ITEM 10 Appendix 9. Yorkshire Ambulance Service Demand Management Plan (DMP)

Transcription

1 ITEM 10 Appendix 9 Yorkshire Ambulance Service Demand Management Plan (DMP) Version 2.10 March 2013

2 Table of Contents Record of Amendments Introduction Aim Objectives Scope Defining the Plan Call Answer Resource Allocation Levels of Escalation De-escalation Management of Unresourced Incidents Implementation of call taker scripts Implementation of recorded telephone messages Communication of the DMP Escalation Levels Demand Management Plan Escalation Triggers Demand Management Plan Escalation Level One Actions Demand Management Plan Escalation Level Two Actions Demand Management Plan Escalation Level Three Actions Demand Management Plan Escalation Level Four Actions Demand Management Plan Escalation Level Five Actions Appendix 1 - Escalation Alert Form Appendix 2 - Recorded Messages for 999 and Urgent Lines Appendix 3 - Objectives and Procedure for Clinical Directorate Page 2 of 26

3 Appendix 4 - EMD Call Taker Scripts Escalation Level One & Two Escalation Level Three Escalation Level Four Escalation Level Five Appendix 5 DMP Escalation Level Action Cards by Role Page 3 of 26

4 Record of Amendments Amendment List Amended by Version No. Date Name and Initial in Version Date of Signature BLOCK CAPITALS number amendment 1. Nov 12 BEN HOLDAWAY 2. Dec 2012 TREVOR BALDWIN /12/ Dec 2012 TREVOR BALDWIN /12/ Dec 2012 BEN HOLDAWAY /12/ Dec 2012 TREVOR BALDWIN /12/ Jan 2013 Ben Holdaway /01/ March 2013 Ben Holdaway /03/ March 2013 Ben Holdaway /03/ Page 4 of 26

5 YAS Demand Management Plan 1.0 Introduction There is a requirement within YAS to ensure that front line ambulance services are delivered and performance targets achieved consistently throughout the year, to enable safe, effective and quality patient care. It is the intention of YAS to maintain the highest level of care to the public of Yorkshire including times when it is experiencing capacity pressures and periods of high demand. It is critical for the Trust to maintain public confidence and safeguard the good reputation of the Service. During periods of challenge to performance, quality or safety, YAS will consider a variety of strategic and tactical options that are most suitable to deal with the situation, these include: The YAS Demand Management Plan (DMP) Will support YAS in responding to situations where the available resource capacity does not match the demand across the Yorkshire & Humber region. Local Escalation Action Plan (LEAP) The Local Escalatory Action Plan (LEAP) is being developed to assist in maintaining a steady state of operations across each Clinical Business Units (CBU) in YAS. Resource Escalatory Action Plan (REAP) A strategic plan supporting LEAP and the DMP that allows for escalatory measures from the corporate body to support performance and disruptive events that are assessed as high risk to service delivery e.g. Major Incident Although this plan is separate from the LEAP & REAP plans it should be read and, where feasible, used in conjunction with them. However, the more flexible and immediate nature of this plan will often mean that it provides a more effective and expedient response to unforeseen over capacity situations that are likely to be for short durations. 1.1 Aim The DMP is designed to be utilised in situations of excessive call volume or reduction in staff numbers, which results in the supply of ambulance service resources being insufficient to meet the clinical demand of patients. Page 5 of 26

