Call taking procedures - London Ambulance Service

Control Services - Call Taking Procedures
OP/060
Control Services - Call Taking Procedures
Page 1 of 48
DOCUMENT PROFILE and CONTROL
Purpose of the document: To provide Control Services with agreed procedures to manage
call taking arrangements.
Sponsor Department: Control Services
Author/Reviewer: Control Services Staff Officer
To be reviewed by: December 2017
Document Status: Final
Amendment History
Date
*Version
07/02/2017
4.1
Author/Contributor
IG Manager
25/01/2017
3.10
IG Manager
20/01/2017
3.9
Snr QAM
22/12/2016
3.8
Staff Officer
15/12/16
3.7
Staff Officer
16/10/16
3.6
Staff Officer
OP/060
Amendment Details
Document Profile and Control update .
Document Profile and Control update
and correction.
Layout.
Amendment to Protocol 1 – additional
instructions to managing SMS/Text Talk
calls.
Amendment to Procedure 2 – EMDs to
note delay due to using LL
Amendment to Procedure 3 change
―Section c‖ TO Procedure 3)
Amendment to Procedure 18 –to include
conferencing the HEMS paramedic into a
call.
Amendment to Procedure 19 – As above
Addition to Procedure 21.
Updates to job titles in Introduction.
Amendment to protocol 15 – addition of
2.3
Amendment to protocol 11 - 3.2.1/3.2.2
Merged to 3.2.1 - ‗Foetal heart rate
abnormalities‘
Splitting of Patient Specific Protocols and
Safeguarding/ Vulnerable patients into to
2 separate protocols
Addition of Conversion of 3rd and 4th
Party calls
Delayed responses to HCP calls
renamed to HCP Calls
Addition of section 4.4 of Channels of
emergency communication (attempt to
convert 3rd/4th party calls to 1st/2nd party)
Removal of Alpha Numeric procedure
headers and replaced with Numeric
Review by EOC SMT, Watch Managers,
CHub Managers
General Amendments to document
Control Services - Call Taking Procedures
Page 2 of 48
22/09/16
3.5
Staff Officer
01/07/2016
3.4
Snr QAM
28/06/2016
3.3
Staff Officer
10/09/15
3.2
QAM
20/04/15
3.1
QAM
14/02/13
2.5
IG Manager
14/02/13
2.4
Deputy Medical
Director
05/02/13
2.3
AOM Control Services
19/09/12
05/07/12
2.2
2.1
A Pule
IG Manager
15/05/12
1.8
A Pule
02/03/12
1.7
IG Manager
28/02/12
1.6
A Pule
16/01/12
1.5
A Pule
13/01/12
1.4
A Pule
13/01/12
12/01/12
14/12/11
1.3
A Pule
A Collard
A Pule
OP/060
1.2
1.1
Update of Procedure Q – International
Calls
Additions of Procedures T, U V and W.
Amendment to Procedure K – addition to
Medical Director defined High Risk
Complications in MPDS.
Amendment to Procedure L –
clarification of overrides to be used.
Additions of Procedures R and S
Amendment to Protocol L – section 2.1 –
limb deformity
Amendment to section 3.6. – process for
calls with no location.
Amendment to Protocol C – section 6.6
abandoned calls
Amendment to Protocol H – section 2.2
passing information to callers, and
section 4. ETAs for HCP calls
Removal of Procedure R – Use of
Recorded Messages
Removal of Appendix 3 Recorded
Message text
Addition to Protocol P – HEMS – Section
3 EMD call process
Addition of Protocol S - APP
Review of document by QA Department
Formatting and Document profile and
Control changes.
Minor amendment
Minor amendment and new
Implementation Plan added
S.2.4 added to Procedure A
Document Profile and Control changes
Amendment to Procedure C Section 3.7 regarding actions during abandoned calls
Amendment to Procedure G Section 2.5
- relating to recording of patient info.
Amendment to date of next review.
Amendment to Procedure O Section 4.3
relating to where info is recorded.
Reviewed by K Canavan (C/S PIM).
Document Profile and Control changes
Amendments to section numbers, page
numbering issues resolved. Glossary of
terms added as appendix 1.
Added procedure R – recorded 999
messages.
Amendment to Trust roles and titles
addressed (section 4)
Added fallback (section 6)
Formatting Changes
Added general principles (section 5)
Control Services - Call Taking Procedures
Page 3 of 48
19/4/11
14/4/11
March 2011
Feb 2011
0.4
0.3
0.2
0.1
S Kime
S Kime
J D Gummett
J D Gummett
Amendments from ADO Group
Amendments and reformatting
Second Draft
First Draft
*Version Control Note: All documents in development are indicated by minor versions i.e.
0.1; 0.2 etc. The first version of a document to be approved for release is given major version
1.0. Upon review the first version of a revised document is given the designation 1.1, the
second 1.2 etc. until the revised version is approved, whereupon it becomes version 2.0. The
system continues in numerical order each time a document is reviewed and approved.
For Approval By:
PMAG
ADG
ADG
ADG
Ratified by (If appropriate):
SMG
Published on:
The Pulse
The Pulse
The Pulse
The Pulse
LAS Website
LAS Website
LAS Website
LAS Website
Announced on:
The RIB
The RIB
The RIB
Date Approved
26/01/17
27/02/13
27/06/12
27/04/11
Version
4.0
3.0
2.0
1.0
11/05/11
1.0
Date
07/02/17 (v4.1)
15/02/13 (v3.0)
02/10/12 (v2.2)
09/07/12
07/02/17 (v4.1)
15/02/13 (v3.0)
02/10/12 (v2.2)
09/07/12
Date
14/02/17
19/02/13
10/07/12
Equality Analysis completed on
18/01/2012
Staff side reviewed on
18/01/2012
OP/060
By
Governance Administrator
Governance Co-ordinator
Governance Co-ordinator
Governance Co-ordinator
Governance Administrator
Governance Co-ordinator
Governance Co-ordinator
Governance Co-ordinator
By
IG Manager
IG Manager
IG Manager
Dept
G&A
GCT
GCT
GCT
G&A
GCT
GCT
GCT
Dept
G&A
GCT
GCT
By
Andrew Pule
By
Samad Billoo
Control Services - Call Taking Procedures
Page 4 of 48
Links to Related documents or references providing additional information
Ref. No.
Title
Version
OP014
Managing the Conveyance of Patients
1.1
OP061
Control Services – Dispatch Procedures
0.5
OP066
Use of Paper Operations with Control Services
1.3
Document Status: This is a controlled record as are the document(s) to which it relates. Whilst
all or any part of it may be printed, the electronic version maintained in P&P-File remains the
controlled master copy. Any printed copies are not controlled or substantive.
OP/060
Control Services - Call Taking Procedures
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Table of Contents
Procedure Title
Introduction, Scope, Objective and Responsibilities
1
Channels of Incoming Emergency Communication
2
Language Translation Service
3
Abandoned Calls
4
Meningitis
5
Sickle Cell Crisis / Thalassaemia
6
Incubator Journeys
7
Requests for Advice from Callers
8
Estimated Time of Arrival
Use of Free Text to Alert for Specific
9
Conditions/Relevant Information
10
Shifting in ProQA
11
Obstetric Emergencies
12
Distal and Proximal Injuries
13
Health Care Practitioner Calls
14
Public Access Defibrillators
15
Patient Specific Protocols
16
Safeguarding/ Vulnerable Patients
17
Conversion of 3rd and 4th Party Calls
18
Helicopter Emergency Medical Service
19
Advanced Paramedic Practitioner
20
HM Prison Coded Calls
21
Accepting Calls From Other Ambulance Services
22
International Calls
Implementation plan
Appendix 1 - Glossary of Terms
Appendix 2 – Shifting in PROQA
OP/060
Control Services - Call Taking Procedures
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7
9
13
15
18
19
20
22
23
25
26
27
29
30
32
33
34
36
37
38
39
40
41
43
44
47
Version
3.10
3.10
3.10
3.10
3.10
3.10
3.10
3.10
3.10
3.10
3.10
3.10
3.10
3.10
3.10
3.10
3.10
3.10
3.10
3.10
3.10
3.10
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1.
Introduction
The London Ambulance Service (LAS) attends a diverse range of patients, often in unique and
demanding circumstances. The Emergency Medical Dispatcher (EMD) handling the call is,
normally, the first point of contact in the whole patient care delivery and the patient experience
can be influenced by the way this call was handled.
2.
Scope
This procedure specifies the actions to be taken by EMD‘s when receiving emergency and
non-emergency calls.
3.
Objective
To ensure that all emergency and non-emergency calls received by the LAS are handled
correctly, consistently and safely whilst ensuring that the level of patient care and service is
optimal at all times.
4.
4.1
Responsibilities
The Chief Executive has overall accountability for having an effective operational and
risk management system in place and an effective system of internal control within the
Trust. The day to day responsibility for risk and operational management is delegated
to nominated directors.
4.2
The Medical Director has delegated responsibility for managing the strategic
development and implementation of clinical management, clinical governance, and
infection prevention and control.
4.3
The Deputy Directors of Operations (Control Services and Sector Services) have
overall responsibility for core operational delivery.
4.4
The Head of the Emergency Operations Centre has delegated responsibility for
managing risks associated within Control Services (CS), and has responsibility for the
development of operational strategy in order to meet national performance and clinical
targets.
4.6
General Managers, (GMs), Watch Managers (WMs) and Area Controllers (ACs
have tactical responsibility for the day to day delivery of core services and line
management within CS.
4.7
Emergency Medical Dispatchers (EMDs) are responsible for triaging, and handling
all calls received and dispatching resources to the patient. This can involve giving the
patient/caller information to assist the crew on arrival or giving lifesaving instructions.
4.8
Clinical Hub Clinicians assist with clinical queries, including – but not limited to –
patients who have pre-existing care plans, or complex medical needs.
4.9
Mental Health Nurses assist with the triage and management of patients presenting
with Mental Health needs.
4.10
Operational Staff are responsible for the day to day delivery of core services.
5.
5.1
General Principles
The EMD should remain empathetic and professional at all times whilst handling
incoming calls. It is their responsibility to make a supervisor / manager aware if they
experience difficulties as soon as possible and practical to ensure quality of service is
not compromised.
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Control Services - Call Taking Procedures
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5.2
The EMD should never question the validity of any request for assistance, or the
