Standard Operational Guidelines Title: HEOC SOG SOG Reference: 1.0 Version Number: 1.0 Owner: Head of HEOCs Approved: 1 st Operational From: 1 st Last Updated: 1 st Next Review Date: July 2014 Applicable to: Distribution: Health & Emergency Operations Centre staff Operational frontline staff Any other on duty response resource All staff via internal media, email and special bulletin Equality Impact Assessment The East of England Ambulance Service NHS Trust has made every effort to ensure this policy does not have the effect of discriminating, directly or indirectly, against employees, patients, contractors or visitors on the grounds of race, colour, age, nationality, ethnic (or national) origin, gender, sexual orientation, marital status, religious belief or disability. This policy will apply equally to full and part time employees. All East of England Ambulance Service NHS Trust policies can be provided in large print or Braille formats if requested, and language line interpreter services are available to individuals who require them.
Contents Section Page 1 Introduction 7 2 Purpose 8 3 Duties 8 3.1 Duties within the organisation 8 4 Definitions 9-13 5 General HEOC Procedures 14-18 5.1 Shift start 15 5.2 Conduct 15 5.3 Escalation 16 5.4 Release of Information 16 5.5 Vulnerable Children and Adults 17 6 Call Handling Procedures 18-59 6.1 General Rules for Call Handling 19 6.2 Support from Call Handler Team Leader 19 6.3 Call Answer 20 6.4 Address Verification 20 6.5 Call Back Number Verification 22 6.6 Calls Requiring Assistance of Other Emergency Agencies 23 6.7 Calls Received from Other Emergency Agencies (SEND) Protocol 24 6.8 Emergency Calls Received from Other Ambulance Trusts 25 6.9 Exchanging Times with Other Ambulance Trusts 25 6.10 Emergency Calls Received Located Outside Trust Geographical 26 Boundaries 6.11 Calls from NHS Direct 27 6.12 Call Handler Responsibilities for Protocol 35 HCP Admission Requests 27 (Card 35) 6.13 Card 35 Urgent Welfare Calls Call Handler Responsibilities 29 6.14 Psychiatric Upgrades 30 6.15 Calls Triaged Through NHS Pathways (Including Luton 111 Service) 30 6.16 Protocol 37 Interfacility (Hospital) Transfer (Norwich HEOC Only) 31 6.17 G3/G4 PSIAM Procedure 33 6.18 Early Identification and Escalation of Potential Risk 35 6.19 Abandoned Call No Location Operator Passing 36 6.20 Abandoned Call With Location Operator Passing 36 6.21 Abandoned Call Part Way Through Call Response Not Yet on 37 Scene 6.22 Abandoned Call Response May Have Arrived on Scene 37 6.23 Voicemail Messages for Silent or Abandoned Calls 38 EEAST HEOC SOG_V1.0 Page 2 of 143
6.24 Misrouted and Inappropriate Calls 38 6.25 Hoax Calls 39 6.26 Silent calls with no CLI or EISEC information 39 6.27 Voice over Internet Protocol (VOIP) calls 40 6.28 Emergency Roamer Calls 40 6.29 Use of FIRST Call Sign 41 6.30 Request to Cancel 999 Events 43 6.31 Urgent Disconnect (EXIT4) 44 6.32 Providing Dispatch Life Support (DLS) to 3rd Party Callers 46 6.33 ProQA Override Function 47 6.34 ProQA Shift Function 50 6.35 Language Barriers and Language Line 53 6.36 Emergency Short Message Service (e-sms) for the Deaf and Hard of 54 Hearing 6.37 AMPDS Surveillance Tool 55 6.38 Pandemic Flu (Card 36) 55 6.39 Aircraft Incidents at London Luton and London Stansted Airports 56 6.40 CBRN and HAZMAT Incidents 57 6.41 Bomb Threat or Terrorist Action 58 6.42 Major Incidents 58 6.43 Call Handling and REAP Levels 59 7 Dispatch Procedures 60-102 7.1 General Rules for Dispatching 61 7.2 Pre-Alert Events 62 7.3 Regional Data Mobilisation/Activation System 63 7.4 Resource Allocation and Dispatch Deployment & Back up to Rapid Response Vehicles (RRVs) 64 7.5 Request for Backup Process 67 7.6 Mobilisation 70 7.7 General Broadcasts 71 7.8 Dispatchers Responsibilities for Scene Safety 72 7.9 Event Monitoring 72 7.10 G1 G4 Events 73 7.11 Reprioritisation of Emergency Events 73 7.12 Dynamic Deployment of Resources and System Status Plan 75 (SSP/SSM) 7.13 Running Calls 79 7.14 Hospital Transfer Procedure (Card 35) 79 7.15 Dispatch Assign 80 7.16 Dispatch Responsibilities for Card 35 HCP Admissions 82 7.17 Upgrading of Events on I/CAD 83 7.18 Dispatch Responsibilities for Unassigned Incidents 84 7.19 Setting Up of Trust Officers on I/CAD 85 7.20 Community First Responders 87 7.21 HEOC and Operational Staff Meal Breaks 88 7.22 Deployment of Emergency Care Assistant (ECA) Crews 88 7.23 Trust Vehicles/Staff involved directly in a Road Traffic Collision (RTC) 89 EEAST HEOC SOG_V1.0 Page 3 of 143
7.24 Hospital Turnaround, Delays and Escalation 89 7.25 Abandoned Calls 90 7.26 Cross Border Incidents 91 7.27 Mutual Assistance for Near Boundary Incidents 92 7.28 Out of Area Emergency Events 92 7.29 Duplicate Events on I/CAD 93 7.30 Manual Time Entry 94 7.31 Use of Closure Codes Within I/CAD 95 7.32 Not Initial Call (NIC) 96 7.33 Bariatric Patients 96 7.34 Special Situations (SS) 97 7.35 Deceased Patients and Do Not Attempt Resuscitation 97 (DNAR)/Preferred Place of Care Orders 7.36 Cardiac Arrest/Death in Patients Under 18 Years of Age 98 7.37 Special Care Baby Unit Transfers (SCBU) 98 7.38 Critical Care Transfers 98 7.39 PAS/VAS/NES Resources 98 7.40 Operational End of Shift Management 99 7.41 Aircraft Incidents at London Luton and London Stansted Airports 99 7.42 CBRN/HAZMAT Incidents (Including Chemical Suicides ) 101 7.43 Bomb Threat or Terrorist Action 101 7.44 Major Incidents 102 7.45 Dispatching and REAP Levels 102 8 Enhanced Clinical Triage (ECT) Procedures 103-111 8.1 Aim 104 8.2 Background 104 8.3 ECT Call Monitoring and Telephony Procedure 105 8.4 Monitoring Events in I/CAD 106 8.5 Monitoring Events in ProQA 107 8.6 ECT Interception of Calls 108 8.7 Completion of ECT Process 108 8.8 Referral to Clinical Support Desk 110 9 HEOC Shift Management 112-134 9.1 Introduction 113 9.2 General Rules for Shift Management 113 9.3 Shift Start 114 9.4 Duty Manager Cover in HEOC 115 9.5 Performance Delivery, Monitoring and Reporting 115 9.6 FIRST Response on Scene 116 9.7 Duplicate Calls 117 9.8 Abandoned Calls 117 9.9 Hoax Calls 117 9.10 Request to Cancel 999 events 117 9.11 Out of Area, Cross Border and Near Border Events 118 9.12 Dynamic Deployment and Allocation Across Trust Sectors 118 EEAST HEOC SOG_V1.0 Page 4 of 143
9.13 HEOC Duty Manager Responsibility and Accountability for Card 35 118 Urgent Admissions 9.14 Clinical Coordinator Responsibility and Accountability for 119 Card 35 Urgent Requests 9.15 Card 35 Four Hour Pick Ups 119 9.16 HEOC Duty Manager and Clinical Coordinator Responsibilities for 120 Unassigned Events or Delayed Response 9.17 Difficulty Verifying a Location/Locating a Patient/No Trace 121 9.18 Resourcing of Non Urgent Events 122 9.19 PAS/VAS/NES Resources 123 9.20 Data Validation and Accuracy 123 9.21 Manual Time Entries 123 9.22 HEOC Staff Shortages and Shift Cover 123 9.23 Shift and Line Management of HEOC Staff 124 9.24 Operational Rest Periods 124 9.25 Management of Operational Staff 125 9.26 Assaults, Serious Injury or Death of Trust Staff On Duty 125 9.27 Trust Vehicles/ Staff involved directly in an RTC 126 9.28 Special Situations and Temporary Warnings 126 9.29 Operational Non-Staff Issues 127 9.30 Liaising with other NHS Trusts and HCPs 127 9.31 Release of Information 128 9.32 Press Interest 129 9.33 Positive Feedback and Complaints 129 9.34 Risk Management 129 9.35 Vulnerable Children and Adults 130 9.36 Deaths in Patients under 18 years of Age 130 9.37 IT and Estates Issues 131 9.38 Urgent Disconnect (EXIT4) 131 9.39 I/CAD, ICCS and Telephone Systems Failure 131 9.40 Fire Procedure and Evacuation 132 9.41 Dynamic Escalation and On Call 132 9.42 HEOC Management and REAP 133 9.43 Digital Radio Fault Reporting 133 9.44 ICCS Talkgroup Monitoring 133 9.45 Extraordinary Incidents or Those Requiring a Specialist Response 133 (Including Bomb Threats, Notification of Terrorist Action, CBRN/HAZMAT incidents) 9.46 Major Incidents 134 10 Equality Impact Assessment 135 11 Process for Monitoring Compliance and Effectiveness 135 12 Standards/Ambulance Quality Indicators 136 13 References 136 EEAST HEOC SOG_V1.0 Page 5 of 143
Appendices Appendix A Appendix B Appendix C Appendix D Appendix E Appendix F Appendix G Appendix H Appendix I Appendix J Appendix K Appendix L Appendix M Appendix N Appendix O Appendix P HEOC Demand Management Plan Resource Escalation and Management Plan (REAP) Card 35 Flowchart Language Line Bomb Threat or Terrorist Action Major Incident Plan Major Incident Action Cards Major Incident Cascade Procedure Initiation of Emergency Panic Button Card 35 Hospital Transfer Procedure Community First Responders ECA Deployment Guidelines, Scope of Practice Critical Care Desk Procedures Clinical Support Desk Procedures HEOC Specific Control Instructions Business Continuity Plans EEAST HEOC SOG_V1.0 Page 6 of 143
1 Introduction The Health and Emergency Operations Centres (HEOCs) are the first point of contact for members of the public and Health Care Professionals (HCPs) from across the community to request an emergency or time-critical response from the ambulance service. The HEOCs provide a service which effectively manages incoming calls and coordinates an appropriate response to each request. Those responses include telephone advice and the deployment and allocation of operational ambulances, a range of responders and specialist teams. For those callers who would benefit from a nonambulance response to their request, the HEOC will refer their request to the most appropriate service. All HEOC staff contribute to the delivery of a high standard of appropriate care, to meeting performance targets and to supporting the Trust s vision: To be the recognised leader in emergency, urgent and out-ofhospital care in the East of England. All members of HEOC staff must work as a team within the department and also with operational colleagues, other HEOCs and other members of the health care team to provide the most appropriate care for the patient, in the most appropriate place, at the most appropriate time, by the most appropriate service. These procedures relate to all staff operating in any role within the HEOCs for all or any part of a shift and it is the responsibility of all to thoroughly familiarise themselves with all the sections that are relevant to their role. Any staff member involved in Call Handling has been referred to as a Call Handler regardless of their job title and, similarly, all those involved in Dispatching have been referred to as a Dispatcher. Where there are differences in role for specific procedures (e.g. Call Handler and Call Handler Team Leader) these have been included separately. These documents have been written in conjunction with the defined principles, practices and standards of care which the International Academy of Emergency Medical Dispatch (IAEMD) has set for the practitioners of Emergency Medical Dispatch (EMD). They are supplemented by Trust Standard Operating Procedures (SOPs) and HEOC Training notices. All legacy HEOC procedures, protocols or guidelines previously produced by any part of the Trust are replaced by these HEOC guidelines. These procedures are live documents and will be updated with appropriate changes required to keep them current with Trust requirements. EEAST HEOC SOG_V1.0 Page 7 of 143
2 Purpose This document provides details of the procedures for all staff employed within the Trust s three Health and Emergency Operations Centres (HEOCs) at Bedford, Chelmsford & Norwich in order to produce a regional standard. 3 Duties It will be the responsibility of all staff employed within the HEOCs to follow the processes outlined in these guidelines. 3.1 Duties within the Organisation The Head of HEOCs is responsible for the implementation of these guidelines and delegates this responsibility to the General Manager HEOCs. The General Manager HEOCs has the responsibility for monitoring adherence to these guidelines. These guidelines will be assessed by the Information Governance Group to ensure that they meet all external requirements where applicable and to give the Trust Board assurance of the processes undertaken. The KA34 and HEOC Processes Review Groups are responsible for monitoring all audits and information generated by the HEOCs. EEAST HEOC SOG_V1.0 Page 8 of 143
4 Definitions Term Definition Description A8 A19 A&E AQI Airwave ALSEC (A)MPDS BASICs Bronze Category A 8 Minute Response Time Category A 19 Minute Transportation Time Accident and Emergency Ambulance Quality Indicator Communications Company Automatic Location Service for Emergency Call (Advanced) Medical Priority Dispatch System British Association of Immediate Care Service Operational Level Category A incidents: presenting conditions, which may be immediately life threatening and should receive an emergency response within 8 minutes irrespective of location in 75% of cases. Category A incidents: presenting conditions, which may be immediately life threatening and should receive an ambulance response at the scene within 19 minutes irrespective of location in 95% of cases. Dependent on context. Used to define front line responses and operations. Indicators based on patient clinical experience and outcome. Delivers critical communications solutions to Emergency Services. Ability for Emergency Authorities to receive electronic transfer of data from Cable and Wireless Emergency Service Data Base holding location information. Typically Caller details (name, address, telephone no.) 999 call handling and triage system. Pre-Hospital Immediate Care practitioners trained in advanced clinical patient interventions. Typically refers to an Operational (DOM) level of responsibility. BT British Telecom Communications provider. CA Clinical Advisor Clinical Support Desk clinician usually ECP or Nurse. Card 35 MPDS Protocol for processing Health Care Professional Admission requests See left Cat A Category A call A potentially life threatening emergency event Cat C Category C call A non-life threatening event CBRN Chemical, Biological, Radiological or Nuclear incident See left EEAST HEOC SOG_V1.0 Page 9 of 143
CCD CCP CFR CH Chief Complaint CHTL CI CLI CSD CSOP Critical Care Desk Critical Care Paramedics Community First Responder Call Handler See left Call Handler Team Leader Control Instruction Call Line Identification Clinical Support Desk Clinical Standard Operating Procedure Regional Centre for dispatching of Air Ambulances, Medical Teams and other specialist resources eg. HART. Paramedics trained in more advanced clinical interventions or to assist Medical Practitioners. Volunteer who responds from home to emergency calls of a set criteria. Staff member receiving an emergency or urgent request for assistance. Call that has had a protocol selected but not finished coding e.g. Fall Team leader for Call Handlers on shift. Specific instruction to be used in specific situations. Tells the recipient of a telephone call the number at the other end of the line. Clinical advisors who secondary triage low acuity calls. Procedure for clinical situations. DNAR Do Not Attempt Resuscitation Advanced directive indicating no attempts at resuscitation to be made. DOM/COM Duty Operations Manager/Clinical Operations Manager Manager working in operations responsible for group of operational staff. DSA Double Staffed Ambulance Two person crew manning an ambulance. DTL Dispatch Team Leader Team Leader for HEOC Dispatchers. ECA Emergency Care Assistant Operational staff trained to assist and work alongside more clinically qualified personnel. ECC ECP ECT EEAST Event Closure Code Emergency Care Practitioner Enhanced Clinical Triage East of England Ambulance Service Trust Code used in I/CAD for closure of events. Typically a paramedic or nurse with enhanced patient assessment and treatment skills. Process by which a Trust Clinician based in HEOC will intercept an emergency call to ascertain further clinical information and provide clinical support. The Trust EEAST HEOC SOG_V1.0 Page 10 of 143
EISEC Enhanced Information Service for Emergency Calls Ability for Emergency Authorities to receive electronic transfer of data from BT s Emergency Service Database holding location information. Typically Caller details (name, address, telephone no.) EMD Emergency Medical Dispatch Call Handling/Handler EMT Emergency Medical Technician Highly trained front line emergency responder. e-sms Service for people who cannot make Emergency Short Messaging voice calls because they have Service hearing loss or speech impairment. ESR/PIN Electronic Staff Record/Personal Used for logging staff onto vehicles, Identification Number I/CAD, etc. ETA Estimated Time of Arrival See left. EXIT4 Urgent Disconnect Call Handling rule to be invoked when 999 calls are waiting to be answered and no Call Handlers are available. FIRST First Response on scene Somebody with a defibrillator who is trained and prepared to use it if necessary e.g. HCP, first aider etc. GM General Manager Senior Manager responsible for a particular Operational Sector or area. Gold Strategic Level Typically refers to a Very Senior Manager level of responsibility. GP General Practitioner Community Doctor HART/USAR Hazardous Area Response Teams/Urban Search And Rescue HAZMAT/HAZCHEM Hazardous Materials/Chemicals Specialist trained teams to provide medical care in restricted environments e.g. fires, building collapses, CBRN incidents etc. See left. HCP Health Care Professional Nurse, GP, midwife etc. HDU High Dependency Units See ITV/Urgent. HEMS Helicopter Emergency Medical Services Air ambulance missions. HEOC Health and Emergency Central Co-ordination Centre for Operations Centre locality call handling and dispatch. I/CAD Computer Aided Dispatch System used for processing all calls received in HEOC and coordinating resources. ICCS Integrated Communications Digital radio and telephony system Control System used across the Trust. IHCD D1/D2 Institute of Healthcare Driving Standards required to drive Development Driver Training Emergency Ambulances. Awards EEAST HEOC SOG_V1.0 Page 11 of 143
I-Recommend See left System used in I/CAD to recommend closest resource to an event. ITV Intermediate Tier Vehicle Known as Urgent or HDU vehicles non front line ambulance used for Urgent journeys. KA34 KA34 Ambulance Services Data Set (KA34) providing performance management measures of response times. MDT Mobile Data Terminal Equipment in a vehicle capable of receiving call location and details. MEOC Mobile Emergency Operations Mobile HEOC that can be deployed Centre to incidents as an on-site Control NHSD NHS Direct Health advice and information service. NIC Not Initial Call Specific SRC used for closure of events where the event was received and passed by another Ambulance Trust. NSC Norfolk, Suffolk and Cambridge Regional locality. PAI Pre Arrival Instructions Specific medical instructions provided to the caller to assist the patient until the arrival of the ambulance e.g. CPR. PALS Provides information about the Trust Patient Advice and Liaison to patients, relatives, carers and Service friends. PAS/VAS PDIs Private Ambulance Service/Voluntary Aid Societies Post-Dispatch Instructions Independent services commissioned to assist the Trust with patient journeys. Instructions provided to guide the caller through the steps necessary to assist the patient until the arrival of the ambulance. PDR Personal Development Review Annual staff appraisal. PRC Primary Result Code Primary code used in I/CAD for closure of events. Pre-Alert See left Call that has no information other than location (i.e. no chief complaint) that is in process of being triaged. Automated tool to assist a Call ProQA Emergency Medical Dispatcher Handler with collecting information software from a caller and choosing an appropriate dispatch level. PSiam Priority Solutions triage software Secondary triage software used by Clinical Advisors that interlinks with I/CAD. EEAST HEOC SOG_V1.0 Page 12 of 143
QSAP Qualified Student Ambulance Paramedic See EMT REAP Resource Escalation Action Plan A framework to ensure emergency preparedness and business continuity management. ROI Release of Information Any information given out to an individual or organization for whatever reason. RRV Rapid Response Vehicle Typically a car dispatched as an immediate response to all calls prior to full coding. RTC Road Traffic Collision Typically an event involving vehicle vs. vehicle, vehicle vs. pedestrian, etc. RVP Rendezvous Point Agreed location for resources to meet. SAP Student Ambulance Paramedic A trainee QSAP/EMT who has not yet completed qualifying period of training on the job SEND Dispatch procedure followed when Secondary Emergency taking calls from other emergency Notification of Dispatch services. Silver Tactical Level Typically refers to a Senior Manager level of responsibility. Solo Single member of staff Typically clinician on an RRV or SSA. SOG Standard Operating Guidelines Guidelines for specific situations. SOP Standard Operating Procedure Standard course of action to follow. SRC Secondary Result Code Secondary code used in I/CAD for closure of events. SS Special Situation Information stored on I/CAD indicating safety or treatment issues at a location. SSA Single Staffed Ambulance Single staff member responding on an ambulance that would normally be double staffed. STSR Script read by Call Handlers to Secondary Triage Submission callers whose calls have been triaged Request as low acuity. Urgent HCP call (See Card 35) An event requested by a HCP with a specified time frame. VOIP Voice Over Internet Protocol Method of making telephone calls over internet e.g. Skype EEAST HEOC SOG_V1.0 Page 13 of 143
SECTION 5 GENERAL HEOC PROCEDURES EEAST HEOC SOG_V1.0 Page 14 of 143
5 General Procedures for All HEOC Staff 5.1 Shift Start 5.1.1 All staff must sign in at the commencement of the shift and must inform the HEOC Duty Manager if they leave the building at any time during their shift. 5.1.2 Dispatching staff should familiarise themselves with the resources on duty in the area for which they are primarily responsible including those which are shortly expected to start and end their shift. All units are checked to confirm their status and location are correct on I/CAD. 5.1.3 All staff must be at their work stations and ready to start work at the commencement time of their shift. 5.1.4 All HEOC Staff at the commencement of their shift must log onto (where applicable) Symposium, ICCS and I/CAD and any other systems required to fulfil their role for that shift. 5.1.5 At the start of their shift, Call Handling and Dispatching staff will organise their breaks for the shift with their respective Team Leaders. The HEOC Duty Manager will oversee these arrangements and will be responsible for those in roles that do not report directly to a Team leader. 5.2 Conduct 5.2.1 Work stations are to be kept clean and tidy at all times and should be handed over to the next user in this condition. 5.2.2 No personal electronic equipment, including mobile phones, games consoles and music players are permitted to be used within the HEOC by any member of staff. At the discretion of the HEOC Duty Manager, appropriate non workrelated material can be read by staff between the hours of 2300 and 0700 if there are no tasks outstanding and their role does not require them to monitor their screens. All reading material must be closed and put to one side when the staff member is engaged in a task. 5.2.3 HEOC staff should not shout across the HEOC to pass messages to other members of staff. Proactive use of the telephony system is to be utilised to communicate with colleagues. 5.2.4 With the exception of the HEOC Duty Manager, Dispatch Team Leader (DTL), Clinical Advisor, ECT Clinician, Clinical Coordinator and Call Handler Team Leader (CHTL), staff are not permitted to access the internet within the HEOC. Please refer to Internet and Email Acceptable Use Policy which can be found on the Trust intranet. EEAST HEOC SOG_V1.0 Page 15 of 143
5.2.5 Bags, Coats and other bulky personal belongings must be kept in the personal lockers provided and not kept at work stations. 5.2.6 Should a staff member need to leave the room at any time, their Team Leader must be informed. CHTLs and DTLs will be responsible for facilitating all requests to leave the room. 5.2.7 Access to HEOC is restricted to HEOC staff only. Non-HEOC staff will not be granted access unless they have a legitimate reason for which their presence is a necessity. In this case permission should be sought from the HEOC Duty Manager or other Senior HEOC Manager. On Call Silver, I.T. and Estates are exempt from this instruction. 5.3 Escalation 5.3.1 All HEOC staff must proactively escalate any identified service pressures to their Team Leader or HEOC Duty Manager in order for them to evaluate, manage and if necessary escalate to the HEOC Assistant General Manager /HEOC Silver. They in turn may decide to initiate the HEOC Demand Management Plan (Appendix A) or refer to the Trust Resource Escalation Action Plan (REAP) (Appendix B) where appropriate. Examples would include dispatchers identifying hospital delays, HEOC or operations staff shortages and significant equipment failure. Escalation within HEOC is primarily the responsibility of the HEOC Duty Manager. 5.3.2 As the Trust experiences increased pressures generally, various measures may be introduced to maintain service provision using the REAP Plan (Appendix B). 5.3.3 Individual mitigating actions are shown in the table (Appendix B) as a guide only and these may be initiated by the Trust at differing REAP levels. HEOC managers and staff will be kept notified of the REAP level and any mitigations implemented. 5.4 Release of Information 5.4.1 HEOC staff are not permitted to share with members of the public or other agencies any information which could lead to the identification of any individual. All requests for information should be referred to the HEOC Duty Manager. EEAST HEOC SOG_V1.0 Page 16 of 143
5.5 Vulnerable Children and Adults 5.5.1 Any staff member who has concerns about a vulnerable child or adult has a responsibility to both advise social services and register those concerns within the Trust. For HEOC staff, this process is accessed via the HEOC Duty Manager although it may be more suitable for the staff member to make the referrals directly themselves. 5.5.2 All enquiries regarding vulnerable children and adults, including those from operational staff, should be forwarded to the HEOC Duty Manager in the first instance. 5.5.3 The Trust has a Clinical Specialist for Safeguarding as well as a Safeguarding Lead, both of whom are available to give advice. Please refer to the Trust Policy section on Safeguarding located here for further information. EEAST HEOC SOG_V1.0 Page 17 of 143
SECTION 6 CALL HANDLING PROCEDURES EEAST HEOC SOG_V1.0 Page 18 of 143
6 Call Handling Procedures 6.1 General Rules for Call Handing 6.1.1 The Call Handler must be either dealing with a call or be ready to answer calls at all times, unless authorised to be unavailable by the Call Handler Team Leader. 6.1.2 When a Call Handler is not available to take a call they must ensure they put themselves on NOT READY on Symposium to ensure they do not get a 999 call connect automatically. 6.1.3 When a Call Handler leaves their desk or goes out of the room they need to ensure they log out of the telephone completely, using the correct code, to avoid dropped calls and also log out of I/CAD. 6.1.4 For the Call Handler, incoming 999 calls take precedence over all other calls and requests. 6.1.5 The Call Handler must not engage in non-essential duties or telephone conversations which impede their ability to immediately answer an incoming call. 6.1.6 The Call Handler should minimise their call duration by proactively managing the call whilst following all MPDS procedures. 6.1.7 Call Handlers should use the Send Alert function to notify the dispatching team of time critical information. 6.1.8 The Call Handler is expected to use customer care techniques at all times to assist the Trust in providing a high standard of service to all callers. 6.1.9 The Call Handler must give emergency callers Pre-Arrival Instructions (PAIs) when indicated. The caller has implied consent by calling for help and should not be asked whether they want to carry out the necessary instructions. 6.1.10 The Call Handler must stay on the line with the caller once PAIs have been commenced until the crew arrive on scene. 6.2 Support from Call Handler Team Leader. 6.2.1 Whenever a Call Handler requires the CHTL to assist them with a call they should raise their hand and wait for assistance, continuing with the call where possible. 6.2.2 The Call Handler should immediately notify the CHTL if there are perceived safety hazards or potential violence at an event. All information must be entered in the I/CAD remarks. EEAST HEOC SOG_V1.0 Page 19 of 143
6.2.3 The CHTL manages the incoming calls using the Symposium system to maintain the optimum response from the call handling team. 6.3 Call Answer 6.3.1 When a Call Handler receives an emergency call, a beep will be heard in their headset one second prior to receiving a call and a new pre-alert event will populate on the I/CAD screen. 6.3.2 If the Call Handler is already using I/CAD for any reason when a call is received, this will prevent the pre-alert from automatically populating and a message will appear stating Warning Partial event exists, with three options to either ABANDON, STACK or CANCEL. On receiving this message, the call handler must select STACK, not CANCEL which will allow the call details to populate on the screen. Once the call has been completed, the call handler will then need to click on the STACKED button to retrieve their previous work. Click on PREV or NEXT to retrieve a stacked event. The call handler can then proceed by clicking ACCEPT EVENT or ABANDON EVENT. 6.3.3 When answering an emergency call, the Call Handler must use the standard answering salutation: Ambulance emergency, what is the address of the emergency? 6.4 Address Verification 6.4.1 If I/CAD has received CLI/EISEC information that has populated the emergency call handling screen, this is considered obtained If the address given by the caller provides an EXACT match with the CLI/EISEC data, then this is considered verified and there is no need to ask for it again. 6.4.2 If there is no address obtained by CLI/EISEC or the Call Handler has to amend the address in any way, the address must be verified. 6.4.3 When verifying an address, the information must be verified in full. This includes the house name/number, road name, village/town/city or any other feature of a location/address that is applicable. 6.4.4 Verification in MPDS requires the Call Handler to have the caller repeat the information back. The Call Handler reading the address back to the caller carries a risk of the caller simply agreeing because they are anxious or frightened and this therefore is considered an incorrect verification. Verification should be sought from one of the following phrases: Please repeat the address for verification EEAST HEOC SOG_V1.0 Page 20 of 143
