d like to say there was a happy ending to the story, but this isn’t Casualty, and there wasn’t. Two days later, when I came in for my next shift, HEMS told me that the tests on the toddler’s brain had come back with bad news, and she’d subsequently died. The consolation was that her organs had been suitable for donation – which they wouldn’t have been if she’d died before she got to hospital – and so even though everyone’s efforts didn’t save her life, they indirectly saved others. So all in all, a good day’s work.

Published Sep 23, 2008 - 28 Comments and counting

28 Comments on “Teamwork and the Disaster Desk”
  1. Lola Snow Says:

    This post genuinely touched me, what an amazing amount of negotiation and teamwork for just one incident. True, life is not like “Casualty”, but this story brings tears to my eyes, unlike any depiction of teamwork in a TV drama. The ending (although heartbreaking) was far preferable to the worst case scenario, and the potential for further tragedy. Your post also reminded me to replace my lost donor card (if they still do them?), something which I had forgotten about completely.
    Lola

  2. dishuiguanyin Says:

    Wonderful teamwork. Inspiring story.

    It’s so sad that the toddler died. I know you professionals are affected by this kind of thing, but at least you can put it into perspective. I hope the teenage girl has lots of support to deal with it though.

  3. Elliott Says:

    Lola – They do still do them, you can sign up online – https://www.uktransplant.org.uk/ukt/Consent.do?campaign=1656

    NeeNaw – Good job; even if the Grim Reaper won this time. I could never do your job… calls like that would break my heart.

  4. Beattie Says:

    Taking a very deep breath after reading that. I’m very glad that there are teams like yours looking after all of us.

  5. Vic Says:

    You’ll do it all again one day, and that time it will be all smiles.

  6. Petrolhead Says:

    It’s calls like these which make our jobs so worthwhile, and make me proud to work for the ambulance service and NHS.

    A tragic outcome, but a job well done by control and the crews involved.

  7. Em Says:

    That really is amazing.

  8. Kieran Says:

    A genuinely touching post. It goes to show what an amazing job you guys do!

  9. Darren Says:

    How much do professional footballers get paid? Whatever, your worth to the human race is a million times their’s.

  10. Natalie Says:

    What a story, and what a teenager! I second Darren’s comment… you can’t possibly be paid enough for all you do!

  11. Greg Says:

    When it all comes together it is like a beautiful symphony. Unfortunately life isn’t always nice. I do hope the rescuer is supported and told she made a difference. Thanks for your posts.

  12. Em Says:

    As a double lung recipient can I say my thoughts are with the toddlers family who made that amazing and generous decision after such a tragedy. I am only alive now thanks to someone who signed the organ donor register, and I have no idea how hard it must be to contemplate giving your child’s organs. However stories like this http://sarahmilne.blogspot.com/ and this http://fairenuff-familypficblog.blogspot.com/ show how badly bravery like that is needed. Thank you for raising that point on this post. http://www.uktransplant.org.uk/register

  13. Liam d Says:

    hello
    i found your blog on the internet tday, and it is really interesting.
    you see i want to become a paramedic, and i recently applied for an assistant ems postions in controll in south east wales, next week i have my assessments, which are the typing test, dictation test and the test on the pre-learning document, and if we pass them then we get an interview on the same day, i have prayed to god that i get this job cause it is my dream to work for the ambulance service.

    im wondering if you can give me some more in depth info on the work you do in ambulance control. the postion is a call taker, so i was pritty interiged by what you had to say lol.

    if you could email me back on my email ill be much appreciated

    cheers

    liam

  14. Mark Myers Says:

    Hi Liam! If you search my blog for posts entitled “How to become a Nee Naw Controller” you’ll find some info about my tests/assessments/interview/training and if you look at some of my earlier posts, there’s lots of stories about call taking. Hope that helps!

  15. Liam d Says:

    hi mark
    i dno if you can help me with this but, in the dictation test did they speak normally or slow??

    im really worrying about this test, if i fail i know im going to fail on this one lol

    do you know how you can revise for a dictation test??
    cause its really bothering

    if you can help me itl be much appreciated if not then no worries

    cheers liam

  16. Mark Myers Says:

    Don’t worry about the dictation test! It was easy. They spoke slowly enough for you to write it down. They just want to see you have basic literacy and listening skills – I don’t think anyone fails on that bit because people who can’t read and write wouldn’t bother applying!

  17. deek_m Says:

    Had occasion to take a call which resulted in a patient waiting for a liver transplant going into cardiac arrest. The locus was 31 minutes from the nearest crew and out-with the landing capability of hems aircraft.