integrity of the caller or of any information passed from the caller.
6.
6.1
Paper Operations
Whilst Control Services is utilising paper operations (See OP66 Paper Operations) all
of the procedures and protocols below should be adhered to at all times.
6.2
As stated in OP66, incoming calls should be recorded in triplicate on the requisite Call
Receipt Form (CRF).
6.3
During paper operations EMD‘s must wait for a verbal handover from the telephone
exchange with the incoming call details, and then the EMD must always use the
opening phrase ―Emergency Ambulance, what‘s the location of the incident‖.
7.
Procedures
The following sections provide specific procedures needed for call taking.
OP/060
Control Services - Call Taking Procedures
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Procedure
1
Channels of Incoming Emergency
Communication
Version 3.10
1.
1.1.
Initial Details
For any 999 call to be connected to the LAS, the caller must have indicated to the
Communication Provider (CP) Operator that an ambulance was required.
1.2.
In every instance the EMD will determine the location of the emergency/incident by
asking: ―What‘s the address of the emergency?‖
1.3.
In every instance the EMD will determine a call back number for the caller by asking:
―What‘s the phone number you‘re calling from?‖
1.4.
The EMD will always verify the location details and the call back number by asking the
caller to repeat them.
2.
2.1.
Caller Line Identification (CLI)
The CLI location will be automatically placed in the location field and verified by the
gazetteer.
2.2.
If it is not an exact match to the CLI data, or the location of the call is different, the EMD
will alter the information in the location field.
2.2.1. This will cause the gazetteer to search again in order to verify the new location.
2.2.2. If the CLI data is changed the vehicle may be taken to a point some distance
from the call - and the response to the patient may be delayed.
2.3.
If a gazetteer match is found, a secondary location is not required unless the address is
a flat, a major/long road, or the location may be difficult to find (e.g. parks/open spaces
etc.).
2.4.
If the CLI data does not generate a verified location in the gazetteer, the EMD should
make necessary adjustments to this data as per issued guidance to facilitate the
selection of a verified location and the event to enter in CAD.
3.
3.1.
No Caller Line Identification (CLI)
The EMD will type the location given in the location field and search the gazetteer for a
location match.
3.2.
Secondary locations must be obtained for calls where the gazetteer location is not
found, where possible gaining a door number or junction road using the ―@‖ to gain a
precise map reference.
3.3.
If the location is found by entering the full post code and house number, the EMD
MUST STILL ask the caller for the address in full.
3.4.
If unable to find a gazetteer match, the EMD must establish the location of the incident,
using their map book, or any other available resource (e.g. NSY GS (general search)
etc.).
3.5.
It is essential that the EMD log any gazetteer error by ticking the ‗Q?‘ check box, and
recording the relevant details in the ‗CMT‘ field (or the ‗Remarks‘ field if insufficient
space in ‗CMT‘ field).
OP/060
Control Services - Call Taking Procedures
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3.6.
If an EMD has difficulty finding a location, using both gazetteer and mapbook,
assistance must be sought from the Area Controller – Call Handling (Call Taking
Manager CTM) or Call Handling Supervisor (CHS). Under no circumstances will
the EMD advise the caller to find out the location and call back – the EMD must
stay connected to the caller whist they attempt to find the location details. The
call must not be quit due to the inability to find a location.
4.
4.1.
Alarm Centres & 4th Party Callers
Where calls are passed from alarm centres/care lines the CLI information is likely to
present with the patient‘s address and phone number.
4.2.
EMD‘s should not change the origin phone number displayed as this shows the
patient number.
4.3.
The alarm centre number (requested as a direct dial number from the caller) should be
noted in the ‗Transport Contact‘ tab.
If the patient‘s number is not presenting, an origin number should be obtained for the patient
and noted in the patient telephone number field. Where possible EMDs should attempt to
convert these calls to a 1st or 2nd party call to obtain a more accurate triage.
5.
5.1.
Roaming Calls
It is possible to make a 999 call from a mobile phone that has no network coverage.
5.2.
The mobile phone will ―link‖ into the first available network signal it finds, regardless of
network supplier.
5.3.
These calls differ from normal mobile calls in these respects.
5.3.1.
5.3.2.
5.3.3.
5.3.4.
5.3.5.
No customer telephone number will be automatically available.
It is highly unlikely the EMD would be able to call them back.
Any CLI details supplied will be ―dummy‖ default network settings.
No mobile eastings or northings will be available.
It is not practical to trace calls – it can take up to two days.
5.4.
The operator passing the call will identify it as a ―Mobile Emergency Roamer with no
customer number displayed‖.
5.5.
The EMD will take the call in the usual manner, but must take particular care to record
all details.
6.
6.1.
Emergency Short Message System (SMS) Calls
Emergency SMS has been developed as an alternative for those who are unable to
use the usual voice 999 service. It is meant for those with hearing or speaking
difficulties who routinely use SMS, as an option in circumstances where a text phone is
not available.
6.2.
When a call is connected to the operations centre, the operator will identify it as an
Emergency SMS text call.
6.3.
The operator will stay on the line to ensure the connection is completed.
6.4.
The EMD will continue to take the call in the usual manner; however, there are some
key points for EMD‟s taking emergency SMS text messages.
OP/060
Control Services - Call Taking Procedures
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6.5
Case Entry will be completed as normal except that the answer to the caller party
question will be entered as fourth party regardless of who is making the call
6.5.1 The appropriate chief complaint should be selected.
6.5.2 Initially, all answers to the key questions will be entered as ―unknown‖
6.5.3 Once Key Questons have been completed the EMD will then use the ―Delta
Override‖
6.5.4 Enter ―SMS Text Message Delta Override‖ into the Special Instructions‖ field
6.5.5 PAIS must be given and will MPDS PDIs which offer medical or safety
instructions. The closing message should be:
―I need to hang up now to take another call. I have organised help for you. Put
away any family pets. Help will be arranged as soon as possible but this may
take up to XX minutes (appropriate Surge timescale) to be sent. If his /her
condition worsens in any way, contact us for further instructions‖
6.6.1
Key recommendations for managing these calls are:
6.6.1Listen carefully to information passed by the relay assistant from the first text
message; it might contain both location and incident details.
6.4.1. Ask the questions as if you are talking directly to the caller.
6.4.2. Ask no more than two questions per message.
6.4.3. Reassure the caller as soon as possible that answering these questions will not
delay help. If help is already on the way tell them it is on the way.
6.4.4. Try not to ask for the same information more than once.
6.4.5. Ask for the postal area, street name or local landmarks, rather than for a
postcode.
6.4.6. Be aware that these calls will take longer to handle as questions/answers
exchanged verbally with the relay assistant have to be sent/received as
standard SMS texts.
7.
7.1.
Text Relay
Text Relay has been developed as an alternative for those who are unable to use the
usual voice 999 service. It is meant for those with hearing or speaking difficulties who
routinely use SMS via real-time text terminals (textphones, minicoms) to contact the
Text Relay emergency service.
7.2.
When a call is connected to the operations centre, the operator will identify it as
―.Connecting a Text Relay call from number…‖. The operator will stay on the line to
ensure that the connection is completed.
7.3.
The EMD will continue to take the call in the usual manner, however, there are some
key points for EMD‟s taking Text Relay calls (as detailed in see 6.5.1. – 6.6.6.).
8.
8.1.
Voice Over Internet Protocol (VoIP) Calls
Using a fixed or wireless broadband connected to a personal computer (PC), service
users are able to use a handset or headset, Personal Digital Assistant (PDA), mobile or
a fixed telephone handset to make calls.
8.2.
When the VoIP call is passed to the operations centre the operator will verbally identify
that they are connecting a VoIP caller and pass the telephone number.
8.3.
The EMD will document this and continue to take the call in the normal manner.
9.
CLI and VoIP Calls
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9.1.
As this service allows users to move location, simply by logging onto their internet
anywhere in the world, it enables them to make and receive calls with their home CLI.
9.2.
It is essential, therefore, that the location of the incident is asked for and verified.
10.
GPS Telematics Calls
10.1. Emergency calls may be transmitted from on board vehicle GPS units which can be
either manually or automatically activated by vehicle sensor (airbag, bumper contact
etc.).
10.2. These units will send either voice or data (or a combination of both) to the operator who
will contact the relevant Emergency Control as normal.
10.3. The operator will announce the call as a ―GPS Telematics call‖ and pass the details
they have.
10.4. This data could include, but not limited to:
10.4.1. Vehicle make/model
10.4.2. Vehicle registration number
10.4.3. Direction of travel
10.4.4. Eastings and northings.
10.5. If voice contact has been made there could be further details to pass.
11.
ProQA
11.1. EMD‘s must complete all calls through ProQA ensuring all pertinent information is
recorded as free text, such as:



