What to expect when you call 999
South Western Ambulance Service, supported by local clinical commissioning groups (CCGs), is committed to working with the wider health community including care and nursing homes, as well as other care providers to highlight opportunities for collaborative working.
Wherever possible, please have the following information to hand
Is the patient awake/conscious?
- Is the patient breathing?
- Do you need clinical help right now to deliver an immediate life-saving intervention/or are you declaring an obstetric emergency?
- Is there a need for an immediate intervention that cannot be carried out at the current facility and the patient is at immediate risk of death, or life-changing loss of a limb or sight?
- Pick-up location/address for the patient
- Have you assessed the patient or do you require the ambulance service to undertake a triage of the patient?
- Main presenting problem/diagnosis (reason for admission)
- Any serious bleeding (bright red blood) in last 30 minutes?
- Is the patient’s condition immediately life threatening?
- Patient observations and a NEWS2 score
- Does the patient require any clinical observations or assessment by the ambulance crew?
- Destination (e.g. hospital and ward and that this has been confirmed
- Patient details:
- Name, date of birth and NHS number
- Contact telephone number
- Mobility level
- Are they infectious?
- Do they have a DNAR?
- HCP details:
- Name of surgery/organisation and authorising HCP
- Contact telephone number
- How has the HCP assessed the patient (e.g. home visit, telephone call or in surgery).
The following outlines the 999 and 111 call process
Identification of the Critical Patient
Before further details are taken we will establish if the patient is conscious and breathing. This is so that critical calls can be immediately prioritised and first aid or CPR instructions can be provided.
What is the reason for the call?
This enables us to follow the most appropriate triage route for the presenting complaint. This determines the clinical assessment undertaken and subsequent questions that you will be asked.
What is the full address- including the postcode? We will ask you to repeat the address to confirm that we have the correct location.
How old is the patient? It would be helpful to have the patients’ date of birth.
The call handler will ask a series of questions in order to determine the clinical priority of the incident. Instructions may be given throughout the triage.
Depending on the nature of the incident, the triage may include questions about the patients’ medical history and current medications. All questions throughout the telephone triage are asked in order to identify potentially time critical or serious underlying conditions. It may feel as though some of these questions are not relevant to the call but it is important that we gather as much information as possible in order to arrange the most appropriate response. These questions will not delay the help that is being provided. Wherever possible, the call handler will ask to speak directly with the patient in order to better understand their clinical need.
Access and Safety
We will need to know if there are any difficulties in accessing the patient or the property. For example, are door codes required? Where within the property is the patient located? Is the address particularly difficult to find? We will also request that pets are put into a separate room. You may feel that the animal is no risk to the attending crew but animals can be unpredictable in emergency events or interrupt the timely provision of care.
After your call has been triaged you will be informed of what the next step is. This could include an emergency or non-emergency ambulance, referral to a G.P., other specialist service or advice to make own way to a treatment center or hospital. Some calls may be passed to a Clinical Supervisor for further remote triage or for telephone advice in order to ensure that the most appropriate response is arranged.
If an ambulance is arranged and the incident is immediately life threatening (or if continued pre-arrival instructions are required) the call handler will remain on the line until help arrives.
Unfortunately, we are unable to provide an estimated arrival time for non-emergency calls. Allocated ambulances can be diverted to patients where there is a more urgent clinical need or risk to life. This is a dynamic process as 999 calls are continually received. Regular contact from the clinical hub will be made to ensure that the clinical priority of your call is still appropriate to the patients’ needs so please try to keep the telephone line open so that we can call you back.
Please be assured that we will provide assistance as soon as possible. If there is a change in the patient’s condition please call 999 for re-assessment.
When we arrive
If the patient is conveyed, we will need to take medications and up to date Medication Administration Records (MARs chart), relevant care plans and end of life documentation such as Treatment Escalation Plans (TEPs) and Do Not Attempt Resuscitation (DNAR) forms. SWASFT have created a template care home handover form which can be accessed here.
Following a clinical assessment of the patient, the attending ambulance may decide that the patient can safely remain at their current location or may refer the patient for onward care and support within the community. Certain conditions also require treatment at a specialist center which may mean bypassing a local hospital in order to reach the most appropriate definitive care for the individual.