This is another of those posts that I’m writing in the hope that next week’s 999 callers will see it!

A common source of frustration for ambulance callers is that bellowing “20 Albert Square, ambulance, NAAAH!” like they do on TV will not actually get you an ambulance, and that if you dial 999, you will actually be kept on the phone for about three minutes answering what can seem like stupid questions. I always explain to callers that this won’t delay help before I start, but unfortunately there isn’t time to explain to them how it works or why we do it. However, there’s plenty of time for me to explain here!

The first thing we ask is the nature of the problem, followed by the address. Hopefully, no-one will think those questions are pointless. Once they are in, the call is visible to the dispatchers who sit upstairs on various sector desks controlling various parts of London. They can send the call to an ambulance straight away. If there were more ambulances than calls, then we could probably dispense with most of the questioning, but there aren’t. If there’s no ambulance available to send to a call, or we’re down to our last one and the call is about something minor, it goes into a queue.

There then follows the “four commandments”, which are the age and sex of the patient and whether they are conscious or breathing. These are important because they change the questions that will be asked, the instructions that will be given and/or the priority the call is given.

Next follow the triage questions. These determine whether a call is high, medium or low priority and the high priority calls get an ambulance before the medium priority ones, who in turn get one before the low priority ones. In the good old days, calls weren’t triaged and were dispatched in the order that they came in. So a broken leg would get an ambulance before a baby who had stopped breathing if the leg’s owner phoned up five seconds earlier. These are the questions that a lot of people think are stupid, since they are fairly standardised and designed to check that a lot of things definitely aren’t happening, rather than to go into any detail about the things that are. Basically, we’re trying to be sure we haven’t missed anything. Callers do have a habit of dwelling on the most painful symptom and sometimes overlooking other life-threatening symptoms. I’ve had calls that have started off being about blocked catheters and have ended up being suspected heart attacks, because the patient has been so worked up about their catheter problem they haven’t bothered to mention that crushing pain in their chest and arm… or sometimes someone has fallen and broken a bone and no-one mentions they have also knocked their head and seem concussed until you ask… We have to ask every single question on the list, unless it’s obvious, and by obvious, I mean face-slappingly, already stated explicitedly obvious, not just logically obvious. So if someone rings with a dislocated shoulder, I still ask if there is any serious bleeding, but I do know that dislocated shoulders don’t bleed and have guessed that there isn’t — I just want to be 100% sure!

There’s usually between five and ten of these questions, and all the questions only demand one word answers — the vast majority of them are “Yes/No/Don’t Know”. It should take less than a minute to answer them all. Arguing about whether you’re going to answer them or not generally takes a lot longer. Answering them can speed up the ambulance too — the questions might yield some information which makes the call sound more serious. Not answering anything, on the other hand, might cause a delay — for instance, “Breathing Problems ” on its own with no other information is an medium priority call, but after asking the questions most “Breathing Problems” turn into category A, highest priority calls.

After the questions, there’s a few instructions. Obviously, if I hadn’t asked any questions, I wouldn’t know exactly what was happening, so I wouldn’t be able to tell anyone what to do next. So there’s another place they come in useful.

The final use for the questions is to give the ambulance crew a bit more information. While they don’t see the answer to every single question, we do pass them the most salient bits.

999 callers, if you still think the questions are pointless after reading this, and I hope you don’t, please remember that us call takers are under strict instructions to ask them and if you refuse, the call is going to turn into a stressful battle of wills and take far longer than if you just gave in and answered them. If you want to complain about the questions, our complaints department will be happy to listen, but our call takers will not. Believe it or not, call takers were not put on this earth to stand in the way of people getting ambulances and actually want the ambulance to arrive and the call to be over as quickly as possible too. It’s also worth pointing out that the call taker has no control over if and when an ambulance is dispatched; there is no big red button on our computers marked “SEND AMBULANCE”. So shouting “Just send the ambulance!” repeatedly when a call taker is trying to ask you something is going to have no effect whatsoever, except perhaps making the call taker bang their head against the desk and start losing the will to live.

Published Nov 21, 2005 - 16 Comments and counting

16 Comments on “Stupid Questions”
  1. biscuits brother Says:

    Hi Mark,

    Enjoy the blog.