Relevant Crew Safety
Patient care
Access information
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Procedure
2
Language Translation Service
Version 3.10
1.
1.1
Connection
For any 999 call to be connected to the LAS, the caller must have indicated to the
Communication Provider (CP) Operator that an ambulance was required.
1.2
It is recognised that in many cases a number of callers may not have English as their
first language.
1.3
In such instances a third party language translation service may be used to assist the
EMD in taking the details of the call and/or the any staff on scene with the patient.
2.
2.1
999 Calls and Ring Backs
The EMD will put the caller on hold, using the Conference Key, whilst connecting to the
translation service, ensuring that they first have fully explained their actions to the
caller.
2.2
The EMD will conference the caller back into the call at the earliest opportunity
especially where there is a comfort message being played in both languages.
2.3
The EMD will select ‗Unknown‘ as the event type and enter ―Unknown, delay Language
Line‖ in the remarks field.
2.4
The EMD will select MPDS protocol 32 (Unknown Problem) and code this call as 32B4
– caller‘s language not understood and update the event.
2.5
When an interpreter does come on line, and/or it becomes apparent what the problem
is, the EMD will change to the most relevant MPDS protocol.
3.
3.1
When connected to the Language Translation service:
The EMD will identify themselves, to the interpreter, using the EVENT number as the
LAS‘ identifier.
3.2
If no location has been identified at this stage the EMD will need to give their 4 DIGIT
phone LOGIN PIN as the LAS‘ identifier.
3.3
If control is working under fall back conditions, the EMD will give their 4 DIGIT phone
LOGIN PIN.
3.4
On the rare occasions the LAS details fail to pre-populate the field on the translation
service operator‘s terminal, the EMD will be asked for the customer ID number. This is
held by the Area Controller – Call Handling (CTM).
3.5
The interpreter‘s identification number must be recorded in the Remarks field.
3.6
The interpreter should be given a brief of the situation.
3.7
The interpreter should be asked to inform the caller that they are there to help both the
caller and the EMD to communicate.
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4.
4.1
Statements
The statement to be made on initial contact with an interpreter is ―This is the London
Ambulance Service with a 999 emergency call in progress. Please inform the
caller that the answering of questions will not delay the help”.
4.2
Users should conduct the call as though they were talking directly to the caller. This
makes the interpreter‘s task easier, as they are simply translating what the EMD is
asking.
4.3
Do not say “Can you ask if the patient is breathing”; the question should be “Is the
patient breathing”.
5.
Control Services Staff (other than Call Handlers) connecting to Language
Translation Service
Where staff (Sector Dispatch or Clinical Hub for example) are required to call back a
caller who requires translation services, the actions from section 3 will be followed.
5.1
6.
6.1
Connecting VCS to Language Translation Service
VCS have access to the language translation service through their service
communication device, and should normally make contact on their own.
6.2
If an EMD is requested to connect a crew on scene to the language translation service,
the crew‘s call sign should be used as the LAS reference.
6.3
This should be recorded as supplement information in the Event Chronology, along
with the language requested.
7
7.1
Issues
Ensure that any issues using the service are recorded via the reporting forms held by
the CTM.
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Procedure
3
Abandoned Calls
Version 3.10
1.
Introduction
1.1
For any 999 call to be connected to the LAS, the caller must have indicated to the
Communication Provider (CP) Operator that an ambulance was required.
1.2
Silent calls to Exchanges are all directed to the police.
1.3
Any call that is therefore abandoned during the connection to us, or is a silent call,
must be responded to.
2.
2.1
Calls from Landlines
The location details as presented by CLI or verbally by the CP operator on abandoned
calls must be noted in the Location field and the call must be rung back immediately.
2.2
The time and the outcome of the ring back is to be noted in the remarks field, and the
Event must be updated.
2.3
At least three attempts should be made to reconnect to the caller.
2.4
If the call is answered it is to be managed and triaged through MPDS as appropriate.
2.5
If there is no answer but an answer phone is available, a message must be left,
indicating that we have called, and for the caller to contact us if an ambulance is still
required or let us know if they wish to cancel.
2.6
On silent calls or if on ring back there is no reply or an engaged tone, the call should be
completed as an ―Unknown Problem - please investigate‖ through protocol 32 and sent
for sector to respond to. If, on arrival at the address/location there is no reply or no
trace, OP/14 must be followed. If specific information was obtained and the CP
operator passes that to the EMD then the appropriate protocol should be selected.
However, the nature of the termination of the call (any suggestion of sudden collapse
etc.) should be considered as to whether the ―Life Status Questionable‖ option on
Protocol 32 would be more appropriate.
2.7
In the event no CLI location is presented and CP does not know any subscriber details
the EMD must discuss with the CHS on whether a RIPA request should be made. If it is
not, the call should be quit in this manner:
2.7.1 Unknown, should be entered in the Location field.
2.7.2 Event Type Aband should be selected.
2.7.3 The Atom should be set to CTM in the Combined Override Panel.
2.7.4 „Abandoned call – no dispatch OP/60 procedure 3 applies‟ should be
entered in the Remarks field and the Event must be updated.
3.
3.1
Calls from Mobiles
Abandoned calls from mobiles should be rung back immediately and clarification
sought as to whether an ambulance is required.
3.2
The time and outcome of the ring back is to be noted in the remarks field, and the
Event must be updated.
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3.3
If the number is engaged or diverts to voicemail on first attempt, a second attempt to
contact the caller must be made.
3.4
Assistance must be sought from the CHS/CTM to identify if a call from the same origin
number is in progress elsewhere in the EOC.
3.5
The CTM would use the ASQ (ANI/ALI record Query) form to search for the phone
number.
3.6
If there is no answer, after three attempts to contact the caller, and voicemail is
available, a message must be left, indicating that we have called, and for the caller to
contact us if an ambulance is still required. The following can be used to relay this
message;
“This is the London Ambulance Service calling in regards to an abandoned 999 request
made from this number. If an ambulance is required then please ring us back
immediately on 999 for further instructions. An ambulance has not been sent at this
stage.”
3.7
3.8
The event should be updated and closed as 2.7 (above) if answered though MPDS.
If the call is answered it is to be managed and triaged through MPDS as appropriate.
3.9
If a silent call is received or the phone is answered on ring back but the patient cannot
speak/speak clearly EMDs must immediately inform a CHS/CTM. They must:
3.9.1 Using the location information provided by the CP and translating those
Easting‘s and Northing‘s into a map reference, establish the area from which
the call is being made (triangulation).
3.9.2 Contact the CP to obtain subscriber details. If the two sets of information tie up,
an ambulance should be dispatched to the subscriber‘s address and
investigated.
3.9.3 If the mobile phone is unregistered or subscriber details are not known,
provided a message has been left on voicemail the call may be processed as
‗abandoned call‘.
3.10
If for any reason the call handler decides to progress to a subscriber check they should
seek authorisation from the CHS/CTM to do so. If the registered details are provided
immediately the call handler should update the Event and proceed normally. Should
an agency need to ring back to confirm subscribers details the event should be closed
as per 2.7 and the CHS/CTM updated. The call handler should then be available for
other incoming calls. On receipt of the information from the CP the closed event
should either be updated that there is a lack of subscriber‘s information (and
source/reference of the update) , or re-opened and populated with subscriber‘s details
so that an ambulance resource can be dispatched
4.
4.1
Public Telephone Kiosk
It is important that a potential patient is not treated as a hoax caller.
4.2
The location details as presented by CLI or verbally by the CP operator on abandoned
public telephone kiosk calls must be noted in the Location field and the call must be
rung back immediately.
4.3
The time of the ring back is to be noted in the remarks field, and the event must be
updated.
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Control Services - Call Taking Procedures
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4.4
At least three attempts should be made to reconnect to the caller. To avoid operator
error, the telephone number is to be entered manually on both occasions.
4.5
If the call is answered it is to be managed and triaged through MPDS as normal.
4.6
If the call is silent or if on ring back there is no reply or an engaged tone, the call should
be completed as an ―Unknown Problem - please investigate‖ through protocol 32 and
sent for sector to respond.
4.7
Where an abandoned or silent call is received from a mental health unit, contact should
