On call for emergency, voices that tell the story from health care's front line

"AMBULANCE Service. What's the address of the emergency?"... "Is he breathing?"... "Is any part of the baby visible?"... "No, my asking you these questions is not delaying help getting to you"... "Place one hand on her forehead and the other behind her neck and tilt her head back..." "I'm going to tell you how to do chest compressions"... "I need you to stay calm..."

These are all snatches of real-life conversations heard during a normal afternoon in an ambulance 999 communications centre. This one happens to be in Wakefield, one of two (the other's in York) that receive calls from across Yorkshire and despatch 208 rapid response vehicles, 294 ambulances and other medical emergency help.

About 300 staff work in various roles within the two communications centres. Last year they handled 671,100 emergency and urgent calls – an average of 1,800 calls per day or one every minute. The room never sleeps and the atmosphere is one of purposefulness and efficiency. Uniformed staff gaze intently at screens, listening closely, reading carefully-constructed scripts, asking questions, inputing information, and all the while maintaining a soothing, reassuring tone.

The open plan layout means all sorts of snippets drift towards you, with staff at this end – they're called emergency medical dispatchers (EMDs) – sharing the same calm, even delivery as they quickly work their way through the questions, each one determined by an algorhythm system based on the answer to the last, coaxing information out of callers who may be sick, frightened patients or shocked, hysterical loved ones calling on their behalf.

The EMD's job is first and foremost to confirm the location of the emergency, although a superfast BT system clicks in as soon as the call is connected and provides an instant location for landlines. This information then goes to ambulance dispatchers at another desk, and the nearest available ambulance is sent off in the direction of the call.

This happens while the EMD is still getting details of the emergency. Once he or she has established the basic nature of the problem – be it an elderly person having had a fall, a road crash or a child choking – the computer system allocates a category A, B or C to the call. When a call has been categorised, the ambulance that's already on its way to that call may be diverted to a case that's judged to be more urgent.

Category A are immediately life-threatening and include heart attacks, asthma attacks, anaphylactic shock, cardiac arrest, breech births and suspected meningitis – any call where a patient is having severe difficulty breathing, has chest pain or is losing consciousness. "Cat A" also includes serious road traffic accidents, shootings, stabbings. These cases may get both a Rapid Response Vehicle (cars that zip at high speed through the traffic) and an ambulance and the target for response is within eight minutes of the 999 call being connected to the EMD.

Category B are serious but not life-threatening, and include minor strokes, uncontrollable bleeding, diabetic hypos and people threatening suicide. The aim is to get an ambulance to these patients within 19 minutes.

Category C calls are defined as neither serious nor life-threatening, for example sprained ankles, flu, minor cuts, and diarrhoea and vomiting, plus doctors' requests for non-urgent patients who need admission to hospital and can't get there without an ambulance.

Most staff in this room work 37 and a half hours a week. On average calls are answered within five seconds, and each EMD of the 15-20 on a shift will answer between 60 and 70 calls, with peak periods between 8am and 10am, lunchtime and 4pm-6pm, plus spikes in the very early hours of Saturday and Sunday mornings.

Sam Taylor became an EMD three years ago, having worked as a carer and care supervisor in services for the elderly. She didn't really enjoy the administrative side of her last job.

"Maybe I'm just very soft, but I like to really help people. When I looked at this job, which needs listening skills, empathy, the ability to stay calm and cool and get information out of people, it sounded like me."

Becoming an EMD involves 10 weeks' training, becoming adept at using an international system that requires users to follow a strict protocol for each of many kinds of emergency without deviating from the prescribed lines of questioning. After initial training, new EMDs take real calls under the supervision of mentors for a further three months before being signed off as qualified.

"Our priority is to get an address," says Sam. "You often have to calm the caller down, using repetitive techniques. It's also useful to get them to do something for the patient, if only getting their medication together for when the ambulance team arrives.

"Even if someone calls and says 'I think she's dying' I never use the word myself, but will ask them why they think that. Calls come in where you can make a huge difference, giving instructions to someone on how to give CPR or using techniques to manage their airway before the ambulance arrives.

"I love my job, and even look forward to weekend night shifts. We work brilliantly as a team, and because colleagues can hear if you are taking one of those really difficult calls, they're there to help if you need it. You don't tend to get that much feedback on the outcome of calls you've handled, but then you don't necessarily want to know. We are only human and can get upset."

Not many gifts or thank-you calls make their way to the communications centre, although Sam has has had an odd bunch of flowers from a grateful family.

YAS was told last month by the watchdog the Quality Care Commission to improve its ambulance response times as delays meant "patients may not be receiving treatment promptly".

Looking, albeit briefly, at how the system works, it's difficult to see how calls could be handled more efficiently without staff losing any touch of humanity and intuitive response, and possibly missing out on detail that equips ambulance staff to deal with patients more speedily on arrival at a scene.

"When we merged the three ambulance services in 2006, there were difficulties in standardising the service," says Steve Pitchfork, the clinical service delivery manager. "More recently we've restructured, put in new systems, moved into a new communications centre and implemented new rotas for staff. We're now hitting the nationally-set target of responding to 75 per cent of Category A calls within eight minutes."

Many calls received by YAS and all ambulance services are not emergencies at all, although the caller may well be upset and agitated and feel their need is urgent. Among the staff in the communications centre are district nurses, specialists dealing with cases of environmental contamination, emergency care practitioners, a desk that looks after falls and diabetic referrals and clinical advisers, who call patients back and triage their condition, offering other pathways to medical care if necessary. They often deal with the "frequent callers" who may have long-term conditions and also need directing to different kinds of care.

YAS is justifiably sensitive about patient confidentiality, and not keen for a visiting journalist to hear too much of any one "live" scenario. But Sam Taylor and practice developer (staff trainer) Ben Sargent are only too keen to list a few of the past calls that fall clearly into the "time-wasting" category – and take up time that should be spent on people in dire need.

They tell tales of lost car keys, a leg bruised by banging into a desk, a man wanting to know where to buy cigarettes on a bank holiday, a caller who panicked because he'd fused the lights at home and a woman who'd swallowed mouthwash.

"I had a woman caller on New Year's Eve who was out in the snow without her shoes," says Sam. "I made sure she was all right but she didn't get an ambulance. If that was a normal night we'd have had to send an ambulance because she was in a public place. On the other hand one woman called to say her husband had 'a cut at the end of his thumb'. On the face of it this was a non-urgent call, but as the conversation went on it turned out that he was actually unconscious and had cut off the end of the thumb with a circular saw."

There are of course the tragic stories, says Ben: "Once an elderly woman rang on Boxing Day to say her husband had died the day before but she hadn't called because she thought we'd be on holiday. And another older person called at six or seven in the morning, saying they've been on the floor for hours but hadn't wanted to bother us in the night."

Each year, the staff at the communications centre are involved in their fair share of helping to deliver babies who arrive before the mother can get to hospital or an ambulance arrives.

"It's usually the friend or partner who rings and you give them instructions," says Sam. "It's such a relief when they've followed what you've told them to do and you hear down the phone as the baby starts to cry. I cried the first time. You also feel satisfied when you've instructed someone in how to give emergency first aid like CPR and the patient is still alive when the ambulance arrives. You go home feeling you've made a difference."