This week, a bulletin came round from the control room from the Complaints Department. It said that when ringing back lower priority calls, people have been saying things like “We don’t have an ambulance to send at the moment. All our vehicles are out on higher priority calls, like heart attacks, babies not breathing – that’s what we’re here for”. The bulletin said we should not say things like that, because it gives the caller the impression that their call isn’t important.

I just don’t agree with this. It seems to be saying that it is wrong for Control staff to try to educate people about the proper use of the service. How are we ever going to cut down on inappropriate calls if nothing is done to teach people? By not saying things like that, we are effectively encouraging people to hang on and wait for an ambulance they don’t even need when a subtle prod would have them seeking more appropriate help which they could obtain more quickly. (We do have a telephone advice service, CTA, who ring back lower priority calls and try to point callers in a more appropriate direction, but they’re very busy, so callers have to wait about half an hour for a call back, and if the caller refuses to speak to CTA or insists on an ambulance, there is nothing they can do – we have to send, except in a very small number of cases which are covered by the almost defunct No Send Policy).

Of course, we are not *only* here for heart attacks and babies not breathing. Not every valid call is an immediately life threatening emergency – but if the call *isn’t* immediately life threatening, there should be a concrete reason for needing the ambulance (“Can’t afford a taxi” does NOT count!) – in most cases, it’s because the physical condition of the patient prevents them getting to hospital any other way. An elderly person who has fallen and has minor injuries is an example of a valid but low priority call (actually, if I had my way, it would not be a low priority call at all, but that’s a topic for another post) and it would just make the poor patient feel bad for “bothering us” if we were to point out the more serious calls we have to deal with. But for calls of the variety of sprained ankles, kids with temperatures, stomach aches, etc, I really think “We’re here for heart attacks…” is a totally appropriate and useful thing to say. Thoughts? Do you agree with me?

Published Sep 29, 2008 - 55 Comments and counting

55 Comments on “We’re here for heart attacks and babies not breathing”
  1. Tom Reynolds Says:

    Oh dear… have people up in EOC been using ‘common sense’ and ‘initiative’? That just won’t do now will it – I think a blanket ‘advice and guidance’ disciplinary will soon beat *that* bad habit out of you all.

  2. Mark Myers Says:

    Actually, we’re too busy chasing ambulances that have spent half an hour at hospital and putting crews on breaks and Active Area Cover to ring back any delayed calls, so it’s a non issue…

  3. Erin Says:

    It drives me nuts how we can get the crap abused out of us, but the minute we’re sarcastic, blatantly truthful about their injury, or even snap, we’re in the wrong. Yet the caller will never be pulled up on it. They should seriously be sent a bill for every horrid thing they say to a call taker.

    Now I can understand stressful behaviour, when I’m stress and scared, I swear like a trooper without realising it. I will always give people the benefit of the doubt when it comes to things like that. (or wait 10secs after the call disconnects and swear my head off right back at them.)

    But I once had a woman who was so foul, who refused to get me an address “Because you like, should get it from me mobile, I called in on me mobile.” And no amount of insisting that I needed to know the street, the full name of the place she was at, or heck, even the damn county at the very least, would work. All she had done was sprain her wrist slipping over in some mud. She had her best friend with her, who drove, and had a car, and who also refused to go ask someone, anyone, where the hell they were.

    I finally managed to get an address from three identifying features she had shouted at me (google is god, and I’m annoyed now they’ve taken it from me), and it came out as, “You’re in a public place, so we will respond as emergency.” Needless to say, we were run off our feet that day, and 20mins later, she was on the phone again and wonder of wonders, it came to me. The BT gods hate me some days, they really do.

    I had to retriage the call and wasn’t she happy about that. During the usual spiel of “We are very busy at the moment, but we will be with you as soon as there is a crew available…” was interrupted by the biggest amount of swearing and name calling I believe I have ever recieved. Aimed at me and the ambulance service in general. I’m used to being sworn at, but I really take offence when it’s the crew who’s getting the abuse. I don’t know why, I’m just a little overprotective of them. So I responded to her by letting her know, fairly politely, that the last call I had taken was that of a drowning baby, and I’m sorry, calls like that take priority, and we’re a little tied up trying to stop people dying. But if she gets worse in any way, call us back immediately.

    Now, there hadn’t been a drowning baby. That was the shift before, but she didn’t need to know that. Suffice to say, after she disconnected with me, she called back up 20 mins later to abuse another call taker and then took herself to hospital.

    And my previous record of 100% customer service in audits took a hit because of that one stupid call. That still really annoys me. I hope she had to wait 2 days in casualty before someone saw her.

    Sorry for the long post, but this whole subject is something that really irritates me the most out of anything.

