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New 999 ambulance priorities piloted

South Western Ambulance VX09FYP

A new response system for 999 calls is to be piloted by the Scottish Ambulance Service.

It will mean changes to the way calls are prioritised to concentrate on “immediately life-threatening” cases.

The ambulance service has struggled to meet its target to respond to 75% of category A calls within eight minutes.

Under the new system, some call-outs, including certain types of chest pains or head injuries, will be downgraded.

This will give ambulance crews longer to attend.

Right response

The ambulance service said the changes would mean highly-trained call handlers targeting the right response for each patient.

The new system will start at the end of this year and be reviewed after a year.

Patients with immediately life-threatening conditions, such as cardiac arrest, or who have been involved in serious road traffic incidents, will be prioritised and receive the fastest response.

In less urgent cases, call handlers may spend more time with patients to better understand their health needs and ensure they send the most appropriate resource for their condition.

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New response categories

-Immediately life-threatening calls, such as cardiac arrest, where someone is in imminent danger of death

-Calls where a patient needs a fast response and transfer to a healthcare facility for treatment. These cases will be prioritised on the basis of clinical need and will receive a blue light response but there will be no time target

-Calls which can be managed safely at home or by referral to the most appropriate care, such as GPs, NHS 24, or Social Care Services

The move follows similar changes in Wales and parts of England which have proved to be highly successful – leading to faster response times for critically-ill patients.

The Scottish Ambulance Service said the new response model had been developed following the most extensive clinically-evidenced review of its type ever undertaken in the UK – with nearly half a million calls examined.

It is the first major change to the time-based targets system since 1974.

Medical advances

Pauline Howie, the service’s chief executive, said: “The new model will allow us to respond faster to more patients with time-critical, immediately life-threatening conditions. In other situations, we will safely and more effectively identify and send the right resource first time for patients, resulting in better overall clinical outcomes.

“The focus on time-based targets for ambulance responses has changed little in around 40 years and does not take account of the advances made in clinical development of pre-hospital care.”

Scotland’s Chief Medical Officer, Dr Catherine Calderwood, said: “The Scottish Ambulance Service has undertaken a rigorous review of its clinical data, involving a full year of actual patient outcome data being analysed.

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“What the analysis showed was that the current coding system does not always accurately identify some patients’ conditions as immediately life-threatening. And that other codes were getting an eight-minute response, although the patient’s condition had no time-critical response requirement.

“I am persuaded by the extensive clinical evidence that the Scottish Ambulance Service has put forward and know that patient safety is at the heart of these changes.”

‘Pragmatic target’

She added: “We will keep this pilot under close review over the next 12 months to ensure that we are seeing the improvements to patient safety and patient outcomes that are expected.”

Dr Mike Knapton, associate medical director at the British Heart Foundation, said: “I am pleased that this new clinical response model is based on evidence, unlike the eight-minute standard response time which was a pragmatic target set in 1974.

“The quality of patient care, before a person even reaches hospital, has improved dramatically over the years and we understand that today’s operational practices should evolve to reflect that.

“In the event of a cardiac arrest, time is critical and the best way to get professional help is to call 999 without delay. I’ll look forward to seeing the results of this pilot to ensure that heart patients continue to receive timely and quality care.”

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