Nee Naw

Sick of ambulances? Sick of posts about whinging patients, dying people and crews who don’t want to take meal breaks? Then go and read my friend Victoria’s Jukebox, where you can read all about the summer’s music festivals and other music related stuff. And, should you enjoy what you read, you can vote for her in the Digital Music Awards here.

It’s just the thing you need to cheer you up after a week of nightshifts *yawn*

It was a block of four day shifts this week, and I was allowed to allocate on every single one of them, so I’ve pretty much got it mastered now. I still have to ask my more experienced colleagues for advice from time to time, but usually it’s just for reassurance I’ve got it right. It helped no end that I’ve been with people who have taken the time out to help me even though they’ve got their own workload, so if you’ve been on the east sectors this week - thank you!

On my last post, a couple of you asked questions about how allocating works, so I’m going to give you a quick run down. Of course, I’m new to this and a more experienced allocator would probably be able to explain it better, but here goes!

There are three priorities of calls Red, Amber and Green (sometimes referred to as Cat A, Cat B and Cat C). Red are the most serious, followed by amber, followed by green. There are also subdivisions (red 1, red 2, red 3, amber 1, amber 2, green 1, green 2) but this is a minor detail really. When allocating, I sit and watch a screen, and when a call is received to my area (north-east London, which includes Waltham Forest, Edmonton, Tottenham, Stoke Newington, Enfield, Wood Green, Woodford Green, Dagenham, Romford, Hornchurch, Upminster, Ilford and probably some others I’ve left out) it pops up on the screen. At busy times the sector is split so there are two allocators, one taking the northern half of the section, the other the eastern half). As soon as there is a diagnosis and an address on the call, I decide what to do with it, even before it has been officially classified. I have to guess which category it is going to be - if I over-estimate, I can always cancel the ambulance, but if I’m not given enough information to know it is going to be a high priority call, then it will cause a delay. (This is why it is important for the caller to give the vital bits of information straight away and for the call taker to type it out as fast as they can - because otherwise, no ambulance. And no, “it’s very serious and you must get here quickly” isn’t good enough!) What happens next depends on the seriousness of the call:

Green Calls: These are ‘neither serious nor life threatening’. They include a lot of inappropriate calls and a lot of elderly people’s niggles. They also include ambulances which have been booked by a doctor, in which case the doctor will have indicated a timescale in which we should reach the patient - between 1-4 hours. If a call is classified as Green, it disappears from my screen and goes Upstairs to Urgent Care, who can then send a Patient Transport Ambulance or get Telephone Advice to call it back. If neither of these are appropriate or possible, I get the call back. I then send an ambulance on it, but only if one is free and nearby and I have other ambulances covering the area in case I get a more serious call. The ambulance will not use blue lights to this call. If I do not have an available ambulance, I will hold the call until I do. If I think a Green call is more serious and should have a higher category, I do have the option of sending on it straight away. I can ask the ambulance to use blue lights, or they can decide themselves to do so.

Amber Calls: These are ’serious but not immediately life threatening’ and include things like diabetic problems, fits, strokes, broken bones, back injuries, etc. If I have an available ambulance, I will send it straight away on blue lights. The FRU desk may also send an FRU (car) depending on the diagnosis. In general, I will not send a vehicle more than around 3.5 miles (as the crow flies) to a call because driving on blue lights is dangerous and a nearer vehicle often becomes available anyway. At busy times or if the call is in a rural area they may have to travel further. If I do not have an available ambulance, I will get the radio op to broadcast the call to see if any ambulances who are finishing paperwork or having an unofficial break offer up, and/or borrow an ambulance from another sector.

Red Calls: These are ‘immediately life threatening’ calls such as heart attacks, status epilepticus, serious head injuries and of course suspendeds. The practice is the same as for amber calls, except that an FRU is always sent if one is available, broadcasts are made more frequently and the nearest available vehicle up to about 7 miles away will be sent if no one else is available. Basically, one does not want a red call hanging around on one’s screen!