Please repeat the address for confirmation Please confirm the address to make sure that I have it correct The Call Handler should seek assistance from the CHTL if they are having difficulty in obtaining the address information. If address verification is taking more than 60 seconds, a warning will be generated. 6.4.5 If the event location changes at any time including at the initial confirmation of the pre-alert location, the Call Handler must immediately inform the dispatcher using the Send Alert icon as well as amending the address in the location field. 6.4.6 The Call Handler must update I/CAD or advise the CHTL of any change of location as the call is progressing. This will ensure the most appropriate resource is allocated. Additional location information should be entered at the end of the call. 6.4.7 If a residential property has a name and no number, the Call Handler must obtain additional address-related information to assist the Trust responders in locating the address. 6.4.8 If the location is a flat above a shop, the Call Handler must ask for the name of the access road for the property and the name/type of shop that the flat is above. 6.4.9 If the address is a small shop, the Call Handler must ask the name of the access road for the property and the name/type of shop. 6.4.10 If the location is a large retail store or similar, the Call Handler should obtain the following information if applicable: The floor and department the patient is on Which entrance the Trust responders should use Where the Trust responders will be met 6.4.11 The Call Handler must request additional address information if it is required to assist Trust responders. Types of location where further information is frequently required include: Retail parks & shopping centres New residential or commercial developments Industrial complexes Large public buildings or open areas Military sites EEAST HEOC SOG_V1.0 Page 21 of 143
6.4.12 For a large, public or complex location, the Call Handler must always establish the exact location of the patient. 6.4.13 If the event is at industrial premises the Call Handler must ascertain the name of the premises and what is produced or stored there. 6.4.14 If the precise location of the event is difficult for the caller to describe, the Call Handler must ask the caller to identify a landmark or some other feature that will help the Trust responders to locate the scene. 6.4.15 Where a Call Handler has difficulty in plotting the exact location of an event they should plot it as accurately as possible and add sufficient directions to enable an appropriate resource to be dispatched. 6.4.16 If, at any time during the address verification process, the origin caller becomes insistent that they will not remain on scene and/or await a response then this should be referred immediately to the CHTL AND HEOC Duty Manager. 6.4.17 The Call Handler is responsible for identifying addresses which have a special situation or have other information recorded on I/CAD and must alert the dispatchers that there are further relevant scene safety issues or special requirements for the patient. 6.5 Call Back Number Verification 6.5.1 The correct question to ask the caller when initially dealing with a call back number is: What s the telephone number you re calling from? If the call back number has been populated automatically (obtained from CLI/EISEC) and this exactly matches the number that the caller has given, this is classed as verified and there is no need to ask it again. 6.5.2 If the call back number is manually entered then the Call Handler should verify the number. 6.5.3 If the caller gives a different call back number to that displayed through CLI/EISEC then this new number must be logged in the I/CAD notes and then verified. The number on screen may be a switchboard/fax number or a number that may not accept incoming calls. Verification of the call back number should be sought from one of the following phrases: Please repeat the phone number for verification EEAST HEOC SOG_V1.0 Page 22 of 143
Please confirm the phone number to make sure that I have it correct Please repeat the phone number for confirmation The dialling code must be repeated in full. This is to ensure accurate receipt of all information. 6.5.4 Some Carelines will have forced through the patient s number (and this will have populated the emergency Call Handler screen), however it is the Carelines call back number that must be obtained and verified as they are the originating caller. It is important though, that the patient s number is clearly recorded in I/CAD. The phone number that has come through on CLI/EISEC should not be deleted or changed. Ultimately both numbers must clearly be displayed in I/CAD. 6.5.5 In the event that CLI/EISEC has provided the Careline number, the patient s number does not need to be obtained during Case Entry and should be done after completion of Key Questions. 6.5.6 An origin call back number must be obtained from all third and fourth party callers i.e Fire, Police etc. 6.5.7 If the caller does not know their telephone number or cannot confirm it verbally, then the Call Handler must stay on the line at the end of the call and verify the number on their screen with the operator, even if it was obtained by CLI or EISEC. 6.6 Calls Requiring the Assistance of other Emergency Agencies 6.6.1 When a Call Handler identifies during a call that assistance is required from another emergency agency it is their responsibility to contact that agency as soon as the initial call is complete and enter notes on I/CAD including references numbers. Some examples are given below: Calls to Road Traffic Collisions (RTCs) should be passed to Police and also to Fire if the caller confirms someone is trapped. Events with violence on scene are always passed to the Police. Where the caller confirms that the ambulance crew will not be able to gain entry without assistance, the Police should be contacted. 6.6.2 If the Call Handler is unable to contact the other agency in a timely fashion because they are giving PAIs, they should notify the CHTL who will take responsibility for calling the other service. EEAST HEOC SOG_V1.0 Page 23 of 143
6.6.3 If the Call Handler identifies that the scene is violent, that there may be some immediate danger or that operational responders may be attending a dangerous location, they must always immediately notify the CHTL who will inform the relevant dispatcher without delay and ensure that they receive an acknowledgement from them. 6.7 Emergency Calls Received From Other Emergency Agencies (SEND Protocol) 6.7.1 When receiving a 999 call from another emergency service (Police, Fire and Coastguard) the Call Handler will follow the SEND protocol (Secondary Emergency Notification of Dispatch). It enables the delivery of the Four Commandments and other pertinent medical information (Priority Symptoms). 6.7.2 The Call Handler should verify the incident location in exactly the same manner as they would any other 999 call. 6.7.3 They should enter the agency reference number in the Name box on the right hand side of the screen and open ProQA. 6.7.4 Case Entry is completed in full and then, depending on the Chief Complaint, the Call Handler will ask if there is any chest pain Medical - Q5) or serious bleeding (Trauma - Q6). The answers to these questions will be logged in the Key Questions section of the ProQA. The Four Commandments are: Chief Complaint Age Conscious (awake) Breathing The Four Priority Symptoms are: Level of Consciousness Difficulty Breathing Chest Pain Serious Bleeding 6.7.5 The Call Handler is not required to ask any of the other Key Questions and the answer Unknown can be recorded in ProQA for these questions. However, if the caller volunteers the answer to one of the Key Questions, this MUST be recorded in ProQA e.g. if the Police report that a male has been assaulted and sustained a head injury, the Call Handler must answer the Key Question What part of the body is injured? with head and not unknown. This ensures that the ProQA is accurately reporting the information received during the call. EEAST HEOC SOG_V1.0 Page 24 of 143
6.7.6 Please note that Q7 on the SEND card (pictured above) is not used by the East of England Ambulance Service Trust. The category of response will be determined by the information entered into ProQA. 6.7.7 The Call Handler should then ask for the informant s contact details and establish if the emergency service is on route or on scene, these details should be entered into the remarks of I/CAD. 6.7.8 If the Call Handler needs any further information from the emergency agency then they should ask them at the end of the SEND protocol questions. 6.7.9 The Call Handler should then offer any advice - either PAIs or PDIs if they are requested. 6.7.10 The Call Handler should enter their extension number into the event notes. 6.8 Emergency Calls Received From Other Ambulance Trusts 6.8.1 When receiving a 999 call from another Ambulance Trust, the Call Handler takes the incident details in the same way as other emergency calls but should also follow these additional procedures. 6.8.2 The Call Handler must record the originating telephone number in the caller details section of the new event. 6.8.3 The Call Handler must ask for and record the patient s telephone number in patient details within the I/CAD event log. 6.8.4 The Call Handler should ask Has this call been taken using MPDS or NHS Pathways? if this information has not already been volunteered. If the call has been triaged using NHS Pathways then please refer to Section 6.15. 6.8.5 The Call Handler must record the origin Ambulance Trust name and reference number in the caller s details field. 6.9 Exchanging Times with Other Ambulance Trusts 6.9.1 If another Ambulance Trust calls to pass times for an event then the call is passed to a DTL or HEOC Duty Manager who will manually enter the times given and include notes on the event in line with the CAD Data Quality Audit Policy. EEAST HEOC SOG_V1.0 Page 25 of 143
6.10 Emergency Calls Received Located Outside Trust Geographical Boundaries 6.10.1 The Call Handler must accept all emergency calls regardless of geographical location. 6.10.2 The Call Handler must immediately notify the CHTL that an out of area event has been created on I/CAD and requires passing to another Ambulance Trust to dispatch a response. In the event of the CHTL not being available the Call Handler must inform the HEOC Duty Manager. 6.10.3 The Call Handler must process the call as usual via ProQA and MPDS. If the patient s condition is unstable or the patient is not alert the Call Handler should remain on the line, and give Pre-Arrival Instructions (PAIs) or Post- Dispatch Instruction (PDIs) where applicable. The CHTL MUST inform the receiving Ambulance Trust that PAIs or PDIs are being given to the origin caller. 6.10.4 The CHTL takes responsibility for passing the call information to the appropriate Ambulance Trust. This must be carried out in a timely manner and must contain: CAD Number Chief Complaint MPDS Determinant Code Scene Safety Information Access/Address Information Medications/HCP advice on the treatment of a patient Information relating to the patient s condition/injury sustained Any further medical history that has been given, which has been recorded into the notes of the I/CAD 6.10.5 Once the call has been passed to the appropriate Ambulance Trust, their reference number should be entered into the Inform Other Agency field in the I/CAD system. It is the responsibility or the responding Ambulance Trust to notify other agencies such as the Police, Fire and Coastguard if the incidents require their attendance or that they need to be notified about as the Trust HEOCs do not possess national contact numbers for these services. EEAST HEOC SOG_V1.0 Page 26 of 143
6.11 Calls from NHS Direct 6.11.1 Calls that are passed to the HEOC from NHS Direct will have originated from a member of the public who has dialled a non-emergency line for help and advice regarding their health. Often callers will not realise that their condition is potentially serious and so the frequency of these calls is high. Each call is regarded as an emergency call and will present to the HEOC as such. 6.11.2 When a call is received by NHSD it is initially answered by a Health Advisor (Call Handler). They will undertake an initial assessment and prioritization of the patient, including symptoms and demographic. If certain conditions are evident (such as chest pain) they will dial 999 to pass the call. 6.11.3 If the patient s condition does not require an immediate transfer to the HEOC, the Health Advisor will organise for an NHSD Nurse to assess the patient which may require them to call the patient back. Upon further triage the Nurse may decide that the patient s condition warrants an ambulance response and also pass the call to HEOC. In some cases they may book an urgent response for a patient. 6.11.4 Regardless of whether the call is from an NHSD Nurse Advisor or the patient is transferred through from an NHSD Health Advisor (Call Handler) the call should be processed through MPDS. 6.11.5 Ensure that additional relevant details are taken e.g. case reference number and which NHSD call centre is referring the call. 6.12 Call Handler Responsibilities for Protocol 35 HCP Admission Requests (Card 35) 6.12.1 The Trust is required to use Protocol 35 of Medical Priority Dispatch (MPDS) when responding to a request from a Health Care Professional (HCP) for all admissions to appropriate care facilities (Appendix C). 6.12.2 All HCP admissions across the East of England Ambulance Trust will be treated identically and be given the best possible patient care at all times even when experiencing higher than forecast UHUs and will be based on the acuity of their health care needs. 6.12.3 Card 35 is designed to be used specifically for situations where the patient has been assessed by a HCP either in the community or at an acute hospital trust and requires additional care, treatment or assessment at a place of definitive or higher level of care. The questions in Card 35 are more appropriate to these situations as they request detailed information regarding the patient, the HCP and the receiving hospital. EEAST HEOC SOG_V1.0 Page 27 of 143
6.12.4 Card 35 is to be used for all requests received from Health Care Professional irrespective of how the call is received i.e. 999 and urgent lines. For a HCP to request an emergency response the HCP must be defined as one of the following, have conducted a face-to-face patient assessment and made a tentative diagnosis: A Hospital Doctor/GP or their representative (e.g. Staff Nurse/Receptionist) in the same location. Emergency Care Practitioner Midwife Any other HCP calling 999 (e.g. community nurse, dentist, social worker, carer) will be handled through the MPDS Chief Complaint that best addresses the patient s condition. 6.12.5 Card 35 should not be used when a HCP has come across a patient, for example at the scene of an incident such as an RTC. 6.12.6 Card 35 should not be used when an HCP has triaged the patient over the telephone (this includes NHSD calls) and in these situations the appropriate MPDS Chief Complaint protocol should be followed. 6.12.7 In some cases the HCP may not volunteer that he/she is a HCP and the Call Handler may have already started to triage the call through another chief complaint. If this should happen, a manual shunt to Card 35 is required. 6.12.8 In the event that a call from a HCP/Representative being managed through MPDS Chief Complaints 1-32 results in a PSIAM Referral (G3 & G4 Calls) then the Call Handler should inform the caller that a response has been arranged and worsening instructions should be given. The Call Handler should notify the PSIAM clinicians (via the CHTL) that the call is from an HCP and requires a response. The PSIAM clinician should prioritise the call and abort Ambulance Required. 6.12.9 If the patient is reported to be in cardiac arrest, Protocol 9 (Cardiac/Respiratory Arrest/Death) should be selected as this protocol is more appropriate in gathering the information in a timely manner and linking quickly into Pre-Arrival Instructions where appropriate. 6.12.10 For all Urgent requests the time agreed with the HCP is the latest time that is medically acceptable for the response to be at the patient s side. The agreed time will be between 60 minutes and 240 minutes. 6.12.11 When processing calls for mental health assessments (Urgent calls) the Call Handler must ask if the patient has any history of violence and if the police will be required. The answers to these questions must be entered in the I/CAD remarks. EEAST HEOC SOG_V1.0 Page 28 of 143
6.13 Card 35 Urgent Welfare Calls Call Handler Responsibilities 6.13.1 The Call Handler Team Leader is to nominate one member of staff per shift to review Urgent calls and to conduct regular welfare checks. 6.13.2 The nominated Call Handler should action the following when making welfare calls. Introduce themselves as a CH from the Ambulance Service. Then either o o Advise that the ambulance has been booked for xx time and that they are calling to check on the patient s condition. Apologise for the delay and check on the patient s condition. Always ensure that worsening instructions are given if the patient s condition worsens in any way call back on 999 Add the appropriate notes to the I/CAD remarks, E.g. welfare check no change to patients condition Ext number 2323. 6.13.3 Welfare call time frames to be adhered to Type of Call 1 st Welfare call Remaining Welfare calls 4 Hour Urgent 2 hours into the call Every hour until a response arrives on scene 3 Hour Urgent 1.5 hours into the call Every hour until a response arrives on scene 2 Hour Urgent 1 hour into the call Every hour until a response arrives on scene 1 Hour Urgent At the time of pick up Every 30 minutes until a response arrives on scene. 6.13.4 When instigating a welfare call and the patient s condition has deteriorated the Call Handler is to enter notes and advise the Duty Manager who will upgrade the call to a Priority 1 (G1) and the nearest resource is to be deployed. The Call Handler is to give the Caller following instructions. As the patient s condition has deteriorated, we are sending an immediate response if anything changes please call back on 999. The resource can be diverted as per the resource allocation guidelines. 6.13.5 If at any time the Call Handler has any concerns they are to raise this to the attention of the CHTL, DM & Clinical Coordinator notes to this effect are also to be entered into I/CAD. EEAST HEOC SOG_V1.0 Page 29 of 143
6.13.6 If when conducting a welfare call there is no answer at the property the Call Handler is to attempt to call three times in succession. If there is no answer the Duty Manager is to be notified and the priority of the call is to be amended to a Priority 1 (G1) on I/CAD and the nearest resource is to be deployed. 6.14 Psychiatric Upgrades 6.14.1 Calls from Approved Social Workers/Mental Health practitioners for pick-up following assessment will be input manually by the Call Handler onto I/CAD using Type - 35-HCPAdms - Health Care Professional Admission (Bypassing ProQA) with the appropriate time frame. 6.14.2 Once the ASW calls back to advise that the assessment has been completed and the patient is ready, then a new event is created on I/CAD by selecting as Type - PSYCHUP and accepting the event. The new I/CAD event should contain the original Urgent I/CAD reference and the extension number. 6.14.3 The CHTL/DTL/HEOC DM should then be advised so that the event can be cross-referenced and the information transferred. 6.15 Calls Triaged Through NHS Pathways (Including Luton 111 Service) 6.15.1 Some Ambulance Services and 111 Service Providers in the UK are now using the NHS Pathways triage system as opposed to the Medical Priority Dispatch System. This means that the patient will have been triaged using a different set of questions and a response priority obtained. Trust Call Handlers will be unable to re-triage using MPDS questions and will be required to deal with these calls in a different manner. 6.15.2 The Call Handler should answer the call with the standard salutation as per Section 6.3.3. If the call is from another Ambulance Service or 111 Service Provider then they will identify this. 6.15.3 The Call Handler should request and enter the patient telephone number and location. These details should be verified. 6.15.4 The Call Handler should ask Has this call been taken using MPDS or NHS Pathways? if this information has not already been volunteered. 6.15.5 If the call has been triaged using MPDS then continue call as per Section 6.8. 6.15.6 If the call has been triaged using NHS Pathways then the Call Handler should ask What responding priority is required? EEAST HEOC SOG_V1.0 Page 30 of 143
6.15.7 The Call Handler should then select Type - NHS Pathways Call from NHS Pathways Service and then Subtype as: CatA Category A Event CatB Category B Event CatC Category C Event 6.15.8 The Call Handler should enter information in the I/CAD notes related to: Patient name Patient age Gender Chief Complaint Conscious Yes/No Breathing Yes/No Other pertinent information 6.15.9 Enter the name of origin Ambulance Trust or 111 Service in the Caller Details Field. 6.15.10 Reference numbers should be exchanged and entered in the I/CAD remarks. 6.15.11 Any HCP requests that have been processed through NHS Pathways should be processed in this manner. 6.16 Protocol 37 Interfacility (Hospital) Transfer (Norwich HEOC Only) 6.16.1 Previously the Trust has managed these transfers under Card 35 and work has been undertaken initially with the Critical Care Network (CCN) for Norfolk/Suffolk/Cambridgeshire to move to Protocol 37 which is specifically designed to manage these types of calls. 6.16.2 Work continues with other networks (such as Stroke/Cardiac/Trauma) and it is hoped we will be using Protocol 37 for these types of calls across the region from April 2012. 6.16.3 Work has been undertaken with the CCN to produce a script for CCN clinicians to follow which mirrors the key questions from MPDS Protocol 37. This will ensure that CCN Clinicians have the appropriate information when the Call Handler requires it at the time of booking. EEAST HEOC SOG_V1.0 Page 31 of 143
6.16.4 The CCN (NSC) Protocol 37 Process: Call Handler greets caller Ambulance Emergency. The Caller will identify this as a Critical Care Transfer. Call Handler to obtain phone number and verify address. Call Handler to switch off Auto Accept. If not already volunteered, Case Entry Question 3 should be replaced with What is the reason for transport. Complete Case Entry as per ProQA. Call Handler opens Chief Complaint Protocol 37. Dispatcher should await final code before dispatch. All Critical Care Transfers will be Evaluation The Call Handler should select Evaluation for Incident Type. KQ#2 Has the pt been seen by a Dr/Nurse in the last 2 hours? Obvious Yes KQ#3 Call Handler should select No in the case of a CCN Transfer KQ#4 Does the crew need to administer or monitor Always answer Not Applicable KQ#5 Specialist Equipment Ask as written KQ#6 Additional Personnel Always answer Yes KQ#7 Personnel Required Ask as written KQ#8 Call Handler should ask What response is required? Select one of the following options only: Delta Evaluation Immediate Blue Light Response (R2) Charlie Evaluation 20 Minutes Blue Light Response (G1) Bravo Evaluation 1-2 hours (G4)(These must be time stamped) Delta Evaluations are coded at this point Complete remaining KQs to obtain logistical information Call Handler to book a First on Scene using the AED Button 6.16.5 Additional questions for entry into I/CAD following ProQA (in caller detail fields); EEAST HEOC SOG_V1.0 Page 32 of 143
What is the diagnosis of the patient? - Answer to be entered in reason field Where are we taking patient to? - Hospital must be verified Are there any special considerations such as obesity or infection we need to be aware of? - Answers to be added in remarks. 6.16.6 Call Handlers should then give the following PDIs; Help is being arranged as requested (Call Handler to confirm response) If there are any changes please call us back quoting reference number (give CAD reference number). 6.16.7 Additional Information: Specialist equipment This will be requested by the clinician and may include the Critical Care Trolley (dispatch implications to ensure appropriate vehicle is allocated), Balloon Pump and Ventilator. The Call Handler should note all specific requests. If the Dispatcher has a query this should be directed to the Clinical Coordinator in the first instance. BLS/ALS Crew BLS (Basic Life Support) Crew would allow the transfer to be allocated to a non-paramedic crew. If ALS (Advanced Life Support) crew is requested, a Paramedic crew should be dispatched. Advanced Directives This relates to any documented information regarding the patient s wishes, such as DNAR (Do Not Attempt Resuscitation) which the clinician is aware of. 6.17 G3/G4 PSIAM Procedure 6.17.1 Once an emergency event has been coded through MPDS, I/CAD will automatically identify PSIAM approved G3/G4 events to transfer to the PSiam stack for triage by the Clinical Support Desk (CSD) or NHS Direct (NHSD)* - * only as part of heighted REAP levels and after consultation with Gold on Call/SMA. EEAST HEOC SOG_V1.0 Page 33 of 143
6.17.2 The Secondary Triage Submission Request (STSR) window will be displayed in I/CAD (below). 6.17.3 This will prompt the Call Handler to Accept the event for PSIAM and to read the following script from the SOP button on the I/Dispatcher Event Information screen: CSD - Your call has been coded as not immediately life threatening and I am going to arrange for one of our clinicians to call you back. Is it OK to call you back on this number? Can I take your/the patient s name please? 6.17.4 There are exemption criteria for G3/G4 events which require an ambulance response and these will not be accepted by the PSIAM interface (G3/G4 SEND). 6.17.5 In these cases the Secondary Triage Submission Request (STSR) window (Section 6.17.2 above) will NOT be displayed, however the SOP button above (Section 6.17.3) will still illuminate and this will prompt the Call Handler to read the following script: Your call has been coded as not immediately life threatening. We are sending an immediate response but it will not be coming EEAST HEOC SOG_V1.0 Page 34 of 143
on blue lights and sirens. Should your/the patient s condition change please call us back on 999. 6.17.6 Some events that have been received from/triaged by NHSD may still produce a PSIAM accepted MPDS code in these cases the Call Handler should Accept the event for PSIAM. 6.18 Early Identification and Escalation of Potential Risk 6.18.1 With the increasing number of calls now being passed to the Clinical Support Desk (PSIAM), it is imperative that all Call Handlers remain vigilant and escalate to their Call Handler Team Leader any identified issues or concerns over a call. 6.18.2 This does not solely apply to PSIAM coded calls but also any call to which the Call Handler feels the outcome priority may not be appropriate. This is particularly important where our response is either a Hear & Treat code (G3 & G4) or our response is not under emergency conditions (G4 Send - Priority 6). Examples may include: A caller stating thinks leg is broken Patient fallen outside in public place in poor weather Fallen down stairs Colour is blue, Unresponsive etc. 6.18.3 Due to the reliance of MPDS on the answers given by the caller, who for example may state that somebody is unresponsive but conscious it is essential that any call that may require a vehicle to be dispatched is identified early. 6.18.4 If the Call Handler team Leader receives notification of any concerns they must immediately relay these to the Clinical Advisor on the CSD/Clinical Coordinator or, in the absence of these individuals in the room the HEOC Duty Manager must be informed in order to escalate this to a CSD in another HEOC or the Regional Clinical Coordinator. 6.18.5 If the CSD is in agreement that the call requires a resource to run then the call must be transferred back to Dispatch at the earliest opportunity. Dependent on Clinical Advice the call may be upgraded to a G2 (Priority 4) response under emergency conditions. EEAST HEOC SOG_V1.0 Page 35 of 143
6.19 Abandoned Calls No Location Operator Passing 6.19.1 This type of call is one in which the caller is no longer connected when the call is passed by the operator and for which there is no EISEC location. 6.19.2 The Call Handler confirms the telephone number with the operator and then asks if they have any other details. 6.19.3 If the location is still unknown, the Call Handler enters @Unknown Location in the location field, selects the ABAN Abandoned call option from the Type drop down box and then enters any relevant details into the I/CAD remarks including their extension number. 6.19.4 The CHTL is then advised immediately who will call back straight away (this may be delegated). 6.19.5 If the call back is successful, the CHTL (or delegated Call Handler) should confirm whether an ambulance attendance is required. If a response is required then the CHTL must initiate a new event and process the call as normal through MPDS. Otherwise remarks should be entered as to why a response is not required. 6.19.6 If the call back is unsuccessful, a voicemail message is left where possible (see Section 6.23 below). The CHTL (or Call Handler) will attempt to contact the origin caller at least 3 times. 6.19.7 As soon possible, the CHTL should search I/CAD for similar previous incidents to that telephone number and enter notes in the most recent event. If the call history suggests a pattern, pass details to the HEOC Duty Manager. 6.19.8 Further attempts to make contact should be attempted if possible. 6.20 Abandoned Call With Location Operator Passing 6.20.1 If an address is produced from EISEC/CLI then this should be confirmed along with the telephone number. DO NOT delete the address or change it. 6.20.2 The Call Handler selects the ABAN Abandoned call option from the Type drop down box and then enters any relevant details into the I/CAD remarks including their extension number. 6.20.3 The CHTL is then advised immediately who will call back straight away (this may be delegated). 6.20.4 If the call back is successful, the CHTL (or delegated Call Handler) should confirm whether an ambulance attendance is required. If a response is required then the CHTL must initiate a new event and process the call as normal through ProQA. Otherwise remarks should be entered as to why a response is not required. EEAST HEOC SOG_V1.0 Page 36 of 143
6.20.5 If the call back is unsuccessful, a voicemail message is left where possible (see Section 6.23 below). The Call Handler/CHTL must enter their extension number and remarks that they have tried to call back the origin caller. 6.20.6 The CHTL must make DM/DTL aware to ensure that a resource is sent. 6.21 Abandoned Call Part Way Through Call Response Not Yet on Scene 6.21.1 If the line drops out part way through a 999 call, and the Call Handler is still in Case Entry of ProQA then the Call Handler Team Leader must be notified who will call back immediately. If the Call Handler has started to enter Key Questions in ProQA then the Call Handler should call back. The Call Handler will call back immediately to contact the origin caller and will try at least 3 times to make contact. 6.21.2 If the call back is successful, ProQA is completed including appropriate PDIs or PAIs. 6.21.3 If the call back is unsuccessful, the Call Handler/CHTL should leave a voicemail where possible (Section 6.23). The Call Handler should now abort out of ProQA, select the ABAN Abandoned call option from the Type drop down box and then enter any relevant details into the I/CAD remarks including their extension number. Make the CHTL aware of the call. 6.22 Abandoned Call Response May Have Arrived on Scene 6.22.1 If the line drops out at any point before the 999 call process is complete, the Call Handler must call back immediately. 6.22.2 If the call back is successful and confirms a resource has arrived, or a unit has booked on scene, the Call Handler terminates the call and aborts out of ProQA, The Call Handler MUST ensure that the resource is physically with the patient/caller before aborting the call. 6.22.3 If a Chief Complaint and Determinant Code has been selected (i.e. the call has been coded ) then no changes are to be made and remarks should be entered. 6.22.4 If a Chief Complaint has been selected but no Determinant Code has been reached then the Chief Complaint must be left in the Type box and ProQA aborted. The Duty Manager must be made aware. 6.22.5 This call will be coded appropriately by the HEOC DM as PCA (Pre Alert Crew Arrival) from the Type drop down list on the I/CAD System. EEAST HEOC SOG_V1.0 Page 37 of 143
