Emergency Operations Centre

Each regional ambulance service in the UK has an Emergency Operations Centre (EOC). It is here where 999 or 112 calls requesting the ambulance service get taken, passed to an emergency medical dispatcher, prioritised, and resources allocated. Whilst crews are en route, the call handler may continue to provide clinical advice and talk those who are with the patient through any life-saving efforts, such as CPR. In most ambulance trusts the call handler and dispatcher are separate roles, but some trusts combine them.⁴

There are currently two approved triage systems in use to prioritise calls.⁵

• Advanced Medical Priority Dispatch System (AMPDS), which is an international system used in many ambulance services in the UK. It assigns a code (such as 06E01 – Breathing Problems, Ineffective Breathing) which may be familiar to those of you who already work pre-hospitally. This code then has a priority allocated with an associated recommended response timeframe.
• NHS Pathways, a UK system which is used in NHS 111 and a few 999 services. It is hierarchical and so questions asked early on are designed to pick out life-threatening problems and trigger ambulance response if needed, progressing through to less urgent conditions requiring a less urgent response.

Call handlers are usually not clinicians, and so clinical advice they give over the phone is usually generated by the triage systems above in response to questions answered by the caller. Sending an ambulance is not the only option available and calls may rather be routed to other teams such as mental health nurses, the patient’s general practitioner, or a clinical desk where a senior paramedic or other clinician talks to the caller and asks further questions to decide on the most appropriate response.

Each centre also has a trauma desk, where senior paramedics review calls remotely to expedite the sending of critical resources, such as HEMS, advanced paramedics, BASICS clinicians or MERIT teams to the scene. As well as co-ordinating the ambulance service response to these patients, they also advise crews attending trauma patients on decisions such as whether to convey the patient to a major trauma centre or a trauma unit, based on decision tools and the clinical picture.