Not an Emergency — or the "999 doesn't think I'm worth it" effect
I’ve written before about public misconceptions when calling 999. I had planned to touch on this there, but there’s enough nuance and detail that it deserves its own post.
When you call an ambulance, your call is triaged based on your current condition. If it’s not critical, an ambulance may not be sent — instead, you’ll be directed to contact 111 for further assessment or advice, or to talk to your GP or make your own way to hospital. This can sometimes come across as though the operators at 999, or the ambulance service in general, doesn’t care about your problem; the reality is exactly the opposite.
Critical, Emergency, Urgent
These are terms used fairly frequently in the ambulance service that, on the surface, appear to mean the same or similar thing. They’re actually well-defined levels of urgency, depending on how life-threatening the call is.
- Critical (Category 1) calls are those where the patient’s life is in immediate danger — the patient may be not breathing, or choking, or drowning.
- Emergency (mostly Category 2) calls still involve a risk to the patient’s life in the near future. This could be something like a heart attack or a stroke.
- Urgent (usually Category 3 or 4) calls are those needing usually same-day treatment, but where there is no immediate threat to life. Most broken bones and dislocations go here, along with mild breathing difficulties.
There are also Non-Emergency calls, which are those where the patient could safely make their own way to a hospital, just needs some advice, or would be better served by accessing care elsewhere.
As a service, obviously we respond to critical and emergency calls as soon as we possibly can. Critical calls will usually need more than one crew dispatched to deal with them. This leaves urgent calls in a bit of an odd position — they’re not not our responsibility, but clearly we have to respond to the more serious calls first. What happens when all our crews are already engaged on jobs? Beyond that, there’s non-emergency — sure, if we had the crews, we’d send ambulances to these calls too, but the reality is that even if we tried to send to these calls, the patients would be waiting significant lengths of time for anyone to get there. Particularly on the lower-category calls, it’s not rare to see an ambulance assigned and en-route, but then redirected halfway there to a more serious call nearby.
For critical and emergency situations, the right option is clearly to call an ambulance. They’ll get to you faster than you can get to hospital, and they can start life-saving care on board en route. For calls for urgent care, it’s a bit more fuzzy: yes, we’ll get to you, but you may be waiting a little while. How long, exactly, depends on how busy we are — a month ago, we had Category 3 calls waiting for 12 hours and more, although at the moment we’re mostly getting to them inside an hour.
This is where we rely on the public making a judgement for themselves: can the patient get to hospital (with assistance, if necessary)? Is there someone who could take them, or could they get in a taxi? Or would it not be safe to move them, or there’s no other way of getting there, or do they need treatment where they are?
Category 5 is where the misunderstandings and miscommunications start to crop up. Lots of aches, pains, and chronic conditions end up falling into this category — back pain, abdominal pain, minor bleeding and burns, and lots of long-term medical conditions. Unless there are other more concerning symptoms present to make the call a higher priority, these callers are directed to 111, to a GP, or to make their own way to hospital.
These situations aren’t life-threatening, but they can be debilitating, painful, and dehumanising, and having a 999 operator tell you that you’re not going to get an ambulance can add to the frustration and upset. The common refrain to being referred to 111 is “but they’re in agony here!” Trust me, I know. I don’t want the patient to be in agony, or unable to move, but my hands are tied.
This is twofold: firstly, I don’t have a choice. As I’ve mentioned before, I’m following a protocol, and that protocol dictates the priority assigned to the call; I don’t get to choose who gets an ambulance. Secondly and more importantly, we as a service know that if we tried to send you an ambulance, you’d be waiting for hours and hours in the same condition. We’re sending you to 111 or to hospital not to say “this isn’t a problem”, but because you’ll get help much more quickly there.
When you call 111, you’re connected to a health advisor. This operator can assess your condition in much more detail than I can at 999. They can access your medical records. They can connect you to healthcare professionals — doctors, nurses, mental health professionals, specialists. They can arrange emergency appointments for you. And, in the worst case, if their detailed assessment reveals something that does mean an ambulance should be sent as a precaution, they can arrange that for you automatically, without having to send you back to 999.
We’re always working on ways to improve the communication and experience around that. If you do call 999 and get referred to 111, remember: we’re not saying this isn’t a problem, we’re just trying to get you help in the quickest way possible.