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

They do at my DD’s school!

Anyone in the Yorkshire area will know Crucial Crew and what they teach them - I had this in the 90’s and it still goes on.

Not that it served me too well in my waffly phone call 😂😂 if I’d had a level head I’d have said let’s just go to A&E not call 999 it’ll be quicker but I did just freak out and do what someone told me.

In hindsight the operator just wanted me to tell her the medical details and address as quickly as I could, she actually didn’t do anything wrong. I can’t imagine how tough that job must be

I know! I was fucking horrified.😂 I can laugh now years later and with him (by the grace of god) more or less fully recovered.

All of them are first aid trained including dh. I think in a real life emergency the training goes out of the window and panic sets in.

Dh did say he felt like he might die if he lay there in the mud and rain for 4 hours. The operator may well have told him to not move and wait. I’m not blaming them.

The ambulance service just cannot keep up with demand.
The choice was a make shift “stretcher” using ply and stick him in a van or wait several hours in the winter on the building site for an ambulance.

Im not angry with the call handler (or any of the NHS staff at ground level) for this sorry state of affairs.

You say this as if it is an excuse for things being so shit. It's not. It's a good example however of where the problem lies.

@allergic to ironing. Based on the calibre and ability to think.critically that I experienced, they'd possibly get better staff for less if it were outsourced to Bangalore. If UK staff don't step up that will happen more and more.

Your comments are verging on obnoxious and a bit arrogant now. I take it you’re voting Tory in the next election? 😐

You’re failing to consider the bigger picture. The myriad of reasons why call handlers might be failing to deliver the best service to all callers.

Lots of posters have explained the systemic failings in ambulance trusts and some of the reasons behind them. Pointing at the call handlers fighting fire at ground level and calling them stupid is failing in critical thinking yourself.

No idea if it's a single crew.

Why are we paying a person to sit in a car/ambulance/fire station/other building an entire day with nothing to do? I guess this is countrywide? Not solely in my area?

Why are they in an ambulance if they cant transport anyone?
Why cant they sit in a medical practice or minor injuries unit where they can be useful while waiting to be called out?

“ I guess this is countrywide? Not solely in my area?”

It is possible that it’s just your area.

They may perhaps be doing first aid training for the firefighters some of the time.

Apologies if this was linked upthread and I missed it, this is a review of ambulance services in 2019 of changes made in 2017, which describes improvement in response times and call Protocols

https://nhsproviders.org/the-ambulance-service-understanding-the-new-standards

There are often single-man crews in a car (or sometimes a truck, but usually an RRV) who will be reserved for the highest priority calls. This means that even if all other resources are on calls or stuck outside hospital waiting to offload, there's a trained paramedic who can be quickly dispatched to a cardiac arrest / choking call to provide CPR, defib and BLS drugs until a crew can arrive.

It's vital that they're ringfenced for reds and not seeing people in a doctors surgery because they need to be able to leave at a moment's notice - they may be doing admin, CPD or working on their studies on station, however (many paramedics are working on additional qualifications alongside their roles).

Thank you @iwentjasonwaterfalls

Based on the calibre and ability to think.critically that I experienced, they'd possibly get better staff for less if it were outsourced to Bangalore. If UK staff don't step up that will happen more and more.

I'm saying that to the people who seem to think they "should" be employing intelligent compassionate people with experience in dealing with high pressure situations, plus the abuse they get, for 12 hours a day without at any stage losing their perfect customer service skills. I really think some people need to walk in the shoes of call handlers and get paid peanuts for it, under the same conditions.

No good outsourcing to India - they get paid better for working for the banks or IT companies with less pressure!

It may only be in my area, but it's been going on at least 9 years.
I dont think the fire service needs that much training.

Well quite and the posters complaining most about a lack of empathy and critical thought don’t seem able to summon empathy for those working at the bottom of the NHS, or be able to see beyond that.

It’s not possible to do that job productively if you get emotionally invested in the calls. They are desensitised to trauma (being exposed to it daily) and they are forced to follow a script in order to gather information.

They are forced by the system to ask you to identify the worst injury/illness so that their computer can tell them what you must do to treat or manage that injury while you are waiting for help.
That can prove frustrating for patients but it’s proven to work as a blunt tool.

Call handlers taking “initiative” to go off script and make decisions or ignore the questions they are told to ask would have dangerous consequences. They are not medically trained. They cannot make decisions for you- they’re recording as much information as possible to pass to a dispatch team.

Well quiet and the posters complaining most about a lack of empathy and critical thought don’t seem able to summon empathy for those working at the bottom of the NHS, or be able to see beyond that.

I don't need to have empathy for those working at the bottom level. I feel annoyed at the way I was treated as a disabled person and citing 'these people are low paid' isn't at all in any way an acceptable reason for that. I fully believe these people should not be low paid, it should be a much more skilled position with a lot more training involved. Of course I can have empathy for them, they are doing a hard job for shit money, but that isn't a reason for the call handlers to be as they are. Things need to change.

