A cub scout leader, who trains his cubs to call 999, left a comment on one of my posts asking for a 999 “script” of sorts to assist with this. I think this is a very good idea, since if everyone knew what to expect when they called 999, it would be far less stressful both for them and us, and we’d probably get the ambulances out quicker and certainly make the calls shorter. Apparently the average person only calls for an ambulance once in their lifetime (I have already called for one twice, both before I started working there — once for a girlfriend who had an asthma attack, and once for a rather drunken accident I experienced in my younger, more frivolous days) and on Eastenders characters find it sufficient to bellow “15 Albert Square, ambulance, NAAAH!” and hang up, so it’s no wonder callers are thrown by the Nee Naw Service’s procedures.

Anyway, here’s a copy and paste job of my reply to the cub leader!

The way a call is taken varies a bit from area to area, but here’s what we say in London:

Me: Ambulance Service, what’s the address of the emergency?
Caller: 1 High Street, E8 (Caller needs to give at least the road name and either the post code or the name of the local area. If they don’t know where they are, tell them to ring from a callbox or a landline rather than a mobile as the call can be traced.)
Me: And what is the telephone number you’re calling from?
Caller: 07999 999999 (this can usually be traced too, so not that important, but try to get them to learn their numbers.)
Me: What’s the problem? Tell me exactly what’s happened?
Caller: There’s an old man with chest pains. (They need to give a reason for an ambulance, just asking someone to call an ambulance without telling them what is wrong might cause a delay).
Me: Are you with him now?
Caller: Yes. (It helps if the caller is with the patient, as we need to know some things about the patient, but it’s not essential).
Me: How old is he (approximately)?
Caller: About seventy.
Me: Is he conscious? (We ask this whatever has happened, even if it’s just a sprained ankle, it’s one of those over cautious things! I’m guessing some children wouldn’t understand the word “conscious” so it might be a good idea to teach them — when I get someone who doesn’t understand it on line I usually rephrase it as “Are they responding to you at all?” or ask “Are they awake?”, and if they say “no” I ask “can you wake them up?”.
Caller: Yes.
Me: Is he breathing?
Caller: Yes.
Me: Thank you. Now I just need to ask a few questions, this won’t delay help at all, it will be arranged while we’re talking…

At this point, we have all the information that is needed to send an ambulance. In practice it might have been sent as early as when the caller said the man had chest pains. The remainder of the call is to give the call a priority (if it is going into a queue for an ambulance, we send to the most urgent calls first), find out if there’s anything that needs to be done whilst waiting for the ambulance, and give the crew a bit more detail whilst they are (hopefully) on their way.

Next follows a bunch of questions which vary according to what has happened to the patient. I won’t go into detail here, but the most important thing for the cubs to find out is if the patient has any of what we call priority symptoms, which are:
* Difficulty breathing
* Reduction in consciousness (“not completely awake”)
* Severe bleeding (bleeding that can’t be controlled with a bandage, spurting or pouring out, etc)
* Chest pain
Tell them if they don’t know the answer to any of the other questions just say “I don’t know” (or find out the answer if they can) and not to guess. Some of the questions might seem a bit irrelevant at times — we ask them to make absolutely certain that something *hasn’t* happened (eg. if someone has dislocated their shoulder we ask if they have any serious bleeding, to which people often reply “Are you mad? Dislocated shoulders don’t bleed!” but of course if they’ve fallen they may be bleeding somewhere else!)

The call either ends with the standard closing phrase, which is:
“Help is being arranged. Don’t let him have anything to eat or drink. Watch him closely. Put any family pets away. If possible, gather his medications and write down the name of his doctor. Unlock the door, turn on any outside lights and send someone to meet the ambulance. If his condition worsens before help arrives, call us back immediately for further instructions”.

