Clinical Escalation Plan

Transcription

1 Clinical Escalation Plan Clinical Escalation Plan Author: Kevin Mulcahy : Date of Approval: 09 July 2012 Status: Approved Approved By: EMT Review Date: 18 February 2014 Page 1 of 12

2 Recommended by Approved by Service Delivery EMT Approval Date 09 July 2012 Number Review Date 09 July 2013 Responsible Director Responsible Managers (Sponsors) For use by Deputy Chief Executive Director of Emergency Services Director of Contact Centres All Trust Employees Change Record Form Date * Author/Contributor Amendment Details Kevin Mulcahy Bob Williams/Vic Workload triggers Calland/Mark Newton KM/BW Hospital delay triggers KM Remove references to Amber2/Red KMJ Added/Removed comments BW/DC/KMJ/SH/PK/KM Full review KM Minor amendments KM Realignment with new K34 process BW/KM Minor amendments SB Minor amendments KMJ Minor amendments KMJ Minor amendments Sector Managers Minor amendments KM Full review HoS Review KM Amendments to tables SH Additions to Clinical Triggers KM Amendments KM Addition of Recovery Phase KM Amendments to table 4.2 to include R1/R2 differences Clinical Escalation Plan Author: Kevin Mulcahy : Date of Approval: 09 July 2012 Status: Approved Approved By: EMT Review Date: 18 February 2014 Page 2 of 12

3 CONTENTS Page Introduction 4 Scope 4 Objectives 4 Triggers 5 Urgent Care Resources 7 Level of Authority, Attendance & Review 7 Recovery Phase 7 Interaction with REAP 8 Debrief 8 External Agencies 9 Implementation Plan 10 Quick Reference Guide 11 Clinical Escalation Plan Author: Kevin Mulcahy : Date of Approval: 09 July 2012 Status: Approved Approved By: EMT Review Date: 18 February 2014 Page 3 of 12

4 1. Introduction 2. Scope 3. Objectives 1.1. The purpose of this plan is to provide the North West Ambulance Service NHS Trust (NWAS) with risk based flexibility to resourcing at times when demand exceeds the capacity of the service to respond in spite of every effort having been made to match resourcing with forecasted demand The reason for the excess demand may be because of a variety of causes including major incidents, pandemics or any other unexpected eventuality The overriding aim of this plan is to ensure that NWAS maintains the highest possible level of patient care services to the communities of North West when experiencing demand pressures and retains public confidence This plan is linked to the NWAS Resource Escalation Action Plan (REAP) levels of response; it should be read and, where feasible, used in conjunction with it This plan is predominantly applicable to Emergency Control Centres (ECC), Urgent Care Desks (UCD) and Health Control Desks (HCD) The business activity of these services has a direct bearing on the operational activity of frontline staff. There are no specific actions required of frontline staff This plan must be understood by ECC Managers, and all Command and Control structure Managers To provide a framework by which the Trust may respond to periods of high pressure that arise because of short-term demands To utilise the triage system to ensure those patients with the most serious conditions or in greatest need continue to receive NWAS services. The Paramedic Pathfinder tool will assist in determining the need To provide a set of flexible and immediate tactical options to NWAS managers to dynamically respond to developing demand profiles where the provision of service cannot be met by the available resources. Clinical Escalation Plan Author: Kevin Mulcahy : Date of Approval: 09 July 2012 Status: Approved Approved By: EMT Review Date: 18 February 2014 Page 4 of 12

5 4. Triggers 4.1 Call-handling triggers The table below sets out the actions to be taken within an ECC callhandling suite when the triggers are reached. Call-handling actions Stages Triggers Actions Lead Responsibility 1 Normal working None None 2 3 Emergency calls waiting to be answered >3 minutes Emergency calls waiting to be answered >5 minutes across the Region more than three times the total number of EMDs on duty Emergency Rule called across NWAS Non-ECC staff fielding non patientrelated calls (Skillset required) Consider requesting mutual aid from buddy Trusts Local or on-call ECC Sector Manager Senior Operational Lead or ROCC Gold, in consultation with Head of Service ECC, or on-call ECC Sector Manager 4.2 Dispatch Triggers The table below sets out the actions to be taken within an ECC Dispatch Suite when triggers are reached. Clinical Escalation Plan Author: Kevin Mulcahy : Date of Approval: 09 July 2012 Status: Approved Approved By: EMT Review Date: 18 February 2014 Page 5 of 12

