Deep Dive - Calling 995? You may be rerouted to the NurseFirst helpline instead

Key Concepts

• Medical Emergencies: Situations requiring immediate medical attention.
• Non-Emergency Medical Situations: Situations that require medical attention but are not immediately life-threatening.
• 995: Singapore's emergency ambulance service number.
• Nurse First: A medical triage helpline (6262 6262) designed for non-emergency medical situations.
• Medical Triage: The process of sorting and prioritizing patients based on the severity of their condition to determine the appropriate level and location of care.
• Alternate Care Pathways: Alternative routes for patients to receive medical care outside of the traditional emergency department setting.
• Urgent Care Centers: Medical facilities that provide immediate care for illnesses or injuries that are not life-threatening.
• Medical Literacy: The ability to understand and use health information to make informed decisions about one's health.

The Problem: Overburdened Emergency Services

• High Call Volume: SCDF (Singapore Civil Defence Force) responded to 245,000 calls last year, averaging 672 calls per day.
• Non-Emergency Calls: Approximately 5-10 calls per day are non-emergency cases that do not require ambulance transport to a hospital.
• Example: An elderly lady called 995 because she ran out of prescription medication. She was transported to the emergency department and waited for hours to have her prescription filled, which was not the appropriate use of emergency services.
• Inefficient Use of Resources: Non-emergency calls tie up emergency resources (ambulances, paramedics, emergency physicians) that could be used for genuine emergencies.

The Solution: Nurse First Helpline

• Purpose: To alleviate the burden on the 995 system by providing a triage service for non-emergency medical situations.
• Function: Trained nurses assess the caller's condition through a series of questions and guide them to the appropriate level of care (emergency department, urgent care center, GP, or self-care at home).
• How it Works:
  1. Caller dials 995 or 6262 6262 (Nurse First).
  2. If 995 determines the call is not a life-threatening emergency, they transfer the call to Nurse First.
  3. Nurse First nurses ask questions based on validated protocols to assess the situation.
  4. Based on the assessment, the nurse advises the caller on the appropriate course of action.
• Example Questions: For chest pain, nurses ask questions to determine if it is a life-threatening condition.
• Operating Hours: Currently, Nurse First operates from 8 AM to 11 PM daily, including weekends and public holidays.
• Staffing: Two nurses are typically manning the line at any given time.
• Nationwide Trial: Nurse First is currently undergoing a six-month nationwide trial.

Addressing Public Concerns and Change Management

• Expectation of Immediate Response: Singaporeans expect a certain level of certainty and immediate response from the EMS system.
• Change Management: Requires educating the public about the purpose and benefits of Nurse First.
• Safety Assurance: Emphasize that the triage process is safe, with multiple layers of assessment.
• Positive Feedback: Some positive feedback has been received, particularly in cases where Nurse First provided reassurance and advice for minor injuries like burns.
• Example: Burns: Nurse First can provide advice on first aid and subsequent care for minor burns.
  • Burn Size Estimation: Nurses use relatable terms like "coin size" or "palm size" to estimate the percentage of the body affected by the burn. A person's palm is roughly 1% of their body surface area.

Differentiating Nurse First from Other Services

• Nurse First vs. 1777 (Non-Emergency Ambulance Service): Nurse First provides medical triage and advice, including first aid, while 1777 is primarily for conveyance (transportation) to medical facilities. Nurse First can route patients to 1777 if appropriate.
• Nurse First vs. Urgent Care Centers: Nurse First can guide patients to urgent care centers if their condition is suitable for that level of care.

Defining Emergency vs. Non-Emergency

• Life-Threatening vs. Non-Life-Threatening: A key indicator is whether the situation is life-threatening.
• Examples:
  • Emergency (Call 995): Suspected heart attack, severe difficulty breathing, major trauma.
  • Non-Emergency (Consider Nurse First): Sprained ankle, minor burn, toothache, headache (if not the worst headache of their life and not associated with fever or rash).
• Worst Headache Example: If someone experiences the worst headache of their life with fever and a rash, it could indicate a serious condition requiring immediate emergency care.

Addressing the Aging Population

• Increased Workload: The aging population is expected to increase the demand for emergency services.
• Alternate Care Pathways: Nurse First is one part of a broader strategy to develop alternate care pathways for different populations, including the elderly.
• Community Care: Focus on providing care for the elderly in the community to improve outcomes and reduce the need for hospitalization.

International Best Practices

• Adopting Best Practices: Singapore is learning from other countries with mature EMS systems, such as the UK, Denmark, Japan, and Finland, which have implemented similar triage helplines.

Conclusion

The Nurse First helpline is a crucial initiative to address the increasing strain on Singapore's emergency medical services. By providing a triage service for non-emergency medical situations, Nurse First aims to ensure that emergency resources are used efficiently and that patients receive the appropriate level of care in the right setting. Public education and change management are essential for the successful implementation of this program. The key takeaway is: If it's a life-threatening emergency, call 995. If it's a non-emergency, consider calling Nurse First at 6262 6262.