Ambulance Response Priorities

Could include:

• Cardiac arrest

• Unconscious (Scoring U on AVPU, or GCS3)

• Respiratory distress (noisy, shallow, rapid, inadequate)

• Fitting/Seizures (ongoing or multiple)

• Catastrophoic bleeding (squirting or pooring, more than a cup full)

• Serious allergic reaction (anaphylaxis)

• Imminent or ongoing birth requiring assistance

• Road traffic collisions with persons trapped or ejected

• Mass casualty incidents or CBRN incidents with potential for muptiple casualties

Could Include:

• Stroke, or stroke-like symptoms

• Chest pain (including heart attacks)

• Reduced responsiveness or conscious level

• Severe abdominal pain (acute)

• Non-life threatening injuries

• Bleeding (controllable)

• Burns

• Potential sepsis

Could include:

• Worsening of chronic illnesses or injuries

• Abdominal pain

• Late stage labour

• Uncomplicated diabetic issues

• Minor injuries (non life/limb threatening)

• Falls

Could include:

• Back pain

• Diarrhoea and vomiting 

• Patient transfers (IFT)

• GP admissions to hospital

• Transport to-or-from care facilities 

When talking to the call handler there are several things to condiser to ensure the correct response,

Do not exaggerate or create false signs or symptoms, but ensure you highlight any serious concerns.

Inadequate breathing - If you feel that your patient's breathing is too fast, slow, shallow or noisy and is having, or is likely to have, a negative effect on their condition. Any significant airway or breathing concerns should be considered a Category One response.

Airway concerns - Allergic reactions, asthma or COPD, chest or neck trauma or anything else causing limited airflow, wheezing, cyanosis (blue skin) or respiratory distress are immediately life threatening concerns and would usually warrant a Category One repsonse.

Trapped casualties - Is your patient medically trapped? (injuries too severe to move them), Mechanically trapped (pinned or unable to move because of their environment), or just stuck due to a door being jammed? (not trapped). If you cannot reach your patient to assess them and they are not responding - ASSUME NO BREATHING. 

Seizures - Someone actively convulsing, having more than one seizure, having a prolonged seizure or not becoming fully responsive after a seizure should ALWAYS receive Category One ambulance care.

Penetrating injury - Penetrating injuries such as stab wounds can often appear small on the surface with limited bleeding - ensure you inform the call handler you have a stab wound/penetrating would, especially to the chest, back or abdomen. This would usually be a Category One response.

Blood loss - Blood loss can appear worse than it is. Consider the surface (is it soaking into a carpet or jacket), is is quirting, spurting or pouring rather than merely trickling, could you fill a coffee cup, is it controllable in any way. Severe bleeding should be Category One, controllable bleeding may be Category Two.

Not alert - If your patient is not fully awake and alert, i.e. only responds to physical stimuli or is awake but not responding to you or talking to you appropriately. If your patient is breathing, this may be a Category One or Two call depending on other factors.

Pain - Pain is subjective, so what your patient tells you is what you tell the call handler. Where is the pain EXACTLY, describe the pain (stabbing, heavy, burning etc), use a 1-10 scale to score the pain, is it acute (sudden) or chronis (long term). Remember, even a suspected heart attack is likely to be a Category Two call, unless breathing or conscious level are affected.

BEFAST Positive (stroke) - If you believe your patient is displaying stroke symptoms, be descriptive. Consider their responsive level, are they awake and alert, what symptoms do they have - are these symptoms new or normal? Strokes are generally Category Two calls.

Fallen and can't get up - If your patient has fallen and cannot get up, and only has minor injuries or pain, an ambulance response is likely to be Category Three. Keep your patient comfortable, or carefully consider ways of guiding or assisting them off the floor.

Ambulatory (walking) - If your patient presents no life or limb threatening injuries or symptoms, is mobile and fully alert and an emergency ambulance is delayed for a significant time - suggest alterative transport (taxi, family, friend etc) - Ensure to call back and cancel the ambulance