6 1.2 Objectives To enable YAS departments to identify and respond dynamically to service pressures. To ensure YAS continues to maintain a safe and clinically appropriate level of care at times of increased demand and resource pressure. To provide all management and supervisory teams with a plan in times of increased demand and resource pressure. To ensure that YAS responds to the most seriously ill patients in an appropriate timescale To minimise clinical risk to patients with lower priority triage levels. To provide guidance on appropriate triggers to levels of demand management 1.3 Scope The DMP is designed to work dynamically to ensure a YAS wide response can be implemented as soon as the triggers are met. Consideration should be given in regards to appropriate actions within the LEAP and REAP plans. This DMP is applicable to all Clinical Business Units (CBUs) of YAS and has been developed in order to ensure operational consistency and ensure a coherent approach to escalation levels across the organisation. 1.4 Defining the Plan The plan is designed to be both simple and dynamic to enable YAS to respond in a timely and appropriate manner to increased service pressure. Service delivery can be negatively affected by a number of reasons, but is primarily impacted by Lack of resource Increase in Demand Serious/Major incidents Pandemic Flu The DMP levels and actions have been aligned with the key national REAP plan to give guidance to the level and severity of the situation. As REAP is utilised at a strategic level it is not suitable for use in a dynamic situation, where actions are required immediately. Actions and information within this plan can be used to assist with the delivery of other business continuity plans and is not designed to replace them only supplement them Call Answer The trigger for escalation for 999 call answer is designed to take into account brief spikes in demand that occur, e.g. Road Traffic Collision on a Motorway. These cause a brief influx of calls that are cleared quickly. It was also deemed that calls abandoned would be defined as calls being unanswered for two minutes. This is the amount of time that the 999 service providers will attempt to connect to the primary and secondary numbers before alerting the Page 6 of 26

7 trust there is a delay. The service providers also report nationally on the number of calls that exceed the two minute threshold. Normal Level 1 Level 2 Level 3 Level 4 Level 5 Level Trigger No issues 5 or more 999 calls unanswered one of which for 2 minutes over a sustained 5 minute period 10 or more 999 calls unanswered one of which for 2 minutes over a sustained 5 minute period 20 or more 999 calls unanswered one of which for 2 minutes over a sustained 5 minute period 30 or more 999 calls unanswered one of which for 2 minutes over a sustained 5 minute period 40 or more 999 calls unanswered one of which for 2 minutes over a sustained 5 minute period 1.6 Resource Allocation As previously stated the resource allocation escalation has taken into account the spikes that can occur at times when a large number of emergency incidents are presented at once. All grades of A&E incidents have been included as this has a large implication to YAS if not dealt with correctly, in the fact that a large number of unallocated incidents can present a significant clinical risk. The unallocated Red Call triggers are listed below; it should be noted that Red Incidents should not be looked at in isolation: Level Trigger Normal No issues Any one of the triggers below 10 or more Red Incidents - one of which is in excess of 5 minutes. Level 1 20 Green 1/Green 2 Incidents not allocated - one of which is in excess of 5 minutes. 80 Green3/Green 4/HCP and routine incidents not allocated. 10 FRV s requesting immediate back up one of which is in excess of 30 minutes Page 7 of 26

8 Any one of the triggers below 20 or more Red Incidents - one of which is in excess of 5 minutes. Level 2 30 Green 1/Green 2 Incidents not allocated - one of which is in excess of 5 minutes. 90 Green3/Green 4/HCP and routine incidents not allocated. 15 FRV s requesting immediate back up one of which is in excess of 30 minutes Any one of the triggers below 30 or more Red Incidents - one of which is in excess of 5 minutes. Level 3 40 Green 1/Green 2 Incidents not allocated - one of which is in excess of 5 minutes. 100 Green3/Green 4/HCP and routine incidents not allocated. 20 FRV s requesting immediate back up one of which is in excess of 30 minutes Any one of the triggers below 40 or more Red Incidents - one of which is in excess of 10 minutes. Level 4 50 Green 1/Green 2 Incidents not allocated - one of which is in excess of 10 minutes. 110 Green3/Green 4/HCP and routine incidents not allocated.. 25 FRV s requesting immediate back up one of which is in excess of 30 minutes Page 8 of 26

9 Any one of the triggers below 50 or more Red Incidents - one of which is in excess of 15 minutes. Level 5 60 Green 1/Green 2 Incidents not allocated - one of which is in excess of 15 minutes. 110 Green3/Green 4/HCP and routine incidents not allocated. 30 FRV s requesting immediate back up one of which is in excess of 45 minutes 1.7 Levels of Escalation Each level of escalation is designed to deliver the following: Increase capacity Call handling by increasing staff and reducing call time(s) Resource Capacity by further triage of incidents/assisting turnaround at key receiving units Requesting Patient Transport Service Voluntary Ambulance assistance Reduce Demand Clinical directorate assessing Health Care Professional/Interfacility Transfers Increase triage of Green Incidents No send on certain categories of call Escalation to stakeholders Use of messaging on Health Care Professional lines Reduce Clinical Risk Utilisation of Clinical directorate Assessment of unresourced incidents Prioritisation of incidents 1.8 De-escalation The EOC should ensure that the Trust de-escalates the levels as soon as possible once demand falls below the relevant trigger. It is important that this information is communicated to all partners particularly BT/Cable & Wireless/Global Crossing and the neighbouring ambulance trusts. Page 9 of 26