6 CEP Dispatch Stages Stages Trigger Action Lead Accountability Authorised by Review Time Notification A Normal working None None None None None B C D E F > 10 Red 2 and/or 5 Red 1 calls unallocated for more than 5 minutes AND/OR > 35 G1 & G2 being held >40 minutes >10 Red 2 and/or 5 Red 1 calls in each ECC unallocated for more than 5 minutes >20 Red 2 and/or 10 Red 1 calls in an ECC unallocated for more than 5 minutes >50 Red 2 and/or 20 Red 1 calls in an ECC unallocated for more than 5 minutes >100 Red 2 and/or 50 Red 1 calls in an ECC unallocated for more than 5 minutes All G3 & G4 calls held for ring-back Green 1/2 calls held for ring-back (ECC006) No response to Green 3 or 4 calls No response to Green 2, 3, 4 calls. Green 1 calls held for ring-back All hospital transfers to receive ring-back from UCD No response to Green calls Respond to Red 1 calls only All other calls held for ring-back Local Gold Senior Operational Lead Senior Operational Lead Deputy Chief Executive Chief Executive Local Gold 3 x ECC Managers ROCC Gold on-call Senior Operational Lead (BW/DC) Executive on-call Medical Director/AMD ROCC Gold, if open. If not then local on-call gold has primacy with other two golds. Senior Operational Lead (BW/DC) Executive on-call Medical Director/AMD ROCC Gold (as above) Chief Executive Executive on-call Medical Director/AMD Senior Operational Lead (BW/DC) ROCC Gold (as above) Chief Executive Executive on-call Medical Director/AMD Senior Operational Lead (BW/DC) ROCC Gold (as above) 2 hourly Every 90 minutes Every 60 minutes Every 45 minutes Every 30 minutes Exclusions from this plan paediatric cases, and patients in public places Clinical Escalation Plan Author: Kevin Mulcahy : Date of Approval: 09 July 2012 Status: Approved Approved By: EMT Review Date: 18 February 2014 Page 6 of 12 NWAS NWAS SHA Lead Commissioner Lead PCT Golds NDOG NWAS SHA Lead Commissioner Lead PCT Golds NDOG NB - Consultation NWAS SHA Lead Commissioner Lead PCT Golds NDOG NACC NB Consultation NWAS SHA Lead Commissioner Lead PCT Golds NDOG NACC

7 From stage B onwards, Comms must be engaged Clinical Escalation Plan Author: Kevin Mulcahy : Date of Approval: 09 July 2012 Status: Approved Approved By: EMT Review Date: 18 February 2014 Page 7 of 12

8 4.3 Review Once invoked, the Clinical Escalation Plan will be subject to reviews as per the table. 5. Urgent Care Resources 5.1. As escalation through stages C to F takes place the availability of High Dependency/Intermediate Tier/Special Transport Service resources will increase These resources are to be utilised to undertake hospital transfers and to provide conveyance capabilities where solo responders are on scene to ensure front line Accident and Emergency crew availability is maximised Hospitals requesting critical transfers are required to provide the medical escort for the patient and it is not within the remit of the hospital to dictate the skill set of the attending NWAS crew Wherever possible, due consideration must be given to the skill set of staff deployed on urgent care resources. 6. Level of Authority, Attendance and Review 6.1. Details of these are contained in the triggers set out in Section Roles contained within the Authorised by box have autonomy to escalate the plan but must contact the accountable lead to notify them of the change. 7. Recovery Phase 7.1 Following resumption of normal working (Stage A), there will be a number of calls still on the waiting screen which would have had a response but did not receive a response because of the escalation. 7.2 Key to the successful management of patients during the Escalation phase is the management of these patients who will now require some form of triage and/or transportation. 7.3 To manage these patients, the following actions must be carried out: A number of resources (PES and UCS ambulances, APs and SPs) will be identified and held to deal with the backlog of work These resources will be agreed between the ECC Sector Managers (or on-call Sector Manager) and the UCD Manager/Performance Manager. Clinical Escalation Plan Author: Kevin Mulcahy : Date of Approval: 09 July 2012 Status: Approved Approved By: EMT Review Date: 18 February 2014 Page 8 of 12

9 CEP Levels All delayed patients will receive a ring-back by an appropriate clinician and further triaged using the MTS to establish the clinical priority of the patient If required, the ring-fenced vehicles will respond to these delayed calls No new calls will be triaged by the Urgent Care Desk until the backlog of calls have been dealt with. All new calls will receive an appropriate vehicular response, using resources which have not be ringfenced for the delayed calls. Red ring-backs will, however, continue during this process The above will be adjusted according to the opening hours of the Urgent Care Desk. 8. Interaction with the Resource Escalation Action Plan (REAP)/MI Plan 8.1 The table below sets out how the Clinical Escalation Plan interacts with REAP. Interaction with REAP REAP Levels A Y Y Y Y B Y Y Y Y C Y Y Y D Y Y E Y Y F Y 8.2 At any stage, the Major Incident Plan can be invoked, and this will replace the actions set out in the Clinical Escalation Plan. 9. Debrief 9.1. Every time the CEP is escalated a debrief must take place in a timely manner. This needs to be used to brief onwards within the organisation therefore need to be conducted immediately afterwards (or possibly even during if extended timeframe) Clinical Escalation Plan Author: Kevin Mulcahy : Date of Approval: 09 July 2012 Status: Approved Approved By: EMT Review Date: 18 February 2014 Page 9 of 12

10 9.2. The Head of Service, ECC is responsible for ensuring that debriefs take place. These debriefs are to be lead by the Tactical Advisor or suitable appointed person. 9.3 The purposes of this debrief are: 10. External Agencies To understand what activity leads to escalation of the CEP. Monitor and evaluate Control Services response. Identify any learning points for future use. Establish any shortcoming in Trust planning This plan and any amended versions are to be shared with the following external and partner agencies: Strategic Health Authority Lead PCT 10.2 Informing external and partner agencies of activation and escalation through CEP is important, to ensure demand generated by and through those agencies is managed as best as possible Cascading of information regarding escalation and de-escalation of the CEP to both internal and external partners, and to the public will be the responsibility of the Trust s Communications Team, who must be kept informed of all changes to Plan levels. This will include local Police and Fire Services. Clinical Escalation Plan Author: Kevin Mulcahy : Date of Approval: 09 July 2012 Status: Approved Approved By: EMT Review Date: 18 February 2014 Page 10 of 12