    Can I ask, are the questions / responses computer prompted. Does the answer to one question determine what subsequent questions are asked. And then does the collected information automatically update the priority that is shown to the dispatcher. Apologies for being a Geek!

    BB

  2. Anonymous Says:

    “…except perhaps making the call taker bang their head against the desk and start losing the will to live.”

    Made my day! Funny, an oh-so true.

  3. pete Says:

    Sorry, that last comment was from me…

  4. Mark Myers Says:

    Can I ask, are the questions / responses computer prompted.
    Yes, there’s a program called ProQA that we stick them all in (although I could say them in my sleep by now!)

    Does the answer to one question determine what subsequent questions are asked.
    There’s a different set of questions for each of the 32 different chief complaints (eg. chest pain, breathing difficulties, RTA, etc). Sometimes the questions trigger small changes in what is asked subsequently, but they’re basically the same.

    And then does the collected information automatically update the priority that is shown to the dispatcher.
    Yep, it appears at the top of the screen and can change throughout the call depending on the answers given. Fainting calls, for example, often start off red and then turn yellow or green as the patient comes round, whereas breathing problems calls usually go up in priority as more information comes to light.

  5. Nocode Says:

    It seems that your organization has rather strict rules about asking the key questions (is the person conscious, breathing, etc.?)which is probably a good practice. Yesterday I went to a call at a local gym. The caller said that an elderly man had dropped a weight on himself. The caller failed to mention (and our dispatcher failed to ask) whether the man was breathing or not. Turns out the elderly gentleman had dropped the weight when he went into cardiac arrest! Clearly that is important information to have when assigning paramedics and fire/rescue personnel.

  6. Mark Myers Says:

    Yes, we have to ask conscious and breathing on every single call, however obtuse it may sound. The only exception is if we’re actually talking to the patient themselves. This would be a good case in point as to why.

    I once had a call where a hotel owner said that a guest was “very depressed, I think he’s harmed himself”. She had opened his door but didn’t want to go inside his room. By the end of the call I had established it was a little more serious than that. The ambulance arrived and found him hanging from the light fitting, throat and wrists slit, blood up the walls, overdose taken for good measure. I guess she was right about him being depressed…

  7. Deirdre Says:

    This post, and the 999 Script one from October, are the sort of thing that should be covered by the school curriculum (along with things like how mortgages work, and other real-life stuff). I hope you don’t mind, but I’ve printed them out so that I can talk to my kids about them.
    I hope they never need to call 999, but, like carrying a donor card, it’s something that is always easier to discuss before the need arises.

  8. Mark Myers Says:

    Kids seem to be better at answering the questions than adults anyway. Perhaps they are used to adults asking them silly questions and have learned never to ask why? Please do talk to your kids about it, though — maybe they’ll remember into adulthood how the system works. I wish there was more awareness of what a 999 call is like as it would make my life so much easier.

  9. Ponytail Says:

    As a first aider, we are taught to send people off to call the ambulance with the info about the patient, such as “adult, breathing, unconscious, has been bleeding from the nose for 10 minutes” precisely so that the ambulance service can do the triage thing. Thanks for the informative entry.

  10. Sarah Says:

    In reply to Ponytail, I have rarely come across a first aider who wanted to answer the questions, never mind take instructions on how to help the patient. I the few first aid courses I’ve done, I’ve never been taught things like that, and I think first aid training everywhere should always involve teaching like that. I have had enough “discussions” with first aiders in response to “Just send me a (insert colourful language) ambulance!” when, more often than not, an ambulance is already on the way (but don’t tell my supervisor I just used those words!). And I thought some of the first aiders I’ve spoken to have actually been trained to put the person in the recovery position (regardles of consciousness or status of breathing), get someone else to phone 999, then come on the phone when that person has been asked questions and swear at the call taker, tell them they won’t answer any questions, an ambulance had better arrive quickly, and then hang up.

    Definitely more education required across the board, I think! And I’m sure most first aiders have more common sense than the ones who stick in my head!