  4. Mark Myers Says:

    Erin – that sounds so unbelievably annoying and frustrating. As you say, WE get pulled up for our customer service but there’s no reprisals on the caller for speaking to you in that vile way – it’s so unfair. And what makes it even more unfair is that what you said was a perfect valid point, and if no one else was going to stand up for you and tell her she was behaving unacceptably… why SHOULDN’T you say it?

  5. Erin Says:

    I sometimes think we get so disassociated with the injuries people are having though, that we can get a bit harsh unnecessarily. The whole mentality of “if the patient is conscious and breathing, why should we care?” and I see people in my area get snipey at callers who maybe do need an ambulance because they have no other option. So there are some times when the remarks some call takers make should be critiqued. I know one call taker who every time she gets a suicidal patient should be beaten over the head with a 2×4 because of the tone of her voice and her choice of words. But when they’re rude like that to you, and you’ve determined that they’re a genuine time waster and not just a snapping scared person, why can’t you simply say the truth?
    “I appreciate your situation, I would love to send you an ambulance, but then tell me what you would say to the family of that man three blocks from you with a ?MI if he dies while we’re showing you how to put a plaster on?”

  6. Mark Myers Says:

    Quite. I think another reason for this problem is because the AMPDS system doesn’t distinguish between inappropriate calls and low priority appropriate ones. Because we haven’t got anything scripted to say, we start being arsey, which is the wrong thing to do but it’s out of frustration, not genuine arsiness.

    What you say about psychiatrics, I have also noticed and the whole “mental illness isn’t a real illness, he’s just a nutter” attitude annoys me. Psychiatric calls can be appropriate or inappropriate just like medical and trauma calls can!

  7. Sue Says:

    My parents had to ring 999 for me once – it was *only* a blocked catheter but I was screaming in pain and was only a week post discharge after having my bum sewn shut (which had gone wrong and I had a 10cm deep hole there!). LAS were v busy, and someone rang back but they said we did need the ambulance and were really nice, and the crew were lovely too – shame the doll in A&E did not understand the “can not sit at all, got a huge hole in my bum”!! I was mortified at having to ring though.

    Oh, and the other week I had a sub-acute small bowel obstruction and I got the bus to A&E (even though I could hardly stand upright by then). Have Oyster, will travel!

  8. Mark Myers Says:

    Blocked catheter is a good example of a low priority appropriate call! That would have been CTA ringing you back, I guess. Bowel obstruction on a bus – ouch! I am impressed! (Not sure impressed is the right word!)

  9. Boy on a bike Says:

    I may be wrong, but I think Australians are more careful about calling an ambulance, because over here, you have to pay for it. The callout fee in NSW is $290, and then a per km rate on top of that – to a maximum charge of $4700. My son was hit by a car last year, and the closest hospital that could treat him properly was 100km away (we were in the country). The ambulance bill was over $550.

    Which is why we all have ambulance cover as part of our private health insurance – the insurance paid for it. Certain groups pay a concessionary rate (war veterans etc), but they still pay one way or another.

    If you want to cut down on the time wasters, you have to make people pay for the service. They have to understand that it isn’t free.

  10. brunette Says:

    “We don’t have an ambulance to send at the moment. All our vehicles are out on higher priority calls, like heart attacks, babies not breathing – that’s what we’re here for”

    Got no problem with this statement, except perhaps the last 5 words. The above statement without those 5 words is education of the way the ambulance system should work, but those last 5 words are the part that would offend. Often the message is right, it’s the delivery that sucks.

    Boy on a Bike is right – in Australia we pay for Ambulance trips. I’m not sure that it goes anyway to preventing call outs though, if people are paying for it, they might actually see themselves as more entitled to a trip via ambulance. Why get a taxi when I’ve already paid for an ambulance via my private health insurance?

  11. Petrolhead Says:

    I do agree in principle, but it depends on the manner in which it’s said.
    If the call taker comes across in a way that sounds like they’re telling the caller off or being rude, I can see that the caller would probably get agitated and complain, but if they put the point across in a way that the caller understands, with a respectful attitude, then it’s positive.
    On so many occasions I’d love to be helpful to my callers and give them the NHS Direct number, but policy says that we’re not allowed. That’s what gets me – sometimes, callers just don’t know how to contact other services, such as out of hours GPs and NHS Direct. Yes, it’s obvious to us, but what if the patient is elderly and has never had to use it?
    On the other hand, I’d love to explain to some of our regular callers exactly what kind of life-threatening illnesses/accidents that could have been dealt with by the crew who was tied up with them fetching their TV remote…

  12. Chris Rigby Says:

    Nope, a totally inappropriate comment. Better would be “A sprained ankle? OK, we’ve got one ambulance available, and my colleague’s just had a call about a baby that’s stopped breathing. Can I give you a taxi number, or shall I send you the ambulance and leave the baby to die like her sister did last week?”