Or, the call taker will give basic instructions for what to do while you are waiting — usually instructions about patient positioning (if they are unconscious), resuscitation, controlling bleeding, what to do when someone is having a fit, how to deliver a baby, stopping someone choking. Often the call taker will stay on line for this sort of call until the ambulance gets there, especially if the caller is a child. They don’t need to worry about this until it happens as the caller taker will assume they’ve never had any first aid training and start from the beginning.

If they’ve asked for more than one service (eg police and ambulance) tell them to stay on the line after the ambulance hang up. We do call the police ourselves if we think it is necessary, but the police have their own specific questions, so like to speak to the callers themselves if they can.

Published Oct 13, 2005 - 29 Comments and counting

29 Comments on “999 Script”
  1. Jean Says:

    Thanks for that! It might have been aimed at cub scouts, but for those of us not in any of the emergency services (we’re just voyeurs!) knowing WHY what might appear to be irrelevant questions are asked, is reassuring.
    I have one complaint – your blog is quite addictive and I should actually be working right now!!
    But thanks anyway.

  2. Dave Goodman Says:

    Very useful stuff Mark. I’ve only ever had to call an ambulance once (for a woman I found passed out in the street in Angel – she was utterly dead to the world til the crew started shining lights in her eyes, then she just got up and walked off!) but knowing what’s going to be asked would, I’d imagine, make a heck of a lot of difference for most people. I used to work in call centres, so I make a point of never losing my rag at people and answering questions as completely and quickly as possible (it gets you off the phone and help/technical assistance/whatever to you quicker if you follow their process, rather than one you’re making up on the spot) but I can imagine a lot of people will simply not see the point of some questions. I used to know someone who worked in a Fire Service control room, and he regularly got calls which were someone picking up the phone, shouting “FIRE” and hanging up. But as he said, that could be a scared kid in a house with a burning chip pan.

    My question would be how best to get this information more widely known. Publishing it on the Ambulance Service websites would be a good start, but unless someone, somewhere was willing to pony up the cash for an advertising campaign, it wouldn’t do much good really I suspect. And it’s probably cheaper just to keep paying you poor guys to take horrendous, cyclical calls. All in all, I don’t know how you do it mate, selling mobile phone package extensions was bad enough.

  3. Becca Says:

    Wow, thanks for that. I’m a severe asthmatic, and let’s just say I’ve had to call for an ambulance more than once for myeslf. I’m new to London and having that kind of information is really helpful.

  4. Flash Wilson Says:

    That was very interesting. I’ve called an ambulance twice, once for a drunk who had been punched in the face on a Saturday night (he hit his head on the kerb when he fell, and blacked out briefly) and the ambulance came almost immediately. I thought I was doing all the right things – recovery position, keeping him talking and so on, but the police showed up as well as the ambulance and just shook him and said “get up, you’re fine” which made me feel stupid.

    The second time was during the working day for a kid who came to the door with his hand pumping blood; I put a clean cloth on it, told him to hold it tight, sat him down and called him an ambulance (then gave out damp cloths so his mates could clean the blood off him and themselves). I told the call taker that it was pumping blood, but that when pressure was put on blood was not obviously seeping out and I didn’t want to lift the dressing to see if it was still pumping out underneath.

    They rang back an hour later to see if I still needed the ambulance.

    The boy had gone.

  5. Lauren Says:

    I think people definitely need to be educated on how to make a 999 call – that was a helpful post. It’s also important that they know that the first person they’re going to speak to is an operator, who ONLY wants to know what service they require. We can’t tell the caller what service they require, we don’t need to know anything about the emergency, and we can’t decide for you whether or not it’s actually an emergency. Also, if the operator is trying to verbally hand a call over to the EA, it helps if the caller just lets us do that without interrupting.

    I like how you said for them to stay on the line if they requested more than one service. So many EMDs tell them it’s OK to hang up, they’ll call the police. Which I think confuses callers if the operator has made a point of telling them to stay on the line, and the operator still has to phone the police on the caller’s behalf – which takes longer than having the caller still on the line.