11 IMPLEMENTATION PLAN This plan forms part of the Command and Control Managers suite of documents and must be carried in their on-call pack Intended Audience All Control Services Staff All Officer Grade Personnel Medical Directorate Communications Emergency Preparedness Department Central Resource Unit Staff NWAS Support Services Strategic Health Authority Lead PCT Dissemination Communications Training Monitoring Available to all staff via the Intranet. Revised Policy and Procedure to be announced and a link provided to the document. ECC Memorandum All other users will be notified of policy All aspects of the document will be monitored. A formal debrief lead by the Tactical Advisor shall take place each time stages B F of CEP are invoked. The Head of Service, ECC will hold the responsibility for ensuring debriefing takes place within an appropriate timeframe. The Head of Service, ECC will ensure learning points gained from debriefs are fed into the CEP as part of the annual review process and shall feed urgent matters to the appropriate group. Clinical Escalation Plan Author: Kevin Mulcahy : Date of Approval: 09 July 2012 Status: Approved Approved By: EMT Review Date: 18 February 2014 Page 11 of 12

12 Control Response Escalation Action Plan Quick Reference Guide A B C D E Call in trained UCD staff & extra vehicles F Red Green 1/2 Green 3/4 Normal response Normal response Normal response Grade calls, take in order Grade calls & UCD triage with downgrade to clinical need Triage as normal Green calls held for ring-back Green 1/2 calls held No for ringback response Green 1 calls held for ring-back. No response to Green 2/3/4 calls No response HCP Referrals Triage as normal Triage as normal Triage as normal Calls receive ring-back Pass appropriate work to Planned Care Planned Care Normal response Normal response Normal response Normal response Crews deal with selected HCP referrals Call in trained UCD staff, extra vehicles and employ outside agencies Respond to Red 1 determinants only. No response to Red 2 calls No response Authority to refuse booking. Pass appropriate work to Planned Care No routine OPD work. Crews do selected HCP referrals. Clinical Escalation Plan Author: Kevin Mulcahy : Date of Approval: 09 July 2012 Status: Approved Approved By: EMT Review Date: 18 February 2014 Page 12 of 12

13 Clinical Escalation Plan Stage B ECC Duty Control Manager Guidance B DCM 1 of 3 Prior to introducing Stage B, the ECC Duty Control Manager (DCM) must ensure all ECC staffing has been reviewed to bring about the best possible cover across ECC, UCD and HCD. The components of Stage B may be implemented in entirety or in part depending on the area that is over capacity. This discretion rests with the ECC Duty Control Manager. It is important to note that all components of Stage B MUST be invoked prior to further escalation through the Clinical Escalation Plan. Authorisation Levels 2 hours 4 hours +4 hours Urgent Disconnect/Emergency Rule ECC Supervisor DCM Local Gold Dispatch Call Backs DCM DCM Local Gold UCD Ring Back Extension DCM DCM Local Gold VAS DCM DCM Senior Operational Lead/Medical Director No response to GREEN Ώ calls. G3 & G4 calls will be held but will be called back by UCD and may not get an NWAS resource. The DCM must tell the Dispatchers not to allocate to any G3/4 calls unless instructed by the UCD. Resources which are freed up from G 3/4 calls can be utilised for dealing with higher acuity calls following the agreed see & treat and/or hear & treat protocols in conjunction with appropriate advice from Band 6 or 7 Paramedics. It is likely that this action will reduce the need to move to the next stage. The Emergency Control Centre Supervisor may authorise two hours of Urgent Disconnect or the Emergency Rule. The Emergency Control Centre DCM may authorise two hours of any component of Stage B. The Emergency Control Centre DCM may authorise a further two hours at Stage B after a review of the original decision has taken place (totalling four hours). At any point the Emergency Control Centre DCM is of the view there should be consideration to escalating to higher stages of this plan or the authority to continue Stage B beyond four hours is required then a conference call is to be arranged. If required, the conference call is to involve the Senior Operational Lead (BW/DC), Executive on-call, Medical Director/AMD, ROCC Gold, if open. If not then local gold has primacy with other two golds. The DCM is to commence an Incident Management Log and ensure all rationale for decisions taken are recorded. Page 1 of 5

14 Clinical Escalation Plan Stage B B DCM 2 of 3 Call Handling Urgent Disconnect/Emergency Rule Urgent disconnect and Emergency Rule are to be used when all or any of the following triggers have been met: call handling performance has been significantly below call answering target levels (95% of calls answered in 5 seconds for at least two consecutive hours) the number of calls waiting to be answered is greater the number of EMDs on duty within a local ECC, where call patterns suggest they are not linked with a single incident there are any number of calls holding persistently each minute for at least 10 minutes During periods of Urgent Disconnect/Emergency Rule, abandoned calls must continue to be rung back in line with regular policy (ECC0032 refers). The DCM should consider requesting special measures from BT and Cable and Wireless which enables 999 operators to be made available for further 999 calls. Call Backs Regular Emergency Control Centre Procedures require call backs where calls are being held. Red calls are called back at 6 minutes and G1 & G2 calls are called back at 20 minutes. The Urgent Care Desk is to support these call backs at the following time frames to provide greater clinical expertise when speaking with callers/patients. Red 12 minutes G1 & G2 40 minutes G3 & G4 60 minutes Given the increased workload, there must be at least 2 members of clinical staff on duty or the UCD Manager must undertake arrangements to supplement the staffing at this position. Page 2 of 5