  11. Mark Myers Says:

    I’ve had first aiders from both ends of the spectrum — some of them have given me all the information needed and then got on with first aiding with minimal instructions from me, whereas others have taken the attitude “I’m a first aider, I know what I’m doing, I’ll tell you what I think is important and how urgent I think the ambulance is and I will not answer anything else. I am in charge of this phone call!” I’m actually a first aider with St John myself but I’ve never had to call for an ambulance with them — I have, however, given talks to the rest of my group about 999 calls so hopefully they’ll be very helpful when they call up!

    I think the recovery position is the thing that sticks in people’s minds after first aid courses and sometimes people forget when they are and aren’t supposed to use it. It’s not going to help if the patient isn’t breathing and it’s pointless if they’re fully awake! I actually had someone who’d put a patient in the recovery position after they had fallen and injured their leg (nothing else wrong). Ouch!

  12. Clare Says:

    I am a an Emergency Medical Dispatcher also, and I find one of the worse callers I have had are from nursing homes. Often the carers, are X-Nurse’s from 20 odd yrs ago and refuse to listen as they know best. The worse one I remember was when the Patient was in Cardiac Arrest and I must have been on the phone for 15 minutes giving CPR instructions, then to find out after the crew had arrived that they haddn’t done a thing (just pretending! WHY?) these carers are the people who many trust with their loved ones. I think all carers should have to have first aid training (even if they are x-nurse’s, doesn’t hurt to update your skills)
    This is a great site Mark!

  13. Tina Says:

    Also an EMD. That reminds me of a job a few years ago where i gave CPR instructions for 10 minutes only to hear from the crew that the people at the house with the patient were not doing what I told them but decided to use the time laying paper down on the carpets so the paramedics didn’t dirty the rugs when they arrived!!!!! One other of my now infamous instructions was talking one lady through CPR instructions on her daughter who turned out to be a rather large house plant! I thought at the time that it sounded like she was blowing into the air although she kept telling me her ‘daughters’ chest was rising. Little did I know her daughter was an Aspidistra!!

  14. Wendy Smith Says:

    Found this while browsing from work in Austin, Tx. It sounds like your dispatchers get the same sort of really stupid arguments that ours do! I’m not a dispatcher, but I’ve worked in search & rescue, other volunteer work, and technical support, so I understand what you’re going through!

  15. tony Says:

    Yes, i’m not an EMD, but i did apply for an emd/call opp job at secamb a few weeks ago and went for an essesment.

    I heard a lot of “silly calls” where people think that everything is an emergency.

    People need to reailse that if you cut your finger, you probably arn’t going to get an ambulance from the nhs for a while, unless they are incredibly quite!!

    I volenteer for st john also and am fully ambulance qualified and half the people that ask for plasters don’t need them.

    Anyhow, i wanted to say this site is great, people need educationg and first aid should be a 100% priority in school from age 10 upwards. Kids with first aid knowledge are much more likely to be caring and likable young people in the long-run and won’t be so “blasey” about the whole ambulance dispatching issues that so many call takers/ dispatchers get these days!

    I scincerley hope I get into SECAmb, as i would love the challange of being a call taker.

    great work, keep it up!

  16. chris Says:

    Well I am a Fully Qualified Defib and St Andrews First Aider and atm doing Advanced Training which take me to Paramedic Training and reason is due to what my job is full time. But when i was 17 i used to work in a Call center which i would basically answer the 999 calls and i remember one women called and ask if a ambulance would hurry up and unknown to me the ambulance was there and ambulance crew were downstairs while she was upstairs and while i tracked the call and found out that they were there and it was a call about there cat and last time i check NHS crews r not qualified in Animals

    and while i do my current job which is I spend loads time on phone to people who say I was a nurse in 1975 and while i understand they may of know the procedure but again I must say the worse is Nursing Homes and at times I have Told them this ” I MUST ALLOW YOU TO HELP THE CAUSALITY AND IF YOU REFUSE WE CAN NOT BE HELD RESPONSIBLE” and quite often they will go on with that and i always try get the Crew to call me back and tell me exactly what happen and few crews have said wot other person said “layering paper on rugs” and this what i remember crew telling me ” Well we entered and women had Bags for our shoes and Paper all over place and the Seats where covered in Dust sheets as they never want us to make there room mucky” and I was like now only they take that much care in casualty than there house

    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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