  6. tjwood Says:

    If, say, I came across a road traffic incident which required both police and ambulance presence, what do I ask the operator for? If I say “police and ambulance”, will I be transferred to ambulance control first, before police (as I suspect the ambulance might be the priority if someone is in a critical condition)?

    What about if there is fire as well… is there a specified order things go through?

  7. Lauren Says:

    Hope you don’t mind me replying to your comments!

    But tjwood, you are put through to whichever you asked for first. If you say ‘police and ambulance’, you’ll be put through to the police, then the ambulance. If you say ‘ambulance and police’, it’s the other way round. There’s no specified order, it all depends on what the caller asks for.

  8. lastechnician Says:

    Hi Lauren, tjwood and Flash Wilson.

    If the operator puts a call through to the ambulance service, and the call also requires police attendance, we will activate the police via a direct computer link to their control room, so it is not necessary to keep the caller on the line and then transfer them to the police.

    Equally, it is not necessary to hold them to call the fire service, as we will also do that if required.

    It also works the other way round, if you put them through to the police, certainly in London, they will run you through similar questions, and activate us via the direct computer link.

    Flash, you did the right thing. Don’t feel stupid about the crew turning up and telling the drunk bloke to get up. Remember we see this day in and day out, and more so at the weekends, so we can tell almost straight away if somebody is faking unconsciousness. I wouldn’t expect someone who doesn’t see it all the time to recognise this.

    The second time, I guess it was either a very busy day (they all are now!) and/or it was categorised as a low priority call (because the bleeding was under control) so other higher priority calls would get an ambulance first.

    Hope this is of some help

  9. Mark Myers Says:

    Yes, you should ask for whichever service you want most — eg. if someone has been assaulted and has serious injuries, ask for ambulance, but if their injuries are minor and the person who assaulted them is still nearby, ask for police. The ambulance service will put the call through to the police (or fire) so it doesn’t matter if you don’t speak to them, but the police/fire/etc have their own specific set of questions, so they’d rather you spoke to them yourself.

    Thank you, Lauren, for pointing out that the first person they speak to is an operator. I forgot to mention that as obviously I get the caller after the operator does… often they have been pouring everything out to the operator and feel indignant about having to repeat themselves, but of course I haven’t heard a thing.

    Flash — the “bleeding” call that you mention would have probably got a “green” priority because the bleeding was under control. Unfortunately at busy times green calls do have to wait, as you discovered, plus if the cut was self inflicted (I’m not sure if it was from your description) the crew may have requested the police to go with them, which can cause a delay. You did the right thing with the assaulted guy — just remember it’s better to call an ambulance for something which turns out to be minor than not call one and let the patient die. We get a lot of calls for patients who are being “drama queens” and pretending to be collapsed/unconscious when they’re not, but it’s not the callers’ fault, and we’d far rather be safe than sorry.

  10. monster Says:

    I have a great life here as an expat in the US. But I don’t like how the 911 (999) script is different here. Details of the medical insurance are high up there. Brits see/hear the joke in the movies etc. that the ambulance staff check for the patient’s insurance card before they start treatment. Sadly, it’s not that far from the truth.

  11. Tom Says:

    Ive had to call 999 once, for an RTC outside my old school. It was the last day of school, and it was the last thing id expect to happen after my final GCSE! Police and Ambulance were requested, however, i only spoke to the Ambulance Service (she requested Fire automatically due to the nature of the incident.

    Thanks for sharing that, is very useful.

  12. flip Says:

    monster: Thats very sad. We might all moan about grey and rainy Britain but at least we make some effort to look after others in our country..

  13. Amanda Says:

    As a US citizen, I must say that I’ve never come across an emergency dispatcher who refused to send assistance because of lack of health insurance. Health insurance is not a requirement for ambulance service or other EMS help.

    However, you will be billed & if it is determined that it wasn’t ‘truely’ an emergency your bill is likely to be quite high. Unfortunately, the health insurance industry here wields a big stick & not always with compassion & forethought.

