I did an observer shift in Control a while back.  I wanted to watch and listen to how calls come in, got triaged, allocated and then managed.

So, sitting with Laffieres*, a Clinical Team Leader, I was able to listen in to a patient call back.  They had rung 999 feeling faint and had won themself an Amber response that could see her waiting a long while for an ambulance.   London were holding a ridiculous amount of calls and, as usual, only had a finite amount of ambulances to send.  So, it was Laffieres’ job to ring the patient back and re-check their clinical status to see if anything had changed and to see if there were any ‘alternatives’ that could be used to help the patient.  This was all done using the Manchester Triage System, a quick, more concise generalised system to help clinicians triage a patient’s needs over the phone.

After a short conversation Laffieres concluded the patient did not need an ambulance at all.  And, upon receiving the news that they were no longer going to be getting one, the patient’s demeanour changed.  One second their voice had been woeful and demure, the next it was harsh, cruel and direct.

“If you don’t send me an ambulance I’ll ring 999 again!  And I’ll keep ringing, over and over!”

My jaw had genuinely dropped.  I could not believe what I’d just heard.  Laffieres laughed.

“We get it all the time mate.  Every day, over and over.  She’ll call back in a minute, I guarantee”

And she did . . .

London Control Room

Across the open planned floor in Control, sat the Call-Takers.  This is where the initial 999 call comes in.  The staff there follow a strict algorithm to triage the call as quickly as possible before moving on to the next one.  Laffieres calmly and deftly swapped about call takers, listening in to their discussions trying to track down our patient before they got dealt with again.

“Ah, here we go . . . ” Laffieres snapped his fingers to get me to listen.

“. . . Ok madam,”  the call taker was wrapping up, “I’m afraid due to pressures there is going to be a long wait, possibly several hours.  Do you have any other means of transport?”

“I’m sorry, I don’t understand . . . ”  the patient’s weak and demure voice was back in play.  Her last decree was almost theatrical,  “I feel confused”

“Confused?  Ok, stand by please . . . ”  we could tell the call taker was re-calculating the algorithm, “due to your onset of confusion, we’ll get an ambulance to you as soon as we can . . .”

Laffieres turned off the listen-in.  He could see me raging and just gently shook his head.

“We can’t change that now.  That’s a Red 2.”

“Seriously?!”

“Nope”  He then explained the processes and rules involved dealing with downgrading calls.  For the life of me I can’t remember, and probably didn’t at the time either.  I was fuming.

This was a new low as far as misuse of the emergency services went.  We never appreciate how much crap is sifted through the Control room before we actually get to see a patient.  But, the bare knuckle rubbish Control have to contend with is on an astronomical scale.  And Laffieres had anecdote after anecdote, story after story of similar, if not worse, cases that had come in.  And this was not counting the just plain stupid calls that have to be sifted by the call-takers.

I was in genuine awe.

The very next call back – to do with a young man with abdominal pain – had us talking with the patient’s dad.  He informed us that the patient had decided to make his own way in a taxi . . . cos they were fed up waiting for an ambulance.  Again, I was dumbfounded.  They hadn’t thought, for one second, that they should ring us back and tell us.  If we hadn’t called back, an ambulance would have been sent to the patient’s address, making it one less resource available until it was sorted what had happened.

After only two calls I’d nearly had enough.  But Laffieres continued dealing with call after call, as if it were nothing.  I stayed and listened to a few more before moving on.

I spent a short time listening in with the Call-Takers before moving on to sit with Dispatch/Allocators.  My shift pattern ran exactly the same as one of their teams so it was genuinely nice to go and say hi.  They are the miracle makers of ‘who goes where’.  These were the guys not to piss off.

Before long though, it was the end of my observer shift and I went back to say thanks to Laffieres and the team.  To lighten the heavy load of depressive enlightenment, Laffieres decided to finish with an anecdote of a time, he’d rung managers with a paper issue.

“I phoned them up telling them we’re completely out of paper for the printer, and asked them if they could fax a load over to us?”  Laffieres started laughing, “and they bought it completely”

What made this even more poignantly funny, and why it stuck in my memory so, was how another CTL sitting nearby, couldn’t quite see what the issue was.

“What?” she said, looking round perplexed, “I don’t understand.  That’s actually a good idea . . . isn’t it?”

I’d recommend any front line medic or tech to go do an observer shift in Control.  Go and see how it all unfolds.  Go and see how everything is triaged and why you end up with the jobs you do.  Go and see it from their perspective.  Because, guaranteed, it will change the way you view how everything works – for the better too, I hope.

Binder

*not his real name of course