    Followed by “Sod off and die (that’s cat A) you worthless lowlife” when they inevitably say they want the ambo!

  13. Lightsandsirens Says:

    boy on a bike- here in Western Australia so long as insurance conditions are met the ambulance costs for mvc’s are met by riskcover. All vehicle licenses include a premium for third party personal injury. I thought that the rest of the country would be similar.
    Brunette- Generally people who have private health cover aren’t time wasters. It seems that it’s the people in state housing who drink til their organs fail and need an ambulance because they missed the dialysis appointment because they couldn’t afford to get there are common. These people either have ambulance cover (around $30 a year unlimited use) or just never pay the bill.

  14. Erin Says:

    Petrolhead– don’t you have the function of when it’s a cat-a, passing it to NHSD? And I’ve been told if the person says “I want a doctor!” I can give them the out of hours or NHSD number once I’ve determined that it’s not for one of the priority complaints. (in other words, “why do you want one? oh, you have a tiny splinter… right…. NHSD?”)

    I’m always handing out that number or pushing them through. I’m getting very good at shouting at the dispatchers “Stand down whatsis call sign!” :P
    Mind you, there’s a certain group who seems to send them anyway, and that’s the most frustrating thing under the planet.

  15. Mouselet Says:

    I am a regular reader of this and other similar blogs and am fully aware of what the ambulance service is for. However, I recently found myself assisting a man with Motor Neurone Disease who had cut his face. The obvious solution was “drive to A&E” but I wasn’t going to inflict Saturday night A&E on a man in his condition. What I needed was a doctor/medic to come and out and tell me whether he needed stitches or not. Unfortunately, they don’t exist. As a result I called 999. The EMTs were great, patched him up and said that he didn’t need stitches, but I still felt stupid.

  16. Mark Myers Says:

    Erin: We are explicitly forbidden from giving callers NHS Direct or GP phone numbers. Apparently it all boils down to the legal principle of medical abandonment, which, according to the training department, states because they’ve rung *you* for help, you are not allowed to tell them to ring someone else. (Actually, I just googled it and I don’t think it says that at all, but what would I know, I am not a legal expert!) It is frustrating because sometimes the callers are actually asking you for advice and don’t want an ambulance and all you can do is ask the questions and hope it comes out as CTA Suitable.

  17. Weefz Says:

    I can fully understand the frustration with inappropriate calls. The part I worry about is that saying things like this could discourage people like the old lady you wrote about a few days ago with the “silly pain in her chest and down her arm”.

    As brunette says, it’s “that’s what we’re here for” that’s the real problem. That sentence tips it across the line from education to passive-aggression.

  18. Flora Gardens Says:

    I suspect this is the medical abandonment thingie:

    “Abandonment of a patient, in medicine, occurs when a health care professional (usually a physician, nurse, dentist or paramedic) has already begun emergency treatment of a patient and then suddenly walks away while the patient is still in need, without securing the services of an adequate substitute or giving the patient adequate opportunity to find one. It is a crime in many countries and can result in the loss of one’s license to practice. Also, because of the public policy in favor of keeping people alive, the professional cannot defend himself or herself by pointing to the patient’s inability to pay for services; this opens the medical professional to the possibility of exposure to malpractice liability beyond one’s insurance coverage.”

  19. Mark Myers Says:

    Yeah, I found something like that too, but I am not sure that pointing someone who wants advice from the ambulance service (who are unable to provide it) in the direction of NHS really constitutes “abandonment” – I think it counts as “securing the services of an adequate substitute” personally.

  20. Ellie Says:

    last summer i fell over on my rollerblades and felt my hip ‘pop’ when i tried to move i absolutley could not move my leg unaided, i was terrified to put any weight on it and had to be lifted to a bench by my friends. we called an ambulance because i couldnt sit up enough to go by car. i really felt guilty about doing so as i kept thinking i should wait it out (i have a form of hypermobility and various joints dislocate and relocate all the time) the calltaker and crew were fantastic but i still feel i should have done something else.

  21. quixote Says:

    (Mouselet, wasn’t it Mark who said –more elegantly– that the ones who do need an ambulance think they’re wasting people’s time, and the ones who don’t, shout?)

    Mark, the closest I’ve come to doing your job is filling in for the plant person on a poison control hotline for a day. (I’m a botanist.) I only had 3 or 4 calls that whole day, and by #3 I was already having to bite back smart remarks. I have no idea how any call taker keeps their cool.