6.23 Voicemail Messages for Silent or Abandoned Calls 6.23.1 If a call back is unsuccessful but there is a voicemail or other answering service, the CHTL (or designated Call Handler) should leave the applicable message: This is the ambulance service. We have received a 999 call from this number at (time and date) but no details were given. We have not been able to send an ambulance. If you do require ambulance assistance please call 999. This is the ambulance service. We have received a 999 call from this number at (time and date) but the call was not completed. Help is currently being organised. Please call back on 999. 6.24 Misrouted and Inappropriate Calls 6.24.1 Misrouted calls are those which have come through to the ambulance control room mistakenly for any reason. An example would be a caller who, upon connection, immediately says they did not want the ambulance service but asked for the police. 6.24.2 Inappropriate calls are those which have not been misrouted but are clearly inappropriate for the ambulance service. However, the Call Handler must always remember to never doubt the integrity of the caller and this procedure is not to be used if there could be any doubt that an ambulance is required. An example might be a caller asking for a taxi to a non-clinical destination. Additionally, this procedure could be invoked by the Trust to counter an identified specific issue. An example might be a newly instigated service with a procedure that is inappropriately referring callers to the Trust. In these circumstances, the Trust would activate this procedure and circulate notification to all Call Handlers. 6.24.3 For both misrouted and inappropriate calls, the Call Handler will ask the caller to repeat the statement which identified the call as inappropriate. If this is very early in the call and the caller requires another emergency service, the Call Handler should attempt to make contact with the operator and ask them to pass the caller to the appropriate service. In all other cases, the Call Handler should advise the caller that they have come through to the wrong/inappropriate service and ask them to either redial 999 for another emergency service or to contact another, more appropriate agency. 6.24.4 If the caller is resistant, this advice should be repeated once before passing the call to the CHTL. EEAST HEOC SOG_V1.0 Page 38 of 143
6.24.5 The Call Handler stops the call process on I/CAD by selecting the abandon call option from the drop down menu and entering sufficient notes to explain the events. 6.24.6 The CHTL must be advised of all misrouted and inappropriate calls and the action taken. 6.25 Hoax Calls 6.25.1 A hoax call is one in which, although an ambulance response is being requested, one is not required. In some cases, these can be abusive and upsetting for the Call Handler and the CHTL should offer support, if required. Other hoax calls, however, can be purposely calm or chaotic and intended to be amusing. All represent an abuse of the emergency service. If there is any doubt about whether a call is a hoax, a resource should continue to attend the given location. 6.25.2 During some hoax calls, the caller will advise they no longer require an ambulance, in which case Section 6.30 Request to Cancel 999 Events should be followed and any allocated units stood down. 6.25.3 In other potential hoax calls the caller does not overtly decline an ambulance but may lead the Call Handler to suspect a response is not required. The call should be completed to the best of the Call Handler s ability and any suspicions immediately passed to the CHTL. 6.25.4 The HEOC Duty Manager alone may decide not to respond on any potential hoax call as detailed in Section 9.9. 6.26 Silent Calls With No CLI or EISEC Information 6.26.1 On receipt of an emergency call where the caller is silent and Call Line Identity (CLI) and EISEC location data is not available the Call Handler must do the following: 6.26.2 If the line is still open stay on the line for 1 minute continuing to ask the caller to respond and listen for any sounds that may indicate signs of life. In the absence of any response, the Call Handler should read the following script: This is the Ambulance Service. We do not have a location for this emergency call and an ambulance is not responding at this time. If you do require an ambulance, call back immediately on 999. 6.26.3 Once completed, the Call Handler should terminate the call and advise the CHTL. EEAST HEOC SOG_V1.0 Page 39 of 143
6.26.4 The CHTL takes responsibility for calling the number back three times (which may be delegated to a Call Handler). If there is still no response, the HEOC Duty Manager is advised. 6.26.5 If at any time during the calls signs of life are heard, the CHTL is responsible for contacting the telephone service provider to obtain a possible location as per the subscriber details (This is currently not possible for VOIP calls). The HEOC Duty Manager must also be informed. 6.27 Voice over Internet Protocol (VOIP) Calls 6.27.1 VOIP calls originate from telephones or PCs connected to the Internet. The customer can use their service from any location where they can access the network and, therefore, the CLI location given may not be where they are calling from. Currently there is no method of proactively tracing the location of VOIP calls. Therefore, the operator will pass callers to the Call Handler verbally. 6.27.2 When a VOIP call is connected, the operator will say either "(Centre name) connecting VOIP caller (number)" or (Centre name) connecting a VOIP caller at an unknown location. In either case, the Call Handler will need to verify the location of the event and confirm it. The operator will stay on the line until these details are confirmed. 6.27.3 If the operator has been unable to establish the current location of the caller, a VOIP call may be presented to a Trust HEOC which is from a location outside the region. The call is processed as for other calls for locations outside the region. 6.27.4 If the operator has been unable to get a verbal response from the caller, the call may be passed with the advice "(Centre name) connecting a VOIP caller the line is silent, there may be a caller". The Call handler follows the procedure in Section 6.26 for silent calls. 6.28 Emergency Roamer Calls 6.28.1 When a mobile subscriber s network does not have network coverage, it is now possible for them to make a 999 call via another mobile network. 6.28.2 There are certain characteristics for emergency roamers which are different from normal mobile calls: No customer telephone number will be automatically available EEAST HEOC SOG_V1.0 Page 40 of 143
If the connection is lost, it is highly likely that you will not be able to call them back, as the caller may still be out of their home network s coverage area. Sometimes a series of digits may be given which looks like a phone number but may not be. No Mobile Location Information (MLG) will be available. It will not be possible for the operator to trace calls in a timely fashion and in some circumstances could take up to two days. 6.28.3 When handing a 999 caller over to the Call Handler, BT will identify these calls as Emergency Roamers. They will advise (Centre name) connecting Mobile Emergency Roamer with no customer number displayed. 6.28.4 The CLI automatically provided through EISEC will generally be either the default switch CLI or a dummy CLI of 0777000000, unless the Advisor has managed to obtain the customer s number verbally. No location information will be provided. 6.29 Use of FIRST Call Sign 6.29.1 The FIRST call sign is used to identify where a defibrillator is available on scene for use if the patient s condition warrants it. The defibrillator must be in close proximity to the patient and there must be an additional person or persons on scene in order for it to be assigned (i.e, if the patient is a 1st party caller and is alone, the FIRST call sign should not be assigned). 6.29.2 Clear evidence must be gained from the initial 999 call and must be logged in the I/CAD remarks and notified to the dispatcher to allow them to make an informed decision on what resources are required for the incident. 6.29.3 On receipt of a 999 call and it is identified that an HCP is making the call or that a defibrillator is available at the scene, the following question must be asked; Is there a defibrillator available? 6.29.4 This question must be asked where it is scripted in the MPDS protocols (on Protocols 9 and 35) but can also be asked during any other protocol where it is evident from the location or I/CAD that a defibrillator may be available. The question must also be asked when calls are received from a health care setting (GP surgery, Walk in Centre or MIU). 6.29.5 It is the Call Handlers responsibility to assign the FIRST as a resource upon confirmation of the above question. This should be done using the AED Available on Scene button. It is necessary to write the keyword NODEFIB EEAST HEOC SOG_V1.0 Page 41 of 143
when there is not one available it since this signifies to dispatch that the question has been be asked and not simply omitted. 6.29.6 The above question and defibrillator keyword are not necessary only when the call is received from an Acute Hospital as it is assumed that a defibrillator will be available. 6.29.7 Some properties may generate a special situation note stating that there is a defibrillator available on scene. The Call Handler is responsible for clarifying this availability. This may also give a phone number to contact the trained person. If this is the case the Call Handler Team Leader or Dispatch Team Leader are to be made aware. They must attempt to make contact and ask them to attend to the patient where possible. This must then be recorded in the comments field of the I/CAD. 6.29.8 The time in which the FIRST is to be recorded as on scene is the time that the evidence has been obtained as per the comments in the I/CAD notes. A Call Handler or Dispatcher may not allocate a FIRST retrospectively. However, in exceptional circumstances (for example, when the caller appeared to give incorrect answers to the above question or the receiving Call Handler did not ask the appropriate question, the HEOC Duty Manager may call back the caller or another person at the scene to determine whether a FIRST could have been allocated at the time. It is the Duty Manager s responsibility to satisfy themselves that, at the original time of the call, there was a defibrillator available It will be necessary for someone who was at the location to confirm these details on a recorded line and the Duty Manager will enter sufficient I/CAD notes to explain why this was not recorded at the time to allow the auditors to confirm that the criteria was met. The Duty Manager is accountable for ensuring that every effort is made to confirm the FIRST is applicable before allocating it retrospectively. In these circumstances, the time that the FIRST is allocated will reflect that time that the person and defibrillator were actually on scene in relation to the original call. This must be completed during the shift in which the incident was received. 6.29.9 Upon retrieval of a defibrillator, if required, further instructions should be provided through the MPDS pre-arrival instructions (Protocol Z). Protocol Z (AED Support) helps the caller to prepare both the patient and the AED. It then lets the AED guide the actions of the caller. It provides CPR instructions when necessary and also provides trouble shooting advice. 6.29.10 If the patient s condition is unstable and the caller is advised to retrieve a defibrillator (where available) the Call Handler will stay on the line with the caller. Where this is not possible (due to high call volume resulting in Urgent Disconnect) the caller should be advised to call back should the patient s condition worsen. 6.29.11 Where a caller rings 999 and requests help, this is considered implied consent and, therefore, the Call Handler will assume that the caller is willing EEAST HEOC SOG_V1.0 Page 42 of 143
to aid the patient unless the caller indicates otherwise. If the caller indicates that they are not willing to use a defibrillator, if necessary, the call sign can be removed 6.29.12 If certain codes are generated on Protocols 6,10,12,14, 17,19 and 31 and it is applicable to read the Post-Dispatch Instruction if there is a defibrillator (AED) available, send someone to get it now in case we need it later, the Call Handler must confirm that the defibrillator is available and with the patient before assigning the call sign. 6.29.13 The DM is responsible for ensuring that this instruction is adhered to and for ensuring that non-compliance is managed in accordance with the CAD Data Quality Audit Policy. 6.29.14 If a FIRST is assigned to an incident inappropriately, this call sign should effectively be removed. As the call sign cannot be deleted, the on scene time should be amended in I/CAD to the same time as the first responding unit. 6.29.15 If the FIRST call sign is assigned in error, a note must be entered in I/CAD to identify this. The CHTL / DTL / DM must be notified immediately and asked to amend this in I/CAD. Once reported, the Call Handler / Dispatcher must also note in I/CAD who they have reported it to. The Duty Manager is responsible for ensuring completion of any amendments required in I/CAD. 6.29.16 If the incident comes up for audit and notes have been added and the time has been changed appropriately this will not generate a non-compliance form. If no notes have been added acknowledging that this was an error, this will be treated as a non-compliance against the person who has assigned the call sign. 6.29.17 If the notes have been added but the time has not been amended this will generate a non-compliance form. The form will be against the person responsible for changing the time as per the notes. It will not go against the individual who made the initial error if it is clear that they have reported the mistake and noted this in I/CAD. If there is any conflict as to whether messages were passed, this will be for the Duty Manager to deal with. 6.29.18 The availability of a defibrillator must be clearly evidenced within the I/CAD remarks and accurately assigned to the incident, in order to ensure that the Trust is reporting in line with Department of Health guidelines. 6.29.19 In order to ensure this instruction is being followed, compliance will be audited in line with the CAD Data Quality Audit Policy. 6.30 Request to Cancel 999 Events 6.30.1 If a caller requests to cancel an active event, the Call Handler should confirm with the patient themselves that they do not require an ambulance response. EEAST HEOC SOG_V1.0 Page 43 of 143
If this is not possible, confirmation should be sought from the original caller or agency. 6.30.2 Once the Call Handler has confirmed that cancellation is required, they should cancel the event using the Request to Cancel function in I/CAD and ensure sufficient notes entered to explain the reason for this. 6.30.3 Details of all requests for a 999 cancellation should be passed to the CHTL immediately, to ensure the resource is stood down. 6.30.4 If the caller states that they are not prepared to wait for the attending resource and are implying that they may leave scene and/or make their own way then this needs to be escalated immediately to the CHTL AND HEOC Duty Manager (See also Section 9.10) 6.31 Urgent Disconnect (EXIT4) 6.31.1 The CHTL or Duty Manager will call EXIT4 or Urgent Disconnect when there are no Call Handlers available and there are 999 calls waiting to be answered. This will allow the CH to end the call promptly, where possible, and be ready to take the next call waiting. 6.31.2 Any time in which EXIT4 is called must be logged in the CHTL file. 6.31.3 If EXIT4 has been used by a Call Handler this must also be logged in the notes of the event on I/CAD using the keyword EXIT4. 6.31.4 EXIT 4 should not be considered on any call where the patient s condition could be considered immediately life-threatening or when the CH is giving lifesaving DLS instructions. These include situations in which the patient is: In Cardiac Arrest Unconscious Not alert with ineffective breathing Having an allergic reaction which is worsening or the patient is unconscious Actively choking or has choked and is now not breathing normally and not alert Actively fitting Labour with imminent delivery 1st Party caller with imminent threat of suicide EEAST HEOC SOG_V1.0 Page 44 of 143
In a sinking vehicle 6.31.5 When EXIT4 is implemented the Call Handler must complete Case Entry and Key Questions in full and code the call. Relevant PDI s should be completed relating to: Scene safety Control of bleeding Fitting (if patient not alert) Amputation Cooling and flushing 6.31.6 The Emergency Urgent Disconnect Script for Cat A calls should be used in ProQA by using the Specific PAI/PDI target tool. (2 nd Party) I need to hang up now to take another call. Help has been arranged. If s/he becomes less awake and vomits, quickly turn her/him on her/his side. If s/he gets worse in any way, call us back immediately for further instructions. (1 st Party) I need to hang up now to take another call. Help has been arranged. If anything changes, call us back immediately for further instructions. This script can be found in ProQA by using the specific PAI / PDI target tool 6.31.7 The purpose of staying on the line (Using X-3) is to closely monitor the patient s condition. During this time the Call Handler should advise the caller to remain on the line and keep the phone with the patient so that regular checks (including the breathing diagnostic tool) can be performed. The Call Handler should not advise the caller to put the phone aside or to leave the EEAST HEOC SOG_V1.0 Page 45 of 143
patient to carry out any further instructions as this means that the caller cannot be advised of urgent disconnect or given any pertinent information. 6.31.8 If the caller is not directly next to the patient and the Call Handler is required to stay on the line, the caller should be encouraged to get the phone close to the patient. If possible, the Call Handler may ask to call back on a mobile phone that can be taken to the patient s side. 6.31.9 If the caller and phone is away from the patient and it is not possible for them to get closer in order to keep in constant communication, the Call Handler will advise the caller the following: I ll stay on the line as long as I can. Watch him/her closely and look for any changes. If s/he becomes less awake or starts getting worse come back to the phone and tell me immediately. I may need to disconnect the line to take another call before you re-turn. If the patient has got worse in any way and I am no longer on the line, hang up and then call us back immediately for further instructions. 6.31.10 If the call is coded G3/G4, read the referral script as normal and the call will be passed in the usual manner. 6.31.11 When there are Call Handlers available, Urgent Disconnect must be discontinued. 6.32 Providing Dispatch Life Support (DLS) to 3rd Party Callers 6.32.1 This instruction details the processes required for making 3 rd party callers into 2 nd party callers and reducing the risk of a call being abandoned. 6.32.2 When a 999 call is received and the patient is in need of Dispatch Life Support instructions, these will be delivered most effectively when the caller is 2nd Party (with or in close proximity to the patient). MPDS encourages the Call Handler to, where possible; make a 3rd party caller (not with the patient) into a 2nd party caller. 6.32.3 When the caller is not directly with the patient and all information has been obtained through the Key Question interrogation, the delivery of Pre-Arrival Instructions may present with some difficulties. The Call Handler must consider the following: Is the phone a mobile or cordless and can it be taken to the patient s side? If it is not possible to take the phone to the patient, is there another person who can relay the instructions? EEAST HEOC SOG_V1.0 Page 46 of 143
If neither of these are an option and the call is received on a landline; is there a mobile phone that we can call back on? 6.32.4 If the only option is to call back another telephone number then the following process MUST be applied: The Call Handler must NOT disconnect from the original call but obtain the new number The Call Handler must inform the Call Handler Team Leader of the situation The CHTL will request another Call Handler to call back and make contact on the new number. Only once contact has been made on the new number can the original call be disconnected. The new call is to be transferred back to the original Call Handler so that they can continue with the call. The CHTL will make contact with the new number if no other Call Handlers are available to carry out this task. 6.32.5 This process ensures that the call is not abandoned and any potential problems such as an incorrect number given, no reception in the area or mobile not switched on, will not result in lost communication with the caller and delays in giving PAIs. 6.32.6 If there is a problem during the transfer of the call, the Call Handler must immediately try to call back both numbers until contact is made. The Duty Manager must be informed should this happen. 6.33 ProQA Override Function 6.33.1 The Override function has been created by the International Academy of Emergency Dispatch in ProQA, to allow the Call Handler to select a higher priority than that generated by MPDS when working to strict guidelines. This will benefit the patient as it will allow for a more appropriate and accurate response based upon their condition. There are limited codes that will be available and these have been agreed by the Trust s Medical Director. 6.33.2 The Override facility is used to ensure that the Trust are responding appropriately to patients where the response type required is higher than that allocated to the Determinant Code identified by the patient evaluation through ProQA. 6.33.3 The Override function is to be used in the following situation: EEAST HEOC SOG_V1.0 Page 47 of 143
Protocols 4 (Assault), 17 (Falls), 29 (Transportation/Traffic Accidents), 30 (Traumatic injuries) where the caller has volunteered the information that the patient has a gross deformity or open fracture to the following body areas; upper arm, knee, lower leg, ankle, elbow, foot, forearm, hand or wrist (as outlined in ProQA) Gross deformity or open fracture to the shoulder and collar bone (clavicle). These are not highlighted with an asterisk in ProQA but are deemed by the Trust as appropriate for Override. Protocol 17 (Falls) where a patient has a recent hip or pelvis injury Protocol 12 (Convulsions/Fitting) where the patient has been coded a 12-A-01-E These have been identified by the Trust as situations in which an emergency response is appropriate as opposed to a G3/G4 referral to the Clinical Support Desk. This function will remove any confusion as to how these calls should be upgraded. The guidance in this instruction replaces the section that refers to gross deformities, open fractures and hip injuries in the document Patient Safety Responses 6.33.4 The Call Handler should not use OVERRIDE in cases whereby the patient is deteriorating during a call. In these cases, the Call Handler should return to the appropriate sections of the Protocol and log the changes in ProQA in order to reconfigure the Determinant Code and allocate the updated response. For example, if during a call a patient starts to become not alert, the Call Handler should return to Key Questions, change the answer relating to the not alert status, and send the reconfigured Determinant Code. 6.33.5 When a call is received the Call Handler will open the ProQA and complete Case Entry in the usual manner. The Call Handler will progress through the Key Questions until an answer is selected that prompts a dispatch code to be sent. 6.33.6 At this point, if there is an Override code available, this will be identified by the text entered into the Responses (user defined) column. This text will read Open#,Hip/Pelvis,Gross Deform (due to limited space) or ***12-A-1-E***. 6.33.7 The Call Handler can use the arrow keys on the keyboard or cursor to select the appropriate code. When a code is available it is highlighted in yellow. Once selected, it will be highlighted in green. The Call Handler should Override if the patient s condition matches the description as written in the override code. EEAST HEOC SOG_V1.0 Page 48 of 143
6.33.8 An example of how Override is used: If a patient falls, is alert and breathing normally and sustains an obvious open fracture to the upper arm, the call would be coded as 17-A-1. This is a G4 coded call - ProQA advises that if a gross deformity or open fracture is present, override to the appropriate non referral code if the injury is a body part highlighted with an *. See below: The override code must be selected before the original code (17-A-1 in this example) is sent. If it is sent prematurely, the Call Handler can use the reconfigure icon (highlighted here in blue) to return to the codes screen and re-select the correct code. The available override code is 17-B-0 which is responded to and reported as a G2 code. This is clearly identified by the text written in the Responses (user defined) Column. The Call Handler can use the arrow keys on the keyboard or the cursor to select the 17-B-0 code. EEAST HEOC SOG_V1.0 Page 49 of 143
6.33.9 The Call Handler receiving the 999 call is responsible for following this procedure. The decision to Override must not be influenced by the availability of resources or distance from the responding units. 6.33.10 Call Handlers are unable to downgrade calls by utilising the Override function. Where there are Override codes which are not to be used, these will be clearly labelled Do not use. 6.33.11 The Override function is only to be used by EMDs who have been trained in its use. Proper use of this function will ensure that the patient receives the most appropriate response and resources to meet their needs. It will also eliminate the current confusion within the HEOCs due to I/CAD limitations. 6.33.12 This function has a clear audit trail which can be monitored. Failure to Override when appropriate will have serious consequences for patient care and will be treated as non-compliance. Any concerns or queries regarding the use of this instruction should be passed to the Audit Department for further investigation. 6.34 ProQA Shift Function 6.34.1 When using MPDS, ProQA selects the earliest identified determinant descriptor that best describes the patient s condition subject to the information given by the caller. The dispatch code generated for each call is comprised of a protocol number, determinant level and determinant descriptor, and a suffix if applicable (eg 10-D-01). 6.34.2 This unified process of Call Handling allows informed decisions to be made about resource allocation and which response category is to be used. The decision as to which response category is assigned to the MPDS determinant is not made by MPDS or ProQA. These decisions are made by the Department of Health (DoH). 6.34.3 The Shift Function will benefit the patient as it will allow for a more appropriate and accurate response based upon their condition. 6.34.4 The same DoH Categories are not always assigned to all determinant descriptors within a determinant level. When more than one determinant descriptor is available within the same determinant level, MPDS selects the highest determinant descriptor, but this may not always be the highest DoH category. 6.34.5 ProQA recognises that if more than one determinant is relevant, the Call Handler will be allowed to shift between these codes. The Shift Function allows the Call Handler to select the most appropriate code based on evidence and response priority. EEAST HEOC SOG_V1.0 Page 50 of 143
6.34.6 When a call is received the Call Handler will open the ProQA and complete Case Entry in the usual manner. 6.34.7 The Call Handler will process through the Key Questions until an answer is selected that prompts a dispatch code to be sent (as shown in Fig 3). The sunrise icon (Fig 1 - which means SEND the code) flashes red and in the list of codes shown below, a GREEN tab highlights the recommended code. The Call Handler is required to click on the icon which reads SEND followed by the code before they can move on. 6.34.8 As the Call Handler continues with the key questions, the answers may generate another relevant code. When more than one code is applicable, the alternative code or codes will be highlighted with a YELLOW tab. The current selected code will be highlighted in GREEN. 6.34.9 The EMD can shift between these codes by using their cursor or the arrow keys on the keyboard. 6.34.10 The choice of codes may become evident during the Key Question sequence. If all Key Questions have been answered and there is a further available code, the SEND icon in ProQA will flash YELLOW. The Call Handler will click on this icon (as shown in Fig 1) to show all available codes and make the appropriate selection. Alternatively, the RECONFIGURE icon (figure 2) can also be clicked on to show the available codes. Figure 1 Figure 2 6.34.11 The following example demonstrates the Shift Function in ProQA: A 25 year old female is in labour with her first child. Her delivery is imminent (contractions less than 2 minutes apart). She has a serious bleed and a bleeding disorder. Figure 3 EEAST HEOC SOG_V1.0 Page 51 of 143
There are three relevant determinant codes: the delivery is imminent (D-3), she has a 3rd Trimester bleed (D-4) and high risk complications (D-5). ProQA automatically selects 24-D-03 (highlighted in green) because it is the highest in the numbered sequence. The response priority is written beside this and will allow the Call Handler to select the highest response category (which is not always the highest determinant code). 6.34.12 Any code that says Override should NEVER be selected. This function has NOT been authorised for use by the East of England Ambulance Service NHS Trust. Please note: due to the size of the ProQA screen, if not all the determinants in a level are in view, the Call Handler will need to scroll down to ensure that any codes highlighted in yellow are not missed. 6.34.13 The Call Handler receiving the call (regardless of whether they are a Call Handler, Call Handler Team Leader or Duty Manager) is responsible for following this procedure. 6.34.14 When there is more than one response category available, the EMD must always select the highest UK response Category available to them. This ensures that the patient receives the most appropriate and timely response, and that the correct resource is allocated. These responses will be clearly written next to the MPDS codes. 6.34.15 The decision to shift must not be influenced by the availability of resources or distance from the responding units. 6.34.16 Dispatchers must be vigilant in checking the priorities of each call as this function will result in a shift in the priority of the call. This upgrading will typically occur during or after Key Questions and could be some minutes into the call, requiring a review of resources allocated/sent. 6.34.17 When the SHIFT function has been used the Call Handler must enter the keyword SHIFT into the comments field of I/CAD for auditing and reporting purposes. 6.34.18 The SHIFT function is only to be used by EMDs who have been trained in its use. Proper use of this function will ensure that the patient receives the most appropriate response and resource to meet their needs. There is a clear audit trail of the SHIFT function through the ProQA sequences section which shows every ProQA keystroke. Failure to shift when appropriate will have serious consequences for patient care and will be treated as non-compliance. Any concerns should be passed to the Audit Department for further investigation. EEAST HEOC SOG_V1.0 Page 52 of 143
