So there I was, sitting on the train to work, and I picked up a copy of the Evening Standard someone had left on the seat next to me. Thumbing through the news about Elton John’s wedding and Carol Thatcher winning I’m a Celebrity…, one headline jumped out at me:
Ambulance Call Centre Failure Leads to £200,000 Damages Claim! Wife sues 999 service after father of five is left crippled by ‘operator error’!
(I guess the call taker in question loses the right to complaining about being called “the operator” after making that kind of mistake).
The text of the article was actually quite confusing as to what actually happened, especially when coupled with the report I read in Metro on the way home, which states that two calls were made — the ES only mentions one. The ES published a partial transcript, but omitted some of the most important parts — the beginning of the call, and everything that was said after the patient was confirmed to be not breathing. (I’d be grateful if anyone could point me in the direct of a link with a full transcript. I’ve been searching the internet but can’t find anything at all). What it boils down to is that the patient had a fit, choked on his own vomit, stopped breathing and was starved of oxygen leading to brain damage. He’s now in a vegetative state.
From what information there is, I think that the call taker made at least two mistakes:
1) After the caller reported that the patient had had a fit, the call taker should have told her to turn him on his side. Instead s/he followed the protocol for an unconscious patient, which is checking the airway and breathing while the patient is on his back, ready to start CPR if necessary.
2) If the call taker had followed the “unconscious patient” protocol correctly, the situation may have well been rectified — the protocol includes a check in the mouth for obstructions such as vomit, which the call taker omitted. Had they done this, they would have discovered the vomit and been able to clean it out, which may have started the patient breathing again.
3) It’s not quite clear from the haphazard reporting, but it sounds as if the call taker allowed the caller to hang up while the patient was unconscious. This is wrong — we should always stay on the line when a patient is unconscious, except in extenuating circumstances (eg. doctor on scene and dealing, caller refusing to give aid, etc).
(As an aside, the article goes on at length about how wonderful the recovery position is and how to do it, but worryingly does not give any instructions about when it should be done. I have had a lot of experience of callers who think that the recovery position will solve everything from death to a broken leg and this is only going to encourage them).
My first reaction on reading the article was “Oh god, that wasn’t me, was it?” (No, it wasn’t!) I’ve heard it said before that the thing us nee naw people are most scared of is not the harrowing incidents we have to deal with, but the possibility we might make a mistake. I know I often replay calls in my mind thinking if there was anything I should have done differently. However, I think a lot about saving someone’s life and failing to save someone’s life (not through error but through failing to get the right information to the caller, or failing to get them to comply with the instructions), but rarely about how I could actually do something which would lead to someone’s death or disablement. It certainly makes me realise what a position of power we are in.
Although the real victims of this are the patient and his family, and my full sympathies are with them, I can’t help putting myself in the shoes of the call taker. Such a grave mistake amounted from something as simple as clicking wrong protocol and omitting one short line of text, and now s/he has to live with it for the rest of his/her life.
On the other hand, I am aghast to see that a woman has been awarded £2.8 million pounds after she waited 30 mins for an ambulance and suffered brain damage after taking an overdose. Firstly, ambulances are not delayed because of incompetance and laziness, they are delayed because idiots keep calling them up for flu and bellyache. It’s a shame you can’t sue those idiots! Secondly, ambulances are delayed because we don’t have enough funding and therefore don’t have enough ambulances. £2.8 million pounds would buy a whole lot of ambulances! Finally, if you want to avoid brain damage after taking an overdose, may I suggest that you don’t take an overdose in the first place?
December 8th, 2005 at 6:55 pm
“stopped breathing and was starved of ***vomit leading to brain damage. He’s now in a vegetative state.”
Think you might want to fix this
December 8th, 2005 at 7:49 pm
I think we have to be very careful of criticising the EMD. None of us know the full story and we can all have 20 20 hindsight. There but for the grace of god…
December 8th, 2005 at 9:00 pm
Yeah, if I can confuse “vomit” and “oxygen” (fortunately only on my blog, not whilst working… yet) then it just goes to show how easily mistakes can be made!
I can imagine how the mistake happened, too — I guess the EMD was concentrating on the fact the patient was reported to not be breathing and wanted to start CPR, rushing past the other instructions. As you say, there but for the grace of god…
December 8th, 2005 at 9:41 pm
What a horrible situation. Admittedly, if it was my partner in a vegetative state, I’d be fit to be tied too, and would feel that 2.8 million wasn’t enough. That said, from an objective standpoint, it is a physical impossibility for any system to be 100% error-free. Even if there were plenty of ambulances and funding, problems could still happen. Certainly, the wronged people should get compensation, but in some cosmic sense, the mistake shouldn’t really count against anyone if it’s within a statistical margin of expected error. I wonder if there could be any way to implement something like that? Or would people soon take advantage of it to excuse a 50% failure rate?