    The call I remember was a panicked mother whose son had eaten some blue berries. The only even slightly probable poisonous blue berry in that area was belladonna, which is the size of a small cherry and almost black, both traits quite unlike any other bluish berries around there. I simply could not get her to slow down enough to tell me what the damn berries looked like! It took about ten minutes of hyperventilating just to get to that point.

    The reason I’m describing it all is that I’m pretty sure if God Herself had told her to calm down, no matter how politely, she would have gone rocket-shaped and wound up in orbit.

    What that brief experience suggests to me is that the real problem for the call takers is that the geniuses who come up with your scripts don’t listen to you folks. There are whole categories of calls for which they haven’t given you anything.

    They’re the ones who need to get their act together. Not the call takers, trying to handle umpteen calls at once, some of them matters of life and death.

  22. Ellie Says:

    “…it gives the caller the impression that their call isn’t important.” Isn’t that the whole point? I wish more services (the one I work for as an example) would attempt to educate the public about how to appropriately use the 911/999 system.

  23. Lanes Says:

    On the “Pay for your Ambulance” theme…

    We have a similar system in NZ. If we make the callout, we pay – however, ambo’s have discretion here, and can choose not to charge for the callout. ie, if it’s a REAL emergency, they don’t charge. If it’s a timewaster, they get charged. Makes you think twice about whether your call is important before you dial.

  24. flow Says:

    I’ve just found this website and I’ve spent two hours reading all the posts – it’s fascinating and informative stuff!

    I’m amazed by the idea that there are people deliberately calling ambulances they don’t need – it must be incredibly frustrating to deal with. But I just wanted to add this thought: not all the inappropriate calls are deliberate and malicious.

    Unfortunately, the times when people need an ambulance – or think they do – tend also to be times when frightening things are happening and people are panicking … and people don’t always make good decisions when they panic!

    This is why I think the option of giving callers advice is a VERY good idea.

    I know this, cos I once called an ambulance ‘inappropriately’ (many years ago when I was young and much less sensible, I hasten to add!). I was just a teenager, and a friend was staying the night, and we were in the house alone. She woke me up at 3am saying she had gone totally blind. I had NO idea what to do – blindness seemed both serious and urgent to me – and we were both scared and panicky – so I called an ambulance.

    Of course (you knew I was building up to this) my friend’s vision started to come back as soon as the ambulance arrived, and was more-or-less normal by the time we got to A&E.

    The crew who came were great, but the house officer at A&E gave me a VERY hard time. He told me off, and threatened to charge us. I agreed that – with hindsight – it probably hadn’t been a job for an ambulance – but my point is, I *didn’t know* that when I called 999 – I called *in good faith*.

    IF ONLY someone had been able to ask some thoughtful questions, or even been allowed to suggest we called a taxi – which simply didn’t occur to me! That ambulance did have a wasted journey, but as the person making the ‘inappropriate call’, I regretted the waste as much as everyone else!

  25. Always Tired Says:

    In our area where we have green calls which really don’t need an ambulance we have a local policy which has us directing their inquiries to NHS Direct on their behalf. This usually means us calling NHSD on the patients behalf promising them NHSD will call them back within 10 minutes. Works ok when NHSD can actually be bothered to answer their phones!!

    I think there needs to be a massive education programme in this country about what the 999 service is actually for and what alternatives there are in a non life threatening case. I feel that the simple move of making the first aid at work course compulsory for 16 years olds under the citizenship course in schools would be a start! But 999 education needs to start at primary school and continue throughout education and perhaps then we might start to see a difference in the calls we get.

  26. Sewmouse Says:

    1) Always Tired states “Works ok when NHSD can actually be bothered to answer their phones!!”. If the 999 people cannot get the telephone attention of NHSD, then assuming that the patient will have any better luck seems disingenuous.

    2) I agree that the last 5 words are the kicker. Leave them off, and you’re not ignoring or belittling the patient’s call – just prioritizing.

    3) I think that getting sarcastic with comments like “A sprained ankle? OK, we’ve got one ambulance available, and my colleague’s just had a call about a baby that’s stopped breathing. Can I give you a taxi number, or shall I send you the ambulance and leave the baby to die like her sister did last week?” or “I appreciate your situation, I would love to send you an ambulance, but then tell me what you would say to the family of that man three blocks from you with a ?MI if he dies while we’re showing you how to put a plaster on?”, while perhaps immediately “satisfying”, would in the long run be counterproductive.

    Dealing with the public in ANY job is stressful. Ask a cop. Ask a salesclerk. Ask a beautician or barber. Ask the Station Agent in the mass transit of your choice. This is why I became an accountant – because numbers only RARELY argue or smarta$$ at me.

  27. MarkUK Says:

    OK, so what’s appropriate in this case?

