Monday, October 10, 2005

Triage

We rarely get to have a break during our shifts, and it's been getting worse lately. It's quite a normal thing now to go out right at shift start time, and to not get back to station at or after your finish time.

Part of the problem is AMPDS (Advanced Medical Priority Dispatch System) our computer triage system in control that is used to categorise every 999 call. There are three categories of call:

1. Red Calls. Also known as Category A calls. These are the calls classed as immediately life-threatening, from Chest Pain, fitting, difficulty in breathing, and high energy impact road collisions to Cardiac Arrest. We have to get a response to these calls within 8 minutes e.g. a fast response car, motorcycle response unit or an ambulance. Where one of the rapid response units achieves the 8 minutes, an ambulance should be on scene withing 14 minutes.

2. Amber Calls. These are category B calls. These are calls that are determined to be serious but not immediately life-threatening, and include problems such as assaults, falls, some RTAs , broken pelvis, abdo pain.

3. Green Calls, or category C calls. These are calls that are not deemed to be serious or life-threatening. These include the back pains for 4 weeks, broken legs, arms and ankles (these are painful, but not life-threatening) old folk that have fallen out of bed with no apparent injury but just need help to get up, early stages of labour (never really have understood why ladies in the early stages of labour call for an ambulance only to be sent back home from the delivery suite - and "maternataxi" calls will be the subject of a future post)

The problem with our system is that it over-triages the non life-threatening stuff, giving an inappropriate category, such as a category A because there is apparently serious bleeding and when we turn up it's a simple cut finger that a rinse under the tap and a plaster would easily do.

I hasten to add that this is not the fault of the call-takers, but the way the questions are phrased in the system. Another example is the question "are they breathing normally?" Well of course they're not if they're crying! But an answer of no to that question will cause the system to triage the patient as having Difficulty in Breathing because they're not breathing normally. So someone who is just crying, instead of being a green call will end up being an Amber call or even a Red call.

Having said that, the system really is sound legally, and nobody has successfully sued a service over a categorisation of a call.

Remember though, if you need to call for an ambulance, don't be worried that answering all the questions will delay the ambulance, cos it won't. As soon as the call is answered, it appears on the dispatchers screen as well as the call-takers, so as soon as the address where the ambulance is required is confirmed (which is the first question) the nearest ambulance can and will be dispatched. Don't give the call-takers grief - they're asking stuff that we on the ambulance need to know, as it can affect what equipment we take into the call.

If I get a message on the screen in the ambulance that a caller has been abusive or has refused to answer questions, I always challenge them about it. Some crews don't, but the way I look at it is if they're not told about it, they'll think it's acceptable to give verbal abuse down the phone.

1 Comments:

Anonymous Mark Myers said...

The AMPDS needs a bit of work, if you ask me. The biggest thing they could do to improve is change "Are you breathing normally?" to "Are you having difficulty breathing?". A lot of calls go from green to red because of that question, and a lot of the red calls are actually less serious than the amber ones. Another problem is that any bleeding during labour, even a show, gets a category A. And a broken leg gets the lowest category, because it's not life threatening, and so does a pimple on the bottom.

I cringe when a really rubbish call comes out as a high priority and it's even worse when someone is on death's door and I can only get it to come out as an amber. Sometimes you can "lead" the caller into answering the question in a way which will get them a higher priority but other times there is nothing you can do. It can be very frustrating. I had a green call the other day that ended up having HEMS sent to it. The guy had his arm mangled in machinery, but he wasn't trapped any more, and the arm hadn't actually come *off*, so it came out green, and there was nothing I could do about it. Dispatch ignored the code and sent on it straight away, of course!

10:54 pm  

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