15 Clinical Escalation Plan Stage B B DCM 3 of 3 UCD Ring Back Time Limit At REAP levels 1 and 2 the call back time limit for the UCD calls is 30 minutes (this increases to 60 minutes at REAP3 and above). Stage B increases the 30 minute call back time to 60 minutes. The UCD Manager shall be responsible for informing NHS Direct when this occurs and shall ensure priority responses to patients who are -5 years and 65+ years. Voluntary Ambulance Service Support The DCM (or delegated manager) is to contact the on call Red Cross and St John Ambulance Duty Officer and ask if they have provisions to provide any operational support to NWAS. Paging The following should receive a pager message to advise that Stage B has been invoked. Head of Service, ECCs Local Head of Service On-Call Emergency Control Centre Sector Manager The on duty Emergency Control Centre DCM should consider the attendance of the On-call Emergency Control Centre Sector Manager. Page 3 of 5

16 Clinical Escalation Plan Stage B Instruction for Call Handlers B CH 1 of 1 Urgent Disconnect/Emergency Rule EMDs must: Complete Case Entry and key Questions as normal Provide the patient/caller with Post Dispatch Instructions which give medical or safety advice as normal. If the call is graded G3 or G4 the following statement will be given: 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 For all RED and G1 & G2 calls the following statement will be given: I need to hang up now (to take another call). Help has been arranged. If anything changes, call us back immediately for further instructions EMDs should only remain on the line with callers where not doing so may cause significant harm to the patient (e.g. if the caller were threatening self harm, or was clearly vulnerable a child without an adult). EMDs should not ask if the caller wishes them to remain on the line. Where an EMD remains on the line with a caller the Call Handling Supervisor/Call Taking Manager must be alerted. Page 4 of 5

17 B Clinical Escalation Plan Stage B UCD 1 of 1 Urgent Care Desk Instruction for Urgent Care Desk The UCD Manager is to alert NHS Direct that the NWAS have moved to Stage B of the Clinical Escalation Plan. This is done by calling (Check number). If the Trust is at REAP1 or 2, the ring back time limit is extended to 60 minutes. At REAP3 and above the limit is automatically extended to 60 minutes. The UCD Manager is responsible for maintaining priority responses to patients who are less than 5 years or 65 or more years of age. The clinicians at the UCD are to provide clinical support to those calls that are awaiting allocation of an NWAS resource. This support is provided by ringing back; Red calls held for 12 minutes G1 & G2 calls held for 40 minutes G3 & G4 calls held for 60 minutes The aim of this ring back is to ascertain/undertake: A rapid clinical assessment as to need to upgrade. If the patient s condition has changed alter the call grading where applicable. The call log is to be updated with the rationale. The call log should be updated with details of the time of the call and any other relevant information. If the call does not need to be re-triaged this should also be noted. Whether a Red or Green1/2 call can be dealt with by a resource freed up from dealing with Green 3/4 calls, following the agreed see & treat and/or hear & treat protocols The UCD Manager is also to triage all requests from the local Police Service to assess both suitability and advise on appropriate care pathways. Page 5 of 5

18 Clinical Escalation Plan Stage C Instructions for ECC Duty Control Managers C Manager 1 of 2 Stage B of CEP MUST be implemented prior to escalation for consideration to moving to Stage C, D, E or F. Initial authority for Stage B rests with the DCM. Stage C Authority: Senior Operational Lead 1. All calls graded GREEN will be called back by UCD and may not get an NWAS resource. 2. Issue the Stage C action cards to ECC staff according to role and ensure actions are undertaken. 3. UCD must be provided with at least 4 Paramedics/Advanced Paramedics at this stage. 4. Send pager message to the following to advise that Stage C has been invoked. Senior Operational Lead ECC Head of Service Local Head of Service On-Call Emergency Control Centre Sector Manager The on duty Emergency Control Centre DCM should consider the attendance of the On-call Emergency Control Centre Sector Manager. 5. Reviews will be undertaken as directed by the Senior Operational Lead and will be at no less than two hour intervals. Continual reviews may be undertaken by conference call involving Senior Operational Lead (BW/DC), Executive on-call, Medical Director/AMD, ROCC Gold, if open. If not then local gold has primacy with other two golds. 6. During opening hours, ensure the Central Rostering Unit (CRU) are informed this stage has been implemented.

19 C Clinical Escalation Plan Stage C Manager 2 of 2 7. Additional resources that become available and who contact ECC will be asked to contact the CRU. If the CRU is closed they should make themselves available to their local Operational Manager. 1. Manager 2 of 2 8. At this stage all abandoned calls are to be rung back and managed in accordance with existing procedures. 9. Ensure local Police and Fire Services, BT and Cable and Wireless are informed that this stage has been invoked. 10. Ambulances should not be sent to AS3 calls. When practicable these should be rung back and informed of the situation and instructed to make their own arrangements for the duration of the incident. Ideally, this should be dealt with by staff other than core ECC staff (i.e. HQ Admin). ECC Sector Manager will need to make arrangements to identify this staff member. 11. Implementation of this procedure will release additional vehicles from normal operational duties. 12. Ensure UCD Manager has informed NHSD this stage has been invoked. 13. As Urgent Care resources become available they should be considered for appropriate hospital transfer requests and conveyance in line with current practice.

