FRAILTIES in the Greater Manchester Ambulance Service (GMAS) have been exposed in the BEN recently, writes Karen Stephen. We reported that a Bolton man died after waiting for 20 minutes for an ambulance to arrive because his street didn't exist on the service's map and also that Bolton ambulance crews were using street maps which were five years old. The BEN called for a more efficient and effective service. As a result, Regional Ambulance Service chief executive, Adrian Lucas pledged just that. GMAS also invited the BEN to visit their control centre to see how the emergency call system actually works -- from start to finish. MAKING an emergency call is something we hope we never have to do.

The service is there but it's one we don't particularly wish to utilise.

But when we do make that 999 call, what happens?

How does the system work? Who takes the call? How does the information get to the ambulance, fire engine or police car and how does the response vehicle manage to get to us so quickly?

From the moment we tap those three numbers into the telephone, highly trained staff using high-tech equipment storm into action -- making sure the caller on the other end of the line receives the correct treatment in the fastest possible time.

We spent a day with GMAS at the control centre in Belle Vue and at one of the North-west's busiest stations, Manchester City Central where we followed a 999 call from start to finish.

First stop was a chat with general manager of communications and IT, Peter Clarke.

Peter is based at GMAS control centre in Belle Vue and is responsible for the efficient running of the emergency call system.

GMAS is the second largest ambulance service in the UK (London is the first) and receives around 1,000 calls a day -- 999 calls and "urgent" calls made by doctors.

Thirty five ambulance stations are serviced by 335 paramedics and, according to Peter, GMAS has one of the most successful call rates in the country.

"The ambulance service has a national standard," he says, "which is for 50 per cent of vehicles to be on scene within eight minutes of receiving a call.

"In GMAS we have an internal standard of 95 per cent of vehicles mobile within three minutes."

Peter then took us to the control room which houses an elaborate communications system.

All calls are answered by highly-trained EMDs -- emergency medical dispatchers --and dispatched to the relevant ambulances using the MPDS -- medical priority dispatch system.

This requires the EMD to ask relevant questions when receiving a call to establish whether the injured person is conscious, breathing and able to talk.

As each answer is tapped into the screen, another follow-on question will appear which the EMD asks.

"Now," explains Peter, "the EMD can ascertain what treatment will be required at the scene and therefore notify the crew.

"It also helps them categorise the call -- red for life threatening, amber for serious and green for neither of those."

But the first three questions are always the same -- where are you? What is your telephone number? What is the problem?

While the EMD is talking to the caller, the ambulance will have been dispatched within the first few seconds of the call by the dispatch crew on the other side of the control room.

This information is also transmitted on to a small screen in the front of each ambulance cab in addition to the A to Z map reference of the destination address.

"For example," says Peter, "Once the EMD has the address of the call, they tap into the system and bring up the grid reference. They can then inform the crew that the address is, say, on page 32, grid reference A3.

"If someone is on a stretch of road but they can't tell us where exactly, then we tap in the road and various landmarks appear on screen such as pubs.

"The EMD would then ask the caller if they are near a certain pub."

Meanwhile the dispatch crew are busily looking at the screens to see which ambulance is nearest to the scene.

All vehicles are monitored by satellite and their whereabouts is constantly displayed.

It takes a dispatcher seconds to locate a vehicle and send it to the scene.

Peter says: "The grid reference shows the distance 'as the crow flies', so one vehicle may be seen to be two miles from the scene while another is six.

"But the dispatcher may realise the vehicle closest will have to take a longer route and will take longer, so they'll sent the other."

He adds: "If at any time the system fails then we use the back-up of voice -- the EMD or dispatcher will relay the information to the crew by radio."

Watching the EMD's in action, it quickly became clear they are all highly trained individuals who keep completely calm throughout the calls -- especially as the callers were in an obvious state of panic.

In the two calls we witnessed -- one had a vehicle mobile in 36 seconds, the other in just 26.

Peter told us: "Our aim is to get all the information and get a vehicle on the scene as quickly as possible."

Now it was time to see how the call is received by the ambulance crews and we transferred to Central station to 'shadow' Graham, the paramedic, and Keith, the technician.

On receiving a 999 call Graham and Keith jump into the cab. The black screen at the front holds all the information they need.

One press of a button and Keith tells Graham it's a woman who's repeated vomiting and stomach pains have worried her work colleagues.

Blue lights flashing and siren blaring we race across the city to the lady's place of work.

Because all the information has been supplied by the EMD, the crew know exactly what medical equipment they will need once they arrive at their destination.

Within minutes of arriving, Graham and Keith are out of the cab and up the stairs to their patient.

Meanwhile, back at the control centre, the dispatchers know the vehicle has now arrived at the scene -- Keith tapped the information into his screen as the cab sped across Manchester.

The lady appeared to be in a great deal of pain and was taken to Manchester Royal Infirmary. Keith and Graham's comforting, yet professional technique had ensured their patient got to the hospital quickly.

During the 999 call, the EMD will have requested the patient's doctor, brief medical history and any medication taken to be jotted down for the paramedics.

This is passed on to the hospital staff on arrival.

Once the patient has been admitted, Keith and Graham return to their ambulance and Keith taps details of the incident into the computer.

The dispatch staff back at control acknowledge receipt and the crew are sent to another call.

Back at base, Peter says: "As you can see, the system is extremely efficient, but that's down to the excellent staff -- EMD's, dispatch and, of course the crews.

"Everyone's aim is to react to calls as quickly as possible but we are only human.

"Rarely, and it's very rarely, things may not go exactly right. But we are proud of our service at GMAS -- it's one envied by many other ambulance services."

Converted for the new archive on 14 July 2000. Some images and formatting may have been lost in the conversion.