Holidays are the busiest times of year for the Northern Ireland Ambulance Service (NIAS) Health and Social Care Trust, and 2017 was no exception.
Calls were rapid-fire at Emergency Ambulance Control (EAC) on the outskirts of south Belfast, Northern Ireland, U.K., with numbers reaching far beyond the average 2,000 calls per week. Ice, freezing fog, and snow gripped the country, demanding almost daily warnings for pedestrians and motorists to tread carefully on treated and untreated surfaces. Persistent freezing air from the North Pole was delivering the coldest winter since the bitter freeze of 2012–2013.
Compounding problems of high demand were resource issues. Northern Ireland’s health system is funded through the Department of Health, Social Services and Public Safety (DHSSPS) (patrons don’t pay directly for the services). Similar to other health trusts in the U.K., money allocated to the separate services, including ambulance, struggles to keep up with increased demand.
The pressures are particularly notable during the busy seasons.
During the holidays, NIAS EMDs and controllers juggling calls for every imaginable incident—traffic accidents, falls, breathing difficulties, and cardiac arrest—relied on a variety of voluntary and private ambulance services as well as their own crews and diverted ambulances and paramedics to meet shifting medical priorities.
March didn’t start off any easier. Blizzards and strong winds of Storm Emma and Beast from the East forced closure of 400 schools in Northern Ireland, and hundreds of people were stranded due to the treacherous and snowy conditions.
So, receiving the Team Award at the Ambulance Leadership Forum 2018 Conference was just the right antidote for lightening the stress of a profession that gets busier by the season. Just take a look at these statistics:
- In total, the NIAS answered 216,741 emergency calls between Jan. 1, 2017, and Dec. 31, 2017 (and another 600,000 non-emergency calls).
- The overall number of calls made to the NIAS continues to increase by thousands each year, with December—the busiest month—at two to three times higher volumes.
It doesn’t take numbers, however, to quantify the award.
“Something like this recognizes the hard work that has gone on before and every person who’s been part of it,” said EMD Ruth Leonard, who has been with NIAS since 1985 (and in 999 emergency communications for the past 29 years). “We earned it.”
It’s also a good thing that everyone gets along so well.
“We’re a close team,” said EMD Sarah Brunton. “You never feel alone when you’re taking calls. You know that when you need help, everyone in that room will come to you.”
EMD Emma Campbell described the camaraderie as a situational awareness that develops from answering emergency calls, gathering the information and, maybe more importantly, listening closely to what the caller might and might not be saying. The ability to be aware of what’s happening in a non-visual situation transfers to the environment inside the EAC.
“We’re always looking out for other people; that’s our job, and the same applies in the control room,” Campbell said. “We encourage one another. We are aware about what’s going on in the room. We are aware when it’s time to take a breather.”
Leonard emphasizes “the team” recognition, which includes every one of the 60 employees who keep the EAC humming. This includes the EMDs, controllers (who dispatch ambulances to patients divided into three regions), IT, and management in the EAC. Everyone shares in the significance behind the certificate and trophy presented in March at the Ambulance Leadership Forum, held in Chesford Grange, Warwickshire, U.K. The Association of Ambulance Chief Executives sponsors the forum and awardees are selected from nominations the U.K.’s 14 ambulance trusts submit. Sixteen awards were presented at the 2018 conference.
This isn’t the NIAS’s first recognition for exemplary 999 service. Five NIAS EMDs were nominated for the Dispatcher of the Year (DOY) award at Ireland NAVIGATOR 2017. All five EMDs made the DOY shortlist and the eventual recipient was Kelly McKee from NIAS.
The EAC became an IAED™ medical ACE in February 2017.
What else is there?
NIAS is the country’s emergency communication hub created from consolidating several smaller centers. The consequent increase in call volume and staff size is indicative of communication’s evolution, which Leonard has seen during her long career. Prior to the implementation of the Medical Priority Dispatch System™ (MPDS®) in 2004, pre-hospital response was left to EMTs and paramedics. Control room staff had little to offer callers, except words of encouragement after gathering limited location and incident type information.
“There was nothing we could do even if people asked us to tell them what to do,” Leonard said. “We always wanted to do something more for our callers and we couldn’t. MPDS changed all that.”
Leonard recalls her first use of Post-Dispatch Instructions to provide safety precautions to bystanders at the scene of a traffic accident.
“It was straightforward,” she said. “I told them to stand well clear of approaching traffic. But we couldn’t even do that much before MPDS.”
Since then, there isn’t a Medical Protocol she hasn’t used and, to top that off, she still looks forward to her time at the EAC.
“I love my job,” she said. “It’s as simple as that.”
The same goes for Brunton and Campbell.
Three years ago, Brunton determined working in hospital administration wasn’t enough.
“I wanted to do more to help people,” she said.
She saw a “Working For Us” ad for the EAC and, after reading more about the position, decided to give it a go. She admits the job can be tough but, at the same time, finds the rewards in a profession that makes her feel good about what she does at the end of the day.
Campbell wanted to jump into something completely different from her administrative job, with the caveat of helping others.
“I can’t imagine doing anything else,” said Campbell, who is in her fourth year at NIAS. “I hope to have at least another two decades in me.”
NIAS responds to the pre-hospital needs of 1.8 million people in an operational area covering 5,450 square miles.
Approximately 100 people work in two control rooms in Belfast and Londonderry. The Regional Emergency Medical Dispatch Centre (REMDC) at Ambulance Headquarters (Belfast) employs 60 people who handle 999 calls and Doctor Urgent Requests. The Regional Non-Emergency Medical Dispatch Centre (RNEMDC) in Londonderry deals with non-emergency patient transportation issues including taking patients to outpatient appointments throughout hospitals in Northern Ireland.
In addition, the NIAS EAC recently introduced a secondary triage system, staffed by general practitioners who diagnose and refer patients to more appropriate health services based on their complaint (such as the patient’s general practitioner or other community support programs). In 2016, nearly 24 percent of 999 calls did not require ambulance services with paramedics referring patients to general practitioners, falls teams, and diabetes services.1 The program is transitioning to a paramedic Clinical Support Desk (CSD).
NIAS has a fleet of 313 ambulances (supplemented by private and volunteer services during projected periods of heavier demand). In 2016 NIAS partnered with the charitable Air Ambulance in Northern Ireland to provide a Helicopter Emergency Medical Service (HEMS). The national trust does not cover flight ambulances. NIAS provides dispatch and the medical team, while Air Ambulance provides the aircraft and airbase.
1 “Annual Report for year ended 31 March 2017.” Northern Ireland Ambulance Health and Social Care Trust. 2017; June. http://www.nias.hscni.net/download/public/Corporate/Reports/Annual%20Reports/NIAS-Annual-Report-and-Accounts-2016-17.pdf (accessed March 27, 2018).