6.35 Language Barriers and Language Line 6.35.1 Language Line is a service available to the trust to provide an interpreter when a language difficulty prevents the Call Handler from obtaining the address and other important information. The procedure for using this service is summarised in Appendix D. 6.35.2 On receipt of any emergency call where there are significant language difficulties, a resource must always be deployed to make a face to face assessment of the patient. 6.35.3 The Call Handler must ensure they have the caller s telephone number. If the Call Handler cannot confirm the caller s location they must speak with the Emergency Operator either to confirm the CLI or EISEC information or to request any details they may have of the caller. 6.35.4 The Call Handler must attempt to determine the caller s first language and complete Case Entry with all details entered as Unknown, then Select Protocol 32 Unknown Problem. 6.35.5 Question 1 will ask: Are there any special circumstances about this call? Select 3rd option down Language not understood (No interpreter in centre). This will generate a code of 32B04 Send through to dispatch. CONTACTING LANGUAGE LINE should be entered into the I/CAD remarks. 6.35.6 Dial Language Line on 0845 310 9900 Select Option 1 for telephone interpretation. 6.35.7 The operator at Language Line will ask you for the a Customer ID: State LIMA 30643 6.35.8 When asked for the name of the organisation: State EAST OF ENGLAND AMBULANCE SERVICE 6.35.9 When asked which language state: I NEED A 3 WAY CONVERSATION IN.. and state which language you require. EEAST HEOC SOG_V1.0 Page 53 of 143
6.35.10 When asked for a call reference number: Give the CAD number 6.35.11 When asked for a station/area: State (Which HEOC) 6.35.12 When asked for the phone number: Give the phone number in the caller details on I/CAD. 6.35.13 The Language Line operator will then advise to hold the line for the interpreter. Following this the interpreter will then come on the line and give their ID number. This needs to be logged in the remarks of I/CAD. 6.35.14 Once this is done state: HELLO INTERPRETER, THIS IS THE AMBULANCE SERVICE REQUIRING TRANSLATION ON AN EMERGENCY CALL. PLEASE TRANSLATE EXACTLY WHAT IS SAID AS EVERY WORD IS IMPORTANT. WHEN YOU ARE CONNECTED PLEASE ASK FOR THE ADDRESS OF THE EMERGENCY. OPERATOR, PLEASE CONNECT THE 3 WAY CALL. 6.35.15 The operator will then contact the original caller. You will hear the dialling tone. Once the call has been answered you will be able to hear both sides of the conversation. 6.35.16 Speak to the interpreter as if they were the caller, complete ProQA in the usual way, reconfiguring to the relevant code. 6.35.17 Once the call has been completed say PLEASE TELL THE CALLER TO HANG UP. 6.35.18 Once they have hung up say: THANK YOU INTERPRETER, WE CAN NOW CLEAR THE LINE. 6.36 Emergency Short Message Service (e-sms) for the Deaf and Hard of Hearing 6.36.1 The Emergency Short Message Service (e-sms) is for people who cannot make voice calls because they have hearing loss or speech impairment. It is a national service which provides direct access to all the UK s emergency services with over 4000 registered users. EEAST HEOC SOG_V1.0 Page 54 of 143
6.36.2 The SMS text message will connect to 999 through the Text Relay 18000 service. A Text Relay assistant will speak the SMS message to the CH, whose questions will be sent back to the caller as an SMS message. The number to text is 999, users must pre-register their phone before they can use the service. 6.36.3 Text Relay assistants will announce the call to BT 999 Advisors This is a message from the emergency SMS service through Text Relay, the message reads. ). The BT advisor will see the customer s mobile CLI on the screen and will be able to route the call to the correct Emergency Authority (EA) by using the normal EA Control Room numbers used for all 999 calls. 6.36.4 When the BT advisor connects the call to the HEOC they will clearly identify it as SMS originated by saying (Centre name) connecting an Emergency SMS text from (number). They will remain on the line to check that the Call Handler and the Text Relay assistant are speaking before relinquishing the call into the BT system as usual. 6.36.5 The Text Relay assistant will read out the initial SMS message to the Call Handler, who can then ask questions via the Text Relay assistant who will text questions back to the caller and then verbally pass responses back to the Call Handler. The HEOC will also receive the normal location information provided over the EISEC service that allows Call Handlers to automatically know the caller s approximate location. 6.36.6 The Call Handler should otherwise process the 999 call in the same way as any other call. 6.37 AMPDS Surveillance Tool 6.37.1 The Surveillance Tool within ProQA is used to identify patterns and trends around symptoms of a specific illness. The use of this tool will assist the Trust with pinpointing any geographical areas of large outbreaks of illness. 6.37.2 The Trust will notify Call Handlers when the surveillance tool is required to be used for monitoring of an identified illness. 6.37.3 When the tool is in use, the Call Handler accesses it after completion of key questions by clicking the orange circle with a V symbol in it, and asking the caller the listed questions. 6.38 Pandemic Flu (Card 36) 6.38.1 The Pandemic Flu procedure is activated by the Trust upon agreement with the wider health care community. Once activated, patients for protocols 6 (breathing problems), 10 (chest pain), 18 (headache) or 26 (sick person) chief EEAST HEOC SOG_V1.0 Page 55 of 143
complaints are assessed using card 36. Please refer to OI 122 - MPDS Protocol 36 (Pandemic Flu) for further information. 6.39 Aircraft Incidents at London Luton and London Stansted Airports 6.39.1 There are two large International Airports in the region, London Luton and London Stansted. The methods by which calls are passed to the Trust differ between the two airports but the procedure from then on is the same and is to be processed under MPDS Card 29. 6.39.2 The other (smaller) airports (i.e. Norwich and Southend) will call 999 and the call is to be processed under MPDS Card 29. 6.39.3 Types of Emergency Local Standby - An aircraft approaching the Airport is known, or is suspected, to have developed some defect which should not prevent the completion of a safe landing. Full Emergency - It is known that an aircraft is, or is suspected to be, in such difficulty that an accident is possible. Aircraft Imminent - Air crash is imminent. Aircraft Accident - An aircraft accident has occurred or is inevitable on, or in the vicinity of, the Airport. An aircraft which travels off the paved surface of the runway will be treated as an Accident. 6.39.4 Terminology Category A An incident involving an aircraft 24m 76m long; Category B An incident involving an aircraft 12m 23.9m long; Category C An incident involving an aircraft up to 11.9m long. 6.39.5 Rendezvous Point (RVP) - The point to which all emergency services attending one of these incidents report and therefore the event location for all such incidents. For London Luton, the Rendezvous Point (RVP) is: Airport Fire Station Airport Way Luton EEAST HEOC SOG_V1.0 Page 56 of 143
For London Stansted, the RVP is: RVP 1 (Opposite the Hilton Hotel) Round Coppice Road Stansted 6.39.6 Calls received from either airport tower, to a potential incident or aircraft accident can include the following information: Type of Emergency Category of Aircraft Nature of Defect Number of persons on Aircraft (sometimes referred to as souls ) Estimated time of arrival (ETA). 6.39.7 Calls from Luton airport tower will be received on the Omnicrash line which will be answered by the CHTL or HEOC Duty Manager. 6.39.8 Calls from Stansted tower will be received on the 999 lines answered by a member of the call handling team. 6.39.9 If the CHTL or Duty Manager needs to clarify any of the information from the Omnicrash call, they should complete the initial call and then call back the tower on 01582 482796. 6.39.10 Upon receiving any such call to incident at either airport, the Call Handler creates a new event with the RVP as the location, entering all the details given in the remarks of the event. The CHTL and HEOC Duty Manager must be made aware immediately. 6.39.11 Further information can be found in the Section 7.41 of the HEOC Dispatch Procedures. 6.40 CBRN and HAZMAT Incidents 6.40.1 Events including Chemical, Biological, Radiological or Nuclear (CBRN) or Hazardous Materials require specialist responses. 6.40.2 If a chemical incident call is received, the Call Handler must process the call via MPDS and at the end of key questions, use the essential HAZCHEM tool on ProQA to collate essential scene information. 6.40.3 The CHTL and Duty Manager must be informed of CBRN and HazMat incidents. EEAST HEOC SOG_V1.0 Page 57 of 143
6.40.4 The CHTL has responsibility for ensuring other emergency agencies are advised. 6.41 Bomb Threat or Terrorist Action 6.41.1 Should the Call Handler receive a telephoned bomb or terrorist threat, they should follow the advice given in Bomb Warnings, Suspect Devices and Security Advice (Appendix E). 6.41.2 The Call Handler must do everything possible to obtain the fullest information, using the Bomb Threat Proforma and Action Card 1. 6.41.3 Once the caller has cleared, the Call Handler must also complete Part 2 of the Proforma. All information must be logged in the event notes. 6.41.4 The Duty HEOC Manager must be made aware of all potential explosive device calls immediately. Only on their instructions should ambulance resources be deployed. 6.42 Major Incident 6.42.1 Refer to the Major Incident Plan (Appendix F) for full details of the Trust response; this includes action cards specifically for each role within HEOC (Appendix G). 6.42.2 If the Call Handler receives details of a potential major incident, the CHTL and HEOC Duty Manager must be informed immediately. 6.42.3 The Call Handler creates a new I/CAD event and processes the call in the usual way, adding all additional information in the event notes at the end of the call. The Call Handler uses Major Incident Action Card 21 (Appendix G) to obtain as much information as possible. 6.42.4 If there are no current casualties at the incident the Call Handler must process the call using the SEND protocol. 6.42.5 Should a Call Handler receive a Major Incident declaration, the full and correct details must be obtained using Major Incident Action card 20 (Appendix G), and all information entered into the event notes. The CHTL and HEOC Duty Manager must be advised immediately. 6.42.6 If the caller is from an emergency agency and they identify a rendezvous point (RVP), this should be taken as the location of the event and entered in the address field. Any further location details of the incident, if this is different to a RVP, should be entered into the notes in full. EEAST HEOC SOG_V1.0 Page 58 of 143
6.43 Call Handling and REAP Levels 6.43.1 The above call handling procedures apply to working within the usual range of expected pressures broadly associated with the Trust REAP Plan. However, in order that the Trust can respond to further increases in pressure, other mitigations may be implemented as described above. These may not all be implemented at once. EEAST HEOC SOG_V1.0 Page 59 of 143
SECTION 7 DISPATCH PROCEDURES EEAST HEOC SOG_V1.0 Page 60 of 143
7 Dispatch Procedures 7.1 General Rules for Dispatching 7.1.1 It is essential that all Dispatchers are thoroughly familiar with the Resource Allocation & Dispatch Guidelines SOG 4.0 V11.0 and Dynamic Deployment SOG. 7.1.2 It is the responsibility of the Dispatcher to ensure that they have logged onto I/CAD and ICCS using their personal log in details; that the systems are set up correctly for the node that they are covering and that the previous dispatcher has signed off. 7.1.3 A short but concise handover should be taken from the off-going dispatcher with regards to current events and resource status in addition to any relevant issues from the previous shift. 7.1.4 Ensure that all Trust resources are logged on and set up correctly in the I/CAD (including confirmation and set up of appropriate shift and rest break times and verification of staff names and ESR/PIN numbers). 7.1.5 Check that all Community First Responders are logged on correctly on I/CAD if they are available and are showing in their correct location. 7.1.6 Dispatchers must ensure, where possible, crews are stood down within the rest break window. It is also the responsibility of the Dispatcher to ensure that crews finish on time at their base station (subject to emergency events). 7.1.7 Dispatchers must proactively escalate potential hospital delays, high activity and other service pressures (i.e. staffing) to the Dispatch Team Leaders. It is then the responsibility of the DTLs to inform the HEOC Duty Manager in line with the Trust s Resource Escalation Action Plan (REAP) (Appendix B). 7.1.8 All Dispatchers must immediately advise the Dispatch Team Leader of any A8 or A19 incident that will potentially be out of standard. 7.1.9 All Dispatchers must add information regarding dispatch related decisions relevant to a particular emergency into the remarks field of that event. Reasons for all events that are out of standard must also be logged within the remarks field to ensure a full audit trail of the decision making process for each event exists. 7.1.10 When utilising the Digital Radio system, correct radio procedure including the use of the phonetic alphabet must be adhered to at all times. 7.1.11 The Dispatcher is responsible for answering incoming radio and telephone calls from crews in a timely fashion. When the dispatcher is not available, the DTL must ensure that the lines are being answered. EEAST HEOC SOG_V1.0 Page 61 of 143
7.1.12 If a priority radio or telephone call is received, the Dispatcher/DTL must respond to this immediately. 7.1.13 Dispatchers/DTL s are to remain Ready on Symposium at all times unless engaged in a role that does not facilitate the taking of calls. 7.2 Pre-Alert Events 7.2.1 Pre-Alert is the early notification of the location of an incident, displayed on the Computer Aided Dispatch (I/CAD) system. This will normally be the address of the landline caller or for mobile telephones, an approximated area (mobile ellipse) based on the strength of signal at the mast location. Pre-Alert will therefore present a location before the Call Handler can ascertain the chief complaint. It is assumed that the patient has a life threatening condition until the telephone triage is completed. 7.2.2 In the event of a call originating from a mobile phone, the approximate location of a caller can be traced and plotted on the I/CAD mapping system using a mobile ellipse. The accuracy and geographical size of the mobile ellipse area plotted on the I/CAD map depends on how many mobile phone masts are in the mobile phone user s vicinity. I/CAD will indicate an accuracy percentage against the mobile ellipse plotted on the map. 7.2.3 The Dispatcher upon receipt of a Pre-Alert notification will allocate the nearest available on duty resource. In some instances resources may be co-located, for example a Double Staffed Ambulance (DSA) and a Rapid Response Vehicle (RRV). In this case, the RRV would normally be dispatched on Pre- Alert. Consideration should be given to mobile resources which may be a slightly greater distance from the location but will facilitate a quicker response (and/or specialist response) to scene as they are already travelling. 7.2.4 The responding resource at the Pre-Alert stage of the call will be dispatched to a geographical location with no other details known. Updates will be given to the responding resource via radio and/or MDT prior to arrival at scene. 7.2.5 If the dispatcher has allocated a unit to a Pre-Alert and there is a duplicate event with a confirmed location, the dispatcher must continue with the original event and the DTL uses the duplicate and cancel command for the second event. This will cancel the subsequent call but also cross-reference the two events. 7.2.6 If, for any reason, the Pre-Alert event does not update with a confirmed location e.g. call terminated before answer, and it is confirmed that the same caller has come back through on another line then the event location in the duplicate call should be inputted into the original Pre-Alert and the event abandoned. The dispatcher should continue with the original event as per Section 7.2.5 above. EEAST HEOC SOG_V1.0 Page 62 of 143
7.3 Regional Data Mobilisation/Activation System 7.3.1 Resources under all three HEOCs will now only receive data alerting for assignment to incidents. This is the data mobilisation system. Crews should be familiar with the current system of the radio alert and the need to push soft key 3 on the Airwave handset to acknowledge the alert. It is essential that crews press soft key 3 as soon as they receive the alert message so that HEOC are aware the message has been received. 7.3.2 All crews must have fully functional digital radios and must not under any circumstances swap them between vehicles and cars. 7.3.3 All vehicles must have a fully functional Terrafix MDT unit or Airwave set (see 7.3.4 (f) below). 7.3.4 Regional Operational Process: a) Emergency call is received into the HEOC b) Normal process undertaken for the dispatcher receiving call on prealert c) Dispatchers will assign the appropriate resource as per resource allocation guidelines. d) If the resource assigned is a unit with Terrafix / Airwave device no voice contact will be made. The unit will receive a data alert on their digital radio, push and hold soft key 3 to acknowledge the alert and proceed immediately to the vehicle. Details of the incident will be available on Terrafix and Airwave digital radio sets. The unit will book mobile via the MDT and respond. Operational resources must not await verbal contact before mobilising toward the patient. e) If operational resources have any questions regarding the incidents and incident updates sent via data they can contact HEOC by voice utilising the request to speak function on Airwave digital radio. Data updates are automatically sent to responding resources via MDT as the call progresses. f) If the resource assigned is not a Terrafix / Airwave unit voice contact will be made immediately by the dispatcher. Crews on a non Terrafix vehicle (or a vehicle where the MDT is defective) that receive an incident via the Airwave digital radio, must immediately mobilise to the incident and contact HEOC by voice to confirm mobile. g) RRV s must be initially activated to incidents via data but dispatchers must provide further incident updates via Airwave voice whilst the unit is mobile to the scene as they are unable to read the MDT. Where a EEAST HEOC SOG_V1.0 Page 63 of 143
manager is in an available status and HEOC wish to deploy them they must do so by voice to confirm they have received the alert as managers may not always be with the device. h) The dispatchers and Dispatch Team Leader (DTL) in HEOC will observe units acknowledging messages via Airwave and booking mobile via MDT. i) Where dispatchers stand down a resource allocated to an incident they must do so by voice. Work is underway for NSC & Essex resources to receive a stand down message from the MDT in the same way as Beds/Herts resources and this is anticipated for delivery very soon. j) If at any stage the dispatcher or DTL believe a unit may not be responding correctly immediate voice contact must be established to ensure a safe response to all patients is maintained. k) If at any stage a crew experience any problems or have any concerns they should make immediate voice contact with the dispatcher via Airwave. l) If any crew is aware of a resource/vehicle that does not receive data alerting please immediately notify the DTL/HEOC Manager who will if required inform the IT department (ITPMO@eastamb.nhs.uk) for an amendment to the system to be made. 7.4 Resource Allocation and Dispatch Deployment & Back up to Rapid Response Vehicles (RRVs) 7.4.1 (RRV in this instance also refers to Operational Managers/Single Staffed Resource). The deployment of RRVs is essential to being utilised primarily on RED 1/2 incidents within a 6 minute 3 mile drive time of their deployment point/ location. RRVs will be pre mobilised to incidents on pre alert stage within their drive zone. If the incident once coded is not a RED incident they will be stood down. If the incident is a RED 1* the RRV will be left to run. If the incident is a RED 2 and is more than 6 minutes or 3 miles from their location and a DSA is available within 15 minutes of the patient the RRV will be stood down**. This will be the key principle of RRV deployment. (* = Cardiac arrest/confirmed unconscious or with ineffective breathing). (**The RRV will be left to run on RED 2 incidents as listed in Section 7.4.7 if the clinical qualification of the DSA crew is lower than that of the RRV in line with Sections 7.4.8 and Section 7.22) EEAST HEOC SOG_V1.0 Page 64 of 143
7.4.2 The Dispatch Team Leaders will be able to override this procedure in conjunction with the Duty Manager and leave RRVs running where they believe it appropriate. 7.4.3 If an incident is subsequently coded as a G1 incident then the RRV should be stood down if a DSA is available within a 20 minute drive time. 7.4.4 If an incident is coded as a G2 incident then the RRV should be stood down if a DSA is available within a 30 minute drive time. 7.4.5 RRVs can be utilised for G1 and G2 incidents at the discretion of the Duty Manager especially in rural areas or where DSAs may not be available. Those Duty Managers who do not have a clinical background should consider advice from the Clinical Coordinators if appropriate. 7.4.6 When a call is categorised as a Green 3 or 4 (requiring a telephone assessment within 20 or 60 minutes respectively) the responding resource will be stood down. 7.4.7 Solo responders (clinically qualified) will be deployed to all calls without immediate back-up on Pre-Alert or before an MPDS determinant code. The role of the single responder (clinically qualified) is to attend as a solo responder wherever possible and undertake a clinical assessment of the patient to identify the most appropriate care pathway. An RRV will be automatically backed up by the nearest available DSA on the following chief complaints that are coded as a Category A (Red 1 and 2). 9 Cardiac or Respiratory Arrest 10 Chest Pain (Non-Traumatic) 11 Choking 28 Stroke (CVA) 24 Pregnancy/Child Birth/Miscarriage Other than the above listed criteria, RRV clinicians are to assume that no back up is en-route and that they must pro-actively advise HEOC of the type of back up required on every single incident as soon as they have made a primary assessment and established what is required. This will ensure that back up is available for those RRVs who need it urgently and not responding to RRVs that do not require it. 7.4.8 Paramedical skills should be dispatched immediately to support a nonparamedic response to all Category A (Red 1 and 2) calls described in Section 7.4.7. In all other cases when a non-paramedic resource is dispatched, paramedic assistance should be requested from the scene. EEAST HEOC SOG_V1.0 Page 65 of 143
Consideration should be given to the location of the nearest paramedic and proximity to definitive care. 7.4.9 Once a solo responder is backed up by a transporting resource, the solo responder should (where clinically appropriate) complete the handover to the crew and commence withdrawal to enable them to clear scene in a timely manner to ensure they are available for the next emergency call. 7.4.10 Back up requested procedure; KEYWORD to be entered into I/CAD notes by dispatcher. HOT1 Immediate Back Up No Divert (under emergency conditions (KEYWORD HOT1) This request should only be used by a solo clinician for a time critical patient who requires immediate intervention at the receiving acute unit (e.g periarrest/resus/ppci/hyper acute stroke unit). DSA Back up will be sent and will NOT diverted unless a for a confirmed cardiac arrest call or to a Category A (R1/R2) incident with no East of England Trust resource on scene. The backup DSA may be stood down if another DSA has become available closer. Solo clinicians to request HOT1 back up via Airwave priority request for speech. HOT2 Hot Response Divertible (under emergency conditions) (KEYWORD HOT2) DSA to be allocated but can be diverted for a Category A (R1/R2) priority incident or a HOT1 backup request. Once the solo clinician has been waiting more than 30 minutes for back up the next available resource which is dispatched will default to a HOT1 backup. COLD3 Cold Response Divertible (Under non-emergency conditions) (KEYWORD COLD3) This request is for non-time critical patients who require transport to hospital for further investigation but, for whatever reason, cannot be reprioritised to an urgent pickup request e.g. dementia patient with no responsible person present, or do not require transportation (fall assist only). Every effort should be made to allocate an Intermediate Tier/PAS/VAS resource to these requests. Every effort will be made not to send solo clinicians to patients fallen and who are still on the floor. This backup can be diverted if required e.g. it is the nearest response to an emergency call or for a HOT1/HOT2 request. EEAST HEOC SOG_V1.0 Page 66 of 143
REPRI4 Reprioritisation to HCP Referral (Dr s Urgent) - Divertible (Under non-emergency conditions) (KEYWORD REPRI4) (See also Section 7.11) Solo responder to request the incident is re booked as an HCP referral, 120, 180 or 240 minutes pick up. The solo clinician will also advise HEOC as to the most appropriate skill level to transport. In the majority of cases it is expected that Intermediate Tier/PAS/VAS resource will transport. 999 calls will not be reprioritised for a response of less than 120 minutes. HCP Referral calls are to be monitored to ensure that the agreed pick-up time is not exceeded. Comfort calls and clinical call backs to take place in line with existing instructions and upgraded if appropriate. NOBUP5 No Back Up Required (KEYWORD NOBUP5) If the patient is assessed by a solo responder (clinically qualified) as not requiring transport then the solo should contact the HEOC at the nearest available opportunity and advise them that no backup is required and that they are dealing on scene. 7.4.11 If the skill level on the transporting resource (e.g. DSA) requires the solo responder to travel with the patient because of the clinical skill level required then a member of the crew of the transporting resource should replace the RRV staff member where they are clinically qualified to do so. The conveying resource must have the suitable specification and equipment to transport the patient safely. The RRV should not normally then follow the DSA but the DTL has the discretion to minimise disruption by requesting the RRV to follow to the treatment centre. 7.4.12 Solo responders will only transport patients to hospital where it is clinically safe to do so and in exceptional circumstances, and when HEOC confirms that no suitable alternative transport arrangements can be made available within an acceptable period. The clinician should not convey patients where they pose a risk of bodily fluid contamination during conveyance. Safeguarding issues should also be considered and advice sought from the clinical advice line as required. 7.5 Request for Backup Process 7.5.1 HEOC Dispatchers are able to select the priority of backup transportation in line with the Resource Allocation & Dispatch Guidelines. The use of RRV in following instances relates to any Trust solo responder (RRV/SSA/Officer). 7.5.2 The use of RRV in following instances relates to any Trust solo responder (RRV/SSA/Officer). EEAST HEOC SOG_V1.0 Page 67 of 143
7.5.3 Once an RRV is booked At Scene of an incident then the clinician is responsible for requesting the priority of the backup required based on clinical need. 7.5.4 The Dispatcher can select the priority of backup by right-clicking on the resource in the Committed tab of the Unit/Event Status Screen (formerly Request for Transport ) 7.5.5 Dependent on the priority of backup request chosen this will change the colour of the resource on the Committed screen to one of the following: EEAST HEOC SOG_V1.0 Page 68 of 143
7.5.6 This will also change the Status of the unit within the I/Dispatcher Event Information screen. 7.5.7 Within the I/Dispatcher Event Information screen the Request for Backup will also be automatically Time Stamped into the I/CAD remarks 7.5.8 The colour of the resource icon on the I/CAD mapping will also change to match the priority of the backup request. HOT1 HOT2 COLD3 REPRI4 NOBUP5 (H1) (H2) (C3) (R4) (NB) 7.5.9 Once the Backup resource has arrived on scene - it will be necessary for the Dispatcher to re-book the RRV At Scene. I/CAD will not automatically do this and is necessary to enable the Dispatcher to differentiate between an RRV still requiring backup and an RRV whose backup has arrived. 7.5.10 This should form part of a Dispatcher s normal function of reviewing their events. EEAST HEOC SOG_V1.0 Page 69 of 143
