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.