    One of the blokes at work, a 68yo with an impeccable attendance record, had some pains in his chest. He took a morning off work to go to his GP. The GP did not think that there was a cardiac issue but wanted the patient to go to the hospital “No rush, but you should go today – and by the way, don’t drive”.

    The patient was going to get the bus (8½ miles) to the hospital. However, he phoned his son (a Production Manager at the same company) who took his dad in.

    The hospital found an irregular heartbeat. After tests and scans, the patient was diagnosed with a pulmonary embolism but not a particularly bad one. He’s being warfarinised.

    Now, who should have taken the patient to hospital? IMHO, he should have called an emergency ambulance himself as he had chest pain (and is 68). Granted that he is of a generation brought up not to “bother” the emergency services, the GP should have called it as a “doctor’s urgent” – chest pains, and he’d told the patient not to drive.

    The least acceptable was a 35 minute bus ride for an elderly (and he’ll kill me if he finds out I’ve used that word!) patient with a chest pain.

  28. Steve Says:

    MarkUK – it should be an ambulance every time for chest pain. Infact, the GP should have called it there and then – he/she didn’t “think” it was cardiac related, but there’s no way to rule this out without blood tests. I really hate it when GPs do this.

    I’ve been to a man who (according to his wife) was given exactly the same advise from his GP, and walked home to get his bus pass. We found him on his front door step in cardiac arrest.

  29. Steve Says:

    Just to add – a PE, even one that’s “not particularly bad”, can easily become fatal. It can either grow, or become dislodged, and move to a smaller blood vessel wither in the heart or in the brain.

  30. MaverickMDM Says:

    Hi Mark Myers,

    I am currently applying to join LAS; your blogs make a great read.

    I was wondering where you got the name Mark Myers from?

  31. Petrolhead Says:

    MaverickMDM, most police forces in the UK have a non-emergency contact centre, and the health care equivalent is NHS Direct. However, even the police get inappropriate 999 calls because the non-emergency number isn’t publicised enough.

  32. Rosy Says:

    Question for Mark:

    A couple of years ago I had a bike crash, and (as it turned out) broke my elbow. I got straight back on my feet and tied the bike to a fence, and set off home. After half a mile or so the adrenaline wore off and the movement involved in walking was making me cry.

    Fortunately, I was with my boyfriend and he (after parking me in a nearby pub) went home for the car and drove me to A+E.

    Now, to my mind that’s not an ambulance call. I could, after all, walk quite OK and the pub I was parked in was another half-mile on. But on the other hand I’m not sure, given that I didn’t have the cash for a taxi, taxis in my experience don’t take plastic, it was about 10:30pm* and I was about several hundred yards from the nearest cash point, what else I could have done had the car not been available (we’re one of only two couples in my circle of friends to have access to a car, so calling a friend for a lift was right out).

    Do A+E’s have cash points these days? If not, can anyone think of any reason why it wouldn’t be a good idea for them to be installed as a matter of routine outside all A+E’s so that people can get taxis even if they haven’t any cash (not no money, you understand, just nothing to hand to pay the cabbie).

  33. Rosy Says:

    Oops, forgot to add the *

    * No, I wasn’t drunk. I’d just left the lab after a 14 hour day and hadn’t had any dinner yet, so I was a bit tired and maybe thinking more about what to buy at the corner shop than about the road…

  34. Mark Myers Says:

    Rosy: I would have had no issues whatsoever with sending an ambulance to someone in your situation. However, the reason you were a “valid ambulance case” was because you’d been involved in an RTA and had a broken bone NOT because you had no money. You might have had more serious injuries from the accident and not realised, and a broken elbow is good enough reason to travel by ambulance because they can immobilise it and offer you pain relief.

    However, I do get a bit irritated by the “I can’t afford a taxi” reasoning. I hear it a lot and what I want to say (and am not allowed, of course) is “We are here for medical emergencies, not financial ones. You can’t afford a taxi, and we can’t afford for our ambulance to be used as one. Besides, if you can’t afford a taxi TO the hospital, how are you going to get home FROM the hospital?”

    But I would like to emphasise I would only like to say this to the trivial callers (cut finger, kids with the sniffles, ingrowing toenails, etc etc) NOT to someone who has broken their arm in an RTA!

    The hospital I used to work at (the Whittington in North London) had a cashpoint outside A+E – no idea about any others, though. You’re right, it does seem a sensible idea to have them there.

  35. Mark Myers Says:

    MarkUK: You should always call an ambulance for chest pain. Especially if you are over 35, have a cardiac history or any of the other symptoms of a heart attack (pale, cold, clammy, pain down the arm, dizziness, nausea, difficulty breathing, etc). If we get a call for chest pain, we always treat it as an emergency and assume that the patient is having a heart attack until proven otherwise.

