As some of you may know, ambulance 999 calls are triaged using a package called AMPDS — Advance Medical Priority Dispatch System. This is where we get all those stupid questions from. AMPDS is a very good thing in principle — without it, a patient with a broken leg would get an ambulance before a baby who had stopped breathing, if they called in five seconds earlier — but there are a couple of things that I (and others share this opinion) don’t like about it.
The biggest problem is the question which finds its way into almost every protocol: “Is he/she breathing normally?” This is a silly question, because when people are sick, in pain, or scared. It doesn’t mean that their breathing is dangerous. In my opinion, the question should be changed to “Is he/she having difficulty breathing?” but apparently that was judged as too medical/subjective for some callers. Because of this question, a lot of calls get a higher priority than they should — good news for those calls, not so good news for patients with more serious ailments who are breathing normally!
Another question which bothers me is “Is he/she completely awake?” This question used to be “Is he/she alert?” but again, this was rejected as “too medical”. The trouble here is that after midnight, very few people are “completely awake”, regardless of their state of health. I, for one, am rarely “completely awake” on nightshifts. Again, this question leads to inappropriately fast responses.
Finally, I would like to see a “Fevers” card added to AMPDS, which would effectively weed out the meningitises from the influenzas. Right now, fevers are handled on the “sick person” card which usually results in patients with flu getting a category A response because, guess what, they aren’t breathing normally. I think old people with flu should get an automatic amber response, because they can deteriorate rapidly, but young, healthy people should not be sent an ambulance for flu!
I would be very interested to see what happened if someone did a little experiment: as well as triaging each call by AMPDS, the call takers should be asked whether they think the call deserved a red, amber or green response. Then, when the crew assesses the patient they should be asked which response level the call really deserved. I have a very strong feeling that the call takers’ assessments would be a lot closer to the crews’ than AMPDS’s would be.
Of course, the reason we don’t do it that way is because this way, if a call gets the wrong category and the patient sues, AMPDS’s makers are responsible, not us. If call takers had the responsibility, we’d be liable in the event of a mistake. It’s a shame that fear of being sued makes us rely on a system that is less effective than our own intuition.
