More AMPDS Nonsense

AMPDS priorities?

I’ve mentioned before that our service is now using AMPDS (Advance Medical Priority Dispatch System or more correctly Another Maddening Piece of Dumb Software), it’s supposed to identify the type of call and allow the EMDs to dispatch an appropriate vehicle; RRV, bus, first responder, etc. They use it in London. Nee Naw has posted a number of pieces about it: AMPDS and Angry Paramedic. (read through the comments, they show the depth of feeling about this system). I think it’s fair to say that no one likes it, not even Nee Naw. Anecdotally I’d say things were better with CAD (computer aided dispatch) though even that could be rigged to distort the stats; all RTAs used to be ‘A’ cat until we got monitored then they all became ‘B’s – no matter how life threatening the injuries.

Before we go any further let’s be clear, this is not a bitch at EMDs but just some examples of how inflexible this system seems to be.

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I’d just rolled up to my ‘hot’ spot the other night (there’s nothing ‘hot’ about sitting by a roundabout at 11pm with the temp at 2ºC). I’d barely got my book open when a call came across on the bat phone; “start heading to New Street for a patient unwell.” Stone me! That’s just around the corner. See, this dynamic cover stuff does work. I was just turning into New Street about a minute or so later when the phone went again.
“Cancel. Cancel. The call has been coded as a ‘B’ cat and we have a local crew available.”
“But I’m just at the end of the road. Let me go and check it out.”
“Negative. Cancel and return to your ‘hot’ spot.”

I spoke to the crew later, it was a six year old child who was very unwell. They didn’t waste time but just scooped and ran. Quite right you may say but consider this. The crew were two EMTs, one still within their probationary period. With the call being coded as a ‘B’ cat they had up to 18 minutes to get there. I’m an ECP (not that that makes me special). I’ve done the paediatric course twice plus the “how to be a paediatrician in 2 days” module on my ECP course. I was less than 2 minutes away from the call with a car full of antibiotics and other stuff that may have helped. Suppose the child had meningitis? I carry, and can administer, benzylpenicillin (which I don’t think EMTs can do – I may be wrong here). If you were the parent of that child wouldn’t you have liked someone to turn up ASAP instead of having to wait for up to 18 minutes. It’s also depressing for me as I just feel my only role is to stop the clock for those ‘magical’ 8 minute ‘A’ cat calls and all other patients be damned.

Later in the night two ‘A’ cat “severe breathing difficulty” calls came in at the same time. The crew headed out to one – it was our old friend Mrs Peacock. She’s now becoming a regular. Crews have been out to see her at least 7 times in the last week that I know of. One of my ECP colleagues has seen her twice. I saw her the previous day. She’s been to see her GP, she’s even had a private consultation with a physician at the local BUPA hospital. Everyone is in agreement; she suffers from panic attacks. The Doc’s given her buspirone, personally I think she needs to be on an anti-depressant as well – but what do I know. Apparently there doesn’t seem to be any facility within AMPDS to have this address flagged as a regular caller. Anyway, the upshot of the call was that Mrs P was having another panic attack. At 3 in the morning the crew just decided to run her “up the road” and pass the buck to A&E.

My “severe difficulty breathing” call was to Margaret. Margaret had been having abdominal pains for 3 weeks but with no other associated symptoms; no vomiting, diarrhoea, constipation, dysuria or anything else I could think of. She’s been to see her GP as well. He’s not sure what’s up so she’s been referred for an endoscopy. She said she was in “a lot of pain” though she appeared very well and, if she was engaged in conversation for a few minutes, all that “pain” seemed to disappear – until she thought about it again that is. What to do with a patient presenting with ‘acute abdomen’? My diagnosis was N.F.I. so I reprioritised the call as an ‘urgent’ and Margaret eventually went to A&E an hour or so later. I still don’t know where the “severe difficulty breathing” came from.

So that was two “life threatening” calls that weren’t; but not to worry, we reached them both within the magical 8 minutes so the bean-counters will be happy that they can tick the right boxes. Consider though what would have happened it granny had an M.I or some hot-shot smashed his car up while we were otherwise engaged. The nearest vehicle was probably at least 10 miles away. Does AMPDS work – not in my view.

++++++++++++

The debate over ambulance response, or lack of it continues. I’ve mentioned the changes proposed by LAS, and Tom Reynolds has also posted about it.