  36. Rosy Says:

    Ye-es. I do totally see where you’re coming from, but as far as I was concerned I’d stupidly fallen off my bike (no other vehicles involved) and bruised my arm. Which apart from the total obnoxiousness and the fact there was a car available (in both cases, infact) isn’t really distinguishable to the lay person from the sprained wrist for which the stupid woman with the mobile phone was demanding attention.

    I guess had I had a similarly incapacitating accident in the home (previous comments about sprained ankles) I would have been somewhere safe (and warm) and could have summoned a friend to lend me some cash for a taxi and been OK waiting for them to show up..

    And I do think the question of being able to (physically, in cash) pay for a taxi is one that needs looking at. Not by the ambulance service/calltakers, it’s not your problem, but certainly by someone. The amount of money it would save the ambulance service would probably be worth it… even if it was something along the lines of taxi firms having accounts with the hospitals and the hospitals being equipped to take card transactions and checques in payment. As the world (well, my world) gets less and less cash based, I now rarely carry more than a couple of sandwiches worth of cash on me which wouldn’t get me to a hospital and certainly wouldn’t get me back again.

  37. Mark Myers Says:

    Yep, I agree. Some kind of “pay later” arrangement for getting to hospital by taxi if you need to get there unexpectedly would be good, or maybe even free transport there for elderly people and those on a low income.

  38. Mark Myers Says:

    Mark Myers was the real name of one of my teenage idols. 10 points if you know who it was!

  39. Erin Says:

    Chest pain is always an ambulance and I have spent many a night having pleading conversations with old dears who ring up for chest pain and then say they don’t want the ambulance.

    I get annoyed with patients who have constipation and ring 999 with no presenting symptoms other than the fact they’ve been sitting on the loo for an hour to no effect. If you can sit on the toilet you can sit in a car.

    To people from the outside reading all this, it might seem calltakers can be malicious and we don’t care. But trust me, we do. We care so much and get treated like crap over and over again that when we get a time waster who is rude and abusive, sorry, but why should we care?
    And the timewaster title generally goes to someone who is an idiot and capable to get themselves to hospital–or shouldn’t be going to hospital at all. Not an old dear or someone unable to get to the hospital on their own steam.

    The amount of times I have sat looking at the screen utterly frustrated that the male with a cold who rants about his right as a tax payer gets a red call and that sweet old dear who is being transported to hospital for tests by the doctor has to wait another 4 hours after already waiting 2 because of time wasters.

    I have to take my quiet delight in the triage nurse at A&E making them sit in the waiting room for hours. Maybe that’s one thing we should educate people with. An ambulance only gets you to the hospital. It won’t get you the bed straight away and on some nights it might even not get you a chair in the waiting room because of other time wasters doing the same thing.

    Rosy-We can sometimes send taxis to people that the service pays for, but they have to be a green call or lower, and we need patient assessment by a triage clinician and the patient to agree.

    Mike-I can’t believe you don’t pass to NHSD! I know you at LAS though can turn down sending out, though, I read that somewhere. NHSD is our way of not sending out yet not abandoning because we transfer rather than say the nurses will ring them back. It’s so odd how different we are yet we work in the same country. I don’t get it.

  40. JB Says:

    I don’t really mind people calling because they don’t understand the service and they think they really need an ambulance, that’s just a lack of understanding.

    But having taken a call recently where the caller only wanted us to deliver meds, and upon being told this wasn’t a service we could offer stated ‘well what will you do if I say have chest pains? You’ll send an ambulance then, I have chest pains’.

    That hurt, to have a really bad day and then listen to that!

    We should be able to take people on the way they say things as much as what they say the problem is, but alas…

  41. Always Tired Says:

    Last night was a case in point for us. A horrific road accident which was described by long serving crew member (20 years plus) as being the worst he had ever attended, a male who had hung himself (who the call taker and caller managed to just about bring back as the crew arrived), a male who had cut his wrists and then decided to sew them up himself and a 15 year old girl who hung herself and we couldn’t bring back.
    Follow this with some *expletive, deletive* who phoned for an ambulance to take him home because he didn’t feel safe when he was stood next to a police station!

  42. MaverickMDM Says:

    I dunno, who is Mark Myers?

  43. Sadge Says:

    This is an interesting thread, and particularly interesting to hear how different ambulance services work.

    In my opinion, and going by what I’ve read here, these people that call for an ambulance inappropriately don’t seem to be intentionally abusing the service- just have a lack of understanding. But I don’t feel it should be the call takers’ job to educate them. Surely thats for the service or the government??

