Ambulances, helicopters and medical advice: Behind the scenes at one of Ireland's 999 call centres

CHANCES ARE THAT if you’ve dialled 999 or 112, it has been a worrying time in your life.

But for over 230 staff at the National Ambulance Service, your call was just one of around 1,000 emergencies that are processed at their command and control centres every day.

The National Emergency Operations Centre (NEOC), where calls are taken, is split across two sites: one is based in Tallaght in Dublin; and a smaller site is based in Ballyshannon in Co Donegal.

In Tallaght, Martha Loorem can see the Dublin Mountains from her desk as she answers the phone to people in need from a centre that’s five storeys up.

“It can be very varied; you know it pretty much covers everything,” she tells The Journal when asked to describe her work.

“It can range from somebody with a cough or a cold [who doesn’t] know where to go for help or [who doesn't] have a GP, right up to… very tragic, very traumatic cases, and everything in between really.”

Although no two emergencies are the same, Loorem says that there are some common features in the calls – and common types of caller – that they get.

Every call-taker follows a script and inputs the caller’s answers about the situation they’re ringing about in order to determine the seriousness of the incident.

Call-takers work 12-hour shifts, some during the day and some at night, but everyone alternates on a shift pattern.

“I like the mix, so I wouldn’t want to do either full-time; I actually like switching between the two,” Loorem says.

“I think it just suits me, I don’t really think I have a body clock any more. I suppose in terms of why I chose the job, I wanted to do something that I thought I would find rewarding.

“There are calls where people are very, very sick, and they’re genuinely panicked, and they really don’t know what to do or where they’ve just seen something tragic; they need that reassurance on the other end of the phone as well, not only that the help is coming, but [that they can be told] what to do.”

“When you have those calls where you know you made a difference, that is quite rewarding, and it is quite satisfying to bring somebody from being panicked to quite panicked, and then the ambulance gets there, and paramedics take over.”

Martha Loorem, an Emergency call-taker with the National Ambulance Service Alex Rowley Alex Rowley

‘Pieces to a puzzle’

As The Journal walks through the control room, it feels surprisingly calm given the number of people in it and the work they’re doing.

However, Duty Control Supervisor John Larkin assures us that things can get hectic during peak hours.

“Everybody is trained as an emergency call taker,” he explains.

“Technically, everyone is classed as an emergency medical controller… Generally, the journey is call taking, and then some will decide they want to take on dispatch.”

There are rows of desks on either side of the room, with supervisors in a back corner who oversee everything.

Screens hang from the ceiling which show how many call-takers are active across both call centres in Dublin and Donegal, as well as how many calls are coming in and the number of response vehicles that are in active use at a given time.

At a dispatcher’s desk, Amy Curtis sends crews in the southwest of the country out to calls.

She joined the NEOC after completing a PLC in the Pre-Paramedic Fire and Ambulance course at Blackrock Further Education Institute.

Curtis spent two years as a call-taker before moving into her new role as an Emergency Medical Dispatcher just over six months ago.

In her job as a dispatcher, she collates all the information received by call-takers and assigns an appropriate response vehicle and crew to the emergency.

Dispatchers have to take into account a myriad of factors, including the severity of an emergency, vehicle availability, and the safety of the scene.

“Dispatching is a lot more fast-paced than call-taking,” Curtis says.

“I would call dispatching like putting pieces to a puzzle; you’re trying to figure things out for each case. Every crew member is your responsibility from the start of the shift until the end.

“You need to know where all your crew members are and who is going where, because sometimes when the radio is going, and you are on your own at the desk, there could be six or seven radio transmissions, and you need to know what each crew is doing to be able to prioritise which crew you answer first.”

Trainee dispatchers are mentored by a senior member of staff for 13 shifts before becoming fully qualified.

This may seem like a relatively short schooling; however, Duty Control Supervisor John Larkin points out that although it is a particularly difficult job, NEOC staff are constantly receiving further education through the HSE’s learning and development programmes.

