PLEASE BE AWARE THIS BLOG CONTAINS STORIES WHICH MAY CAUSE SOME UPSET
A lot of people don’t really understand what they’re getting themselves into when applying for a call taking position in an emergency control room. It is a tough job and the majority of applicants are at the beginning of their working lives. Some quite intensive training follows where you have to learn the ins and outs of the triage system and pass tests to gain your licence to operate it. Currently in the UK there are 2 triage systems in use across the 999 and 111 network, these are Advanced Medical Priority Dispatch System (AMPDS) and Pathways. Both systems depending on the type of incident entered initially by the call taker (for example – chest pains) will then present the call taker with a series of structured questions usually requiring a yes or no answer. At the end of these questions a response priority is attached to the call which informs the dispatchers and the responding vehicles of the severity of the incident. As you can imagine these systems aren’t without their faults and both have been known to be over cautious and grade calls higher than necessary which can be frustrating for both control and operational staff. However we all realise it wouldn’t be a safe system if it was grading calls lower than appropriate!
As I have mentioned in previous posts, most if not all UK Ambulance Trusts have control room clinicians on duty who can intervene in calls once the call taker triage is complete if they believe the grading given is incorrect. This ensures the patient receives the quickest and most appropriate form of help rather than simply the nearest resource as fast as possible. In some scenarios the fastest response (whatever it may be) is required but these immediately life threatening calls only make up about 20% of our total workload.
So once you finish your triage software training as a call taker and have your licence you then need to learn how to operate the control room systems. Unfortunately Ambulance Trusts across the country use different Computer Aided Dispatch (CAD) and telephony systems. My personal opinion is that the same systems should be used nationally to enable any Trust to assist another in times of major incident or evacuation for example. Also this would mean that once trained, you could work anywhere in the UK. It’s possible this could happen one day with more and more 999 and 111 centres now working on Pathways. AMPDS is purely a 999 system whereas Pathways can triage both 999 and 111 calls meaning that Trusts with 111 contracts can train their call taking staff in both roles giving greater flexibility to manage workload. (For those not in the UK, 111 is a new national non-emergency medical helpline giving access to advice, out of hours Doctors, community nurses, dentists etc.)
Normally after completing all relevant training you will spend a period of time sat with a call taking mentor, the length of time depends on the Trust you work for (once again there is no national standard here) and your level of progress. It’s now when you begin operating as a live 999 call taker that you realise what this job can entail. I remember some trainee call takers receiving their first ever 999 call and it being a cardiac arrest, whilst others can go through their whole training period without taking one. The fear of that first arrest call is present in all new control staff. After working in control for a while you could almost walk into the room and without knowing anyone, be able to pick out the staff who haven’t dealt with an arrest call yet. It’s almost like the initiation is complete once that inevitable cardiac arrest call is taken.
Unfortunately my initiation was particularly severe when I received a cardiac arrest call for a baby. This is the one call that no-one wants to take and you will know after dealing with one if a job in Ambulance control is for you. I won’t lie; I struggled to hold it together during the call. The second the call was connected and I said ‘Ambulance Emergency’ all I could hear was screaming. Now a lot of people scream at the start of a 999 call as the situation they are faced with can be frightening, however the scream of a parent who has just found their baby not breathing is unique and completely terrifying. It is at this point when you realise the importance of your training, you have to remain calm and most importantly you need to get an address out of this screaming parent. The majority of 999 calls these days are from mobile phones so all we are presented with in the control room is a rough grid reference of the area that mobile phone is in. We can progress no further with this 999 call until an address is confirmed. An ambulance resource will already be allocated and heading in the general direction of the call but at this stage they will not have an address to head towards.
Trying to calm someone down enough to think rationally and pass their address in this situation is extremely difficult. As the call taker you have to keep your tone calm and reassuring and not raise your voice to meet the panicking caller. Sometimes obtaining the caller’s name and giving yours can make a massive difference and saying something like ‘together we are going to help your baby but first I need an address for the ambulance to come to’ can reassure the parent that we are going to do everything we can to help. Once the address was confirmed I felt relieved that at least if I could get no further in the call the help would arrive as quickly as possible. Once I had confirmed that the baby was unconscious and not breathing I then proceeded to give paediatric resuscitation instructions to the parent, something that I will never forget. No parent should ever have to perform CPR on their child but you can’t let thoughts like this enter your head during the call as you will lose control. You have to remain professional, follow your training and do the best you can to keep the parent calm and reassured. During calls like this you realise as a call taker how it feels to be the one waiting for the ambulance to arrive, the response time may only be a few minutes but it can feel like hours whilst you remain on the phone providing the instructions and reassurance required to give this baby the best chance possible.