    Or perhaps wouldn’t it be more appropriate for the ambulance crews when they arrive to perhaps suggest that next time they consider phoning a friend or taking a cab?

    I mean, as a call taker can you ever be 100% sure its an inappropriate call or timewaster, having only the caller’s word to go on?

    I once spent 15 minutes on the phone to 118 trying to find my nearest NHS walk-in centre. Until reading this blog I had no idea the ambulance service had this call back advice service. I think if people knew how the ambulance service worked they’d use it properly, but telling them in their hour of need that someone else’s emergency is more important is hardly going to solve the problem.

  44. Jamie Says:

    I think that non-emergency ambulance service that the 999 call takers could refer to would improve the system currently in place. Something like an “emergency” PTS? Or do you think it would help if a number of ambulances were set aside for Category A calls, so you could be sure that as far as possible, the people who need it most are getting ambulances?

  45. Always Tired Says:

    Jamie: I don’t know if they do the same in the LAS as in my area, but we have UTV transport to cover for things like ‘emergency PTS’
    To be honest we barely have enough ambulances to cover for the cat A and cat B calls let alone cover the non emergency stuff which most of the time is usually a case of someone with the sniffles, someone who just wants to be taken to A&E but hasn’t got the money for a taxi.
    We already use the PTS service to cover the HCP urgent calls and the St John Ambulance is used on a daily basis to cover some of the HCP calls where they person will need observations on route.
    If you can persuade the government to give us more vehicles and crew then you are a better person than the Chief Executives who have been asking for these resources for a long time.

  46. Jamie Says:

    Always Tired: Interesting to know that, thanks.

  47. Fiona Says:

    10 years ago today I had to call an ambulance for my 14 month old daughter who had collapsed and stopped breathing. The call handler remained calm and talked me through cpr and stayed with us while we waited on the ambulance. The ambulance arrived and we were quickly whisked off to hospital. I believe that if hadn’t been for the call handler and the quick reaction of the ambulance staff (Liz & Liz) I wouldn’t be the very proud Mum of a beautiful 11 year old now. She was diagnosed as having encephalitis and spent 5 days fighting for her life.
    We are just lucky that an ambulance was available and not off dealing with someones broken nail!

  48. Stonehead Says:

    I’ve had a few “interesting” experiences.

    When we lived in North Yorkshire a few years back, I was at home with our youngest child, then 11 months old. He had an allergic reaction to scrambled egg, went into anaphylactic shock and was having severe breathing difficulties due to his throat having constricted. I dialled 999 but the calltaker told me no ambulances were available as they were on high priority calls.

    I had no car, so I hung up, called the GP’s surgery, told them I was coming in and then ran the two miles to the surgery where he was injected with epinephrine. It was the fastest, scariest run I’ve ever done (and fortunately, I’m bloody fit).

    Then, living in Scotland, a heavy door came off its hinges and fell onto the left hand of the same boy, crushing it and splitting the sides of his fingers. It was a Sunday, the village hospital minor injuries unit was closed, G-Docs had no doctors on duty, and NHS Direct put us through to 999. The calltaker said no ambulances were available (we’re out in the boonies now) and we should take him to hospital ourselves.

    I’d already dressed his wounds and splinted his hand and fingers, so we loaded him into the car and drove him the hour to the nearest, open A&E. That was not a nice drive, with a screaming, sobbing child, blood seeping through the dressings, and stopping every 10 minutes to check the circulation in his fingers and hand.

    I have called for (and got) an ambulance once up here, for a woman with possible pelvis and spinal injuries after a road crash. Even then, the calltaker was doubtful at first as to the seriousness of the incident—even though my wife (I was attending the victim) explained the woman had been thrown from the car when it hit a stone wall at 50mph, was unconscious when found (but came round fairly quickly), and had pain in her pelvis plus pins and needles in her feet.

    So when I was knocked off my bike by a hit-run driver last year, I dragged myself and my bike off the road, slumped back into the saddle, and got to the minor injuries unit under my own steam. Then my wife came and got me, before driving me the hour to the A&E. I had a fractured clavicle, severe bruising all down my right side, gashes to my knee and ankle, and multiple abrasions but there was no way I was going to call an ambulance.

    The way it’s come through to us is that unless someone is halfway through death’s door or really, really mashed up, then don’t bother the ambulance services. That’s not slagging anyone off, but it is the message that’s come through to us.

  49. kayla Says:

    Great blog some how i found you looking for info on our sons birth defect esophageal atresia, i wish you the best. also i was wondering if there is any way you would be willing to exchange links? I woulds be so greatful, thanks so much i iwsh you nothing but the best.