10 1.9 Management of Unresourced Incidents Management of unresourced Incidents will be necessary when the workload exceeds the available resource and there are outstanding incidents awaiting dispatch of an appropriate resource. In these circumstances the clinical risk to patients increases as the waiting time for dispatch lengthens. Therefore a role is required to be filled by an appropriate clinician from either EOC or the Medical Directorate to manage this risk. The role is designated as a Clinical Queue Manager. The purpose of Clinical Queue Manager is to reduce the clinical risk within the outstanding unallocated incident stack as follows: To provide a clear assessment to the management team of the current work outstanding and potential risks involved To assist the dispatcher with appropriate resource allocation based on the presenting clinical condition of the patient/s Identify and manage any inappropriate requests for inter facility transfers with the requesting hospital Identify any incident or groups of incidents that may be suitable for alternate responders i.e. Patient Transport Services, St Johns or neighbouring ambulance services Safely increase the incident response time where possible To safely identify patients who may be taken to hospital by means other than an ambulance response To clinically assess any patients waiting for HCP admission or transfer on the CAD system who are at risk and upgrade these according to presenting symptoms Depending on the amount of outstanding HCP incidents ensure call takers have been allocated to contact the requesting clinicians and where possible obtain additional time to respond to the patient. This should be done for all of the incidents regardless of the amount of time outstanding. Identify all of the IFT3 and IFT4 incidents and contact the requesting Clinicians/hospitals to advise of the current delays and where clinically appropriate request that these are deferred to an alternate date and time. Identify the IFT incidents in the waiting stack that have breached their time scale and assess any obvious presenting clinical symptoms during the call. Based on the information given a decision may be made by the Queue Manager to upgrade the call or to continue to allow the patient to wait. The remaining unresourced incidents in the stack can then be assessed in the same way as above. All actions taken by the Queue Manager will be documented in the incident notes on the respective CAD at the time of the intervention. The Queue Manager should liaise with the management team to identify those incidents that may relate to bottle necks in particular localities. i.e. where hospitals are on Red Bed Alert and where crews are exceeding agreed turnaround times. The management team may then be able to plan alternate resource to deal with this and reduce waiting times for patients. Page 10 of 26

11 Queue management is a dynamic process with changing priorities and will cease when the workload becomes manageable. 2.0 Implementation of call taker scripts Introduction of call taker scripts can be actioned at various stages that reflect the level of escalation that the service is currently experiencing. The decision to action the scripts are the responsibility of the Gold Commander and the Medical incident Commander (MIC). The scripts should be read verbatim by the call taker, each script will appertain to the current level and will be escalated and deescalated accordingly. Scripts are contained in appendix Implementation of recorded telephone messages Introduction of recorded telephone messages can be actioned at various stages that reflect the level of escalation that the service is currently experiencing. The decision to action the recorded messages are the responsibility of the Gold Commander and the Medical incident Commander (MIC). The recording will require the Duty manager to introduce the recording on the telephony system by entering the relevant code. The recording will appertain to the current escalation level and will be escalated and deescalated accordingly. The content of the telephone messages and the activation codes are contained in appendix Communication of the DMP Escalation Levels Internal notification of the escalation levels will be through the group text system PageOne Connect. The relevant pre prepared text message will be delivered through the YAS DMP group which will date and time stamp the message. The group member response will also be logged in the same way. The same DMP group will be ed to supplement the notification of escalation levels. External notification will be through use of the Escalation alert Form which can be accessed in appendix 1 Page 11 of 26

