Diagnosis? N.F.I.

More AMPDS Nonsense

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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.

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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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