This is all quite simple when you have more ambulances than calls. Once you have more calls than ambulances (which is at least 50% of the time), decisions have to be made. These decisions are based on various factors:

- The priority of the call
- How long the call has been waiting
- How far the ambulances are from the calls
- Whether there are any other ambulances likely to become available soon
- Whether the call needs a paramedic or a tech crew
- Whether an FRU has already been sent
- Whether sending an ambulance to a particular area will unbalance the distribution of ambulances throughout London
- Whether sending an ambulance on a call will force them to keep working past the end of their shift
- Whether one thinks the call is a load of rubbish
- How polite the caller was to the call taker (Okay, not those last two. But sometimes it is tempting.)

Here’s some examples based on real life situations over the last week:

1) I’m holding 2 calls - a Fitting (amber) and an Old Woman Fallen, On Floor, Leg Injury (green). K701 becomes available near Fitting. K702 becomes available near Old Woman. But K702 is a paramedic crew and K701 isn’t. Fitting might need a paramedic crew (the patient had actually stopped fitting at the time of the call, so they might not), Old Woman probably won’t. Do I: a) send both ambulances to the calls they are near and try to find a third crew with a paramedic for Fitting if needed b) send both crews to Fitting and wait for a third crew for Old Woman or c) send the paramedics to Fitting and techs to Old Woman, thus using one less ambulance but meaning both patients have to wait longer?

I started off doing a), then decided to do c), which didn’t please K701 at all, especially as they passed K702 on the dual carriageway, but I don’t think any solution is perfect…

2) I’m holding Asthma Attack in Edmonton (red) and Diabetic Hypo in nearby Enfield (amber). H701 becomes available at the hospital in Enfield - 3 miles from Asthma Attack and 1 mile from Diabetic. I decided to send H701 to Diabetic, because there are no other ambulances at Enfield Hospital but three busy ones at Edmonton Hospital. Sure enough, one of the crews in Edmonton responds to a second broadcast of Asthma Attack and both calls are covered. Had there been more ambulances at Enfield than Edmonton, I would have sent H701 to Asthma Attack.

The scariest thing about allocating is that you are responsible for any decisions that you make and, while there are guidelines and protocols for most things, they don’t cover every eventuality. And anyway, if a patient dies, it won’t be much consolation to their family if you stand up and say ‘but I was just following protocol’. The consequence of this is that I feel terribly anxious until I get every single call off my screen and I treat every call as if it were a national emergency, even if they are obviously a load of rubbish. I’m told this feeling passes after a while.

Quick recap of roles in Nee Naw Control for those who don’t work here, in “career ladder” order (note: not necessarily order of importance):

Call Taker (takes 999 and doctor’s calls. Sits downstairs in “the pit”.)
Telephone Dispatcher (takes calls from ambulance crews, deals with queries, takes orders from radio op and allocator)
Radio Operator (speaks to crews on radio, deals with queries, takes orders from allocator, assists allocator when busy)
Allocator (decides which ambulances go where, makes all the important decisions, generally rules the desk)
Management (give out late reports, talk about statistics)

Due to reshufflement of our desk and people going on holiday or leaving for bigger and better things, the time has come for me to move on to allocating. Actually, most people who started when I did (3 years ago) have already started allocating, but I’ve been quite comfortable with the first three roles and we’ve had plenty of allocators on our desk so I’ve not really put myself forward for it. (I still think call taking is the most important and most interesting role in the room, but it’s too stressful to be doing all the time.) So last week, the sector controller turned to me without any warning and said “let’s swap seats!” Of course I panicked. “I can’t sit THERE,” I said, “that’s the scary seat.”

Then I realised it was 8am on Sunday morning and nothing was happening.

“This is simple!” I said, like a kid on a bike taking his hands of the handlebars. “I can do this! Look, blank screen!”

A call flashed up. Aargh! A call! What do I do with that? Oh yes, the same thing that has been done with every call over the last three years. Someone’s having a stroke in Ilford? Oh dear! Ring Ilford ambulance station. Hello Ilford, there’s a call for you. Send it down. Write on the paperwork. There, I did it. Simple. Ooh, another call. Heart attack in Walthamstow? Ring Whipps Cross. Fallen down the stairs in Enfield? Ring Chase Farm. There, I’m an old hand. Pass me a big sign with ALLOCATOR written on it.

