ABSTRACT

Introduction: Most United Kingdom (UK) ambulance services undertake remote clinical consultation of 999 emergency calls, often using computerised decision support systems, such as the Emergency Communication Nurse System (ECNS). In 2021 the Welsh Ambulance Services NHS Trust implemented ECNS in a novel way. Both nurses and paramedics used the tool to assess the full range of Advanced Medical Priority Dispatch System (AMPDS) codes and acuities. This study reports the ECNS outcomes of the full range of AMPDS codes, aiming to inform future discussion, protocol evolution, and clinical models internationally.

Methods: Anonymised patient data was exported from the WAST system for all completed calls between the 17^th May 2022 to 8^th November 2022. A total of 21,076 clinical cases were included for review and the data was descriptively analysed.

Results: 2% of cases were categorised as OMEGA, 16% as ALPHA, 20% as BRAVO, 22% as CHARLIE, and 40% as DELTA cases. 59% of the 21,076 cases were sent a vehicular response, 20% were referred advised to make their way to the Emergency Department (ED), and 21% were advised to seek other support. Falls, sick persons, stroke and chest pain calls featured heavily in both calls assessed and vehicular responses sent. Most Psychiatric calls, however, were managed with no vehicular response or onward referral to an ED, with high levels of alternative dispositions also seen in unconscious fainting calls.

Conclusion: The highest acuity coded calls received the highest priority vehicular response most often. A positive and diverse range of outcomes were however reached through secondary clinical consultation of the full range of AMPDS codes. Whilst a HOT response is likely the best predictor of a higher acuity patient, receiving a vehicular response in of itself is not a strong predictor of acuity (such as low acuity falls case). Further research is required to understand better characteristics of patient presentation leading to alternative responses, and the authors welcome opportunities for linked data studies to achieve this.

 

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