Journal Staff


By Journal Staff

When London Ambulance Service (LAS) medics respond to a 9-9-9 call at a flagged address, they carry out a risk assessment—either for guiding management of patient care or deciding whether it’s safe for responders to enter.

Patient care management—the newest 9-9-9 flag added to the system—provides the control room and ambulance crew with vital information about a palliative care patient, including patient wishes not to be resuscitated (DNR) in case of an emergency. The way it works, a flag is raised—metaphorically speaking—at the point the control room receives a 9-9-9 call placed from an address of a Coordinate My Care (CMC) registered patient. LAS has secured patient/family permission to access more than 7,250 patient records.

According to the article “Coordinate My Care from the perspective of the London Ambulance Service” (London Journal of Primary Care 2013;5:111-12): The LAS clinical support desk staff in the control room access CMC records and send a message about the patient to the ambulance crew. Once the crew arriving on scene has assessed the patient, CMC information is used to make decisions regarding treatment, referral, or conveyance. In April 2013, 67 records were shared with crews on scene. Work is under way to develop a Web interface that will enable address “flags” for new patients, alter the records of existing patients, and automatically update records within LAS command and control systems every 12 hours.

Another flag that has been in place in the control room provides cautionary messages to crews arriving at addresses where response scene safety is in question. However, responders only delay treatment if they believe they are in danger at the time of the call.

Risks include people with a history of violence and aggression toward ambulance staff, addresses with dangerous animals or weapons, and patients with psychiatric or alcohol-related conditions and mental health disorders.

According to Ambulance Operations Manager Athar Khan, at least one member of staff is attacked every day in London and at least two are verbally abused. Last year, 451 medics reported a physical assault and 737 were verbally abused as they responded to emergency calls.

“We have a duty to protect our staff and let them know if they’re about to be sent into a potentially violent situation,” Khan said. “We have to balance the need to protect our staff and the need of the patient.”