    As soon as we spotted how far away the patient was from help, the dispatchers started phoning round local gp surgeries but the best they could come up with was a midwife that was on duty at a med centre across the road. Once she got beside the patient she took over cpr from the mother but what she did next was probably the best thing that could have happened to the girl…..the midwife was dating an ex paramedic and she called him to the scene and between everyone involved, the patient was eventually taken to Hospital and underwent an op that saved her life.

    As you say it’s not casualty and there was some serious additional health problems that were attributed to the delay in specialist hospital treatment being given.

    Why the patients mother hadn’t considered moving nearer a main town or city when her daughter had such a life thretening condition is beyond me.

  18. deek_m Says:

    Liam, if the test you do is the same as the one thats given in Scitland then the dictation part usualy consists of a number of addresses being given over the phone and you having to type them into an address box. Our test centre has somethng like 100 addresses in the training audio file, and from the beginning you will hear an address, then it’s repeated and if it’s a complicated one like a street beside another street or stated in the term something like “beside the chip shop on the high street” rather than a fully listed address then it will be repeated a third time.

    Our test for this part is 10 minutes, at the end of which you’ll have been expected to input about 30 addresses. Some people do less than that as you can press backspace and have the audio repeat the address it’s just given.

    The key to passing the test is recording the information acurately. Flats are input similar to this: 1/1 high street, anytown-should be input as 1 flat 1 high street anytown. some punctuation marks don’t display correctly on the invehcicle monitors so the ability to give the address correct first time from what the caller has stated at the start of a call is important.

    Required typing speed up here is 35wpm, although it’s accepted that on the day of a typing test other factors such as nerves will have an affect on someone’s ability to type at that speed and be accurate, so there is an allowance for errors and therefore a pass mark of 28 wpm is ok.

    Better to concentrate on accuracy than speed on test day…….good luck

  19. deek_m Says:

    so Liam d, a good way to revise is this. ask a friend to look up 30 or 40 address from the phone book, include other places as well like the local cinemas or leisure places and while you type ask them to time you for 10 minutes and fire off some addresses at you. If you’ve no one that will do that, if you have a microphone on your pc record 50 addresses or places of interest into your pc and play them back usinmg windows media player or similar and have it play the selections randomly. You just type what you hear. then go back and check. If your copying is ok, try and increase your speed.

    When the addresses are being read/played to you then they should be given clear and concise. then repeated, then allow a gap of about 20 seconds to start the next one.

    Also, don’t just use easy addresses, like The High Street. Try using places with difficult spelling and others that are off the beaten track In our test there are always some of them.

    Lastly, don’t panic or get worked up. if you miss one address, don’t worry just go on to the next one. They’re not looking for typing professionals, just people that will listen and be able to relay the information as given.

    Once your in an EMDC proper you have all sorts of aids for putting address in place and on most occasions you will never type a full address again, the comp will find it from small parts of the info that you type in

  20. Liam d Says:

    OMG thank u so much deek m, thats really helpfull, thank u so much. ye ill try that see if i can do it. ive been on this website.
    its this woman speaks like, does a paragraph and you gotta listen to it, and another then when she speakes more slowly, and thats when you write, so i been trying that.
    on the job specifcation it says, required 20wpm, well im on the computer everyday typing and talking to people so i shouldn be to bad at that.

    thank you very much for your help and hopefully ill c if i get to and interview.

    if i pass both of them than i will let you both know on here THANKZ AGAIN BOTH WILL LET YOU BOTH KNOW.

  21. Sam Says:

    This blog entry made me cry and cry. What a wonderful family that child had to be able to say yes when they were in a time of trauma and unbelievable stress. My daughter is waiting for a liver transplant, we are listed and waiting for the call. Her life is going to be saved by someone saying YES. You can read about her on her health update site http://www.caringbridge.org/visit/bethanysalmon (we are one of the families mentioned by Em earlier).

    deek_m, I dont want to get into a debate, each to their own, but you really need to consider living in someone else’s shoes before you make comments like “Why the patients mother hadn’t considered moving nearer a main town or city when her daughter had such a life thretening condition is beyond me.” So many people in my situation get frustrated with other peoples opinions on what we should do. Walk a mile in my shoes, feel my stress, feel the swell of love and joy just to see your child do something normal, suffer the sleepless nights, deal with the torment and anguish of never knowing when the call will come and being unable to make any plans. Now, could you add moving house to that? I can’t pretend to know what that family was going through, everyone deals with things in their own way, but I do know it’s not as simple as just moving.

  22. Stonehead Says:

    An excellent bit of teamwork, but I do wonder if it happens elsewhere.

    When our youngest went into anaphylactic shock, his airway closed up until he could barely whistle a breath in or out and he was cyanotic but the calltaker (Yorkshire) was very distant and robotic as she explained “there were no ambulances available as they were on high priority calls”. She told me this several times and said I’d have to wait “some time”, so I hung up and ran two miles with him to the GP’s surgery.