7.6 Mobilisation 7.6.1 In order to assist operational staff to achieve mobilisation within 45 seconds of allocation to an emergency call, Dispatchers must ensure that they communicate enough information to enable units to go mobile to the emergency without delay whilst the MDT is updating. This should consist of a confirmed location or an approximate geographical area to head towards. 7.6.2 Any anticipated delays in mobilising must be brought to the attention of the DTL or the HEOC Duty Manager and clearly documented in the remarks of I/CAD with the resource callsign and reason given. E.g. (Callsign) delayed due to (reason) NOT (Callsign) delayed. 7.6.3 Operational crews are not to book delays mobilising due to crew changes before end of shift finish. Whilst crews are permitted time to conduct Mandatory Vehicle Checks at the commencement of their shift this does not apply to crews taking over early from off-going crews. If this is the case the oncoming crew forfeits this time and must mobilise without delay to the emergency call. The Mandatory Vehicle Checks can then be completed at the next available opportunity. 7.6.4 If a unit fails to mobilise within the 45 seconds mobilisation target the Dispatcher must bring this to the attention of the DTL or HEOC DM who must pass the delay to the appropriate DOM to investigate. 7.6.5 The Dispatcher must communicate to the unit any risks or scene safety related information associated with the event (see Section 7.8 below) and an acknowledgement must be received from the solo responder or crew. 7.6.6 Solo responders should be verbally updated in addition to the MDT update, once mobile on an incident in order that they do not need to read their MDT screen whilst driving. 7.6.7 Units which do not have a full MDT for passing all information relating to the incident must be contacted verbally to ensure they have received the incident and to pass further details. This must include a map reference for the location. 7.6.8 Dispatchers must not manually book units mobile on I/CAD, unless the vehicle is either not fitted with or has a defective MDT and only once voice contact has been made with the crew who have confirmed they are mobile to the event. This should be documented in the remarks of I/CAD e.g. (Callsign) confirmed mobile at (time) on ICCS (channel). 7.6.9 For HCP (Card 35) Urgent events only, Dispatchers should only verbally communicate the details of the event that the crews will not receive on their MDT. EEAST HEOC SOG_V1.0 Page 70 of 143
7.7 General Broadcasts 7.7.1 General Broadcasts (GB s) are defined as open channel radio transmissions broadcast on one or more Airwave talkgroup(s) by a HEOC to make operational resources aware of a particular issue. 7.7.2 General Broadcasts can be considered either routine, crew requests or non-routine. Examples of routine General Broadcasts: R1/R2 incident unlikely to be achieved in A8/A19 standard Un-resourced emergency event Examples of General Broadcasts (crew requests): Solo clinician requesting HOT1 backup Solo clinician requesting additional clinical assistance (paramedic backup) Examples of non-routine General Broadcasts: Hospital Diverts Critical Systems failures (Loss of I/CAD, paper working) Road closures 7.7.3 General Broadcasts should be conducted in a concise manner and must not contain any potentially identifiable patient information but should detail location down to street level to enable a resource to determine if they are potentially nearer to an incident than a resource that has been assigned. Patient age or gender should not be specified in the General Broadcast: Examples: General Broadcast Red 2 Chest Pain, Main Street, Anytown. Currently running an RRV from Anytown station. Any vehicle nearer, or able to render aid please contact HEOC. General Broadcast Solo requesting HOT 1 backup for patient fitting in Main Street, Anytown. Any DSA able to assist please contact HEOC. 7.7.4 It should be noted that every time a General Broadcast is conducted, a significant number of Airwave masts are utilised and a proportion of allocated transmission bandwidth is consumed. This has implications for the Trust should this bandwidth be exceeded. It is therefore important that General EEAST HEOC SOG_V1.0 Page 71 of 143
Broadcasts are utilised for all routine and crew requests but that non-routine broadcasts are kept to a minimum. 7.8 Dispatchers Responsibilities for Scene Safety 7.8.1 Dangerous or volatile situations at events may have health and safety implications for responders. Therefore, the Dispatcher must reduce this risk by considering the following questions and advising the responder of the answers: Are there any Special Situations flagged against the address? (Section 7.34) Is there any information from the Call Handler/CAD notes that may indicate a danger? Is the area potentially dangerous? Is the location itself a potentially volatile setting? Were weapons involved or violence identified? Is there a HAZMAT or CRBN risk? 7.8.2 Solo responders are especially vulnerable when attending any incident where there is a potential perceived risk of violence/aggression and will usually identify with Dispatchers a safe point at which to wait until back up arrives or confirmation that the scene is now safe i.e. Police in attendance. 7.9 Event Monitoring 7.9.1 Dispatchers must monitor all emergency events and the alert messages on I/CAD for an update to ensure that appropriate resources have been sent to an event and they have received all relevant event messages. These could include updates regarding scene safety, door access codes, key holder information or notifications of police on scene etc. 7.9.2 It is the Dispatcher s responsibility to act immediately to either a verbal report of assault from a unit or when an Emergency Alarm message is received via I/CAD or the ICCS systems (Appendix I). 7.9.3 On activation of the Emergency Alarm on Airwave the activated handset or terminal will transmit on its relevant talkgroup Open Channel for a period of 10 seconds during which time all other transmissions are blocked. 7.9.4 On receipt of either - the Dispatcher must immediately do the following: EEAST HEOC SOG_V1.0 Page 72 of 143
Respond (Callsign) acknowledged Arrange for a Police response to unit location, unless the crew confirms a false alarm. Advise the HEOC Duty Manager 7.10 G1 G4 Events 7.10.1 The Trust response to events coded as Green 1 or Green 2 is to deploy an operational response to arrive within a time frame of 20 minutes and 30 minutes respectively in line with Resource Allocation & Dispatch Guidelines. 7.10.2 The Trust response to events coded as PSIAM coded Green 3 or Green 4 is to pass them to the Clinical Support Desk for secondary clinical triage and to stand down the allocated resources. 7.10.3 However, there are a number of exclusions and these events will require an operational response as follows: Events coded as G3 & G4 not accepted by PSIAM Where a potential clinical risk has been identified and secondary triage by Clinical Support Desk deemed not suitable 7.10.4 Should a G3 or G4 event time out of the PSIAM stack after a pre-determined time period for any reason then it must be resourced and upgraded to a P4 (G2) by the HEOC Duty Manager or a Clinical Coordinator. 7.10.5 The Clinical Advisor may choose to call the patient simultaneously and decide to stand down the allocated resources having made contact with the patient. 7.11 Reprioritisation of Emergency Events 7.11.1 Reprioritisation allows solo responder ECPs and paramedics to reprioritise a 999 call as an Urgent event. (See also Section 7.4.10 REPRI4) 7.11.2 Reprioritisation also allows Trust resources on scene of an incident to request an ECP visit. 7.11.3 When a Trust solo responder arrives on scene of an emergency event and following a clinical assessment requires the patient to be transported within an agreed timeframe then the call is to be reprioritized as an Urgent event. 7.11.4 The solo responder will contact the Dispatcher to request the journey to be booked on I/CAD and agree appropriate time parameters (normally up to 4 EEAST HEOC SOG_V1.0 Page 73 of 143
hours). The Dispatcher must ask if a PAS/VAS/NES resource would be appropriate. 7.11.5 It is the Dispatcher s responsibility to ascertain the following information and pass to the Dispatch Team Leader to book create an event on the I/CAD system: Patient Name Patient Address D.O.B Contact Telephone Number Diagnosis 7.11.6 When a Trust resource (DSA/SSA/RRV) arrives on scene at an emergency event and following a clinical assessment, concludes it appropriate for an ECP assessment then they should either contact an ECP directly or request the HEOC to gain contact details of an ECP in order to discuss the patient. 7.11.7 If an ECP is not available to discuss the case then the resource may need to make other arrangements to speak with the Clinical Advisor on duty to discuss the patient s care or Clinical Coordinator. 7.11.8 Only once the case has been discussed and agreed with an ECP should the resource contact the HEOC and request the call to be reprioritised and booked as an ECP visit. 7.11.9 The Trust resource should then contact the Dispatcher to request the ECP visit to be booked on I/CAD and agree appropriate time parameters (normally within 2 hours). 7.11.10 It is the Dispatcher s responsibility to ascertain the following information and pass to the Dispatch Team Leader to book create an event on the I/CAD system: Patient Name Patient Address D.O.B Contact Telephone Number Diagnosis Name/Callsign of ECP who agreed visit 7.11.11 Once an ECP is available then the dispatcher will allocate the call as per normal dispatch function. EEAST HEOC SOG_V1.0 Page 74 of 143
7.11.12 It is the DTL s responsibility to ensure the event is reprioritised with the required patient details and supporting information inputted onto I/CAD as detailed above. 7.12 Dynamic Deployment of Resources and System Status Plan (SSP/SSM) 7.12.1 When not required to respond to an event, each available unit will be deployed to provide emergency cover in accordance with the System Status Plan for that area and in line with the Trust Dynamic Deployment SOG. The dispatcher must take into account operational cover levels as well as staff rest breaks and finish times. 7.12.2 It is the Dispatcher s responsibility to be aware of and follow the Trust s deployment plan and to use the I/CAD System Status Plan to ensure deployment points are covered according to their priority. 7.12.3 Consideration should be given to moving units into other nodes if required. The DTLs will be responsible for co-ordinating this. 7.12.4 Units will usually be expected to be ready for deployment 15 minutes from their shift start time and, those resources that operate from a designated dynamic activation point, should self-mobilise without instruction to their designated point within 10 minutes of the commencement of their shift. 7.12.5 SYSTEM STATUS PLAN The system status monitor is a new form that is attached to I/CAD, it will appear when you log into CAD. This window will show you your System Status Plan or your DAPS (Dynamic Activation Points) for the area you are working on for that shift. The dialog comes up empty, however the Active Plans: drop-down list is populated with the current active SSP plans filtered by the current I/CAD user s Dispatch Area. Selecting a plan will allow the user to start to monitor that plan. EEAST HEOC SOG_V1.0 Page 75 of 143
The top of the window is the system status plan in priority order. Colours denote the status of a DAP RED DAP IS UNCOVERED ORANGE UNIT IS ON ROUTE TO DAP GREEN DAP IS COVERED GREY YOU DO NOT HAVE ENOUGH AVAILABLE UNITS TO COVER THIS DAP DAP S are defined by 3 different types Normal side of road with no facilities max time 45minutes Social Stand by DAP with facilities Stand By Ambulance stations The bottom of the window is a list of all the units that are in the plan that are available for you to use, showing the callsign, type of unit, status, location. The window does not show any out of service units, except units that are on a disturbable break. The colours for the unit status are the same as CAD. DARK GREEN AT BASE/COVER LIGHT GREEN MOBILE The system represents the available units that are in the plan in order of crow-flies distance, with the nearest at the top. EEAST HEOC SOG_V1.0 Page 76 of 143
This window also shows the time since a unit s last event, this clock will count up from the time they were cleared from their last event. The top right hand corner of the window is where you choose which plan you are going to use for your shift. Active Plan will bring a drop down menu of all the System Status Plans for you to choose from. Show all plan stations must always be ticked to show all of your DAP S Auto Display will display your DAP S on the map Display - will display your DAP S on the map Undisplay your DAP S will not be displayed on the map Undisplay all your DAP S will not be displayed on the map Plan Compliance shows if the dispatcher is compliant in covering all of their DAP S Regional Plan Compliance shows if the HEOC is compliant Recommend will recommend the nearest unit to send to the chosen DAP Other Units will show other unit s that are not in your plan to send to the chosen DAP Reset - Pressing the button marked Reset will reset the unit list view to show only those units that are in the current plan, available for dispatch and not in DS, MS or SB statuses. The reset button has to be pressed after every command 7.12.6 HOW TO SEND A UNIT TO A COVER POINT Highlight the DAP using left click on the mouse that you wish to send a unit to Right click on the unit you wish to send choose option stand by Click Ok on the pop up box to confirm the correct unit to the correct DAP EEAST HEOC SOG_V1.0 Page 77 of 143
The status of the unit will change to DS dispatched status; book the unit Mobile to stand by. If the unit is at its base station and this is a DAP you have to book it to stand by for the SSM to recognise that the DAP has been covered. If you do not book it at stand by this will show as a non compliance. Right click on the unit you wish to send choose option standby to current, i.e. Thurrock to standby at Thurrock station, book the unit at stand by point now the SSM will recognise that that DAP is now covered If you have more than one unit at a DAP i.e. Thurrock station and one of you other point becomes uncovered, because they are already at a DAP you have to go to your other units button to move them from one DAP to another. AFTER EVERY COMMAND YOU MUST USE THE RESET BUTTON ( TOP RIGHT) TO RESET ALL OF YOUR WINDOW TO SHOW THE RESOURCES NOW AVAILABLE TO YOU 7.12.7 TO ADD OR REMOVE A UNIT FROM YOUR PLAN If you have extra resources available to you they will not be included into your System Status Plan, you will have to add them in, and we suggest that when you log your unit you add them into your SSP at the same time (as one process) EEAST HEOC SOG_V1.0 Page 78 of 143
Go to your other units and locate the unit you wish to add to your plan, right click on the unit and choose option PLANNED, this will add the chosen unit to the plan you are using at that time. You may need to take a unit out of your plan for whatever reason. To remove a unit from your SSP right click on the unit and choose the option NON-PLANNED, this will remove the unit from the plan you are using at that time and put this chosen unit into the other units screen. 7.12.8 Any difficulties or dispute regarding deployment should be referred to the DTL or HEOC Duty Manager. 7.13 Running Calls 7.13.1 In the event that a Trust resource initiates a running call by coming across an emergency event or being approached by a patient requiring assistance directly, they will either use their running call button on the MDT or verbally contact HEOC. 7.13.2 A DTL or HEOC DM should create a new emergency event on I/CAD by selecting the Type as RC (Running Call). The attending unit should be booked booked mobile and on scene at the event at the time of the original notification from the responder. 7.13.3 If the resource initiating a running call is already at the scene of an incident e.g. a second patient, then the resource should be Dispatch Assigned as per Section 7.15 below. 7.13.4 Brief details of the nature of the call should be entered in the I/CAD remarks along with the origin details. 7.14 Hospital Transfer Procedure (Card 35) 7.14.1 The Trust receives a variety of calls from healthcare facilities which are currently coded as Card 35 and if graded as R2 require a transportable response on scene within 19 minutes. There are occasions where ambulance resources are delayed offloading patients at Acute Trusts requiring an immediate transfer. In these cases the following should apply (Appendix J). 7.14.2 Calls received from Acute Trusts requiring transfer: The dispatcher should assign the closest available DSA to the hospital requesting transfer. The call will then be reviewed for a closer resource. In this case a DSA will be deemed available for the transfer if it: EEAST HEOC SOG_V1.0 Page 79 of 143
has been at that hospital for more than 20 minutes is not overdue its meal break is not due a meal break within 30 minutes there are no clinical reasons for extended out of service delays Is not due shift end within 30 minutes 7.14.3 If there are delays at hospital and there is a Trust manager on site, they will be assigned to the incident to attend the department requesting transfer and liaise with the appropriate hospital staff to inform them a DSA needs to be freed to facilitate the transfer and identify an appropriate resource. The Trust manager on site will then confirm this with HEOC Duty Manager. 7.14.4 In this case the DSA at hospital will be allocated. 7.14.5 The specific process will be as follows: A dummy call sign will be utilised to avoid problems with multiple assignments and impacting on hospital waiting time. The dummy call sign (EDxxx, NDxxx, BDxxx) will be set up as singleton transport resource so that it remains on the pending stack in the HEOC. This will ensure clinical safety in terms of avoiding delayed transfers. The crew will be notified that there is an emergency transfer pending and that they have been assigned to this. Specific notes will be entered within the I/CAD notes (see flowchart Appendix J) The hospital will be informed of the resource location using a predefined script 7.14.6 If it is known that the Acute Trust cannot take hand over of the patient, the department requesting transfer should be informed that the DSA is available for the call once the patient is offloaded. The Trust should be informed that they should escalate internally if they are unable to release the crew for the pending transfer. 7.14.7 If there is a delay of more than 19 minutes (from time of call) in the crew being released to facilitate the pending transfer, the local DOM should be informed and asked to contact the hospital to agree a resolution. 7.15 Dispatch Assign 7.15.1 If a Trust resource is already on scene of an incident and requests a Running Call (Section 7.13) e.g. a second patient - then the requesting vehicle must be EEAST HEOC SOG_V1.0 Page 80 of 143
Dispatch Assigned to the second incident as described below. This ensures that the correct resource is booked on the incident and to ensure that the incident is reported on correctly. 7.15.2 A Running Call should be entered on I/CAD in the normal way: The unit should then be dispatched to the event either by dragging and dropping the unit from the Committed tab of the Unit/Event Status onto the Running Call event or by right-clicking on the unit and selecting Dispatch with the Running Call open in the Event Information screen: 7.15.3 Following Dispatch a Pre-empt Box will appear: EEAST HEOC SOG_V1.0 Page 81 of 143
The Dispatch Assign Event to Unit box must be checked. DO NOT check or tick any other option. 7.15.4 This will now Dispatch the unit to the Running Call and Dispatch Assign to the original incident. 7.15.5 The Unit will now need to be manually booked Mobile and At scene of the Running Call event: 7.15.6 If the Running Call requires a transportable resource then this should be dispatched as normal. 7.15.7 Once the unit that is Rendering Aid is cleared from the Running Call then it should be booked Clear However, presently this will book the unit Clear of both events. The unit must now be reassigned to its original event. 7.15.8 There needs to be a heightened awareness of time verification on these calls to ensure that all the times have been correctly recorded. 7.16 Dispatch Responsibilities for Card 35 HCP Admissions 7.16.1 It is the responsibility of the dispatcher to monitor any unassigned HCP Protocol 35 Urgent request within their geographical dispatch sector and to ensure that the HCP admission performance standards are met. EEAST HEOC SOG_V1.0 Page 82 of 143
7.16.2 Card 35 Urgent admission requests should be targeted in the first instance for PAS/VAS resources that are booked on duty. 7.16.3 The maximum time given to be with the patient is based on the patient s clinical condition and would have been determined at the time of the call by the HCP. 7.16.4 The Dispatcher will highlight to the DTL if they are unable to allocate a resource to a HCP urgent within the last 30 minutes of the allocated appointment time or a Cat C response outstanding >45 minutes. This action will be noted in the event by the dispatcher. The DTL will review all resources for a response and enter any actions taken into the CAD. If the DTL is unable to resource the call they must bring this to the attention of the Duty Manager, again this need to be entered in the CAD. 7.17 Upgrading of Events on I/CAD (See also Section 7.29 Duplicate Events on I/CAD) 7.17.1 There may be the requirement to upgrade the responding priority of an event on I/CAD. This may be due to the clinical need of the patient (e.g. following an Urgent welfare call where the patient has deteriorated) or due to a second call for the same event which is of a higher priority. 7.17.2 The process for manually upgrading the I/CAD Priority of an event is shown below. (The process shown below relates to the upgrading of an Urgent event (P7) but applies equally to any event priority). 7.17.3 In I/CAD Select Update Mode: Right Click on the priority of the event (P7 above) and amend to match the priority of the second incident: EEAST HEOC SOG_V1.0 Page 83 of 143
Once the Priority has been changed Select Reason Code Other (Details Required) Enter Remarks into I/CAD and Accept Event 7.17.4 The user must then cancel the second event as a duplicate using the Duplicate and Cancel event command. 7.17.5 All actions must be noted in the I/CAD remarks of the original event. 7.18 Dispatch Responsibilities for Unassigned Incidents 7.18.1 Dispatchers must monitor the events in their Dispatch Group and immediately notify their Dispatch Team Leader of any unassigned emergency call. 7.18.2 Dispatchers must notify their Dispatch Team Leader if all the resources within their dispatch group are being utilised. 7.18.3 On notification that an emergency call is unassigned, the Dispatch Team Leader will review all resources within their Dispatch Group(s) and endeavour to make any resource available to respond. 7.18.4 Dispatch Team Leaders will ensure that a General Broadcast (Section 7.7) is made for any unassigned emergency event. 7.18.5 It must be clearly documented in the I/CAD remarks that the event is unassigned along with any plan for resourcing it. 7.18.6 The DTL will liaise with DTLs for other geographical dispatch areas to ascertain if there is any other resource available. 7.18.7 The DTL is responsible for escalating to the HEOC Duty Manager and/or Clinical Coordinator any unassigned event to ensure that there is a heightened awareness of these events and to ensure consistent monitoring and welfare calls if required. EEAST HEOC SOG_V1.0 Page 84 of 143
7.19 Setting up of Trust Officers on I/CAD 7.19.1 It is vital for resilience that the Trust is aware of the location of its Officers at all times when on duty, including when they are unavailable for routine response. 7.19.2 All officers who are allocated a call sign within the ICAD and have a Terrafix PDA device, or Airwave set, are required to be booked on ICAD whenever they are on duty. In the very near future officers with just Airwave will be tracked on ICAD in the same way as those with a Terrafix PDA. 7.19.3 When commencing duty, Officers are to contact the dispatcher of the area they are in via Airwave. Officers other than Ops GM s must not book on with HEOC via landline to the Duty Manager, AGM s requiring an update of their area should book on with the relevant Dispatcher and ask for the Dispatch Team Leader to make contact who will have a much better overview of the specific AGM area. All Officers must ensure that they are aware of the core A&E talk group channel numbers and the areas they cover. ESSEX TALKGROUPS NSC TALKGROUPS B&H TALKGROUPS Area Talk Group Area Talk Group Area Talk Group South East Essex 2 Norfolk West 9 North Beds 5 South West Essex 32 Norfolk Central 10 South Beds 6 South Mid Essex 65 Waveney 11 North East Herts 7 Mid Essex 64 Suffolk East 12 South East Herts 8 West Essex 4 Suffolk West 13 North West Herts 27 Colchester 31 Cambs South 14 South West Herts 28 Tendring 3 Cambs North/West 15 7.19.4 Officers will confirm they are on duty and advise HEOC of their availability level in line with the following; Level 1 Available to respond to any 999 incident and be utilised as an RRV. This status is for exceptional circumstances only and will normally be agreed in line with the Trusts REAP plans. Officers booking onto their own vehicle for a shift must be at level 1. Level 2 Available to respond to a RED (Category A) patient once coded that is within a 6 minute drive zone, where they are significantly closer than the nearest Trust core resource. Level 3 Unavailable to respond to any routine 999 calls. Will remain identified on the ICAD and tracked so the Trust is immediately aware of the location of all its on duty Officers should there be a major incident standby or declared or other very serious incident potentially requiring the assistance of an Officer. It is not the role of Trust Officers to respond routinely to incidents and therefore is the default position for Trust Officers. EEAST HEOC SOG_V1.0 Page 85 of 143
Officers are expected when booked on and mobile to their first destination, between meetings and returning home to be at Level 2 as often as possible. 7.19.5 HEOC Dispatch Team Leaders and Dispatchers will ensure that all Officers are booked onto ICAD correctly when on duty. Officers will call via Airwave when coming on duty and will speak to the dispatch area that they are operating in. They will be answered by the Dispatcher or Dispatch Team Leader but not the HEOC Duty Manager. Officers will book on duty at one of three pre-determined levels as set out above. The following describes what Dispatch staffs are required to do in ICAD for each availability level. Level 1 Available to respond to any 999 incident and be utilised as an RRV. This status is only for exceptional circumstances and will normally be agreed in line with the Trusts REAP plans. Officers booking onto their own vehicle for a shift must be at level 1. CAD Action - On ICAD this level of Officer would be set up as an RRV, which would make the resource recommendable to all category of calls Level 2 Available to respond to a RED (R1/R2) once coded that is within a 6 minute drive zone where they are significantly closer than the nearest Trust core resource. CAD Action - leave available as Officer: Officer will show in i Recommend for Category A calls only. Level 3 Unavailable to respond to any routine 999 calls but will remain identified on the ICAD and tracked so the Trust is immediately aware of the location of all its on duty Officers should there be a major incident standby or declared or other very serious incident potentially requiring the assistance of an Officer where there is no local DOM available. It is not the role of Trust Officers to respond routinely to incidents and therefore this is the default position for Trust Officers. CAD Action -- On ICAD this level of response would be set as an Officer and out of service in meeting status, not recommendable to any incident but still traceable on ICAD and shown on the map. 7.19.6 These arrangements will enable the Trust to make the best use of the technology available and also ensure that there are robust and resilient arrangements in place to deal with serious and major incidents. EEAST HEOC SOG_V1.0 Page 86 of 143
7.19.7 Going forward there will be further enhancements where Officers can book at a level for response from home and receive relevant Text alerts but not actually show on duty in the CAD should they wish to do so. 7.20 Community First Responders (CFRs) 7.20.1 Dispatchers are responsible for deploying community first responder s (CFRs). If the dispatcher is unable to e.g. due to demand then this should be passed to the DTL/HEOC DM. 7.20.2 It is important to remember and respect the fact that all CFRs are volunteers who are giving up their time to assist the Trust and serve their local community. 7.20.3 CFRs should be dispatched to all categories of emergency calls within their remit (Appendix K). 7.20.4 Dispatchers need to be aware that the CFRs will not appear on Closest unit/i Recommend on I/CAD 7.20.5 Dispatchers must ensure CFR s are backed up immediately by Trust Resources regardless of running time. If it is not possible to do so for any reason, or consideration is being given to diverting this back up, this must be drawn to the attention of the HEOC Duty Manager immediately 7.20.6 CFRs must be contacted to attend appropriate events by Dispatchers via telephone. Only once it has been confirmed that the CFR is attending should they be assigned on I/CAD. Those teams with Smart Phones/PDA s will receive details electronically also. 7.20.7 Community Responders do not have the authority to advise the HEOC that a Trust resource can be stood down from the incident nor can they downgrade an ambulance to a cold response. 7.20.8 It is also important that the Dispatcher makes verbal contact with a CFR after they have attended a 999 emergency in order to: Check on their welfare, particularly after they have attended a serious and/or distressing incident, which may have affected people the CFR personally knows within their locality. Thank them for their assistance. Verbally confirm with the CFR their attendance times and clear them from the event. Enter their times on I/CAD and book them back available at their location. EEAST HEOC SOG_V1.0 Page 87 of 143
7.20.9 In the event the CFR has attended a serious and/or distressing emergency (e.g. cardiac arrest) then the relevant Community Partnership Manager should be informed by the HEOC Duty Manager. 7.21 HEOC and Operational Staff Meal Breaks 7.21.1 Please refer to the current Meal Break arrangements that are available on the Intranet - Meal Break Arrangement V2 0 7.22 Deployment of Emergency Care Assistant (ECA) Crews 7.22.1 A full breakdown of the ECA Allocation and Deployment Guidelines, Scope of Practice and Deployment table is listed in Appendix L 7.22.2 A double ECA crew can be allocated to emergency calls as identified on the list of appropriate call types that is also used for Community First Responders. Deployment will be accompanied by the simultaneous mobilisation of the nearest qualified Trust resource (clinically qualified). If several resources are equidistant, it may be more appropriate to send a crew rather than an RRV to minimise the impact caused by committing two resources to the eventual transportation of the patient. It is essential that ECA crews are immediately backed up on emergency calls and, if the original back-up is diverted, then another qualified resource must be allocated as the ECA crew are not expected to make a clinical assessment prior to back up being allocated. 7.22.3 A double ECA crew can be allocated to Green 3 & 4 calls which have been assessed by a Clinical Advisor on the CSD without requiring back up by a qualified Trust resource (clinically qualified). For Green 1 & 2 calls which have only been triaged using MPDS, a qualified resource will also normally need to be allocated. It is important to note that a double ECA crew cannot stand themselves down on scene and leave a patient without further clinical assessment by a qualified Trust resource (clinically qualified) 7.22.4 A double ECA crew can be allocated to Health Care Professional (HCP) urgent calls and transfers with the exception of those where a defibrillator or cardiac monitoring may be required. The call handler taking the booking should be clear whether the patient will require monitoring or defibrillation and enter this into the notes to avoid inappropriate allocation of an ECA crew. 7.22.5 It is important to note that ECA crews work to red flag criteria, and if an ECA crew identifies such a criteria and requests back up, HEOC should instigate this without delay. EEAST HEOC SOG_V1.0 Page 88 of 143
