NZ - ST John Ambulance service investigates handling of flu calls - Protocol 36

[Sally Furniss]

Ambulance service investigates handling of flu calls

<!-- UID: c59185d3ed5d39a88874071feb5ba3e90bed2f18 AID: 2047809 C: 2009-08-27 18:20:09 U: 2009-08-27 20:26:55 P: 2009-08-27 21:50:31 --> Updated at 8:26pm on 27 August 2009
The St John Ambulance Service is investigating whether the use of a new procedure for handling 111 calls delayed ambulances at the height of swine flu.

The organisation runs emergency ambulance communications centres throughout New Zealand and says it adopted an internationally recognised way of assessing flu-related calls in Auckland, Wellington and Christchurch.


St John says a new manual protocol was added to regular computer-based procedures in mid-July to handle a dramatic increase in demand for ambulances from callers with flu.


But by late July, concerns were raised about the priority given to cases under the special protocol, and its use was ended.


The new system was used when answering just over 1000 cases. St John medical director Tony Smith says seven cases are of particular concern, and three of these involved patients who subsequently died.


The organisation is stressing there is no information yet showing that the deaths had anything to do with the new procedure's use.


http://www.radionz.co.nz/news/stories/2009/08/27/1245c29e0fb9

 

[Pathfinder]

St John swine flu rules failed patients

St John swine flu rules failed patients

St John swine flu rules failed patients

4:00AM Tuesday Sep 15, 2009
By Vaimoana Tapaleao


St John says Protocol 36 was implemented during a time of extreme pressure for the service. File photo / Hawke's Bay Today

A St John investigation has found insufficient training of call staff in its swine flu pandemic protocols was a key factor in ambulance response delays.

Protocol 36 was introduced during the winter to help cope with the influx of swine flu-related calls coming in at the time. It allowed the dispatcher to rate each emergency call as being a priority one, two or three job in order to determine which cases were most important.

People who reported flu symptoms were given a priority three response as it was usually non-life threatening.

But concerns were raised after four patients died after the ambulance response was incorrectly given a lower priority.

Medical director for St John, Tony Smith, said the system was put in place during a time of "extreme pressure" which on the whole did prove to be helpful. But more sufficient training was needed, he said.

"We underestimated how much training was required [and] subsequently, these people have died.

"We've identified that all call-takers did not receive sufficient training. But we need to put this in perspective - we responded to over 21,000 emergency calls and we've identified nine where there was a delayed response."

The investigation found that of the 21,858 emergency calls responded to at the time, dispatchers referred to the Protocol 36 system 1025 times.

Of those, nine cases were found to have been given an incorrect lower priority than the patient needed.

Dr Smith said that he had personally reviewed each case and in his medical opinion found that a faster ambulance response would not have saved the patients.

The fact Protocol 36 was a manual system, not computer-based, was also a factor in the call-out delays, the investigation found.

Call handlers would have to refer to a manual on their desks before deciding on the level of priority that an emergency call required.

When coupled with the computer system already in place, Protocol 36 became a complicated process for the call-takers to handle.

Dr Smith said the system would be introduced if swine flu - or another epidemic - returned.

"If the use of Protocol 36 is needed again, we will make sure that there is adequate call-taker training and refresher [updated] training in place.

"[We will also] use Protocol 36 as a routine part of our computer-based systems, except where there is a need to revert to desk-top cards in the event of loss of emergency power or other critical failures," Dr Smith said.


http://www.nzherald.co.nz/emergency-services/news/article.cfm?c_id=118&objectid=10597311&ref=rss

 

[Pathfinder]

Re: St John swine flu rules failed patients

Re: St John swine flu rules failed patients

Errors in ambulance response to swine flu patients

Tue, 15 Sep 2009

An investigation into ambulance response times at the peak of the swine flu pandemic has found there were flaws in the system, but they did not contribute to the deaths of anyone affected.

The inquiry was launched after St John Ambulance staff raised concerns in July .

Call centres were swamped by a record number of 111 calls as the H1N1 virus spread, prompting the introduction of Protocol 36 - an internationally recognised series of questions designed to help call takers prioritise patients complaining of flu-like symptoms.

St John's investigation found the use of this protocol led to nine cases in which the ambulance response was given a lower priority than it should have.

Four of those patients died.

However, St John medical director Dr Tony Smith, who reviewed the cases, said a faster response would not have saved their lives.

Two had received ambulance care within the Priority 1 (most urgent) target response time, despite the mix up.

"Despite this, any preventable delay in getting an ambulance to a sick patient is of significant concern to us.

"We have to learn from these cases and are making changes ," Dr Smith said.

Several key factors contributing to the delays were identified in the investigation:

* Insufficient training for staff in using the protocol;

* Its introduction as a manual system to be used alongside the computer-based system, complicating the process;

* Insufficient support provided to call takers after the introduction of Protocol 36, given the volume of calls and new process they were using.

Dr Smith said these issues would be addressed if the system needed to be used again.

While faults were found, Protocol 36 was still considered a useful tool.

"(It) helped us to have ambulances available for life-threatening emergencies at a time when the demand for ambulances sometimes exceeded our capacity to provide them," Dr Smith said.

"It is likely that Protocol 36 helped save lives that would otherwise have been lost during this time."

He said concerns with the system had been raised quickly and were addressed immediately.


http://www.odt.co.nz/news/national/74072/errors-ambulance-response-swine-flu-patients

 

[Sally Furniss]

Re: NZ - ST John Ambulance service investigates handling of flu calls - Protocol 36

More on protocol 36 here

Protocol 36: Pandemic/Epidemic/Outbreak (Officially Enacted Triage)

4 August 2009 New Update to Protocol 36 ....adds a new answer choice "Asthma-related (no difficulty speaking between breaths)"