20 Clinical Escalation Plan Stage C Instructions for Call Handlers C CH 1 of 2 Urgent Disconnect EMDs must: Complete Case Entry and key Questions as normal Provide the patient/caller with Post Dispatch Instructions which give medical or safety advice as normal. If the call is graded GREEN 3/4 the following statement will be given: Due to (specify reason), we do not have an ambulance to send. Our advice is to contact a GP or call NHS Direct or make your own way to a Minor Injury Unit or to an Accident and Emergency Department. I need to hang up now (to take another call). If anything changes, call us back immediately for further instructions If the call is graded GREEN 1/2 the following statement will be given: 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 Provide the CAD reference number to the caller to use as evidence of contacting the NWAS. NHS Direct may require this from the caller. For RED calls the following statement will be given: I need to hang up now (to take another call). Help has been arranged. If anything changes, call us back immediately for further instructions

21 C CH 2 of 2 Clinical Escalation Plan Stage C All calls received from HCP/NHSD should be triaged using MPDS Card 35 (HCP). This includes calls where the patient is waiting to be put through from NHSD. NHSD should be advised that it is not necessary to speak to the patient due to the clinical escalation plan being in place. The call should be completed in the usual manner and when passed by a Nurse Advisor the longest possible clinically safe time of arrival should be obtained and included on the call log. EMDs should only remain on the line with callers where not doing so may cause significant harm to the patient (e.g. if the caller were threatening self harm, or was clearly vulnerable a child without an adult). EMDs should not ask if the caller wishes them to remain on the line. Where an EMD remains on the line with a caller the Call Handling Supervisor must be alerted. If at any time a Call Handler feels it is unsafe to leave a patient on their own, a patient in the street/public place or if the patient is alone or infirm, complete the call as normal explaining rationale in the call log. Abandoned calls are to be handled according to current policy. Quick Guide Call Type GREEN All Patients RED Response UCD Dispatch resources as normal

22 C Clinical Escalation Plan Stage C Instructions for UCD UCD 1 of 1 If the call is graded GREEN 3/4 the call will not receive an NWAS response and will receive referral and NO SEND advice by the call handler. If the call is graded GREEN 1/2 callers will be told that initially an ambulance will not be sent and that UCD will ring them back. The clinicians at the UCD positions are to provide clinical support to those calls that are awaiting allocation of an NWAS resource. This support is provided by ringing back; RED calls held for 12 minutes GREEN 1/2 calls held for 40 minutes GREEN 3/4 calls held for 60 minutes The aim of this ring back is to ascertain: If the patient's condition has changed and if informed that the patient s condition has changed alter the call grading where applicable. The call log is to be updated with the rationale. The call log should be updated with details of the time of the call and any other relevant information. If the call does not need to be re-triaged this should also be noted. Every effort should be made to encourage the use of appropriate care providers, alternative transport and/or to cancel the response. UCD will continue to manage hospital transfer requests. The UCD is also to triage all requests from the local Police Services to assess both suitability and advise on appropriate care pathways. UCD will be responsible for calling back HCP calls to negotiate longer response times for these calls as required/dictated by the Senior Operational Lead. As Urgent Care resources become available they should be considered for appropriate hospital transfer requests and conveyance if a solo responder is on scene. C

23 Every effort should be made to encourage the use of appropriate care providers, alternative transport and/or to cancel the response. Send on any calls where there is no contact on ring back. When below REAP3 this stage of CEP extends ring back time to 60 minutes. The UCD Manager is to inform NHSD ( ) that Stage C of the Clinical Escalation Plan has been invoked. C

24 Clinical Escalation Plan Stage C Instructions for Dispatch Desks Do not dispatch a vehicle to any calls that are coded as GREEN. If you have already dispatched a vehicle to a call that becomes GREEN then cancel down the crew. Call Takers have been instructed that if at any time a Call Handler feels it is unsafe to leave a patient on their own, a patient in the street/public place or if the patient is alone or infirm, complete the call as normal explaining the rationale in the call log. Do not dispatch a vehicle to any AS3 calls as alternative arrangements will be made to deal with these. As Urgent Care resources become available they should be considered for appropriate hospital transfer requests and conveyance if a solo responder is on scene. Quick Guide Call Type GREEN All Patients RED Response UCD Dispatch resources as normal

25 Clinical Escalation Plan Stage D Instructions for ECC Control Managers D Manager 1 of 2 Stage B of CEP MUST be implemented prior to escalation for consideration to moving to Stage C, D, E or F. Initial authority for Stage B rests with the ECC Duty Control Manager Stage 3 Authority: Senior Operational Lead 1. Calls graded GREEN 2/3/4 will not receive an NWAS response. GREEN 1 will be called back by UCD and may not get an NWAS resource. 2. Issue the Stage D action cards to Control Services staff according to role and ensure actions are undertaken. 3. UCD must be provided with at least 6 members of UCD staff at this stage. 4. Send pager message to the following to advise that Stage D has been invoked. Senior Operational Lead Executive on-call Medical Director Head of Service, ECCs Local Head of Service On-Call Emergency Control Centre Sector Manager Duty or on-call ECC Sector Manager must attend the relevant ECC 5. Reviews will be undertaken as directed by Senior Operational Lead but will be at no less than two hour intervals. The EMT will be required to attend HQ once this level has been authorised. 6. If open, Central Resource Unit is to be informed that this stage of the CEP has been invoked.

