Volunteer 999 responders part of ambulance service overhaul

There are some things that ambulance call handlers cannot detect over the phone - and that's where Jackie Hatton-Bell comes in. She is one of 130 volunteers in Wales trained to attend the scene of 999 calls to provide "eyes and ears" observations for staff in the control room. Her role is part of a raft of changes being brought in by the Welsh Ambulance Service from Tuesday, including anew "purple" category for calls. The aim is to improve patient outcomes in a country whereless than 5% of people survivehaving an out-of-hospital cardiac or respiratory arrest, compared to 9% in Scotland, 10% in England and as many as 25% in some European countries. Jackie and the other volunteer community welfare responders receive two days of training. They cannot provide treatment, but Jackie's actions have already helped to save lives. On one occasion, the "observations" she was trained to take – blood pressure, oxygen levels or spotting signs of a stroke – determined a patient was actually having a heart attack. "We spoke to the clinical desk and in six minutes the paramedic turned up," Jackie recalled. On the flip side, she said the information she had gathered has also "de-escalated" some calls to more appropriate options in the community. Another change is the creation of a new position in the control room - called "clinical navigators" - who closely monitor the list of those waiting for an ambulance. Head of service, Gill Pleming, explained that these trained paramedics and nurses would screen the calls to decide if some needed "enhanced clinical triage". They may also call patients back to check for symptom changes where appropriate, re-prioritise their place in the queue or, when necessary, deploy community welfare responders like Jackie. "I see it as instead of a patient having to wait a number of hours where it's potentially not such a serious condition, we can go out and be the eyes-on," said Jackie, who volunteers for a minimum of eight hours each month. The information she gathers is then fed back to paramedics and nurses in the control room to make a clinical decision. "That's saving the ambulances going out to absolutely everything," she explained. Covering a large chunk of rural west Wales, Jackie said many in the traditional farming community were "made of tough stuff" which meant they could down-play their symptoms. On the day the BBC spent with Jackie in Pembroke Dock, a call came in at lunchtime for a patient in their mid-50s who had fallen overnight and vomited. "You start thinking there has been a head injury, because of the vomiting," said Jackie, 53. "But when I got to the patient there was a significant injury. It had happened in the night and they rang 999 at midday, so [they] had waited all that time in severe pain." The detail given to call handlers by a relative had not conveyed the full extent of the injuries but Jackie was able to elevate the call, with an ambulance and fire service arriving within an hour to help safely transfer the patient to hospital. "We don't go to the most serious and we won't go to under-18s, but we will take anything in between," she added. It is a far cry from Jackie's previous career in human resources, and more latterly running a restaurant with her husband in Pembrokeshire. Being diagnosed with breast cancer in 2020 changed her outlook and she decided not to return to work. Instead, she answered an advert seeking Welsh Ambulance Service volunteers and expected to be driving patients to and from hospital. "I turned up to the interview and there was a lot of equipment, manikins and defibs and I suddenly realised it wasn't driving patients," she laughed. "I thought 'I'm going to give it a go', and it's the best mistake I've ever made." She said friends and family were surprised by the move, as she had always been quite squeamish. "But you put this uniform on and you don't see that, you just see the patient. It's given me the confidence to go forward to be a first responder, which is what I'm doing next." Over time, it is hoped that these changes will help to improve survival rates for out-of-hospital cardiac and respiratory arrests in Wales. Anthony Crothers, from Cardiff, said he was well aware that he was "one of the lucky ones" after he had a cardiac arrest last October near the café at Three Cliffs Bay, Swansea. Between his friend, the café owner and – by chance – a passing doctor, they were able to use the nearby defibrillator and get his heart beating using CPR. A paramedic was also on the scene within 15 minutes, followed by the Air Ambulance. Anthony woke up two-and-a-half weeks later in the intensive care unit of the University Hospital of Wales in Cardiff. He had always been fit and healthy, but a scare earlier in the year had flagged that he had angina. He also had a familial risk of heart attacks and had made lifestyle changes to improve his health - but the cardiac arrest came as a huge shock. "I was apparently in the right place at the right time, surrounded by all the right people," he said. "If I'd been down on the beach – as I was half an hour before – it might have been a very different outcome." He said he was eternally grateful to his friend Glyn who reacted so quickly, as well as the bystanders walking past who "jumped in and did something". "I've consequently learned that doing something is better than nothing. The training for CPR takes about 15 minutes and I think we should all have some appreciation of what to do." Wales' health secretary, Jeremy Miles, said the changes were intended to "save more lives". "Until now, cardiac arrests have been categorised in the same way as less critical problems like breathing difficulties. This new approach ensures ambulance teams prioritise people with the most urgent needs," he added. Jason Killens, chief executive of the Welsh Ambulance Service, said: "The ambulance service of today provides much more sophisticated care, so shifting the focus to how many people survive a life-or-death emergency because of our interventions, rather than how many minutes it takes us to arrive, is an important step to reflect that."