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National Health Executive talks to Peter Suter of the London Ambulance Service NHS Trust about how communications technology is enabling the NHS to save lives

When one considers the task facing ambulance services in Britain, it is hard to comprehend how they manage to do such a good job. Serving millions of people, each service has to locate and retrieve the sick and injured as quickly as possible from a specific location within a huge geographical area. And they have to do this on a very tight budget.

Needless to say, they use some of the most sophisticated telecommunications systems to enable them to answer the 999 call, evaluate its urgency then launch the most appropriate type of response, in the most efficient and effective way possible.

“We use a combination of different systems to meet our business requirements,” says Peter Suter, the London Ambulance Service NHS Trust’s director of information management and technology.

“First the caller is put through to the operator who asks which emergency service is needed. Once that is established, in our case ‘ambulance’, the call is then put through to the appropriate ambulance control room using our call system and switch. Our command and control system then comes into play using a secure database to establish the address of where the call is emanating from.”

This means that as staff at the control room are taking the emergency call, their systems will have already identified the location of the caller. This is then confirmed by the caller to staff over the telephone.

“We will then ask the person what is wrong and as we do that, we are firing up another system called AMPDS which is linked into our call taking system. This will then bring up a set of questions to help staff establish the severity of the emergency, such as whether the person is breathing and whether they are they conscious. Also because it is a clinical decision making system; the answers which are given, govern the following questions.”

This means that within the first few moments of an emergency call being made to the ambulance service, staff will have been able to identify both where the emergency is and its nature. This information will then govern the type of response given by the service.

“Calls are then graded into categories, either A, B or C. Category A means that this is an immediately life threatening call which requires a response within eight minutes. A category B call indicates that the situation is still serious but is not life threatening and requires a response within 19 minutes. Category C is a non-priority call and there are no national targets for that.”

It is clear that without the help of such sophisticated telecommunications technology, it would be incredibly difficult for the ambulance service to meet its government targets on response time.

“On both of our targets, the clock begins ticking, so to speak, from the moment the emergency telephone call hits our switch. This means that, in the case of a category A call, if we leave it ringing for seven minutes we would only have one minute to get to the scene.

“Obviously, this is a nonsense and would never happen, but it makes the point that our targets do not begin from the moment we answer the call, but from the moment that the call is received by our systems. This means that we are giving the public the best service possible.”

The ambulance service has other telecommunications technology which goes into action, locating where the trust’s vehicles are located in order to dispatch a timely response.

“This means that the system is already starting to look at where the address is, where our nearest vehicle is located and is making automated decisions about an appropriate dispatch. This means that we already have vehicles moving before the caller even finishes speaking on the telephone and is key to hitting our eight minute target.”

Even when the ambulance has been despatched and is on its way to the patient, technology still has a vital role to play.

“There are a variety of onboard computer systems in the ambulances themselves, carrying out a variety of tasks. One of those is to send a signal to the control room, giving us the geographical location of that unit in real time, along with providing the team inside the ambulance with the dispatch address, straight to their satellite navigation system.”

Apart from this recent digital procurement, Peter’s trust is also going through a rather large major technological upheaval.

“We are now in the process of replacing our command and control system which has served us well since being designed and implemented in 1995. However we are now taking a new direction.”

This new direction will have to take account of the new demands which are being put upon the ambulance service. Although the current system has been designed and tailored by the trust’s in house specialists to fit their needs as much as possible, there is a limit to how much more modification could be made.

“Demand on our services is constantly growing. At the moment we deal with around a million calls a year just in London. This has led to us working with a major contractor who has extensive experience in designing and building extremely hi-tech military systems to build a system which will be the first of its kind in the UK.”

This process is now ongoing and the trust hopes to have their new system live by February 2011.

Whilst looking into the future, I asked Peter how he thought these kind of systems could be improved in the future?

“I think that firstly, through the future shift of health services into the community, there will be far more medical equipment in people’s homes. This will enable far more telemetry between systems and semi-intelligent systems in the future.

“This will in turn allow people to monitor their own health far more effectively and also keep clinicians informed of their progress remotely. This will lead to the more efficient use of the ambulance services, because people will be able to manage their health more effectively.”

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