26 Clinical Escalation Plan Stage D D Manager 2 of 2 7. Additional resources that become available and who contact ECC will be asked to contact the CRU. If the CRU is closed they should make themselves available to their local Operational Manager. 8. At this stage, instruction is to be given that when an abandoned call is received it will be rung back. Where no direct contact is able then whenever possible a message will be left advising the caller to ring back if required and that no resource will be sent at this time. 9. Ensure the local Police and Fire Services, BT and Cable and Wireless are informed that this stage has been invoked. 10. Ambulances should not be sent to AS3 calls. When practicable these should be rung back and informed of the situation and instructed to make their own arrangements for the duration of the incident. Ideally, this should be dealt with by staff other than core Control Services staff (i.e. HQ Admin). Local Ops Head of Service will need to identify this staff member. 11. Implementation of this procedure will release additional vehicles from normal operational duties. 12. Ensure UCD Manager has informed NHSD this stage has been invoked. 13. As Urgent Care resources become available they should be considered for appropriate hospital transfer requests and conveyance if a solo responder is on scene.

27 Clinical Escalation Plan Stage D Instructions for Call Handlers D CH 1 of 2 Urgent Disconnect Call Handlers must: Complete Case Entry and key Questions as normal Provide the patient/caller with Post Dispatch Instructions which give medical or safety advice as normal If the call is graded GREEN 2/3/4 the following statement will be given: Due to (specify reason), we do not have an ambulance to send. Our advice is to contact a GP or call NHS Direct or make your own way to a Minor Injury Unit or to an Accident and Emergency Department. I need to hang up now (to take another call). If anything changes, call us back immediately for further instructions Provide the CAD reference number to the caller to use as evidence of contacting the NWAS. NHS Direct may require this from the caller. The call should then be quit with the reason entered as NO SEND - CEP. If the call is graded GREEN 1 the following statement will be given: 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 For RED calls the following statement will be given: I need to hang up now (to take another call). Help has been arranged. If anything changes, call us back immediately for further instructions

28 Clinical Escalation Plan Stage D D CH 2 of 2 All calls received from HCP/NHSD should be triaged using MPDS Card 35 (HCP). This includes calls where the patient is waiting to be put through from NHSD. NHSD should be advised that it is not necessary to speak to the patient due to the demand management plan being in place. The call should be completed in the usual manner and when passed by a Nurse Advisor the longest possible clinically safe time of arrival should be obtained and included on the call log. Call Handlers should only remain on the line with callers where not doing so may cause significant harm to the patient (e.g. if the caller were threatening self harm, or was clearly vulnerable a child without an adult). Call Handlers should not ask if the caller wishes them to remain on the line. Where a Call Handler remains on the line with a caller the Call Handling Supervisor must be alerted. If at any time a Call Handler feels it is unsafe to leave a patient on their own, a patient in the street/public place or if the patient is alone or infirm, complete the call as normal explaining rationale in the call log. Abandoned calls are to be handled according to current procedures. Quick Guide Call Type GREEN 2/3/4 Response NO SEND GREEN 1 RED UCD Dispatch as normal

29 D Clinical Escalation Plan Stage D Instructions for UCD UCD 1 of 2 If the call is graded GREEN 2/3/4 the call will not receive an NWAS response and will receive referral and NO SEND advice by the call handler. If the call is graded GREEN 1 callers will be told that initially an ambulance may not be sent and they may receive a call from UCD/NHSD. UCD will initially manage all GREEN calls. The clinicians at the UCD are to provide clinical support to those calls that are awaiting allocation of an NWAS resource. This support is provided by ringing back; RED calls held for 12 minutes GREEN 1 calls held for 40 minutes GREEN 2/3/4 calls held for 60 minutes The aim of this ring back is to ascertain: If the patient's condition has changed and if informed that the patient s condition has changed alter the call grading where applicable. The call log is to be updated with the rationale. The call log should be updated with details of the time of the call and any other relevant information. If the call does not need to be re-triaged this should also be noted. Every effort should be made to encourage the use of appropriate care providers, alternative transport and/or to cancel the response. UCD will continue to manage hospital transfer requests. The UCD Clinician is also to triage all requests from the local Police Services to assess both suitability and advise on appropriate care pathways. UCD will be responsible for calling back HCP calls to negotiate longer response times for these calls as required/dictated by the Senior Operational Lead. As Urgent Care resources become available they should be considered for appropriate hospital transfer requests and conveyance if a solo responder is on scene. Every effort should be made to encourage the use of appropriate care providers, D

30 alternative transport and/or to cancel the response. Leave message if possible on any calls where there is no contact on ring back. The UCD Manager is to inform NHSD ( ) that Stage D of the Clinical Escalation Plan has been invoked.

31 Clinical Escalation Plan Stage E Instructions for ECC Duty Control Managers E Manager 1 of 2 Stage B of CEP MUST be implemented prior to escalation for consideration to moving to Stage C, D, E or F. Initial authority for Stage B rests with the ECC DCM. Stage 3 Authority: Deputy Chief Executive 1. Calls graded GREEN will not receive an NWAS response. 2. Issue the Stage E action cards to Control Services staff according to role and ensure actions are undertaken. 3. UCD must be provided with at least 6 members of UCD staff at this stage. 4. The Medical Directorate may seek to open an enhanced clinical hub if not being used for a major incident. 5. Send pager message to:- Chief Executive Deputy Chief Executive Executive on-call Medical Director/AMD Senior Operational Lead (BW/DC) ECC Head of Service ROCC Gold (if covered) 6. Reviews will be undertaken as directed by the Deputy Chief Executive but will be at no less than two hour intervals. The Executive Management Team will be required to attend HQ when this stage is authorised. 7. If open, the Central Resource Unit is to be informed this stage of the plan has been invoked. Page 1 of 7

