Ambulance services to vet 999 calls

Three thousand lives a year could be saved if the most urgent 999 calls were given priority, according to a report published yesterday by the Department of Health.

Detailed research is now under way on "prioritised despatch" systems already in use in the United States. After further study, the first UK ambulance services are likely to adopt them from next year.

Dividing patients into three categories - "immediately life-threatening", "serious" and "non-urgent" - would allow faster response times to the most pressing cases, the report says. A new target could be set of a 90 per cent response in 8 minutes to conditions such as a heart attack.

"Serious" emergencies would retain the present standards - 95 per cent response within 14 minutes in urban areas and 19 in rural, with half of ambulances responding in 8 minutes.

But "category C" calls - including minor cuts and bruises - would receive a range of responses, including advice over the phone, a visit by a paramedic or referral to social services.

Ambulance control would, however, still have to arrange action, not merely tell callers to ring elsewhere.

Prioritising the most serious cases - including those who are unconscious, fitting, have severe breathing problems, chest pain or penetrating injuries - would save 3,000 lives a year from coronaries alone, the report says.

Cardiac arrest is usually reversible by defibrillation, but the prospects of success diminish by 10 per cent a minute if only basic first aid is given and by 20 per cent per minute if no help is provided.

Reaching such patients within 8 minutes would save 3,000 lives annually among those aged under 70 alone. Such "category A" cases account for about 15 per cent of 999 calls, while non-urgent cases account for 30 per cent of calls.

Because all calls are currently treated equally, London ambulance has dispatched full emergency crews to a model who broke her fingernail, a man who did not know how to remove his contact lenses and a woman who complained that the strings had come off her tampon.

"There is a cost in lives in maintaining the status quo," the report says, adding that safeguards will be needed "to ensure that no serious case is missed or poorly handled".

Health unions feared the system could lead to rationing of ambulances, but Tom Sackville, the junior health minister, insisted the aim was to get ambulances more quickly to those who lives are at risk.

Some services, including Derbyshire, are already running the system on a shadow basis. None has yet gone live.

t The Royal London Hospital's high-profile helicopter ambulance service does not improve the chances of survival after serious injury compared with normal, paramedically trained ambulance crews, a paper in today's British Medical Journal concludes.