Can We Send Back The Computers Please?

We have recently updated the AMPDS dispatch system in Control. This piece of software is supposed to categorise all the calls into the three different priorities…
Cat A (Red)– High priority, life threatening injuries and illnesses.

Cat B (Amber)– Medium priority, chance for disability.

Cat C (Green)– Low priority, cut fingers, coughs, colds.

We had been hoping that the new update would cut the number of 'Cat A' calls we would be going to by better triage.

Unfortunately, the opposite seems to be true (for me at least).

For example, Maternataxis, which mainly used to be 'Cat B' and 'C' calls are coming out as 'Cat A' calls because it is often classed as “Bleeding from dangerous location”.

“Dangerous area” seems to be a new criteria with this 'upgrade', as it's the discriminating factor on a lot of the calls I go on.

I've just come back from a 'Cat A' call to a 16 year old boy who heard a crack in his neck as he got out of bed. No history of trauma, no neurological deficit, just the normal sound us old people make after waking up.

This was a 'Cat A' because it was a “Dangerous area”. I hate to say it, but pretty much every point on the body could be considered a “Dangerous area” depending on what had happened.

I understand that we have to over-triage in order to be safe, but our Call-takers aren't allowed to use any common sense or clinical judgement in deciding the category of a call. It's all very “ Computer says 'No'“, I'm afraid.

The flipside is that strokes (CVA) tend to be categorised as 'Cat B' calls, which is something that really needs to change if the National Service Framework is to be implemented. Road traffic accidents also tend towards being 'Cat B' calls.

Crazy.

Why am I mentioning this? Well I've just come back from the boy with the neck cracking, and after cracking my knuckles in front of him, the crew took him to hospital and the thing is, after being either cleaning my new flat, decorating it or at work for the past month, I'm starting to have a sense of humour failure.

So I may be a little 'terse' with some of my patients.

Which is good, because if you mollycoddle idiots they'll only think that what they have is serious.

Reynolds is moving on Tuesday, and has a lot of packing to do by then, he is tired, fed up and looking forward to the end of the week when it should all be finished and he can get back to the pursuit of joy…

17 thoughts on “Can We Send Back The Computers Please?”

  1. Computer not always right. Compter need sane humand to programme it. Much complication about who is to be sober on which night and then death. Very very sad. I hate programing.

  2. you have to be 'firm but fair' with the idiots of society.Does a 'bang to the head' warrent a hospital visit if there is unknown loss of Consiousness, but all observations seem normal? and apart from a small cut to the head there is no other injury or deficite?

    What would warrent an ambulance???

  3. I'm in a Same Day Surgery, using the exact same computer charting as the main OR. Problem? Same set of screens/number of required fields for a trigger finger release as for a Heart Transplant. Somebody who doesn't know rectum from hole in ground decided this was what was right without ever asking the people who know the different tissue layers in the rectum.I also lose my sense of humor when I get too tired for too long, especially when moving (like now, you have my commiseration.) It is usually just misplaced, have you tried looking behind the sofa?

  4. QA say they'll be changing that thing that makes all the maternataxis come up as Cat As soon. There's also an interesting quirk which means a “sick person” cannot be a green call if the patient rings for an ambulance themselves. No-one has been able to come up for a coherent reason why this happens, and it will hopefully be changed soon.

  5. There's something I don't understand abot maternataxis. If I got it right, it means taking a pregnant woman to hospital because she's aboy to deliver, right? And how does Tom assist in those services, given that he cannot carry any person on the RRU?

  6. Well see…it's “Potentially serious bleeding”, which makes it a 'Cat A' call, which means that someone needs to get there within eight minutes, which means……me.

    Then I stand around telling the first time mother that the pain will get *much* worse, and will go on for *much* longer.

    …Well I do if I'm feeling nasty.

  7. so far as I understand it, the criteria for warranting an ambulance is that some muppet, be it the patient, a family member, or a bystander, decided to call one… and that sometimes people who really should call an ambulance “don't want to be any bother”.As for bangs on the head, about ten years ago I had a nasty one at school on concrete, I lost consciousness for about a minute, and the dinner lady plonked me in the receptionists' area for the rest of break on the basis that “it's not bleeding, you'll be fine, just a bit dizzy.”

