Thursday, December 11, 2008

AMPDS again

Last weekend was really busy for the LAS. We were working nights, and spent the vast majority of our shifts running round after people who'd been going to Christmas parties, drinking too much and falling over.

This is where I have a problem with our AMPDS system that our colleagues in control have to follow. Almost all calls for drunks are Cat A calls because the patient is "unconscious", meaning they get priority over other calls to people who are actually ill as opposed to being drunk, with a cardiac arrest being the only type of call that would get a higher priority.

So at half past two in the morning, after going to a flurry of calls to drunk people, we were sent to an underground station for an elderly woman who'd been knocked over by someone running for a train and was now lying on a cold platform with a hip injury. Because this call was an Amber call (Cat B), it had been held for two hours, no doubt in favour of the Cat A drunks. This is not the fault of our dispatchers - it's the system that demands we send ambulances to the Cat A calls first, regardless of what is actually wrong with them.

The woman was in a lot of pain, and may well have broken her hip. She was surprisingly still in very good spirits and laughed and joked with us as we gave her a pain killer before moving her to the ambulance.

This is when AMPDS is wrong in my opinion. This lady needed an ambulance far more than any of the drunks we'd been to, all of whom could have made it home with a little help from their friends, but calling 999 for an ambulance is so much easier! She'd been waiting so long that the last train was long gone and the station had closed. I have no doubt that if dispatchers were allowed to use common sense, then this lady would have had an ambulance much quicker. But they're not.

For our management, getting to those Cat As is what matters, cos we have to hit the targets, so our dispatchers have to send on what they know will be just another drunk, or a violent person who will kick the crap out of some poor unsuspecting FRU person. Get well soon "Fred"


Anonymous Anonymous said...

I would have sent on this long before the2 hour mark. This is where the F2 colour blind allocators fail the patients. The elderly can die from an injury like this as you are well aware and I'm with you - AMPDS is wrong. I had a very similar argument with one of my managers the other day!!!!

On the other side of the argument - hell they may have been so short staffed they were holding Cat A's just as long. Not taking a dig at the road staff but we can lose entire stations for their christmas parties and that can make us a bit thin on the ground!! But hey - everyone deserves a christmas party!!

7:31 pm  
Blogger Viking83 said...

Anyone can die from hip fractures, a fractured feamur can lead to severe blood loss, shock and death (all bleeding stops-eventually). NOF fractures are the most common fractures in old women who fall (a month on an Orthpod ward and that was the most frequent injury I saw).

And quite frankly if some one can't tell that a person has gotten plastered and is now trying to sleep it off, then there's serious questions that need to be asked about regular joes 'common sense' qouta.

also that FRU article sent a shiver down my spine!!


7:46 pm  
Blogger Dan said...

Can't the call taker or dispatcher upgrade a call to a higher priority then it was automatically given? I know they can't/won't downgrade the drunks, but surely no media circus would attach to "Drunk man dies while ambulance crews tend to old lady with broken hip"

1:32 am  
Blogger Axel Rümmele said...

Hej Steve,

I´m completely with your argumentation that the woman should have been treated faster than all the drunken guys.
But as you describe it, it´s in my opinion not a failure of AMPDS. I think it´s more likely a wrong application of the system. This problem can just be solved as paramedics and dispatchers request their management for change.
I am really happy that my management has done the step and reviews our work. In simple words do they match the code which is produced by the dispatcher with the Glasgow Coma Scale, NACA Score, and necessity of an ALS-Unit which is collected by the emergency-physicians of the ALS-Units. Afterwards decide the managemnt of the EMS and its medical director which code recieves a BLS-Unit and which codes recieve both, BLS & ALS Unit.
This leads me to the lucky situation that I can send my dozens of BLS units to all the drunken guys whereas i save my few ALS-Units to help the persons that really need help.

So far, good work done. I really like your blog.

Greetings from the Alps in Tyrol/Austria


11:57 am  
Blogger Dr Fostes said...

nice stuff to read here

9:25 am  
Blogger Centennial College said...

You are right. lady needed an ambulance far more than any of the drunks.

12:11 pm  

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