CRISIS IN THE HEALTH SERVICE: 999 crews face emergency of their own

Ambulance outside Royal Preston Hospital A&E Department entrance
Ambulance outside Royal Preston Hospital A&E Department entrance
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The region’s ambulance service is under pressure all year round – not just in winter – as the number of calls for help keeps rising. Laura Wild reports

The region’s ambulance service is drafting in extra staff and using volunteer first aideers to try and cope with unprecedented demand.
The service revealed today that since last April it has seen the busiest time since it formed in 2006.

Derek Cartwright, of the North West Ambulance Service, said activity has increased on an “unprecedented level” and the quiet period they expected to see in the summer didn’t occur.

“Since April we have answered an additional 63,021 ‘999’ calls compared to the same period in 13/14 with a 12.5 per cent increase in ‘Red calls’ – those we deem as life-threatening or potentially life-threatening. As a result, we took more patients into hospital which of course then results in a rise in activity for the emergency departments. This then presents us with the challenge of handover times and crews being available for the next patient.

“We understand that waiting for an ambulance response can be an anxious time but we need to prioritise the resources we have and attend to those who need our help the most. This is why some patients with minor or less serious conditions may find themselves waiting longer.

“It is as concerning for us as it is for the public to hear of falls, for example, where a patient has been on the ground for some time and we acknowledge the stress the patient and bystanders may experience. While we try to reach these cases as quickly as possible, those with life-threatening conditions must take priority.”

The North West Ambulance Service says it has done as much as it can to try to mitigate the challenges the call increases are bringing by introducing initiatives to ensure as many ambulances as possible are available to attend emergency cases.

This includes:

l Increasing staffing levels in control rooms with seven starting in December and a further 42 before the end of March 2014

l Increasing frontline resources, with 68 new clinical staff out on the road later from December and a further 68 before the end of March

l The use of volunteer services such as Mountain Rescue teams, Red Cross and St John’s Ambulance and the increased use of Community First Responders.

Mr Cartwright added: “The rise in calls we have seen has coincided with the rise in life-threatening calls. However, there are some calls we receive which don’t warrant an emergency response.

“We’re getting better at educating the public as to what we are here for, and transferring the caller to our urgent care desk which may advise the caller to use alternatives, give advice on self-care or assist in arranging a GP appointment.

“We do ask that people only call us in life-threatening, potentially life-threatening or serious emergencies, but we have had calls from people requesting help to find their wallets, to report that they have locked themselves out of their home or even to ask for the number of the 111 service. The 999 number is most definitely not for these kinds of enquiries.

“With very minor conditions, it is very likely that our response will be to refer patients to our urgent care desk. This is manned by Specialist Paramedics who will ask additional questions to determine whether the call requires an emergency ambulance response and if not, the patient will be offered a different source of care, such as a GP or Pharmacist or self-care advice.

Mr Cartwright said the message to the public is when it is not serious you should consider taking care of yourself at home, talking to a pharmacist, making a GP appointment or visiting a walk-in centre.

But he added: “Because of the rise in activity, it is more important that we triage our calls thoroughly.

“How we prioritise calls is based on a serious of questions asked by the call centre and the answers given by the caller.

“It is important that callers give us as much information as possible, try to stay calm and don’t hang up until the call-taker says it is ok to do so.

“In many cases, particularly cardiac arrests or choking, the Emergency Medical Despatcher (EMD) can give life-saving advice and instruction on how to help until the ambulance arrives.

“We fully appreciate that an emergency can be frightening and the number of questions can seem irrelevant or frustrating but they are all carefully designed to get as much information as possible and to ensure the patient gets the right response.”

Mr Cartwight concluded: “We are doing all we can to continue to provide a high- quality service but would be very grateful to the people of the North West if they would assist us by only calling in real emergencies and first of all consider the alternatives we have outlined here.

“I’d finally like to express my admiration and gratitude of NWAS staff, who work extremely hard under 
very challenging circumstances.

“In all weathers and at all times of the day and night, our staff strive to reach all patients as quickly as possible and I am very proud of how they represent the Trust and the work hard to provide the very best care.”

Read our investigation into Lancashire’s crisis-hit health service here