The Talking Point #23: Are ambulances stuck on a red light?

(Title Image: via Youtube)

In 2015, a new ambulance 999 call category system was introduced following a pilot across Wales. The system was developed after a review of ambulance services and concerns over poor response times.

999 calls are placed into three categories in the system, which was designed by clinicians:

  • Red – Life-threatening emergencies where someone is in “immediate danger of death”. This includes patients who’ve stopped breathing, choked, gone into cardiac arrest or are in septic shock etc. The all-Wales target is for 65% of Red calls to be responded to by ambulance within 8 minutes.
  • Amber – Defined as serious, but not life-threatening, emergency calls that require an ambulance/paramedics to attend and transport to a hospital. Patients are prioritised based on clinical need and this category includes strokes, falls, fractures and chest pain (including heart attacks where a patient is still conscious). There’s no response time target for Amber calls, but performance is judged based on “clinical outcomes”.
  • Green – Non-urgent or less serious calls that don’t require an ambulance or can be managed by other health professionals. This includes transferring patients from, for example, a GP surgery to hospital.

So far, it’s been a qualified success. In 2016-17, 76.3% of the 20,286 Red calls received by the Wales Ambulance Trust were responded to within 8 minutes (target 65%). In January 2018, every single health board met the target despite the national average falling to 69.7%.

The most common call category is, however, Amber. In January 2018, the Ambulance Service received 22,932 Amber calls (compared to 2,187 Red) and almost half of those calls (49.7%) were responded to in 30 minutes or more.

Some extreme examples have been raised inside and outside the Senedd chamber. Stroke patients and elderly people who’ve fallen have been said to have waited up to 10 hours or more for an ambulance, and there have been cited examples of 20-hour waits.

AFAIK, unless your heart has stopped completely during a heart attack, then you can endure a moderate delay in receiving treatment; similarly, there’s a window of 2-3 hours to treat strokes and, while falls amongst the elderly will often cause severe pain and discomfort, it’s not always a life-threatening emergency unless they’ve done a serious injury to themselves.

If you had a limited number of ambulances (because of delays in transferring patients to A&E departments, for example), you would want as many as possible to be available to respond to Red calls and other major incidents like car accidents.

Clinically, the system is justified – but clinical/expert evidence will only go so far in shaping public opinion (pointing back to what I’ve said recently about populism and technocrats).

People will rightly ask: What damage can be done during those waits? Even a “minor” heart attack causes long-term damage. If any of us saw a relative or friend suffer a heart attack, fall or stroke, we would want paramedics there immediately, not in several hours. It’s a natural reaction.

Would leaving a response to an Amber call too long lead to it eventually becoming a Red call? For example, an elderly person falling in the street on a cold day is going to be in worse shape than someone who falls during the summer? Are these sorts of factors taken into account when categorising calls?

I don’t think these concerns should be as easily brushed aside as they have been simply because the response time performance for the most urgent calls has undoubtedly improved.

When the call category system is inevitably reviewed in the future, there’s going to be a strong argument to introduce time targets for Amber calls. That doesn’t need to be a requirement for an ambulance to be on the scene within X minutes; it could, for example, set a target percentage for the number of patients admitted to hospital or seen by a paramedic within (for argument’s sake) 3 hours of a 999 call being received.

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