I’ve just come from a management meeting about changes and suggestions for the Rapid Response Car. Given that I now want to stab things, I think I’ll wait until tomorrow before letting you know what was discussed…It is, in part about this report.
Loads of people have asked me about the recent UK news items about the response times of various ambulances. Essentially the BBC investigation suggests that ambulances that should respond to “Category A” (high priority) calls within 8 minutes, are only doing so because trusts fiddle the numbers.
Note: I am not a Dispatcher, and have only spent a few hours up there – if anyone in Control wants to correct anything I write below, just let me know.
I’ve mentioned this before, but for any new readers…
“Cat A” calls are the highest priority calls, and from the time of activation we have 8 minutes to get to the patient. There is absolutely no medical reason why it is 8 minutes, and although it is often mentioned as he maximum time that someone can survive with a stopped heart, the actual number is actually closer to 6 minutes.
The story is that different ambulance trusts start the clock a different times, so that they have more time to get to a call. You can read more about it here, and listen (for the next couple of days) to a radio discussion about it here (MP3).
What has amazed many in the ambulance services is that the Staffordshire trust is being held up as the ‘golden child’, when it has been widely believed that they fiddle the figures more than anyone else… (Just a rumour, I’m not suggesting that it’s true, please don’t sue/sack me)
The government, whose bright idea this is, tells us that the clock should start when the calltaker has,
a) The name of the patient (or caller).
b) The complaint or injury (enough detail to know how serious it is)
c) The location the ambulance needs to go to.
Rather reasonable I think.
The problem is that some trusts have been starting the clock later (apparently).
There is a crazy idea that the London Ambulance Service has a delay of minutes when dealing with calls. Well I can only see the times when the phone is picked up, and when the clock starts. The times are often around a minute apart. Sometimes it is longer, and that is because of the problems that the LAS has due to the size and makeup of our patient population. One of our calltakers has posted a comment, and it’s pretty much as I expected.
The problems are…
a) Only 1 in 6 callers has English as a primary language.
b) People dial 999 shout “I want an ambulance” down the phone and hang up.
c) People with mental health problems will ring up for a chat, and calltakers can’t hang up the phone on them.
d) People don’t know the address that they want the ambulance sent to. Our computer mapping system isn’t brilliant and pretty much requires a postcode.
e) People who keep talking, but don’t answer the questions the calltaker asks.
When I spent a couple of hours up there once, none of the calls I listened to were easy to understand…
Do I think that we ‘fiddle’ the numbers? Well – back in the good old days before we had the computer dispatch and all the times were taken from your paperwork, then we could use the ‘magic pen’ to knock a minute or two off the times. Now we can’t fiddle the times, as they are all collected, to the nearest second, by the computer system.
Does getting to 75% of all calls within 8 minutes help patient outcome? Well no, except in a very few cases. Remember, if I get to a dead body in 7 minutes that is a ‘success’, while If I get to someone and save their life in 9 minutes, then its a ‘failure’.
Do Trusts ‘fiddle’ the numbers? Possibly. Do they wait four or five minutes before starting the clock? Probably not, and almost certainly not in London.
Was the radio piece biased? Oh yes…
Maybe more later, check on the comments – but I desperately need some sleep.