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

Thank you. For things like age it makes sense, as very difficult to think of a situation whether an approximate age can't be given.

But for others, it's clear that some people have ended up stuck.

Take the guy who was repeatedly told to switch off a machine even though it would result in someone's arm being ripped off, it where someone can't physically do the action requested. Or where someone is being asked to do CPR on ac skeleton or something. In those situations surely those questions can be skipped or a N/A box ticked. If there is no option to use common sense in those instances, I'm failing to see the benefit to it being an actual person rather than AI

No need to be untruthful but it’s worth noting that you need to communicate the reason you cannot get yourself to hospital and require a paramedic; in your case a back injury that left you unable to walk. The broken wrist should not have been recorded as the main injury needing attention.

I expect that should have been marked in the category of ambulance required but not life threatening so with a long wait (possibly hours).

You we’re issued with an apology and an admission of fault so your experience was clearly not within established protocol.

Of corse people play the system. People lie. Saying a patient is not breathing or struggling to breathe will get you an ambulance immediately. Possibly one diverted from a far more serious emergency.situation.

@iwentjasonwaterfalls

Thanks for your detailed reply, I really appreciate it.

I wasn't refusing to go inside the house, it was locked. I gave the detail I had, if they can't work out how to prioritise an ambulance for a 90+ year old incoherent woman stuck on the floor I'm not sure they are in the right job.

The repetitive thing, like I said when I disclosed autism and said I was struggling to talk and can't manage she really needed to listen to me. I understand the patient I'm calling for is the priority, of course, but at the same time she wasn't listening to me. There is a lot of talk on here about how callers need to listen but actually I think the handler needed to listen to me and take on board what I was saying. When my breathing started to increase and I was mumbling 'need help, need help' repetitively for several minutes, she should have stopped the abrasive questioning

Yeah, these are situations where I think it's a system issue (my old trust used a system that is in use internationally and goes through continuous improvement, they work with police/fire/rescue etc to ensure all advice makes the most sense for all eventualities - I'm not sure the same can be said for the Pathways system that some ambulance services use 😬)

It may also be a common sense issue, call handlers being scared to deviate from the script even when it's a clear scene safety issue - feedback and training would be given in those cases (the call handling system we used would have options for "can't reach patient" in the case of not being able to turn off a machine, for example, and the instruction would be prefaced with "if it is safe to do so", leaving it to the caller's discretion.

Same with CPR on a skeleton - I can only speak for the system I experienced; as soon as the caller gave a descriptor of a patient who had obviously been dead for a long time/obvious decomposition, CPR instructions would stop straight away. We'd still have to ask conscious/breathing just to confirm, but I'd always explain "I understand what you're telling me - for the telephone record, please confirm..." because the call will potentially go to coroner's etc and following process is important. If a call handler doesn't do that, it could be a training issue or down to panic/inexperience.

I did repeatedly and no heed was taken. I have also the advantage of having listened to the tapes.

I told them there were two injuries and was categorically told they would only triage the worst and they made me identify the worst which initially I said I couldn't do. At that time the pain was equal from both.

There was no understanding whatsoever and I was made to insist I needed an ambulance.

I find it interesting that you have tried to push the blame back to me when it was not mine. I should not have had to make anfirmal complaint and there should have been no need for an apology if those I spoke with had an iota of understanding or initiative. They did not.

Oh and to add to the above it took two and a half hours and I was out on the pavement in the rain.

The crew, when they arrived, said they weren't particularly busy.

That makes a lot of sense re: the locked door, I wasn't sure if it was down to panic (it's something we encountered a lot - everyone responds to an emergency in very different ways, some people point blank refuse to enter the house with a casualty but also won't hand over the phone to someone who will).

Certain trusts have an exact protocol to follow for this scenario (inaccessible patient) but it's a bit of a tricky one because it involves a lot of questions that 99% of callers will not be able to answer. Good customer service (in my eyes) is deviating from the script a little and saying "I completely understand that you can't get into the house - if you don't know the answer to these questions, that's all you need to say". We can't assume they don't know, we have to ask it on the off-chance that they've heard shouting from inside the house or hear information while we're on the phone with them or one of the questions jogs their memory. Customer service is the make or break on calls like this, and your call handler didn't get it right.