  14. Mark Myers Says:

    I think that in a way, that is a good thing. Our ambulance service would be so much more efficient if some callers didn’t equate it with a free taxi service to the hospital.

  15. poons Says:

    Well would you believe it, I read this post last night having never had to call an ambulance for someone before, only to have a regular customer throw an epileptic fit after telling us that he wasn’t feeling too good because he had 3 or 4 in the last few days (he lives alone so doesn’t always know when he has had them).
    I’d like to think my prior knowledge of what to expect helped speed the arrival of the ‘bulance and that as I type this Eric will be spending an evening in the good care of the local infirmary.
    So thanks for the info, and keep up what is a great blog.

  16. Lauren Says:

    lastechnician -

    Procedures might have changed since I left a few months ago, but when I was working as an operator, if a caller requested more than one service we kept them on the line so we could let them speak to each service. I know that the police/ambulance or whatever is automatically requested if needed, but our procedures do state that we have to ask them to stay on the line. Although maybe this is just BT trying to cover their backs :)

  17. pete Says:

    I am a dispatcher in the US, and the scrip we use is exactly the same as the one just posted. I’m asuming you use the Priority Dispatch systems (http://www.medicalpriority.com/Mprotocol.html), and were certified by the National/Internation Academies of Emergency Dispatch. It is used in almost all dispatch centers in the US.

    I have never asked, or heard of anyone asking, even the slightest detail about a persons financial situation or health insuance information before or after sending an ambulance. Even if you couldn’t pay, you would never be turned down for any services needed.

    I work for a smaller county, where we can dispatch to all three services {police, fire (first responders), and ems} at the same time. Makes it very convienent when more than one service is needed. Quicker, also, since you would only have to explain the situation to one person. If pre-arrival instructions were needed, and police assistance, there is no transferring back and forth between agencies, or delay for either agency. I understand that’s probably not possible for a larger center though.

  18. Mark Myers Says:

    Yep, we use the priority dispatch thingy, and as you noticed, it’s pretty much the same as it is in the US. The way it is written makes it quite obvious it is American, and when I was at training school I kept on lapsing into a bad American accent when I was practicing! Plus “haemorrhage” is in the wrong place on the alphabetical pick list, because Americans spell it “hemorrhage”… that one gets it every time. I think the majority of British ambulance services use it too.

    The idea of having police, fire and ambulance dispatched by the same centre is a good one, and I’d like to see it here… except that would mean spending an eternity back at training school learning police and fire stuff. And I have a bit of a phobia of fire so I’d not be the best person to speak to whilst your house in burning down. I think the reason we don’t do it is because the three services are all independently organised and funded and they’d have to do a big merger to have people working for all three. Probably.

  19. SWbod Says:

    There was a whisper some time ago to amalgmate the LAS and LFB control, but as far as im aware the LFB were totally opposed to the idea, as were they about ‘sharing’ stations. A merger with the METpolice would be a logistical nightmare as though NSY is the main outfit, all met boroughs have their own cad rooms and call takers.

  20. Bazzab Says:

    Great site. Good idea teaching cubs what to expect if they dial 999, I do a similar thing for my ladys’ brownies and guide groups in Berkshire. I think all this should be part of the National Curriculum and taught at school, I believe kids do something called ‘Citizenship’ or something like that perhaps it would fit in there. I also think that First Aid should be taught as well, good CPR by anyone with training prior to a crew getting on scene would keep a few more people out of Rose Cottage for a while. Any teachers wish to comment?

  21. Richard Says:

    Is it useful to the operator to know if the person calling has any relevant skills (e.g. first aider / first responder / doctor) or if there is someone there with such skills? If so, when should such information be volunteered?