    And for the doubters, a Google search will throw up more examples from Yorkshire, like the lady who called for an ambulance for her husband (heart attack) and was told it could be a two hour wait. Or the woman whose daughter died after waiting an hour for an ambulance (an RRV was there in about 20 minutes but couldn’t transport). There are others.

    And no, not trying to take away from the teamwork mentioned in the post, but it’s a upsetting and annoying to see what can be done and yet isn’t in other places.

  23. Mark Myers Says:

    Do you think the examples you mention is due to a lack of teamwork/people caring, or a lack of resources? When someone has a long wait for an ambulance, should you blame the ambulance service, or the people who call them out for non-threatening conditions? Do you think the ambulance service ever deliberately withholds help from someone who needs it?

  24. Stonehead Says:

    I think it’s a combination of lack of resources, wasted resources, poor recruitment and training and poor leadership and management.

    In some ways, calltakers have one of the toughest jobs in the emergency services—they have to deal with distressed and panicking people while not being able to help directly themselves and knowing just how limited resources are at any given time. They have to be calm, controlled and unflappable, but they also have to be compassionate and understanding. And, of course, being firm (and allowed to be firm) with the genuine timewasters.

    Doing that day in, day out requires very careful recruitment and training, plus good leadership and management to keep calltakers at their best.

    On top of that, a calltaker who knows there aren’t enough resources to go around is going to have to tell distressed people that help isn’t coming or that it will be delayed. Coping with that requires putting the emotional barriers up and that comes over as callousness (as with the calltaker when I phoned about my son). Thinking about it afterwards, it was quite clear she was trying to distance herself from the horrible reality that she had someone with a seriously ill child but the dispatcher was telling her no one was available to help.

    As for your final question, of course ambulance services withhold help from people in need. They have to as there will never be enough resources to go around. Take the example of my son, he was barely able to breathe and was cyanotic. But what if the available resources were allocated to someone who was suspended? Who’s the priority? The one that’s gone a pulse and breathing, if barely? Or the one that has neither?

    Having said that, I think that ambulance services—particularly outside London—are under-resourced for what they’re expected to do. I live out in the boonies these days and accept that waits are inevitable, but one ambulance covering the area at night is ludicrous given the population and the geographic area. (Even more so when the out-of-hours GP service is often unmanned, when the minor injury units are closed, and the nearest A&E is an hour away.)

    Anyway, I hope it’s clear that I’m not bad mouthing the front-line staff. I know where they’re coming from but it’s extremely unpleasant when you need help, none is available and the person you’re asking to send help is cold and distant.

  25. Stonehead Says:

    Sorry, typing too fast. That should have read:

    “The one that’s got a pulse and is breathing…”

  26. Mark Myers Says:

    It’s not “withholding” help if there is no help available. Your first comment made it sound rather like we have a battalion of ambulances sitting on station that we choose not to send to people because we are lazy, incompetent or just plain cruel. From your second comment I appreciate this isn’t quite what you are trying to say, but the first one did come across as a bit of an attack on control staff. It does get to me when people start pointing out the relatively rare times when we don’t do as well as we could have, when we are trying our hardest to make sure these things never happen, and most of the time they don’t.

    Regarding the “cold” attitude of the call taker, I can sympathise with her, because what she was doing was just part of the routine and what she does many times every single day. If you imagine something you have to do at work routinely and the clockwork manner in which you do it – dealing with someone having a heart attack is like that to us! I think I’ve mentioned before, I sometimes deliberately pretend to be shocked by calls to reassure callers that we care – but if you go overboard on that, you can sound incompetent/inexperienced or just fake! It is very difficult to get the tone of voice right, and if you don’t try, then yes, it probably comes out flat and emotionless.

    Another thing is that the only call that is higher priority than an allergic reaction with DIB and cyanosis would be a cardiac arrest. I highly doubt the other ambulances in the area were ALL out on cardiac arrests at the time and there is a good chance that one was out on a 20 year old with flu who we are not allowed to put our foot down to and refuse. And I wish people would get angry about this and not about the poor staff who are doing their best and are just seen as useless and uncaring…

  27. Stonehead Says:

    Getting overly defensive and rejecting my experience as yet another attack on poor staff is missing the point. It is profoundly shocking to call for help in a genuinely life-threatening situation and to find not only is no help available, but that the person you’re talking to gives the impression of not giving a stuff. All the reasons behind that response are irrelevant at that point—all you know is that you are on your own, you have to find your own solution, and if you get it wrong, your child is dead. That’s a ****** hard place to be.

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    Nee Naw
    Nee Naw was a blog about life in the London Ambulance Service control room. It was written by Suzi Brent from 2005 to 2010. The blog is no longer being updated, but the archives will remain here.
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