Why are you calling 999? Stop and Think! Is this a life threatening emergency? Is it appropriate for this patient to go to hospital? Known advance care plans, i.e. preferred place of care (PPOC) /death (PPOD) DNACPR in place? Could problem be dealt with by primary care response ie GP/OOH GP, Rapid Response Team, Community Palliative Care and Hospice teams? Can call hospice 24/7 for advice even if patient is not under their care

What happens when you call 999? Call takers in the Control room (non clinicians) will take demographics and details of the patient They follow a script, asking questions, resulting in the call being categorized according to clinical need If patient unconscious, not breathing etc an ambulance will be dispatched straight away (8 mins response) All other calls will remain in a queue waiting until an ambulance is available to attend During peak busy times LAS can be holding up to 200 calls pan London!

Clinical Support Desk – C.S.D A Team of General/Mental Health Nurses and Paramedics in the Control Room will review and call back patients/carers to gain more details and perform an enhanced clinical telephone assessment using the Manchester Triage System. Based on this assessment calls will be re-triaged, and given an appropriate response time. A decision will also be made as to whether the patient requires an Emergency Frontline Ambulance response or can be safely conveyed to hospital with Non Emergency Transport (NETS) Alternative care pathways will also be explored such as referrals to GP, District Nursing, Mental Health Teams and Hospice/Community palliative Care Teams.

As much information as possible please! LAS (C.S.D) do not have access to any patient hospital records LAS can access a patient’s Summary of Care Record, which is very basic overview of conditions, disease states and medication, often not up to date CMC is the ONLY source of information LAS can access regarding a patient’s resus status, ceilings of care, PPOC/PPOD and any Hospice/Community Palliative Care involvement PLEASE provide as much information as possible when calling for an ambulance ie Past Medical History DNACPR? On CMC? Under Hospice Care? Recent Hospital admissions? Set of observations?

C.M.C A small purple “INFO” button will appear on the call record if a CMC record is linked to an address The clinician in the Control Room ( C.S.D) will therefore have to log in to CMC to confirm the care record belongs to that particular patient at the location Informing LAS when requesting an ambulance that the patient is on CMC will also help to prompt C.S.D clinicians to access the care plan Unfortunately Paramedics on scene are unable to access CMC , they are required to call C.S.D to open the care record and relay information over the phone to them

In Summary ……. Is an ambulance really required? The need for information sharing CMC

Expert in end of life care St Christopher’s provides and promotes skilled and compassionate end of life care of the highest quality, working with, and through, our communities.   info@stchristophers.org.uk stchristophers.org.uk St Christopher’s is registered charity number 210667