Why are 999 call handlers like this?

[NotADailyMailJournalist]

Hello

I came across a man collapsed and bleeding heavily from a head wound in the street today. Literally a thick puddle of blood. I slammed a folded, fabric shopping bag on the wound to stem the bleeding.

Me: Hello, I've found a collapsed male, conscious but with heavy bleeding
Call Handler: what age is he? Do you know his name? Did you see him fall?
Me: 60-ish maybe, not sure on name, Davie he says, maybe, no I didn't see it happen. Is the ambulance on its way?
Call Handler: YOU NEED TO ANSWER THE QUESTIONS, LISTEN TO ME! Further questions about when did this happen etc etc.
Me: he's very distressed, can I tell him the ambulance is coming?
Call Handler: FINALLY says ambulance is on way.

Speaking to friends, they say this is common. Why can't the call handler just say "it's ok, ambulance is on way, answer these questions in the meantime"?

Thanks

@NotADailyMailJournalist aside from the call handling, it's likely that the gent you helped was on blood thinners, which is why there was so much blood, and why it splashed on you. I thought it might help you to process what you saw.

Unless I'm misunderstanding what people are saying, there seems to be the suggestion that callers hang up once they know an ambulance is on the way, as they've got what they wanted and don't care about helping any more with further information.

However, I'm thinking that most of them are actually doing so because they figure that the call-handler's side is now finished, and they don't want to tie up the line/their time and stop other new callers from getting through; ergo they aren't trying to be selfish and unhelpful, but the exact opposite.

If, just before saying "The ambulance is now on its way", the call-handler says "Now this is important: I do just need you to stay on the line for a little while longer, please", would most callers really still hang up?

My ds is a call handler for the ambulance service. They do have to follow a script to enable them to prioritise calls and make sure the right help is provided.
You wouldn't believe the amount of abuse he gets at work.

Most of the first aid courses I've done (every few years since the '80s) have covered calling the emergency services and the information you should expect to give - though not necessarily in depth.

What has changed more recently is there is more acknowledgement that dealing with something like this can be traumatic for the first aider, and there is help available if you are struggling. (Recent courses for me have been St John Ambulance- it's probably a decade or so since I did Red Cross, but they all seem to be pretty much in line with each other.)

Question for the call handlers here - does the system change which questions you need to ask, or the order of them, depending on what the previous answers are? Examples would be things like going straight to the "check they are breathing & if not do CPR" questions if someone is reported as being unconscious, but ask for a different set of answers for conscious but bleeding?

From the times I've called before, I'm pretty sure the system must be designed to do this as each time I've only been asked relevant questions, and in what seemed to be a reasonably sensible order.

Yes. The system isn't perfect but has been strictly designed for the best interests of the patient (not the caller). The US ones are more litigation-based, also the call handlers' calls are audited regularly for compliance to the script. It's a really, really hard job - balancing the demands of the fixed system with unpredictable, emotional, wobbly human callers.

They have a set script they have to complete to grade the call to see how urgent the ambulance is. Also they're trained to stick to the script even when the caller will naturally be in distress so sometimes they have to be stern to get the info they need to get the help to you.

Ok, so does that mean that if a question is not capable of being answered, or a task requested can't be done, it can go on to the next?

Lots of people on here report it effectively getting 'stuck' because of this.

It's system dependant, but in the one our centre used it couldn't be skipped so much as we'd encourage the caller to answer as best as they could, or try their best to carry out the instruction, and then move on. For example, the patient's age is asked early on because of its relevance - CPR is different for a baby, a child and an adult; abdominal pain could be very different in a woman of childbearing age vs a male over 50; just to give two examples.

That means that if we don't have an age in the box, we can't move on, but a sensible call handler will encourage the caller (if they're a stranger and panicking because they don't know the patient) to look at the patient and give their best guess, reassuring them that they're doing their best for the patient and they won't be in trouble if they're wrong. If the caller is still struggling, you could suggest some categories like teenager, thirties, middle aged, elderly to help them out and get a rough idea.

Taking a name etc wasn't part of the dispatch priority system though (that part was handled separately, after the call priority had been assigned and all the most important questions are dealt with and any big instructions are given - you'd never be asking for a name when you should be giving CPR, for example - so I can only imagine the people getting stuck on name questions have called 999 in trusts that use a different dispatch priority system.

Things like medical conditions, you can write or click "Unknown", but you can't just assume that - it's important that every question is asked, because the caller or another bystander might have some useful information (if you ask if they have any medical conditions, the caller might suddenly find a medical alert bracelet or some other clue that builds a bigger picture of the scenario and creates a safer, more accurate dispatch for the patient.

I'm interested to hear from people who have done the job, a lot are answering questions on how the system works but nobody has given any detail about what happens if the caller isn't 'able' - I have posted early on about disclosing my own disability to the call handler, telling them I can't do the things they were asking for and reiterating that I am autistic. There was no shift in her attitude she was quite rude and kept saying I NEED you to... and you HAVE to do... and didn't have any understanding of my lack of ability. Looking back now I perhaps should have raised it at the time as feedback, or even questioned the process there. I was left unable to speak, having a panic attack outside my relatives house and one of the paramedics had to tend to me on arrival.