7.22.6 When double ECA crews are allocated to an emergency call THEY MUST confirm their clinical skill level to the HEOC dispatcher. 7.23 Trust Vehicles/Staff Involved Directly in a Road Traffic Collision (RTC) 7.23.1 It is vital that, when a unit (including PAS/VAS) is involved in an RTC, the Dispatcher takes the following actions: - Immediately identifies exact location of incident and create an event on I/CAD with event type as Running Call Book the crew involved as Out of Service Identifies the number of vehicles involved Identifies any injuries to crew, patient and/or public. Immediately informs the DTL and HEOC Duty Manager The DTL is to ensure the police are called. If vehicle involved was en-route to an incident, immediately pre-empt the event and reallocate to the next available, most timely resource. In liaison with the HEOC Duty Manager and DTL, deploy the required resources to deal with the incident which would include a Duty Operations Manager in the first instance. The Dispatcher must hand-over the RTC incident to the DTL to coordinate, who must keep the HEOC Duty Manager updated. The HEOC Duty Manager in liaison with the Duty Operations Manager will decide whether to escalate further dependent on the incident. 7.24 Hospital Turnaround, Delays and Escalation 7.24.1 It is the expectation of the Trust that no patient conveyed to an acute receiving hospital should wait more than 15 minutes on an ambulance trolley/chair, before receiving clinical triage from a qualified member of staff and handover to the respective department. A clinical handover is not complete until the patient has been transferred from the ambulance trolley/chair enabling the ambulance crew to leave the patient in the care of the department. 7.24.2 Due to the risk to patient care and the Trusts emergency service provision it is imperative that any Acute Hospital delays are escalated by the HEOC in EEAST HEOC SOG_V1.0 Page 89 of 143
accordance with the Trust current escalation policies. SOG 1 - Minimising Delays and OI 130 - Handover at Hospital (staff actions). 7.24.3 Operational crews should contact HEOC via Digital Radio to book Out of Service Trolley Clear following handover. 7.24.4 Any resource at hospital for 20 minutes with no handover time should be called on the radio to confirm their status and details of any delays. 7.24.5 Any resource that has handed over without booking OOS within 5 minutes should be called on the radio to confirm their status and details of any delays. 7.24.6 The DTL should escalate any handover delays to a local Operational Manager as per the Hospital Delays Escalation card. 7.24.7 The DTL should escalate to the local Operational Manager any crew booking OOS >15 minutes without a reason being given and any crew that is not contactable. 7.24.8 Once the crew have booked Out of Service Trolley Clear the resource should immediately be cleared from the event on I/CAD and booked Out of Service Trolley Clear (15 minute default). 7.24.9 The Dispatcher should monitor the resource on I/CAD and, where possible, call on the radio after 10 minutes to confirm they will be available at the end of 15 minutes. 7.24.10 I/CAD will otherwise move the resource to a Clear and available status after 15 minutes. 7.24.11 The crew should advise the Dispatcher if they expect to be >15 minutes until they are available. 7.24.12 If crew advise they will not be available within 15 minutes confirm the reason why and book that resource Out of Service for that particular reason. 7.25 Abandoned Calls 7.25.1 Resources dispatched on a call that subsequently abandons must be left running if there is a confirmed address but told not to approach scene until full details have been gained. 7.25.2 Resources dispatched on a call that subsequently abandons but with no confirmed address may be stood down or requested to stand by pending call back by the Call Handling team. 7.25.3 If successful callback is achieved and confirmed that an ambulance is still required then the resource must be reassigned to the original call (now coded as Abandoned) in order to satisfy KA34 reporting requirements. EEAST HEOC SOG_V1.0 Page 90 of 143
7.25.4 A new event will be created and coded through ProQA. The verified address must be copied into the original abandoned event in order to update resource MDT and Sat-Nav systems and to ensure a comprehensive audit trail is followed. 7.25.5 It is the responsibility of the Dispatch Team Leader or HEOC Duty Manager to Duplicate and Cancel the second event into the original. 7.25.6 The I/CAD priority of the original event should be changed to match the priority of the second call. 7.26 Cross Border Incidents 7.26.1 This applies to all R1/R2 and G1/G2 incidents on the external borders (approximately within 20 minutes running time) shared with neighbouring authorities. 7.26.2 Emergency calls to locations at or near operating area borders (internal or external) present a higher than normal risk for both the patient and the ambulance service. These procedures are designed to ensure that the risk from a break in continuity of care in cross-border incidents is kept to a minimum and those patients in locations near borders receive no less quality of care than any other patient. 7.26.3 The HEOC receiving the initial emergency event (referred to here as the Receiving Trust ) is responsible for the provision of service to which it has been called until that responsibility has been handed over to the Host Trust. 7.26.4 The Receiving Trust is also responsible for reporting on the event. The HEOC primarily responsible for the geographical area in which an event is located (referred to here as the Host Trust ) will frequently have the nearest unit for an event. 7.26.5 An existing emergency takes precedence over a possible later emergency. Resources should therefore immediately be deployed to the existing emergency and not held back because local cover may be at risk. 7.26.6 When a cross border emergency call is received the Dispatcher must dispatch the nearest and most timely appropriate resource. 7.26.7 Subject to, and after clarification, that the Host Trust has an available and nearer resource and that resource has been mobilised, the Receiving Trust resource may be stood down by the Dispatcher. 7.26.8 If the Host Trust has no appropriate resource to respond, the Receiving Trust resource must continue to run to scene. 7.26.9 The Receiving Trust retains the right to divert their resource assigned to a cross border incident to a higher priority event within their service provision EEAST HEOC SOG_V1.0 Page 91 of 143
area. The Host Trust must be notified immediately in the event that the Receiving Trust divert their responding resource and if still unable to respond, the Receiving Trust must deploy the next nearest resource to the original event. 7.26.10 All information relating to a cross border incident must be entered onto I/CAD including details of conversations, operational responses actions and reasons for standing down responses so there is an accurate record of the Trust response to the emergency event. 7.27 Mutual Assistance for Near Boundary Incidents 7.27.1 This procedure applies to events which are received by the Trust and are within the Trust geographical boundaries but for which a neighbouring service may be able to provide a nearer and more timely response. 7.27.2 The Trust Dispatcher must ensure the nearest and most timely resource is deployed without delay to the event. 7.27.3 Contact must then be made by the DTL with the neighbouring Trust Control Centre asking for a nearer response to the incident if they have one available. 7.27.4 The location of the incident, chief complaint and MPDS answers of the event must be given to the neighbouring Trust. 7.27.5 All information relating to the incident must be entered onto the I/CAD event log, including details of conversations, operational responses actions and reasons for standing down responses to ensure there is an accurate record of the Trust response to the emergency event. 7.27.6 If another service passes the Trust a call in our area where their resource is nearer than ours a new event will be generated by the Call Handler. The DTL must take responsibility for ensuring that an Out of Area (OOA) call sign has been put on the event and will continue to monitor the event in case a Trust resource comes available near to the location. The DTL has responsibility for liaising with the Receiving Trust to review progress of the event and further allocation if required. 7.28 Out of Area Emergency Events 7.28.1 This protocol applies to any emergency event that relates to an incident that occurs where the borders of the Host Trust are not shared with the Receiving Trust and, therefore, is not covered by the Cross Border Incident procedures. EEAST HEOC SOG_V1.0 Page 92 of 143
7.28.2 The DTL is responsible for liaising with the CHTL (Section 6.10) to ensure the event has been passed to the appropriate Ambulance Host Trust. 7.28.3 If the Call Handler is staying on the line with the patient e.g to provide PAIs then an Out of Area (OOA) call sign should be assigned on I/CAD until such time that the call is terminated. 7.28.4 If the Call Handler is not staying on the line with the caller/patient and it is confirmed that the appropriate Ambulance Host Trust has all the required details in line with Section 6.10 then the event can be Closed with the Secondary Result Code (SRC) of Passed to other Amb Trust. 7.29 Duplicate Events on I/CAD (See also Section 7.17 Upgrading of Events on I/CAD) 7.29.1 If a duplicate emergency event is received for a current emergency or Urgent event logged on I/CAD and the additional call is a higher category, the clinical resource already allocated to scene should be informed by voice or MDT immediately of the upgrade. Consideration should also be given to a nearer and more timely unit or one with a more appropriate crew skill mix. 7.29.2 Dispatchers must not cancel the original event 7.29.3 Dispatchers must not pre-empt the resource from the original event 7.29.4 Dispatchers must be aware that calls may be received to the same or similar location but for another incident in which case another event should be created. 7.29.5 Duplicate calls must be linked to the original event by using the Duplicate and Cancel option in I/CAD. 7.29.6 If the Duplicate Call is of a higher priority (e.g. the original event is G2 and the duplicate call is R2), then the priority of the original event is changed as shown below but not the Dispatch Code [Type and Subtype]. Before After The Dispatcher should be aware that I/Recommend will not recognize this event as an emergency and will suggest the unit is diverted to a subsequent EEAST HEOC SOG_V1.0 Page 93 of 143
emergency event. Dispatchers must follow their protocols for diverting resources. 7.29.7 Dispatchers should remain vigilant and monitor the incident, and must not close the additional call until they are satisfied that all the relevant staff are aware of the upgrade. 7.29.8 If a duplicate emergency call is received where the original event is an Urgent and no unit has yet been assigned, the Dispatcher must allocate an appropriate resource to the new emergency event. This should normally be a vehicle capable of conveying the patient, unless the patient will benefit from timely intervention from a RRV/SSA, in which case they should be dispatched as well. 7.30 Manual Time Entry 7.30.1 The manually altering or of I/CAD data by HEOC staff must only be undertaken for legitimate reasons. It is essential that the data within I/CAD represents an accurate picture of the delivery and performance of the emergency service that is provided to patients by the Trust. 7.30.2 I/CAD retains an audit trail of all originally entered times, even when an event time is manually altered or added. Therefore, HEOC staff making manual changes to I/CAD incident records must always record a full explanation for the change in the event that they have altered the times for in the Remarks field (e.g. From EA321 on scene 12:30 ext. 111.) It is essential that all emergency incident resource response times are recorded within I/CAD. In the instance where an event on scene time is missing from the event log on I/CAD, the Dispatcher or the must establish the actual on scene time from the crew/responder who attended the event. The time of arrival at an RVP or safe location should be recorded as the on scene time on the I/CAD event log by the Dispatcher. The time the resource arrives on scene must be noted in the event remarks log. If the unit has gone off duty, the DTL should contact the relevant DOM asking them to retrieve the time from the PRF/EPCR. The Dispatcher must manually enter the on scene time in the unit time field within the event log retrospectively and record the reason for the manual entry in the Remarks, together with the details of when the information was passed. (e.g. On scene time not received on MDT. From DOM On scene at 12:30, ext. 111). 7.30.3 Please refer to the Trust CAD Data Quality Audit Policy for more details. EEAST HEOC SOG_V1.0 Page 94 of 143
7.31 Use of Closure Codes within I/CAD 7.31.1 When an event has been completed, or cancelled, the event will go to the awaiting closure stack. It is the responsibility of the Dispatcher to close events within their Dispatch group. Prior to an event being closed the Dispatcher needs to consider the following; Are all of the necessary times in the event and in the correct order? Check any Cleared units and ensure that there are no times missing (If there are times missing from the event these need to be collated and entered in I/CAD prior to closing the event.) Check the CAD notes for calls received from other Ambulance Services, these calls must be closed as a Not Initial Call (NIC) (Section 7.32). Any events which are non compliant with the relative Performance Standard must contain sufficient notes in the remarks to explain why the event is out of standard. Check CAD notes to see if HCP and AED on scene (immediate life threating) if so ensure a defibrillator has been booked on scene. Check CAD notes and ensure that any manual time entry has the relevant HEOC extension number and call sign (for data audit purposes) If the event has been cancelled and no unit has attended scene it is the DTL/DMs responsibility to ensure that the reason cancelled is valid and that the event has not been closed in error. (If the event has been closed in error the DTL is to advise the DM who will Pre-empt the event and investigate why the event was cancelled). 7.31.2 Whenever an incident created within I/CAD is closed a closure code called a Primary Result Code (PRC) must be applied to the record. The PRC when closing an event is Closed. 7.31.3 In addition to the PRC there is a Secondary Result Code (SRC) that can be recorded this further describes the incident and what happened. 7.31.4 Apart from being descriptive the SRCs have been developed to assist the Trust in analysing operational activity and performance. Therefore it is vital for HEOC staff to use the correct SRC codes when closing events as incorrect use of these codes will affect the accuracy of any operational activity and performance analysis. EEAST HEOC SOG_V1.0 Page 95 of 143
7.32 Not Initial Calls (NIC) 7.32.1 When a call is received from another ambulance service it is the responsibility of the service that received the call to report on the times for the event. The Trust do not report on NIC calls whether in standard or out of standard. 7.32.2 When the DTL is closing an event which is a NIC it is essential that the SRC selected is NIC Not initial Call. 7.33 Bariatric Patients 7.33.1 A bariatric patient is a person whose weight exceeds a safe limit (usually in excess of 25 stone /160kg). A patient whose weight is less than this can still be deemed to require the use of bariatric assistance after the attending crew have completed a risk assessment. 7.33.2 When a crew identifies that a patient is bariatric and needs to be conveyed they will pass this information to the Dispatcher requesting a bariatric ambulance attend. 7.33.3 The dispatcher needs to ascertain the following information; How heavy the patient is What clinical need the patient has (including if the patients status is life threatening) 7.33.4 The dispatcher must then pass this onto the DTL/DM who will arrange the following. A DOM to attend scene with the crew to risk assess and where necessary will remain with the patient. Call the nearest PAS/VAS firm to see what service they can provide; St Johns Suffolk 01473 241500 Norvic 01603 869 032 Thames 01268 512005 Almond First Peterborough 01733 705190 7.33.5 The DTL/DM needs to liaise with the DOM/Crew on scene to advise them of the ETA for the ambulance attending and make provision for assistance if more members of staff are needed to assist with getting the patient on/off of the ambulance. EEAST HEOC SOG_V1.0 Page 96 of 143
7.33.6 The DM is to be kept informed as to the progress of the event and to be advised of any delays/issues in order to escalate as necessary. 7.34 Special Situations (SS) 7.34.1 Where HEOC have been advised by an emergency service, a HCP or by a member of Trust staff that there is pertinent information which could have an effect on staff safety or the treatment of a patient a Special Situation can be placed on a property. 7.34.2 When a dispatcher looks at an event it is their responsibility to see if the SS button has been populated and to ensure that the crew are notified of the information and acknowledge it. 7.34.3 If the SS suggests that there could be scene safety issues, the Dispatcher/DTL is responsible for ensuring Police are on scene prior to the crew entering. Where there is a mention of weapons/firearms the HEOC Duty Manager is to be informed and the Dispatcher/DTL should consider sending a DOM to scene. 7.34.4 If the SS relates to patient care/condition then the Dispatcher is to pass this information to the responding crew as it could have an effect on the treatment provided. 7.35 Deceased Patients and Do Not Attempt Resuscitation (DNAR)/Preferred Place of Care 7.35.1 When the Trust respond to an event and the patient is deceased on arrival or at the end of clinical intervention the Trust staff on scene will call HEOC. 7.35.2 Clinical Standard Operating Procedure 3 14 Recognition of Life Extinct gives clear guidance on the process to followed in this situation Recognition of Life Extinct 7.35.3 Where the patient has a DNAR/Preferred Place of Care order in place and the Dispatcher is aware it is their responsibility to make contact with the crew in order to avoid any conflicting issues on scene or treatment given by the crew. If there are any issues/queries from operational crews with regards to these orders, these should be directed to the Clinical Advice Line Clinician On Call. EEAST HEOC SOG_V1.0 Page 97 of 143
7.36 Cardiac Arrest/Death in Patients Under 18 Years of Age 7.36.1 If an event is presented to dispatch indicating the death of/the possibility of death occurring in a patient aged 18 years or younger it is the responsibility of the dispatcher to advise the DTL and the HEOC Duty Manager. 7.36.2 The DTL is to ensure that the appropriate resources have been dispatched including a Duty Operational Manager. The Trust manager is to be deployed to ensure the welfare of the attending crews and to ensure that staff conform to Trust guidance/protocol. 7.36.3 The police must be notified of all cardiac arrests in under-18s. 7.36.4 The HEOC Duty Manager has overall responsibility for this event and is to be kept updated of all stages. 7.37 Special Care Baby Unit Transfers (SCBU) 7.37.1 A SCBU transfer is a transfer of a baby who will need to be in an incubator and conveyed to a specialist hospital for further care. When these calls are passed to the HEOC they will come through as either a blue light response or a non-emergency response. 7.37.2 The Trust HEOC s have different resource types/staffing to accommodate these transfers; Please refer to Appendix O for HEOC Specific Control Instructions. 7.38 Critical Care Transfers 7.38.1 A Critical Care Transfer is for the transfer of a patient who is critically unwell and requires transportation from one hospital to another hospital ITU/HDU. 7.38.2 These patients often have complex medical needs and may be sedated and ventilated with an array of medical interventions in place. 7.38.3 The Trust HEOC s have different resource types/staffing to accommodate these transfers; Please refer to Appendix O for HEOC Specific Control Instructions. 7.39 PAS/VAS/NES Resources 7.39.1 At the commencement of each shift, all PAS, VAS and NES crews will confirm with HEOC that they have an AED on board, that one of the crew is trained to use it and whether or not they are IHCD accredited to use blue lights for responding to emergency calls. EEAST HEOC SOG_V1.0 Page 98 of 143
7.39.2 Subject to conditions all PAS, VAS and NES resources should only be dispatched to emergency calls if the individual crew have the appropriate accreditation to drive using blue lights and sirens, (IHCD Qualified) confirmed at the commencement of each shift. Dispatch will be in accordance with the Trust agreed CFR code set and in these cases they will be automatically backed up by a suitably qualified trust clinician. HEOC will identify whether any PAS/VAS vehicles available are able to be deployed under emergency conditions in accordance with the current approved accreditation process. 7.39.3 PAS, VAS and NES crews who are not individually trained to drive under emergency conditions may be deployed to emergency calls following the CFR codeset under normal road conditions (no blue light and sirens, or road traffic law exemption) where they are identified as the closest resource. 7.39.4 PAS, VAS and NES crews must update HEOC of all statuses during their journey (e.g. at scene, depart scene). Prior to arrival at scene, they must confirm with HEOC that they are able to continue the loading of the patient onto their vehicle (normally this would be only for loading urgent category patients). The reason for this is to ensure that they can be deployed to any uncovered emergency call near to their location. 7.40 Operational End of Shift Management 7.40.1 Please refer to OI 118 - Emergency Calls (End of Shift) 7.41 Aircraft Incidents at London Luton and London Stansted Airports 7.41.1 There are two large International Airports in the region, London Luton and London Stansted with dedicated Crash lines. The other (smaller) airports (i.e. Norwich and Southend) will call 999 and the call is to be processed under MPDS Card 29. 7.41.2 Types of Emergency Local Standby - An aircraft approaching the Airport is known, or is suspected, to have developed some defect which should not prevent the completion of a safe landing. Full Emergency - It is known that an aircraft is, or is suspected to be, in such difficulty that an accident is possible. Aircraft Imminent - Air crash is imminent. Aircraft Accident - An aircraft accident has occurred or is inevitable on, or in the vicinity of, the Airport. An aircraft which travels off the paved surface of the runway will be treated as an Accident. EEAST HEOC SOG_V1.0 Page 99 of 143
7.41.3 Terminology Category A An incident involving an aircraft 24m 76m long; Category B An incident involving an aircraft 12m 23.9m long; Category C An incident involving an aircraft up to 11.9m long. 7.41.4 Rendezvous Point - The point to which all emergency services attending one of these incidents report and therefore the event location for all such incidents. For London Luton, the Rendezvous Point (RVP) is: Airport Fire Station Airport Way Luton For London Stansted, the RVP is: RVP 1 (Opposite the Hilton Hotel) Round Coppice Road Stansted 7.41.5 In all cases, the HEOC Duty Manager must be made aware of the incident and they will lead a co-ordinated response from the HEOC. Refer to Appendix H. 7.41.6 Initial Dispatching procedures for Local Standby : Put all vehicles and staff on a state of readiness for allocation in the event of the type of emergency being upgraded. A broadcast should be sent to all operational units (by radio or MDT) and managers (by pager/text message), advising that there is a Local Stand-By at (Luton/Stansted) airport. 7.41.7 Initial Dispatching procedures for a Full Emergency/Aircraft Accident: Initiate the Major Incident Cascade Procedure (Appendix H) and refer to the Major Incident Plan (Appendix F) including putting the Luton & Dunstable/Princess Alexandra Hospitals on Major Incident Standby. Deploy the TWO nearest available vehicles to the RVP, and ensure a further four vehicles are clear in the local area (Resource permitting) Inform other HEOC Duty Managers and request available neighbouring resources be moved towards area on standby. EEAST HEOC SOG_V1.0 Page 100 of 143
A broadcast message is sent to all operational units (by radio or MDT) and managers (by pager/text message), advising that there is a Full Emergency*/Aircraft Accident* at (Luton/Stansted) airport. (*delete as applicable) Should information from Air Traffic Control/Combined Control Centre (CCC) indicate the potential seriousness of the incident, or at the request of the Ambulance Incident Officer on scene, the HEOC Duty Manager should mobilise both the Mobile Control Vehicle and Ambulance Incident Support Units. 7.41.8 Stand Down. The HEOC will only accept and action a Stand Down from the Ambulance Incident Officer or Air Traffic Control/Combined Control Centre (CCC). 7.42 CBRN/HAZMAT Incidents (Including Chemical Suicides ) 7.42.1 Events including Chemical, Biological, Radiological or Nuclear (CBRN) hazards require specialist responses and the DTL and HEOC DM must be informed immediately. Only on their instructions should ambulance resources be dispatched as specific instructions may be invoked dependent on the nature of the call. 7.42.2 The event notes will give all details given to the Call Handler regarding the incident including any information regarding the type of substance involved and any known dangers, resent or potential. This information must be supplied to the responding units. 7.42.3 HEOC Duty Manager to consider invoking the Major Incident Cascade Procedure (Appendix H) dependent on information given. 7.42.4 The relevant On Call Tactical Advisor (Resilience Manager) must be advised and, if required, deployed to the location. 7.42.5 In all cases, a Trust Operational Manager must attend the incident and may be the first manager on scene. 7.43 Bomb Threat or Terrorist Action 7.43.1 The Duty HEOC Manager must be made aware of all potential explosive device calls or threats of terrorist action immediately. Only on their instructions should ambulance resources be dispatched as specific instructions may be invoked dependent on the nature of the call. 7.43.2 HEOC Duty Manager to consider invoking the Major Incident Cascade Procedure (Appendix H) dependent on information given. EEAST HEOC SOG_V1.0 Page 101 of 143
7.43.3 The relevant On Call Tactical Advisor (Resilience Manager) must be advised and, if required, deployed to the location. 7.43.4 In all cases, a Trust Operational Manager must attend the incident and may be the first manager on scene. 7.44 Major Incidents 7.44.1 The Duty HEOC Manager must be made aware of all potential Major Incidents immediately. Only on their instructions should ambulance resources be dispatched as specific instructions may be invoked dependent on the nature of the call. 7.44.2 HEOC Duty Manager to consider invoking the Major Incident Cascade Procedure (Appendix H) dependent on information given. 7.44.3 The relevant On Call Tactical Advisor (Resilience Manager) must be advised and, if required, deployed to the location. 7.44.4 In all cases, a Trust Operational Manager must attend the incident and may be the first manager on scene. 7.44.5 Refer to the Major Incident Plan for full details of the Trust response; this includes action cards specifically for each role within HEOC. 7.45 Dispatching and REAP Levels 7.45.1 The above dispatching procedures apply to working within the usual range of expected pressures broadly associated with levels 1-3 of the Trust REAP Plan. However, in order that the Trust can respond to further increases in pressure, other mitigations may be implemented as described above. These may not all be implemented at once. EEAST HEOC SOG_V1.0 Page 102 of 143
SECTION 8 ENHANCED CLINICAL TRIAGE (ECT) PROCEDURES EEAST HEOC SOG_V1.0 Page 103 of 143
8 Enhanced Clinical Triage (ECT) 8.1 Aim 8.1.1 The East of England Ambulance Service NHS Trust is committed to provide a clinically effective response to life threatening emergencies and to ensure that the most appropriate response is provided to all patients in a timely manner. 8.2 Background 8.2.1 MPDS is a highly effective tool for identifying life-threatening emergencies promptly and allowing dispatch of an immediate response. It is essentially a triage sieve, and although it has a high sensitivity its specificity is low and there are high numbers of calls coded as high acuity which on review were not life-threatening, or in which a different response would have produced the best patient outcome first time without using multiple resources. 8.2.2 The purpose of Enhanced Clinical Triage is to increase the specificity of MPDS triage and accuracy of code allocation. 8.2.3 Deployment of resources to ensure a clinician is always available to respond immediately to an emergency is a constant challenge, managed through the Systems Status Plan. The over-triage resulting from MPDS causes disruption of the SSP through dispatch to multiple calls which turn out to be non lifethreatening. 8.2.4 Increasing the specificity of the triage without losing sensitivity through more accurate coding will improve dispatch decisions and management of the Systems Status Plan. This can be achieved through further information gathering by a clinician after initial MPDS triage. 8.2.5 Early indications are that up to 75% of Cat A calls did not, in fact, require this response. Improving availability of resources to respond to a genuine lifethreatening emergency will therefore improve patient safety. 8.2.6 Warm transfer of the call to a clinician means that the patient and caller will receive expert clinical advice prior to arrival of the healthcare response. 8.2.7 Patients will receive a response which is tailored to their individual needs, which is likely to improve clinical outcome for individuals and all patients requiring a 999 response. 8.2.8 Anecdotal experience so far is that patients and callers appreciate talking to a clinician who is able to reassurance and provide information about the progress of the face-to-face resource. EEAST HEOC SOG_V1.0 Page 104 of 143
