Not Every Alarm Needs An Ambulance

The last article in this series ended inside the Alarm Receiving Centre, with a call answered, a person spoken to and a situation assessed against a care plan that the operator actually had in front of them. This one is about what happens in the minutes that follow, because choosing the response is where a technology enabled care service either proves its worth or quietly squanders it. The task sounds simple enough, send help. The discipline lies in sending the right help, and the right help is very rarely the most drastic.

The instinct to reach for the blue lights

There is a deeply human instinct at work here, and it deserves to be named rather than mocked. When someone vulnerable is in difficulty and you are the person holding the decision, escalating hard feels safe. Nobody was ever hauled into a review meeting for calling an ambulance, and so services without a better plan default to 999, every time, for everything.

The trouble is that as a default it fails everyone it touches. It fails the person, because a night on a trolley in a busy emergency department is a miserable outcome for somebody who needed a hand up off the carpet and a cup of tea. It fails the wider system, because an ambulance dispatched to a non-injury fall is an ambulance unavailable to the cardiac arrest three streets away. And it fails the programme itself, because the savings that justified the investment at step one evaporate the moment every alert becomes a blue-light event. Proportionate response is sometimes described as a cost-cutting measure, which rather misses the point. It is better care that happens to cost less, and that combination is not as common as it should be.

Five rungs, lightest first

The escalation ladder in a well-designed service runs from lightest to heaviest, and the first rung is the call itself. A surprising share of alerts resolve right there, in conversation, because the pendant was pressed in a moment of fright, or someone woke confused at three in the morning and simply needed a calm voice to talk them back to bed. Reassurance is a genuine clinical outcome, not a brush-off, and a good operator delivers it dozens of times a night.

When a voice is not enough, the next rung is the people who already love the person, family and the named informal carers who agreed, back at the kitchen table conversation of step three, to be called in exactly these circumstances. A daughter ten minutes away, arriving with her own key, is often the best possible response to a low-level worry, and she would far rather take that call than hear about an ambulance afterwards.

Above that sit the professional responders, mobile response and dedicated falls teams, who arrive with training and lifting equipment and can get an uninjured faller safely off the floor, checked over and settled back into the evening. Then comes the care or housing provider on duty, the right answer when the problem is a failed heating system, a door that will not secure or a scheduled carer who has not arrived. And at the top of the ladder, ready when genuinely needed, sit the emergency services.

One thing must be said plainly, because it is the objection everyone reasonably raises. A ladder climbed rung by rung does not mean a slow march through the options while somebody deteriorates. The assessment at the ARC decides where on the ladder the response begins, and a suspected stroke goes straight to the top without pausing on the way. Proportionate means matched to the situation, never merely gradual.

Why the order matters

Climbing no higher than needed keeps people in their own homes, and that is worth dwelling on, because home is where independence lives. Every unnecessary trip to hospital carries its own risks for an older person, from deconditioning to infection to the disorientation that a ward can bring, and the faller left waiting on the floor for hours, what clinicians call the long lie, comes to harm from the wait itself quite apart from the fall. A falls team reaching that person quickly does not just tidy up an incident, it interrupts the exact sequence by which a small stumble becomes a hospital admission and a hospital admission becomes a care home placement.

The order matters to the public purse for the same reason it matters to the person. Every callout avoided and every admission prevented is a number, and because the service took an honest baseline at step one, it is a number the programme can actually claim. This single step is one of the biggest measurable savings in the whole chain, which is a remarkable thing to say about a stage that involves buying no technology at all.

A ladder is built, not improvised

Here is the part that separates services that talk about proportionate response from services that deliver it. The ladder only exists at two in the morning if it was built during office hours, and every rung was assembled at an earlier step of this pathway.

The named family contacts, and their genuine consent to be called, came from the conversations at step three. The falls team and the mobile responders exist because somebody commissioned them at step one, when the service was being designed rather than rescued. The ARC can choose the right rung at step six only because the care plan tells it what normal looks like for this particular person, and the community assets mapped at step two sometimes turn out to be part of the response model too. None of this can be improvised on the night. An escalation policy has to be written down, response times agreed, and the whole arrangement tested before it is needed rather than discovered live.

And every decision, every dispatch and every outcome is logged as it happens, which quietly sets up the next stage of the journey. Because the same data that answered tonight's alarm can, handled properly, start preventing next month's, and that is where this series goes next, into insight, reporting and the shift from reacting to crises towards seeing them coming.

If you are planning a technology enabled care service and the response plan currently amounts to hoping the ambulance arrives, that is exactly the conversation we help with. We are independent, we work across the whole market, and we work for you, not for any vendor. Get in touch, we can help you.

Harry MacLean is the Founder and Managing Director of Creating Better. He has spent his career making complicated things simpler and broken things better, and he has not finished yet.