December 8th, 2005 at 11:26 pm
Quite right. Maybe the ambulance crew should have let her die and not be sued (irony) .
December 9th, 2005 at 1:04 am
Whether or not the decision to award her £2.8m was correct, the lady that attempted suicide was suffering from post-natal depression at the time. As such it’s a tragic situation and your sarcasm is unwarranted, to say the least.
December 9th, 2005 at 1:57 am
In response to Calypso, surely the fault lies with the woman not seeking appropriate medical care for her post-natal depression?
However: maybe she was too depressed.
Surely the fault therefore lies with the father of the child; why didn’t he notice and take action? Or their GP? Or the midwife offer advice that she may suffer from symptoms leading up to… and so on.
This is the kind of chain that could go on for years, and I really don’t see see why one person should receive the salary that could employ over 150 trainee nurses in London.
December 9th, 2005 at 3:26 am
Calypso/Cod — I agree that the patient was depressed and deserving of help. However, the ambulance service did the very best they could to help her rectify a situation of her own making (while the depression was not her own fault, everyone, no matter how depressed, has ultimate control over whether they commit suicide or not) and she should be grateful that they tried to help.
It’s like someone being stabbed and, instead of the person who stabbed them being send to prison, banging up the doctors and ambulance crew because they couldn’t manage to save their lives.
I’m sorry if you think I am taking the mickey, but this kind of claim is taking the mickey too. As Tom says, it’s depriving the NHS of money which could pay for medical staff. It could have bought enough ambulances to make sure that the next overdose patient got an ambulance in ten minutes. So no, I don’t think my sarcasm is unwarranted.
December 9th, 2005 at 3:27 am
(that last comment was me, btw!)
December 9th, 2005 at 8:10 am
Firstly - I am a First Aid Trainer, in Australia. Have taught for St John & Red Cross for 19 years. Was an ambulance officer for 4 years, pre-children. Just so you know where I’m coming from.
Something we have always taught here [Australia], in first aid classes, is when you get no response from a patient, ie. they’re unconscious, you turn them into the recovery position *in order to check their airway*. It allows vomit, blood, liquid & saliva to start dribbling out. I have been questioned many, many times as to why we don’t do airway checks with patient on their back, before rolling them over, like many countries overseas. The rationale has always been given to us as “we have so many drownings that we treat them all as if they have been in the water” or “you can’t see a throatful of water / blood / liquid, but you’ll see it run out”. Ok, fair enough. *Our* protocol / procedure / process, call it what you will, has been “roll first, *then* check airway”.
I’m not going to say that our way is specifically any better or worse than any other way, but I have had quite a few students over the years come back [often in their update course] to say that they’d have missed [couldn't see it] the vomit / blood / liquid in the patient’s mouth, if they hadn’t rolled first & watched, [usually in horror], as the patient proceeded dribble & drool. Some patients needed resuscitating, some started breathing on their own, either way, there was nothing liquid, nothing wet that could dribble on it’s own, obstructing these patients’ airways.
Of course, there is a protocol change in the wind, but no one will tell us to what until it’s Official. March. Hopefully it’s a sensible change…
My 2.5p anyway…
While I’m here, I have another wee comment to make & that is… Taking note of something you said a week or 3 ago, we have added into our classes a little bit, just a comment I guess, about Listening To The Dispatcher’s Questions & Answering Them, Even If They Seem Irrelevant. Explaining that it will help the whole process go more easily. Really it will.
I figure someone’s got to start somewhere & it’s worth passing that along.
December 9th, 2005 at 11:10 am
The man who was left crippled by “operator error”: I would argue it wasn’t the operator’s fault at all. At least, they weren’t solely to blame. The EMD is miles away from the scene, can only go on what the caller tells them, and may have a clever computer system telling them what to say, but it still must be very difficult to work out what is going on at the end of a phone.
On the other hand, the caller was stood in front of the patient, and had the caller known some basic First Aid, she would have been able to note what was wrong with the patient (they’re not breathing…) and act accordingly (open airway, check for obstructions, etc…). Ok, so most callers don’t know first aid, or if they do they forget it in an emergency… but I don’t see how the calltaker can be held solely responsible for this error. I think it’s great that EMDs can give so much help and offer potentially lifesaving instructions over the phone, but there’s obviously going to be occasions where it doesn’t work. We all make mistakes every now and then. It’s unfortunate in this case that it had such dire consequences. Maybe the caller can use some of the £200,000 to go and take a first aid course.