8.2.9 The clinician is able to update crews on their way to scene with further useful information about the patient (such as age and likely weight of a child). As the coding accuracy of high acuity calls is improved, crews will be more likely to pull out all the stops for Red 1 /2 calls as they will have more confidence that they are going to a genuine emergency. 8.3 ECT Call Monitoring and Telephony Procedure 8.3.1 The ECT Process is reliant upon the ability of the clinician to monitor and review 999 calls as they are processed. The focus should be on R2 calls where the patient may not receive a timely or appropriate response. 8.3.2 The Call Handler is to triage all 999 calls in the normal manner and the dispatchers are to activate the nearest resource in line with Resource Allocation & Dispatch Guidelines SOG 4 V11.0. 8.3.3 The ECT Clinician will be logged into the Symposium telephony system enabling outgoing calls and Supervisor rights. A specific ID will be allocated within Symposium. 8.3.4 Whilst the Call Handler is triaging the 999 call the ECT clinician (where possible) will listen into the call using the Supervisor function. This function allows the clinician to make some informed decisions prior to deciding if it is appropriate to accept the call for Enhanced Clinical Triage. 8.3.5 To login to telephony system: Plug in headset Press In Calls (bottom button on right of telephone) Enter the following code 401700 Press the # key 8.3.6 To monitor an incoming 999 call: Identify correct extension for call Press Supervisor on telephone keypad Dial listening number (Displayed on ECT Desk) Press the red RLS button to end monitoring of the call N.B. Only one person may monitor a call at a time. If the CHTL is doing so then the ECT clinician will not be able to do so. 8.3.7 To make an outgoing call: EEAST HEOC SOG_V1.0 Page 105 of 143
Open a line by pressing button 2 2 nd button up on the right of the telephone Dial the call back number preceded by the number 9 To end the call / disconnect press the red RLS button 8.4 Monitoring Events in I/CAD 8.4.1 The ECT Clinician will log onto the ICad system and adjust the screens to view Pending & Emergency Queues on one monitor screen, alongside IRecommend & Map and Event information on another as shown in the following Illustrations (Fig 1 & 2) Fig 1 Fig 2 EEAST HEOC SOG_V1.0 Page 106 of 143
8.4.2 By selecting a call (double click) from the Pending / Emergency Queue, the clinician will be able to review projected response time for the incident (1) and the event information (2). 8.4.3 If the projected response time is greater than 6 minutes the clinician should consider the call for ECT. 8.4.4 If the caller is on the line the ECT Clinician should request a warm transfer of the call to them but if the caller has cleared a call back should be made immediately. The preferred method is to warm transfer (Section 8.6). 8.4.5 The clinician should then contact the original caller and assess the patient to determine the most appropriate response. On completion of extended triage the clinician will update the priority as described in Completion of ECT Process. (Section 8.7) 8.5 Monitoring Events in ProQA 8.5.1 By selecting the incident from the active queue as above and selecting the ProQa button (see below), once the call handler has completed the case entry phase of the call, it is possible to monitor ProQa data whilst the call is processed. This will allow the clinician to gain an insight into the likely priority attached to the completed call and consider the call early for ECT if appropriate. (Fig 3) Fig 3 EEAST HEOC SOG_V1.0 Page 107 of 143
8.6 ECT Interception of Calls 8.6.1 If an ECT Clinician identifies that a call would be suitable for further assessment they should request a warm transfer of the call to them if the Call Handler is still on the line with the patient/caller. 8.6.2 The Call Handler should complete the ProQA process and inform the caller that: A response is on the way and I am going to pass you to a clinician who will ask you some further questions. 8.6.3 The Call Handler should then transfer the call to the ECT clinician s extension number. If for any reason the call does not transfer, inform the caller that the clinician will call back and please keep the line clear. If the Call Handler is no longer on the line then the clinician will call the number back. 8.6.4 On contacting the caller / patient the clinician must introduce themselves, explain the reason for calling and reassure the caller that a response is on route. 8.6.5 The Clinican must then carry out a thorough and complete assessment ensuring information pertaining to the assessment is clearly logged in the I/CAD Remarks. 8.6.6 Once notes have been entered into the CAD the Clinician is to fill out a spread sheet on Excel in order to capture accurate auditable data that can be used internally and externally to the Trust. 8.6.7 If, during the triage, the patient s condition is identified as immediately life threatening and further Pre Arrival Instructions (PAIs) are required then the Clinician is to liaise with the CHTL to transfer the call back to a Call Handler who can offer the caller PAI s utilising an MPDS card set. 8.7 Completion of ECT Process 8.7.1 The outcome of the assessment must be clearly explained to the patient and the event type and subtype amended accordingly. 8.7.2 ECT Outcomes: Subtype Secondary triage repri to G1 Secondary triage repri to G2 Secondary triage repri to G3/G4 Stand down resource repri card 35 60 mins Stand down resource repri card 35 120 mins Stand down resource repri card 35 180 mins Stand down resource repri card 35 240 mins Stand down resource repri HCP/ECP visit Response Priority G1 20mins G2 30mins G3/G4 20mins/1hr Card 35 1 hr Card 35 2 hrs Card 35 3 hrs Card 35 4 hrs Appropriate for call See Referral to CSD Below Below Not Currently Used EEAST HEOC SOG_V1.0 Page 108 of 143
8.7.3 If a call has been monitored or assessed and the clinician believes that no change to the original response is required, the key word ECTNOCH must be entered in the I/CAD remarks of the event. This must be spelt correctly with no spaces to allow for data gathering. (It is an abbreviation of ECT No Change) 8.7.4 If the priority of an incident requires updating, follow the steps below: From Mode menu select Update. Select ECT Extended Clinical Triage from the Type drop down list Select appropriate response priority from the Subtype drop down list Click ACCEPT EVENT 8.7.5 Ammendments to the priority of any incident are to be undertaken by approved ECT clinicians only. EEAST HEOC SOG_V1.0 Page 109 of 143
8.7.6 To send Alert Message: In the Event Information screen select Send Alert In the Send Alert Dialogue box either type message for Dispatcher or select message that corresponds to the response priority for the event. Click SEND 8.8 Referral to Clinical Support Desk (CSD) 8.8.1 If, after assessment, a call is deemed suitable for referral to CSD for further triage, the following process must be undertaken in the event front page. From Mode menu select Update Open Subtype menu and select G4 Secondary Triage Reprioritised to Green 4 Accept Event - A dialogue box will appear prompting the clinician to Accept the CSD referral. Ask the caller for the Patient s name and date of birth Go back to Update mode and enter these details into the Patient Details for the event. Accept Event EEAST HEOC SOG_V1.0 Page 110 of 143
Click Send Alert on event info page (See 10.7.6 above) Select Cat C and then click Send Right click on the call in Pending Queue Select Transfer Event - check number in dialogue box From Agency/Group drop down menu select EOEAS/PSIAM then click OK. Make sure local CSD or Clinical Coordinator are aware that the call needs CSD Triage as this is a manual PSIAM process. 8.8.2 The caller should then be advised that: A clinician will call back to further assess the patient if their condition worsens during this time the call should call back on 999 EEAST HEOC SOG_V1.0 Page 111 of 143
SECTION 9 HEOC SHIFT MANAGEMENT EEAST HEOC SOG_V1.0 Page 112 of 143
9 HEOC Shift Management 9.1 Introduction This section of the procedures relates to the management and leadership functions of the HEOC focusing upon the roles of HEOC Duty Manager (DM), Clinical Coordinator (CC), Dispatch Team Leaders (DTL) and Call Handler Team Leader (CHTL). The DM is responsible for the smooth running of the HEOC during the course of their shift including all aspects of call handling and dispatching. Responsibility for key aspects of Call Handling and Dispatching is delegated to the appropriate Team Leaders. The DM, CHTL and DTLs must therefore work as a team to ensure that the department operates in accordance with the HEOC Standard Operating Procedures and to meet the performance standards shown for all HEOC staff. In particular, it is this team s responsibility to supervise and support their staff and to ensure they work together effectively. Additionally, the DM is responsible for co-ordinating responses effectively with the other HEOCs to provide optimum service delivery and performance across the region. 9.2 General Rules for HEOC Shift Management 9.2.1 The DM and CHTL and responsible for ensuring Call Handling is conducted according to these procedures and in accordance with the standards of the International Academy of Emergency Medical Dispatch. 9.2.2 The DM and DTLs have responsibility for efficient and effective deployment and allocation of all resources during the course of their shift. 9.2.3 Whilst the DM is responsible for all call handling and dispatching during the course of the shift this should not be their primary role and, in particular, they will not answer 999 calls whilst responsible for managing the room. It is their responsibility to facilitate lines being answered by resolving issues rather than taking the calls themselves. If managers are covering all or part of a call handling or dispatching shift (rather than working as the duty shift manager) they should follow the relevant HEOC procedures for that role. 9.2.4 It is the DM s responsibility to keep informed of all significant operational issues. 9.2.5 The DM is responsible for the management of the Team Leaders and all staff on duty within the HEOC. The Team Leaders are primarily responsible for their team staff during their shift. However, they do share responsibility for the smooth running of the department as a whole and the DTLs, in particular, must work together to support one another. 9.2.6 Out of normal working hours the DM takes the role of the first point of contact representing the Trust in situations requiring senior managerial involvement. EEAST HEOC SOG_V1.0 Page 113 of 143
9.2.7 The DM is the central point of information, advice and support for all HEOC staff. 9.2.8 The DM is also the central and frequently first point of contact for operational staff requiring information, advice and support. 9.2.9 The DM is responsible for clear and effective communication around the HEOC and for maintaining an environment that is conducive to effective working for all staff. Messages are not to be shouted across the room. 9.2.10 The DM is also responsible for maintaining a visible high standard of professionalism from all staff in the HEOC. 9.2.11 Additionally, the DM is responsible for general line management and shift management of the HEOC staff who are on duty and also any who are allocated to them as a team. The generic management roles and responsibilities for Trust managers are not detailed here but can be found in the job description and contract for the Duty HEOC Manager. 9.2.12 The DM ensures compliance with the rules of conduct within the HEOC at all times and maintains a professional environment conducive to effective call handling, clinical care and dispatching of operational resources. 9.2.13 The HEOCs are considered to be clinical environments and, as such, access is restricted to only those who have a legitimate need to be there. This is managed by the DM. Access doors should be secured and accessed only via security swipe card/fob/code and all visitors must report to the DM. 9.3 Shift Start 9.3.1 At the start of the shift, the HEOC Duty Manager will receive a hand-over of outstanding issues from their colleague including any HEOC or operational issues. 9.3.2 The DM will log onto I/CAD, Symposium and the Data Warehouse and ensure all the systems are functioning correctly. 9.3.3 The DM will then familiarise themselves with the HEOC staffing for the coming shift and monitor the arrival and hand-over of the team. All staff must be signed on duty. The DM is responsible for recording shortages in the Silver Notes on the Data Warehouse. 9.3.4 The DTLs, at the beginning of their shift, will each determine the operational cover for their areas of responsibility and pass this, together with any outstanding dispatch-related issues, to the DM. The DM will also familiarise themselves with the operational cover of front line resources, Urgent vehicle and PAS/VAS together with any outstanding issues. Shortages and any significant issues are entered into the Silver Notes. EEAST HEOC SOG_V1.0 Page 114 of 143
9.3.5 The DM is responsible for co-ordinating the crewing and initial deployment of operational staff that do not have a crew partner or, for some other reason, need to be redeployed within operations for all or part of the shift. This process is led by the DM in consultation with the Duty Operations Managers (DOMs) and decisions are made through a process of discussion and negotiation based around maintaining safe levels of cover in each area and an even spread of resources relative to anticipated demand. Funded RRVs may not be removed in order to accommodate a single staff member unless all other avenues have been exhausted and the issue is related to that of lone worker safety. Any issues which cannot be resolved should be escalated to the HEOC AGM/GM or Operational Silver on Call if out of hours. 9.3.6 If required, the DM should also contact the DMs of the other Trust HEOCs to discuss staffing issues within each department and operationally that may have an impact regionally. 9.3.7 The DM is responsible for planning and executing appropriate rest periods for all HEOC staff on duty although much of this is devolved to the team leaders. The CHTL has responsibility for planning rest breaks for all Call Handlers on duty and for monitoring cover levels in the room throughout the shift. DTLs will organise rest periods for all members of the dispatch team during the course of the shift, including the Urgent dispatcher. CSD staff rest periods must be co-ordinated with colleagues in all three HEOCs. 9.4 Duty Manager Cover in HEOC 9.4.1 The HEOC Duty Manager is responsible for the leadership of the HEOC throughout the course of their shift and should therefore be in the room at all times. When it is necessary for the DM to leave the room, to take rest breaks for example, they must be covered by another experienced DM (HEOC AGM, for example) or nominate an appropriately experienced DTL to provide manager cover in their place and notify all staff on duty. The HEOC management team are responsible for developing team leaders to safely cover the DM role. 9.5 Performance Delivery, Monitoring and Reporting 9.5.1 The HEOC Duty Manager plays a key role in the Trust in delivering and reporting performance. They are accountable for all performance reporting during their shift and must ensure that data is accurate. 9.5.2 The DM is responsible for the optimal resourcing of all events to achieve performance. The DTLs will be primarily responsible for this resourcing including diverting of resources as required to achieve performance. One of EEAST HEOC SOG_V1.0 Page 115 of 143
the DTLs primary roles is the review of resource allocation to all events once they have been coded. 9.5.3 The DTL is accountable for incidents being responded to in an appropriate time frame and also for maintaining optimal cover - making best use of the units available at all times. The Resource Allocation & Dispatch Guidelines and Dynamic Deployment SOG are therefore key documents for the DTL. The DTL will immediately refer to the DM for advice and support when required. 9.5.4 Any events which are out of standard will have sufficient notes entered on I/CAD by the DTL to explain the reason for this. At this point in the process, it is also important for the DTL to identify any events which are not the initial call to the ambulance service or located outside the Trust geographical boundaries and exclude them from performance appropriately (the Information departments of the Trusts involved will co-ordinate this information retrospectively). 9.5.5 It may be necessary for the DTL to liaise with the operational staff or local DOM to investigate before these can be added. In all cases, any necessary investigation will be conducted as near to the event as possible. The DM is responsible for reviewing all out of performance events and ensuring the information on the data warehouse is correct including the reason for being out of performance. As a result, they are accountable for signing-off and closing all non-compliant A8 and A19 events and all those with data quality issues. 9.5.6 The CHTL is responsible for the timely answering and effective processing of all incoming calls. Any events found to be out of compliance due to a delay before allocation will be passed to the CHTL and an explanation entered in the remarks. 9.5.7 The DM has responsibility for analysing why any error or delay in HEOC may have occurred and, where appropriate, provide feedback to individual members of HEOC staff. This process may include requesting a review by the audit department or referral to the HEOC AGM. In all cases, the details should be documented. Where there is thought to be an issue for the local DOM to take up with a member of operational staff, the two managers will liaise in the first instance. Such issues should be dealt with by the operations manager and not the DM. 9.6 FIRST Response on Scene 9.6.1 The HEOC Duty Manager is required to monitor every allocation of a FIRST resource to an event and ensure they have been appropriately allocated according to Section 6.29 of the Call Handling procedures. If a FIRST has been inappropriately allocated, the DM is accountable for removing that EEAST HEOC SOG_V1.0 Page 116 of 143
resource from the event, entering the reason on the remarks and feeding back to the staff member responsible for the error. 9.7 Duplicate calls 9.7.1 The HEOC Duty Manager is responsible for ensuring that the DTL and CHTL effectively communicate in relation to potential duplicate calls. If the DTL is unsure whether a call is a duplicate, the decision will always be referred to the DM who may task the CHTL to investigate further. In any case, resources will continue to run until the DM is satisfied that an event is a duplicate of one already allocated. 9.8 Abandoned Calls 9.8.1 The HEOC Duty Manager is ultimately responsible for ensuring that any abandoned call either receives a response or appropriate ring back to establish whether a response is required as per Sections 6.19 6.22 and Section 7.25 and that these guidelines are followed appropriately. 9.9 Hoax Calls 9.9.1 The initial Hoax call procedure is given in Section 6.25 however, the HEOC Duty Manager is ultimately responsible for all hoax calls which do not receive a response and must ensure this process is conducted safely. 9.9.2 When callers are rude to the Call Handler or abusive, particularly if they call repeatedly, details should be passed to the police, asking them to investigate. 9.9.3 For callers who repeatedly phone for an ambulance and do not require one this should be escalated to the HEOC AGM for them to consider contacting the service provider to terminate the telephone service to that number. 9.10 Request to Cancel 999 Events 9.10.1 Section 6.30 of the Call Handling procedures deals with this. However, the DM will make a decision, in consultation with the CHTL, on whether to reinstate a response on a cancelled event and thereby maintains accountability. EEAST HEOC SOG_V1.0 Page 117 of 143
9.11 Out of Area, Cross Border and Near Border Events 9.11.1 The HEOC Duty Manager has overall responsibility for ensuring all events are initially appropriately resourced by the Trust including those near to, but within approximately a 19 minute travelling distance of Trust borders. 9.11.2 On occasion, the DM may be required to actively participate in passing events across boundaries to ensure appropriate resourcing from both Trust HEOCs and neighbouring Trusts. In these circumstances, the DM will contact the control room/heoc of the other service and speak to the DM directly. 9.11.3 At the time of passing or receiving a call cross-border, it is the responsibility of both HEOCs to exchange reference numbers and times on the event up to that point. However, the exchange of further times retrospectively with other Trusts is not the responsibility of the HEOC and will be collated in a nonoperational environment. Events passed to the HEOC from another HEOC are therefore closed as Not Initial Call and those passed from the HEOC to another Trust are usually closed without the remainder of the times being completed as PASS (Pass to another Amb Trust). It is the DM s responsibility to identify such events and ensure they have been correctly closed with sufficient accurate notes. 9.12 Dynamic Deployment and Allocation Across Trust Sectors 9.12.1 The HEOC Duty Manager has primary responsibility for the proactive deployment of resources across localities to improve dynamic emergency cover. To facilitate this, they may contact the other HEOC DMs for assistance, as required. 9.12.2 The DM is also responsible for co-ordinating effective allocation of units to events on or near the locality borders by rapidly and proactively liaising with the other DMs. This function will usually be fulfilled in the first instance by the relevant DTL with the support of the DM. 9.13 HEOC Duty Manager Responsibility and Accountability for Card 35 Urgent Admissions. 9.13.1 The HEOC Duty Manager is accountable for the delivery of HCP admission performance standards. 9.13.2 Where the HEOC Duty Manager is notified of a HCP Protocol 35 Urgent admission request that has run out of time or will remain unassigned then they are accountable for ensuring that all the necessary processes are followed in terms of call backs and upgrades as appropriate. EEAST HEOC SOG_V1.0 Page 118 of 143
9.13.3 The Duty Manager is responsible for ensuring that all available options have been considered by the dispatch team. When an Urgent journey is nearing the expiry time, the Duty Manager is responsible for locating the nearest DSA/PAS/VAS and assigning them to the call via the dispatcher. If there are no available resources the Duty Manager is to (where geographically appropriate) liaise with the Duty Manager in either of the other HEOCs to ascertain available resources that could complete the journey. It is the Duty Managers overall responsibility to ensure that the actions stated above are completed. 9.14 Clinical Coordinator Responsibility and Accountability for Card 35 Urgent Admissions. 9.14.1 The Clinical Coordinator (this also applies to a clinical floor walker/coms who are on duty within that HEOC) is responsible for the monitoring of the HEOC Urgent pending stack to identify clinical risk and ensure that any unassigned HCP Protocol 35 Urgent events approaching the agreed pick up time have been identified and actioned. 9.14.2 The Duty Manager & Clinical Co-Ordinator (this also applies to a clinical floor walker/coms who are on duty within that HEOC) are responsible for the time expired urgent calls. If there is any concern regarding a call or the clinical appropriateness of the call it is their responsibility decide to upgrade the call. Should a call be upgraded a decision is to be made by the DM/CC/COM as to whether an RRV/CFR should also be deployed. The DM/CC/COM is to liaise with the Call Handler Team Leader regarding further welfare checks up to the arrival of the response on scene. 9.15 Card 35 Four Hour Pickups 9.15.1 When a HEOC reaches 15 unassigned HCP Admission requests on the Pending stack then the HEOC Duty Manager must liaise with the HEOC AGM/Operations Cell (in hours) or HEOC Silver on Call (out of hours) who will assess the situation and may instruct the HEOC that four hour pickups are all that the HEOC can commit to. Any patient that clinically cannot wait four hours should be entered as an emergency call using the relevant AMPDS chief complaint protocol. 9.15.2 The HEOC Duty Manager should contact the Operations Cell/Silver on Call who will liaise with Gold to request additional assistance from PAS/VAS providers if required. 9.15.3 Gold on call should seek advice from the Senior Medical Advisor as required. EEAST HEOC SOG_V1.0 Page 119 of 143
9.16 HEOC Duty Manager and Clinical Coordinator Responsibilities for Unassigned Events or Delayed Response (See also Section 7.18 Dispatch Responsibilities for Unassigned Incidents) 9.16.1 Whilst the HEOC will always endeavour to ensure that all emergency calls are immediately resourced, during periods of high demand this may not always be possible. HEOC Duty Managers and Clinical Coordinators are responsible for ensuring that any unassigned event is welfare called appropriately. 9.16.2 The HEOC Duty Manager will have overall accountability for ensuring that welfare calls are made for unassigned incidents as listed below and must monitor these events to ensure that welfare calls are being made. 9.16.3 The HEOC Duty Manager will request a Clinical Coordinator (Clinical Advisor in the absence of a Coordinator) in any of the Regional HEOCs to carry out a Welfare Call (999 ring back) on any unassigned emergency call. 9.16.4 Welfare calls are important to the patient or their representative in the event that transport is delayed because: It is the Trust s opportunity to check on the patient s condition, so that if it has deteriorated in anyway the priority of our responses can be upgraded. Reassurance to the patient or their representative that they haven t been forgotten. Confirmation or an update on likely timescale to transport if the patient s condition hasn t deteriorated in any way can be given. 9.16.5 The HEOC Duty Manager to liaise with DTL to explore every option for resourcing a response. These may include: Reviewing Out of Service resources Reviewing of vehicles offloading at hospitals Inter HEOC assistance Deployment of CFRs Deployment of specialist resources (HEMS/BASICs) Officer availability Incidents with more than one resource on scene PAS/VAS Cross-border assistance EEAST HEOC SOG_V1.0 Page 120 of 143
Paging of off-duty managers. 9.16.6 HEOC Duty Manager to update Silver Notes detailing CAD details of unassigned incidents and actions to date. 9.16.7 The Clinical Coordinator (or Clinical Advisor in absence of Clinical Coordinator) should ring back the contact telephone number for the patient (if contact cannot be made this must be relayed to the HEOC Duty Manager). 9.16.8 Apologise for the delay and offer an explanation. 9.16.9 If the delay is for a Protocol 37 transfer request then the Clinical Coordinator should discuss the delay with the requesting HCP and offer an ETA if possible. Delayed responses to Protocol 37 events should not be re-triaged as described below. 9.16.10 Check if the patient s condition has deteriorated by asking Has the patient s condition worsened in any way? 9.16.11 Clinical Coordinator (or Clinical Advisor in absence of Clinical Coordinator) to re-triage patient using the PSIAM system. 9.16.12 A record of this conversation must be recorded in the I/CAD remarks that a welfare call has been made and a brief summary of the conversation (e.g. welfare call made to apologise for the delay, caller advised that condition is still the same). PSIAM reference should also be documented. 9.17 Difficulty Verifying a Location/Locating a Patient/No Trace 9.17.1 If a Call Handler and CHTL have exhausted all usual methods i.e I/CAD, Map Books of obtaining an address or location e.g. a sports ground, then the HEOC Duty Manager should proceed to explore more wider tools such as: Internet based services e.g Google Maps Internet based sports services e.g. www.pitchfinder.com and www.activeplaces.org.uk Request assistance of PIR for mapping Request assistance of Police Air Support Assets Contact local Operations Management Teams (local knowledge) 9.17.2 Trust resources are unable to locate a patient for whom a response has been requested, the HEOC Duty Manager is responsible for satisfying themselves of the patient s safety, beyond reasonable doubt. EEAST HEOC SOG_V1.0 Page 121 of 143
9.17.3 In the event that operational responders cannot gain access to the location of an event or locate the patient for any other reason, the DM must satisfy themselves that the resource is at the correct location and make attempts to confirm this from voice recordings of telephone calls and/or attempt to call the patient directly or the original caller. The operational responders may also have valuable insights from the location and the DM should assemble information from all sources. 9.17.4 Potential treatment centres should also be contacted to determine whether the patient has made their own way there. 9.17.5 The DM should consider the clinical condition and circumstances of the patient at the time of the call and the time elapsed since then together with any further insight from the original caller (especially if this was a referral from an HCP). If applicable, the relevant Doctor s Out Of Hours service provider should also be contacted to see if they have further information. 9.17.6 It may be necessary for a non-clinical DM to seek advice from a Trust clinician regarding the seriousness/potential adverse outcome of individual patients as described in the original call. 9.17.7 If the DM is unable to satisfy themselves of the patient s safety, beyond reasonable doubt, it is their responsibility to take further timely action to locate the patient. This may include contacting the police for assistance with gaining access to a property or for assistance with locating a vulnerable person. This decision may need to be made early in the process and should be considered for all emergency events. 9.17.8 All information and decisions should be noted in the CAD event. 9.17.9 Additionally, for any HCP referral where the patient could not be located, the referring clinician must be informed retrospectively. If the event occurs out of hours, this responsibility should be delegated to the Clinical Support Desk or other HEOC support personnel to make contact during working hours and document this in the I/CAD. 9.18 Resourcing of Non-Urgent Events 9.18.1 The HEOC Duty Manager and DTLs have responsibility for appropriately resourcing requests for post treatment and discharge journeys, in those areas where the Trust is contracted for these. This must be completed within an acceptable time frame. EEAST HEOC SOG_V1.0 Page 122 of 143
9.19 PAS/VAS/NES Resources 9.19.1 The HEOC Duty Manager is responsible for ensuring any PAS/VAS resources are correctly managed and utilisation is fully and accurately recorded. They are also responsible for ensuring that PAS/VAS resources on duty comply with, and do not exceed, the numbers agreed by the GM in advance. The DM may receive, or initiate, a request for further PAS/VAS. This must be passed to the GM or Duty Silver for authorisation. 9.20 Data Validation and Accuracy 9.20.1 The HEOC Duty Manager has responsibility for all data generated by the HEOC during the course of their shift. I/CAD anomalies may appear in the HEOC Data Validator screen for which the DM is responsible. All apparent errors should be addressed and corrected where appropriate. 9.21 Manual Time Entries 9.21.1 The HEOC Duty Manager is responsible for ensuring that all manual time entries are correct and that sufficient notes have been added to the event to ensure compliance with manual time entry CAD Data Quality Audit Policy. If times are entered incorrectly, the DM will correct them and provide appropriate feedback to the staff member. 9.22 HEOC Staff Shortages and Shift Cover 9.22.1 The HEOC Duty Manager is responsible, in conjunction with the Planning Department and HEOC AGM for identifying HEOC staff shortages, particularly on the current and following shifts. In hours, these shortages are passed to either Scheduling/Planning or the HEOC AGM. Out of hours, the DM takes responsibility for contacting staff and endeavouring to cover shortages. 9.22.2 If this cover is at an unsafe level the DM will escalate to the HEOC AGM/GM or Silver on call. 9.22.3 It is also the role of the DM to ensure that rota sheets are maintained and up to date. All changes must be either directly made by the manager or passed to the scheduling staff. The relevant administrator must be informed in all cases. EEAST HEOC SOG_V1.0 Page 123 of 143