12 Demand Management Plan Escalation Triggers Levels 999 Call Answer Resource Allocation NORMAL No issues Outstanding unallocated work within limits EOC (COMBINED SITES) DMP LEVEL ONE ESCALATION DMP LEVEL TWO ESCALATION 5 or more 999 calls unanswered for 2 minutes across the Trust Over a sustained 5 minute period 10 or more 999 calls unanswered for 2 minutes across the Trust Over a sustained 5 minute period Any one of the triggers below 10 or more Red Incidents - one of which is in excess of 5 minutes. 20 Green 1/Green 2 Incidents not allocated - one of which is in excess of 5 minutes. 80 HCP and routine incidents not allocated. 10 FRV s requesting immediate back up one of which is in excess of 30 minutes EOC (COMBINED SITES) Any one of the triggers below 20 or more Red Incidents - one of which is in excess of 5 minutes. 30 Green 1/Green 2 Incidents not allocated - one of which is in excess of 5 minutes. 90 HCP and routine incidents not allocated. 15 FRV s requesting immediate back up one of which is in excess of 30 minutes Page 12 of 26

13 DMP LEVEL THREE ESCALATION DMP LEVEL FOUR ESCALATION 20 or more 999 calls unanswered for 2 minutes across the Trust Over a sustained 5 minute period 30 or more 999 calls unanswered one of which for 2 minutes over a sustained 5 minute period EOC (COMBINED SITES) Any one of the triggers below 30 or more Red Incidents - one of which is in excess of 5 minutes. 40 Green 1/Green 2 Incidents not allocated - one of which is in excess of 5 minutes. 100 HCP and routine incidents not allocated. 20 FRV s requesting immediate back up one of which is in excess of 30 minutes EOC (COMBINED SITES) Any one of the triggers below 40 or more Red Incidents - one of which is in excess of 10 minutes. 50 Green 1/Green 2 Incidents not allocated - one of which is in excess of 10 minutes. 110 HCP and routine incidents not allocated. 25 FRV s requesting immediate back up one of which is in excess of 30 minutes DMP LEVEL FIVE ESCALATION 40 or more 999 calls unanswered one of which for 2 minutes over a sustained 5 minute period EOC (COMBINED SITES) Any one of the triggers below 50 or more Red Incidents - one of which is in excess of 15 minutes. 60 Green 1/Green 2 Incidents not allocated - one of which is in excess of 15 minutes HCP and routine incidents not allocated. Page 13 of 26

14 30 FRV s requesting immediate back up one of which is in excess of 45 minutes Page 14 of 26

15 Resource Allocation DMP LEVEL ONE ESCALATION Call Answer Demand Management Plan Escalation Level One Actions GENERAL ACTIONS Update all YAS Emergency Operations Centres Brief On Call EOC Manager to attend appropriate EOC Brief YAS On Call Gold Commander Brief YAS Performance Cell Brief Medical Incident Commander YAS DMP group to be notified of escalation level through group text using PageOne connect system and by group Update wallboards with current escalation level ACTION 999 / HCP CALLS Introduce level 1 & 2 EMD telephone script All HCP Non-Life-Threatening calls to be given a 4 hour response and coded as 35A04 Monitor that all EMDs are in ready status or active Check staff on meal breaks If staff on urgent calls advise them to terminate urgent call to answer 999 Is there any other staff available to take 999 calls? e.g. auditors, trainers, dispatchers EOC EMD Team Leader requests blanket implementation of the urgent disconnect procedure (Using AMPDS X Card) from Notify BT/Cable & Wireless/Global Crossing Notify neighbouring Ambulance Services (EMAS/NWAS/NEAS) ACTION 999 / HCP INCIDENTS Ensure all available RRV and DMA are allocated YAS wide. Consideration given to crewing up FRV s to give additional patient carrying capability Ensure HART RRV s deployed Ensure EOC dispatch divert procedure for A&E Resource has been followed Contact Clinical Supervisors and activate level one operating Dispatch Team Leaders to review vehicles that are at an unavailable status Contact YAS Private & Events for assistance Consider asking neighbouring Trusts for assistance on incidents near borders Ensure Air Ambulance utilised if available Consider requesting Operational Managers to increase response level Clinically assess G3 and G4 exceptions if there are more than 3 Clinical Advisors on Duty Increase assessment time for G 3 s to 60 minutes. Anything greater G2 response Increase assessment time for G 4 s to 90 minutes. Anything greater G2 response Gold/MIC Gold/MIC EOC EMD Team Leader EOC EMD Team Leader EOC EMD Team Leader EOC EMD Team Leader EOC Dispatch Team Leader EOC Dispatch Team Leader EOC Dispatch Team Leader EOC Dispatch Team Leader Performance Cell Page 15 of 26

