Flu codes back for 111 staff if epidemic recurs

National Ambulance Sector Office Emergency 111 call-takers could reintroduce flu dispatch codes which were pulled after slow ambulance response times to emergency patients in a small number of cases.

Protocol 36 was introduced last winter to help 111 call-takers distinguish influenza cases from life-threatening illnesses, after emergency services were swamped with calls from people with swine flu symptoms.

Normally an ambulance is sent quickly to anyone with breathing problems, chest pains and headaches as a "priority one", or potentially critical case.

But overloaded with patients with flu symptoms during the epidemic alert, St John and Wellington Free Ambulance used the new procedure to identify suspected influenza cases and reduce the urgency of those reporting flu-type symptoms to priority three.

Herald inquiries found that concerns were raised internally after four patients died after the ambulance response was incorrectly given a lower priority. As a result, Protocol 36 was pulled less than one month after it was introduced.

St John medical director Dr Tony Smith personally reviewed each case and found that a faster ambulance response would not have saved the lives of the four patients who died.

Two of the ambulances arrived within "priority one" timeframes anyway, while the other two patients were described as having "significant morbidity risks".

However, the internal review found insufficient training of 111 call staff was a key factor in ambulance response delays.

The fact that Protocol 36 was a manual system, not computer-based, was also a factor in the call-out delays.

The influenza protocol could be reinstated to help 111 call staff cope if another flu pandemic is declared.

Dr Smith said St John was making sure systems were in place to cope with peaks in demand for ambulances as the influenza season approached.

He said Protocol 36 would this year be used in electronic form embedded in the communications centre computer network.

Last year, the protocol was available only as a card-based system, which meant staff had to switch from the electronic system to a manual one. Staff would soon be trained how to use the electronic version.

But Dr Smith said Protocol 36 would be used only if:

* A pandemic is officially declared by the Ministry of Health.
* The pandemic is beginning to overwhelm ambulance resources.
* It is approved for use by the Communications Centres Clinical Oversight Group.

Emails released under the Official Information Act show Ministry of Health staff - and the families of affected patients - were not actively informed about the problems with Protocol 36.

After being told of the internal investigation, Donaleen Shiell, the National Ambulance Sector Office contract manager, asked St John for an urgent update for Health Minister Tony Ryall given the media interest in swine flu.

"We will need to ensure that the minister is kept informed of any potential risks, especially if there have been sentinel events and/or fatalities associated with the use of Protocol 36.

"Again, I am disappointed that I have to ask for information as a result of what I was told in a casual conversation, rather than being proactively informed of the problems."