Depending on how long ago it was and whether you feel up to it, I highly recommend raising it with the trust in question. Repetitive persistence is such an beneficial skill for call handlers, but they need to be using it correctly and understanding when to use it and when to give space and listen and allow for silence - your feedback would help them identify some extra training for the call handler to find the balance (only if you feel up to it though - completely understandable if you'd rather not relive it!).

No need to be untruthful but it’s worth noting that you need to communicate the reason you cannot get yourself to hospital and require a paramedic; in your case a back injury that left you unable to walk. The broken wrist should not have been recorded as the main injury needing attention.

How is that supposed to work when people are in shock (eg they’ve just had a bad fall), don’t think right (concussion), struggle to speak (stroke), are in pain.
It seems that the whole system is assuming that whoever is calling is rational, able etc….
It doesn’t seem like a reasonable expectation for a 999 call.

I'm baffled by the "we can only triage one issue at a time" thing 😵‍💫 I'm glad you've had an apology from them.

I don't know for certain, but it would make sense. A paramedic immediately on the scene of an RTC could quickly update the dispatcher that no other crews were required.

For those commenting on some of the call handling staff seeming to be possibly sub-par when it comes to common sense, intelligence, life experience etc, you do realise that the average salary is just under £24k, and a person relatively new to the job earns under £20k? Bear in mind that minimum wage is £19.5k....

@iwentjasonwaterfalls I could only assume at the time that I was dealing with people who were jobsworths and in the style of Little Britain just couldn't be bovvered. The gentleman who told me "saying please, won't get you help faster" was truly beyond the pale. As for the clinician who said "yeah, the UK where yiu all get free ambulances" when I noted the service was unacceptable, I have no words for. At least the gentleman who sorted it all out confirmed they were no longer with the Trust.

The standards the public have to face in a crisis and when vulnerable are simply not good enough and I fail to see how attitude links to resources u less they are employing individuals who are frankly unemployable elsewhere. As far as I am aware, in any event, we don't get free ambulances. They are funded through taxation and are free only at the pointnof delivery. Had there been the option that afternoon of paying £500 for some prompt, courteous and competent service, I'd have happily paid it.

Thankfully I wasn't critical. I can only imagine what might have happened if I had been.

It makes me wonder how they'd handle a car accident with multiple patients, if they're that much of a jobsworth about multiple injuries 😵‍💫

I can only speak for my experience but on the call you've described, as soon as you'd said you'd injured your back and your wrist, we'd select 'back' on the triage system and make a note of your wrist in the incident notes, because your back is the higher clinical priority. That's basic call handler training; asking you to pick one injury shouldn't even come into it! There are some things people have spoken about on the thread where I think maybe it's a training issue or inexperience or nerves, but this one has totally spun my mind.

I'm very glad the individuals you interacted with aren't in the role any longer, because there are absolutely some who go into it for the wrong reasons and they let the side down (and more importantly, they are a public safety risk).

@iwentjasonwaterfalls thank you.
Even more concerning was the fact that I am pretty articulate and day to day run a complex organisation. Even with clear communication (admittedly, I sounded very potentially frail on the call) they simply would not listen.

Without an XRay machine, there was no way I could identify which was the more serious injury.

I’m not trying to push blame back on you.

You seem to be under the impression that if you had been “economical with the truth” and said your hand was turning white you’d have got an ambulance.

I was pointing out No you wouldn’t. Broken arms don’t need ambulances.

No need to be economical with the truth but there was a need to establish a suspected broken back was the injury requiring an ambulance to take you to hospital. I understand you may have been in shock and pain.

Your ambulance trust have admitted fault and apologised so your experience, although awful was not an example of “what all call handlers are like”

My husband feel from a 2 storey roof two years ago on a building site.and sustained smashed arms and a shattered pelvis. His wait time for an ambulance was 4 hours in bad weather.
He couldn’t bear the pain and allowed his work mates to take him to A and E in the back of a transit van lying on a bit of ply wood.