be made with a staff member to confirm if ambulance attendance is required. The
contact attempt and outcome, including details of staff members spoken to is to be
documented in the event chronology.
5.
5.1
Urgent Disconnect / Surge Management Plan
During periods of high demand or at times when Urgent Disconnect has been
implemented, the CTM/CHS may dedicate one member of staff to ring back all
abandoned calls.
6.
6.1
Subscriber Checks
The Regulation of Investigatory Powers Act 2000 (RIPA) provides the legal framework
in which access to subscriber details may be obtained from CPs.
6.2
Under normal circumstances, the Code of Practice for the Public Emergency Call
Service (PECS) allows the Emergency Authority (EA) to request subscriber details for
the purpose of preventing death or injury or any damage to person‘s physical or mental
health or for mitigating any injury or damage to a person‘s physical or mental health.
6.3
EAs may only request subscriber (caller name and address) details under the
provisions of section 22 of the Regulation of Investigatory Powers Act 2000 (RIPA).
Other than in limited circumstances it is necessary for Emergency Authority Control
Rooms to obtain a notice under RIPA. This should not be necessary when seeking
telephone subscriber details in order to respond to a call for emergency assistance.
6.4
CPs will only confirm or reiterate caller location information for up to one hour after the
original emergency call without the need for a RIPA notice. Caller location information
not previously supplied but which would otherwise have been available can also be
supplied for up to one hour after the original emergency call without the need for a
RIPA notice. Use of the information is restricted to helping the EAs to respond to a
request for emergency assistance.
6.5
If a third party can only provide a telephone number for a patient the agent is to make
at least two attempts to contact the patient utilising the number provided. If
unsuccessful, the call is to be referred to the WM for the following actions to be
completed.
6.6
The WM is to contact the Metropolitan Police Service (MPS) METCC pan London
supervisor desk on 0208 721 7945and advise the supervisor that it is a life at risk
issue/grade 1 RIPA request and you require the on call SPOC (Single Point of Contact)
who can then ascertain subscriber details in these circumstances.
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Procedure
4
Meningitis
Version 3.10
1.
1.1.
Coding
Any 999 calls, from a member of the public, that the patient may have meningococcal
septicaemia (meningitis), or where symptoms of possible meningitis are given, must be
triaged using MPDS Protocol 26 ―Sick Person‖ and coded as 26A12 (possible
meningitis).
2.
2.1
Symptoms
Symptoms that may indicate that a patient is suffering from meningitis include, but are
not limited to:
2.1.1 Rash that is non-blanching when a glass or finger is pressed on the rash – this
may develop rapidly.
2.1.2 Constant headache
2.1.3 Severe ‗Flu-Like symptoms
2.1.4 Fever
2.1.5 Photophobia
2.1.6 Neck stiffness – touching their chest with their chin will be very painful or
unachievable.
2.1.7 Vomiting
2.1.8 Drowsiness
2.1.9 Confusion
2.2
A patient may present with all or some of the symptoms listed above and not
necessarily a rash.
2.3
If the EMD suspects the patient may have meningitis, from the symptoms described,
the call should be handled as if it were meningitis.
2.4
Patients of any age can contract meningitis.
3.
3.1
ProQA
There is no need to ask the Key Questions BUT be sure to enter the answers as
below:
3.1.1
3.1.2
3.1.3
3.1.4
―Is he completely alert?‖
―Is he breathing normally?‖
―Does he have any pain?‖
―Is he bleeding or vomiting blood?‖
Unknown
Unknown
Other or Unknown
No or Unknown
3.2
The EMD must then select the determinant 26A12 from the list of Alpha level
determinants and the call will receive a Red response.
3.3
If using the manual card set EMDs should select the code 26A12
3.4
If the call is from a Health Care Professional (HCP) it should be triaged using Protocol
35 and EMDs must select ―Meningitis‖ in response to Key Question number one ―What
is the reason for the admission?‖
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Procedure
5
Sickle Cell Crisis / Thalassaemia
Version 3.10
1.
1.1.
Introduction
It is recognised that patients suffering a Sickle Cell Anaemia or Thalassaemia crisis are
unlikely to present with priority symptoms, but will be experiencing symptoms including
extreme pain.
1.2.
They should be responded to quickly.
2.
2.1
ProQA
Sickle Cell and Thalassaemia are dealt with on Protocol 26 (sick person)
2.2
The Key Questions should be answered as follows:
2.2.1
2.2.2
2.2.3
2.2.4
―Is s/he alert?‖
―Is s/he breathing normally?‖
―Does s/he have any pain?‖
―Is s/he bleeding or vomiting blood?‖
Yes or Unknown
Yes or Unknown
Sickle Cell or Thalassaemia.
No or Unknown
2.3
This will ensure a 26C3 (Sickle cell crisis / Thalassaemia) response code.
2.4
If the patient reports that they are vomiting blood (a Red 2 response on Protocol 21
(Haemorrhage/Lacerations) then that protocol should be used. If the patient has chest
pain, then Protocol 10 should be used, but if the response priority is less than C1, the
call should be completed as above on Protocol 26.
2.5
The EMD will also need to document:
2.5.1
2.5.2
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The patient‘s name.
The patient‘s regular treatment centre.
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Procedure
6
Incubator Journeys
Version 3.10
1.
1.1.
Introduction
The LAS has a responsibility for the transportation of ill or injured neonates between
Special Care Baby Units (SCBU) and Neonatal Intensive care units (NICU).
1.2.
The Neonatal Transfer Service (NTS) based at the Royal London Hospital, should
undertake the journeys, where the patient is being moved in an incubator.
1.3.
There may be occasions where EOC are required to take the details and deal with
these journeys.
2.
2.1.
Guidelines
The EMD must ensure that the authorising doctor has already tried to contact NTS.
2.2.
The EMD must document this information in the Remarks field.
2.3.
Unless the authorising doctor specifically requests a delay, all SCBU/NICU journeys
requiring an incubator should be documented as an emergency event. Ensuring that
ProQA is ―aborted‖ prior to adding ANY information in Case Entry.
2.4.
„SCBU‘ should be selected from the abort drop down list.
2.5.
Call takers should inform the CTM that they are taking a SCBU journey. This will
provide assistance to the call taker if required and enable sector staff to start planning
the journey.
3.
3.1.
3-Way Journeys
All 3-way SCBU/NICU journeys must be recorded as SCBUEM (emergency events).
Only journeys booked for the next day or beyond will be recorded as SCBUNE (nonemergency events).
3.2.
Three way SCBU journeys will normally consist of:
3.2.1. Collection of the medical team and equipment, to be recorded in the Location
field.
3.2.2. Collection of the baby, to be recorded in the Additional Location field.
3.2.3. Returning the baby, team and equipment to the designated hospital, to be
recorded in the Transport field.
As an example:
Example Location
1
LONDN ―SCBU‖
2
HOMER ―NICU‖
3
LONDN ―SCBU‖
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Collect / Drop Off
Collect Medical Team
and Equipment
Collect Baby
Baby, Medical Team,
Equipment
Document Where?
Control Services - Call Taking Procedures
Loc Field
Add Loc Tab
Transport Tab
Page 20 of 48
4.
Incubators
4.1 Incubators can be transported in all Mercedes ambulances and should be used as
they:
4.1.1 Decrease manual handling issues as staff can utilise the tail lift.
4.1.2 Allow equipment to be secured safely within the vehicle.
4.2
Transfers to or from NICU or SCBU that do not require the use of an incubator should
be handled as any other hospital transfer.
5.
5.1
Issues
Any problems, concerns or issues must be brought to the attention of the Head of
Patient Transport Service responsible for NTS, in hours by pager message and by email out of hours.
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Procedure
7
Requests for Advice from Callers
Version 3.10
1.
1.1.
Requests for Advice / GP Attendance
It is recognised that members of the public will call 999 requesting advice.
1.2.
EMDs must triage the event through MPDS and only give the instructions contained
within the MPDS, including appropriate Pre-Arrival Instructions (PAI) and Post
despatch Instructions (PDI).
1.3.
If the caller subsequently refuses ambulance assistance, the event can be quit and
recorded as ‗XCALL‖.
1.4.
Many calls for advice may result in the event being triaged as a C4 response, and, if no
exclusions apply The call may be given the C4 closing phase which includes being
referred to NHS 111
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Procedure
8
Estimated Time of Arrival (ETA)
Version 3.10
1.
1.1.
ETA Requests
When callers request an ETA for a previous event, call handlers must ask for and verify
the location of the original event. Call handlers will then be able to view ‗Nearby‘ for
duplicate event(s).
1.2.
EMDs must ensure they check the details of the correct event before checking the
event Category – it may be awaiting a ring back for further assistance or referral to
NHS111.
1.3.
Viewing the Dispatch Group will show who is currently responsible for the event.
1.4.
Checking the Unit Summary tab to see if a unit has been assigned, this determines
whether a unit is still assigned.
2.
2.1
Passing Information
The caller may then be told as appropriate, that:
2.1.1. “Help is on the way”
2.1.2. “Help will be with you as soon as possible”
2.1.3. “Unfortunately, we don‟t have a resource on the way yet, but help will be
with you as soon as possible.”
2.1.4. “Your call has been referred to a clinician for further advice and they will
