(photo courtesy of the Christchurch Star and Canterbury Museum)
AMBULANCE TECHNOLOGY CHANGES
Ambulance Communications Centres have come a long way since the days when calls for emergency ambulances were handled by individual ambulance stations or ambulance officers and by hospital operators. The calls were all handled manually, details were taken with pen and paper, and the volunteers or operators taking the calls would find an ambulance crew to respond. The people taking the calls and dispatching the ambulances often worked from home.
There were 170 ambulance answering points nationally by 1970, each taking local 111 calls. Regional communications centres developed around the 1980s as the benefits of greater co-ordination were identified and implemented. In the main, the development of regional centres was technology-driven, by the rationalisation of telephone exchanges (i.e. when Telecom’s predecessor NZ Post and Telegraph moved from manual to automated telephone exchanges).
In the year 2000, St John began a project to consolidate the six St John Regional Communications Centres (in Auckland, Hamilton, Napier, Palmerston North, Christchurch and Dunedin). The project became a nationwide project when Wellington Free Ambulance, and the Taranaki and Wairarapa District Health Board Communications Centres joined the project.
The nine Centres operating at the time had varying levels of capability, out-dated technology, different processes and no comprehensive back-up systems. They were replaced by the St John-led project with three modern, substantially upgraded, high-performing centres of excellence. The three upgraded centres became fully operational from early 2007.
The three upgraded Centres, in Auckland, Wellington and Christchurch, now operate as one virtual Ambulance Communications Centre. For the first time ever, the Ambulance Communications Centres all operate with standardised procedures and equipment nationwide. All processes, systems and new technology have been designed to meet international best practice.
This major project would not have been possible without the collaboration of the whole Ambulance Sector, significant investment by St John and Wellington Free Ambulance (St John’s joint venture partner in the Wellington Centre), and the support of major funders of Ambulance services – the Ministry of Health and ACC.
The overall objective of this project is to provide New Zealanders with an efficient and effective emergency ambulance call handling and dispatching service, coordinating clinically effective and appropriate responses to all patient emergencies. The benefits to patients from fast and appropriate emergency responses are well documented.
Additional new technologies have been introduced into the Centres’ environment, all linked together and operating within a disaster resilient network. These technologies include:
- Advanced systems for prioritising patient needs
- Caller Location Identification to confirm callers’ address details
- High-technology equipment installed in the approx 600 ambulances nationwide to show the real-time location of every ambulance and improve communication to and from the Centres
- Extensive on-screen mapping giving dispatchers more geographical information than ever before.
The project is already bringing benefits that will continue to flow. For the first time ever, the Ambulance Communications Centres are capturing national data which will enable more strategic, long-term decision-making about ambulance services. The benefits for patients, ambulance officers, ambulance service providers and funders will ultimately include better coordination of ambulance responses, faster response times, and improved outcomes for patients.
New technology brings brighter Ambulance Communications future
A closer look at the technology introduced into the Communications Centres under the Ambulance Communications Project:
Communications Centre linkages: The three new Ambulance Communications Centres are all linked for the first time, with inter-connected telephone, paging, radio and dispatching systems nationwide. Full back-up arrangements mean the Communications Centres can support each other during times of unprecedented demand or a Civil Defence Emergency.
Advanced electronic mapping systems: The Ambulance Communciations Centres all use the same advanced electronic mapping systems, providing extensive data throughout New Zealand.
The mapping data is provided by Land Information NZ (LINZ), which is responsible for providing New Zealand's authoritative land and seabed information. LINZ is the primary collection agency for core data and is a government department responsible to the Minister for Land Information.
The maps used in the Ambulance Communications Centres are digital maps provided by Terralink. This same digital data is also provided to Police and Fire. Terralink not only takes their data feed from LINZ but also relies on data provided by Territorial Local Authorities (TLAs) and updates from Ambulance, Police and Fire. These agencies all undertake to share the information they have on the changes that are taking place all the time, new suburbs, new roads and so on. Terralink maintains this comprehensive and accurate physical land database of New Zealand.
The Terralink maps are upgraded monthly to reflect changes to all road data. Other data such as parks, rivers etc is updated annually. This can mean that the Ambulance Communications Centres could have information that is not yet available in the printed maps available through hard copy providers.
Automatic Vehicle Locators: GPS signals are sent from each ambulance to the electronic mapping system in the Ambulance Communications Centres. Communications Centre staff can now see the status and location of every ambulance in New Zealand at any given time, its availability for dispatch and proximity to emergencies. Dispatchers can also visually track the movement of road and air ambulances on-screen. This ensures the dispatch of the nearest and most appropriate resources to emergencies, and is also used to guide ambulance crews into difficult locations.
Advanced Medical Priority Dispatching System (AMPDS): The Advanced Medical Priority Dispatching System is a world-class system designed to ensure that each 111 caller requesting an ambulance receives a professional and complete service, resulting in the most appropriate response being dispatched. The system is used internationally by 2,300 emergency services and is the most advanced medically managed dispatch system available today for Ambulance services.
The system assists our Communications Centre staff in determining the seriousness of patients’ conditions and scene safety. A specialised call taking system, known as ProQA, assists Communications Centre staff in triaging emergency ambulance calls and ensures that the appropriate clinical response and speed of response is dispatched. Callers are asked a series of specialised questions to determine the seriousness of the patient’s condition and enable ambulances to be dispatched first to the patients most in need of urgent assistance. This system recognises that the number of ambulances is finite, therefore the dispatch of ambulances takes place on a priority basis – i.e. ambulances are dispatched to the more seriously injured or unwell people first. The system also determines the levels of clinical capability required for dispatch to each patient.
The system is designed to deliver safe and effective patient care based on the knowledge of the caller, who may be the patient or the person calling on behalf of the patient. The system also ensures ambulance staff have full and detailed information about the patient, the patient’s condition and the safety of the scene before arriving.
The system is used throughout the world, including in the United Kingdom, the United States and Europe. Its use is overseen in New Zealand by a Clinical Advisory Group of Medical Directors. A regular audit is undertaken on call samples from the whole population, with any required updates implemented nationwide.
Caller Location ID: All Ambulance Communications Centres have Caller Location Identification systems. This technology electronically confirms the location of 111 calls made from a land-line to 111 (using the Telecom and TelstraClear white pages data), giving additional assurances that ambulances are being dispatched to the correct location. The call taker will still need to verify with the caller whether the address they are calling from is the address of the emergency. Joint Emergency Services are working to obtain Caller Location ID from all cellular providers as soon as practicable.
Funding
The consolidated capital cost of the project to consolidate the Ambulance Communications Centres was $16 million, funded by St John ($13.5 million) and Wellington Free Ambulance ($2.5 million). St John Area Committees have contributed substantially to funding our significant investment.
The operational costs average $20 million a year to manage the 1.1 million emergency and non-emergency calls, and rising, each year. These costs, including provision for regular refreshes of new technology, are funded annually by the Ministry of Health and ACC, and by a St John and Wellington Free Ambulance contribution from reserves of $2 million.