@draquin: if the protocol changes you’re talking about are the same as those in the UK and US, they’re available from http://www.resus.org.uk/pages/guide.htm
December 9th, 2005 at 2:01 pm
Draquin — When I first joined the nee naw service I had already done first aid, so I was surprised that we had to maintain airways with the unconscious patient on their back. When I questioned it, the reasons I was given were: 1) it is easier to see whether a patient is still breathing when they are on their back 2) if they stop breathing, CPR can be started quicker 3) recovery position is very difficult to explain over the phone. It does worry me that the caller has to quickly turn patients over if they vomit, since callers aren’t always great at doing things quickly, but it’s protocol and I have to go with it. Apparently in all the time EMDs have been doing it that way, it has never done any harm until now, and this was only because a mistake was made.
I am glad you’ve added that bit into your classes! Thank you!
tjwood — I agree — the situation sounded very confusing in the newspaper, and that was with a clear transcript written out — I bet it was even more confusing down the phone. You make a very good point about the first aid. Apparently the patient’s wife argued in the court case that she shouldn’t have been expected to know about the recovery position but really I would argue that it is everyone’s responsibility to know a bit of basic first aid and not something you should just “leave to the professionals”. For a start, there might not always be a phone available when there’s an emergency. This isn’t excusing the mistake, but the consequences of the mistake would have been alleviated if the caller knew first aid.
December 9th, 2005 at 5:11 pm
The recovery position is brilliant for a patient that is unconscious and breathing. It is not brilliant however for checking breathing. Any patient who is unconscious is unconscious for a reason and that means that constant monitoring is needed.
Unfortunately there is a trend to put patients in the recovery position and assume they will stay breathing because ‘thats what the position is for.’
This is one of the reasons that the advice is to keep the patient on their back. You are more likely to recognise respiratory / cardiac arrest that way (it is easier to observe the rise and fall of the chest, the facial colour when you can see them clearly - especially for someone who is not trained)
This can lead to a conflict. I once came accross a fitter as an off duty paramedic. I cleared and checked the airway, checked the pulse and rolled the patient into the recovery position, having enough experience of monitoring patients that way. The patients relative was on the phone to the nee naw control and was telling me to move him onto his back. I explained my position and was told again to put him on his back. I then spoke to nee naw control who told me to put him on his back (even after I explained who I was) I then hung up the phone to break the protocol as the call taker couldn’t. (And all was well)
If followed word for word the protocols are there to protect the patient and call takers. If the protocol was followed word for word and the patient came to harm the protocol developers would bear a proportion of responsibility. if the call taker strayed from the protocol it becomes ‘human error’
I believe the nee naw services pay a license to use the mpds / cbd protocols and this affords some protection in cases where protocols are wrong. Thus the maternataxi scenario… overkill, just in case.
December 9th, 2005 at 5:22 pm
If the patient you came across was fitting, Nee Naw Control (assuming they were using AMPDS) should have told you to put him on his side. The on-his-back stuff doesn’t apply to fitting patients, unless they’ve stopped fitting and still aren’t breathing. Maybe the call taker didn’t know he’d been fitting? Often members of the public don’t recognise a fit and describe it as a “collapse” instead.
December 9th, 2005 at 6:11 pm
Hmm, this is interesting. I’m a first aider and member of a large national first aid organisation. As such I am covered by their liability insurance when treating patients both on and off duty in accordance with the training they have given me.
If I were in a situation as Al described above, I would obviously follow my training (unconcious => open airway & check breathing (present) => recovery position & monitor closely) but it appears that on occasion this could differ from the advice given down the phone by the EMD to the caller, who could be a member of the public with no first aid training. Obviously the call taker has to give the instructions as per his/her protocol…and i have to treat the patient as per the protocol I was trained to… which could presumably cause confusion and distress for the member of the public making the 999 call? And wouldn’t reflect well on either the EMD or myself?
December 9th, 2005 at 6:16 pm
If one of my callers was para theres no way Id presume to give him advice.
We are only required to give PAI’s if relevant appropriate and necessary. I dont think its appropriate or necessary to a give a para advice on maintaining an airway!
December 9th, 2005 at 6:37 pm
It’s always a hard call when the person on scene wants to follow a different protocol. What I normally do is try to establish what they are doing, tell them what our protocol is and let them make up their mind if they want to take control or follow instructions. I believe that so long as we *offer* our protocols, we’re not in breach of The Rules.
