1 March 2002
Change in 999 procedure could save more lives
New research to be published in the March Journal of the Royal Society of Medicine suggests that there may be a more effective and safer way of managing emergency calls than the first-come, first-served system used by most UK ambulance services. The authors, from Ninewells Hospital in Dundee, looked at the implications of applying triage criteria - assessing which cases are most urgent - to incoming emergency calls before ambulances are sent out. Their results suggested that changing to a two-tier, priority-based system could save lives, not only by getting ambulances faster to those who really need them, but also by reducing the number of ambulance vehicle accidents.
Does every call need "blue lights and sirens"?
The pilot study, carried out by Dr Morrison, Mr Thakore and
Ms McGugan in Ninewells Hospital Accident and Emergency Department,
looked at nearly 500 patients entering A & E as a result of
a 999 call. They collected data to find out how many patients
had genuinely needed the fastest possible ambulance response,
by assessing whether they had any of ten emergency conditions
such as heart attack, chest pain, and seizure. This was then
compared with the information given by the original 999 caller,
to see if triage criteria could have been applied over the
phone. The authors concluded that ambulance dispatchers could
have reduced the number of "blue lights and sirens" needed
by at least 23% simply by identifying patients who did not
actually need hospital admission, and that 55% of calls for
emergency ambulances "do not merit an immediate response".
Rising pressure on the ambulance service
The number of ambulance callouts is rising, with no increase
in resources to match. Research suggests that if response times
to really urgent cases could be brought down from 14 to 8 minutes,
another 300,000 emergencies could be reached each year. Making
every callout immediate has safety implications too. Dr Morrison
and his colleagues discovered that in Scotland, there were
328 road accidents involving ambulances in 2000-2001. "The
response to true emergency calls can be delayed if an ambulance
is dealing with some minor incidents. An immediate response
puts ambulance personnel and other road users at risk and may
make no difference to the outcome of the patient."
When is it 'appropriate' to call 999?
Many 'inappropriate' calls are made by the public in good faith,
and it would be unreasonable to expect the average 999 caller
to decide how urgent a medical emergency is. Even under the
article's suggested system, where the ambulance dispatcher
makes simple prioritisation decisions, the authors emphasise
that triage criteria must be "safe enough to ensure that patients who genuinely need a rapid response are not missed".
Call for more research
The authors stress that their data should be viewed as a pilot
project "providing groundwork for further studies". They are
now calling for more comprehensive research to be done.
ends - 1 March 2002
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