    If I hadn't thrown up when I tried to get up to go to class, I don't think they'd have even called my mum. She called a doctor for advice, the doctor told her to bring me in to the surgery, he examined me and then called an ambulance, and wrote an angry letter to the school saying that with head injuries it was better safe than sorry.

  8. went to a 10 year old boy 'fallen and impaled on fence – spike right through arm – Report for HEMS – LFB en route'Green 2 – because the arm is considered a non-dangerous distal body area.

    what a LOB!

  9. If I read the classification correctly I can call you out if I have a cold. Seems fair :-)Good luck with the continuing move……

  10. Same problem here in the States. Our categories are Delta (A), Charlie (B but with lights and sirens), and Alpha (C – nonemergency), and our computer-aided dispatch churns out more Charlie calls than anything. The vast majority are downgraded to Alpha five minutes in, or whenever the system controller thinks the crew might not make it in the required time. How many times have we run hot for a nursing home patient going for a PEG tube replacement? And yes, I've been to several Alpha calls that later became Priority-1 transports. Ah, computers…

  11. Call me cynical but a lot of times distance seems to take a part. 'running calls' are always red (0min response). Children dragged under cars with multiple # can be amber. Oh, and a broken leg on a horse. (Still sat on the horse!) could be green.Fortunately we can use discretion when it comes to green calls and I often travel on blues when the computer says no.

    Funnily enough by ignoring the MPDS and going on 'experience' I don't often feel like a prat when I get there. There is nothing worse than putting someone on a spine board after trundling to the job at 'road speeds' only to find that mechanisms have been overlooked by the caller when the call was made.

    However there have been improvements. It has been quite some time since i have turned up in a rush to take someone to the toilet.

  12. If I got that call I'd consider triaging it as a stab wound rather than a traumatic injury, which would get it at least an amber. We are limited by the system and the information the caller gives, of course, but there are ways of guiding the system towards giving you the response you want. For instance, the question “Is there any *serious* bleeding?” usually gets a “no”, but if you change your intonation and say “Is there any serious *bleeding*?” so long as there is some bleeding, you will usually get a “yes”. This will bump the call priority up to at least an amber. Another favourite is the infamous “Is he breathing normally?” question. If the caller is unsure (they often are) you can rephrase the question to “Is this how he normally breathes?” or “Is he having any difficulty breathing?”I'm very careful not to push for a lower response (tempting though it is at times — I hate it when I get someone with the flu coming out as a cat A) since you can get in all sorts of trouble, but if someone sounds like they are at death's door I think it's my duty to make sure they're not going to end up with a call from TAS.

  13. We have been using AMPDS for for about 10 years in Melbourne AUST. Have experienced similar issues with despatch to jobs. We are able to have jobs refered to a Clinical Support Officer (senior intensive care paramedic) at the dispath centre who can upgrade or downgrade a job. This decision may be based on the available information or the CSO may talk to the requester We also reserve the right for crews to upgrade to a Signal 1 ( lights and bells ) if they believe the case warrants such a response. However, this option is not exercised often.We are unable to change the AMPDS questioning as it a propriety program but we can change “the Grid” , which determines the ambulance response, ie Chest Pain SOB and changing colour, will recieve a response an Ambulance Paramedic crew and a MICA crew both on a sig 1, whereas Chest Pain , no SOB, will get a AP crew or a MICA crew travelling sig 1 with backup (if available) on a sig 2 (normal aapproach).

    The grid is reviewed approx 3 times a year, with additional reviews occuring when any particular issue arises

    Initially the establishment of AMPDS through an outside contractor was a painful experience, but it has improved dramatically.

  14. yea clearly you cant bleed to death now can you..of course the IR op can see down the telephone line and tell. .. cant they …. of course they can

    Oh and sending out HEMS and 2 crash units to a twat who fell off his moped while stationary … clearly a good use of resourses

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