He has permanent nerve damage down his legs as a result. I’m not bitter and angry with the call handler or demanding compensation.

The fact is if you’re not dying, the resources aren’t available, or you’re in for a very long uncomfortable wait.
All the dispatch team can do is categorise your call on the information they’ve extracted from the caller.

Clearly mistakes were made in your case in recording your information. It doesn’t mean the system call handlers use doesn’t work when used properly.

Limited resources mean the 6000+ calls for ambulances per day have to be filtered using an established system rather than relying on a member of staff’s “initiative” “intuition” or “common sense” that’s an unreliable variable.

I thought this once OP

CONTENT WARNING

A few years ago I was at a family BBQ and a family member chopping lettuce chopped half her finger off.

It was a mad panic someone screamed at me to call 999, so I did. At the time I found the operator quite snippy and aggressive and demanding. However on reflection Because I’m shit in panicked situations and I waffle when nervous, I realised I was saying “So my Aunty was chopping salad, we’re at a bbq you see, and she’s cooking, she had a knife and I’m not sure how, but she screamed and when I ran through her finger is on the chopping board” - the operator probably thought STFU and get to the point so I can triage this, and dispatch an ambulance if I need to.

They have such a hard job and seconds literally matter, it doesn’t matter about their tone as long as they get the right help for the right people. They can’t just send an ambulance for every call. My Aunty didn’t actually need an ambulance, we were told to stem the bleeding, pop the finger in a bag with ice and drive to A&E, there’s nothing else a paramedic could do except take her to hospital. That ambulance was clearly needed elsewhere and I’m pleased in hindsight it wasn’t automatically dispatch

They need to grade the injury and how urgent it is, shocked u needed to post this, thought everyone knew.

The conduct of the call handlers on the day I had my accident, persuades me that a form of National Service is required. Such people learnt no manners at their mothers' knees and clearly didn't at school, notwithstanding the failure of their training. Who trains the trainers I wonder?

No one can know all the things that, allegedly, “everybody knows”

Hmm I mean let’s also acknowledge they have to listen to abuse from many “Ill mannered” callers themselves on a daily basis, as well as perverts, death threats and mentally unwell people ranting drunkenly down the phone. The turnover is vast, there are recruitment issues, staff shortages and adults that are no more than kids thrown onto the phones with inadequate training. Many suffer anxiety depression and PTSD.

Im not excusing the rudeness you received but you can see how many call handlers are stressed, impatient and completely emotionally and mentally detached.

Very often, the training has been stripped back to the bone. I posted earlier in the thread about when I was a trainer; I went from delivering four weeks of training and sending them out for four weeks of mentoring, to being told I had to condense their training into two days and they'd get two weeks of mentoring if they were lucky, but their mentors were being pressured to sign them off sooner.

The staff turnover means the quality of training and experience of trainers is diminished too. I was trained by people who'd been there for over twenty years; I was training call handlers alongside presenting about dispatch at national conferences. Nowadays, I'm told there are people doing the mentoring within six months of starting because the turnover is so rapid, they don't have enough experienced staff.

In fact, if I remember rightly, when I asked for advice on how best to condense the customer service segment of the training for the new "streamlined" training, I was told to just cut it out 🙃

Oh rrrage &@iwentjasonwaterfalls

(good username)

@YaMuvva you see what you’re describing is, for me, the sort of call I’d expect 999 to receive.
Someone who is panicked, doesn’t make sense etc….

Because few people have been in that situation, so not ‘doing it right’ when you ring 999 isn’t surprising.

Maybe what we need is compulsory first aid training in schools that would include what to say when you ring 999.

@SmileyClare im 😱😱at the idea that the first aider at your dh work thought it was a good idea to transport him like this to hospital. He really took the risk of being paralysed 😢

Im also surprised that the call handler didn’t make it clear that he should NOT be moved during the call (for the same reasons). Two storeys fall is a BIG fall.