contact you shortly.”
2.2.
If a resource has been activated, it is important to point out that the information
provided on the call log is only estimated by the MDT system and may change. Inform
the caller of this fact, particularly if a lower priority call as responses can be cancelled
for other incidents.
2.3.
The caller must not be told how long the resource will take to reach the location.
2.4.
The caller must not be told how far away the resource is.
3.
3.1
Changing Condition
EMDs must ask if the patient‘s condition has changed on all ETAs, if in any doubt retriage the call. EMDs should ask ―Tell me exactly what happened‖, in case more
information is available, and make their own decision as to the appropriate protocol for
triage.
3.2
If the patient‘s condition has is reported as having changed in any way the event must
be re-triaged. EMDs should read the details of the previous calls to confirm if
information given during the call is new information, even if callers say that the patient‘s
condition has not changed. The call can then be re-triaged accordingly.
3.3
If the patient‘s condition has not changed, this must be recorded in the remarks field of
the new EVA.
3.4
The event should always be cross referenced (XRE) with the original event.
3.5
All Events must be recorded on a new EVA (Event entry form).
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Control Services - Call Taking Procedures
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3.6
ETAs must not be simply a supplement to the original event chronology and viewed as
a means of reinforcing if the call was originally taken correctly.
4.
4.1
HCP ETAs
When receiving an ETA from an HCP, ensure to differentiate between inter-hospital
transfers and GP admission referrals. If a HCP call is out of time, (especially a hospital
transfer) and the caller reports the patient must travel, CHub should be involved in the
conversation regarding any potential upgrade.
4.2
If an ETA is received from a patient/family member, then the call should triaged
through MPDS based on the presenting condition at that time.
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Procedure
9
Use of Free Text to Alert for Specific
Condition/Relevant Information
Version 3.10
1
1.1
Free Text
EMDs should use the free text facility to note the following conditions/information
when/if it is mentioned by a caller. This information may influence the decisions
regarding the disposition of the call by the CHub and must be communicated.
1.2
EMDs should not ask for this information; the questioning within MPDS should be
adhered to, but when a patient volunteers the following information the EMD must
record this information in the ‗Problem Description‘ field on the EMD data tab, along
with a problem description, i.e. Abdo Pain/Difficulty in Breathing
Patients with Haemophilia
HAEMOPHILIA
Patients with Addison‘s Disease
ADDISONS DISEASE
Patients who voluntarily describe themselves STEROID DEPENDENT
as ―Steroid Dependent‖. (This is NOT every
patient who states they are on steroids)
Patients who have been administered Drug Name e.g. DIAZEPAM
Diazepam,
Midazolam
or
Lorazepam
(Benzodiazepines)
Potassium Levels
High/Low POTASSIUM
Blood Thinners/Warfarin
BLOOD THINNERS
WARFARIN
Patient undergoing Chemotherapy
during and between cycles)
Neutropenic
Recent Surgery < 72 hours ago.
both CHEMOTHERAPY
Back Pain aged >55 years
NEUTROPENIC/NEUTROPENIA
RECENT
SURGERY
(description
knee/appendectomy etc.)
BACK PAIN >55
Groin Pain in males (between 12-55 years)
GROIN PAIN
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-
Procedure
10
Shifting in ProQA
Version 3.10
1.
1.1.
MPDS
The majority of 999 calls received in control will be triaged through the Medical Priority
Dispatch System (MPDS).
1.2.
MPDS allows informed decisions to be made about resource allocation.
1.3.
By asking a series of questions about the presenting signs and symptoms, the EMD
will select an MPDS determinant descriptor.
1.4.
The Department of Health (DH) reviews and sets a priority level for all the determinant
descriptors in the MPDS code set.
2.
2.1.
MPDS Card Sets
When using the MPDS card sets, the EMD gathers pertinent information about a
patient.
2.2.
The EMD selects, from a List of determinants, the most relevant determinant based on
the answers to the questions.
2.2.1. In many instances more than one determinant is relevant; the EMD must decide
which is the most appropriate.
2.2.2. These DH priority levels are to be found on the ‗Fall Back Priority Sheet‘.
2.3.
The EMD must select the determinant descriptor with the highest priority level, based
on the priority levels set by the DH.
3.
3.1.
ProQA
The EMD will gather pertinent information about a patient and enter onto the electronic
system.
3.2.
The answers to the questions will determine a determinant descriptor, which will be
highlighted in a green band.
3.2.1. Where other determinant descriptors are also relevant they will be highlighted in
a yellow band.
3.3.
The EMD must select the Determinant descriptor displaying the Highest DH priority
level.
Refer to Appendix 2 for more information.
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Procedure
11
Obstetric Emergencies
Version 3.10
1.
1.1.
Introduction
Many 999 calls result are in relations to maternity/obstetric conditions. These may
result in, for example, the identification of patients with high risk complications,
imminent birth, a baby born before the arrival (BBA) of VCS.
1.2.
For all maternity/obstetric calls, routine or otherwise, the EMD must document:
1.2.1. The patient‘s name.
1.2.2. The maternity ward the patient is booked into.
2.
2.1
High Risk Complications
The Medical Director recognises a number of high risk complications - these must be
recorded as a yes to the question of any high risk complications on MPDS:
2.1.1 Premature birth (20 to 36 weeks gestation and in labour).
2.1.2 Multiple birth (over 20 weeks and in labour).
2.1.3 Bleeding Disorders.
2.1.4 Current treatment with blood thinners (anti-coagulants).
2.1.5 A patient who knows she is placenta previa and is in imminent delivery.
2.1.6 A Midwife or Health Care Professional requesting immediate assistance to a
delivery or other pregnancy related problem. Note: HCP calls should be
triaged on protocol 35 or 37
2.1.7 Diagnosed Pregnancy Induced Hypertension or pre eclampsia.
2.2
Positive identification of any of these situations should result in a 24D5 determinant,
ensuring a RED response.
2.3
If ―birth is imminent‖ is selected, it will be necessary to shift to 24D5 ensuring a RED
response if no High Risk Complication applies
2.4
If the caller gives any other conditions that they consider are high risk complications,
the EMD should select ―Unapproved other condition‖ from the drop down list in ProQA
and document the complication in the dialogue box. This will not affect the determinant
but should be flagged to the CTM for referral to CHub.
3.
3.1.
Calls from HCPs
Any calls received from Midwives or other Health Care Professionals to women giving
birth at home/public place should be triaged using Protocol 35. Community Birth
Centres are triaged on Protocol 37.
3.2.
Midwives and other health professionals are able to identify other pre-delivery
complications, including, but not limited to:
3.2.1.
3.2.2.
3.2.3.
3.2.4.
3.2.5.
3.2.6.
3.2.7.
OP/060
Foetal heart rate abnormalities.
Premature birth (over 20 weeks but under 36 weeks‘ gestation).
Multiple birth (over 20 weeks).
Eclampsia (maternal seizures)
Severe vaginal bleeding / post-partum haemorrhage.
Placenta previa or placenta abruption.
Breech positioning or prolapsed cord.
Control Services - Call Taking Procedures
Page 27 of 48
3.3.
In order to minimise this risk; ANY call from a HCP stating that an emergency response
is required for a pre-delivery complication MUST be triaged using Protocol 35 and
selecting Obstetric Emergency at Key Question 1.
3.4.
EMDs must ensure that they free text in the Remarks field what the HCP has stated
and what the problem is. This will make it clear to dispatch staff and crews what the
diagnosis is.
3.5.
EMDs should use as reference the ―Midwives Communication Tool‖ as guidance for
language they can expect Midwives to use for both Community Midwives on scene and
in a Birth Centre. This will also provide the guidance issued by the LAS to Midwives as
to the priorities they should be providing for specific types of calls.
4.
4.1
Escalation
An EMD highlighting an obstetric emergency during the process of a 999 call must alert
the CTM, who must in turn alert the relevant Area Controller and/or Allocator of the
situation immediately.
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Procedure
12
Distal and Proximal Injuries
Version 3.10
1.
1.1
Introduction
It is known that delayed treatment for some distal or proximal injuries can lead to the
risk of neurovascular damage and/or a threat to the long term viability of the limb.
2.
2.1
Identification
On MPDS Protocols 4 17 and 30 after asking the Key Question ―what part of the body
is injured?‖ EMDs must ask the following question (unless the information is provided
by the caller):
“Does the limb look grossly deformed or is the bone visible (protruding through
the skin) or is there an open wound over the deformed area?”
Any mention of a dislocation of a joint must also be included in calls requiring an
override.
3.
3.1
Overriding
When dealing with injuries where gross deformity or an open fracture or dislocation is
present, EMDs must select the Bravo override code in ProQA (MPDS). If triaging on
protocol 4, a subsequent triage through 30 to gain the appropriate non-referral code is
required.
3.2
The reason for selecting an ―Override‖ must be documented in the Remarks field – for
example: gross deformity / dislocation / bone visible / open fracture.
4.