32 E Clinical Escalation Plan Stage E Manager 2 of 2 8. Additional resources that become available and who contact ECC will be asked to contact the CRU. If the resource centre is closed they should make themselves available to their local Manager. 9. At this stage all abandoned calls are to be rung back and managed in accordance with existing policy. 10. Ensure the local Police and Fire Services, BT and Cable and Wireless are informed this stage has been invoked. 11. Ambulances should not be sent to AS3 calls. When practicable these should be rung back and informed of the situation and instructed to make their own arrangements for the duration of the incident. Ideally, this should be dealt with by staff other than core ECC staff (ie HQ Admin). 12. Implementation of this procedure will release additional vehicles from normal operational duties. 13. Ensure the UCD Manager has informed NHSD this stage has been invoked. 14. As Urgent Care resources become available they should be considered for appropriate hospital transfer requests and conveyance if a solo responder is on scene. Page 2 of 7

33 E Clinical Escalation Plan Stage E Instructions for Call Handlers CT 1 of 2 Urgent Disconnect EMDs must: Complete Case Entry and key Questions as normal Provide the patient/caller with Post Dispatch Instructions which give medical or safety advice as normal If the call is graded GREEN the following statement will be given: Due to (specify reason), we do not have an ambulance to send. Our advice is to contact a GP or call NHS Direct or make your own way to a Minor Injury Unit or to an Accident and Emergency Department. I need to hang up now (to take another call). If anything changes, call us back immediately for further instructions Provide the CAD reference number to the caller to use as evidence of contacting the NWAS. NHS Direct may require this from the caller. The call should then be quit with the reason entered as NO SEND - CEP. For RED calls the following statement will be given: I need to hang up now (to take another call). Help has been arranged. If anything changes, call us back immediately for further instructions Page 3 of 7

34 Clinical Escalation Plan Stage E E CT 2 of 2 All calls received from HCP/NHSD should be triaged using MPDS Card 35 (HCP). This includes calls where the patient is waiting to be put through from NHSD. NHSD should be advised that it is not necessary to speak to the patient due to the demand management plan being in place. The call should be completed in the usual manner and when passed by a Nurse Advisor the longest possible clinically safe time of arrival should be obtained and included on the call log. EMDs should only remain on the line with callers where not doing so may cause significant harm to the patient (e.g. if the caller were threatening self harm, or was clearly vulnerable a child without an adult). EMDs should not ask if the caller wishes them to remain on the line. Where an EMD remains on the line with a caller the Call Handling Supervisor/Call Taking Manager must be alerted. If at any time a Call Handler feels it is unsafe to leave a patient on their own, a patient in the street/public place or if the patient is alone or infirm, complete the call as normal explaining rationale in the call log. Abandoned calls are to be handled according to policy (CSOP/9 refers). Quick Guide Call Type GREEN All Patients RED All Patients Response NO SEND Dispatch as normal Page 4 of 7

35 Clinical Escalation Plan Stage E Instructions for UCD E UCD 1 of 2 If the call is graded GREEN the call will not receive an NWAS response and will receive referral and NO SEND advice by the call handler. CSD/CCD 1 of 1 The clinicians in the UCD are to provide clinical support to those calls that are awaiting allocation of an NWAS resource. This support is provided by ringing back; RED calls held for 12 minutes GREEN calls held for 60 minutes The aim of this ring back is to ascertain: If the patient s condition has changed and if informed that the patient s condition has changed alter the call grading where applicable. The call log is to be updated with the rationale. The call log should be updated with details of the time of the call and any other relevant information. If the call does not need to be re-triaged this should also be noted. Every effort should be made to encourage the use of appropriate care providers, alternative transport and/or to cancel the response. UCD will continue to manage hospital transfer requests. The UCD Clinicians also to triage all requests from the local Police Services to assess both suitability and advise on appropriate care pathways. UCD will be responsible for calling back HCP calls to negotiate longer response times for these calls as required/dictated by Gold Medic. As Urgent Care resources become available they should be considered for appropriate hospital transfer requests and conveyance if a solo responder is on scene. Page 5 of 7

36 E Every effort should be made to encourage the use of appropriate care providers, alternative transport and/or to cancel the response. If the call is graded as GREEN and it is impossible for the patient s condition to be managed without a clinical response then the call should be sent to Urgent Care in the first instance, for response by an HDS crew. UCD 2 of 2 Send on any calls where there is no contact on ring back. The UCD Manager should be aware that some categories of abandoned call may attract a GREEN category. One attempt should be made to contact, if after which contact cannot be established, the call should be shown as RED and passed for dispatch. UCD will be responsible for calling back HCP calls to negotiate longer response times for these calls as required/dictated by Gold Medic. The UCD Manager is to inform NHSD ( ) that Stage E of the Clinical Escalation Plan has been invoked. Page 6 of 7

37 Clinical Escalation Plan Stage E Instructions for Dispatch Desk E Dispatch 1 of 1 Do not dispatch a vehicle to any calls that are coded as GREEN. If you have already dispatched a vehicle to a call that becomes GREEN then cancel down the crew. Sec If the call is graded GREEN the call will not receive an NWAS response. Call Takers have been instructed that if at any time a Call Handler feels it is unsafe to leave a patient on their own, a patient in the street/public place or if the patient is alone or infirm, complete the call as normal explaining the rationale in the call log. Do not dispatch a vehicle to any AS3 calls as alternative arrangements will be made to deal with these. As Urgent Care resources become available they should be considered for appropriate hospital transfer requests and conveyance if a solo responder is on scene. Quick Guide Call Type GREEN All Patients RED All Patients Response NO SEND Dispatch as normal Page 7 of 7