I’m not sure how your emergency call for an ambulance could have panned out differently from a logistical point of view?

They sent assistance fairly rapidly, despite you not being able to communicate.

Yes the caller should have been more patient with the way she asked questions after you disclosed you were autistic, perhaps should have instructed you to find a neighbour to take over the call?

Beyond that, there is such a vast spectrum of autism and processing disabilities- would it be possible to tailor responses to each one?

If the person on the phone is having a panic attack and is struggling to cope with the situation then the first thing a call handler does is repeat the basic questions firmly and clearly. That often calms the person because someone is taking control. It might appear quite cold and aggressive.

Its certainly worth raising this with your trust. I think you make some valid points.

It was a suggestion; you are better reading the reply shortly after mine for much more informed suggestions,

I am pretty sure that no one has been wasting a paramedic with ambulance or car for 9 years and the NHS is just ignoring it.

I would imagine the autism example is a case of general public knowledge of autism being poor; many people would assume that if you are speaking at all, you don't have any communication difficulties and they probably would not know why autism was relevant or what they should do differently.

It might be more effective, even though arguably not right, to say something like "I'm prone to panic attacks so please can you be gentle with me?"

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?

I would think yes, because when somebody is in a panicked state, the brain centres that process language are not working very well, so they may literally not be taking in anything other than that confirmation they are looking for. That is probably why call handlers are trained to stick to asking direct, closed questions and simply repeating the question if someone doesn't give a useful answer.

The brain state that we go into when there is imminent threat/danger is much more instinctive and probably doesn't "understand" a telephone system very well - it's made for immediate, physical action with immediate, impactful consequences and not very much else makes sense. That's why your heart rate goes up and stuff like digestion stops because your body is diverting all your resources to allow you to do things like lift a car off a child, or fight a bear or whatever. While in normal situations you'd be disgusted and cautious to encounter vomit, you might launch in with your bare hands without thinking to clear a blockage from someone's airway or whatever.

If you know the system very well, and you have strong trust and understanding that behind the scenes while you're talking to this call handler, somebody else is lookng at all the current emergencies and status of all local ambulances and working to prioritise them all according to need and you trust the system that your call will get handled appropriately, then just making the call itself likely will meet that need even if you are panicking, and actually in a lot of cases of an emergency, there won't be a great deal that you can do, so providing information can feel (and be) useful enough to help calm that person back into rationality.

But in terms of your brain's reaction to "there is a threat, something very very bad is happening and can't stop it; I need assistance" phoning somebody up and waiting for a system to do its work (especially if you don't really know how it all works behind the scenes) doesn't really compute - your only goal is basically HELP THIS PERSON > GET ASSISTANCE and if you then feel like that goal is accomplished, you will immediately drop that action to focus on the next immediate action that will actually give you a real-time feedback and confirmation.

@BertieBotts

I would imagine the autism example is a case of general public knowledge of autism being poor; many people would assume that if you are speaking at all, you don't have any communication difficulties and they probably would not know why autism was relevant or what they should do differently.

This was my whole point though. They are not the general public they are doing a job that relies on communication so some training on communication difficulties would be helpful. I'm not critical of the individual, it's a shit system with a severe lack of training. Of course everyone is different but the handler should have been able to recognise the escalation in distress and inability to talk and adapted rather than getting shorty and abrasive. I know they have to ask but I had disclosed my disability so under those circumstances I think it would be ok for her to assume I was struggling for that reason rather then the 'push on repeat' attitude to questioning.

It might be more effective, even though arguably not right, to say something like "I'm prone to panic attacks so please can you be gentle with me?"

I'm not prone to panic attacks though, so that would never occur to me to say. I did have a panic attack, I can only think of 2 other instances in my entire 40+ years where that has happened.

Ah OK. Well then sorry I'm clearly illustrating the same problem - I don't know what would be helpful in that instance. I am just thinking along the lines that I have a diagnosis of ADHD, but rather than tell people "I have ADHD" and expect them to know what that means in terms of supporting me, I tend to ask for the specific thing that I need e.g. "Can you send me that in writing please?" (Because I know I am prone to forget details of verbal agreements). Most people have a very poor understanding of ADHD and I expect the same is true for autism.

I do agree that a lack of training may be an issue, as illustrated above by the poster who described 4-week training being condense into two days and her concern about this. But I don't think it's quite right to say that somebody trained in communication should know the ins and outs of every possible difficulty with communication. Being a child or being a non-native English speaker are both much more common than someone being autistic, and the most obvious thing I can think which most people would be aware of with clear autistic communication is using clear words without euphemism, slang, sarcasm etc - which a 999 call handler would hopefully be doing to begin with.