St John An incident received Notes stating that Ambulance and NZ Ambulance and NZ from NZ Police was patient unresponsive Police communications Police met. 2382SJA2016 coded as not urgent. On was not read by the centre operations arrival 24 minutes later, dispatcher. managers to meet and the patient was found to identify areas of There was a heavy be status one (with improvement and workload in the immediate threat to life). communications centre at the time. St John Incorrect configuration The dispatcher did not Develop checklists to Checklists developed. selected within the select all appropriate ensure dispatchers have 2612SJA2016 computer aided dispatch divisions in CAD system, verified the correct (CAD) system by the resulted in the divisions. dispatcher resulted in a incident not presenting Standard operating delay in dispatching for dispatch. procedure to be updated ambulances to a patient to reflect new in cardiac arrest. requirement for verification of jurisdiction selection as part of the handover procedure. St John Incorrect priority coding The call handler did not Provide one to one Training enacted. of an industrial incident select the appropriate training to call handlers 2701SJA2016 resulted in a delay in determinant descriptor on correctly applying dispatching appropriate for the mechanism of determinant descriptors. care to a patient with injury that was reported. urgent needs. St John Incorrect priority coding The incident was coded Dispatcher to review Dispatcher review of a NZ Police incident as an assault instead of incident. enacted. 2766SJA2016 resulted in a delay in an overdose. Assaults Duty centre manager to Duty centre manager dispatching appropriate are pre-coded green review incident. review enacted. care to a patient with (not urgent) and NZ Police urgent needs. overdoses orange response (urgent but not priorities to have a immediately life clinical review. threatening). Communications centre The incident dispatch operations manager to did not follow standard review process with NZ operating procedure. Police. St John Address for incident Trainee call handler with Provide feedback and Feedback and coaching coded as purple mentor did not verify the coaching to the call enacted. 2783SJA2016 (immediately life address utilising the handler and mentor. Training release issued. threatening) was standard operating Provide training to incorrectly identified in procedure. communications centre the dispatch system, staff with reminder about resulting in delays in use of available arriving on scene with resources. patient who was deceased. End
St John 2382SJA2016 An incident received from NZ Police was coded as not urgent. On arrival 24 minutes later, the patient was found to be status one (with immediate threat to life). Notes stating that patient unresponsive was not read by the dispatcher. There was a heavy workload in the communications centre at the time. Ambulance and NZ Police communications centre operations managers to meet and identify areas of improvement and Ambulance and NZ Police met. St John 2612SJA2016 Incorrect configuration selected within the computer aided dispatch (CAD) system by the dispatcher resulted in a delay in dispatching ambulances to a patient in cardiac arrest. The dispatcher did not select all appropriate divisions in CAD system, resulted in the incident not presenting for dispatch. Develop checklists to ensure dispatchers have verified the correct divisions. Standard operating procedure to be updated to reflect new requirement for verification of jurisdiction selection as part of the handover procedure. Checklists developed. St John 2701SJA2016 Incorrect priority coding of an industrial incident resulted in a delay in dispatching appropriate care to a patient with urgent needs. The call handler did not select the appropriate determinant descriptor for the mechanism of injury that was reported. Provide one to one training to call handlers on correctly applying determinant descriptors. Training enacted. St John 2766SJA2016 Incorrect priority coding of a NZ Police incident resulted in a delay in dispatching appropriate care to a patient with urgent needs. The incident was coded as an assault instead of an overdose. Assaults are pre-coded green (not urgent) and overdoses orange (urgent but not immediately life threatening). The incident dispatch did not follow standard operating procedure. Dispatcher to review incident. Duty centre manager to review incident. NZ Police response priorities to have a clinical review. Communications centre operations manager to review process with NZ Police. Dispatcher review enacted. Duty centre manager review enacted. St John 2783SJA2016 Address for incident coded as purple (immediately life threatening) was incorrectly identified in the dispatch system, resulting in delays in arriving on scene with patient who was deceased. Trainee call handler with mentor did not verify the address utilising the standard operating procedure. Provide feedback and coaching to the call handler and mentor. Provide training to communications centre staff with reminder about use of available resources. Feedback and coaching enacted. Training release issued. End