38 Clinical Escalation Plan Stage F Instructions for ECC Duty Control Managers F Manager 1 of 2 Stage B of CEP MUST be implemented prior to escalation for consideration to moving to Stage C, D, E or F. Initial authority for Stage B rests with the ECC DCM. Stage 3 Authority: Chief Executive 1. Calls graded GREEN or RED 2 will not receive an NWAS response. 2. Issue the Stage F action cards to ECC staff according to role and ensure actions are undertaken. 3. UCD must be provided with at least 6 members of UCD staff at this stage. 4. The Medical Directorate may seek to open an enhanced clinical hub if not being used for a major incident. 5. Send pager message to Chief Executive Deputy Chief Executive Executive on-call Medical Director/AMD Senior Operational Lead (BW/DC) ECC Head of Service ROCC Gold 6. Reviews will be undertaken as directed by Chief Executive but will be at no less than two hour intervals. The Executive Management Team will be required to attend HQ once this stage is authorised. 7. If open, all Central Resource Units are to be informed this stage of the CEP has been invoked. Page 1 of 7

39 Clinical Escalation Plan Stage F F Manager 2 of 2 8. Additional resources that become available and who contact ECC will be asked to contact their resource centre. If the resource centre is closed they should make themselves available to their sector desk. 9. At this stage, instruction is to be given that when an abandoned call is received it will not be rung back. 10. Ensure the local Police and Fire Services, BT and Cable and Wireless are informed this stage has been invoked. 11. Ambulances should not be sent to AS3 calls. When practicable these should be rung back and informed of the situation and instructed to make their own arrangements for the duration of the incident. Ideally, this should be dealt with by staff other than core ECC staff (ie HQ Admin). Local Head of Service will need to identify this member of staff. 12. Implementation of this procedure will release additional vehicles from normal operational duties. 13. Ensure UCD Manager has informed NHSD this stage has been invoked. 14. As Urgent Care resources become available they should be considered for appropriate hospital transfer requests and conveyance if a solo responder is on scene. Page 2 of 7

40 Clinical Escalation Plan Stage F Instructions for Call Handlers F CT 1 of 2 Urgent Disconnect EMDs must: Complete Case Entry and key Questions as normal Provide the patient/caller with Post Dispatch Instructions which give medical or safety advice as normal If the call is graded GREEN (any) or RED 2 the following statement will be given: Due to (specify reason), we do not have an ambulance to send. Our advice is to contact a GP or call NHS Direct or make your own way to a Minor Injury Unit or to an Accident and Emergency Department. I need to hang up now (to take another call). If anything changes, call us back immediately for further instructions Provide the CAD reference number to the caller to use as evidence of contacting the NWAS. NHS Direct may require this from the caller. The call should then be quit with the reason entered as NO SEND - CEP. For RED 1 calls the following statement will be given: I need to hang up now (to take another call). Help has been arranged. If anything changes, call us back immediately for further instructions Page 3 of 7

41 F Clinical Escalation Plan Stage F CT 2 of 2 All calls received from HCP/NHSD should be triaged using AMPDS Card 35 (HCP). This includes calls where the patient is waiting to be put through from NHSD. NHSD should be advised that it is not necessary to speak to the patient due to the demand management plan being in place. The call should be completed in the usual manner and when passed by a Nurse Advisor the longest possible clinically safe time of arrival should be obtained and included on the call log. EMDs should only remain on the line with callers where not doing so may cause significant harm to the patient (e.g. if the caller were threatening self harm, or was clearly vulnerable a child without an adult). EMDs should not ask if the caller wishes them to remain on the line. Where an EMD remains on the line with a caller the Call Handling Supervisor/Call Taking Manager must be alerted. If at any time a Call Handler feels it is unsafe to leave a patient on their own, a patient in the street/public place or if the patient is alone or infirm, complete the call as normal explaining rationale in the call log. Abandoned calls are not to be rung back. Quick Guide Call Type GREEN All Patients RED 2 All Patients RED 1 All Patients Response NO SEND Dispatch as normal Page 4 of 7

42 Clinical Escalation Plan Stage F Instructions for UCD F UCD 1 of 2 If the call is graded GREEN or RED 2 the call will not receive an NWAS response and will receive referral and NO SEND advice by the call handler. CSD/CCD 1 of 1 UCD will manage all GREEN or RED 2 calls. The clinician at the UCD position is to provide clinical support to those calls that are awaiting allocation of an NWAS resource. This support is provided by ringing back; RED 2 calls held for 12 minutes GREEN calls held for 120 minutes The aim of this ring back is to ascertain: If the patient s condition has changed and if informed that the patient s condition has changed alter the call grading where applicable. The call log is to be updated with the rationale. The call log should be updated with details of the time of the call and any other relevant information. If the call does not need to be re-triaged this should also be noted. Every effort should be made to encourage the use of appropriate care providers, alternative transport and/or to cancel the response. UCD will continue to manage hospital transfer requests. The UCD Clinicians is also to triage all requests from the local Police Services to assess both suitability and advise on appropriate care pathways. UCD will be responsible for calling back HCP calls to instruct them NWAS will not be responding to their requests for transport. As Urgent Care resources become available they should be considered for appropriate hospital transfer requests and conveyance if a solo responder is on scene. Page 5 of 7