  50. John Says:

    Hi, Mark,

    I was very struck by some of what’s been said about what you might call unco-operative calls and the responses to the line “That’s what we’re here for” at the end of an explanation about priorities. It sounds like it really winds some people up.

    I was a student a very long time ago and one temp job I had lasted about one day – telephone selling….

    I found it repulsive (though others obviously didn’t) but I do remember that the idea of closing a sale was all about very specific language and those that could do it were very effective. I’ve read the same applies in hostage negotiations. Your trainers must already be onto the subject of managing unco-operative callers but it’s a field where there’s probabaly always room for new techniques. Otherwise some staff will be more effective than others but there will be a lot more emotional energy expended than is strictly necessary across the board.

    It’s an interesting area – and, yes, I do know exactly what it feels like to be seriously wound up in a professional situation.

    The other area that I’m picking up on where your training could pick up on is instant stress management techniques for clients and yourselves. There must be lots out there that’s just waiting to be copied including from obvious places like the teaching profession or the acting profession though there must be lots more.

    “Modelling behaviour” is a good area to look at too. Or call it setting an example. The real reason for resisting responding in kind is that the attention seeker gets the pay-off of provoking a professional into behaving in an unprofessional manner and causing a little bit of chaos – something they probably feel familiar with. Setting clear boundaries and then behaving in a way that you can then invite the caller to copy is probably going to help calm things and get you better results.

    Those who talked of blowing off a bit of steam afterwards are much closer to the mark.

    Great idea for a blog. You really give people something to think about.

  51. Ex NHSD Says:

    Ah yes, “Getting NHSD to answer their phones”. Sadly it’s not that easy. At the NHSD call centre I worked in for 4 years we started off doing 10-15 calls a shift, when I left last year it was up to 90 in an eight-hour shift. We weren’t allowed any ‘not ready’ time, as soon as one call ended the next call came through. Add to that the fact that we also covered OOH GP and Dental, Government Health Lines and Cat C, and it gives you some idea how busy that place can get. It was as frustrating and horrible for us to see “10 calls waiting” on the boards as it is for callers, believe me. You know that every single call waiting represents someone with a problem, someone that may be seriously ill and too scared to dial 999 or just another drunken idiot with toothache.

    It was funny doing Cat C calls. They’d phone on the NHSD 0845 line, be refused an ambulance for the splinter in their finger, and given a stern telling off by one of the nurses. Ten minutes later ‘Cat C’ would pop up on the phone, the same muppet had invariably dialled 999 for the splinter and been redirected to us via Cat C.

    I used to have the opposite problem to you funnily enough. As well as people inappropriately demanding A&E/Ambulances, you’d get women with blue babies, men having heart attacks, parents of unconscious toddlers etc. all refusing ambulances and saying “Oh [I/he]‘ll sleep it off” One three year old had been unconscious for 6 hours on the couch, totally non-responsive. His mother didn’t care, but for the fact that she was ‘too busy to deal with this nonsense’. I asked her to shout, shake him, call his name. Nothing. She didn’t believe anything was wrong. I asked her to lift him up, and try to stand him up on the floor, and just heard him drop. Still refused an ambulance. The Clinical Supervisor on duty ended up sending the ambos and the police to the house. I hope the poor little bugger was ok, I really do. That’s the awful thing, you rarely (if ever) get any ‘closure’.

  52. jayloo Says:

    I live in fear of needing an ambulance to get to the hospital, being an American with no health insurance. We must pay, and it may be as much as $1000 to get to the hospital, if, for instance, you have anaphylactic shock, as one responder mentioned (and which I watched happening to a friend). This should ALWAYS be treated as an emergency if the condition has never been experienced by the patient before and is not a managed, known possibility in their life. As for the ambulance “not being a taxi service”, at LONG LAST you can pay for a taxi via credit or debit card in NYC, but before that, what would I have done? I often don’t have much cash available in the home or on my person for fear of being mugged. And what about in London, where a taxi is abominably expensive, I might not have enough pounds on me (I usually only carry around 20) and I can’t pay with plastic?

    In NYC there is 311, a 24/7 information line – they can patch you through to police, if you need, give information on various social services, and many other bits of information, and it’s widely publicized. That’s needed in the UK as well as giving EMTs the right to explain to callers what constitutes an emergency and where to go to get help if it isn’t covered under 999 services.

    Also, no one having been in an accident where the head was injured (bike accident, car accident, whatever) should have to get themselves to the hospital under their own devices. People die from walking even 20 feet after a bad head bashing that doesn’t look bad to the casual observer. My boyfriend and I witnessed a man fall over and smash his head on the ground, opening wounds to forehead, nose and lip, and the EMT allowed him to walk out of the subway and to the waiting ambulance. Would never happen in the States.

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  54. sueltehouccal Says:

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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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