16 DMP LEVEL TWO ESCALATION Resource Allocation Call Answer Monitor the live situation and be prepared to escalate or deescalate to the appropriate escalation level. Remember to communicate any change in the escalation level. Demand Management Plan Escalation Level Two Actions GENERAL ACTIONS Contact On Call EOC Manager to attend appropriate EOC Brief YAS On Call Gold Commander Brief Medical Incident Commander Brief YAS Performance Cell YAS DMP group to be notified of escalation level through group text using PageOne connect system and by group Update wallboards with current escalation level and call script where sanctioned ACTION 999 / HCP CALLS Introduce level 1 & 2 EMD telephone script Review non-essential EOC training Postpone all EOC non critical functions (Audit/Gazetteer etc) Consider reducing dispatch bays to assist call taking Contact staff to start shifts early/approach staff to extend shifts Contact staff off duty to fill extra shifts Contact EOC Resource staff to increase staffing levels including utilising bank staff Update BT/C&W/Global Crossing on situation utilise critical phone ( Desk) Consider implementation IVR message on urgent lines Gold/MIC /EOC Manager Gold/MIC ACTION 999 / HCP INCIDENTS Activate Clinical Hub Queue Manager (MIC if resourcing below 3 Clinical Advisors) Contact All On Call CBU Silver Commanders Undertake patient safety assessments for 111 calls to ascertain the correct response Increase assessment time for G 3 s to 90 minutes. Anything greater G2 response Increase assessment time for G 4 s to 120 minutes. Anything greater G2 response Review non-essential EOC training to review manager availability and response level Contact PCT s and Acute Trusts Contact out of hours providers/nhs Direct Contact operational staff to start shifts early/approach staff to extend shifts Contact operational staff off duty to fill extra shifts Contact CBU Resource to increase staffing levels including utilising bank staff Consider mutual aid Gold/MIC EOC Manager All CBU Silver All CBU Silver All CBU Silver Gold Page 16 of 26

17 Monitor the live situation and be prepared to escalate or deescalate to the appropriate escalation level. Remember to communicate any change in the escalation level. Page 17 of 26

18 DMP LEVEL THREE ESCALATION Resource Allocation Call Answer Demand Management Plan Escalation Level Three Actions GENERAL ACTIONS YAS On Call Gold Commander to SH2 YAS On Call MIC to SH2 (If not already present) Brief YAS Performance Cell Consider Activation of YAS Major Incident Plan Implementation of Gold Support Cell YAS DMP group to be notified of escalation level through group text using PageOne connect system and by group Update wallboards with current escalation level and call script where sanctioned Gold Gold ACTION 999 / HCP CALLS Introduce level 3 EMD telephone script Implement Shortened Call Handling-Consider Emergency Rule Consider Implementation of recorded message on 999 Lines Consider formal request to divert calls to neighbouring Trusts Update BT/C&W/Global Crossing Gold/MIC Gold/MIC Gold/MIC ACTION 999 / HCP INCIDENTS All incidents to be reviewed by Clinical Advisor desk/clinical Queue Manager Consider additional Medical Directorate support HART to deploy on DMA All interfacility transfers to be agreed via YAS Medical Directorate. P1 & P2 for immediate triage by Medical Directorate. P3 and longer times to be agreed between YAS & Acute Trusts. Request Mutual Aid Contact all partners (Police/Fire/Coastguard/Wider Health etc) G1 incidents for assessment within 20 minutes. Anything greater R2 Response G2 incidents for assessment within 30 minutes. Anything greater G1 Response Increase assessment time for G 3 s to 120 minutes. Anything greater G2 response No Ambulance sent to G4 where patient is between 5-69 MIC MIC Gold MIC Gold Gold MIC MIC MIC Gold/MIC Monitor the live situation and be prepared to escalate or deescalate to the appropriate escalation level. Remember to communicate any change in the escalation level. Page 18 of 26