Proximal Areas affected:
Upper arm
Shoulder
Upper leg / hip
Knee
Lower leg







Distal Areas Affected:
Elbow
Forearm
Wrist
Hand (excluding fingers and thumbs)
Ankle
Foot (excluding toes)
5.
5.1
Dislocations and Swelling
Dislocations can lead to neurovascular damage and therefore are included under the
heading ―gross deformity‖. Swelling to the upper leg is also to be regarded as a gross
deformity.
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Procedure
13
Health Care Practitioners (HCPs) Calls
Version 3.10
1.
1.1.
Introduction
This procedure sets out groups of HCPs who are able to authorise a delayed response
for a patient, and how these calls are managed.
2.
2.1.
Principles
The EMD should satisfy themselves that:
The HCP is exercising their own professional judgement.
The HCP has practitioner level responsibility for the patient.
The patient and the presenting medical condition fall within the HCP‘s area of
expertise. For example:

A GP can authorise a delayed response for any type of illness/injury for a
patient in their care

A midwife can authorise a delayed response for a pregnant woman in their
care

Nurse practitioners in a Urgent Care Centre (UCC) requesting assistance
with a patient within their treatment centre
3.
3.1.
Additional HCPs
There are additional HCPs who can authorise delays for patients under their care.
These include, but are not limited to:

Community/District nurses for elderly or chronically sick patients for admission to
intermediate/hospice care

Palliative Care (McMillan or Hospice Community Nurses)

Community Mental Health nurses for mental health patients

Certain clinically trained ambulance staff (paramedics and EMTs) for patients
whom they have assessed

Physiotherapists / Occupational Therapists / Chiropractors / Optometrists (within
their scope of practice)

Emergency Bed Service (EBS) when booking a delayed response on behalf of a
GP or Other HCP

Dentists
4
4.1
Calls from Health Care Professional (HCPs)
These calls are primarily managed on either MPDS Protocol 35 OR Protocol 37
dependent on the type of journey.
5
5.1
5.2
5.3
Protocol 35 is used for HCP admissions which include:–
GP admissions from the community (surgeries/home/clinics).
Patients going to Emergency Departments for investigation.
Calls from MIU/UCC/WIC where the clinician responsible for the patient is making the
call.
6
6.1
Protocol 37 is used for:Critical and Immediate Transfers as defined by the current version of the Hospital
Transfer Flowchart.
Other inter-hospital transfers with > 1 hour timescales that are within the LAS contract)
special patient groups)
Mental Health Transfers where the patient is being transferred based on the MH
condition.
6.2
6.3
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7
7.1
7.2
7.3
7.4
MPDS protocols 1-31 should be used for:
Calls from MIU/UCC/WIC where the responsible clinician is not calling
Patient at Mental Health facilities who are unwell with something other than a MH
related condition
Hospitals without an Emergency Department or Community Hospital where the
responsible clinician is not calling.
The HCP is not able to take clinical responsibility for the patient e.g. for a family
member, or member of the public in the street
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Procedure
14
Public Access Defibrillators
Version 3.10
1.
1.1.
Introduction
It is becoming common practice to find that offices, factories, shops, civic buildings,
transport hubs, etc. with Public Access Defibrillators (PADs) on site.
1.2.
It is also possible, but rare, for a caller / patient to have a personal defibrillator.
1.3.
It is paramount that when these defibrillators are available they are deployed as soon
as possible to the patient, to help increase the cardiac arrest survival rate.
2.
2.1.
Calls from Other Agencies
If a call is received from another agency, i.e.: LUL control room, the EMD taking the call
must remind the caller that if a defibrillator is located on site a suitably qualified
member of staff should attend the patient, with the defibrillator, whilst an LAS resource
is en route.
2.2.
The EMD must add “AED dispatched” to the remarks.
2.3.
If the AED is already with the patient add ―AED with Patient‖ to the remarks
3.
3.1.
Calls from Members of the Public
There are occasions in MPDS where the question ―Is there a defibrillator available?‖ is
prompted.
3.2.
In some post dispatch instructions, where the patient is not alert ―If there is a
defibrillator available, send someone to get it now in case we need it later‖.
3.3.
This question should always be asked and this instruction should always be given,
when the MPDS requires it.
3.4.
If a PAD is available and someone has gone to get it, the EMD must add “AED
dispatched” to the remarks.
3.5.
If the AED is already with the patient add ―AED With Patient‖ to the remarks
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Procedure
15
Patient Specific Protocols
Version 3.10
1. Introduction
1.1. Increasing numbers of patients have specific treatment plans shared with the LAS.
1.2. For patient care, it is essential that these plans and records are disseminated to VCS
when we receive a call to that patient.
1.3. The records may be triggered via the Locality Information System by patient address,
name and/or telephone number.
2. Residential/Care/Nursing Homes
2.1. When taking a call from a Residential/Care/Nursing Home, EMDs must ensure they
ask for, and document, the patient‘s name and confirm the name for any subsequent
ETAs.
2.2. PSPs must be viewed when taking a call, before completion
2.3. Where a minimum response priority is indicated on the PSP EMDs should check the
response priority obtained through MPDS and, where this is lower than the minimum
indicated, contact the CTM/CTC to contact CHub or an Area Controller to change the
priority. EMDs must complete the call before this is done, or the response priority will
revert to the MPDS determinant priority when the call is completed.
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Procedure
16
Safeguarding/Vulnerable Patients
Version 3.10
1.0
All NHS employees have a responsibility to ensure that any safeguarding concerns
relating to children (all people under 18 years) and vulnerable adults are notified to the
appropriate agencies.
2.0
2.1
Safeguarding
The LAS has Safeguarding procedures which staff must ensure they are familiar with.
2.2
EMDs, when taking a call may be provided with information, or hear something that
raises a safeguarding concern. Staff should not assume that the information will be
available to/obvious to an attending crew. EMDs are able to make safeguarding
referrals at call handling, by completing the relevant form (LA279 or LA280). It should
be noted in the call log along that this has been done along with the cause of the
concern.
3.0
3.1
Vulnerable Patients
Any patient who is alone is potentially vulnerable. All patients who have Mental Health
issues/ history and self-harmers (including threatening) should be regarding as
vulnerable. Other potentially vulnerable people are those who are cognitively
impaired and/ or learning disabled and those who are frail and elderly.
3.2.1
It should always be established if a patient is alone or not, and if so this should be
documented in Remarks field. The EMD should also:
3.2.2
Establish how access will be made.
3.2.3
Stay on the line with the patient where possible and ensure that all pertinent
information is recorded on the EVA
3.2.4
If there is likely to be difficulty in gaining access, this should also be noted in the
Remarks field.
3.3
If a possible collapse behind locked doors has been identified, this should be
documented in the remarks field and sent as urgent information and be flagged to the
Dispatch Group as MPS are required as soon as possible.
3.4
Please also refer to OP014 – Managing the Conveyance of Patients.
4.0
4.1
Mental Health Patients.
Some Mental Health patients are particularly vulnerable and care should be taken, as
people in the middle of a mental health crisis may not be able to exercise good
judgement.
4.2
Mental Health Units
4.2.1 When a call is received from a mental health unit, contact should be made with a staff
member to confirm if an ambulance is required. It is important that EMDs ensure they
clarify whether the patient has any other health issues/clinical needs at the time of the
call, which would require LAS attendance.
4.2.2 The contact attempt and outcome, including details of staff members spoken to must
be documented on the call.
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4.2.3
When LAS are attending, EMDs must obtain a location for staff at the unit to meet the
crew(s). This is particularly important at night or at any time when attendance is to a
secure unit. This will reduce the likelihood of significant delays in attendance to life
threatened patients where crews are unable to obtain access to the buildings.
5.0
5.1
Self Harm
Upon receipt of a call from (or in relation to) patients who have been or are at risk of
self-harm, EMDs should ensure they have a contact number for the patient (if different
from the caller‘s (origin) number), and the name of the patient.
5.2
It must always be established if a patent is alone and this must be documented in the
Remarks field. The EMD should also establish how access will be gained (see above
– 4.3 and 4.4)
5.3
If the call is from a 3rd party caller, EMDs should try and make contact with the patient
direct to gain current information. If no contact can be made, this should be noted in
the Remarks field.
5.4
Stay on the line with the patient where possible and ensure all pertinent information is
recorded on the EVA. MPDS indicates that where the patient is threatening self-harm
(further self-harm) EMDs should remain on the line if at all possible.
5.5
Patients who have taken overdoses, or are haemorrhaging who are ALONE will not be
able to call us if their condition deteriorates (reducing/loss of consciousness) for the
call to be upgraded. EMDs should remain on the line, or fully document why they are
terminating the call and alert the CTM/Dispatch Group to the risk.
5.6
If, during a call, a patient states that they are going to self-harm and terminates the call
this must be highlighted to the CTM/Dispatch especially when the nature of the
threatened self-harm is likely to have an immediate severe impact, e.g. hanging.
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Procedure
17
Conversion of 3rd and 4th Party Callers
Version 3.10
1.0
This procedure applies to all calls where the caller is not with the patient except those
calls from the Police received through the CAD Link which are managed through
procedures relating to MetDG.
2.0
Calls triaged through a 3rd/4th party may not provide sufficient information to obtain an
accurate reflection of the patient‘s condition and are further hampered by a lack of
ability to update or gain further/new information as the call progresses. In all cases
EMDs should