The whole call lasted 15 minutes and not once did the call handler try to adapt for my own disability. I have communication difficulties, I can't be the only person and the more I go over it the more o wonder why there is no 'deviation' or basic training on how to deal with people who have their own disabilities. If they take a call from a child they seem to be easily able to adapt so why not the same when a disabled caller in on the other end of the line?

Living up to your name!!

the ambulance dispatch system is menu driven and cannot progress without answering the questions…I have cause to contact them regularly through my job, and it’s a SHIT system they use

Because they have to be. Do you know how much hoax calls cost? Do you realise that they have to triage and prioritise? Would you want a relative of yours to not be saved because all available ambulances were seeing to people undoubtedly injured, but not in a life threatening way?

Good grief.

I guess their brusque tone gets people to focus and answer the questions more quickly

They probably have to deal with people freaking out the whole time and just need to get their questions answered quickly before they can dispatch an ambulance she need people to pull themselves together.

Yes it might feel a bit rude, but surely the quicker they get through it the better for the person who needs medical attention 🤷🏻‍♀️

It's not about what you want, surprisingly.

Why should the 999 operator be moved? How would that help the situation? Get a grip.

Could you explain the relationship between being abrupt/bordeline rude and not assessing the need appropriately?

Because in my line of work, usually the opposite happens. The less abrupt you are, the better the answers and therefore (in that case), the better the response re ambulances.
Usually also make taking information quicker.

No it’s not.

But what if…. What if just reassuring the person who is clearly panicking they are sorting help out (not sending someone straight away because it might not be needed), actually was making the whole process easier.
As in easier fir the call handler who can then get their answers straight away and easier for the person calling?

Why is it that some people seem to think there is never a middle of the road answer?

Rude.

I meant 'prioritise' but couldn't think of the word at the time 🤷‍♂️

Usually when a caller cannot communicate (because of language barrier, impairment, disability or being a young child) there are alternatives.

A child for example is usually encouraged to find an adult who can help them with the call- by knocking on a neighbour’s door for example.

Your inability to speak on the phone would not have prevented you from getting assistance, it just made it harder to put your call in a category.

You may have had an inexperienced call handler, you may have encountered a call handler having a bad day, your call handler may have been trying a technique called repetitive persistence. This technique has been shown to be extremely effective in times of panic - repeating the same instruction at the same volume and tone of voice to a caller who is panicking or refusing to carry out an instruction, it sounds counter-productive and counter-intuitive until you've actually had to do it and witnessed it work. Maybe she was trying that, and it didn't work for you or she didn't get it right.

Part of the issue may be that a lot of callers will say "I'm not going anywhere near the patient, just send an ambulance", not realising that the call will get categorised as a very low response without the necessary information (they think if they give as little info as possible, call handlers will go "oh it must be bad, I'll send them super quick just in case!" - there aren't the resources available for that). She may have wrongly assumed you were one of those callers and that may be why she was trying to persuade you to go inside.

Every trust has a QA unit (it comes under different names) that deals with the quality and compliance of call handling. You can make a complaint or raise a query with the ambulance service, and they can access the call log and have a QA (who will be an experienced call handler themselves with lots of additional training) listen to the call, assess whether it was handled appropriately and politely, and arrange feedback and further training for the call handler. If they identify a pattern, they can also arrange trust-wide training for all call handlers on types of callers - when I worked in that role I put together training packages on communication difficulties, child callers, overcoming panic etc.

I have found the police handlers also very rude, actually contemptuous, when reporting a crime currently happening. Similar with 999 ambulance reporting.

So why is there an ambulance/sometimes a car parked almost permanently next to my local fire station?
I work right over the Road so I see it parked there almost all day, 5 days a week. No idea about weekends.
Obviously it moves at times, I guess because a call came in. But mostly it just sits there and the driver/paramedic is seemingly asleep or in the fire station.

Why ? If you know.

If it's a single crew, there will be limited calls they can attend. They're often used as a third pair of hands for tough jobs such as CPRs. Dispatchers don't want to waste them sending to jobs where they can't actually transport the patient, or get stuck on scene with a minor injury waiting for a two-crew vehicle to become available. Be pleased no-one in the area is at death's door.

So would the paramedic ride with or follow the fire engine to eg a car crash, in this instance?

What I did learn from my experience noted above, is that if ever I need an ambulance again, I shall be economical with the truth and say "yes my hand is turning white or similar" to ensure the call is graded up.

Can those with experience please explain why the call handlers refused to take account of the fractured vertebrae as well as the fractured wrist and repeatedly told me to get in a car. Had I had two hands free I could have manouvred re the back, had I just had a broken wrist I could have flexibly turned into a car seat but it was "co.puter says and we can only assess one injury. It is not helpful when there are two.

Also the logic of the call ha.dler who told me to go to the oharmacy and get paracetamol when they had repeatedly been told I could not get up.

It was all very far from helpful and very jobsworths.