Ambulance Drill

RE: Egmanton Parish Meeting PALS/18/1421

Thank you for your email in which you raise concerns regarding the ambulance response time to an incident at Old Plough, Egmanton on 2 March 2019. I hope that the patient has made a good recovery and you are able to pass on our best wishes.

I can confirm that the 999 call was received to the incident at 21:14 hours and an ambulance arrived on scene at 21.47 hours.

As with all 999 calls the 999 call was triaged using the Advanced Medical Priority Dispatch System (AMPDS) which is an internationally recognised triage system which takes callers through a series of questions specific to the patient’s presenting condition. A Government panel of Health Care Professionals have assessed each code within AMPDS and assigned a response level based on clinical need. The Trust is required to comply with the response levels allocated.

From the information provided during the call it was coded as requiring a Category 2 response. This reflects a potentially serious condition that may require rapid assessment, urgent on-scene clinical intervention and treatment and / or urgent transport and include probable heart attacks, strokes, and major burns. We aim to respond to these calls within an average time of 18 minutes and at least 9 times out of 10, within 40 minutes.

I would like to offer our sincere apologies that our service was unable to respond sooner. At the time of the 999 call our service was experiencing a high demand for emergency responses. Due to the high demand on our service at the time of the 999 calls the Trust were unfortunately holding calls and the Capacity Management Plan (CMP), was implemented at level 2 where level 0 is the lowest and level 4 is the highest level of the plan. This procedure is designed to manage demand and resources during high call volumes where the supply of ambulance service resources is potentially insufficient to meet the clinical demand of patients. Our resources need to be carefully prioritised to ensure that we respond to the most seriously ill patients in an appropriate timescale.

As this was the case, and in line with the Capacity Management Plan at level 2, our Emergency Medical Dispatcher advised ‘We are experiencing a high demand for life threatening emergencies and there may be a delay. An ambulance will be dispatched as soon as one becomes available.’ Worsening advice was given i.e. to ring back if the patient deteriorated.

I would like to extend our sincere apologies that we were unable to send an ambulance in as prompt a manner as expected, during what must have been an extremely distressing time.

I have included some information on the 999 call categories to help explain how we prioritise our ambulance responses:

On 19 July 2017 Ambulance Response Programme (ARP) changed the traditional dispatch focus by making sure the best, most appropriate response is provided for each patient first time. In most 999 calls it has been identified that the best clinical outcome for patients is not about the fastest response by the nearest vehicle, but the most appropriate one. This is designed to change the rules on performance standards so that they are met by doing the right thing for the patient. This redesigned system for ambulance services in England focusses on ensuring patients get rapid lifesaving, life-changing treatment, and supports strategic dispatch decision making. ARP is strongly endorsed by expert organisations such as the Royal College of Emergency Medicine, the Stroke Association, and the College of Paramedics. ARP calls are categorised in the following way:

Category 1

This reflects a time critical and life threatening emergency requiring immediate intervention, to which we aim to respond within an average time of 7 minutes and at least 9 times out of 10, within 15 minutes. Such emergencies include cardiac arrest (heart stops) or respiratory arrest (the patient stops breathing), airway obstructions and ineffective breathing.

Category 2

This reflects a potentially serious condition that may require rapid assessment, urgent on-scene clinical intervention and treatment and / or urgent transport and include probable heart attacks, strokes, and major burns. We aim to respond to these calls within an average time of 18 minutes and at least 9 times out of 10, within 40 minutes.

Category 3

This reflects an urgent problem which is not immediately life-threatening but which requires assessment, treatment and possible pain control. In some instances ambulance personnel may treat patients in their own home or refer them onward to an appropriate Health Care Professional (HCP). We aim to respond to calls of this nature within 120 minutes at least 9 times out of 10.

Category 4

This reflects a non-urgent problem which does require some form of clinical assessment which can be completed either over the telephone or face to face. We aim to provide clinical assessment within 180 minutes at least 9 times out of 10.

I hope this information is useful to you, please do not hesitate to contact me directly should you require any further assistance or information.

Kind regards

Julie Cowburn
Patient Experience Officer