999 R.E.S.P.O.N.D. [emerRgEncy diSPatch decisiONs in coviD-19]

Ambulance services around the UK are made up of a variety of emergency care staff, with different skills and capabilities. In addition to the familiar front -line paramedic crewed ambulances, there are a smaller number of specialist teams with extra training, equipment and expertise in treating the very sickest patients.

In Wales, the Emergency Medical Retrieval & Transfer Service (EMRTS) Cymru works alongside the Welsh Ambulance Service. EMRTS provides senior hospital doctors (consultants), specialist paramedics and specialist nurses to treat people at the scene of serious accidents, or when they are taken critically ill. EMRTS can respond to the scene of an emergency by road in rapid response cars, or by air on board the Wales Air Ambulance helicopters.

There are over 385,000 “999” calls to the ambulance service per year in Wales, but only a relatively small number of these are so serious in nature that they require the advanced critical care skills of the EMRTS team. To help decide which calls to go to the service has two members of staff working in the Welsh ambulance control room looking at all the 999 calls that come in 24 hours a day. They can speak to callers, look at notes on the computer system and speak to ambulance crews and first responders that may already be with a patient.

They use this information to decide if they should send a critical care team to help.

It is important that the team is dispatched as quickly as possible to the most seriously ill patients.

However, as a small specialist team, it is also important that they are only sent to emergencies where they are needed. Getting the right information to make this decision in the heat of the moment can be very difficult.

We want to study the way in which the decision to dispatch a cri tical care team is made by the teams in the ambulance control rooms. We will closely study a number of recent cases where a critical care team was dispatched to an emergency. We will use the computer notes, listen to voice recordings of 999 calls, and study any other information that is available about the incident. We will use scientific methods that look in great detail at how members of the dispatch team work together under pressure to make a decision. This involves examining the words and phrases they use between one another, other ways they communicate, and how they make sense of the rapid flow of information from the 999 call.

Researchers have done this before for routine ambulance work, but we will be the first to look at this in the UK for the critical care teams. The process is normally a challenge; the COVID-19 pandemic and its aftermath added even more complexities in making these decisions. We will be looking at calls before and during the pandemic. We want to see if COVID-19 has changed the way tthat critical care teams respond to emergency cases. We will be looking at a selection of all 999 calls where a critical care team is sent to the scene. This includes people whose heart has stopped (cardiac arrest) or suffered a major trauma (e.g. a car accident).

We hope that we will be able to improve the process of getting critical care to the people who need it most. We will use our research to support training for new staff and ambulance staff that work alongside the service and to influence national policy.