A couple of weeks ago, the QA (Quality Assurance) man brought round a copy of the new AMPDS (that is, the system call takers use for triage) protocols. It got a hearty thumbs up from just about everyone. AMPDS’s biggest problem is the inclusion of the question “Is s/he breathing normally?” in just about every protocol. If the caller answers no, it tends to decide that the patient has “severe respiratory distress” and churn out a Cat A response. The trouble with this is that if the patient is puffing with pain, or upset and crying, of course their breathing is going to be difficult from normal - but not in a medically relevant way. Yet AMPDS treats someone who is hyperventilating at the pain of their papercut the same as someone with a life threatening asthma attack.
Well, not any more! The infamous “are you breathing normally” question is completely gone from a lot of protocols, and when it IS there, a “yes” only results in an amber response, not a red. The rationale, which I totally agree with, is that if the breathing was that much of a problem, they’d have told us at the beginning of the call!
I can’t wait for this new protocol to come in. It is going to decrease frustration levels in call takers, allocators and ambulances crews no end, and more importantly, we won’t end up having to waste ambulances on rubbish when people who are really sick are still waiting.
Unfortunately, the new protocols weren’t in in time for the delightful young man who called last week to say he had a cotton bud stuck in his ear. Was he breathing normally? Apparently he wasn’t. Category A call. FRU despatched.
The FRU in question called us on the radio.
“Cotton bud in ear?!” he said incredulously. “How on earth is this a category A life threatening emergency? Do you really want me to run on this?”
“It’s the old ‘Are you breathing normally chestnut’,” I said apologetically. “Severe difficulty breathing… from a cotton bud in the ear. Perhaps this guy breaths through his ears? Sorry about this, but I’m going to have to ask you to continue…”
“But…” said the FRU. “I had a cotton bud stuck in my ear this morning! I got it out myself!”
“You should be an expert in the field then!” I said. “Clearly the most appropriate resource for the job!”
“I walked right into that one,” grumbled the FRU good naturedly, and continued on to the call.
Allocators do have some leeway in using their common sense, so, for instance, if there had been another more serious call for the FRU to go to, I would have been able to cancel him from Cotton Bud Man and send him to that. Unfortunately, refusing to send at all is not permitted. Even though the REAL purpose of FRUs is to get to the life threatening calls quicker than an ambulance can, it is sometimes helpful to send them to the “rubbish” calls that have come up as a high priority. That way, the FRU can ring control and tell us that the patient doesn’t have any difficult breathing, and that an ambulance isn’t needed, or that it is needed but not in any great hurry (for example, if the patient had perforated his eardrum with the cotton bud.) If an ambulance arrives straight away, they tend to take the patient to hospital (they are not allowed to refuse) so the patient gets their big white taxi and doesn’t learn their lesson.
You will be pleased to know that our brave FRU managed to deal singlehandedly with the offending cotton bud, and no further resources were required.
