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What happens when you call 999 for an ambulance?

By Cambridge News  |  Posted: January 17, 2014

  • 15/01/14 CN Health Reporter Adam Luke visits the Bedford ambulance call centre , Hammond Road , Bedford . Shown is HEOC Duty Manager Amit Pau with Adam Lukel . Picture by Warren Gunn

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When you ring for an ambulance from the Cambridgeshire region – which stretches from March in the North to St Neots in the west, Melbourn in the south and Haverhill in the east – your call will be answered in Norwich.

The Norfolk city is one of three Health Emergency Operations Centres (HEOCs) for the East of England Ambulance Service, with the others in Chelmsford and Bedford.

Each is home to call handlers, dispatchers and clinicians who together form the first point of contact for any emergency call in the region.

To find out more, I took a trip to Bedford where I met Zoe Martindale, duty manager, and Gemma Bolland, assistant general manager, for a tour.

Zoe explained: “Our Norwich HEOC takes calls from Norfolk, Suffolk and Cambridgeshire, although centres like this – which is the largest – can help when they receive a very large number.”

So what does a call handler do? I observed at first hand when sitting with Helen Royle while she worked on Hertfordshire calls.

Zoe said: “The address and phone number of a land line immediately appear on the screen when a call comes in.

“The call handler then follows a strict script, with questions relating to the particular ailment or condition.

“If it is chest pain, callers will be asked if the patient is breathing, are they conscious, are they alert?

“The answers given will determine the code assigned to the call, ranging from the highest priority of life-threatening red, which requires an ambulance to attend within eight minutes, or perhaps a G2 code which requires a 30-minute response.”

Gemma added that the AMPDS system – Advanced Medical Priority Dispatch System – is particularly cautious and can often increase the priority of a case to be sure of avoiding errors.

The priority level of the call then goes through the computer to the dispatch team for Cambridgeshire, which is based in Bedford.

It consists of one dispatcher covering South Cambridgeshire and the city itself, one dispatcher covering the north of the county including Peterborough, and a team leader – who on this occasion was Amit Paul.

Their job is to dispatch the nearest resource, which depending on the location and priority could be an ambulance, rapid response vehicle, cycle response team or community first responders.

But not all calls find their way to the dispatchers. If the answers given to the call handler’s questions do not require emergency response it can be passed to clinicians who are also based in the room. They then contact the caller and provide medical advice or refer patients to other services, such as out-of-hours doctors.

As I sat with Helen, three calls came through. The first was from a young mother in Rickmansworth whose 15-month-old daughter was in pain and would not stop screaming. The script judged it as not life threatening and the woman was told that a clinician would be calling her back to give more advice.

Helen said: “We receive a lot of calls about babies and young children because parents get very worried and don’t know what to do.

“They often Google symptoms and although it is good they are taking an interest, it can often be inaccurate and simply frighten them.”

The second call came from Kempston and focused on a 23-year-old man who was having difficulty breathing. An ambulance was sent as a lower priority given his responses to questioning.

But the third call was far more serious, falling into the highest priority red category.

In Letchworth, an elderly man’s wife had suffered a suspected cardiac arrest, had stopped breathing and was not responding.

Looking at one of Helen’s screens in front of me, I could see a live map of emergency vehicles and was able to watch as a rapid response car reached the address in minutes, while we were still on the line, in the hope of using a defibrillator to get her breathing again.

The Bedford centre takes as many as 1,000 calls a day among its seven call handlers, and about 30 per cent are categorized as red, with less than half conveyed to hospital.

Zoe said: “Your team are running themselves ragged to help people.

“You can have cardiac arrest after cardiac arrest and then something amazing will happen like a mum having a baby at home and you talking them through it. We have had families come into the office with their baby and say thank you.

“You can never get complacent as this is people’s lives you are dealing with.”

She added: “People who call us are not necessarily going to get an ambulance straight away because that is not what they always need and it is not possible.

“I wish we had a never-ending supply of ambulances but we don’t. Think before you call.”

And Gemma said: “Ultimately it is what is best for patients. Clinicians will be able to give them advice that call handlers aren’t able to and provide a better outcome.

“There will be times you really need an ambulance and if the situation is life threatening we will be there for you but if there is an alternative you can take, do so. There is a culture of abusing the ambulance service and this needs to stop.”

So what are the qualities needed to work in such a high pressure atmosphere? Zoe said patience and the ability to listen, while Gemma added compassion and empathy into the mix, as well as dispatchers having the ability to multi-task.

And the stupidest calls?

Gemma responded: “I have had a man calling up saying he dropped a fiver down the drain and he wants the ambulance service to get it for him, and a 21-year-old man who kicked a pack of digestives and hurt his toe.”

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