St John call-backs let emergencies get missed - critics

St John medical director Dr Tony Smith said the system was not infallible but was about saving lives, not money. Photo / Sarah Ivey

A St John Ambulance trial in which nurses call people back to assess their condition before sending an ambulance is being criticised by patients who say legitimate emergency calls are being missed.

But St John says the system is about saving lives and will separate those in genuine danger from non-urgent patients calling ambulances for toothache, constipation, headaches or diarrhoea.

The Herald yesterday told the story of a woman who said three emergency calls were needed to get help for a severely ill woman from ambulance staff less than a kilometre away.

The article prompted several emails from readers. One respondent detailed a three-hour wait for an elderly man who had suffered a broken hip and another said they couldn't get through to an ambulance when their neighbour went into cardiac arrest.

But St John Ambulance clinical director Norma Lane said it was early days for a year-long trial for an Auckland DHB region clinical hub.

The service, which began in May and could go nationwide next year, uses a combination of paramedics and nurses for phone-based clinical assessment of low-acuity (non-urgent) calls. Ms Lane said the aim was to not only reduce strain on Auckland's emergency departments by 6000 patients over the trial period but to improve ambulance response times and quality of care.

"We still have a significant number of people who will dial 111 for conditions where they should either have managed it through a different route or should actually have taken themselves to hospital rather than ringing an ambulance." The hub was set up to address the most serious cases among the 125,000-plus emergency ambulance calls in Auckland every year.

Thirty per cent of the total calls were non-urgent.

Among these "low-acuity" 111 calls, which are up 3 per cent since last year, are calls from people saying they need ambulances for toothache, constipation, headaches and diarrhoea.

"Unfortunately we are open to abuse that way, sometimes it's not done deliberately because people are frightened and don't know what to do."

St John medical director Dr Tony Smith said the system was not infallible but was about saving lives, not money.

High-acuity cases included the likes of cardiac arrest, haemorrhaging, serious car accidents or unconscious patients and would still get urgent responses.

"From our perspective it's urgent when a patient has a clinical problem when it's threatening their life or where a delay to initiation to treatment may threaten their life.

"We understand that our view of urgent is frequently different from the patient's or the family's view. Part of the role of our nurses if they are calling back is to help them understand that difference."

Mother's frustration at slow response

A Pukekohe woman raced her ill son to a medical clinic after hanging up on St John staff who told her a nurse would call back to assess his details before sending an ambulance.

Janine Yeoman sought urgent medical help from St John for her son Ben. Photo / Dean Purcell

Janine Yeoman of Pukekohe sought urgent help on Friday for her son Ben, whose symptoms had worsened after a lumbar puncture last Wednesday.

The 24-year-old had head and back pain, and could not stand.

His mother called 111 and was told an ambulance was coming but a St John operator called back five minutes later, saying an assessment was needed before one would be dispatched.

"I said he had an issue with his head, it wasn't a false alarm but she just kept telling me to calm down.

"It felt like I was repeating myself over and over again," she said.

An ambulance eventually took Mrs Yeoman's son to Middlemore Hospital. He was discharged that evening and went home but the symptoms worsened the next morning. Mrs Yeoman again called 111 and pleaded for her son to be readmitted.

"I had the [medical] papers and Middlemore said he had to go back if his pain kicked in again and I was explaining all of this to them again and he [the operator] said, 'okay, I need to take your phone number'. I said, 'you're not going to get someone to ring me back and ask all of these questions again, are you?' and he said 'yes'. I lost it and said it was ridiculous. I just said 'you need to come now'."

Mrs Yeoman and her husband Troy drove their son to a local accident and emergency centre.

St John medical director Dr Tony Smith acknowledged the staff member who told Mrs Yeoman an ambulance was coming on Friday had made a mistake. But he said when an ambulance did arrive - 27 minutes after the initial 111 call was made - it was faster because a nurse had made contact with the family.

He said Mrs Yeoman had hung up on the St John operator when she called back on Saturday.

"When people dial 111 they expect an ambulance and we can understand their level of frustration but we ask people to bear with us. We are acting in their best interests."

The numbers

*Auckland's St John Ambulance receives 125,000 111 calls every year.
30% of these calls are deemed low acuity or non-urgent.
*The service has noted a 3% per cent increase in low-acuity calls since last year.
*Some of these have been for toothache, gout, headaches and not being able to sleep at night.
*St John is trialling a system where nurses and paramedics can call patients back to assess whether they need an ambulance or other care.