London Ambulance Service, Clinical Hub (LAS CHUB): C2 Validation Pilot

OVERVIEW

I re-joined London Ambulance Service (LAS) in November 2022 to work in their Clinical Hub (CHUB), which is part of their control room known as the Emergency Operations Centre (EOC). As a Clinical Advisor Paramedic I performed telephone triage and clinical assessments of 999 and 111 calls assorted by Emergency Call Handlers to help ensure patients received the most appropriate care.

UK ambulance services use a 4 tier system to prioritise patient care according to how unwell they are (categories 1-4, see image below). My focus was on Category 2 (C2) Validation, which involved performing enhanced clinical assessments of C2 calls including potential strokes, heart attacks, high acuity falls, major burns and haemorrhages, breathing difficulties and sepsis.

My role was temporary (finished at the end of March 2023) as I was participating in an NHS England pilot trial of Category 2 Validation. This was developed in response to surges in demand and delays in attending C2 calls experienced by UK ambulance services since Summer 2022. Validation involved providing tailored on-scene management advice + instructions, referring patients to more appropriate care pathways, and escalating/de-escalating the category + severity of call according to structured clinical assessment + judgement.

Media Links

The C2 Validation Pilot received a lot of mainstream media attention during February 2023:

BBC News (2023) Some callers to be told to go elsewhere, by Nick Triggle https://www.bbc.co.uk/news/health-64653483

Independent (2023) Some patients who call 999 to be redirected to GP or treatment centre, by Jane Kirby https://www.independent.co.uk/news/uk/nhs-london-ambulance-service-west-midlands-ambulance-service-house-of-commons-nhs-providers-b2283446.html

Evening Standard (2023) Some patients who call 999 to be redirected to GP or treatment centre, by Jane Kirby https://www.standard.co.uk/news/health/nhs-london-ambulance-service-west-midlands-ambulance-service-house-of-commons-nhs-providers-b1060764.html

ACHIEVEMENTS

C2 Validation Pilot

Outcome

The pilot was successful as from April 2023 C2 Validation is due to be adopted by all ambulance services across England! So I can affirmingly say I contributed to the success of the pilot, which was undertaken initially by LAS and West Midlands Ambulance Service (WMAS).

Personal Reflections

The positive impact of this initiative upon ambulance operations was immediately apparent throughout my involvement with the pilot. Getting people to make their own way to appropriate definitive care made ambulances available quicker for those who required them, or having professional clinical input enabled us to further prioritise resources for patients who were acutely unwell whilst empowering people to manage things more effectively on scene.

Yet the ongoing wider crises with primary and social care, hospital capacities, and cost of living was prevalent throughout the pilot. A significant load of our work continuously came from people who were awaiting definitive treatment, unable to access their GP, or not living well due to wider socio-economic factors like poor housing. This helps explain why there has been a surge in demand with C2 calls.

Addressing these specific shortfalls and challenges with failing healthcare + social systems, and macroeconomics (i.e. national policy), would arguably make a greater difference upon operational demands, particularly in the long-term, and result in better patient outcomes (i.e. more effective for people’s needs).

Individual

I felt grateful receiving recognition for my work throughout my time with LAS. Although the most important thing for me was to support + empower people, to make a difference + contribute so they can deal with their situation better, it is nice to be valued + appreciated:

January 2023 – patient feedback via ‘Thanking our staff and volunteers’ initiative

A patient wrote to LAS detailing how ‘grateful’ they were that I ‘called to keep checking on my condition while we waited for the ambulance’. I was commended for being ‘very calm also and very kind and understanding on the phone’.

February 2023 – Excellence Report

I received the following report from a Clinical Team Navigator (CTN) [can be regarded as duty managers or supervisors) for my performance on a call when I found a patient to be in cardiac arrest:

‘Upgraded a call in a very timely manner, patient was in cardiac arrest. Wasim continued to engage with the person on scene and gave clear CPR instructions and support until the ambulance crew arrived on scene. He was very calm and collected and kept the person engaged at all times with the resuscitation attempt. Well done.’

