A good work-life balance, working alongside other experienced clinicians, and caring for patients from Hull to Milton Keynes without even leaving the 999 control room – we spent the day with CAT nurse Cate Barron to find out how her role makes a difference to the lives of people in the East Midlands.
In her career as a nurse, Cate Barron had never considered that there might be the opportunity to work in the ambulance 999 control room and use her skills to help the five million people who call the East Midlands their home.
The 46-year-old Clinical Assessment Team (CAT) nurse from Derby says: “To be honest, I didn’t even know the ambulance service had nurses until my husband – a paramedic – mentioned it.
“This job suits me so well as it gives me a better work-life balance compared to previous roles; I finish my shifts on time, I have a rota so I can plan my life and can commit to picking my children up from their various after-school activities.
“It also really enriches my skills, in terms of listening to patients to really understand what’s going on and working with pathways and patients across the whole of the East Midlands, but also it helps me to see the bigger picture of EMAS and the wider NHS.”
Throughout her career, Cate has worked across a wide range of specialties including end-of-life care, geriatrics and endoscopy, as well as general nursing. She also spent eight years working with NHS Direct before it became NHS111, and more recently supported students with additional needs at Derby University.
In August 2019 she joined EMAS in the CAT team based at the 999 control room in Nuthall, Nottinghamshire, and each day at work she will take on one of two roles – either telephone consultation or navigating.
Cate’s day normally starts at around 4.15am so she has time to shower and have coffee, before getting to work for a 6.30am start. When she arrives at the control room, the first thing she does is set up her desk and check the daily allocation sheet to see if she is working on telephone consultation or navigating.
Cate says: “It can be challenging because the volume of work expands rapidly at different points during the day. For example, over the last couple of hours we’ve gone from 14 calls on the stack to 124 calls.
“It’s also hard to see some of these patients waiting a long time for help and being unable to do anything about it.
“I have to remember to focus on one patient at a time, and to trust whoever is on navigation duty that day to highlight anything that really can’t wait.”
Navigating is where the clinician is responsible for ‘the stack’ – the less urgent patients who are currently waiting for an ambulance but there isn’t one available to send to them yet.
Cate explains: “My job is to go into each call on the stack and organise the order of patients so that out of everyone waiting, the person with the most serious injury or illness receives the next available emergency ambulance.
“When I’m going into the calls, I’m looking for anything in the notes which might mean that the patient actually needs to be made a higher priority, and I have the ability to upgrade a call based on clinical judgement if it’s needed.”
When she is on navigation duty, Cate is in near-constant contact with her dispatch colleagues and managers in her control room, at the 999 control room in Bracebridge Heath in Lincolnshire, and other clinical colleagues who are home-based since the pandemic.
The other part of Cate’s job – telephone consultation – is where the CAT clinicians are calling back patients who have called 999 for medical help, to see if there is a better place for them to receive the medical treatment they need, rather than an emergency ambulance.
Cate explains that as a result, the CAT deflects a huge number of calls on a daily basis, so that her ambulance crew colleagues on the road can focus on the serious emergencies.
Cate says: “Most of the patients we are calling back are patients who have been categorised as Category 3 – meaning they have an urgent medical problem but it’s not a life-threatening emergency.
“These are the people we are mostly likely going to be able to find a better treatment pathway for, such as patients who have had a non-injury fall, or are experiencing mental health challenges, or calls which have come through from NHS111.
“I love that I’m in a position where I can fix things for that patient. I can help them find a service which will probably get to them more quickly, such as requesting a district nurse for a blocked catheter or the falls teams, or a service which can provide specialist help such as linking in crisis teams and helplines for mental health patients.
“When I’m calling a patient back, I’m looking for red flags such as sepsis, safeguarding concerns, trends in previous calls to the same address, and also to ask those additional questions to make sure the patient’s medical issue isn’t more serious than it initially sounds.
“For example, if it’s a patient who has had a fall, I need to know if they can remember how it’s happened, whether they have chest pains too, if there’s any blood, or if they’ve bumped their head and are on blood thinners.”
In addition, as part of this role Cate sometimes needs to conduct community referrals to the police or to call for care, and she often speaks to GPs to advocate for her older patients to help them.
Technology has progressed even in the time that Cate has been working at EMAS, and she says that software such as video-calling is making it easier to provide care to patients wherever they are.
Cate says: “It allows us to watch a child’s breathing or to check out their bumped head, as well as to view wounds and injuries so that we have a better idea of how serious it is.
“People call 999 because they or their loved one is in pain and they are panicked and frightened. I’m in a position where I can explain to them what I’m seeing, I can reassure them, and help them to access the treatment they need.”
However, Cate is clear that the 999 service should be reserved for genuine emergencies and that often she speaks to patients who could do more to help themselves before ringing for an ambulance.
She says: “Have a think before you dial 999 – ‘have I done absolutely everything I can for myself first’?
“This includes checking on NHS111 Online for tips on managing your own symptoms. Please also use your own GP sensibly and don’t leave illnesses or injuries to get really bad before you contact your GP surgery.
“We are not a ‘checking over’ service and we cannot prescribe medication or diagnose illnesses, but if you are in life-threatening danger we will get you to hospital as quickly and as safely as possible.”
Apply to join our 999 control room Clinical Hub today via our Vacancies page.