Fatal delays - St John probes 111 answers

The swine flu epidemic stretched St John Ambulance services, so cases were given a lower priority. Photo / Hawke's Bay Today

St John is investigating whether slow response times to 111 calls contributed to the deaths of three patients after new dispatch codes were used to cope with the swine flu epidemic.

The Herald has learned the internal inquiry was opened after an Auckland patient died from a heart attack in late July, following a long wait for medical help.

The emergency call was downgraded in priority by the ambulance dispatcher under a swine flu code, because the patient also had influenza symptoms considered less urgent.

By the time paramedics arrived the West Auckland man was in cardiac arrest.

The next day, the "Protocol 36" swine flu code was stopped.

The death led to an internal audit which has found six other cases in which slow response times may have adversely affected patients.

In two of these cases, the patient also died.

St John introduced "Protocol 36" in mid-July to help it distinguish influenza cases from life-threatening illnesses, after emergency services were swamped with calls from people with swine flu symptoms.

Usually, an ambulance is sent quickly to anyone with breathing problems, chest pains and headaches as a potentially critical case. Overloaded with patients with flu symptoms during the epidemic alert, St John used the new procedure to identify suspected influenza cases and reduce the urgency of its response.

In a statement issued after Herald inquiries, St John medical director Dr Tony Smith said St John communication centres would contact the families of the patients involved in the seven cases being investigated.

Four of the cases were from the Auckland centre, which manages 111 calls for the upper North Island. Three were from the Wellington centre, which covers the lower North Island.

"We do not wish to alarm anyone, as the purpose of the investigation is to ascertain whether there was any impact on service delivery as a result of its use," Dr Smith said.

"Our intention is to keep those involved informed of our findings."

He said Protocol 36 was an internationally recognised call-taking procedure, and staff had been trained before it was introduced in New Zealand.

But the 111 computer system could not use the new dispatch procedure, so operators had to use it manually in a paper-based system.

An auditor raised concerns after the death in Auckland on July 28, followed by a similar problem in Wellington, so the procedure was discarded.

"We immediately began an investigation into the use of Protocol 36, as there was a concern that the use of the manual system may have contributed to delays in the dispatch of an ambulance in a small number of cases," said Dr Smith.

The seven cases being investigated were less than 1 per cent of the 1025 calls that were coded Protocol 36 during the two-week period, said Dr Smith.

Health Minister Tony Ryall had not been briefed on the deaths by his ministry when contacted by the Herald.

A spokesman for Mr Ryall said the investigation was "appropriate" but declined to comment further.

Two days after the Herald made inquiries, St John sent a press release to all news media yesterday, saying it was acting because of public interest in the inquiry.

But the response came one month after the problems were discovered.

Ministry of Health technical adviser Dr David Galler said the protocol was intended to help the ambulance service give the best-possible service.

"If there were any issues around its implementation which we can learn from, it's important that we do."

Craig Page, a former paramedic who now represents ambulance staff in the National Distribution Union, said concerns were raised "from day one" about the risk to patients.

Communications staff in Wellington were given one-on-one training on how to use the protocol, Mr Page said, but staff in Auckland received no formal training.

Without the aid of the computer system, Mr Page said it was ridiculous to expect 111 dispatchers to manage a complicated triage decision.

"It is this lack of integration and poor training that we believe has contributed to the errors."