By midday, allocating starts to get more difficult. All the vehicles are out and I’m having to make decisions. I don’t like decisions. I’ve got two Cat As and one ambulance. One call has been waiting longer, but the other is closer to the ambulance. I look at the diagnoses. One is an 80 year old with breathing problems. The other is a 30 year old with a sore neck and throat and fever… tonsillitis or meningitis? I send to the old lady and get the radio operator to broadcast the other one. No ambulance offers up. I start to panic at the red call sitting on the screen. It appears to be angrily glaring at me, turning redder by the minute. I alert my sector controller.

“Help, I’m holding a red call! It might be meningitis! I’m going to kill someone!”

“It’s fine. Someone will come up in a minute. You’ve only been holding it 30 seconds. This happens every day, remember?”

“Not on MY screen it doesn’t!”

“Look, there’s J319 come up at the hospital. Send them the call!”

I breath a sigh of relief as the screen goes blank again. J319 get to the call within the required 8 minutes and do not blue in the patient, so it seems it was tonsillitis after all.

By the end of the day, I find I am juggling several calls, holding some for Telephone Advice and Green Trucks and ringing people to advise a delay and shouting over to other desks to borrow their ambulances and putting crews on breaks (sorry!) and giving instructions and all without making a total idiot of myself or having a mental breakdown. The allocator’s phone rings and the man from the HART team asks to speak to the senior on the North East. I am about to pass it to my sector controller, when I remember and say “Yes, that’s me.”

(Of course, I still have to check with the real sector controller before I answer his question!)

So far, so good, I think. It’s not so scary after all. Hopefully I’ll be able to continue my allocator training once my latest dispatch trainee is signed off. Then all the ambulances will be ruled by my iron fist! Any North East crews reading should comment and say how much they like my blog and in return I will get sloppy with my meal breaks and avoid sending them on any bodily fluid related calls. (Management, if reading: that was a joke.)

I just went down the shops to buy some lunch, and saw a man lying in a doorway. I went up to him and saw he was resting on a dirty blanket and snoring. He smelled of alcohol. I prodded him and he stirred.

“You ok?” I asked. “Need any help?”

“Mmmmph,” said the man grumpily. “I’m sleeping… leave me alone…”

I did as I was told.

When I came back from the shops, there was an ambulance, a police car and an FRU parked by the doorway. Three paramedics and two policemen were standing around the man. He was telling them that he was sleeping and that they should go away.
Why can’t people ASK “patients” if they are okay before they call ambulances for them? Being drunk and homeless and sleeping in a doorway is neither an illness nor a crime!

London finally got some hot, sunny weather this weekend. Where was I? Working weekend nights, of course. I swear there is someone up there planning the weather and he has a copy of my rota. As I walked past the Fire Station pub on Waterloo Road, sweating in my greens on my way to work, it was very hard not to kick over the pints of cool, refreshing beer being sipped by people with normal jobs and not a care in the world. How dare they be enjoying themselves when I have to work?!?

I copped a session call taking on Saturday night because we were seriously understaffed. I haven’t done a Saturday downstairs for absolutely ages and I forgot what it was like. Every call was either: “My mate has had too much to drink and is passed out in the middle of the road!” “My mate has had too much to drink and got into a fight!” or “My mate has had too much to drink and the taxi service won’t take him because they think he might puke in their cab!” I wish people would stop thinking being drunk is an illness because we can put these people in an ambulance and take them to hospital but this is not going to alter the fact that they are drunk and now they are drunk and using up resources that could be used by someone having a stroke or heart attack or broken leg or something. Obviously, if someone has downed fifty-nine bottles of vodka and is completely unconscious, it is understandable that their friends call, but 90% of the calls are for people who are staggering about, talking nonsense and/or vomiting (just like me on a normal Saturday night) and I think most of the time people call expecting us to give them a lift home.

Needless to say, as someone who would have given their right nostril for the night off and to be the one drinking too much and making an idiot of himself in public, I had zero sympathy! The only silver lining to working weekend nights is that I get to take the tube home on Monday morning just as lots of grim faced rat-racers are beginning their FIVE DAY week. Sucks to be them!