March 2023 – Safeguarding Award

A Safeguarding Lead within LAS awarded me with a Safeguarding certificate and badge for going above + beyond during a call with a young person who had experienced sexual abuse and had a subsequent concealed pregnancy.

I was commended for using my professional curiosity and adopting a ‘think family’ approach throughout my interaction with the patient. This included showing empathy, completing the appropriate safeguarding referral, advising the Dispatcher to alert the attending crew to prepare them for the situation, and completing a further referral to enable the patient to have further practical + emotional support via a SARC (Sexual Assault Referral Centre). I did all this in collaboration with the patient, empowering them to choose what care + support they were willing to access whilst receiving their permission to complete referrals.

CHALLENGING + REWARDING

Part of the reason why I’m taking time to reflect upon + appreciate this experience is because it was the best role I’ve had as a Paramedic so far. Yes I encountered harrowing situations like those discussed that did upset me, but it was rewarding for the following reasons:

OPPORTUNITY – I will always feel grateful + privileged to be in a position to help people in their time of need, and was able to do this frequently in myriad ways.

AUTONOMY – I was entrusted to make big decisions regarding patient care and the management of resources independently and with support, and to approach this in my own manner, i.e. adopting my own character, style + personality.

DIVERSITY – it was enriching to work with such a diverse population of identities + cultures, encountering different ways of living and doing things, and having to translate a plethora of languages!

LOCATION – this diversity owed a lot to working in London of course, and how lucky was I to be working at such a beautiful spot with brilliant facilities! Plus the calls I reviewed came from such an array of locations, indoors + outdoors, anything + everything you can imagine, pan-London!

CLINICAL EXPOSURE – averaging 30-40 calls a shift I encountered a very wide range of clinical presentations + scenarios that exercised and enhanced my clinical + non-clinical knowledge + skills superbly.

TELEMEDICINE – it is difficult to ascertain what is happening over the phone and to come up with a plan with time and other logistical constraints, but it’s something I developed effectively with practice.

TEAM – I can’t emphasise enough how AMAZING the people I worked with were! It was hugely stimulating to work with a great group of people who were often encouraging, understanding, supportive, knowledgeable and brimming with experience + kindness. My respect, admiration, love + appreciation of them is huge, and I’m glad I was able to articulate all this along with my gratitude to many of them when leaving.

OPERTIONAL OVERSIGHT – it was fascinatingly insightful to have an overarching picture of operations away from the frontline, and to appreciate the challenges staff have in triaging calls and allocating resources.

ADVICE + REASSURANCE – I was able to empower + educate many people, patients + their families/friends/caregivers with not only access to care, but knowledge, information + advice that they could take away when moving forward beyond our interaction.

WHAT’S NEXT

When the opportunity arose to get involved in this pilot, I had little expectation. I was hungry to try something new + different, and to work hard + perform well with the role I was given. Never did I imagine I would come away with so many memorable achievements + experiences in such a short time.

If given the chance to return to the CHUB at LAS, I would strongly consider it after the experience I had. I feel there’s more I could have developed + experienced and would like to have remained. I felt very sad leaving as it brought a great deal of positive energy into my life.

Part of the reason why is because of how enriching the environment + setting was, and the people I worked with, which is a huge contrast to my many frontline ambulance service experiences (which have largely been toxic for countless reasons).

I love being a Paramedic, a Healthcare Professional, and will forever keep my knowledge + skills active and entertain opportunities to develop this further. So I’m always open to exploring any new roles and projects.

In the meantime, I will miss watching the sunrise from CHUB. Yet what kept me reassured during my last days was the belief that better rises + settings of the sun are coming my way now I will be giving greater impetus to the outdoors in the coming months. I will take all that I achieved + experienced here forward with me, and who knows what opportunities I will encounter next to combine my clinical + outdoor skillsets and personal qualities!

Anything is possible when you’re hungry + ready to give your whole self to new people, places + opportunities.