  22. Mark Myers Says:

    It’s not useful for the operator to know anything except which service you need. (Pet hate, sorry!) The call taker, however, would probably like to know if you’re a nurse/doctor/paramedic/etc as most of these people won’t need first aid instructions — I always offer them though (unless it’s a doctor), and if talking to a third party check if they are doing it right. Some nurses won’t ever have done CPR on a real person so you can’t assume they know how to do it.

    First Aiders are a nightmare, because “I’m a first aider” can mean anything from “I’m a member of St John Ambulance, and know my first aid inside out” to “I did a one day first aid course when I was sixteen and I think I remember some of it”. I tend to assume all first aiders are the latter — better to give someone instructions they don’t need and possibly come across as a bit patronising than assume they know what they’re doing and let them do the wrong thing. In fact, I feel a post about first aiders coming on!

    If you are a medical person, you should volunteer the information after being asked “What’s the problem? Tell me exactly what happened” eg. “I’m an off duty paramedic and I’ve just found an old man lying in the road…” (Sometimes on duty GPs forget to do this when they call 999 and only mention it at the end of the call. I then feel a right pillock for explaining medical terms throughout the call and giving them first aid instructions.)

  23. Aaron Patton Says:

    Only once in a lifetime? wow. I’m waaaaaaaaay over that but only because I volunteer with St. John Ambulance and at motocross we have to call for an ambulance every once and a while.

    It was the best way to teach a 16 year old (me) how to call 911 (I live in Canada). Before that I was always kind of panicing.

    Now I am calm and get all the facts down hard.

    Awesome blog.

  24. Aled Says:

    This is quite fascinating – we had a discussion the other day about whether people looking for Mountain Rescue should ask for “Police” or “Mountain Rescue” (I’m on a MR team in Wales), since we don’t call 999 to activate ourselves, I had to admit to having no idea, but I’m on a bit of a mission to find out.

    Also, just in case anyone gets an MR “Medic” on the phone, we’re also known as “Casualty Carer”, after our medical course. It sounds awfully pathetic, but is in fact quite in-depth, BLS is the minimum entry requirement onto the course which goes into detail about fracture reduction, spinal injuries, and the various drugs we can administer and much more. We don’t cover much anatomy – “supra condylar fracture” is a nice fancy term, but “broken arm just above the elbow” is far easier to understand. *grin* Our course basically gives us enough medical knowledge to look after a casualty until they’re handed over to the county Ambulance.

    On that note, if you ever call for help in the mountains, know your grid refernce if you can, tell us if you’re not sure where you are (we’ll ask more people to attend in case we need to search for you) and STAY WHERE YOU ARE.

    Cheers!
    Aled.

  25. AG Says:

    Incidentally… the Guardian quotes a figure of 4.4m calls rising 6% last year to 4.4 million. These seem to be ambulance calls only, not general 999 calls (the Met Police alone take 2.5m calls!), which averages out to about five ambulance calls per person over their lifetime.

    The frequent-fliers are certainly skewing the statistics…

  26. slt Says:

    I just wanted to say thankyou, I’m attempting to teach emergency calls to my EFL students and this will help them to know what to expect

  27. Diz Says:

    Thanks for such an interesting and informative site. I am just a Jane Smith, so am learning a lot about how the system works, and how a dork at this end of the phone can make such a dreadful difference. I wil try to stir the local Brownie group my daughter helps at to do a bit of a talk about this.
    I definitely agree that how to make a 999 call effectively ought to be covered in PHSE in schools. Snag is, so many of the little b*****s would probably use it to ensure any hoax call they make is rated a priority!

  28. Peter Says:

    Hello Suzi

    I just thought you might want to see this discussion where I've added the article:

    http://www.escouts.org.uk/forum/showthread.php?t=

    Thanks again for your guidance.

    Peter

  29. condylar fracture Says:

    [...] a lateral condylar fracture. The surgeon also removed pieces of bone that could have become …Nee Naw – 999 ScriptWe don’t cover much anatomy – supra condylar fracture is a nice fancy term, but broken arm just [...]

    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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