14. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any indication that something has gone wrong for some aspects of the complaint.
15. Mrs O complains E was actively having a seizure, and the Trust did not initially correctly categorise the call as a category one call.
16. A category one call is the highest priority call out. Generally, the main target for an ambulance service is to attend a scene on average in less than 8 minutes. This is a target, but it depends on where an ambulance is and the location of the emergency.
17. A category three call is a lower priority call. Generally, ambulance crews aim to attend the scene of an emergency within 45 minutes. Our adviser said clinicians in the ambulance control room screen these calls to ensure that the most appropriate help is sent, or in some cases the patient may be referred to an alternative destination than the emergency department, where appropriate.
18. There are two main platforms which an ambulance Trust would use to categorise emergency calls. NHS Pathways and the Medical Priority Dispatch System (MPDS). The MPDS which the Trust was using is a standard platform which is used in many parts of the UK.
19. Our adviser explained when a person calls 999, depending on what the issue is, there is a panel of 36 categories the non-clinical call handler can select. This will then take them down multiple sub-categories which will help categorise the urgency of the call. Call handlers are extensively trained on this system and heavily audited on compliance.
20. Our adviser said the MPDS system provides a dispatch code. Individual ambulance services then set their response to these codes. Relevant to the complaint, seizure codes (MPDS card ‘12’) result in the highest category of response if there are ‘continuous or multiple seizures’.
21. Our adviser said it is important to note if a patient was having a continuous fit or multiple fits in a short period, this would then increase the triage category of the call to category one. This is because these issues can lead to brain damage.
22. From the evidence available, we can see when the emergency call was initially made to the Trust, E could be heard crying. The person on the phone said E had a fit, suggesting the fit had ended, rather than still being ongoing. This was also clarified by the call handler.
23. At this point in the call and based on the information provided to the call handler, the Trust categorised as a category three call. This is because the fit had ended, and a single seizure was described.
24. Our adviser explained it is very normal for a patient to be unconscious for a period after a seizure. The breathing tool was utilised appropriately to ensure that the unconsciousness was not affecting airway or breathing.
25. Around 12 minutes into the call, the person on the phone communicated with the call handler E’s fit was still ongoing. They said he had his eyes open but was not responding, and he was also foaming at the nose.
26. As set out above, when the call handler initially categorised the call, the understanding from the information provided was that E’s fit had finished. However, once the call handler was told E’s fit was ongoing, they re-categorised the call as category one.
27. We can see 18 minutes into the call, E regained consciousness. Our adviser said normal practice would have been to re-categorise the call to a lower category. The Trust did not do this and kept the call as category one for the ambulance to arrive in an according timescale.
28. We can see from the call recording, the call handler initially categorised the call as category three on the understanding E had finished fitting. Once further information was provided to the call handler, the Trust escalated to category one. This was in line with the MPDS.
29. We acknowledge how worrying these events were for Mrs O, and we recognise she has ongoing concerns about any future care E may need from the Trust. We have seen no indication of failing in the Trust’s actions and will not be considering her complaint further. We hope our consideration provides Mrs O with reassurance the Trust acted in line with guidance and that we have explained our decision clearly.