“It is an extremely challenging environment for the dispatchers because [they are dealing with] multiple calls, and are getting a lot of information thrown at them from the radio and the people around the desk.

“It’s about assimilating that information and putting it in a logical order in terms of its priority, and figuring out what each piece of information does to your next decision.”

Larkin explains that there are various layers to learning how to dispatch, but that the ultimate outcome is patient care.

All staff are licensed by the academy, and there is mandatory continuous learning associated with re-certification every two years.

Helicopter responses

In yet another corner of the room, there is a set-up that looks like a mini situation room: it contains a whiteboard with codes, call signs, and maps with a row of desks in front.

This is where the aero-medical dispatch desk is located, and the team that sit there are responsible for coordinating helicopter responses to medical emergencies.

In Ireland, there are two helicopters available to the National Ambulance Service.

The Air Corps operates one air ambulance from the Custume Barracks in Athlone, which is staffed by military pilots, an Air Corps Emergency Medical Technician, and an advanced paramedic from the NAS.

In Cork, the ambulance service contracts another, smaller helicopter based in Rathcoole.

In addition, the Coast Guard has four rescue helicopters based in Shannon, Dublin, Waterford, and Sligo, which are on hand to assist the ambulance service if required.

The Coast Guard can organise medical evacuations for critically ill patients to other countries, such as England.

It’s also responsible for pre-planning and dispatching the Critical Care Retrieval Service (CCRS) – like an intensive care unit on wheels, enabling critically ill patients to be transported to a major hospital alongside a team of specialist doctors, nurses, and pre-hospital practitioners.

The National Emergency Operations Centre in Tallaght Alex Rowley Alex Rowley

Daragh Lettice is one of the members of that team, and explains how he co-ordinates air ambulances to 999 incidents anywhere in Ireland, liaises with the Irish Coast Guard for search and rescue missions, and works with emergency teams for mountain rescues.

“We also look after repatriations with a wider HSE group, the Treatment Abroad service, [looking after] any injured parties on holidays or whatever the case may be, technically, for anywhere in the world,” he says.

“The flip side of that is that if we have a patient going out of the country, we would arrange all the logistics again.

That may involve ambulance transport or an air ambulance with the Irish Air Corps, or from a list of private suppliers that are contracted to the HSE.

The team also carries out vital work helping children who are on organ transplant lists, called the ‘Priority 1′ service.

In those cases, the team’s job is to keep children’s details – their addresses, next of kin, and passports – on file and up to date.

If a call comes in for transport, there is a four-hour window from the time of the call to get a child to the hospital, whether that’s in the UK or elsewhere.

“Our goal is always to get advanced life support to the scene of an incident that may warrant helicopter transfer.” Lettice explains.

“We see it as a completed mission if we deploy the advanced paramedic to the scene, regardless of whether the patient flies to the hospital or goes by road”.

Working culture

But what is the work like day-to-day?

Duty Control Supervisor John Larkin puts considerable emphasis on the working environment of the control room and the overall culture within NEOC.

The aim is to ensure that each staff member can operate at the highest level every day.

The control room is full of people with experience working in clinical settings and in different parts of the HSE, with whom younger colleagues can liaise if they’re faced with a problem.

There are also strong support structures in place for anyone who wishes to avail of them, should they feel overwhelmed by a particular emergency.

“What we are really after here culturally is an environment where people can perform to their maximum ability but also an environment that encourages escalation and cooperation, so that nobody is sitting at their desks wondering, ‘What will I do here?’,” Larkin says.

“We are very open about it: if you have an issue, put your hand up, and we will fix it together.

“If that is on the aeromedical desk, dispatch desk, or call-taking desk, it doesn’t matter.

“If we know about it, we can put the remediation in, and that is the culture that we absolutely promote.”

Sometimes, those tasked with responding to 999 emergency calls need help too.