Writer-Researcher, Laura Pye, blogs about the findings from the LiFE (Life First Emergency Traffic Control) project. This time looking at 999 calls.

Dialling 999

The service journey of an ambulance begins the moment a 999 call is made. After being transferred to the emergency medical centre, the call is picked up by a call taker, who, using a script, asks a number of questions to quickly establish the address of the emergency, the telephone number of the caller and the reason they are calling. Depending on their response, the script will determine whether an ambulance is needed or not.

At the same time, details of the incident appear on the screen of a dispatcher, who follows the call and prepares any resources that may be needed. If the incident is considered to be life threatening, the dispatcher will attempt to allocate two resources, such as a rapid response vehicle (RRV) and an ambulance, to the incident. If an RRV and/or an ambulance are available, the closest vehicles will be assigned to the job. If no vehicles are available, the dispatcher will usually send out a radio message to all paramedics on shift that another job is waiting and notify the call taker that there will likely be delays in reaching the patient.

Ambulance trusts are measured against the time it takes them to reach patients, and in the case of a life-threatening emergency, they are expected to arrive at the incident within 8 minutes of the call being received. If an ambulance trust does not reach this 8-minute target 75% of the time (as set by the NHS) they will lose vital funding for the following year. Therefore, if no vehicles are available when a call comes in, it is likely that the trust will miss this target and patients’ lives will be put at risk.

Why we dial 999

While headlines regularly remind us of some of the extreme requests that 999 call takers receive, interviews with employees from ambulance services allowed us to observe some of the more common reasons behind why people call the line for non-emergency incidents and contribute to increased demand for ambulances.

A small percentage of people intentionally abuse the service with hoax calls, but a growing problem is frequent callers: people who repeatedly call and claim that they are suffering from certain symptoms, which they know an ambulance must be sent for – paramedics then arrive on scene only to find that the situation is not as described. Frequent callers are often vulnerable people with mental health issues, who are either seeking support and do not know which other services are available to them, or they genuinely believe they are suffering from a certain condition.

This tendency to exaggerate symptoms has been exacerbated by the Internet, with many 999 calls being made by people who have misdiagnosed themselves online and subsequently report that their symptoms are more serious than they are – a condition now termed ‘cybercondria.’

The Internet has also reinforced our on-demand culture, where we expect services to be available 24/7. This has meant that if someone is feeling generally unwell or has suffered a minor injury out of hours, they will call 999 to access instant healthcare, rather than calling 111 (the NHS non-emergency medical helpline) or waiting until their local GP, pharmacist or walk-in clinic re-opens.

Although many of us may not be surprised by these reasons, we may not consider ourselves to be contributing to the problem. Yet, what would you do if a colleague fell down a few steps at work and thought they may have broken their ankle? Or if a member of the public started having a seizure in a public space? Would your immediate reaction be to call 111, a taxi… or 999?

An ambiguous area, where many members of the public often make the wrong call, is when witnessing a serious, but not life-threatening incident. It seems that despite our best intentions, it is still hard for many of us to identify what constitutes a real emergency. This is especially challenging when we are in shock and feeling panicked, as calling 999 feels like the quickest means of reaching a medical professional and alleviating the situation. Examples of this might include minor breaks or burns, flu, vomiting or an epileptic seizure (see here for exceptions of when you should call 999 for a seizure). Although it might feel like an emergency in the moment, if it is not life threatening and it’s possible for you to make your own way to a hospital or a walk-in clinic, it’s likely not to be considered an emergency by the ambulance services.

Dialling 999 impacts ambulance journey times

Ambulance services exist to respond to life threatening emergencies. When resources are routinely consumed for responding to non-life threatening incidents –whether by phone lines being occupied, time being spent redirecting people to other services, or ambulances being unnecessarily dispatched because of misreported symptoms – the service becomes inefficient. This inefficiency at the start of the ambulance journey has a substantial impact on a trust’s ability to meet strict NHS targets around journey times and deliver a quality service to those most in need.

North West Ambulance Service runs a successful social media campaign ‘Make the Right Call,’ which aims to educate members of the public of when to use 999 versus other public services. But is there more that we can be doing to shift public behaviour around dialling 999 and give our emergency services a better chance of reaching critical emergencies in a timely manner?

We’re keen to hear your thoughts!

How could we better educate the public around when to call 999 versus 111 or visiting their GP or taking a taxi to A&E? Do we need to improve the efficiency of the triage system? Should we be fining nuisance callers? Or should we be providing free first aid courses to equip people with basic medical response skills?

To learn more about the insights we’ve uncovered and the progress of potential solutions, follow the project on twitter at @8mins2savelives and on our blog.

Future Cities Catapult LIFE Research Team:

Anja Maerz, Research Lead/Cultural Anthropologist @sunnysides
Belen Palacios, Designer/Researcher @belenpalacios

Future Cities Catapult LIFE contact:

Laura Pye, Writer-Researcher @laurapye16
E: lpye@futurecities.catapult.org.uk

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