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Pilot scheme to give call handlers more time to assess 999 calls

Call handlers are to be given an extra two minutes to assess 999 calls before dispatching an ambulance in a new pilot scheme announced by Jeremy Hunt today.

In a written statement to Parliament, the health secretary endorsed proposals from Prof Keith Willett, director of acute care at NHS England, to help make ambulance services more efficient in a time of rising demand.

The new proposals, which will not apply to the most urgent Red 1 category of patients, are to be trialled by the London and South West ambulance trusts before potentially being rolled out nationwide. Currently, ambulance services are allowed 60 seconds before the clock starts for an ambulance to respond. The new scheme will allow an additional 120 seconds to the maximum clock start for all 999 calls except those that are Red 1, where the clock start will remain at zero.

The extra time will allow call handlers more time to assess the call and determine the best response. Under the current arrangements it is quite common for ambulance resources to be dispatched on blue lights and sirens before it has actually been determined what the problem is and if the ambulance is required.

Other examples of inefficiencies that the pilot attempts to fix include dispatching multiple ambulances to the same patient on blue lights and sirens and then standing down the vehicle less likely to arrive first; and diverting ambulances from one call to another repeatedly and using a ‘fast response unit’(car, motorbike etc) to ‘stop the clock’, meeting the required response time but actually providing little clinical value to the patient, who then has to wait a long time before a conveying ambulance arrives.

The extra assessment time has already been trialled by the South West Ambulance Service Foundation Trust and was found to increase the rate of ‘hear and treat’ and decrease ambulance use.

During the pilot scheme, a small number of Red 2 conditions will be upgraded to Red 1. Explaining the reason Hunt said: “In these pilot sites, a small number of potentially life threatening conditions, such as overdoses and certain types of gunshot wounds, will also be upgraded from the Red 2 category into the Red 1 category so they receive a faster response than is currently the case.”

The health secretary laid out three criteria that the pilot has to meet before he will continue any extension or wider implementation. They are:

  • Clear clinical consensus that the proposed change will be beneficial to patient outcomes as a whole, and will act to reduce overall clinical risk in the system.
  • Evidence from the analysis of existing data and piloting that the proposed change will have the intended benefits, and is safe for patients.
  • An associated increase in operational efficiency. The aim is to reduce the average number of vehicles allocated to each 999 call and the ambulance utilisation rate.

A spokesperson for the College of Paramedics told NHE that the organisation was supportive of the proposals and that it makes a lot of sense clinically to have more time to assess the call before dispatching resources.

“It gives longer time to assess the sicker patients because currently ambulance services are sending two or three responses before they fully assess the call, and therefore this allows them more time to make the right decision and also decide, in some cases, if the patient will benefit from telephone review first,” the spokesperson said.

(Image credit: Rui Vieira/PA Wire)

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