Visit to Abulance Opertions Centre

Story by Comms Member Eric Scaresbrook

Caller: "Oh hi! My boyfriend has fallen off his chair and can't get up." Ambulance: "No worries, we'll be right over!" CLICK

There are many more questions in this example that were not asked.

On average, there is a call for assistance for an Ambulance in NSW every 28 seconds. Needless to say, that is a lot of calls for help! In 2007/2008 alone, over 1 million emergency and non-emergency responses were made by the NSW Ambulance Service across the state. With 938 Ambulances of varying types, 365 support vehicles, 4 contracted planes and 9 contracted helicopters to deal with those million plus calls, how does the Accident & Emergency Department on wheels arrive at the scene of the medical emergency?

On Saturday 24 October 2009, several members of the Comms Brigade made the long trip to inner-city Redfern to meet their paramedical equivalents. During this visit, we were able to see and listen first hand the work of the officers in the Sydney Operations Centre of the NSW Ambulance Service. After a briefing and introduction from Patrick and Ann, we were shown into the centre. We were given headsets and assigned to an Operator who could guide us through whatever they were doing at the time. Because of the size of the room and the size of our group, we split up and were located across the room. Because of the use of headsets, the room was a lot quieter than I expected. Unless you were wearing a headset like we were, you would only hear one side of the conversation. Therefore it was very handy to be able to hear both sides of the call.

The room is open plan with many workstations. The majority of the room is taken up with call takers. When someone calls Triple Zero, a Telstra operator in a separate centre will ask "Police, Fire or Ambulance". If the answer is "Ambulance", the call is transferred to the centre we were in if the call is in the greater Sydney area. There are also similar centres in the Newcastle, Wollongong and Dubbo areas. The call taker often receives address details for the origin of the call on the computer screen. Even so, the call taker must confirm the details of where the Ambulance is to attend. These details are confirmed at the start and finish of the call. This prevents the Ambulance going to the wrong location. Sometimes the person needing assistance is calling from another location so these details must be confirmed.

At this point, the call taker asks a series of standard questions that are aimed at working out the priority of the call. Even though the answers might seem simple, the call taker must ask them because the call takers are continually assessed on their ability to get the correct details. Because there are numerous conditions and situations that may occur, the call taker is prompted by the computer (or manual flip-chart backup if required) to ask questions relevant to the condition. The answers may lead to another type of questions being asked until a complete triage (or initial assessment) is completed.

Depending on the nature of the call, the call taker may be able to send the information direct to the the dispatcher for an ambulance to be sent. However in some cases, the computer refers the call taker to refer the call to specialists located on another floor of the centre for a further assessment. These specialists with more clinical experience than the call takers will then take the call.

There are also important tips and suggestions that the call taker can give to make the person more comfortable and to assist with further treatment prior to the arrival of the ambulance. If the call is complicated, the call taker can seek assistance from the specialists upstairs or a supervisor in the centre. While some calls are relatively simple, it is not uncommon for a call taker to spend 30 minutes or more on a call while the ambulance responds. Indeed, you may have heard some of these extended calls on the recent Channel 7 program "Triple Zero Heroes".

Once the call has been finished and electronically transferred either to the dispatcher or the specialists upstairs, the call taker waits for the next call. Yes, there will be a next call. It may be another emergency call, a hospital requesting an ambulance for a medical transfer or a person wanting to know where their ambulance that they called is. There even may be a call from another Emergency Service requesting an ambulance.

In between calls, I was shown the CAD (Computer Aided Dispatch) system which enables everyone in the centre to see where all the ambulances are, the progress of calls and a lot more. All of the ambulances have numbers and GPS so the people in the centre can (usually) have a good idea about the location of ambulances throughout Sydney and the location of the calls. The mapping system can be quite handy in locating the ambulance and the location of the call. This is especially true if the caller calls back wanting to know where the ambulance is. Needless to say, all of the telephone and radio communications are recorded as are call logs as they are used in the event of legal action, coronial inquests and the like.

After being rotated between a couple of call takers, I took my headset to the other side of the room to a dispatch desk. I was located on the Sydney West desk covering the Parramatta, Auburn and Castle Hill areas. Despite this area being geographically small compared to some of the other desks, it is very busy with a number of large hospitals in the area. When the call arrives via CAD from the call taker, the dispatcher can determine the most suitable resource to the situation. There is a greater use of responder vehicles especially in Sydney and Parramatta that can quickly get to a scene and start treatment. While these responders are not generally used for patient transport, the use of the responder may save an ambulance from a response for a relatively minor incident where medical attention is still required but transport is not. Indeed in the centre of Sydney, these responders may even be on motorcycle which is a very handy way to get through the traffic.

Like the call taker, the dispatcher has CAD and can see details of the call and the location of the ambulance and the progress of each call. CAD can also send the details direct to the ambulance on a MDT (Mobile Data Terminal) which greatly cuts down on radio traffic. The dispatcher will send the details to the crew and the crew will hit a button when they receive the job and leave the station. If the job changes while the crew are on-route, the dispatcher can send the details via radio or MDT. Once the crew arrives on-site, they press another button on their MDT. Likewise, other buttons indicate when the crew leaves the scene and arrives at the hospital and when they are available for their next job. It is also the responsibility of the dispatcher to sign the paramedics on and off duty and allocate meal breaks when possible in between calls.

A well known problem in the NSW Health system is known as bed block. Paramedics can spend many hours in a hospital's Accident & Emergency department waiting to unload their patient, making that crew and ambulance unavailable. The dispatcher and crews can be advised via the CAD system which hospitals to avoid in these situations. In other circumstances, the call might dictate that the ambulance go directly to the nearest trauma centre. For the dispatcher, it can be like a game of chess trying to make sure that the right resources get to the right incidents. If the Paramedics on scene require further assistance, each ambulance and each paramedic have radios to talk to the dispatcher. In the event of a paramedic being attacked, every radio also has a distress button which alerts the dispatcher that urgent additional assistance is required.

I was surprised to observe how much information the call takers and dispatchers have at their fingertips via their various computer screens and CAD. The staff in the centre work 12 hour shifts and are encouraged to take time briefly if required along with short meal breaks. The initial training for a call taker takes 9 weeks of on and off the job training. Initially it may seem like a lot of information to take in but as the training progresses, most people find the training makes sense. To do this role, you would need excellent communication and computer skills, an ability to multi task, the ability to switch on and off as required as well as empathy and compassion for the callers. After all, the call is not your emergency but it usually is for the caller. Indeed, this call may be the most important phone call the caller has ever made. It was great to be able to talk with the call takers and the dispatchers. I am sure that everyone who attended the centre had a greater understanding about the role of the centre as well as a greater understanding of CAD that is surely heading our way sometime in the future. Personally, it was great to be able to see where all the vehicles were in relation to incidents.

It was a great working environment to observe in due to the use of headsets and minimal radio traffic due to the use of MDT. It was also great to be able to listen to a call from the call taker, follow the progress of the ambulance response via CAD and then from the other side of the room (or indeed from anywhere in the room), follow the ambulance to the hospital with the patient on board. Thank you to

Troy for organising the trip from our end, Gaye for driving Transport 1, Patrick & Ann for being our hosts at the centre and a massive thank you to the various call takers and dispatchers across the room that let us listen in and ask questions as they worked. Without the co-operation of the staff in the centre, the visit would not have been a great success.

Members that attended: Ralph, Ron, Gaye, Craig, Eric, Leanne, Gwenda, Alan