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
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
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
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)
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
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
"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."
- Auckland's St John Ambulance receives 125,000 111 calls
- 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.