9.23 Shift and Line Management of HEOC Staff 9.23.1 HEOC Duty Managers are responsible for the line management of a group of staff. Should this require the manager to leave the HEOC room, they must ensure cover is first in place. The DM must be aware and understand their responsibility for all relevant HR policies and procedures, which are available on the intranet site. 9.23.2 The DM is responsible for booking HEOC staff sick and fit for work. All sickness reporting must be done via the DM. The DM also conducts Return to Work interviews in accordance with the Trust Sickness Absence Policy, away from the HEOC room. Wherever possible, these will take place on the first day of the staff member returning to work. Completed forms are forwarded to the AGM. The DM is further responsible for identifying staff that need, or would benefit from an assessment by the Occupational Health Department (OHD) and referrals should be made via the AGM. 9.23.3 The DM is responsible for identifying any staff lateness or unauthorised absence during a shift. During the shift, the DM will meet with any staff member who has been late or absent to discuss the issue and initiate an appropriate course of action to include when the time will be made up. Recurrence of lateness is escalated to the HEOC AGM. 9.23.4 The DM is also responsible for invoking the Trust Disciplinary Policy when necessary and may need to leave the room to informally resolve an issue or initiate a formal process. 9.23.5 The DM is responsible for the performance management of each member of staff on duty and should be regularly feeding back to them on their achievements and shortfalls. If individual performance issues have been identified but no improvement is being achieved through informal measures, this should be escalated to the AGM in line with the Trust disciplinary policy. 9.23.6 The DM is also responsible for continually developing all staff and assisting them in reaching their potential. The DM is specifically responsible for conducting the PDR/appraisal process for all their staff at least annually, in accordance with the Trust s PDR Policy. 9.24 Operational Rest Periods 9.24.1 It is essential that all HEOC and Operational staff on duty receive appropriate rest periods in line with the Trust Meal Break Arrangement for which the HEOC Duty Manager is responsible. Particularly, when a staff member has exceeded the maximum amount of time without a rest period, the DM will ensure they are stood down until their rest period is complete in compliance with the Trust rest break arrangements. EEAST HEOC SOG_V1.0 Page 124 of 143
9.25 Management of Operational Staff 9.25.1 It is not the responsibility of the HEOC Duty Manager to line manage operational staff, although they do have full accountability for all work allocated to those staff from the HEOC during the course of their shift. 9.25.2 Due to operational demands and the nature of their working environment, the HEOC may be the first point of contact for operational staff regarding line management issues. The DM should pass all these issues directly to the local DOM. When there is no DOM available, these should either be passed to a DOM in another area or to an operations manager with responsibility. In these circumstances, the DM may be required to take initial action, until an appropriate operations manager can be advised and made available to deal. This is particularly appropriate for staff safety and welfare issues. 9.25.3 In the event of a conflict between operational and HEOC staff or an apparent difference in procedures, the DTL will have responsibility for attempting to resolve the issue in the first instance, escalating to the DM who will deal directly with the DOM. Any issues which cannot be resolved should be escalated to the HEOC AGM/GM or Silver on Call if out of hours. 9.25.4 Operational staff members booking sick or fit should be directed to contact their local DOM team. If this is not possible for any reason, the DM must speak with the individual and will record the details before passing them to the local manager. 9.26 Assaults, Serious Injury or Death of Trust Staff on Duty 9.26.1 The HEOC Duty Manager is responsible for the welfare of all operational staff whilst on duty. This management responsibility is shared with the local DOMs. However, once deployed to a location or allocated to an event, the DM will have responsibility for ensuring staff welfare is maintained as a priority. This will include giving their full and immediate attention to all reports of staff assault, injury or death. 9.26.2 The DM and DTLs will ensure that all responding resources are given any information which may indicate potential danger at a location they are attending. The HEOC do not have responsibility for deciding whether a unit enters a location 9.26.3 The DM will co-ordinate an appropriate Trust response to incidents involving assault, injury or death of Trust staff, with priority given to providing immediate assistance on scene whilst ensuring the safety of staff. The DM must be aware that, until the scene has been confirmed as safe, it may not be appropriate to commit further resources. EEAST HEOC SOG_V1.0 Page 125 of 143
9.26.4 Police attendance will be requested to all incidents of staff assault, serious injury or death. 9.26.5 In all cases of assault, injury or death of staff, the local DOM will be informed and, in all but the most minor of incidents, will be required to attend either the event scene, hospital or response post. 9.26.6 In all but the most minor of assaults and injuries, the DM will notify the On Call Silver. In the event of serious injury or death, the On Call Gold will also be notified. 9.27 Trust Vehicles/Staff involved directly in an RTC 9.27.1 The HEOC Duty Manager co-ordinates the HEOC response to a Trust vehicle or staff member (including PAS/VAS working for the Trust) involved in an RTC. Section 7.23 refers to the initial dispatching responsibilities. 9.27.2 In the event that the crew, patients or members of the public have sustained minor injuries as a result of the RTC the DM will ensure that a local DOM/ Bronze manager is advised of the incident and the actions taken so far by the HEOC. It will be for the DOM/Bronze manager to decide whether to attend scene or talk to the staff directly. 9.27.3 In the event that the crew, patients or members of the public have sustained major or serious injuries, the DM must contact and ensure that two managers (minimum 1 Bronze and 1 Silver) are sent to the scene to manage the incident and staff welfare. 9.27.4 The DM will be responsible for coordinating all further actions in relation to the incident, including liaising with the DOM/Bronze manager, Silver, Gold and Trust press office where appropriate. 9.28 Special Situations and Temporary Warnings 9.28.1 The Duty HEOC Manager has a key responsibility for ensuring that all information relating to potentially volatile or dangerous situations is effectively passed to relevant operational resources. Whilst much of this may be done routinely without the direct involvement of the DM, any information or incidents brought to their attention must receive the manager s full attention and a safe response ensured. In particular, any identified questions or complaints regarding these warnings should be fielded by the DM. 9.28.2 During the course of their shift, the DM may be made aware of an incident location or telephone number requiring a note to be added which will advise the HEOC and operational staff of health, access or potential violence at a location. The DM will add the details of the warning to the relevant section of EEAST HEOC SOG_V1.0 Page 126 of 143
I/CAD, entering sufficient notes to show who has added the notes and why. The DM must also arrange for the information department/individual responsible to receive written confirmation of the warning. Otherwise, the warning will be removed after two weeks. If the details have come from an operational member of staff, they will need to complete an incident (flagging) form and forward it to their DOM team. 9.29 Operational Non-Staff Issues 9.29.1 It is not the responsibility of the HEOC Duty Manager to deal with vehicle, equipment, estates or any other operational issues although they are accountable for making an appropriate initial response until the matter can be passed to the DOM team. 9.29.2 Due to operational demands and the nature of their working environment, the HEOC may be the first point of contact for the reporting of operational nonstaff issues. The HEOC DM should pass all these issues directly to the local DOM. When there is no DOM available, these should either be passed to a DOM in another area or to an operational manager with responsibility. 9.29.3 The DM will have access to the arrangements and contact numbers for out of hours providers for vehicle defects and estates issues. In the event of not being able to pass these issues to an appropriate operational manager in a timely fashion, the DM will initiate the response and pass details to the manager when possible. 9.30 Liaising with other NHS Trusts and HCPs 9.30.1 It is the HEOC Duty Manager s responsibility to effectively communicate with other members of the health care community in relation to events and incidents in progress or anticipated in the near future. The DM must operate within Trust policies and procedures to provide an appropriate level of service. 9.30.2 The world of A&E health care is one of increasing demands and diversity of providers. As such, this aspect of the DM s role is increasingly difficult. There will be occasions when the DM is required to take a view on a specific request and will need to make a decision. If unsure of which decision to make and time allows the DM should refer to the Silver on Call or HEOC GM/AGM for advice. Some issues may be outside the scope of the DM s remit and will need to be referred. 9.30.3 On occasion, the DM is required to negotiate with HCPs, health care managers and other emergency services and is responsible for making decisions in the best interest of the individual patient as well as the wider EEAST HEOC SOG_V1.0 Page 127 of 143
population and in compliance with Trust procedure. When declining a request for assistance, this should be done with polite explanation and an alternative offered wherever practicable. 9.31 Release of Information 9.31.1 The HEOC Duty Manager is responsible for all Release of Information (ROI) by HEOC during the course of their shift refer to the Release of Information Policy. They are accountable for ensuring the requesting party has sufficient reason for requesting the information and has supplied all the details required for that release. The manager should use the six Caldicott principles to satisfy themselves, when considering whether to release information: Justify the purpose of using confidential information Only use it when absolutely necessary Use the minimum that is required Access should be on a strict need-to-know basis. Everyone must understand his or her responsibilities Understand and comply with the law 9.31.2 The DM is not responsible for the Release of Information in hours or for nonurgent requests. These are passed to the ROI/PALS department in Bedford on 01234 408999 Lyn Pickering (lpickering@eastamb.nhs.uk) or Bob Durbin (bdurbin@eastamb.nhs.uk). 9.31.3 All requests for information from other healthcare or social care organisations, GPs, Police or Coroners must be made in writing either by letter or fax and signed. All agencies, except Coroners, are required to ensure a consent form is also completed unless the person has died, is a child or is incapable of providing consent. This consent must be supplied to the DM before the release of information. 9.31.4 Exceptional urgent requests for live incidents or serious crimes (which must be made in writing and signed on an A101 ROI form) are assessed and authorised by the DM. All requests for the release of information must be passed to the ROI department to be recorded and also entered into the I/CAD notes. 9.31.5 Requests made by the police to identify, or speak with Trust staff should be forwarded to the DOM or manager on call who will be responsible for passing the requested information or collecting details from the staff member and passing it on to the police. EEAST HEOC SOG_V1.0 Page 128 of 143
9.31.6 Requests from members of the public must be made in writing to the PALS Department as above. 9.31.7 Occasionally, the DM may be requested to pass information to another health care provider or family member who will continue the care of the patient. In these circumstances, should the manager decide to release the information, notes should be entered into the I/CAD event. 9.31.8 The DM themselves can get support or guidance from the locality or regional vulnerable child and adult leads. 9.32 Press Interest 9.32.1 Press inquiries should not be managed in the HEOC. All enquiries should be passed to the HEOC Duty Manager who will redirect them to the local Communications Manager. No details of any incident may be given to members of the press by HEOC DM s unless they are guided by the communications team. 9.33 Positive Feedback and Complaints 9.33.1 The HEOC Duty Manager, whilst responsible for the smooth running of the department during their shift, should not be distracted from their primary responsibility of managing the operation of the A&E service by engaging in lengthy discussions regarding feedback for the Trust. Any such calls should initially be passed to the DM who will normally advise the caller to contact the locality Patient Advice and Liaison Service team (PALS). However, should the matter appear straightforward, the DM may make a decision to briefly resolve the matter locally. The PALS team must, in any case, be notified of the complaint received and any advice/information given by the DM. 9.34 Risk Management 9.34.1 The HEOC Duty Manager is in a prime position for identifying risk to the organisation and A&E service and, as such, is responsible for appropriately reporting any identified risks. The DM should be familiar with the trust Risk Management Procedure and advice can be sought from the HEOC GM/AGM or On Call Silver. 9.34.2 Any series of events resulting in an actual or potential adverse incident should be reported. EEAST HEOC SOG_V1.0 Page 129 of 143
9.35 Vulnerable Children and Adults 9.35.1 The Children s Act 2004 and the subsequent statutory guidance contained in Working Together to Safeguard Children dictates that all trust employees have a duty to report any concerns they have in relation to children they suspect are being abused or neglected. Whilst not a statutory duty, the Trust is committed to applying the same principles to Vulnerable Adults. The HEOC Duty Manager therefore has responsibility for reporting and recording all concerns regarding vulnerable people. The Trust Policy Protection of Vulnerable Adults and Children deals with this in greater depth. 9.35.2 Any member of HEOC staff who has concerns for the welfare of a vulnerable person will pass those concerns to the DM. 9.35.3 The DM must pass all concerns regarding vulnerable children or adults to social services and for also recording those concerns within the Trust. Whilst the DM takes responsibility for these referrals and the recording of concerns, it may be more effective for the staff member themselves to pass these details, under the guidance of a DOM or DM. 9.35.4 Each HEOC will maintain a record of social services contact numbers and referral routes to enable DMs to make referrals and also to pass those numbers to other Trust staff requesting them. 9.35.5 Operational staff and HEOC must pass vulnerable person concerns to the appropriate social services number directly, not via a third party. The DM does not pass referrals to social services on behalf of operational staff. 9.35.6 All vulnerable person concerns are recorded within the Trust by telephoning the Trust single point of contact number on 0845 602 6856. 9.35.7 If a vulnerable person is thought to be in immediate danger, those concerns must be passed to the police requesting an immediate attendance. 9.35.8 The DM may be contacted by either HEOC or operational staff to discuss concerns and options. As such, the DM may provide advice or guidance. 9.35.9 The Trust has both a Clinical Specialist for Safeguarding as well as a Safeguarding Lead, both of whom are available to give advice. 9.36 Deaths in Patients under 18 years of Age 9.36.1 It is important that the Trust Clinical Specialist for Safeguarding and the Safeguarding Lead are notified of all deceased patients under the age of 18. This should be done by email and include sufficient information for them to identify the incident, including the I/CAD reference. It is the DM s responsibility to ensure this is done although it may be carried out by an operational manager or referred to the HEOC AGM. EEAST HEOC SOG_V1.0 Page 130 of 143
9.36.2 It is the responsibility of the ambulance service to transfer all but a small minority of infants and children who die unexpectedly outside of hospital to the nearest A&E Department. If there is a delay, for example to facilitate an early police investigation, it may be that the police will not release the body from the scene for 2-3 hours. 9.36.3 In this situation it would be appropriate subject to police agreement for the crew to be released and the ambulance service contacted again at a later stage to convey the deceased child to the A&E Department, subject to it not being declared a major crime scene. 9.36.4 There will be other occasions where the ambulance service has not attended in the first instance. On these occasions the ambulance service will be contacted to attend the location in a non blue light response to convey the deceased child or infant to the A&E Department. 9.37 IT and Estates Issues 9.37.1 It is the HEOC Duty Manager s responsibility to ensure all equipment and facilities are working correctly and to immediately report any problems to the IT technician on call or appropriate provider, according to local procedures. 9.37.2 There are resilience measures in place for maintenance of the three HEOCs which can be found at the DM s workstation, including details of support systems and fault reporting. 9.37.3 The DM may also be the first point of contact for estates issues, out of hours, for the whole locality building and should report to the defect to the relevant provider. 9.38 Urgent Disconnect (EXIT4) 9.38.1 The HEOC Duty Manager is responsible for the management of incoming call demand including the use of Urgent Disconnect EXIT4. 9.38.2 The Urgent Disconnect EXIT4 procedure is detailed in Section 6.31 of the Call Handling procedures and may be initially implemented by the CHTL although the DM must be made aware it is being utilised to manage call volume. 9.39 I/CAD, ICCS and Telephone Systems Failure 9.39.1 The procedures for technical failures are included in the HEOC Business Continuity Plans (Appendix P). The HEOC Duty Manager is centrally responsible and accountable for the effective and timely implementation of EEAST HEOC SOG_V1.0 Page 131 of 143
these procedures. Early identification of roles and delegation of duties is critical. 9.39.2 All but the most minor technical failures must be escalated to the On Call HEOC Silver. 9.39.3 The DM is also responsible for the communication to all other parties, smooth transition back to normal operating procedures and for the retrospective entry of all events taken on paper. 9.40 Fire Procedure and Evacuation 9.40.1 The HEOC Duty Manager is responsible for the safety of all HEOC staff and must comply with the Fire Evacuation procedure in place at each HEOC site and detailed in the HEOC Business Continuity Plans (Appendix P). The DM may, especially out of hours, be the Senior Manager on site and, as such, will be responsible for the safe and effective evacuation according to the procedure. 9.40.2 The DM has responsibility for the safety of all their team members and also for maintaining an effective service for the population of the East of England. 9.40.3 Each of the three HEOCs will have local plans for implementation in the event of a fire. All DM s have responsibility for having a thorough working knowledge of their HEOC evacuation procedures and are required, as part of the management team, to ensure all team members understand the procedure and their role in it. 9.41 Dynamic Escalation and On Call 9.41.1 The HEOC Duty Manager has responsibility for the early identification of issues requiring escalation and for proactively attempting to resolve them. Escalation should be immediate upon identification of the shortfall. 9.41.2 A structured approach for some issues is provided in the East of England Escalation Guidelines. It is the DM s responsibility to dynamically respond to changing circumstances and escalate appropriately. 9.41.3 Escalation will usually be within HEOC to the HEOC AGM or General Manager HEOCs and to the wider operations environment via the Silver or Gold managers. 9.41.4 Due to demands within HEOC, normal practice will be for the notified Silver manager to escalate further as required following discussion with the HEOC DM. EEAST HEOC SOG_V1.0 Page 132 of 143
9.42 HEOC Management and REAP 9.42.1 The above procedures apply to working within the usual range of expected pressures broadly associated with levels 1-3 of the Trust REAP Plan. However, in order that the Trust can respond to further increases in pressure, other mitigations may be implemented as described above. These may not all be implemented at once. 9.43 Digital Radio Fault Reporting 9.43.1 It is the role of the HEOC Duty Manager to report any faults relating to HEOC ICCS terminals or operational Digital Radio faults to the Airwave Service Desk in a timely manner. Please refer to OI 126 - Digital Radio Fault Reporting Procedure for further information 9.44 ICCS Talkgroup Monitoring 9.44.1 It is the responsibility of the HEOC Duty Manager to monitor the following Talkgroups on the ICCS: - National Control Talkgroup 69 - This is a national Inter Control room talkgroup between NHS Ambulance Trust ICCS Systems only. Sharers Hailing Talkgroup 204 This is a Trust specific talkgroup to provide access to all other pre-defined sharer organisations such as Fire and Rescue Services, Ministry or Defence Police. Highways Agency and British Red Cross. Ambulance Hailing Talkgroup 203 This is a Trust specific talkgroup to provide access to all NHS Ambulance Services. It is the hailing group that all other Ambulance Trusts can use if they are in our region and require assistance in any way. The Trust will be tested in future on monitoring of the Hailing groups and any Trust that does not respond is formally reported to the DoH with a report going to the Director of Operations and the Chief Executive. 9.45 Extraordinary Incidents or Those Requiring a Specialist Response (Including Bomb Threats, Notification of Terrorist Action, CBRN/HAZMAT incidents) EEAST HEOC SOG_V1.0 Page 133 of 143
9.45.1 The HEOC Duty Manager, with the assistance of the CHTL and DTLs will monitor all events and identify those which may require a specialist, large scale or complex response. The DM will take a proactive and leading role in co-ordinating an appropriate response from the Trust and all other appropriate agencies. The DM is also responsible for the early activation of specialist resources such as the On Call Tactical Advisor, HART/USAR teams and CBRN/HAZMAT teams. It is the DM s responsibility to be aware of all available specialist resources available during the course of their shift. 9.45.2 Bomb threats or notification of terrorist action are managed using the action cards in Appendix E. 9.45.3 In all cases, the HEOC Duty Manager will be at the centre of the Trust s response, ensuring the incident is correctly resourced and communications are effective. 9.46 Major Incidents 9.46.1 The HEOC Duty Manager plays a key role in the early identification of potential major incidents and the implementation of the Trust Major Incident Plan (Appendix F) and Major Incident Cascade Procedure (Appendix H). As such, all DM s must be thoroughly familiar with the Plan and action cards. 9.46.2 On receipt of information the DM is responsible, where appropriate, for declaring a Major Incident Stand By or Major Incident Confirmed and implementing the Plan appropriately. The DM assumes the role of HEOC Silver until relieved by another manager and records all decisions in the Incident Decision log book (separate from I/CAD). 9.46.3 As soon as possible a member of staff (ideally administrative and does not need to be an experienced member of HEOC staff) should be appointed as a dedicated loggist for this purpose. 9.46.4 The DM will, at the earliest opportunity, move the incident management to a separate workstation staffed by an experienced DTL and another suitably experienced staff member who can take calls regarding the incident and enter notes into the I/CAD. 9.46.5 Once sufficient staff and managers are in attendance, the incident management will be moved to the Silver Incident room (for those HEOCs which have them). 9.46.6 It is imperative that the Plan is adhered to at all times and that accurate records are kept, both on the event in I/CAD and also in the Decision Log. All records, regardless of how informal or incomplete, must be kept. EEAST HEOC SOG_V1.0 Page 134 of 143
9.46.7 The DM will be responsible for appropriate deployment and allocation of resources to Major Incidents in liaison with a member of the Trust Resilience team. 10 Equality Impact Assessment The East of England Service NHS Trust has made every effort to ensure this policy does not have the effect of discriminating, directly or indirectly, against employees, patients, contractors or visitors on the grounds of race, colour, age, nationality, ethnic (or national) origin, gender, sexual orientation, marital status, religious belief or disability. This policy will apply equally to full and part time employees. All East of England Ambulance Service NHS Trust policies can be provided in large print or Braille formats if requested, and language line interpreter services are available to individuals who require them. 11 Process for Monitoring Compliance and Effectiveness Conduct will be monitored by the HEOC Duty Manager and Team Leaders during their period of duty. Performance data is constantly updated on the Trust s Portal and is monitored by Operational and HEOC management. The quality of call handling is monitored and audited, through the AMPDS and whole call auditing processes, by the Information Audit department and reported to the KA34 and HEOC Processes Review Group. Feedback on individual performance is also given to the Call Handler. All issues, monitoring and audits, both internal and external, are reported through the KA34 and HEOC Processes Review Group. EEAST HEOC SOG_V1.0 Page 135 of 143
12 Performance Standards/Ambulance Quality Indicators The Trust is required to meet the following performance standards and the entire HEOC team will be instrumental in achieving these: Call Pickup A8 (R1/R2) A19 (R1/R2) Transportable Green 1 (G1) Green 2 (G2) Green 3 (G3) Green 4 (G4) 95% in 5 seconds 75% in 8 minutes 95% in 19 minutes Response in 20 minutes Response in 30 minutes Clinician Call-back within 30 minutes Clinician Call-back within 60 minutes In order to achieve these standards, the Trust has also set the following targets in relation to the individual stages of a 999 event: Call Connect to Call Pickup Address Verification Time Address Verification to Vehicle Assign Unit Mobilisation (Allocation to Mobilisation) 5 Seconds 25 Seconds 30 Seconds 45 Seconds 13 References International Academy of Emergency Medical Dispatch EMD-Q Scoring Standards. KA34 guidance document for 2012-2013. National Priority Indicators for the Ambulance Service. Commission for Health and Social Care. (Care Quality Commission from April 2009) Principles of Emergency Medical Dispatch, (Third Edition). National Academy of Emergency Medical Dispatch, 2006. EEAST HEOC SOG_V1.0 Page 136 of 143
HEOC SOG Appendices Appendix A HEOC Demand Management Plan (TBC) Appendix B Resource Escalation Action Plan (REAP) EEAST HEOC SOG_V1.0 Page 137 of 143
Appendix C - Card 35 Flowchart 999 / Emergency Line (Flowchart 1) Call to be answered Ambulance Emergency, What s the address of the emergency? Address and call back number to be verified as per normal procedures Send Alert to Dispatch e.g 1hr Urgent Follow GP Urgent flowchart 2 NO Caller Identified as HCP Ask Does your patient s condition present an immediate to life? Process through MPDS as normal Caller Not Identified as HCP YES Yes Accept Event, Launch ProQA, complete Case Yes Entry & Select Protocol 35 Yes KQ#1 - What is the reason for admission? KQ#2 Is there a HCP with the patient? YES Yes Ask Are you (they) staying with the Yes patient to manage their condition until the response Yes arrives? YES NO NO Auto answer KQ#3 with Yes Auto answer KQ#4 with No but blue lights and sirens required KQ#4 Is there a defibrillator available (and somebody trained and prepared to use it) Not required if the request is from an Acute Trust (Auto answer YES) YES Assign FIRST using AED icon on ICAD (n NO Enter NODEFIB Post-Dispatch Instructions and Pre-Arrival Instructions are available and should be provided when appropriate and applicable. EEAST HEOC SOG_V1.0 Page 138 of 143
GP Urgent / Direct GP Line (Flowchart 2) Call to be answered Ambulance Service? Caller Indentified as HCP Ask Do you require a 1-4 hour Urgent or an emergency response? Emergency Response Follow flowchart 1 Non Emergency Response Verify Patient Address and HCP Caller details. DO NOT ACCEPT EVENT Open ProQA and complete Case Entry Complete KQ#1 and #2 Auto answer KQ#3 with NO Complete Key Questions and close ProQA Complete/freetext any other relevant details. A Accept Event. Choose Appointment time. EEAST HEOC SOG_V1.0 Page 139 of 143
Appendix D - Language Line EEAST HEOC SOG_V1.0 Page 140 of 143
Appendix E Bomb Threat or Terrorist Action Appendix F Major Incident Plan Appendix G Major Incident Action Cards Appendix H Major Incident Cascade Procedure Appendix I Initiation of Emergency Panic Button EEAST HEOC SOG_V1.0 Page 141 of 143
Appendix J - Card 35 Hospital Transfer Flowchart EEAST HEOC SOG_V1.0 Page 142 of 143
Appendix K Community First Responder Policies and Procedures Community First Responders Staff Information Pack Appendix L ECA Allocation & Deployment Guidelines ECA Scope of Practice ECA Deployment Table Appendix M Critical Care Desk Procedures Appendix N Clinical Support Desk Procedures Appendix O HEOC Specific Control Instructions Appendix P HEOC Business Continuity Plans (TBC) EEAST HEOC SOG_V1.0 Page 143 of 143