Attempt to obtain a contact number for the patient and note it on the EVA
The call must be triaged fully with the 3rd/4th party caller and all appropriate
and possible PDIs provided.
It should be established if the patient is ALONE and, if so, note this in the
EVA.
Try and convert to a 1st/2nd Party caller and re-triage.
3.0
Calls for vulnerable patients should be considered carefully (See Procedure 16).
3.1
For example,



calls from a third party where the patient is alone and is vulnerable (including
self-harmed i.e. overdose) should be converted if possible. If it is not possible
to contact the patient, the Sector and CHub must be alerted to the incident.
If contact is made with the patient, and they refute having self-harmed and
insist they do not want an ambulance: EMDs should not get into a conversation
about this, but should complete the call should so that a face to face
assessment can be undertaken.
Calls from Carelines should, where possible be converted. If a patient is
reported by the Careline as being alone and immobilised (fallen still on the
ground) then this will not be possible if they are alone on scene, but if someone
else is there, then converting to a second party call should be attempted.
The above scenarios are not exhaustive.
4.0
The minimum Dispatch Life Support information that should be provided to 3rd/4th
party callers is protocol specific Post Dispatch Instructions, the time-frame of the call
response and the worsening instructions. If the caller is in contact with the patient or
an appropriate person with the patient, EMDs should attempt to provide full (possible,
appropriate and possible) PDIs to the Caller for them to be passed onto the patient.
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Procedure
18
Helicopter Emergency Medical Service (HEMS)
Version 3.10
1.
1.1.
Introduction
The Helicopter Emergency Medical Service (HEMS) has a trauma doctor and
paramedic on board and are targeted at severe trauma calls in order to get the skills of
a doctor to the scene quickly when needed.
1.2.
The London Air Ambulance is based at the Royal London Hospital in Whitechapel.
When the Helicopter is ―off line‖ the team are supported by cars.
2.
2.1.
Targeted Calls
To target the skills of the HEMS team appropriately, the HEMs paramedic based in
EOC should be made aware of the following types of calls:
2.1.1. Falls higher than 2 floors.
2.1.2. Falls with serious injuries.
2.1.3. Road Traffic Collisions (RTCs) including:
2.1.3.1. Trapped under vehicle – including ―One Under‖ a train.
2.1.3.2. Ejected
2.1.3.3. Associated Fatalities
2.1.3.4. Any other RTC with serious injuries.
2.1.4. Assaults including:
2.1.4.1. Stabbings
2.1.4.2. Shootings
2.1.5. Drowning
2.1.6. Head injuries
2.1.7. Electrocution
2.1.8. Industrial accidents
2.1.9. Explosions
2.1.10. Traumatic amputations (above wrist/ankle)
2.1.11. Ambulance crew request
2.1.12. Service request from:
2.1.12.1. Police
2.1.12.2. London Fire Brigade (LFB).
2.1.12.3. Neighbouring ambulance services
3.
EMD Call Process
3.1
Whilst a call is in progress, the EMD will identify if it meets the criteria in section 2
above.
3.2
The EMD must complete the full MPDS triage and give any appropriate PDI‘s before
transferring the call to the HEMS Paramedic, to allow for any additional HEMs specific
triage.
3.3
If PAI‘s are required the call must not be transferred – the EMD must notify the CHS
who will in turn notify the HEMs Paramedic of the call, who can then monitor or request
to be conferenced in if the EMD must stay on the line.
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Procedure
19
Advanced Paramedic Practitioner
Version 3.10
1 Introduction
1.1 The APP group are targeted at acute calls in order to get the advanced skills to the
scene quickly when needed.
2 Targeted Calls
2.1 To target the skills of the APP group appropriately, the APP based in EOC should be
made aware of the following types of calls:
2.1.1
2.1.2
2.1.3
Falls higher than 2 floors.
Falls with serious injuries.
Road Traffic Collisions (RTCs) including:
2.1.3.1 Trapped under vehicle – including ―One Under‖ a train.
2.1.3.2 Ejected
2.1.3.3 Associated Fatalities
2.1.3.4 Any other RTC with serious injuries.
2.1.4 Assaults including:
2.1.4.1 Stabbings
2.1.4.2 Shootings
2.1.5 Drowning
2.1.6 Head injuries
2.1.7 Electrocution
2.1.8 Industrial accidents
2.1.9 Explosions
2.1.10 Traumatic amputations (above wrist/ankle)
2.1.11 Ambulance crew request
2.1.12 Service request from:
2.1.12.1
Police
2.1.12.2
London Fire Brigade (LFB).
2.1.12.3
Neighbouring ambulance services
3
EMD Call Process
3.1 Whilst a call is in progress, the EMD will identify if it meets the criteria in section 2
above.
3.2 The EMD must complete the full MPDS triage and give any appropriate PDI‘s before
transferring the call to the HEMS Paramedic, to allow for any additional HEMs specific
triage. If the HEMS paramedic is unavailable the call may be transferred to the APP.
3.3 If PAI‘s are required the call must not be transferred – the EMD must notify the CHS
who will in turn notify the APP of the call.
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Procedure
20
HM Prison Coded Calls
Version 3.10
1.0
When a patient is unwell in a prison it may be difficult, due to the communications
issues for Prison staff in secured areas, for sufficient information for the accurate
1.1
To reduce the potential delays prison staff will use a short code to indicate that they
believe the patient‘s condition is immediately life threatening.
2.0
Staff should:
2.1
Enter the location as provided, confirming the access point and, if available
on the Gazetteer, ensuring the specific access point (Gate) is selected.
2.2
Select Code Blue/Code 1(provides a Red 1 priority) or Code Red/Code 2 (Red
2 priority) from the ―EMERG‖ drop down box in CP. ProQA will not open or be
accessible if either code is selected.
2.3
Type any additional diagnosis information in the ―Problem Description‖ field
2.4
Provide PAI‘s via the MPDS Card set if the caller is with or accessible to the
patient
2.5
Confirm the details (read back) to the caller and provide the appropriate and
possible PDIs (minimum of the ―worsening instruction‖.
2.6
Complete the Event/call, passing the Event number to the caller
2.7
Where a Code is not used AND there is no indication from the caller that the
patient may be life threatened, the call should be processed as normal through
the appropriate protocol.
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Procedure
21
Accepting Calls from other Ambulance
Services
Version 3.10
1
This procedure applies to call within the LAS area which is initially taken by other UK
ambulance services.
2
UK ambulance services use both MPDS and NHS Pathways to triage 999 calls.
2.1
When a 999 call is received from another service using MPDS EMDs should
2.1.1
2.1.2
2.1.3
2.1.4
2.1.5
2.2
OP/060
Obtain the Location of the incident
Get the Origin caller telephone number (and patient contact telephone
number if different and available)
Proceed through MPDS questions
EMDs must also ask "Is there any other information, including relevant
medical history and medication relating to the patient or incident?‖. This
should be noted in the ―Problem Description‖ field.
The other Ambulance Service‘s determinant should be confirmed. If this
differs from the one obtained by LAS, then clarity should be sought as to
why. If the response priority differs and the LAS‘ is higher, then that
should be used. If the A/S passing the call has a higher response
priority, then the CTM should be consulted to see which should apply (to
check if the correct triage has been obtained, or a local decision by the
other service as response levels is the cause). Normally the higher
priority from either source should apply
For Ambulance Services using NHS Pathways EMDs should process the call
normally through MPDS (as above) and on completion of triage confirm the
response priority of the other service. If this is lower or the same as the LAS
response, no action is required. If the other services‘ response is higher, clarity
should be sought as to why and the CTM involved to match the higher priority.
Normally the higher priority from either source should apply
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Procedure
22
International Calls
Version 3.10
1. Introduction
1.1. There are instances where an anxious relative in the UK will call for an ambulance for
a relative who is outside the UK. This procedure explains how these calls should be
routed to ensure that they are passed on to the relevant emergency service
2. Call Taking
2.1. The caller should be asked if it is possible for them to direct the patient – or someone
with the patient to call for help in their own country.
2.2. If this is not possible the CTM or CHS should be alerted to the fact that you are taking