19 DMP LEVEL FOUR ESCALATION Resource Allocation Call Answer Demand Management Plan Escalation Level Four Actions GENERAL ACTIONS YAS On Call Gold Commander to SH2 YAS On Call MIC to SH2 (If not already present) Brief YAS Performance Cell Consider Activation of YAS Major Incident Plan Implementation of Gold Support Cell YAS DMP group to be notified of escalation level through group text using PageOne connect system and by group Update wallboards with current escalation level and call script where sanctioned Gold Gold Introduce level 4 EMD telephone script ACTION 999 / HCP CALLS Gold/MIC ACTION 999 / HCP INCIDENTS G1 incidents for assessment within 40 minutes. Anything greater R2 Response G2 incidents for assessment within 60 minutes. Anything greater G1 Response No Ambulance sent to G3 & G4 where patient is between 5-69 MIC MIC Gold/MIC Monitor the live situation and be prepared to escalate or deescalate to the appropriate escalation level. Remember to communicate any change in the escalation level. Page 19 of 26

20 DMP LEVEL FIVE ESCALATION Resource Allocation Call Answer Demand Management Plan Escalation Level Five Actions GENERAL ACTIONS YAS On Call Gold Commander to SH2 YAS On Call MIC to SH2 (If not already present) Brief YAS Performance Cell Consider Activation of YAS Major Incident Plan Implementation of Gold Support Cell YAS DMP group to be notified of escalation level through group text using PageOne connect system and by group Update wallboards with current escalation level and call script where sanctioned Gold Gold Introduce level 5 telephone script ACTION 999 / HCP CALLS Gold/MIC ACTION 999 / HCP INCIDENTS G1 incidents for assessment within 60 minutes. Anything greater R2 Response No Ambulance sent to G2,G3 & G4 where patient is between 5-69 MIC Gold/MIC ACTION URGENT CALLS Monitor the live situation and be prepared to escalate or deescalate to the appropriate escalation level. Remember to communicate any change in the escalation level. Page 20 of 26

21 Appendix 1 - Escalation Alert Form Message from: Date: Time: Contact Details: REAP Level: Situation: Yorkshire Ambulance Service Action taken by alerting manager: Action required from other services (please tick) Message to: YES NO For Information Only Response required (as per escalation policy, & timescale) Other comments or additional response Actions taken if applicable PCT s Acute Trusts OOH Providers NHS Direct NHS Yorkshire & Humber Police Fire Page 21 of 26

22 Appendix 2 - Recorded Messages for 999 and Urgent Lines 999 Line(s) Level One No message to be implemented Level Two No message to be implemented Level Three Message to be implemented - Gold Command & MIC Authorisation The 999 message to read as follows: Yorkshire Ambulance Service is currently experiencing a high numbers of calls we will answer your call as soon as possible The activation code for the message is # Inform BT Newport that the message has been implemented and ask them to queue non distressed calls. Urgent/HCP Line(s) Level One No message to be implemented Level Two Level Two Urgent Message to be implemented - Gold Command & MIC Authorisation The message reads as follows: Level Two Yorkshire Ambulance Service is currently experiencing severe pressures. Please ensure that all Ambulance bookings are appropriate and all other travel options have been explored The activation code for the message is # Level Three Level Three Urgent Message to be implemented - Gold Command & MIC Authorisation The message reads as follows: Level Three Yorkshire Ambulance Service is currently experiencing extreme pressures. Please ensure that all requests for Ambulance transport are appropriate and that all other travel and treatment options have been explored The activation code for the message is # Page 22 of 26

