It is the first cog in the life-saving machine which is East Midlands Ambulance Service...
The EMAS emergency operations centre answers the phone when someone dials 999, and on a daily basis can respond to a new call every 34 seconds.
Amid growing pressure from hospital closures and increased GP waiting times, the volume of calls it handles has increased dramatically in recent years, putting the service under more strain.
John Fryc, a call handler who has been with EMAS for the past 12 months, says no two days are the same.
“There is never a dull moment and you never know when you answer the phone who will be on the other end and how they need help,” he explained.
While at the control room in Nottingham John answered a call concerning a man who was unconscious, and was all set to give advice over the phone on the administration of CPR when the patient started breathing independently.
He also dealt with a casualty who had suffered a fit while at work, reassuring his colleagues that help was on the way, and answered a call from a person who thought they were having a heart attack.
None of the call handlers are medically trained, but follow on-screen prompts which enable them to assess the type of treatment a person will need.
John said: “Most people will never need to call an ambulance, and it’s not like on TV where you ring up and say ‘ambulance’ and your address and then hang up. People are usually surprised by all the questions, but we need to know what is wrong with the patient.
“We need basic information such as if the patient is breathing, their name, age and current location. It can be difficult when people ring up after, say, a road traffic collision and they don’t know where they are, but we go off landmarks and points of interest.”
John said that while he has heard some harrowing calls from patients, he tries not to let it affect him.
He said: “This is someone else’s trauma, someone else’s emergency, and if I get upset I will not be giving them the best help I can.
“I’m the beginning part of the process and I know I will pass it on to the relevant team and get help to them. There are times when I would like to know what has happened - when we give CPR advice over the phone we hang up when the paramedics arrive so we never know if a patient has pulled through or not. But you can’t dwell on it, you have to pick up the phone and help the next person who needs it.”
If John, or the other call handlers, decide a patient does not need an ambulance, but help can be given over the phone, their case is passed to a clinical advisor team consisting of nurses and paramedics, who ring the patient back.
This team is also on hand to offer more specialised medical help which can be given over the phone while the paramedics are in transit, such as helping mothers in labour with breech babies.
Alli Cox is one of these paramedics. She started out working on the ambulances 20 years ago, but made the move into the control room four years ago.
She said: “When I first started we were getting 1,900 calls a day, but that has increased to around 2,500 a day.
“People are not taking responsibility for their own health. Coughs, colds and sprained ankles can be treated with home remedies or by visiting your pharmacist, but people don’t do this and want to see a doctor and if they can’t get a doctor they ring 999.
“We would love to have the resources to go and see everyone straight away, but sadly we just can’t.”
While we were talking, Alli dealt with a care home resident with mental health issues who, in a two-day period, had called 999 for an ambulance a total of 21 times.
She said: “Persistent service users are a problem and while the woman was being supervised by staff they could not remove the phone from her as it is considered a deprivation of her liberty without getting the necessary approval, so there was nothing they could do to stop her making the calls.
“While our call handlers are speaking to this woman a person suffering a cardiac arrest could be trying to get through and we can’t give them the help and support they so desperately need as soon as possible.”
Alli’s role also means that sometimes she has to call people who dial 999 to ask for more information.
Another call saw her speak to a woman whose daughter had fallen off a horse. After a quick conversation it was determined the casualty had landed on her back and could have done damage to her spine and neck, so an air ambulance was dispatched to the scene and had landed within six minutes to treat the patient.
There are 101 ambulances which cover the whole of Nottinghamshire and these are prioritised according to need. Category one cases - when a patient is not breathing or in a life-threatening situation - are set a response time of eight minutes, but in less critical cases people can expect to wait up to 40 minutes.
Steve Wood, who dispatches the ambulances, said: “We have to make sure the people whose life is in danger are seen first, so an ambulance may be travelling to a category two patient but if a high priority case comes in and the ambulance is close it will divert as that patient is more at risk.”
Steve has been a dispatcher for 13 years says everything is a juggling act.
“I have crews which start at 6am and then again at 7am, so that means they are all going for their break at roughly the same time,” he explained.
“Paramedics work long days of 12-hour shifts and it is important that they rest and eat, but it does mean that ambulances are sometimes off the road.
“Other times can be when the ambulance is being cleaned, or while paperwork is being filled in, so we can be a couple of crews down at any one point.
“We will never leave a patient in the hospital until we have handed them over to the right department, but if there are no beds for them to go into we can get a backlog and calls mount up.
“This is why it is so important to make sure you ring for an ambulance only when you truly need it so, we can help as many people as possible.”
Steve said since he has seen the workload increase by 75 per cent compared to when he first started, and while there has been an increase in the number of ambulances and paramedic cars on the roads it does not match the demand.
Alison Crowe, the control room manager, has been with EMAS for 23 years so can recall the time before the internet when all notes to drivers were hand-written on different coloured paper.
She added: “What happens in here is the first cog in a life-saving machine which runs smoothly.
“If there are problems here it has a knock-on effect with the ambulances and in our hospitals across the East Midlands.
“So please help us to help you and only ring 999 if it an emergency.”