Posted by: medicblog999 | March 6, 2009

NHS Pathways

col20neasIn September of 2007, NHS pathways, a new triage and assessment tool for emergency and urgent calls to the ambulance service went live for it’s pilot trials. This replaced the US system that was in use previously called CBD (Criteria Based Dispatch).  Since then it has gone through a number of developmental stages and is now a fully functioning and approved system to assist in the categorization of 999 calls to the North East Ambulance service. It also guides the call handlers to possible alternative pathways for individuals in the community to gain appropriate healthcare treatment or advice.

I was emailed recently to explain how the handling of calls into my service works, so I thought that rather than just email the info back, I would share it with all of you.

So, here goes….

A 999 call comes into our contact centre from a British Telecom operator. As soon as the call arrives at our switchboard the clock starts ticking. It used to start after the address was confirmed but since the concept of ” call connect ” in April last year, it has changed.

The call is taken by one of our services EMSOs (Emergency Medical Services Operator). These are staff that have undergone an intensive 6 week course to familiarize themselves with the systems, triage, basic medical terminology and understanding of basic emergency medical conditions. The course now also focuses on using the pathways system to assist in getting the right patient to the right services at the right time, and also various prompts for the EMSOs to give out some prudent medical advice as scripted from the system, such as advising the patient to take 300mg of aspirin if a cardiac chest pain is suspected.

At the same time as the call is taken by the EMSO, the system also sends an automatic message to the allocators informing then of the location of the caller (taken automatically from the phone number). Once the allocator recieves that information, they have 45 seconds to dispatch a vehicle to the detail. The computer system automatically shows a list of the nearest vehicles in order of distance from the job but it still remains the responsibility of the allocator to choose a vehicle depending on various service demands such as meal breaks, start/finish times etc.

At the same time, the EMSO is still on the phone to the caller, going through the triage questions as guided by the pathways system.
The goal of pathways is that at the end of the triage and assessment process, the end disposition will be displayed to the EMSO.
Some of these are :

  1. Ambulance response within 8 mins
  2. Ambulance response within 19 mins
  3. Ambulance response within 1 hour
  4. Refer to GP services (or out of hours service)
  5. Refer to clinical nurse adviser (more about them in a minute)
  6. Patient to make own way to hospital
  7. No vehicle required

Once the end disposition has been decided, the information is passed to the allocator who then informs the crew via the mobile data terminal in the ambulance or via the radio whether it is a Cat A, Cat B, Cat C (cold response, no lights or sirens) or stood down.

The service also employs a number of clinical nurse supervisors who are there to provide clinical support to the EMSOs and also give advice to patients/families who have dialled 999, but the pathways system has come out with an end disposition of a referral to the nurse advisers. The clinical supervisors can then discuss the condition with the patient/family, provide advice or even negotiate a more appropriate referral process than the arrival of a fully staffed emergency vehicle.

The whole purpose of pathways was to reduce the number of Cat A calls (which have to be responded to in less  than 8 minutes from connection of the call to the contact centre), Reduce the number of Cat B calls (response times of less than 19 minutes),increase the number of Cat C calls (response in less than 1 hour), and overall decrease the amount of ambulance journeys required

The system is certainly starting to provide the results that it was hoped to show, which ultimately provides the service area of the North East of England with more resources, more pathways to care and a more integrated approach to emergency and urgent care for the region.

I hope that makes some kind of sense and gives you an insight into how the jobs end up on my computer screen in my ambulance.



  1. All we need now is for the out of hours doctors to accept our cat c referral and the world will be a much happier place!!

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