a call for a patient outside of the UK
2.3. Complete the call as usual, paying particular attention to the address, which may be in
a different format - for example some countries place the door number after the street
name.
2.4. For the patient telephone number ensure that you also get the country dialling code
where possible.
2.5. Document in remarks the language normally spoken by both the caller and the patient.
3. CTM / CHS
3.1. The CTM and / or CHS should assist the call taker as required to confirm the location
of the patient.
4. DDS
4.1. Identify the country the patient is in, and identify the telephone number for the
appropriate control centre from the international directory folder held in the GR file
4.2. Where no number is listed for that country, then the Clinical Hub may be able to assist
in identifying a number.
5. Passing the Call
5.1. Contact the relevant control, bearing in mind the following:
5.1.1. The call centre may not be able to take the call in English. Consider Language
Line to assist (English is required within the EU).
5.1.2. The call centre may not be a specific ambulance control. It may be police, fire,
or a combined emergency services call answering service.
5.1.3. Identify yourself as the London Ambulance Control in the UK, stating that you
have an emergency call to pass to them.
5.1.4. Pass all details that we have been able to get.
5.1.5. Take a reference number for the call, or the initials of the person who took the
details
5.1.6. Record all of the details, including the number used to contact the relevant
control as supplementary information in the event chronology.
5.2. Close the call with the disposition INTAMB
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6. Complications
6.1. If unable to identify an emergency call centre in the same country as the patient any
call centre within the country should be able to help – it need not be the call centre
that covers the specific area.
6.2. If either the patient or the caller is a UK citizen then the Foreign and Commonwealth
Office will be able to assist.
6.3. The national embassy of the country concerned in the UK may be able to assist.
6.4. The UK embassy in the specified country may be able to assist.
6.5. In extreme circumstances many large multinational companies that have a presence
in that country may be willing to help – if it has proved impossible to arrange help by
other means.
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IMPLEMENTATION PLAN
Intended Audience
Control Services Staff
Dissemination
Available to all Staff on the Pulse
Communications
Revised Policy and Procedure to be announced in the RIB and a link
provided to the document.
Training
EOC – Watch training leads to ensure dissemination and familiarity of
staff with
1-2-1 and scenario based sessions.
Monitoring:
Aspect to be
monitored
Frequency of
monitoring
AND
Tool used
Individual/ team
responsible for
carrying out
monitoring
AND
Committee/ group
where results are
reported
Committee/ group
responsible for
monitoring
outcomes/
recommendations
How learning
will take
place
Operational
Aspects
Monitoring
compliance on
a day to day
basis will be
undertaken by
all managers by
observing staff
during duty
hours.
EOC WMs will
monitor watch and
produce a report
for the Head of
EOC, for reporting
to the Control
Services Change
Board (CSCB)
Control Services
Change Board
(CSCB)
Bulletins and
amendments
to procedure
as deemed
necessary
A revised
Procedure to
be published
as above
3 yearly review
to be conducted
Technical
Aspects
Monitoring
compliance on
a day to day
basis will be
undertaken by
all managers by
observing
systems during
duty hours.
EOC WMs will
monitor watch and
produce a report
for the Head of
EOC, for reporting
to the Control
Services Change
Board (CSCB)
Control Services
Change Board
(CSCB)
3 yearly review
to be conducted
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Control Services - Call Taking Procedures
Bulletins and
amendments
to procedure
as deemed
necessary
A revised
Procedure to
be published
as above
Page 43 of 48
Appendix 1 - Glossary of Terms
112
999
AED
AEU
ALS
BBA
NTS
BLS
CAD
Card Set
CBRN
CHub
Chronology
CHS
CIO
CLI
CP
CRU
CSD
CSOP
CSU
CTM
Distal
DMP
DoH / DH
DSO
EA
EBS
EMD
EOC
ETA
EU
EVA
FRU
GP
GPS
GS
HART
HAZMAT
HCP
HEMS
IDP
IED
IRT
OP/060
The Emergency phone number recognised in the EU
The Emergency phone number in the UK
Automated External Defibrillator
Ambulance Emergency Unit
Advanced Life Support
(Baby) Born Before Arrival
Baby Emergency Transfer Service
Basic Life Support
Computer Aided Dispatch
Card index version of MPDS
Chemical, Biological, Radiological, Nuclear
Clinical Hub
Event Log
Call Handling Supervisor
Community Involvement Officer
Caller Line Identity
Communication Provider
Cycle Response Unit
Clinical Support Desk
Control Service Operational Procedure / Policy
Central Support Unit
Area Controller – Call Handing
Situated away from the point of origin or attachment, as of a limb or
bone
Demand Management Plan
Department of Health
Duty Station Officer
Emergency Authority
Emergency Bed Service
Emergency Medical Dispatcher
Emergency Operations Centre
Estimated Time of Arrival
European Union
Event Form
Fast Response Unit
General Practitioner
Global Positioning Satellite
Gazetteer search
Hazardous Area Response Team
Hazardous Materials
Health Care Professional
Helicopter Emergency Medical Service
Individual Dispatch Protocol
Improvised explosive devices
Incident Response Team
Control Services - Call Taking Procedures
Page 44 of 48
LAS
LFB
LUL
METCC
MDT
London Ambulance Service NHS Trust
London Fire Brigade
London Underground Limited
Metropolitan Police Command and Control
Mobile Data Terminal
A communication device for people who are deaf / hard of hearing or
Minicom Text Phone
have speech problems
MIP
Major Incident Plan
MIU
Minor Injuries Unit
MPDS
Medical Priority Dispatch System
MPS
Metropolitan Police Service
NHS
National Health Service
MRU
Motorcycle Response Unit
NHS SMS
NHS Security Management Service
NHS SMS LPU
NHS SMS Legal Protection Unit
NICU
Neonatal Intensive Care Unit.
NSY
New Scotland Yard
One Under
A person trapped under a train.
OP
Operational Procedure / Policy
PAI
Pre-Arrival Instructions
PC
Personal Computer
PCAT
Patient Centred Action Team
PCT
Primary Care Trusts
PDA
Personal Digital Assistant
PDI
Post Dispatch Instructions
PECS
Public Emergency Call Service
PRF
Patient Report Form
ProQA
A computer software programme than runs MPDS
Proximal
Situated toward the point of attachment, as of a limb or bone
QAD
Quality Assurance Department
RC
Resource Centre
RIB
Routine Information Bulletin
RIPA
Regulation of Investigatory Powers Act
RTC
Road Traffic Collision
RVP
Rendezvous Point
SCBU
Special Care Baby Unit
Silent call
No Voice contact
SMG
Senior Management Group
SMS
Short Message Service
SPOC
Single Point Of Contact
STEP 1-2-3
Method of approach at scene of multi-patient incidents
TP
Training Protocol
TSO
Tactical Support Officer
UC
Urgent Care
UCS
Urgent Care Services
USAR
Urban Search and Rescue
VAS
Voluntary Ambulance Service
VCS
Vehicle Crew Staff
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VDI
VoIP
VOR
VRC
WM
WIC
OP/060
Vehicle Daily Inspection
Voice over Internet Policy / Provider
Vehicle Off the Road
Vehicle Resource Centre
Watch Manager
Walk in Centre
Control Services - Call Taking Procedures
Page 46 of 48
Appendix 2
SHIFTING in ProQA.
Whether using ProQA or the Card sets please ensure that you always select the most
appropriate Determinant.
Normally all you see on
this side of the screen is a
series of Full Stops.
In this example the patient is a 24 YOF. She is in Labour with her First Baby; she has
serious bleeding and a Bleeding disorder
Therefore more than one determinant is relevant, this patient is in imminent delivery
(D3), she is haemorrhaging (D4) and she has a blood disorder (D5).
ProQA highlights D3 in green simply because it is the highest in the Numbering
sequence (7 low —1 high) it also highlights D4 and D5 in yellow as they are also
available to select.
Note: in these instances the Response code has been input to assist in selecting the
Highest LAS response for the call.
Sometimes, due to the size of the screen, only the determinant highlighted in Green
will be visible, however the ―SHIFT AVAILABLE‖ should be a prompt to scroll down and
check.
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Having selected D4, by moving the cursor, the
The Quadrant Timer
becomes Shift: 24-D-4
As the determinant is selected the Quadrant timer will turn Yellow.
The quadrant timer will stay yellow until the call is completed. This
is simply as a reminder that there is a Shift available.
It is worth remembering that if the Quadrant timer is Yellow click on it just to ensure that
the highest LAS code has been selected.
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