Ambulance service to put serious cases first

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A new ambulance priority response system, designed to save more than 3,200 lives a year, was introduced on a pilot basis by four ambulance services yesterday.

Instead of sending out ambulances on a "first come, first served" basis - the usual practice for more than 20 years - ambulance control centres in these areas have started prioritising calls. The aim is to reduce the response time for urgent calls to eight minutes.

Trained operators ask callers structured questions to identify the most serious cases. Patients suffering from heart attacks, severe breathing difficulties, uncontrollable bleeding and other life-threatening conditions, will get immediate attention.

Four ambulance services - from Berkshire, Derbyshire, Essex and West Midlands - are pioneering the new method and all other services are expected to introduce the new system by October.

Gron Roberts, Chief Executive of the Essex Ambulance Service NHS Trust, said: 'Saving time at the right time will save more lives. Saving vital minutes by attending life-threatening emergencies immediately, could save around 100 lives each year in Essex for cardiac arrests alone."

The new system is being introduced following a number of well-publicised cases in the mid-1990s, in which ambulances failed to appear quickly enough to prevent the patient dying.

Under the Patient's Charter standards in operation then, 95 per cent of calls were meant to be answered within 14 minutes in urban areas and 19 minutes in rural areas.

In one case which hit the headlines, a member of the public who phoned for an ambulance because his father was suffering a cardiac arrest, found himself talking to an answering machine.

The Department of Health set up an advisory committee under senior civil servant Robin Chapman to devise a new system. Other experts included Dr Douglas Chamberlain, consultant cardiologist from Brighton and Dr Tom Clarke, consultant anaesthetist from Newcastle-upon-Tyne.

The committee reported two years ago, in 1995, saying that more clinically relevant standards were necessary and recommending the changes now being implemented.

The new system, known as Criteria Based Dispatch, also enables the control assistant to give pre-arrival medical advice over the phone before the ambulance arrives.

This factor alone has already saved lives in Essex, where it has been piloted for the last three years.

Medical experts felt that a new system was vital to take advantage of the advanced training now undertaken by am- bulance crews and the elaborate equipment ambulances now carry, which make a considerable difference to the patient's survival.

Research shows that early treatment with a defibrillator - a device that delivers an electric shock to heart attack patients to restore the normal rhythm of the heart - is by far the most important factor in survival rates.

The new Patient's Charter Standard promises that three out of four immediately life-threatening calls will have an ambulance response within eight minutes by the end of 2,000. The ultimate aim is to achieve 90 per cent.

The Essex Ambulance Service first introduced the criteria-based dispatch system three years ago, after its chief executive, Gron Roberts, went on a fact-finding mission to the US. He saw the system in operation in the King County Emergency Medical Services in Seattle, Washington.

It has subsequently been assessed by Sheffield University's Medical Research Unit, which has found it to be safe and reliable.