Dr Crippen has posted an excellent article; If you are ill, call a taxi, and Nee Naw has countered with another superb post: Handling Inappropriate Calls

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8 Responses to More AMPDS Nonsense

  1. ecparamedic says:

    There is capacity within AMPDS to flag addresses. Many simply choose to ignore the warnings system

  2. ecparamedic says:

    Just spent a whole shift ‘fighting’ with Control, I can’t tell you how peed off I am and just how sickand tired I am of trying to do my job against the tide of ignorance and downright petty mindedness of some of my ‘colleagues’. It’s like swimming in treacle.

    SD
    😦

  3. Kingmagic says:

    As you quite rightly stated CAD was far better although not perfect.
    AMPDS has created a CAT A demand where there was,nt one before…so we need more RRVs/FRUs/FRVs First Responders, but not at the expense of crews on trucks.
    Our Cat A demand has gone through the roof since AMPDS which makes for a very cynical workforce…not so heavy on the gas because it probaly will be sod all. Then the real Cat A will suffer….although we are been questioned and interviewed as to why we di,nt make the time!
    I think if a National Audit were undertaken by the Unions or a University into the Cat A categorisation it would show that AMPDS sucks!

  4. Canadian_EMD says:

    Sounds like the fault is your organization’s use of AMPDS. AMPDS is a call assessment protocol. Period. It does NOT advise how long to respond. It does not say to (or not to) send the closest car (my agency does). It is a response classification system. It doesn’t specify how long to get to a call, what resources should go to a given call, or anything about the ambulance response. Those things are SOLELY dictated by the agency using the system. All AMPDS does is provide a consistent series of questions to allow a science-based classification of ambulance responses, to permit collection of reliable information in order to ascertain HOW to respond based on local policies and demand. What your agency sends to those classifications it is free to determine on it’s own.
    And no, I’m not a sales person.

    • Canadian ALS Paramedics says:

      I work in a Canadian system with a targeted response with very limited resources. We are killing people with AMPS… I am the only Advanced Life Support unit for 500 000 people and the rest of the cars are all BLS. I only respond to the most serious calls (in theory). Since AMPDS was implemented a few years ago I respond to short of breath chest pains all day and none of them have any of these symptoms, they have diarrhea or a soar throat (should BLS response only. Then you hear a crew calling for ALS because their patient arrested… “Sorry no ALS available”. This is murder!!! AMPDS kills people every day in Vancouver. I missed 3 cardiac arrests in one day recently because I was tied up with no BLS back-up… all 3 were 40 to 50’s males witnessed arrests, totally salvageable but all 3 died. AMPDS might work in your general duty system with only one type of resource to send so there is no big impact on care. But in a targeted and layered system it is the WRONG tool on all levels… RAP, QI, and retraining wont help. Get rid of it and look at NHS Pathways

      O and, AMPDS is not evidence based, there are a couple studies written by the founder and owner of the compony… huge conflict of interest. I have also been involved in some data collection, it is set up to gather data that favours the system, totally corrupt! There are however other studies showing just how AMPDS is over sensitive and non specific, a tool you would never trust in medicine. Heres one study in the UK wanting to use a stronger triage tool for non emergent patients, but the study shows AMPDS is not capable because it is “too sensitive and non specific” (conclusion) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1725980/pdf/v019p00449.pdf

      NHS Pathways is much better and licensed.

  5. Robin says:

    Do the paramedic need to learn by heart the AMPDS or they have a little hand book / memo sheet they can refer to?

  6. Aussie Ambulance Calltaker says:

    My agency here in Aus uses AMPDS as well – in conjunction with CAD. We use AMPDS to obtain a response code which is then sent across to CAD, making the whole process a lot more flexible. The organisation has determined the level and type of response to each code and events are actively monitored by an experienced MICA paramedic, meaning that response can be up- or down-graded as necessary. In addition to this, we are more extensively trained in “protocol enhancement”. For example, we consider reportedly abnormal breathing that is due to pain (other than chest pain or after a trauma to the abdomen or chest) or vomiting to be normal breathing, because that’s what our agency has decided.
    We also run a Referral Service, which means that certain codes like a 1A1 or 26Ax are transferred to a paramedic or nurse who will further triage the situation and either provide basic medical advice, refer the patient to a Locum or district nursing service, or determine an appropriate timeframe for Ambulance attendance – often 3-4 hours for the most routine of problems.

    If AMPDS doesn’t work for your agency, it has nothing to do with AMPDS, it’s because your agency isn’t making it work. I couldn’t agree more with Canadian_EMD.

  7. Fantastic site. Plenty of helpful information here.
    I am sending it to a few friends ans also sharing in delicious.

    And of course, thanks on your sweat!

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