The most bizarre part of this call was the end, as the crew walked in the door the parent put the phone down and as they did so began screaming at the arriving staff. For me after several minutes listening to and dealing with a very panicky situation unfolding it was suddenly gone and all was quiet. Other staff in the control room were dealing with calls but to me it felt completely silent. I took a moment to ensure all relevant notes and entries had been made on the CAD screen then the supervisor approached me and advised me to take some time out. It is at this point when you leave the control room that you start to think more about the family involved in this call and question yourself on your performance – ‘could I have done more?’, ‘did I get the address quick enough?’. The final straw for me whilst I was running through these questions in my head was one of my colleagues asking me if I was ok. Up until that point I hadn’t really thought about how I felt and I now knew that I was really upset about it so I made myself a cup of tea, took myself out to the car park for a little walk and let it all out.
I felt better after the tears, during the few minutes on my own in the car park I had managed to reassure myself that I had done everything I could and although the call was extremely distressing and upsetting it was part and parcel of the job and certainly made me realise why I joined in the first place. I didn’t join to be sworn at by aggressive drunks on weekend night shifts, I joined to help people in their time of need and I felt I had done my best on this call. Unfortunately the baby didn’t make it which to be honest I was kind of expecting as it is very rare for paediatric resuscitation to be successful, especially when the baby was found like this and no-one was really sure how long ago it had happened.
So after a quick chat with my supervisor and another cup of tea I assured them I was happy to return to work and sat back down at my desk to warm smiles from my colleagues who were all aware of the call I had dealt with. No matter how big or small a control room is, a paediatric arrest call will change the mood in the room instantly and it’s quite an eerie feeling. I logged back on to await my next call and it wasn’t long before one came through.
As I answered the call the first thing I heard was a male voice shouting ‘I can see the head!’. Once again the call was from a mobile phone so I had to stop the caller from shouting whilst I confirmed address details with him. I then asked a couple of questions to establish the exact nature of call and I couldn’t believe what I was hearing – a female was in labour, felt the urge to push and the head was visible. A very different sense of urgency and emotion flowed through me and the adrenaline once again was pumping. I immediately launched into the delivery instructions and began relaying them to the caller who I must say was very calm and attentive to my every word. Whilst describing to the caller how to cradle the head as it presented I had a quick look on the mapping to see how far away the crew were, it wasn’t far but I knew that this delivery would be happening before their arrival! One of my colleagues was already on the phone to the maternity unit requesting a community midwife to attend the address. By this time the head was out and I had to remain in control of the caller who was on the verge of losing it, once again there was a lot of screaming from the poor female going through this excruciating labour with no pain relief! We were at the point now where I expected the baby to deliver fully with the next contraction so I informed the caller of this and ensured he was ready to ‘catch’! The screaming got louder, the contraction was starting and the caller was doing a brilliant job of reassuring the female and encouraging her through it. The caller confirmed that the baby was now completely out so I immediately noted this on the CAD so the dispatchers could inform the responding crew and the community midwife could be updated. Right now I knew I was about to experience another one of those moments where the whole world stops around you when you ask the question ‘is the baby breathing’. There was a pause of about 2 seconds before I heard the most amazing sound of a new-born cry for the first time. This was an incredible moment and will remain with me forever. I congratulated the caller and ensured the baby was wrapped up and passed to mum and at that point the doorbell rang and the crew had arrived. The caller returned to the phone after answering the door and thanked me before hanging up.
In a similar situation to my previous 999 call it suddenly went very quiet after the call ended but my emotions were so drastically different to 10-15 minutes earlier it was unbelievable. There was a ripple of applause from my fellow control room staff and my supervisor came over again, congratulated me and said something to me that I will never forget ‘that’s the way of the world, people come and people go. Is it your turn to make the tea?!’
Whilst in the kitchen all sorts of things were running through my head. After experiencing an extreme low just a few minutes earlier I was now on a massive high. A colleague of mine came into the kitchen and told me that the crew on scene had confirmed the safe arrival of a healthy baby girl. I know at this point (bearing in mind I was still fairly new) that I would be in this job for a long time.
Not all calls are as challenging or have the adrenaline rush as the two I have described but to receive these calls back to back was quite unimaginable. The majority of our calls are fairly routine and straightforward but then you’ll get one that reminds you why you do this job. The same can be said for operational ambulance crews who will go for days, weeks or even months dealing with non-injury falls, breathing difficulties, chest pains and minor road traffic collisions and will then receive a call which will test their skill, knowledge and training to its full potential.
That’s why we do what we do. We all joined with one aim which is to help people, so help people we shall.
For more insight into the day to day operations of an Ambulance Control room, follow @ambcontrol999 on Twitter
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