St John swine flu rules failed patients

St John says Protocol 36 was implemented during a time of extreme pressure for the service. File photo / Hawke's Bay Today

A St John investigation has found insufficient training of call staff in its swine flu pandemic protocols was a key factor in ambulance response delays.

Protocol 36 was introduced during the winter to help cope with the influx of swine flu-related calls coming in at the time. It allowed the dispatcher to rate each emergency call as being a priority one, two or three job in order to determine which cases were most important.

People who reported flu symptoms were given a priority three response as it was usually non-life threatening.

But concerns were raised after four patients died after the ambulance response was incorrectly given a lower priority.

Medical director for St John, Tony Smith, said the system was put in place during a time of "extreme pressure" which on the whole did prove to be helpful. But more sufficient training was needed, he said.

"We underestimated how much training was required [and] subsequently, these people have died.

"We've identified that all call-takers did not receive sufficient training. But we need to put this in perspective - we responded to over 21,000 emergency calls and we've identified nine where there was a delayed response."

The investigation found that of the 21,858 emergency calls responded to at the time, dispatchers referred to the Protocol 36 system 1025 times.

Of those, nine cases were found to have been given an incorrect lower priority than the patient needed.

Dr Smith said that he had personally reviewed each case and in his medical opinion found that a faster ambulance response would not have saved the patients.

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

Call handlers would have to refer to a manual on their desks before deciding on the level of priority that an emergency call required.

When coupled with the computer system already in place, Protocol 36 became a complicated process for the call-takers to handle.

Dr Smith said the system would be introduced if swine flu - or another epidemic - returned.

"If the use of Protocol 36 is needed again, we will make sure that there is adequate call-taker training and refresher [updated] training in place.

"[We will also] use Protocol 36 as a routine part of our computer-based systems, except where there is a need to revert to desk-top cards in the event of loss of emergency power or other critical failures," Dr Smith said.