Even if the person I was talking to was a paramedic or doctor, I’d still check that they were doing the right thing. After all, you can’t prove that you’re a paramedic over the phone! I also had one call where a “doctor” (I hope to god they weren’t really a doctor) started doing CPR on a fitting patient while they were still fitting. I had to get a member of the public to practically pull the “doctor” off!
December 9th, 2005 at 7:22 pm
Thanks, that makes sense.
Your “doctor” probably had a Ph.D. in Art History or something…
December 9th, 2005 at 8:30 pm
Re: woman with PND getting compensation for overdose…
I would suggest that it was the fault of the maternity services (or, post-28 days following birth, the Health Visiting Services) that her condition was not picked up.
It isn’t the ambulance’s fault for ‘not getting her to hospital in time’. How ridiculous! If the paramedics had stopped for a coffee en route to the hospital with her in the back, then it would be their fault.
If she wants compensation, the cause of her initial injury needs to be assessed (to see if there was any point where professionals failed to diagnose) and the compensation, if any, should come from the relevant people.
Clarie
Midwife
December 9th, 2005 at 11:08 pm
Tjwood said: The EMD is miles away from the scene, can only go on what the caller tells them, and may have a clever computer system telling them what to say, but it still must be very difficult to work out what is going on at the end of a phone. … Maybe the caller can use some of the £200,000 to go and take a first aid course.
Yeah. And maybe some of it can be spent on an ad campaign assuring the general public that panicking, shouting “send a nee naw” and slamming the phone down isn’t terribly helpful.
the patient’s wife argued in the court case that she shouldn’t have been expected to know about the recovery position
Balls. It’s not like it’s top secret or anything.
Al, interesting stuff. I’m Australian and was always taught to use the recovery position first off unless they were conscious then ring for the ambulance (I’m not a medical person). But of course if there’s a better way publicised I’ll go with that. Fortunately I’ve never had to experiment on anyone. The only person I’ve come across so far in need of an ambulance was conscious and had a leg injury from a hit and run so I didn’t try to move her.
December 10th, 2005 at 2:47 am
As a nee naw control worker i have a few comments to make…
Another reason we put the uncons pateint on their back rather than trying to explain the recovery position down the phone is that it means that the caller can not really walk away and leave the pt. They have to physicialy keep the head tilted back and therefore have to stay with the pt and on the phone to us.
With regards to the call taker who told the off duty para a number of times to put the pt on their back, personaly i wouldnt of done that! Have come across this a few times with off duty para’s, dr’s and nurses. If a caller refuses to put a pt on their back and wants to put them in the recovery I say to them again that my advice is to put them on their back. At this point they usualy identify themselfs as off duty whatever, (or just a joe blogs member of the public who has seen it done on ER and thinks they know it all) If they say they are a medical profesional i dont give them any more advice. They are heeps more qualified than me, and they are also at scene, with the pt, so ultimately know better than me what is actualy happening. And in the unthinkable event that they are not really who they say they are, my view is that surely they are taking the responsibility of anything going wrong onto their shoulder by lying to us in the first place?!
just opening my mouth and letting my belly rumble folks!
December 12th, 2005 at 6:37 am
Anon call taker said: Another reason we put the uncons pateint on their back rather than trying to explain the recovery position down the phone is that it means that the caller can not really walk away and leave the pt.
Good point.
December 14th, 2005 at 11:00 am
The £2.8 million compensation story makes me think of the Fry and Laurie sketch where Hugh Laurie is standing over the bodies of his wife’s parents holding a bloody knife and his horrified wife exlaims “why did you murder my parents” He states that HE didn’t kill them, sure he weilded the knife but it was the lack of policemen and social workers to indentify his condition and thereby take appropriate measures to prevent it, that ultimately caused his in laws to die. He totally denies all responsability in the matter, stating that it is the system at fault.
It is quite clear that to deliberately deprive the already underfunded Ambulance service of £2.8 million will in one way or another lead to the deaths of many people who would otherwise have recieved timely treatment from the ambulances and staff that this money would have provided. Is not taking an action that you know will innevitabley lead to the deaths of others murder, or at least manslaughter?
December 15th, 2005 at 5:20 pm
“surely the fault lies with the woman not seeking appropriate medical care for her post-natal depression? However: maybe she was too depressed.”
Getting help for depression out of your typical GP can be like pulling bloody teeth. Mine are of course lovely and wonderful, but there are a lot of really really crap ones.
December 15th, 2005 at 9:29 pm
I work at a GP surgery and see the reports of the idiots that mistreat the services. One patient regularly overdoses (once a week) requiring an ambulance on each occasion. Either do the job properly or don’t bother…..either way stop wasting limited resources and let the paramedics deal with people who really need their help!