The ambulance service remains under significant pressure, so please always consider if there are alternatives to an ambulance which enable prompt transfer to hospital. SWASFT triages every patient and ambulances are dispatched based on clinical priority. The presence of a healthcare professional does not in any way change the prioritisation or the timeframe of the response.
Please see the SWASFT-guidance-for-healthcare-professionals-requesting-an-ambulance-for-a-patient.pdf (clinicaltoolkit.co.uk). Of particular relevance to clinicians in IUC:
- Clinicians are asked to make the referral to the ambulance service, rather than delegating this to an operational colleague, the patient, their relative or carer. This allows accurate clinical prioritisation and avoids the call being re-triaged by the SWASFT clinical team. The SWASFT HCP aide memoire assists with the call flow and may be useful to review prior to making a call.
- Contact the SWASFT HCP Urgent line number on 0300 369 0096 to arrange ambulance conveyance for hospital admission within 4 hours.
- You should call 999 for an emergency ambulance (blue lights and sirens response).
- The document defines the category of ambulance as follows:
- Category 1 – immediately life-threatening event (mean response time 7 mins)
- Category 2 – serious, potentially life-threatening event (mean response time 18 mins)
- Category 3 – urgent condition (mean response time 60 minutes)
- Category 4 – non-emergency but medical clinical need for ambulance (one, two or four-hour response times, often by a non-registered crew).
The SWASFT colleague will use both nationally mandated (the first part) and locally developed (the later part) questions, to offer a category and average time for response based on the answers you have provided. The call process is designed to ensure the right category and response is provided alongside other 999 calls. However, it is important to note that if you feel the outcome offered is not suitable for your patient you are able to decline and to agree a suitable category of call. You would then follow a well-defined escalation process which includes the ability to have a clinician to clinician discussion to understand demand and if necessary prioritise patients who need a faster response.
What if the ambulance is delayed?
When SWASFT is under significant pressure all patients will wait longer for ambulances to arrive, even those requiring a category 1/2 response. This information is not intended to be prescriptive, but to offer considerations to support decision making if you are clinically concerned about a patient waiting for an ambulance and/ or the Treatment Centre is due to close before the crew have arrived.
If you are clinically concerned/ the patient is deteriorating while waiting, please
- Make a Healthcare Professional call back to the ambulance service on 0300 3690096 (999 if the scenario is immediately life threatening) to update SWASFT of the clinical picture and concern, and enable appropriate prioritisation for the current situation. This may need to be repeated if the clinical picture changes again.
- The SWASFT call taker will offer a category and average timescale for response based on the answers you have provided. It is important to note that if you feel this outcome/ timeframe is not a suitable for your patient you are able to decline this outcome and to agree a suitable category of call. This escalation process includes the ability to request a clinical discussion to understand demand and if necessary prioritise patients who need a more urgent response. NB: SWASFT do NOT ‘hold’ or ‘delay’ an ambulance response because the patient is with a HCP or in a HCP setting. Ambulance responses are provided based on clinical triage and need.
- Liaise with the shift manager early to ensure that they are aware of the situation, and they can support decision making/ planning ahead. For example, if you are concerned about running out of equipment/ treatment (eg oxygen) while waiting, they will be able to support provision of supplies from another Severnside location. The shift manager will also be able to manage/ forewarn/ delay patients due to arrive for appointments imminently, in liaison with the Clinical Coordinator.
If the wait for an ambulance arises at the end of a shift or when the Treatment Centre is due to close
- If the clinician’s shift is ending and a new clinician is starting, ensure clinical handover of the case to the next clinician
- Liaise with the shift manager early to ensure that they are aware of the situation and can support decision making
- Consider if the patient is clinically safe to travel independently to hospital. This must be a clinical decision and is influenced by a range of factors, including but not limited to
- whether this will be quicker than waiting for an ambulance
- the nature/ urgency of the clinical problem
- whether medical treatment (eg oxygen) is required for transfer
- whether a family member or friend is able to take them. It is an option for BrisDoc to arrange a taxi for them if this is clinically appropriate for the situation
- If the decision is made for the patient to go to hospital independently, please ensure that SWASFT is informed to stand down the ambulance attendance.
If the patient is not safe to travel without a clinician/ HCP escort and the Treatment Centre is due to close, consider
- Does the ambulance call need to be escalated due to a worsening clinical situation? If so, phone SWAST and follow the escalation advice outlined as above.
- If not,
- Can both the host and clinician at the base stay on beyond the time the Treatment Centre is due to close?
- Is there an option to send a visiting driver and clinician to the Treatment Centre to work from that base and be with the patient, thereby relieving the team who are due to (have) finish(ed)?
- Is there an option to consider moving a clinician from another Treatment Centre to work and be with the patient, and relieve the team who are due to (have) finish(ed)?
- Is another clinical service working in the space when the Treatment Centre closes, such that there is no space for the patient to wait?
If the clinician considers conveying the patient themselves
This is difficult and there is no expectation for any colleagues to do this. If all other options have been explored and are not available, the clinician may consider taking/ escorting the patient to hospital themselves. This requires an ‘in the moment’ weighing up of the balance of risks and benefits, considering both the patient and staff, the likelihood of deterioration/ urgency of the situation, nature of the clinical problem, time of day and proximity of the hospital. Please note that it is not possible to socially distance in the cars, and they cannot be cleaned in the same way that a clinical room can be, or deep cleaned if a patient has infectious symptoms of concern (eg Covid). This should factor into decision making. Similarly, if the hospitals are under significant pressure, it may not be possible for the patient to be immediately handed over to the care of the receiving department or ED. This could potentially mean that conveying staff are unable to leave the patient on arrival at the receiving unit, so we advise liaising with the receiving department as part of the decision making about whether to convey. If a clinician is considering conveying a patient, they should also discuss this with the Clinical Coordinator (or an experienced colleague overnight) and the Shift Manager to sense-check decision making and options.
If the decision is made to convey the patient, conveyance can be undertaken using a Severnside car and driver (to enable the clinician to be a clinical escort, and ensure access to medical equipment if needed). The driver and all passengers will need to wear face masks and ensure good ventilation (i.e. windows down) – this is especially important if the patient has possible Covid symptoms. The shift manager must be aware and will be able to support. Please ensure that a learning event is logged. Again, please ensure that the ambulance is stood down.