23 Appendix 3 - Objectives and Procedure for Clinical Directorate Managing Urgent Calls Objective - to remove the need for transport or if still required verify time required clinically Managing Inter Hospital Transfers Objective - to remove the need for transport or if still required verify time and skill Required clinically Managing Emergency Calls Waiting Objective - to clinically help the dispatchers to prioritise the call stack when there are excessive numbers of incidents outstanding without an allocated resource Page 23 of 26

24 Appendix 4 - EMD Call Taker Scripts Escalation Level One & Two For calls identified as Green 3 and Green 4 From the information you have given me, your condition is not a life threatening emergency. We are experiencing a large number of life threatening emergencies at the moment, however, an ambulance will be provided as soon as possible. You may also be called back by an assessment clinician. In the meantime, if you re / the patient s condition worsens in any way, please call back on 999 for further instructions Do you understand what I have explained? HCP Calls Due to high activity all Non-life threating GP/HCP calls will receive a minimum of a 4 Hour response, if you re / the patient s condition worsens in any way, please call back for further instructions Do you understand what I have explained? Escalation Level Three An ambulance will not be sent to Green 4 calls where the patient s age is between 5 yrs. 69 yrs. The following script will be used Due to high activity, we do not have an ambulance to send. Our advice is to contact a GP or NHS 111 or make your own way to a Minor Injury Unit or to an Accident and Emergency Department. NHS 111 may also be experiencing high demands. You could check your symptoms online at the NHS Direct website ( I need to hang up now (to take another call). If anything changes, call us back immediately for further instructions Calls graded G4 where the patient is aged less than 5 yrs or 70 yrs or over the following script will be used: I need to hang up now (to take another call). We are going to pass your call for a clinical telephone advisor from either the ambulance service or NHS Direct to call you back. Please remain by your phone. If anything changes, call us back immediately for further instructions Escalation Level Four Part of this action a no-send policy will be initiated for Green 3 & 4 between the age of 5-69 calls which are not identified as definitely requiring an ambulance The EMD will use the following script for this action If the call is graded G3 or 4 and the patient is aged 5 to 69 years the following script will be used: Due to high activity we do not have an ambulance to send. Our advice is to contact a GP or call NHS 111 or make your own way to a Minor Injury Unit or to an Accident and Emergency Department. NHS 111 may also be experiencing high demands. You could check your symptoms online at the NHS Direct website Page 24 of 26

25 ( I need to hang up now (to take another call). If anything changes, call us back immediately for further instructions. Calls graded G3 or G4 where the patient is aged less than 5 or 70 years or over the following script will be used: I need to hang up now (to take another call). We are going to pass your call for a clinical telephone advisor from either the ambulance service or NHS Direct to call you back. Please remain by your phone. If anything changes, call us back immediately for further instructions Escalation Level Five As part of this action a no-send policy will be initiated for Green 2, 3 & 4 between the age of 5-69 calls which are not identified as definitely requiring an ambulance The EMD will use the following script for this action If the call is graded G2, 3 or 4 and the patient is aged 5 to 69 years the following script will be used: Due to high activity, we do not have an ambulance to send. Our advice is to contact a GP or call NHS 111 or make your own way to a Minor Injury Unit or to an Accident and Emergency Department. NHS 111 may also be experiencing high demands. You could check your symptoms online at the NHS Direct website ( I need to hang up now (to take another call). If anything changes, call us back immediately for further instructions Calls graded G2, 3 or G4 where the patient is aged less than 5 or 70 years or over the following script will be used: I need to hang up now (to take another call). We are going to pass your call for a clinical telephone advisor from either the ambulance service or NHS Direct to call you back. Please remain by your phone. If anything changes, call us back immediately for further instruction Page 25 of 26

26 Appendix 5 DMP Escalation Level Action Cards by Role The embedded action cards are designed to be used by opening the relevant document printing it and then recording the actions taken within each escalation level where appropriate. DMP Action Card Dispatcher Teamleade DMP Action Card Clinical Queue Manag DMP Action Card Dispatcher DMP Action Card DMP Action Card EMD Teamleader DMP Action Card EMD DMP Action Card EOC On Call Manager DMP Action Card On Call Gold Commander DMP Action Card On Call Medical Director DMP Action Card On Call Silver Commande DMP Action Card ROC Page 26 of 26