999 R.E.S.P.O.N.D. [emerRgEncy diSPatch decisiONs in coviD-19]
End of project summary
In Wales, the Emergency Medical Retrieval & Transfer Service (EMRTS) Cymru works alongside the Welsh Ambulance Services University NHS Trust (WAST) to provide specialist resource (Wales Air Ambulance Helicopters, or Rapid Response Cars), at the scene of serious accidents or patients who are critically ill. As a small specialist team, it is imperative that they are only dispatched to emergencies where this specialist care is needed, therefore getting the right information to make this decision in the heat of the moment can be difficult. The 999RESPOND research project team explored the way in which the decision to dispatch a critical care team is made within ambulance control rooms, and how risk and severity is considered and handled during a dispatch decision. The findings were then used to design a training intervention for ambulance and critical care dispatch staff, and to provide recommendations for policy.
The project team reviewed and analysed 17 cases, constituting 100 episodes of decision making, where a critical care team was dispatched to an emergency. This involved reviewing and analysing the original 999 call audio recordings, audio recordings of the spoken and textual interactions that occur between different members of the teams involved in triaging calls, dispatch decisions and resource allocation, the sequence of events (SoE) textual record and policy, operating procedures and service guidelines relating to critical care dispatch.
Main messages
- Risk negotiation, outside of the call handler and dispatcher relationship is poorly understood.
- Our analysis indicates that there are multiple risk points for information loss throughout the dispatch decision making process.
- Communication practices in this context have not been landscaped before, although it either impedes information flow or promotes interactional cohesion which facilitates the uptake and cascading of risk, enhancing dispatch decision making.